Hospital discharge: recommendations for performance improvement for family carers of people with dementia.

UNLABELLED: BACKGROUND; It is acknowledge that discharge planning benefits both consumers and hospitals. What is not widely understood is the experience that the family carer of a person with a dementia has and whether the hospitals meet their in-hospital and post-hospital needs. OBJECTIVE: To explore whether metropolitan and rural hospital discharge practices meet the needs of the family carer of a person with dementia. RESULTS: Although this and other research indicates that a continuum of care model is beneficial to family caregivers, no evidence has been identified that family carers currently experience this type of quality planning. Family carers were often unaware of the existence of a hospital discharge plan and were rarely engaged in communication about the care of their family member with a dementia or prepared for discharge. CONCLUSION AND RECOMMENDATIONS; Discharge planning processes for family carers of people with dementia could be substantially improved. It is recommended that hospitals develop policy, process and procedures that take into account the family carer's needs, develop key performance indicators and adopt best practice standards that direct discharge planning activities and early engagement of the family carer in healthcare decisions. It is recommended that health professionals be educated on communication, consultation and needs of family carers.

Young adults' management of Type 1 diabetes during life transitions.

AIM: To identify life transitions likely to impact diabetes self-care among young adults with Type 1 diabetes and their coping strategies during transition events. BACKGROUND: Relationships among psychosocial stress, adjustment, coping and metabolic control affect clinical outcomes and mental health. Life transitions represent major change and are associated with stress that temporarily affects individuals' problem-solving, coping abilities and blood glucose levels. DESIGN: A qualitative interpretive inquiry. METHOD: Semi-structured interviews were conducted with 20 young adults with Type 1 diabetes and a constant comparative analysis method. Data and analysis was managed using QSR NVivo 7 software. RESULTS: Participants identified two significant transition groups: life development associated with adolescence, going through the education system, entering new relationships, motherhood and the workforce and relocating. Diabetes-related transitions included being diagnosed, developing diabetes complications, commencing insulin pump treatment and going on diabetes camps. Participants managed transitions using 'strategic thinking and planning' with strategies of 'self-negotiation to minimise risks'; 'managing diabetes using previous experiences'; 'connecting with others with diabetes'; 'actively seeing information to 'patch' knowledge gaps'; and 'putting diabetes into perspective'. CONCLUSIONS: Several strategies are used to manage diabetes during transitions. Thinking and planning strategically was integral to glycaemic control and managing transitions. The impact of transitions on diabetes needs to be explored in larger and longitudinal studies to identify concrete strategies that assist diabetes care during life transitions. RELEVANCE TO CLINICAL PRACTICE: It is important for health professionals to understand the emotional, social and cognitive factors operating during transitions to assist young adults with Type 1 diabetes to achieve good health outcomes by prioritising goals and plan flexible, timely, individualised and collaborative treatment.

Living with amyotrophic lateral sclerosis/motor neurone disease (ALS/MND): decision-making about 'ongoing change and adaptation'.

AIMS AND OBJECTIVES: To present a model that explicates the dimensions of change and adaptation as revealed by people who are diagnosed and live with amyotrophic lateral sclerosis/motor neurone disease. BACKGROUND: Most research about amyotrophic lateral sclerosis/motor neurone disease is medically focused on cause and cure for the illness. Although psychological studies have sought to understand the illness experience through questionnaires, little is known about the experience of living with amyotrophic lateral sclerosis/motor neurone disease as described by people with the disease. DESIGN: A grounded theory method of simultaneous data collection and constant comparative analysis was chosen for the conduct of this study. METHODS: Data collection involved in-depth interviews, electronic correspondence, field notes, as well as stories, prose, songs and photographs important to participants. QSR NVivo 2 software was used to manage the data and modelling used to illustrate concepts. FINDINGS: Participants used a cyclic, decision-making pattern about 'ongoing change and adaptation' as they lived with the disease. This pattern formed the basis of the model that is presented in this paper. CONCLUSION: The lives of people living with amyotrophic lateral sclerosis/motor neurone disease revolve around the need to make decisions about how to live with the disease progression and their deteriorating abilities. Life decisions were negotiated by participants to maintain a sense of self and well-being in the face of change. RELEVANCE TO CLINICAL PRACTICE: The 'ongoing change and adaptation' model is a framework that can guide practitioners to understand the decision-making processes of people living with amyotrophic lateral sclerosis/motor neurone disease. Such understanding will enhance caring and promote models of care that are person-centred. The model may also have relevance for people with other life limiting diseases and their care.

Effects of a cyclooxygenase-2 inhibitor (rofecoxib) on bone healing.

In the study reported here, we determined the effects on bone healing of rofecoxib, one of the selective cyclooxygenase-2 (Cox-2) inhibitors that has been used for postsurgical analgesia, and compared these effects with those of nonselective ibuprofen and placebo. Each of 66 male rats received a closed, nondisplaced femoral fracture and was fed rofecoxib, ibuprofen, or placebo for 4 weeks. Results of postsacrifice evaluation showed gross nonunions in 64.7% of rofecoxib rats (P < .0001), 17.6% of ibuprofen rats (P = .007), and 0% of placebo rats. Compared with ibuprofen, rofecoxib was significantly more likely to produce nonunions (P = .007). Mean callus width was 8.9 mm (SD, 1.3 mm) for rofecoxib (P = .03), 8.9 mm (SD, 1.2 mm) for ibuprofen (P = .03), and 8.0 mm (SD, 1.3 mm) for placebo. Mean healing maturity (Goldberg classification) was 1.6 (SD, 0.7) for rofecoxib (P < .0001), 1.7 (SD, 0.8) for ibuprofen (P = .0001), and 2.7 (SD, 0.6) for placebo. Mean fracture angulation was 30.8 degrees (SD, 16.7 degrees) for rofecoxib (P = .003), 14.3 degrees (SD, 14.4 degrees) for ibuprofen (NS), and 13.4 degrees (SD, 10.3 degrees) for placebo. Mean histologic healing was 5.75 for rofecoxib (P = .02), 6.35 for ibuprofen (P = .05), and 8.25 for placebo. Cox-2 inhibitors should be used with caution when bone healing is necessary. Further study is warranted to determine whether the adverse effects occur in humans.

The atlanto-axial joint: physiological range of rotation on MRI and CT.

AIMS: To measure the range of rotation and determine the instantaneous axis of rotation of the atlanto-axial joint in healthy volunteers using magnetic resonance imaging (MRI) and to highlight the appearances of the rotated atlanto-axial joint on computed tomography (CT) and MRI. MATERIALS AND METHODS: Twenty-eight healthy volunteers were examined using MRI during maximal head rotation. In addition, an anatomical specimen of the atlanto-axial joint, fixed in varying degrees of rotation, was imaged using CT. RESULTS: At the extremes of physiological rotation in healthy subjects there is striking but incomplete loss of contact between the articular surfaces of the atlas (C1) and the axis (C2). The range of rotation to the right was 20-48.5 degrees (mean 32.4 degrees ) and to the left was 13-52.75 degrees (mean 34.2 degrees ). There was no significant difference between rotation to the right and left (P = 0.455). Total rotation was 45-88.5 degrees (mean 69.25 degrees ). The instantaneous axis of rotation was located within the odontoid peg. CONCLUSION: There is a wide range of atlanto-axial rotation in normal subjects. The instantaneous axis of rotation lies within the odontoid peg. The appearances of the rotated atlanto-axial joint are striking and may be misinterpreted as subluxation.