Comparison of a multidomain frailty index from routine health data with the hospital frailty risk score in older patients in an Australian hospital.

BACKGROUND: Frailty is an important determinant of health-care needs and outcomes for people in hospital. OBJECTIVES: To compare characteristics and predictive ability of a multidomain frailty index derived from routine health data (electronic frailty index-acute hospital; eFI-AH) with the hospital frailty risk score (HFRS). METHODS: This retrospective study included 6771 patients aged ≥75 years admitted to an Australian metropolitan tertiary referral hospital between October 2019 and September 2020. The eFI-AH and the HFRS were calculated for each patient and compared with respect to characteristics, agreement, association with age and ability to predict outcomes. RESULTS: Median eFI-AH was 0.17 (range 0-0.66) whilst median HFRS was 3.2 (range 0-42.9). Moderate agreement was shown between the tools (Pearson's r 0.61). After adjusting for age and gender, both models had associations with long hospital stay, in-hospital mortality, unplanned all-cause readmission and fall-related readmission. Specifically, the eFI-AH had the strongest association with in-hospital mortality (adjusted odds ratio (aOR) 2.81, 95% confidence intervals (CI) 2.49-3.17), whilst the HFRS was most strongly associated with long hospital stay (aOR 1.20, 95% CI 1.18-1.21). Both tools predicted hospital stay >10 days with good discrimination and calibration. CONCLUSIONS: Although the eFI-AH and the HFRS did not consistently identify the same inpatients as frail, both were associated with adverse outcomes and they had comparable predictive ability for prolonged hospitalisation. These two constructs of frailty may have different implications for clinical practice and health service provision and planning.

Deprescribing for older people living in residential aged care facilities: Pharmacist recommendations, doctor acceptance and implementation.

BACKGROUND: Deprescribing is an intervention to address the high prevalence of inappropriate polypharmacy in older people living in residential aged care facilities (RACFs). Many deprescribing interventions are complex and involve several stages including initial pharmacist recommendation, subsequent acceptance of the recommendations by a prescriber and the patient, and then actual implementation. OBJECTIVES: This study aimed to investigate pharmacist deprescribing recommendations for residents within RACFs, general practitioner (GP) acceptance, and the actual implementation of the accepted recommendations at 12-month. METHODS: The intervention occurred as part of a randomised controlled trial and comprised a pharmacist-led medication review using an evidence-based algorithm, with the focus on identifying medications to potentially deprescribe. Consent to participate was obtained from residents (or surrogate decision-makers), RACF nursing staff and the resident's GP. Deprescribing recommendations were reviewed by GPs before implementation as part of the intervention and control arms of the trial, although control group participants continued to receive their usual medications in a blinded manner. RESULTS: There were 303 participants enrolled in the study, and 77% (941/1222) of deprescribing recommendations suggested by the pharmacists were accepted by GPs. Of the recommendations accepted by GPs, 74% (692/ 941) were successfully implemented at the end of the follow-up visit at 12 months. The most common reason for deprescribing was because medications were no longer needed (42%, 513/ 1231). CONCLUSION: Pharmacist-led deprescribing recommendations arising from an algorithm-based medication review are acceptable to doctors and can have a significant impact on reducing the number of inappropriate medications consumed by older people in RACFs. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12613001204730.

Reframing Educational Outcomes: Moving beyond Achievement Gaps.

The term "achievement gap" has a negative and racialized history, and using the term reinforces a deficit mindset that is ingrained in U.S. educational systems. In this essay, we review the literature that demonstrates why "achievement gap" reflects deficit thinking. We explain why biology education researchers should avoid using the phrase and also caution that changing vocabulary alone will not suffice. Instead, we suggest that researchers explicitly apply frameworks that are supportive, name racially systemic inequities and embrace student identity. We review four such frameworks-opportunity gaps, educational debt, community cultural wealth, and ethics of care-and reinterpret salient examples from biology education research as an example of each framework. Although not exhaustive, these descriptions form a starting place for biology education researchers to explicitly name systems-level and asset-based frameworks as they work to end educational inequities.

Attitudes to Drug Use in Residential Aged Care Facilities: A Cross-Sectional Survey of Nurses and Care Staff.

BACKGROUND: Residential aged care facility (RACF) staff are well placed to identify opportunities for more appropriate prescribing. However, little is known about their views of polypharmacy, deprescribing and specific medications. OBJECTIVE: The objective of this study was to establish the beliefs and attitudes of RACF staff towards polypharmacy and medication use in residents. METHODS: A cross-sectional survey was conducted on RACF staff in metropolitan New South Wales, Australia using a self-administered questionnaire. The questionnaire was drafted based on the available literature and research team expertise and then piloted by a mixed group of 13 RACF staff. The final version of the questionnaire consisted of 28 questions. A total of 38 RACFs were contacted about the study. The questionnaire was distributed to eligible RACF staff between October 2017 and October 2019. The RACF staff were eligible if they provided direct patient care to residents or worked as a facility manager. Participants were excluded if they had insufficient English language skills. The results were presented in two groups, the nursing and care staff, using descriptive statistics. RESULTS: A total of 176 individuals from nine RACFs completed the questionnaire of whom 160 were eligible for study inclusion. Most considered polypharmacy to be five or more different tablets and capsules per day (95% nursing and 82% care staff respectively). A wide range of beliefs about medication use and deprescribing that centred on what constitutes appropriate polypharmacy was identified. Most thought that preventive medications were essential for residents. Most nurses agreed that sleeping tablets and pharmacological management of verbal aggression and wandering behaviours should be used less frequently whilst most care staff agreed that medications should be used more frequently to manage physical aggression. CONCLUSIONS: To successfully and sustainably optimise medication use in RACF residents, it is important to consider the variation in views of nurses and care staff.

Development and validation of a frailty index based on data routinely collected across multiple domains in NSW hospitals.

OBJECTIVE(S): To develop and validate a frailty index (FI) that covers multiple domains, using routine hospital data. To investigate the FI's validity, after excluding medication-related items (FI-ExMeds), for studies of frailty and polypharmacy. METHODS: A FI was derived from routine NSW hospital data following standard published guidance. In a development cohort (151 inpatients ≥ 70 years), the FI was correlated with the Reported Edmonton Frail Scale (REFS) using Pearson's R. Validity and distribution of FI and FI-ExMeds, and correlation with each other, were evaluated in a validation cohort (999 inpatients ≥ 75 years). RESULTS: The mean FI for the development cohort was 0.27 (SD 0.09). The FI showed moderate linear correlation with the REFS (n = 148, R = 0.52, P < .001). In the validation cohort, mean FI (n = 993) and FI-ExMeds (n = 990) were both 0.28 (SD 0.11). FI-ExMeds showed high linear correlation with the FI (n = 990, R = 0.99, P < .001). CONCLUSION: This multi-domain FI is comparable to REFS, with adequate redundancy to exclude deficits for specific analyses.

Associations between Practitioner Personality and Client Quit Rates in Smoking Cessation Behavioural Support Interventions.

Introduction: There is wide variation in the success rates of practitioners employed to help smokers to stop, even once a range of potential confounding factors has been taken into account. Aim: This paper examined whether personality characteristics of practitioners might play a role success rates. Methods: Data from 1,958 stop-smoking treatment episodes in two stop-smoking services (SSS) involving 19 stop-smoking practitioners were used in the analysis. The outcome measure was clients' biochemically verified quit status 4 weeks after the target quit date. The five dimensions of personality, as assessed by the Ten-Item Personality Inventory, were included as predictor variables: openness, conscientiousness, agreeableness, extraversion, and neuroticism. A range of client and other practitioner characteristics were used as covariates. A sensitivity analysis was conducted to determine if managers' ratings of practitioner personality were also associated with clients' quit status. Results: Multi-level random intercept models indicated that clients of practitioners with a higher extraversion score had greater odds of being abstinent at four weeks (self-assessed: OR = 1.10, 95% CI = 1.01-1.19; manager-assessed: OR = 1.32, 95% CI = 1.21-1.44). Conclusions: More extraverted stop smoking practitioners appear to have greater success in advising their clients to quit smoking. Findings need to be confirmed in larger practitioner populations, other SSS, and in different smoking cessation contexts. If confirmed, specific training may be needed to assist more introverted stop smoking practitioners.

Detection of salivary heat shock protein 27 by enzyme-linked immunosorbent assay and its correlation with histopathology of oral leukoplakia.

CONTEXT: Salivary analytes may be used as biomarkers for translational and clinical applications. Heat shock proteins (Hsps) are ubiquitous, highly conserved proteins found in all prokaryotic and eukaryotic species. Hsp27, a low molecular weight protein, may act as a salivary biomarker. Leukoplakia is the most common oral potentially malignant disorder and various salivary biomarkers such as interleukin-6, 8, tumor necrosis factor-α and MMPs have been detected in it. Oral leukoplakia presents clinically as homogenous and nonhomogenous forms; the microscopic pattern ranges from simple epithelial hyperplasia to carcinoma in situ. AIMS: This study aims to detect salivary Hsp27 in oral leukoplakia by enzyme-linked immunosorbent assay (ELISA) and to correlate its expression pattern with histopathology. MATERIALS AND METHODS: A total of 45 cases had constituted the study group. Salivary Hsp27 levels were assessed by ELISA in histopathologically confirmed cases of oral leukoplakia and were compared with that of healthy volunteers. STATISTICAL ANALYSIS: Mann-Whitney U-test and Spearman's correlation coefficient were used for the detection of Hsp27 and its correlation with mean absorbance levels. RESULTS: The mean absorbance values had shown elevated expression of Hsp27 in oral leukoplakia when compared to that in healthy volunteers. CONCLUSIONS: The present study had shown elevated expression of salivary Hsp27 in oral leukoplakia which could be attributed to altered redox potential.

Role of tissue eosinophils in oral Leukoplakia: A pilot study.

CONTEXT: Tissue eosinophilia in oral squamous cell carcinoma has been well - recognized. Studies have reported both favorable and unfavorable prognoses associated with tissue eosinophils in oral squamous cell carcinoma. However, the role of eosinophils in the development of tumor is still unclear. AIMS: The present study was an attempt to elucidate the potential role of tissue eosinophils in oral leukoplakia, a potentially malignant lesion. SETTINGS AND DESIGN: To count eosinophils in tissues of normal subjects and oral leukoplakia cases. To compare tissue eosinophil count (TEC) between normal and oral leukoplakia cases. To compare TEC between dysplastic and non-dysplastic cases of oral leukoplakia and to correlate with degree of epithelial dysplasia. MATERIALS AND METHODS: A total of 85 cases (59 cases of oral leukoplakia and 26 normal oral tissues) constituted the study material. Tissue eosinophils were counted in 10 different high- power fields. STATISTICAL ANALYSIS USED: Non-parametric tests (Mann-Whitney U-test, Kruskal-Wallis test, Mann-Whitney post hoc analysis and Spearman's correlation statistics). RESULTS: Mean eosinophil count (MEC) in oral leukoplakia cases was significantly more when compared to normal subjects. MEC in dysplastic cases of oral leukoplakia was significantly more when compared to those without epithelial dysplasia (Mann-Whitney U-test). Furthermore, MEC was directly proportional to the degree of epithelial dysplasia (Spearman's correlation statistics). CONCLUSIONS: TEC may be used as an adjunct to predict the malignant transformation of dysplastic cases of oral leukoplakia. Eosinophilic infiltration in oral dysplastic cases should prompt a thorough evaluation for invasiveness, especially when features of invasion are absent or suspected in smaller biopsy specimens. Use of TEC as a prognostic indicator demands larger sample size and mandates long-term follow-up.