Improving measurement of functional status among older adults in primary care: A pilot study.

Despite its importance for clinical care and outcomes among older adults, functional status-the ability to perform basic activities of daily living (ADLs) and instrumental ADLs (IADLs)-is seldom routinely measured in primary care settings. The objective of this study was to pilot test a person-centered, interprofessional intervention to improve identification and management of functional impairment among older adults in Veterans Affairs (VA) primary care practices. The four-component intervention included (1) an interprofessional educational session; (2) routine, standardized functional status measurement among patients aged ≥75; (3) annual screening by nurses using a standardized instrument and follow-up assessment by primary care providers; and (4) electronic tools and templates to facilitate increased identification and improved management of functional impairment. Surveys, semi-structured interviews, and electronic health record data were used to measure implementation outcomes (appropriateness, acceptability and satisfaction, feasibility, fidelity, adoption/reach, sustainability). We analyzed qualitative interviews using rapid qualitative analysis. During the study period, all 959 eligible patients were screened (100% reach), of whom 7.3% (n = 58) reported difficulty or needing help with ≥1 ADL and 11.8% (n = 113) reported difficulty or needing help with ≥1 IADL. In a chart review among a subset of 50 patients with functional impairment, 78% percent of clinician notes for the visit when screening was completed had content related to function, and 48% of patients had referrals ordered to address impairments (e.g., physical therapy) within 1 week. Clinicians highly rated the quality of the educational session and reported increased ability to measure and communicate about function. Clinicians and patients reported that the intervention was appropriate, acceptable, and feasible to complete, even during the COVID pandemic. These findings suggest that this intervention is a promising approach to improve identification and management of functional impairment for older patients in primary care. Broader implementation and evaluation of this intervention is currently underway.

A comparison of excess deaths by UK country and region during the first year of the COVID-19 pandemic.

We compare the impact of the first two waves of the COVID-19 pandemic on risk of age-standardized mortality by sex, UK country, and English region. Each wave is defined as lasting 26 weeks and are consecutive beginning in 2020 week 11. The expected rate is estimated from 2015 to 2019 mean and the projected mortality trend from the same period are used to estimate excess mortality. By both measures, excess mortality was highest and lowest in regions of England, London and the South-West, respectively. Excess mortality was consistently higher for males than females.

Breaking down apoptosis: animating programmed cell death in 3D for a pathology curriculum.

Contemporary medical education is expected to keep up with the rapidly expanding corpus of medical scientific knowledge to train informed doctors. Swift communication and assimilation of complex concepts are required, yet traditional teaching methods are often suboptimal means to this end. This paper details the making of a concise 3D animation on the apoptotic pathways, designed to improve first-year undergraduate medical students' grasp of cell signalling. A simplified visual language was adopted to increase the effectiveness and expedite the production of beginner molecular biology animations. Favourable student feedback suggests that the chosen design approach could yield further positive results.

The cell cycle: development of an eLearning animation.

The use of eLearning resources is becoming increasingly widespread in medical education because of its numerous advantages. They awaken interest in students can be reused without loss of quality and give students added control over their own education by allowing them to review content in their own time. This article describes the development and evaluation of an innovative eLearning animation for the curriculum of the pathology class at the University of Dundee School of Medicine.

Combined T2 and diffusion-weighted MR imaging with template prostate biopsies in men suspected with prostate cancer but negative transrectal ultrasound-guided biopsies.

PURPOSE: Transperineal template prostate (TPB) biopsy has been shown to improve prostate cancer detection in men with rising PSA and previous negative TRUS biopsies. Diagnostic performance of this approach especially MR imaging and using reliable reference standard remains scantly reported. MATERIALS AND METHODS: A total of 200 patients, who were previously TRUS biopsy negative, were recruited in this study. All the participants had at least 28-core TPB under general anesthetic within 8 weeks of previous negative TRUS biopsies. In 15 men undergoing laparoscopic radical prostatectomy, prostate specimens were sectioned using custom-made molds and analyzed by experienced pathologist as a feasibility study. RESULTS: In total, 120 of 200 patients (60 %) had positive TPB biopsy results. All of these men had at least one negative biopsy from transrectal route. T2 diffusion-weighted MR imaging showed no lesion in almost one-third of these men (61/200; 30.5 %). Out of these, 33 (33/61; 54 %) showed malignancy on TPB including high-grade tumors (>Gleason 7). Out of 15 patients underwent surgery with a total of 52 lesions (mean 3.5) on radical prostatectomy histology analyses, TPB detected 36 (70 %) lesions only. Some of these lesions were Gleason 7 and more mostly located in the posterior basal area of prostate. CONCLUSIONS: Transperineal template biopsy technique is associated with significantly high prostate cancer detection rate in men with previous negative TRUS biopsies, however compared to radical prostatectomy histology map, a significant number of lesions can still be missed in the posterior and basal area of prostate.

Meta-analysis of average symptom change in inpatient treatment for posttraumatic stress disorder in veteran and active duty U.S. military samples.

This study tested the hypothesis that inpatient/residential treatment for PTSD associated with military duty should result in significantly lower PTSD symptoms at patient discharge compared to patient intake. Meta-analysis of effects comparing intake and discharge PTSD symptoms from 26 samples, reported in 16 studies, supported this hypothesis (d = -.73; p < .00001). Moderator analysis indicated between-study variation in PTSD symptom changes was predominantly due to the type of measure used, with the Clinician Administered PTSD Scale producing the largest effect (d = -1.60). Larger effects were also observed for more recently published studies and studies with larger percentages of females. These findings support the efficacy of inpatient treatment for military PTSD, although a causal factor for effectiveness could not be identified. Further, the results indicate between-program comparisons of symptom reduction require the same measure of PTSD. (PsycINFO Database Record

Leadership and management skills of general practice nurses: experience or education?

A key finding of this qualitative exploratory descriptive study into advanced nursing for general practice nurses (Australian setting) revealed that participants viewed leadership and management as best learnt 'apprenticeship' style on the job by years of experience. Participants (48) comprised of general practice nurses, practice managers and general practitioners from metropolitan Melbourne were interviewed. Other findings demonstrated that the participants generally had limited awareness that postgraduate education can assist in the development of leadership and management in advanced nursing practice. The participants lacked clarity about professional competencies and generally did not connect these to leadership and management. Professional bodies need to take the opportunity to promote awareness of the national competency standards. All three groups of participants expressed hopes about the future provision of professional development opportunities and support by the Medicare Local for leadership and management aspirations within advanced practice nursing.

Phosphorylation of ERK in neurokinin 1 receptor-expressing neurons in laminae III and IV of the rat spinal dorsal horn following noxious stimulation.

BACKGROUND: There is a population of large neurons with cell bodies in laminae III and IV of the spinal dorsal horn which express the neurokinin 1 receptor (NK1r) and have dendrites that enter the superficial laminae. Although it has been shown that these are all projection neurons and that they are innervated by substance P-containing (nociceptive) primary afferents, we know little about their responses to noxious stimuli. In this study we have looked for phosphorylation of extracellular signal-regulated kinases (ERKs) in these neurons in response to different types of noxious stimulus applied to one hindlimb of anaesthetised rats. The stimuli were mechanical (repeated pinching), thermal (immersion in water at 52 degrees C) or chemical (injection of 2% formaldehyde). RESULTS: Five minutes after each type of stimulus we observed numerous cells with phosphorylated ERK (pERK) in laminae I and IIo, together with scattered positive cells in deeper laminae. We found that virtually all of the lamina III/IV NK1r-immunoreactive neurons contained pERK after each of these stimuli and that in the great majority of cases there was internalisation of the NK1r on the dorsal dendrites of these cells. In addition, we also saw neurons in lamina III that were pERK-positive but lacked the NK1r, and these were particularly evident in animals that had had the pinch stimulus. CONCLUSION: Our results demonstrate that lamina III/IV NK1r-immunoreactive neurons show receptor internalisation and ERK phosphorylation after mechanical, thermal or chemical noxious stimuli.

Comparative localization of two serotonin receptors and sensorin in the central nervous system of Aplysia californica.

Aplysia californica is a powerful model for understanding the cellular and molecular mechanisms underlying modulation of neuronal plasticity and learning. In the central nervous system of Aplysia, serotonin is associated with various behaviors. For example, it induces short-, intermediate-, and long-term synaptic changes in sensory neurons during learning and inhibits the afterdischarge of the bag cells that initiate egg-laying behavior. Little is known about the nature and contribution of serotonin receptors involved in the numerous serotonin-mediated physiological responses in Aplysia. Recently, two G(i)-coupled serotonin receptors (5-HT(ap1) and 5-HT(ap2)) were cloned. We now report that, by using in situ hybridization to express the profile of these receptors, we are able to gain critical insight into their roles in the behavior of Aplysia. We compared their distribution to that of sensorin-A, a peptide specifically found in sensory neurons. We wished to determine their involvement in some simple forms of behavioral modifications. 5-HT(ap1) and 5-HT(ap2) mRNAs are expressed in all ganglia of the Aplysia central nervous system. Stronger signal was observed with the 5-HT(ap2) antisense probe than with the 5-HT(ap1) antisense probe. Notably, mRNA coding for the receptors was found in several identified neurons, in the bag cells, in characterized serotonergic neurons, and in neurons of the mechanosensory clusters that expressed sensorin. We also observed heterogeneity of receptor expression between R2 and LPl1 and among neurons of a single cluster of sensory neurons. These results suggest that 5-HT(ap1) and 5-HT(ap2) receptors may regulate the response to serotonin and/or its release in several neurons.