Instituting a Palliative Care Trigger in a Surgical Intensive Care Unit (SICU): Survey Results of SICU Team Members.

Increasing palliative care presence in the intensive care unit (ICU) improves symptom management, increases goals-of-care discussion, and reduces unnecessary procedures in ICU patients. An interdisciplinary study team developed a palliative care trigger program in a 17-bed surgical ICU (SICU). Surgical ICU patients who met 3 triggers (ICU length of stay > 10 days, repeat ICU admission, and metastatic cancer) automatically received a palliative care consult. The purpose of the current study was to survey SICU health care professionals before and after the institution of the palliative care trigger program. Overall, the palliative care trigger program was viewed positively by interdisciplinary team members with increased team communication and decreased resistance for the inclusion of palliative care in the SICU plan of care. The palliative care trigger program was successfully developed and implemented in a SICU and was accepted by the interdisciplinary team members caring for SICU patients. Team member feedback is being used to expand the palliative care trigger program to improve care for SICU patients.

Family experiences reported by healthcare worker parents during the COVID-19 pandemic.

PURPOSE: Parents, who were working as essential frontline healthcare workers experienced unique stressors during the COVID-19 pandemic including disruption of regular routines, long lapses away from family, extreme work stress and subsequent difficulty in compartmentalizing work-related concerns when at home. The purpose of this study was to assess COVID-19 exposure and impact of frontline healthcare workers who are parents. DESIGN & METHODS: This study quantitatively assessed the COVID-19 exposure and impact and qualitatively explored perceptions of parents of children 9 to 17 years of age, who were also frontline healthcare workers. RESULTS: Participants (N = 79) using the COVID-19 Exposure and Family Impact Survey (CEFIS) reported exposure mean scores of 10.03 (SD = 2.63); and impact scores mean scores of 3.18 (SD = 0.46). Thematic analysis identified four themes, each with 2 subthemes: 1) family stressors increased (e.g., concerns about health and safety, losses of lifestyle patterns); 2) changes in children's health and well-being (e.g., isolation from family and friends, mental health problems); 3) virtual school difficulties (e.g., parent and student challenges, home school option); 4) skill building opportunities (e.g., enhanced emotional connections, increased family activities). CONCLUSION: The CHAMPS Family Health Study suggests that families of essential workers are especially vulnerable to the effect of COVID-19, as are those families of essential workers who include child/ren with special health care needs. PRACTICE IMPLICATIONS: Preparation for future emergencies requires strategies to mitigate consequences and promote well-being. These results highlight the need for supportive approaches to decrease the negative consequences of stress and to augment skills for family connection and cooperation.

The Symptom Experience of Older Adults with Mobility Difficulties: Qualitative Interviews.

Eighteen million older adults have mobility limitations, defined as difficulty walking a quarter of a mile or climbing stairs unassisted. Little is known about how symptom burden impacts mobility difficulty in older adults. Understanding the burden of symptoms responsible for mobility difficulties may be an area for intervention to improve mobility and to prevent adverse outcomes. We conducted 31 semi-structured qualitative interviews (one interview per participant) regarding the symptom burden experience associated with a current mobility difficulty. Thematic analysis revealed symptoms were limiting, were barriers to participation in daily activities, and produced a psychological and emotional burden that negatively impacted quality of life. Older adults employed various strategies to overcome the symptom burden. Participants also believed symptoms were a non-modifiable part of the aging process and at times felt disregarded by healthcare professionals. Future interventions should focus on reducing the symptom burden experience for older adults to improve mobility and prevent adverse outcomes.

Highly Stretchable, Self-Healing, Injectable and pH Responsive Hydrogel from Multiple Hydrogen Bonding and Boron-Carbohydrate Interactions.

A simple and cost-effective method for the fabrication of a safe, dual-responsive, highly stretchable, self-healing and injectable hydrogel is reported based on a combination of dynamic boronate ester bonds and hydrogen bonding interactions. The mechanical properties of the hydrogel are tunable by adjusting the molar ratios between sugar moieties on the polymer and borax. It was remarkable to note that the 2:1 ratio of sugar and borate ion significantly improves the mechanical strength of the hydrogel. The injectability, self-healing and stretchability properties of the hydrogel were also examined. In addition, the impact of the variation of the pH and the addition of free sugar responsiveness of the hydrogel was studied. High MRC-5 cell viability was noticed by the 3D live/dead assay after 24 h cell culture within the hydrogel scaffold. Hence, the developed hydrogels have desirable features that warrant their applications for drug delivery, scaffolds for cell and tissue engineering.

Assessing the Feasibility and Implementation of Palliative Care Triggers in a Surgical Intensive Care Unit to Improve Interdisciplinary Collaboration for Patient and Family Care.

Although palliative care focuses on supporting patients and families through serious illness, it is underutilized in the surgical intensive care unit (SICU). In 2020, patients in the SICU represented only 2.75% of our palliative team's consults. We hypothesize that utilization of palliative care triggers in the SICU will increase collaboration between SICU and palliative care teams and improve patient/family experiences. After reviewing our team's consultation records and the published literature, a consult trigger program was implemented for patients with a SICU length of stay >10 days, unplanned SICU readmission, or new diagnosis of metastatic cancer. A pre-intervention survey assessed SICU providers' perceptions of palliative care. Retrospective analysis evaluated qualitative and quantitative measures. 97% of SICU providers felt increased palliative care would be helpful. During the 6-month project, January 1, 2021 - June 30, 2021, our palliative team performed 27 triggered consults, representing 3.3% of the total 818 consults performed during this period and thus a 20% increase in SICU palliative consults. Triggered consults represented many primary surgical services and the most common consult reason was length-of-stay. All consults included discussions about goals of care and 16 of the 27 patients/families expressed restorative goals. Numerous notes documented family appreciation.

The Relationship of Fear of Falling and Quality of Life: The Mediating Effects of Frailty and Depression.

PURPOSE: To examine the sequential explanatory roles of frailty and depression in the relationship between fear of falling (FOF) and health-related quality of life (HRQoL) in older adults. DESIGN: Secondary data analysis. METHODS: Path models were constructed hypothesizing frailty and depression as serial mediators of the relationship between FoF and HRQoL. FINDINGS: Depression independently and along with frailty serially mediated the relationship between FoF and mental HRQoL. CONCLUSIONS: Frailty and depression are not typically considered when assessing the effect of FOF on HRQoL. CLINICAL EVIDENCE: Understanding the mediating effects and common risk factors on FOF and HRQoL may be an area for interventional development for older adults.

Self-reported symptom causes of mobility difficulty contributing to fear of falling in older adults.

BACKGROUND: Self-reported symptom causes of mobility difficulty that contribute to  fear of falling (FOF) in older adults has not been fully explored as an area for intervention. AIMS: Identify the prevalence of self-reported symptoms causing mobility difficulties and to examine the difference in FOF by symptom category. METHODS: Conduct a secondary data analysis of a population-based cohort of community-dwelling older adults, ≥ 70 years, enrolled in the MOBILIZE Boston study. The analysis included 242 older adults reported difficulty walking » mile (0.4 km) and/or climbing one flight of stairs. Participants identified the main symptom cause of the mobility difficulty from a list of 32 symptoms, grouped into five categories. FOF was measured using the Tinetti Falls Efficacy Scale. RESULTS: Pain was the primary symptom causing mobility difficulty (38%), followed by endurance (21%), weakness (13%), balance (9%), and other (3%). Although a greater proportion of participants who identified balance as the primary symptom category had significantly higher FOF compared to others, there was a greater number overall who reported pain as their main symptom who also had FOF. Therefore, pain contributed to a higher relative burden of FOF in the population than did balance symptoms. DISCUSSION: Various symptoms affect mobility and are associated with FOF, a known fall risk factor. Many older adults identify pain as the main cause of their mobility difficulty and report FOF. CONCLUSIONS: Improving pain symptoms for older adults may improve mobility and reduce fear of falling, potentially averting further decline in mobility and independence.

Age Moderates the Effect of Injury Severity on Functional Trajectories in Traumatic Brain Injury: A Study Using the NIDILRR Traumatic Brain Injury Model Systems National Dataset.

Age is a risk factor for a host of poor outcomes following traumatic brain injury (TBI), with some evidence suggesting that age is also a source of excess disability. We tested the extent to which age moderates the effect of injury severity on functional trajectories over 15 years post injury. Data from 11,442 participants from the 2020 National Institute of Disability and Independent Living Rehabiitation Research (NIDILRR) Traumatic Brain Injury Model Systems (TBIMS) National Dataset were analyzed using linear mixed effects models. Injury severity was operationally defined using a composite of Glasgow Coma Scale scores, structural imaging findings, and the number of days with post-trauma amnesia. Functioning was measured using the Glasgow Outcomes Scale-Extended. Age at injury was the hypothesized moderator. Race, ethnicity, sex, education, and marital status served as covariates. The results showed a significant confounder-adjusted effect of injury severity and age of injury on the linear slope in functioning. The age effect was strongest for those with mild TBI. Thus, the effects of injury severity on functional trajectory were found to be moderated by age. To optimize outcomes, TBI rehabilitation should be developed specifically for older patients. Age should also be a major focus in TBI research.

The experience of baccalaureate clinical nursing faculty transitioning to emergency remote clinical teaching during the COVID-19 pandemic: Lessons for the future.

BACKGROUND: Experiential clinical learning in undergraduate nursing education allows for fusion of nursing knowledge with practice to ensure the development of competent graduate nurses. The global COVID-19 pandemic necessitated an abrupt transition from in-person clinical educational experiences to emergency remote clinical teaching. OBJECTIVES: The purpose of this study was to describe the experiences of baccalaureate nursing clinical faculty who transitioned from in-person clinical to emergency remote clinical teaching during the COVID-19 pandemic in spring 2020. DESIGN: A qualitative descriptive design was used. SETTING: The study took place in the United States. PARTICIPANTS: Nineteen baccalaureate nursing clinical faculty participated in the study. METHODS: Participants engaged in semi-structured, in-depth, online interviews. RESULTS: Five themes emerged from the data: transition, collaboration and support, the joy of teaching, authentic professional experience, and the overarching primary theme, stress of the moment. CONCLUSIONS: The transition to emergency remote clinical teaching during the COVID-19 pandemic caused stress and anxiety. However, there were important lessons learned about how to best support students and faculty while providing a robust online learning experience. Understanding the experiences of clinical nursing faculty during this abrupt transition can support recommendations for best practices in the future.

Original Research: Nurses' Experiences of Caring for Patients and Families During the COVID-19 Pandemic: Communication Challenges.

OBJECTIVE: The purpose of this study was to gain a better understanding of the perceptions and experiences of nurses caring for patients and families under the COVID-19 pandemic's socially restrictive practices and policies. BACKGROUND: The COVID-19 global pandemic has affected the delivery of health care to patients and their families, with many aspects altered because of the need for social distancing, social isolation, and visitation restriction policies. These policies have created communication challenges for interdisciplinary health care teams, patients, and families. As frontline caregivers, nurses have felt strongly the impact of these challenges. METHODS: A qualitative descriptive study was conducted among 17 RNs who were caring for patients during the COVID-19 pandemic and were recruited via social media posts on Facebook, Twitter, and LinkedIn. Watson's theory of human caring served as the conceptual framework for the study. RESULTS: Several themes emerged regarding nurses' experiences of communication with patients and families. These include communication challenges and barriers, prioritization, integration of group communication, nurse self-reflection, and acceptance of gratitude. CONCLUSIONS: The study findings underscore the importance of nurses' communication with patients and families under the pandemic's restricted conditions. They demonstrate the value of nurses' ability to innovate in fostering all parties' participation in the plan of care, and highlight the comfort nurses provide to patients who are isolated from loved ones. Strategies that fostered communication were identified, as were areas for further research.

The impact of exercise on sleep in people with Parkinson's disease a scoping review.

While high intensity exercise is associated with improvement of both motor and non-motor symptoms in Parkinson's disease (PD), there is limited evidence on its impact on sleep disturbances in PD. This scoping review aims to provide a preliminary statement of the potential size and scope of available evidence for the interaction between exercise and sleep in people with PD. Research to date on non-motor symptoms of PD is broad, with scarce information regarding specific effects of exercise on sleep. A systematic literature search was conducted through three phases. Fifteen articles met the inclusion criteria for this study. Resistive exercise and multimodal exercise programs were frequently studied and found to improve sleep and decrease sleep-related disorders. These findings suggest that exercise programs may improve sleep and other non-motor symptoms of PD. The research was inconclusive when comparing the effects of high and low intensity exercises. Further research on the interaction between exercise and sleep in PD may have implications for rehabilitative therapy interventions.

Factors associated with health-related quality of life in PACE participants.

Health-related quality of life (HRQoL) is an important measure of how health and illness affect the lives of older adults. This study aimed to determine the relationship between frailty, fear of falling, and depression with HRQoL in nursing home eligible community-dwelling older adults. A cross-sectional correlational design and chart review were conducted. Eighty four participants (mean age = 70.33 [SD = 6.33]) were surveyed on frailty, fear of falling, depression and physical and mental health measures of HRQoL. Increased frailty, fear of falling, and depression were associated with decreased physical and mental health and well-being. When controlling for sociodemographics, frailty and fear of falling were predictive of lower physical health and well-being whereas depression was independently predictive of lower mental health and well-being. The results of this study will assist in assessment and targeted interventions for modifiable risk factors that affect the HRQoL of nursing home eligible community-dwelling older adults.

Implementing Introductory Training in Trauma-Informed Care Into Mental Health Rehabilitation Services: A Mixed Methods Evaluation.

OBJECTIVE: This paper describes the implementation of training in trauma-informed care (TIC) across a mental health rehabilitation service. METHOD: A mixed-methods approach was applied incorporating baseline measures of staff attitudes toward TIC, quantitative description of staff training participation, and semi-structured interviews of Team Leaders' views on the implementation of TIC. RESULTS: Fifty-five of 123 staff responded to the Organizational Change Readiness Assessment (OCRA) survey (44.7%). Training completion varied considerably between the eight rehabilitation teams (4.8-78%). Analysis of the Team Leader interviews identified four broad themes: The need to respect the person's life journey including the risk of re-traumatization; the importance of considering the context of implementing TIC training; TIC being an essential part of mental health care; and staff may also have trauma histories. CONCLUSIONS: Staff working in mental health rehabilitation are supportive of the need for TIC. The variable training uptake did not reflect the staff comments about the importance of TIC. The burden of adjusting mental health care delivery to COVID-19 restrictions was reported as a major influence on the uptake of training. Systematically implementing training in TIC is required but needs to be complemented by a structured organizational approach to aid embedding this approach into daily mental healthcare delivery.

Factors associated with the risk for falls in PACE participants.

OBJECTIVE: The purpose was to determine the relationship between frailty, fear of falling, and depression with falls risk in vulnerable community-dwelling older adults. METHODS: A cross-sectional correlational design and chart review were completed. Nursing home eligible older adults ≥55 who live in the community were surveyed on frailty, fear of falling, depression, and the risk for falls. Pearson's correlation, multiple regression and hierarchical regression were used to analyze the data. RESULTS: Increased frailty, fear of falling, and depression were significantly associated with an increased risk for falls. Frailty and fear of falling were significant predictors of the risk for falls while depression did not contribute to the regression model. When controlling for sociodemographics, frailty, fear of falling, and incontinence were significant predictors for the risk for falls. DISCUSSION: The results of this study will assist in assessment and interventions to decrease the risk for falls in high risk older adults.

Lymphoproliferative Disease Virus in Wild Turkeys (Meleagris gallopavo) from Manitoba and Quebec, Canada.

This study describes the first recognized clinical case of lymphoproliferative disease virus (LPDV) in Canada and extends the range of LPDV in Canada through its detection in Manitoba and Quebec. We assessed the prevalence of LPDV in eastern wild turkeys (Meleagris gallopavo silvestris) with the use of whole, clotted blood from live birds in Manitoba (n = 65) and tissue samples collected postmortem in Quebec (n = 4). We tested for LPDV proviral DNA through PCR amplification and sequencing of a portion of the gag (p31) gene. Samples were also tested for reticuloendotheliosis virus (REV) by PCR. Twenty-four birds (34.8%) were positive for LPDV, including all diagnostic cases. One bird (1.4%) from Quebec had gross and microscopic lesions consistent with LPDV. Two turkeys (2.9%) were REV positive, one (1.4%) of which was co-infected with LPDV. Phylogenetic analysis of LPDV strains from Quebec and Manitoba grouped with previously sequenced samples from Ontario and publicly available sequences from a North American lineage. This study contributes valuable information toward ongoing surveillance and monitoring of LPDV in North America.

Virus de la enfermedad linfoproliferativa en pavos silvestres (Meleagris gallopavo) de Manitoba y Quebec, en Canadá. Este estudio describe el primer caso clínico reconocido del virus de la enfermedad linfoproliferativa (LPDV) en Canadá y extiende el rango de detección de este virus a través de su detección en Manitoba y Quebec. Se evaluó la prevalencia del virus de la enfermedad linfoproliferativa en pavos silvestres (Meleagris gallopavo silvestris) de la parte oriental, mediante el uso de sangre coagulada de aves vivas en Manitoba (n = 65) y de muestras de tejidos recolectadas postmortem en Quebec (n = 4). Se analizó el ADN proviral del virus de la enfermedad linfoproliferativa del pavo a través de la amplificación por PCR y la secuenciación de una parte del gene gag (p31). Las muestras también se analizaron para detectar el virus de la reticuloendoteliosis (REV) mediante PCR. Veinticuatro aves (34.8%) resultaron positivas para la presencia del virus de la enfermedad linfoproliferativa, incluyendo todos los casos diagnósticos. Un ave (1.4%) de Quebec tenía lesiones macroscópicas y microscópicas compatibles con este virus. Dos pavos (2.9%) fueron positivos a la presencia del virus de la reticuloendoteliosis, uno (1.4%) de los cuales se co-infectó con el virus de la enfermedad linfoproliferativa. El análisis filogenético de cepas del virus de la enfermedad linfoproliferativa de Quebec y Manitoba agrupó a estos virus con muestras previamente secuenciadas de Ontario y secuencias disponibles públicamente de un linaje de América del Norte. Este estudio aporta información valiosa para la vigilancia y el monitoreo continuos del virus de la enfermedad linfoproliferativa en América del Norte.

Signatures of selection in mammalian clock genes with coding trinucleotide repeats: Implications for studying the genomics of high-pace adaptation.

Climate change is predicted to affect the reproductive ecology of wildlife; however, we have yet to understand if and how species can adapt to the rapid pace of change. Clock genes are functional genes likely critical for adaptation to shifting seasonal conditions through shifts in timing cues. Many of these genes contain coding trinucleotide repeats, which offer the potential for higher rates of change than single nucleotide polymorphisms (SNPs) at coding sites, and, thus, may translate to faster rates of adaptation in changing environments. We characterized repeats in 22 clock genes across all annotated mammal species and evaluated the potential for selection on repeat motifs in three clock genes (NR1D1,CLOCK, and PER1) in three congeneric species pairs with different latitudinal range limits: Canada lynx and bobcat (Lynx canadensis and L. rufus), northern and southern flying squirrels (Glaucomys sabrinus and G. volans), and white-footed and deer mouse (Peromyscus leucopus and P. maniculatus). Signatures of positive selection were found in both the interspecific comparison of Canada lynx and bobcat, and intraspecific analyses in Canada lynx. Northern and southern flying squirrels showed differing frequencies at common CLOCK alleles and a signature of balancing selection. Regional excess homozygosity was found in the deer mouse at PER1 suggesting disruptive selection, and further analyses suggested balancing selection in the white-footed mouse. These preliminary signatures of selection and the presence of trinucleotide repeats within many clock genes warrant further consideration of the importance of candidate gene motifs for adaptation to climate change.

Nurse discharge planning in the emergency department: a Toowoomba, Australia, study.

AIM: This study aimed to ascertain whether a model of risk screening carried out by an experienced community nurse was effective in decreasing re-presentations and readmissions and the length of stay of older people presenting to an Australian emergency department. OBJECTIVES: The objectives of the study were to (i) identify all older people who presented to the emergency department of an Australian regional hospital; (ii) identify the proportion of re-presentations and readmissions within this cohort of patients; and (iii) risk-screen all older patients and provide referrals when necessary to community services. DESIGN: The study involved the application of a risk screening tool to 2,139 men and women over 70 years of age from October 2002 to June 2003. Of these, 1,102 (51.5%) were admitted and 246 (11.5%) were re-presentations with the same illness. Patients presenting from Monday to Friday from 08:00 to 16:00 hours were risk-screened face to face in the emergency department. Outside of these hours, but within 72 hours of presentation, risk screening was carried out by telephone if the patient was discharged or within the ward if the patient had been admitted. RESULTS: There was a 16% decrease in the re-presentation rate of people over 70 years of age to the emergency department. Additionally during this time there was a 5.5% decrease in the readmission rate (this decrease did not reach significance). There was a decrease in the average length of stay in hospital from 6.17 days per patient in October 2002 to 5.37 days per patient in June 2003. An unexpected finding was the decrease in re-presentations in people who represented to the emergency department three or more times per month (known as 'frequent flyers'). CONCLUSIONS: Risk screening of older people in the emergency department by a specialist community nurse resulted in a decrease of re-presentations to the emergency department. There was some evidence of a decreased length of stay. It is suggested that the decrease in re-presentations was the result of increased referral and use of community services. It appears that the use of a specialist community nurse to undertake risk screening rather than the triage nurse may impact on service utilization. RELEVANCE TO CLINICAL PRACTICE: It is apparent that older people presenting to the emergency department have complex care needs. Undertaking risk screening using an experienced community nurse to ascertain the correct level of community assistance required and ensuring speedy referral to appropriate community services has positive outcomes for both the hospital and the patient.

Triage nurse perceptions of the use, reliability and acceptability of the Toowoomba Adult Triage Trauma Tool (TATTT).

OBJECTIVE: The 'Toowoomba Adult Triage Trauma Tool' (TATTT) is a computerised clinical decision support tool developed to provide an evidence-based, valid and consistent method of triage assessment and categorisation. The objective of this study was to determine the most appropriate training and testing strategy for implementing the TATTT and to evaluate its acceptability for assisting in the triage prioritization process. METHODS: Triage nurses (15) from two hospitals underwent training in the TATTT and were tested on its application. Semi-structured interviews gathered their perceptions of the training, the methods for testing and the acceptability of the TATTT for assisting in triage. RESULTS: The TATTT was viewed positively by all but one of the nurses. Participants believed that it provided clear direction in the triage assessment process, increased their confidence in reaching a decision and would be comfortable in adopting the TATTT in clinical practice. CONCLUSIONS: The study has shown that the TATTT is acceptable to users and is viewed as a viable alternative to current triage practice.