Clinical cohort studies suggest that mild cognitive impairment (MCI) is common in early Parkinson's disease (PD). The objectives of this paper were to describe cognitive function in a large clinical ...trial of early treated PD patients at baseline and over time using two brief cognitive screening tests.
In total 1741 participants were enrolled in the NINDS Exploratory Trials in Parkinson's disease (NET-PD) Long-term Study-1 (LS-1). The Symbol Digit Modalities Test (SDMT) was collected annually. The SCales for Outcomes in PArkinson's disease-COGnition (SCOPA-COG) was collected at baseline and at year 5. The trial was stopped early based on a planned interim analysis after half the cohort completed 5 years of follow-up. The median length of follow-up was 4 years (range 3–6 years). Predictors of cognitive change were examined using cross sectional (baseline) and longitudinal multivariable linear regression.
The mean (SD) change from baseline to 5 years was −1.9 (5.1) for the SCOPA-COG and −2.1 (11.1) for the SDMT. Age and baseline UPDRS motor scores were associated with a more rapid decline in SDMT scores and 5 year SCOPA-COG scores. Male gender was associated with more rapid decline in SDMT. Self-reported income was a novel predictor of baseline cognitive function, even adjusted for educational status, although not significantly associated with change over time.
This large prospective cohort study demonstrated mild cognitive decline in early treated Parkinson's disease. The study identified income level as a novel predictor of cognitive function.
•Cognitive function was measured over 3–6 years in 1741 PD participants.•Participants experienced mild decline (−1.9 points over 5 years in the SCOPA-COG).•Age, male gender and baseline motor UPDRS were associated with more rapid decline.•Self-reported income predicted baseline cognitive function, adjusted for education.
Objectives
New models for the workforce are required in long-term care (LTC) homes, as was made evident during the Coronavirus Disease 2019 (COVID-19) pandemic. Nurse Practitioner (NP)-led models of ...care represent an effective solution. This study explored NPs’ roles in supporting LTC homes as changes in directives, policies, and recommendations related to COVID-19 were introduced.
Design
Qualitative exploratory study.
Context
Thirteen NPs working in LTC homes in Ontario, Canada.
Methods
Semi-structured interviews were conducted in March/April 2021. A five-step inductive thematic analysis was applied.
Findings
Analysis generated four themes: leading the COVID-19 vaccine rollout; promoting staff wellbeing related to COVID-19 fatigue; addressing complexities of new admissions; and negotiating evolving collaborative relationships.
Conclusions
Nurse practitioners were instrumental in supporting LTC homes through COVID-19 regulatory changes producing unintended consequences. The NPs’ leadership in transforming care is equally essential in LTC homes as in other established healthcare settings, such as primary and acute care.
The aims of this study were to investigate the point prevalence, and associated independent factors, for foot disease (ulcers, infections and ischaemia) in a representative hospitalised population. ...We included 733 (83%) of 883 eligible adult inpatients across five representative Australian hospitals on one day. We collected an extensive range of self‐reported characteristics from participants. We examined all participants to clinically diagnose foot disease (ulcers, infections and ischaemia) and amputation procedures. Overall, 72 participants (9·8%) 95% confidence interval (CI):7·2–11·3% had foot disease. Foot ulcers, in 49 participants (6·7%), were independently associated with peripheral neuropathy, peripheral arterial disease, previous foot ulcers, trauma and past surgeon treatment (P < 0·05). Foot infections, in 24 (3·3%), were independently associated with previous foot ulcers, trauma and past surgeon treatment (P < 0·01). Ischaemia, in 33 (4·5%), was independently associated with older age, smokers and past surgeon treatment (P < 0·01). Amputation procedures, in 14 (1·9%), were independently associated with foot infections (P < 0·01). We found that one in every ten inpatients had foot disease, and less than half of those had diabetes. After adjusting for diabetes, factors linked with foot disease were similar to those identified in diabetes‐related literature. The overall inpatient foot disease burden is similar in size to well‐known medical conditions and should receive similar attention.
We investigated the prevalence and factors independently associated with foot complications in a representative inpatient population (adults admitted for any reason with and without diabetes). We ...analysed data from the Foot disease in inpatients study, a sample of 733 representative inpatients. Previous amputation, previous foot ulceration, peripheral arterial disease (PAD), peripheral neuropathy (PN), and foot deformity were the foot complications assessed. Sociodemographic, medical, and foot treatment history were collected. Overall, 46.0% had a foot complication with 23.9% having multiple; those with diabetes had higher prevalence of foot complications than those without diabetes (p<0.01). Previous amputation (4.1%) was independently associated with previous foot ulceration, foot deformity, cerebrovascular accident, and past surgeon treatment (p<0.01). Previous foot ulceration (9.8%) was associated with PN, PAD, past podiatry, and past nurse treatment (p<0.02). PAD (21.0%) was associated with older age, males, indigenous people, cancer, PN, and past surgeon treatment (p<0.02). PN (22.0%) was associated with older age, diabetes, mobility impairment, and PAD (p<0.05). Foot deformity (22.4%) was associated with older age, mobility impairment, past podiatry treatment, and PN (p<0.01). Nearly half of all inpatients had a foot complication. Those with foot complications were older, male, indigenous, had diabetes, cerebrovascular accident, mobility impairment, and other foot complications or past foot treatment.
The questions of the reception of and role of Lesbian, Gay, Bisexual, Transgender, Queer, Plus (LGBTQ+) persons in the Christian faith and Christian church have increasingly called for churches and ... denominations to discern a position on membership, leadership, and participation in the sacraments. Individuals, families, congregations, and denominations are impacted by the differences in perspective, policy, and practice of affirming, including, or excluding LGBTQ+ persons. This article reports on a qualitative research study of 97 interviews in 20 congregations across three denominations exploring difficult conversations, decisions, and the impact of those decisions. The challenges and opportunities in both conversations and decisions are nested in faith perspectives. One significant finding is the role of individual and corporate faith in the resilience essential to both survival and growth.
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The protection and management of grasslands is a priority to conserve biodiversity, particularly in fragmented landscapes subject to human‐induced disturbance. We examined the success of salvage and ...reinstatement of multiple 90 m² slabs of modified temperate grassland in a pipeline construction corridor in south‐eastern Australia and compared it with a reinstated topsoil treatment (i.e. standard pipeline reinstatement practice) and an undisturbed control. Thirty‐six plots (each 9 × 10 m) representing the three treatments were monitored across six locations, pre‐ and postconstruction every 3 months for 2 years. We sampled 18 vegetation/habitat variables to examine the effect of treatments over time. Introduced grass cover was consistently higher than native grasses for both treatments, and the cover of introduced grasses increased over time in both treatments. Conversely, control plots had considerably higher native grass cover than the slab and reinstated topsoil treatments. Native species richness was not negatively affected by the slab reinstatement process. Our results suggest that in this instance, slab replacement was an ineffective way to reinstate native grasslands, as it appeared to confer minimal benefit when compared to the standard practice of reinstating topsoil. This was most likely due to the high degree of disturbance to slabs during the reinstatement process.
Abstract Introduction Clinical cohort studies suggest that mild cognitive impairment (MCI) is common in early Parkinson's disease (PD). The objectives of this paper were to describe cognitive ...function in a large clinical trial of early treated PD patients at baseline and over time using two brief cognitive screening tests. Methods In total 1741 participants were enrolled in the NINDS Exploratory Trials in Parkinson's disease (NET-PD) Long-term Study-1 (LS-1). The Symbol Digit Modalities Test (SDMT) was collected annually. The SCales for Outcomes in PArkinson's disease-COGnition (SCOPA-COG) was collected at baseline and at year 5. The trial was stopped early based on a planned interim analysis after half the cohort completed 5 years of follow-up. The median length of follow-up was 4 years (range 3–6 years). Predictors of cognitive change were examined using cross sectional (baseline) and longitudinal multivariable linear regression. Results The mean (SD) change from baseline to 5 years was −1.9 (5.1) for the SCOPA-COG and −2.1 (11.1) for the SDMT. Age and baseline UPDRS motor scores were associated with a more rapid decline in SDMT scores and 5 year SCOPA-COG scores. Male gender was associated with more rapid decline in SDMT. Self-reported income was a novel predictor of baseline cognitive function, even adjusted for educational status, although not significantly associated with change over time. Conclusion This large prospective cohort study demonstrated mild cognitive decline in early treated Parkinson's disease. The study identified income level as a novel predictor of cognitive function.
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