ABSTRACT
Assessment of frailty is key for evaluation for advanced therapies (ATs). Most programs use a subjective provider assessment (SPA) or "eye-ball" test; however, objective measures exist. The modified five-item Fried Frailty Index (mFFI) is a validated tool to assess frailty. We compared SPA to mFFI testing in patients referred for AT. We also compared levels of macrophage migration inhibitory factor (MIF), an inflammatory biomarker associated with worse outcomes in heart failure, between frail and not frail subjects. Seventy-eight patients referred for evaluation for AT underwent both SPA and mFFI testing. Three cardiac surgeons independently assessed patients for frailty (SPA). SPA significantly underestimated frailty compared with mFFI testing and correlation between SPA and mFFI was not strong (κ = 0.02-0.14). Providers were correct 84% of the time designating a subject as frail, but only 40% of the time designating as not frail. Agreement between all three providers was robust (76%), which was primarily driven by designation as not frail. There was no significant difference in plasma MIF levels between frail and not frail subjects (47.6 ± 25.2 vs . 45.2 ± 18.9 ng/ml; p = 0.6). Clinicians significantly underestimate frailty but are usually correct when designating a patient as frail.
Subject(s)
Frailty , Heart Failure , Humans , Biomarkers , Frailty/diagnosis , Heart Failure/therapy , Heart Failure/complicationsABSTRACT
BACKGROUND: While distractions and interruptions are leading causes of errors during medication preparation, most nursing students are not taught how to manage distractions in a highly-interruptive environment. To help prepare nursing students to manage distractions and interruptions in clinical practice, we developed, implemented, and evaluated a medication preparation distraction and interruption simulation. OBJECTIVES: To explore student and simulation facilitators experiences and perceptions of a distraction and interruption simulation. DESIGN: A sequential explanatory mixed-methods design was adopted including surveys, interviews, and focus groups. SETTING: A mid-sized research intensive western Canadian university. PARTICIPANTS: A total of 112 third year nursing students who engaged in the distraction and interruption simulation, and five simulation facilitators who facilitated the distraction and interruption simulation, participated in this study. METHODS: Students were invited to complete a cross sectional survey following the distraction and interruption simulation and were then invited to participate in focus groups. Simulation facilitators were invited to participate in one-on-one interviews following facilitating the distraction and interruption simulation. All data were collected between June and December 2020. RESULTS: Data from surveys, interviews, and focus groups were delineated into 4 themes related to the phases of the simulation. The prebriefing provided an overview of the simulation and helped create psychological safety that was imperative for learning about potential medication errors when being distracted and interrupted. The simulation scenario had a high degree of fidelity and helped students implement strategies to manage distractions and interruptions. The structured debrief provided an opportunity for meaningful reflection. The impact of the simulation was apparent as students articulated the balance between speed versus safety and new strategies developed to manage distractions and interruptions in clinical practice. CONCLUSION: This study supports the use of simulation to develop key skills for managing distractions and interruptions during medication preparation in clinical practice.
Subject(s)
Education, Nursing, Baccalaureate , Students, Nursing , Humans , Cross-Sectional Studies , Canada , Education, Nursing, Baccalaureate/methods , Medication Errors/prevention & controlABSTRACT
Given the repeated failure of amyloid-based approaches in Alzheimer's disease, there is increasing interest in tau-based therapeutics. Although methylthioninium (MT) treatment was found to be beneficial in tau transgenic models, the brain concentrations required to inhibit tau aggregation in vivo are unknown. The comparative efficacy of methylthioninium chloride (MTC) and leucomethylthioninium salts (LMTX; 5-75 mg/kg; oral administration for 3-8 weeks) was assessed in two novel transgenic tau mouse lines. Behavioural (spatial water maze, RotaRod motor performance) and histopathological (tau load per brain region) proxies were applied. Both MTC and LMTX dose-dependently rescued the learning impairment and restored behavioural flexibility in a spatial problem-solving water maze task in Line 1 (minimum effective dose: 35 mg MT/kg for MTC, 9 mg MT/kg for LMTX) and corrected motor learning in Line 66 (effective doses: 4 mg MT/kg). Simultaneously, both drugs reduced the number of tau-reactive neurons, particularly in the hippocampus and entorhinal cortex in Line 1 and in a more widespread manner in Line 66. MT levels in the brain followed a sigmoidal concentration-response relationship over a 10-fold range (0.13-1.38 µmol/l). These data establish that diaminophenothiazine compounds, like MT, can reverse both spatial and motor learning deficits and reduce the underlying tau pathology, and therefore offer the potential for treatment of tauopathies.
Subject(s)
Methylene Blue/pharmacology , Neuroprotective Agents/pharmacology , Tauopathies/drug therapy , Animals , Brain/drug effects , Brain/pathology , Cohort Studies , Disease Models, Animal , Dose-Response Relationship, Drug , Female , Learning Disabilities/drug therapy , Learning Disabilities/pathology , Learning Disabilities/physiopathology , Maze Learning/drug effects , Methylene Blue/chemistry , Mice, Transgenic , Motor Activity/drug effects , Neurons/drug effects , Neurons/metabolism , Neurons/pathology , Neuroprotective Agents/chemistry , Oxidation-Reduction , Problem Solving/drug effects , Random Allocation , Tauopathies/pathology , Tauopathies/physiopathologyABSTRACT
The purpose of this study was to describe the knowledge and skills nurses need to be successful clinical instructors. A formal learning needs assessment was conducted to measure the orientation learning needs of new part-time clinical nursing faculty at one university. An existing, validated learning needs instrument was modified and administered online. The respondents (n=44; 16.6%) unanimously identified five essential learning needs for nursing clinical instructors, thus providing sound justification upon which to base an instructor orientation program. From these results, essential content for an orientation workshop to be followed by an online orientation course is outlined. Future research is needed to evaluate the outcomes of clinical instructor orientation; that is, whether participants have acquired the knowledge and skills needed to competently facilitate student learning in the clinical setting.
Subject(s)
Curriculum , Nurse Clinicians/education , Nursing Faculty Practice/organization & administration , Orientation , Cross-Sectional Studies , Education, Nursing, Baccalaureate/methods , Female , Humans , Learning , Needs Assessment , Nurse's Role , Professional Competence , Students, NursingABSTRACT
Front-line caregivers in nursing homes frequently provide bereavement support to family members before and after the death of a nursing home resident. Use of the evidence-based guideline "Family Bereavement Support Before and After the Death of a Nursing Home Resident" (Davidson, 2002) can reduce uncertainty and increase the confidence of staff providing before and after death care to families, and can ensure all families receive consistent bereavement support.
