Factors Associated with Advance Care Planning Engagement Among Community-Dwelling Older Adults: A Cross-Sectional Study.

Aim: To explore the associations between depression, anxiety, decisional conflict and advance care planning engagement and the potential mediating role of decisional conflict in the associations between depression, anxiety and advance care planning among community-dwelling older adults.

Design: A cross-sectional study was conducted with 262 community-dwelling older Australians across metropolitan, regional and rural communities between August and October 2022.

Methods: Validated self-reported questions were used to collect data on anxiety, depression (Hospital Anxiety and Depression Scale), decisional conflict (Decisional Conflict Scale), advance care planning engagement (Advance Care Planning Engagement Survey) and covariates (demographic characteristics, health literacy [Health Literacy Screening Questions]), overall health status (Short form 36).

Improving nursing home safety through Adoption of a practical Resilient Health Care approach.

Nursing homes struggle with safety issues, despite decades of intervention. This may, in part, stem from a reliance on a historical perspective that views safety as an intrinsic part of well-designed systems, with errors resulting from knowable, fixable causes. A new perspective (Resilient Health Care) assumes, instead, that in complex systems such as nursing homes, uncertainties and trade-offs occur in the course of everyday work.

Improving Nursing Home Safety through Adoption of a Practical Resilient Health Care Approach.

Nursing homes struggle with safety issues, despite decades of intervention. This may, in part, stem from a reliance on a historical perspective that views safety as an intrinsic part of well-designed systems, with errors resulting from knowable, fixable causes. A new perspective (Resilient Health Care) assumes, instead, that in complex systems such as nursing homes, uncertainties and trade-offs occur in the course of everyday work.

Assessment of Outcomes in Patients with Heart Failure and End-Stage Kidney Disease after Fluid Resuscitation for Sepsis and Septic Shock.

Background: Sepsis fluid resuscitation is controversial, especially for patients with volume overload risk. The Surviving Sepsis Campaign recommends a 30-mL/kg crystalloid fluid bolus for patients with sepsis-induced hypoperfusion. Criticism of this approach includes excessive fluid resuscitation in certain patients.

Validating care and treatment scenarios for measuring decisional conflict regarding future care preferences among older adults.

Objective: Decisional conflict is used increasingly as an outcome measure in advance care planning (ACP) studies. When the Decisional Conflict Scale (DCS) is used in anticipatory decision-making contexts, the scale is typically tethered to hypothetical scenarios. This study reports preliminary validation data for hypothetical scenarios relating to life-sustaining treatments and care utilisation to inform their broader use in ACP studies.

A phase 3, randomized, placebo-controlled, trial to evaluate the efficacy and safety of bedtime sublingual cyclobenzaprine (TNX-102 SL) in military-related posttraumatic stress disorder.

Sleep disturbances in posttraumatic stress disorder (PTSD) are a potential target for improving PTSD severity with pharmacotherapy. TNX-102 SL is a bedtime sublingual formulation of cyclobenzaprine with potent binding and antagonist activity at 5-HT, α-adrenergic, H histaminergic, and M muscarinic receptors, which play roles in the pharmacological management of sleep disturbances. This Phase 3 trial evaluated the efficacy and safety of TNX-102 SL in patients with military-related PTSD.

Engaging early experiential learners to improve quality at a VA medical center - a cross-sectional analysis.

Purpose: An innovative population health-based introductory pharmacy practice experience (IPPE) leveraging a Veterans Affairs (VA) and college of pharmacy collaboration was implemented in fall 2019. All second-year pharmacy students from the college actively engage in the evaluation of the medical records of veterans identified using population health management tools as needing additional care or experiencing a gap in care. This study examines the clinical impact of the experience on the care of patients at the partnering VA medical center.

Feasibility of conducting qualitative research with persons living with dementia and their caregivers during a home-delivered meals pilot trial.

Background: Among older adults, food insecurity is associated with poor health status and health outcomes; people living with dementia (PLWD) are at increased risk for insecurity. Approaches to addressing food insecurity among homebound older adults include two modes of home-delivered meals: (1) meals delivered daily to participants' homes by a volunteer or paid driver who socializes with the client or (2) frozen meals that are mailed to participants' homes. Research has not examined benefits of these meals for PLWD or their caregivers nor compared the effectiveness of these two approaches in reducing food insecurity.

Identifying individuals with undiagnosed post-traumatic stress disorder in a large United States civilian population - a machine learning approach.

Background: The proportion of patients with post-traumatic stress disorder (PTSD) that remain undiagnosed may be substantial. Without an accurate diagnosis, these patients may lack PTSD-targeted treatments and experience adverse health outcomes. This study used a machine learning approach to identify and describe civilian patients likely to have undiagnosed PTSD in the US commercial population.

A pilot evaluation of sexual and gender minority identity measures in a treatment-engaged military veteran sample.

Sexual and gender minority (SGM) military veterans have endured a history of discriminatory policies and hetero- and cis-sexist-related military culture that can negatively impact identity and mental health. The present pilot evaluation examined measure characteristics of the Lesbian, Gay, and Bisexual Identity Scale (LGBIS) and lesbian, gay, and bisexual positive identity measure (LGB-PIM) in a clinical sample of SGM military veterans in order to assess the potential use of these instruments in understanding identity and mental health in the context of program implementation. A cross-sectional pilot survey of 83 SGM veterans was conducted in 10 veterans affairs sites.

The Economic Burden of Posttraumatic Stress Disorder in the United States From a Societal Perspective.

To estimate the economic burden of posttraumatic stress disorder (PTSD) in the United States civilian and military populations from a societal perspective. A prevalence-based and human capital approach was used to estimate the total excess costs of PTSD in 2018 from insurance claims data, academic literature, and governmental publications. Excess direct health care costs (pharmacy, medical), direct non-health care costs (research and training, substance use, psychotherapy, homelessness, disability), and indirect costs (unemployment, productivity loss, caregiving, premature mortality) associated with PTSD were compared between adults with PTSD and adults without PTSD, or the general population if information was not available for adults without PTSD.

Moderation Effects of Substance Use on Physical and Mental Well-Being in Adults.

Background: Each year about one in five adults experiences mental illness. Although the independent physical and mental health consequences of alcohol misuse and cigarette smoking are well documented, little is known on how substance use moderates the relationship between physical and mental well-being.

Aim: The purpose of this study was to examine whether substance use moderates the relationship between physical activity and mental health in adults.

The Spiritual Experience of Dementia From the Health Care Provider Perspective: Implications for Intervention.

Background And Objectives: Spiritual care aims to counter negative outcomes from spiritual distress and is beneficial to persons living with dementia. Such care needs dementia-appropriate customization. We explored the salient spiritual needs in dementia to inform future intervention development.

Depressive Symptoms and Risk of Stroke in a National Cohort of Black and White Participants From REGARDS.

Objective: The purpose of this study was to examine depressive symptoms as a risk factor for incident stroke and determine whether depressive symptomatology was differentially predictive of stroke among Black and White participants.

Methods: The study comprised 9,529 Black and 14,516 White stroke-free participants, aged 45 and older, enrolled in the REasons for Geographic and Racial Differences in Stroke (2003-2007). Incident stroke was the first occurrence of stroke.

Virtual external implementation facilitation: successful methods for remotely engaging groups in quality improvement.

Background: Relatively little guidance exists on how to use virtual implementation facilitation to successfully implement evidence-based practices and innovations into clinical programs. Yet virtual methods are increasingly common. They have potentially wider reach, emergent public health situations necessitate their use, and restrictions on resources can make them more attractive.

Understanding and Addressing the Unique Challenges and Conditions of the Veteran: Improving Sleep and Well-Being.

Veterans are those who have served our country in one of the branches of armed forces or military reserves. The Veterans Health Administration is the largest integrated health system in the nation, providing health care services and latest research for veterans. Non-Veteran Health Administration primary care clinicians, who also take care of veterans, deserve to have an understanding of the unique challenges and conditions these individuals face and the resources that are available to improve sleep health and well-being of all veterans.

Enhancing sleep quality for nursing home residents with dementia: a pragmatic randomized controlled trial of an evidence-based frontline huddling program.

Background: Disturbed sleep places older adults at higher risk for frailty, morbidity, and even mortality. Yet, nursing home routines frequently disturb residents' sleep through use of noise, light, or efforts to reduce incontinence. Nursing home residents with Alzheimer's disease and or related dementias-almost two-thirds of long-stay nursing home residents-are likely to be particularly affected by sleep disturbance.

Huddles and their effectiveness at the frontlines of clinical care: a scoping review.

Background: Brief, stand-up meetings known as huddles may improve clinical care, but knowledge about huddle implementation and effectiveness at the frontlines is fragmented and setting specific. This work provides a comprehensive overview of huddles used in diverse health care settings, examines the empirical support for huddle effectiveness, and identifies knowledge gaps and opportunities for future research.

Methods: A scoping review was completed by searching the databases PubMed, EBSCOhost, ProQuest, and OvidSP for studies published in English from inception to May 31, 2019.

Adapting Strategies for Optimal Intervention Implementation in Nursing Homes: A Formative Evaluation.

Background And Objectives: Nursing homes pose unique challenges for implementation of research and quality improvement (QI). We previously demonstrated successful implementation of a nursing home-led intervention to improve relationships between frontline staff and residents in 6 U.S.

Use of huddles among frontline staff in clinical settings: a scoping review protocol.

Objective: This scoping review aims to provide an overview of the current evidence on huddles in healthcare settings involving frontline staff.

Introduction: Team-based models are gaining prominence as the preferred method for delivering coordinated, cost-effective, high-quality health care. Huddles are a powerful method for building relationships among frontline staff members.