Maintaining skin integrity in the aged: A systematic review.

BACKGROUND: In aged nursing care receivers, the prevalence of adverse skin conditions such as xerosis cutis, intertrigo, pressure ulcers or skin tears is high. Adequate skin care strategies are an effective method for maintaining and enhancing skin health and integrity in this population. OBJECTIVES: The objective was to summarize the empirical evidence about the effects and effectiveness of non-drug topical skin care interventions to promote and to maintain skin integrity and skin barrier function in the aged, to identify outcome domains and outcome measurement instruments in this field. DESIGN: An update of a previous systematic review published in 2013 was conducted. DATA SOURCES: Databases MEDLINE and EMBASE via OvidSP and CINAHL (original search January 1990 to August 2012, update September 2012 to May 2018) and reference lists were searched. Forward searches in Web of Science were conducted. METHODS: A review protocol was registered in Prospero (CRD42018100792). Main inclusion criteria were primary intervention studies reporting treatment effects of basic skin care strategies in aged people with a lower limit of age range of 50 years and published between 1990 and 2018. Primary empirical studies were included with experimental study designs including randomized controlled trials and quasi-experimental designs. Methodological quality of included randomized controlled trials was evaluated using the Cochrane Collaboration's Tool for assessing risk of bias. Levels of evidence were assigned to all included studies. RESULTS: Sixty-three articles were included in the final analysis reporting effects of interventions to treat and/or to prevent skin dryness, pruritus, general skin barrier improvement, incontinence-associated dermatitis, skin tears and pressure ulcers. Skin cleansers containing syndets or amphotheric surfactants compared with standard soap and water improved skin dryness. Lipophilic leave-on products containing humectants decreased skin dryness and reduced pruritus. Products with pH 4 improved the skin barrier. Application of skin protectants and structured skin care protocols decreased the severity of incontinence-associated dermatitis. Formulations containing glycerin and petrolatum reduced the incidence of skin tears. Thirty-five outcome domains were identified with nearly 100 different outcome measurement instruments. CONCLUSION: Included studies showed substantial heterogeneity regarding design, interventions and outcomes. Basic skin care strategies including low-irritating cleansers and lipophilic humectant-containing leave-on products are helpful for treating dry skin and improving skin barrier in the aged. Lower pH of leave-on products improves the skin barrier. The number of different outcome domains was unexpectedly high. We recommend to identify critical outcome domains in the field of skin care to make trial results more comparable in the future and to measure possible performance differences between different skin care strategies and products.

[Needs and quality of counseling in long-term care : User perspective on counseling services in Germany]. / Bedarf und Qualität von Beratung in der Langzeitpflege : Nutzerperspektive auf Beratungsangebote in Deutschland.

BACKGROUND: A wide range of counseling services with a variety of counseling purposes have been established in Germany to support care recipients and their relatives; however, there is a lack of quality criteria that are based on the counseling needs from the user's perspective. OBJECTIVE: To summarize empirical knowledge on counseling needs and quality of counseling services from the user perspective and identification of counseling-specific understanding of users. MATERIAL AND METHODS: A literature search was conducted in the databases CareLit®, LIVIVO and SpringerLink with additional online research via Google and MetaGer. Analysis of the literature and discussion on the state of research. RESULTS: A trustful relationship between counselor and user as well as the orientation to the user's individual situation are key elements of counseling that have been found helpful; however, a differentiated view of the diverse user groups and counseling purposes is lacking. CONCLUSION: In order to include the user's perspective in conceptual approaches for counseling and to define user-generated quality criteria, further scientific research is needed regarding the counseling needs of different user groups. Consideration must be given to particular care situations that involve various counseling purposes. Particularly vulnerable groups need special support in working out their counseling needs.

[Social inequality in home care]. / Soziale Ungleichheit in der ambulanten Pflege.

Social inequality in Germany is discussed primarily with regard to educational or social welfare issues. There is a political consensus that more action should be taken to ensure equality of chances and fulfillment of basic needs for everyone. In long-term care these considerations have not yet taken place and there are hardly any research studies in this field. However, the startling rise of the need for long-term care will definitely require a discussion of social inequality in various care arrangements. To learn more about social inequality in home care, a qualitative approach was used and 16 home care nurses were interviewed. Our study shows that many care recipients face numerous problems they cannot handle on their own, which may even worsen their situation. In addition, the results reveal that facing social inequalities place a burden on nurses and influence their work performance.

Immersion research education: students as catalysts in international collaboration research.

BACKGROUND: This paper describes an international nursing and health research immersion program. Minority students from the USA work with an international faculty mentor in teams conducting collaborative research. The Minority Health International Research Training (MHIRT) program students become catalysts in the conduct of cross-cultural research. AIM: To narrow the healthcare gap for disadvantaged families in the USA and partner countries. METHODS: Faculty from the USA, Germany, Italy, Colombia, England, Austria and Thailand formed an international research and education team to explore and compare family health issues, disparities in chronic illness care, social inequities and healthcare solutions. USA students in the MHIRT program complete two introductory courses followed by a 3-month research practicum in a partner country guided by faculty mentors abroad. The overall program development, student study abroad preparation, research project activities, cultural learning, and student and faculty team outcomes are explored. RESULTS: Cross-fertilization of research, cultural awareness and ideas about improving family health occur through education, international exchange and research immersion. Faculty research and international team collaboration provide opportunities for learning about research, health disparities, cultural influences and healthcare systems. The students are catalysts in the research effort, the dissemination of research findings and other educational endeavours. Five steps of the collaborative activities lead to programmatic success. CONCLUSIONS: MHIRT scholars bring creativity, enthusiasm, and gain a genuine desire to conduct health research about families with chronic illness. Their cultural learning stimulates career plans that include international research and attention to vulnerable populations.

Impact of antiretroviral dosing frequency and pill burden on adherence among newly diagnosed, antiretroviral-naive HIV patients.

There are few data on the impact of antiretroviral therapy (ART) regimen factors on adherence in ART-naïve HIV patients on contemporary once- or twice-daily regimens. Ninety-nine newly diagnosed patients in a prospective observational cohort study completed a visual analogue scale to assess their ART adherence. Adherence by type of ART and dosing frequency were compared by Brown-Mood median tests. Participants taking once-daily regimens had higher adherence (n = 70, 99.5%) compared with participants taking twice-daily regimens (n = 29, 94%; P = 0.01). Adherence of participants taking the fixed dose combination efavirenz-emtricitabine-tenofovir (n = 34, 100%) compared with those taking once-daily regimens of two or more pills was no different (n = 36, 99.3%; P = 0.34). Among a cohort of newly diagnosed ART-naïve patients, once-daily dosing of ART resulted in higher adherence than twice-daily dosing. Pill burden among once-daily regimens did not predict adherence, suggesting that factors other than pill burden should drive regimen selection.

Functional and total IGFBP3 for the assessment of disorders of the GH/IGF1 axis in children with chronic kidney disease, GH deficiency, or short stature after SGA status at birth.

OBJECTIVE: IGFBP3 immunoreactivity may appear elevated in patients with chronic kidney disease (CKD), in part due to accumulation of low molecular fragments. The importance of these IGFBP3 variants for binding and inactivation of IGF1 and their relevance for the impaired growth of uremic children are unclear. Nevertheless, IGFBP3, measured as total (t-)IGFBP3, is frequently used as a diagnostic parameter in pediatric CKD patients. A new assay for functional (f-)IGFBP3 exclusively detects IGFBP3 capable of IGF binding. The aim of the study was to evaluate the significance of f-IGFBP3 measurements for the assessment of uremic abnormalities of the GH/IGF1 axis. DESIGN: Prospective cross-sectional study. METHODS: t-IGFBP3, f-IGFBP3, and IGF1 were measured in pediatric CKD patients, including patients with CKD stage 3-4 not on dialysis (CKD, n=33), on dialysis treatment (DT, n=26), patients after renal transplantation (RTx, n=89), healthy children (n=29), children with GH deficiency (GHD, n=42), and small for gestational age (SGA) children (SGA, n=34). RESULTS: Mean t-IGFBP3 SDS was elevated in CKD, DT, and RTx children compared with controls and GHD patients (P≤0.0004). Highest values were reached in DT (P<0.0001 vs all groups). In contrast, mean f-IGFBP3 was similar in all groups (P=0.30). CONCLUSIONS: Pediatric CKD patients displayed elevated serum concentrations of t-IGFBP3 but not f-IGFBP3, supporting the hypothesis that IGFBP3 fragments not binding IGF1 accumulate during uremia. f-IGFBP3 is an indicator of IGFBP3 fragmentation and seems to reflect IGF1 binding in CKD better than t-IGFBP3. However, the role of f-IGFBP3 for the diagnosis of disturbances of the GH/IGF hormonal axis appears to be limited.

[Home care counseling for recipients of cash payments in the German long-term care insurance]. / Häusliche Pflegeberatung für Geldleistungsbezieher in der Pflegeversicherung.

Beneficiaries from the German long-term care insurance living at home have the option between cash payments and care-in-kind services. For those who opt for cash payments, there is an obligation to receive expert advice and 'counseling visits' by a professional nursing service at least twice a year. Although more than 2 million of these 'counseling visits' are conducted each year in Germany, hardly anything is known about these visits and whether they are useful for care recipients and their family caregivers. The purpose of this project was to gain insight into the 'counseling visits' in order to develop a useful approach for the performance of these visits. Data collection took place in two regions of Nordrhein-Westfalen (North Rhine-Westphalia). Data were collected using a questionnaire on the general performance of the visits, the perception of care recipients and their family members, and from the perspective of the nursing services. Additional qualitative interviews were conducted with family caregivers and nurse managers. Based on the findings, a family-oriented approach for home care counseling was developed and evaluated in 80 home care arrangements. The findings reveal that despite several efforts the usefulness and quality of the counseling visits basically occurs by chance. The family-oriented approach allowed for a better understanding of the home care arrangements and offered a solid ground on which to base recommendations and advice.

[Options for health care promotion in long-term care: empirical evidence and conceptual approaches]. / Möglichkeiten der Gesundheitsförderung in der Langzeitversorgung: Empirische Befunde und konzeptionelle Uberlegungen.

Using empirical evidence, this paper provides conceptual approaches to prevention and health promotion in long-term care - an area that has gained only limited attention in German discussions on prevention. First, a short analysis of long-term care in Germany is provided; existing problems but also resources with regard to prevention and health promotion in order to identify starting points for the development of interventions are presented. The existing pressure and problem accumulation in long-term care that calls for action on maintaining and promoting the health of long-term care professionals as well as long-term care users are illustrated. Considerations on programs for health promotion in long-term care focus on the users, in particular the oldest old, of long-term care. Finally, considerations on a conceptual framework for a user-oriented approach to prevention and health promotion in long-term care is presented.

'Then I just showed her my arms . . .' Bodily sensations in moments of alienation related to self-injurious behaviour. A hermeneutic phenomenological study.

People committing self-injurious behaviour are often perceived as difficult patients; confronted with unhelpful reactions from nurses, the patients find themselves left alone in their distress. A connection between self-injurious behaviour and feelings of alienation is suggested in the literature. Alienation is described as a state in which the self is perceived as strange, machinelike and not in contact with its emotional and physical needs. On one hand, complex neuro-biological processes are seen as responsible for this; on the other hand, alienation is seen as a means of self-protection when one is exposed to a threatening or traumatic situation. Nursing interventions focus on the nurse-patient relationship and on the handling of self-injuries, but they tend to ignore the client's previous experience. Proceeding from the assumption that patients committing self-injurious behaviour are the experts on their own harm, the purpose of the present study is to get insight into their 'lived experience' and to contribute to the understanding of this vulnerable group. Adopting a hermeneutic phenomenological research perspective, methods of participant observation and qualitative interviewing were chosen to generate data. The database consists of 99 observational sequences, five interviews and a set of email texts written by a self-injuring woman. A thematic analysis as described by Van Manen was done. The main findings are that alienation is experienced in several stages, that nurses can detect early signs of an impending loss of control, and that self-injurious behaviour is an effective strategy to end a painful experience of alienation. Self-injurious behaviour is appropriately understood as a form of 'self-care'.

Nurses' health, age and the wish to leave the profession--findings from the European NEXT-Study.

BACKGROUND AND OBJECTIVES: In many industrialised countries the number of workers with low health is expected to increase in the nursing profession. This will have implications for occupational health work in health care. The European NEXT-Study (www. next-study. net, funded by EU) investigates working conditions of nurses in ten European countries and provides the opportunity to evaluate the role of health with respect to age and the consideration of leaving nursing. METHODS: 26,263 female registered nurses from Belgium, Germany, Finland, France, England, Italy, Netherlands, Poland and Slovakia were eligible for analysis. RESULTS: In most countries, older nurses considered leaving the profession more frequently than younger nurses. 'Health' was--next to 'professional opportunities' and 'work organisational factors'--strongly associated with the consideration of leaving nursing. However, more than half of all nurses with low health wanted to remain in the profession. This group reported rather positive psychosocial working conditions--but also the highest fear for unemployment. CONCLUSIONS: The findings indicate that 'the nurse with low health' is reality in many health care settings. Both positive supporting working conditions but also lack of occupational alternatives and fear of unemployment may contribute to this. Current economic, political and demographic trends implicate that the number of active nurses with low health will increase. Occupational health surveillance will be challenged by this. But NEXT findings implicate that prevention also will have to regard work organisational factors if the aim is to sustain nurses' health and to enable nurses to remain healthy in their profession until retirement age.

Ocular responses to radial optic flow and single accelerated targets in humans.

Self-movement in a structured environment induces retinal image motion called optic flow. Optic flow on one hand provides information about the direction of self-motion. On the other hand optic flow presents large field visual motion which will elicit eye movements for the purpose of image stabilization. We investigated oculomotor behavior in humans during the presentation of radial optic flow fields which simulated forward or backward self-motion. Different conditions and oculomotor tasks were compared. In one condition, subjects had to actively pursue single dots in a radial flow pattern. In a second condition, subjects had to pursue single dots over a dark background. These dots accelerated or decelerated similar to single dots in radial optic flow. In a third condition, subjects were asked to passively view the entire optic flow stimulus. Smooth pursuit eye movements with high gain were observed when dots were actively pursued. This was true for single dots moving over a homogeneous background and for single dots in the optic flow. Passive viewing of optic flow stimuli evoked eye movements that resembled an optokinetic nystagmus. Slow phase eye movements tracked the motion of elements in the optic flow. Gain was low for simulated forward self-motion (expanding optic flow) and high for simulated backward movement self-motion (contracting optic flow). Thus, voluntary pursuit and passive optokinetic responses yielded different gain for the tracking of elements of an expanding optic flow pattern. During passive viewing of the optic flow stimulus, gaze was usually at or near the focus of radial flow. Our results give insights into the oculomotor performances and needs for image stabilization during self-motion and in the role of gaze strategy for the detection of the direction of heading.