Exploring perceptions of frailty, resilience, and self-efficacy in older adults and caregivers in acute care context.

This study aimed to explore the experience and perceptions of frailty in hospitalized older adults and caregivers caring for older adults, in relation to resilience and self-efficacy. A qualitative explorative descriptive study design was utilized. Face to face interviews were conducted from September 2020 to July 2021 with 24 older adults who were 65 years and above and hospitalized in the acute care hospital. Ten informal family caregivers were also recruited. Data were analysed using an inductive content analysis approach. Frailty encompassed physical elements as well as manifestations of psychological traits, fear of the unknown, and being in control. Resilience was determined by individual psychological traits and mindset, and the possession of a coping mechanism. Self-efficacy could influence both frailty and resilience through inner motivation and assistance received. Older adults and family caregivers reported that considerable decline in physical health with age and level of perseverance can determine the level of frailty. Resilience and self-efficacy play a pivotal role in the context of frailty. Understanding resilience in this context will assist nurses to facilitate the use of individual and sociocultural resources to improve the way resilience is experienced by older adults. Various coping strategies can enhance self-efficacy and build greater resilience in older adults, including maintaining their active involvement in health management and social life.

Correcting rotational error in rectal cancer radiation therapy: Can planning target volume margins be safely reduced?

INTRODUCTION: The magnitude and impact of rotational error is unclear in rectal cancer radiation therapy. This study evaluates rotational errors in rectal cancer patients, and investigates the feasibility of planning target volume (PTV) margin reduction to decrease organs at risk (OAR) irradiation. METHODS: In this study, 10 patients with rectal cancer were retrospectively selected. Rotational errors were assessed through image registration of daily cone beam computed tomography (CBCT) and planning CT scans. Two reference treatment plans (TPR ) with PTV margins of 5 mm and 10 mm were generated for each patient. Pre-determined rotational errors (±1°, ±3°, ±5°) were simulated to produce six manipulated treatment plans (TPM ) from each TPR . Differences in evaluated dose-volume metrics between TPR and TPM of each rotation were compared using Wilcoxon Signed-Rank Test. Clinical compliance was investigated for statistically significant dose-volume metrics. RESULTS: Mean rotational errors in pitch, roll and yaw were -0.72 ± 1.81°, -0.04 ± 1.36° and 0.38 ± 0.96° respectively. Pitch resulted in the largest potential circumferential displacement of clinical target volume (CTV) at 1.42 ± 1.06 mm. Pre-determined rotational errors resulted in statistically significant differences in CTV, small bowel, femoral heads and iliac crests (P < 0.05). Only small bowel and iliac crests failed clinical compliance, with majority in the PTV 10 mm margin group. CONCLUSION: Rotational errors affected clinical compliance for OAR dose but exerted minimal impact on CTV coverage even with reduced PTV margins. Both PTV margin reduction and rotational correction decreased irradiated volume of OAR. PTV margin reduction to 5 mm is feasible, and rotational corrections are recommended in rectal patients to further minimise OAR irradiation.

Maggot debridement therapy in the tropics - Preliminary outcomes from a tertiary hospital.

This paper aimed to describe the clinical outcomes and patients' acceptance of Maggot debridement therapy (MDT) at a tertiary hospital in Singapore. Patients with non-viable tissue (NVT) covering at least 25% of wound bed on lower limbs and/or unable to tolerate sharp debridement at the bedside were recruited between January and August 2021. Sterile medical-grade maggots of Lucilla Cuprina were used. Wound specialist nurses assessed the size and wound to determine the type of MDT, either Baggots or free-range larvae (FRL), and the number of maggots required prior to commencement of therapy. Wound sites were measured and photographed at multiple time points: before the start of MDT therapy, during the wound review at 48 or 72 h after each cycle of MDT and completion of therapy. Three patients received Baggot therapy, while the remaining 11 received FRL therapy. The mean age for patients receiving Baggot and FRL were 78.3 (SD = 10.6) and 63.6 (11.4), respectively. Each patient received three cycles of MDT treatment on average. The most common type of wound was ray amputated toe wounds (n = 8), while the most common wound aetiology was arterial ulcerations (n = 12). A reduction of NVT was observed in 11 out of 14 patients, and ten of these 11 patients achieved successful debridement (at least 25% reduction in NVT). Five out of 14 patients had to undergo amputation within the same admission due to poor wound healing, and 60% of these five patients failed to achieve successful debridement. MDT was quite well-accepted by the patients, and they felt some improvement in their wounds. MDT can facilitate wound healing through successful debridement and potentially reduce the need for amputation. Further research needs to be done regarding the type of MDT that is optimal to use in tropical countries with high humidity.