Vaccination for older people in post-COVID-19 era: challenges and strategies for improvement

Background:Unplanned extubation (UE) in intensive care units (ICUs) is a significant patient safety concern, associated with increased morbidity and healthcare utilization; the reported rates of UE vary from 1% to 15%. There is sparse data on the effects of multiple performance improvement (PI) strategies to decrease the rate of UE, particularly in inner-city ICU populations. This study evaluates the impact of PI strategies on UE rates and associated patient outcomes in an adult ICU.Objectives:To determine the impact of performance improvement (PI) strategies on rates of unplanned extubation (UE), reintubation, tracheostomy, mortality, and length of hospital stay in ICU patients.Design:Retrospective cohort studyMethods:This retrospective observational study included 6,397 mechanically ventilated patients admitted to a single tertiary ICU between 2015 and 2023. Three distinct time periods were compared: Period 1 (2015–2017, pre-PI), Period 2 (2018–2020, early-PI), and Period 3 (2021–2023, sustained-PI). Demographics, sedation practices, UE characteristics, and outcomes were analyzed using logistic regression.Results:UE incidence declined significantly from 3.79% in Period 1 to 2.17% in Period 3 (p = 0.002). Reintubation rates dropped from 45.2% to 26.7% (p = 0.011), and tracheostomy rates from 19.0% to 2.2% (p < 0.001). Multivariate analysis showed reduced odds of reintubation in Periods 2 (OR = 0.219, p = 0.001) and 3 (OR = 0.345, p = 0.021) and reduced odds of tracheostomy in Period 3 (OR = 0.011, p = 0.016). Risk factors for reintubation included the absence of prior intubation history and not undergoing spontaneous breathing trials. Older age (⩾71 years) and positive urine toxicology for opiates were strongly associated with tracheostomy.Conclusion:Implementation of PI strategies significantly reduced rates of unplanned extubation, reintubation, and tracheostomy. These findings support continued quality improvement initiatives in ICU airway management.

Admission to an emergency department (ED) may expose the older person with dementia to a range of negative consequences, including a deterioration in their behavioural symptoms. The authors conducted a review of primary research relating to the experiences of older people with dementia, their carers and ED nurses, to understand how these experiences might inform nursing practice. Integrative review with a search of the electronic databases of Medline, CINAHL and PSYCHINFO using specified inclusion and exclusion criteria. Three themes were identified: carers and older people with dementia-waiting and worrying; nurses juggling priorities; and strategies for improvement-taking a partnership approach. Older people with dementia may be exposed to disparities in treatment in the ED. A practice partnership between carers and ED nurses may help to prevent this. ED nurses need support to blend technical- and relationship-centred care. Participatory research exploring the experiences of older people with dementia, their carers and ED nurses is needed.

Oral health care in older people in long term care facilities: A systematic review of implementation strategies

Studies on gender differences in the perception of urban green spaces (UGS) among older people are scarce. Based on this research gap, this paper attempts to explore older people’s subjective evaluations of UGS in Macau, to identify gender differences in their perceptions of these spaces and to propose corresponding improvement strategies, aiming to provide a theoretical basis for the building of an age-friendly city in Macau. A comprehensive literature review was conducted to identify evaluation measurements. Preliminary interviews with older people were undertaken to ensure the local adaptability of evaluation measurements. The characteristics of UGS were measured using 22 attributes categorised into six dimensions. The questionnaire was designed based on these evaluation measurements. Importance–performance analysis was used to discover the importance and satisfaction ranking of UGS attributes. A total of 600 valid questionnaires was collected. Results show that both older women and older men regard social activities as a primary purpose of visiting UGS. Only older women care very much about children’s facilities and their preferences is more for garden plants than for tall trees. Enhancing functional facilities, encouraging social engagement and creating multiple uses are the primary objectives of UGS design.

ABSTRACTWith the increasing trend of delayed childbearing, the decline in oocyte quality associated with advanced maternal age has emerged as a pressing concern. However, the mechanism remains unclear, and effective strategies for improvement are currently lacking. Previously, we reported that the downregulation of the mevalonate pathway in aged granulosa cells (GCs) contributed to meiotic defects in oocytes, which may implicate farnesyl pyrophosphate‐mediated protein farnesylation. Nevertheless, the role of farnesylation in ovarian aging and its impact on oocytes requires further investigation. In this study, using cumulus‐oocyte complexes (COCs) from young and aged female mice, we observed impaired cumulus expansion and concurrent meiotic defects during aged oocyte maturation, accompanied by significantly reduced protein farnesylation in aged GCs. Furthermore, inhibiting farnesylation with FTI‐277 in young COCs recapitulated the aging phenotype, disrupting cumulus expansion and inducing meiotic defects similar to those in aged COCs. Conversely, restoring farnesylation via farnesol supplementation effectively ameliorated these deficits in both aged COCs (in vitro) and aged mice (in vivo). Proteomic analysis and experimental validation identified prostaglandin E2 synthase 2 (PTGES2) as a farnesylated protein. Mechanistically, age‐related decline in PTGES2 farnesylation in GCs reduces its endoplasmic reticulum localization and impairs prostaglandin E2 (PGE2) production, thereby compromising PGE2‐dependent cumulus expansion and oocyte maturation. Collectively, our findings highlight the detrimental effects of decreased farnesylation in aged GCs on oocyte quality and propose a potential therapeutic strategy for improving the developmental competence of aged oocytes.

Explore clinicians' perceptions of practice improvement strategies used to prevent harms to older people during acute hospitalisation. Older people are vulnerable to many interrelated preventable harms during acute care hospitalisation. Improvement strategies recommend standardisation of practices to assist healthcare staff to mitigate risk; however, older people continue to suffer preventable harms in acute hospitals. A qualitative exploratory descriptive design was used to collect data using focus groups and individual interviews from a purposive sample of 33 participants. Participants represented a wide range of clinicians from four diverse healthcare organisations. Qualitative content analysis used a framework informed by common preventable harms derived from key literature and policy documents. Participants' perceptions of practice improvement strategies varied depending on their role within their organisational hierarchy. Recognition of preventable harms was guided by standard risk assessment and management tools used in their organisations. Preventable harms relating to skin integrity and falls were universally recognised across all sites and roles. Alternatively, there was variability in participant recognition of preventable harms related to nutrition, continence, medications and cognition; pain was consistently overlooked as a contributor to preventable harms. Hospital staff perceived standard clinical risk assessment and management tools as the main practice improvement strategy to prevent harms. These tools prompted staff recognition of preventable harms to older people during acute hospitalisation. Variability in the recognition of some preventable harms was attributed to variable use of standard assessment tools. Pain was unlikely to be recognised as contributing to preventable harms. Clinical Risk Management tools may assist clinicians in recognising and responding to preventable harms to older people during hospitalisation. These tools provide critical resources for consistent and timely assessment and evaluation of risk for preventable harms.

IntroductionPeu de données existent sur les plaintes des patients pour identifier des pistes d’amélioration de la qualité de soins des personnes âgées avec des multimorbidités. L’objectif de cette étude était d’analyser les plaintes des personnes âgées qui présentent des multimorbidités dans les formations sanitaires à Bobo-Dioulasso, Burkina Faso.MéthodesNous avons réalisé une étude transversale dans les formations sanitaires de la ville de Bobo-Dioulasso de novembre 2013 à février 2014. Les personnes âgées de 60 ans ou plus, avec au moins une pathologie chronique vues en ambulatoire ou en hospitalisation pendant la période d’étude ont été inclues. Des entretiens qualitatifs ont été réalisés à l’aide d’un questionnaire semi-structuré. Une analyse du contenu a été réalisée.RésultatsNous avons noté des plaintes liées au long temps d’attente pour les soins, des conditions inadaptées de transfert des patients en hospitalisation, un manque d’échanges d’informations sur les maladies et des conditions d’hôtellerie inadaptées pour la personnes âgée venue en consultation et en hospitalisation.ConclusionDes pistes d’amélioration pourraient passer par la rénovation et l’agrandissement des salles d’attentes des formations sanitaires, la séparation des prestations des soins chroniques des soins aigus en ambulatoire et en hospitalisation, l’appui à l’autonomisation par une meilleure communication avec le patient avec l’appui d’un groupe d’entraide communautaire et l’implication des familles.

Hemodialysis patients are vulnerable to infectious diseases and frequent receipt of antimicrobial agents. The aim of this study was to describe the prevalence and characteristics of infections and antimicrobials use among hemodialysis outpatients. We utilized the dialysis event surveillance protocol developed by the National Healthcare Safety Network to conduct a prospective multicenter study in Anhui, China. A total of 41 dialysis centers involving 7393 outpatients were included. Fistula was the most common type of vascular access (85.3%), followed by tunneled central line (12.7%), and non-tunneled central line (1.2%). There were 118 dialysis events with an overall pooled events rate of 1.60 per 100 patient-months. Intravenous antimicrobial start, positive blood culture, and pus, redness, or increased swelling at the vascular access site were detected at rates of 0.91, 0.23, and 0.46 per 100 patient-months, respectively. The prevalence of dialysis events was commonly higher in patients with a central line, and lower in patients with a fistula. Hemodialysis outpatients also had the noteworthy risks of nonaccess infections. Older age, female gender, and having a central line were associated with the increased risk of dialysis events. Findings recommend that regular monitoring and improvement strategies are warranted in management of infections among hemodialysis outpatients.

Risk factors and early outcomes of repeat sternotomy in 1960 adults with congenital heart disease: A 30-year, single-center study

Aim: To study the relationship between the health problems of elderly dependent and training of informal caregivers. Methods: We present an exploratory, descriptive cross-sectional, selecting 41 caregivers through intentional non-probability sampling. He has designed a questionnaire based on the literature and content validity has been agreed upon by experts. For data analysis has been used SPSS version 18.0. Results: 41.5% of informal caregivers received some training, 92.7% of caregivers state that need training regarding the health problems of people cared and 58.5% of seniors have been maintained for caregivers who are not trained. Conclusions: It is significant that in our study there are more untrained caregivers caring for people with health problems than with specific training, being necessary to the main informal cares to attend training programs on issues of health care and requiring older people who care for what is proposed as a strategy for improvement, health management since they provide the resources and facilities needed by caregivers, and enhance the use of training tools (forums, chats, emails, Tuenti, facebook, blog, twitter, Skype, etc.), which can arise as an alternative to face sessions.

The National Service Framework (NSF) for Older People is a set of standards produced by the Department of Health in England in 2001 to overhaul the health and social service delivery systems over a 10-year period aimed at optimizing the care received by older adults. The NSF arose from broader social and health care reforms that likewise sought the establishment of performance assessment, augmented consumer sovereignty, and greater coherence across health and social services. The United States shares with England similar problems with care for its older adults, strategies for improvement, and obstacles to successful implementation of change.

BackgroundDignity and well-being are central concepts in the care of older people, 65 years and older, worldwide. The person-centred practice framework identifies dignity and well-being as person-centred outcomes. Older persons living in residential care facilities, residents, have described that they sometimes lack a sense of dignity and well-being, and there is a need to understand which modifiable factors to target to improve this. The aim of this study was to examine the associations between perceptions of dignity and well-being and the independent variables of the attitudes of staff, the indoor-outdoor-mealtime environments, and individual factors for residents over a three-year period.MethodsA national retrospective longitudinal mixed cohort study was conducted in all residential care facilities within 290 municipalities in Sweden. All residents aged 65 years and older in 2016, 2017 and 2018 were invited to responded to a survey; including questions regarding self-rated health and mobility, the attitudes of staff, the indoor-outdoor-mealtime environments, safety, and social activities. Data regarding age, sex and diagnosed dementia/prescribed medication for dementia were collected from two national databases. Descriptive statistics and ordinal logistic regression models were used to analyse the data.ResultsA total of 13 763 (2016), 13 251 (2017) and 12 620 (2018) residents answered the survey. Most of them (69%) were women and the median age was 88 years. The odds for satisfaction with dignity did not differ over the three-year period, but the odds for satisfaction with well-being decreased over time. Residents who rated their health as good, who were not diagnosed with dementia/had no prescribed medication for dementia, who had not experienced disrespectful attitudes of staff and who found the indoor-outdoor-mealtime environments to be pleasant had higher odds of being satisfied with aspects of dignity and well-being over the three-year period.ConclusionsThe person-centred practice framework, which targets the attitudes of staff and the care environment, can be used as a theoretical framework when designing improvement strategies to promote dignity and well-being. Registered nurses, due to their core competencies, focusing on person-centred care and quality improvement work, should be given an active role as facilitators in such improvement strategies.

User perspective of age-friendly transportation: A case study of Taipei City

To explore the views of nurses on challenges, perceived roles and improvement strategies concerning elder abuse intervention in Malaysia. Eleven focus group discussions were conducted using a semi-structured interview based on the socio-ecological framework. The data were analyzed using a multistep process of thematic analysis. Three themes emerged from the data analysis: (1) The predicament: being unwilling or not able to intervene (2) Bridging the older people and health system gap (3) Getting to grips with the barriers. There are multifactorial contributors identified at the individual, interpersonal, organizational, community and policy levels in each theme. These factors interact across the levels to influence nurses' capability to intervene in elder abuse. A framework is needed to articulate Malaysian nurses' role in elder abuse intervention in terms of personal and professional development through culturally sensitive education and the establishment of clinical guidelines in the primary care setting. Strengthening organizational support and the institution of national policy and permissive reporting laws of elder abuse will empower the primary care nurses to address elder abuse in primary care settings and communities.

Background: Family planning (FP) is important to ensure the wellbeing of mothers and children. There are various facilitators and barriers towards a successful FP program. In the health district of Petaling (PKD Petaling), the uptake of FP is not optimum. However, local data are scarce to pinpoint the reasons. This study aims to assess the knowledge, attitude, and practice (KAP) level among the potential FP recipients and its associated factors. Materials and Methods: A cross-sectional study using self-administered questionnaires was conducted at six health clinics in PKD Petaling from May-July 2017. Descriptive analysis with chi-square and logistic regression analysis were conducted to identify associated factors. Result: Majority of the 360 respondents were Malays (75.3%) and married (91.9%). The overall KAP was 80.3%, 71.9%, and 46.7%. OCP and condom were the two most recognised FP methods whereas OCP and Depo Provera were the most commonly used. Education level was associated with a good knowledge and positive attitude towards FP. The predictors of current FP usage included older age, having 4 or more children, good knowledge and attitude about FP. Conclusion: An effective FP programme require the identification and understanding of the various factors associated with the KAP level of FP to formulate appropriate improvement strategies. Based on the results, fear of side effects and husband’s opposition were the most prominent reasons for not using contraception. Dissemination of accurate information, inclusion of husband in FP decision-making, continuous staff training to improve the counselling effectiveness are needed to improve the uptake of FP in PKD Petaling. Keywords: Family planning, contraception, KAP, Malaysia, service recipient