ABSTRACT Background The Canadian CT Head Rule (CCTHR) is validated in adults who hit their head and experience loss of consciousness, amnesia, or disorientation. There is less evidence to guide brain imaging when the fall history is unclear. Methods This is a secondary analysis of a prospective study on adults aged ≥ 65 who presented to 11 emergency departments across Canada and the United States after a ground level fall. We reported the prevalence of adjudicated clinically important intracranial bleeding within 42 days of the emergency department visit among (a) patients who hit their head and met the application criteria for the CCTHR (experienced loss of consciousness, amnesia, or disorientation), (b) patients who hit their head and did not meet the CCTHR application criteria, (c) patients with an unclear history of the CCTHR application criteria, (d) patients with an unclear head injury history, and (e) patients with no head injury. Results 4303 participants were analyzed. The prevalence of clinically important intracranial bleeding in the subgroups was (a) patients who fulfilled the CCTHR application criteria, 7.7% (54/703, 95% confidence interval [CI]: 5.9%–9.9%), (b) patients who hit their head but did not meet CCTHR application criteria, 2.5% (30/1204, 95% CI: 1.8%–3.5%), (c) patients with head injury but an unclear history of the CCTHR application criteria, 7.6% (19/251, 95% CI: 4.9%–12.0%), (d) patients with an unclear history of head injury, 4.6% (23/502, 95% CI: 3.2%–6.8%), and (e) patients who did not hit their head, 0.8% (13/1643, 95% CI: 0.5%–1.3%). Conclusions Older adults presenting after a fall with an unclear history of head injury, or an unclear history of head injury‐associated loss of consciousness, amnesia, or disorientation have an elevated risk for clinically important intracranial bleeding that merits emergency brain imaging.
ABSTRACT Social drivers of health (SDOH) impact health outcomes across the lifespan, with distinct effects on the health and well‐being of older adults. SDOH contribute to outcomes of particular importance to older adults, including physical and cognitive functioning and aging in place, highlighting the critical importance of addressing SDOH as part of comprehensive, patient‐centered geriatrics care. Yet, there is limited guidance on best practices for the integration of SDOH into healthcare, particularly in subspecialty clinical settings such as geriatrics. Existing geriatrics frameworks, including Age‐Friendly Health Systems and the Geriatrics 5Ms, provide an opportunity to incorporate SDOH concepts, as they are naturally aligned with models of social and medical care integration. Building on existing frameworks, we propose a novel conceptual model that integrates SDOH across the geriatrics care continuum, including practical guidance for geriatrics healthcare professionals to proactively incorporate SDOH into Age‐Friendly care.
ABSTRACT Aim The aim of this study was to explore the motivations, experiences and strategies adopted by adult vegans, in order to identify ways to support others to adopt plant‐based eating dietary patterns. Methods An interpretive approach was used to conduct semi‐structured, qualitative interviews with 18 Australian vegan adults (11 female and 7 male). Participants were eligible if they had followed a vegan diet for 12 months or more. Interviews were interpreted using thematic analysis. Results Motivations for adopting a vegan diet are driven by a reinforcing interplay between ethical, environmental, health and personal concerns. Transitioning to a vegan diet presents practical challenges. However, these are perceived as being relatively easy to overcome. Long‐term adherence to a vegan diet is challenged by interpersonal relationships, cultural and social pressures. Conclusions Nutrition interventions supporting individuals to adopt plant‐based dietary patterns are more likely to be successful if compelling benefits are articulated and reinforced. Quality information about overcoming practical challenges is required. However, long‐term adherence is more likely if psychosocial resilience is supported.
ABSTRACT Background There is promising evidence for the adaptation of online mindfulness interventions for parent carers of individuals with intellectual and developmental disabilities by including supplementary peer support sessions. However, there remain questions about wider implementation beyond the research setting and the inclusion of more diverse populations of family caregivers, including adult siblings and family carers who less typically receive support and are often under‐represented in research. Method One hundred and one family carers ( n = 58 parents, n = 43 adult siblings) were provided with access to Be Mindful (an online mindfulness intervention) with additional telephone peer mentor support. Participants were asked to complete baseline and follow‐up questionnaires before and after the intervention in a pre‐post pre‐experimental design, and engagement with the intervention and peer support was examined. Results Recruitment was successful in targeting more diverse groups, including adult siblings. Intervention completion was low overall ( n = 37). Parent and sibling carers made differing levels of progress with the intervention and peer support calls, although 81.8% of those who completed the intervention before the end of the project had also received all three support calls. Preliminary follow‐up data, though with low retention, indicated improvements in psychological wellbeing for family carers over time. Conclusions The intervention and additional telephone‐guided support were received well by family carers of people with intellectual and developmental disabilities, although further work is needed to determine the feasibility of future implementation.
ABSTRACT Secondary bile acids (BAs) are metabolites produced by the gut microbiota and shown to impact digestive functions, at least in part through the enteric nervous system (ENS). In the ENS, enteric neurons express the BA receptor Takeda G protein‐coupled receptor 5 (TGR5), making them potential direct cellular targets of secondary BAs, although their effects on enteric neuronal functions remain poorly understood. Enteric neuronal activity and connectivity form the basis of the regulatory control exerted by the ENS on gut functions. Yet, the influence of microbiota‐derived metabolites, such as secondary BAs, on enteric neuron connectivity and synaptic activity remains largely unexplored. To address this question, we studied the effects of secondary BAs on neuronal connectivity using a model of rat primary culture of enteric neurons. We found that exposure to deoxycholic acid (DCA) increased the expression of key presynaptic proteins, synapsin‐1 and synaptophysin, and enhanced synaptic density in enteric neurons. Moreover, DCA enhanced synaptic activity by increasing synaptic vesicle exocytosis upon KCl depolarisation, potentially through amplified phosphorylation of synapsin‐1 at the Ser62–67 sites. In addition, we found that DCA modulated the intracellular Ca 2+ response induced by acetylcholine, a major excitatory neurotransmitter in enteric neurons, through a mechanism mediated by the TGR5 receptor. Overall, this study identifies DCA as a microbiota‐derived compound capable of reshaping the enteric neuronal functional network. These findings highlight the potential of bacterial metabolites like DCA to link the microbiome with modulation of enteric neuronal activity and connectivity, supporting the relevance of secondary BAs in digestive physiology and their possible roles in gastrointestinal disorders.
ABSTRACT Introduction and Objectives Dermocosmetics have proven their benefit in acne management. However, only very few studies investigated their efficacy kinetics. This study assessed the efficacy kinetics of a dermocosmetic cream (DC) containing Punica granatum Pericarp extract, Salicylic acid, Niacinamide, Zinc gluconate, and Aqua Posae Filiformis in subjects with acne. Material and Methods 16 subjects (14 women, 2 men; mean age 29.4 ± 7.7 years; phototype II and III) with mild to moderate acne participated in a randomized, intra‐individual, split‐face study for 15 days. Hemi‐faces randomly received DC or remained untreated. Assessments included lesion counts, acne severity, and local tolerance; subjects also rated the perceived benefit of the DC. Efficacy was also evaluated using standardized multi‐modality full‐face imaging and a mobile connected imaging system. Results The inflammatory lesion count significantly ( p ≤ 0.05) decreased with DC at Day 8 and Day 15; a significant decrease of the non‐inflammatory lesion count was observed at Day 15 ( p < 0.01). The total lesion count had significantly ( p ≤ 0.05) decreased with DC at Day 8 and Day 15. Between‐side differences were significant (all p ≤ 0.05) for all lesion types at D15. Local tolerance was good. Most subjects considered that their skin appearance and the visibility of acne lesions had improved. Conclusion This exploratory study provides strong evidence on the efficacy kinetics of a DC cream in acne management in subjects with fair skin tones. It shows that early, daily and specific treatment with a targeted DC significantly improves all acne lesions type, as well as acne severity as soon as 15 days.
ABSTRACT Introduction and Objectives Acne is a chronic inflammatory skin disease that can cause acne‐induced hyperpigmentation (AIH), especially in subjects with phototype IV and above (hereafter darker skin tones). This study evaluated the efficcay kinetics of a dermocosmetic cream (DC cream) in adults with darker skin phototypes and mild to moderate acne. Material and Methods An intra‐individual, randomized, split face, single centre 57 day‐study was conducted in 16 adults with dark skin tones (phototype IV, V and VI) and mild‐to‐moderate acne. DC cream was applied 2/day on one hemiface. Assessments included total, inflammatory and non‐inflammatory lesion counts, AIH intensity and darkness severity, PAHPI score and local tolerance. Subjects rated the perceived benefits of DC cream. Results 75% of subjects were women, mean age was 26.8 ± 6.7 years; 50% had phototype IV, 31.2% phototype V, and 18.8% phototype VI. 68.8% had mild (GEA 2) and 31.2% moderate (GEA 3) acne. The total lesion count significantly decreased from Day 5 (−17.1%; p < 0.05) until Day 57 (−44.9%; p < 0.01) on the DC‐treated side versus − 28.4% on the untreated side at Day 57. Inflammatory and non‐inflammatory lesion counts significantly ( p < 0.01) decreased from Day 11 to Day 57 with DC cream. AIH marks intensity significantly ( p < 0.01) decreased starting Day 11 until Day 57; as did the PAHPI score (−22.7%) after 57 days with hemi‐face differences being significantly ( p < 0.05) in favor of DC cream. AIH darkness severity significantly improved with DC cream, with no changes on the untreated side. DC cream was highly appreciated and very well tolerated by the subjects. Conclusions This clinical study provides strong evidence on the efficacy kinetics of a DC cream in acne management in subjects with dark skin tones. It shows that early, daily and specific treatment with a targeted DC significantly improves all acne lesions type, as well as AIH marks as soon as 11 days of use, in addition to exhibiting high patient satisfaction rates and excellent tolerability.
ABSTRACT Aims To summarise current research that defines cardiopulmonary resuscitation and to provide a succinct conceptual definition of cardiopulmonary resuscitation. Design Scoping review using JBI guidelines to develop the study protocol. Methods The most recent (2024) research papers on cardiopulmonary resuscitation were evaluated for inclusion. Individual definitions of cardiopulmonary resuscitation extracted from 25 papers were summarised and then analysed to conceptualise a single definition for cardiopulmonary resuscitation. Data Sources CINAHL, Medline and Scopus databases were evaluated for inclusion. Results Definitions of cardiopulmonary resuscitation focused on interventions, mainly chest compressions and ventilation. Defibrillation was inconsistently included. There was less emphasis on criteria for initiating cardiopulmonary resuscitation and desired outcomes. Conclusion This scoping review found limited consensus between definitions of cardiopulmonary resuscitation. Analysis of the range of perspectives found in the review enabled the researchers to propose definitions in three areas: cardiopulmonary resuscitation, basic life support and advanced life support. Implications for the Profession and Patient Care Nurses working in hospitals and responding to cardiac arrests are guided by Advanced Resuscitation Plans and Do Not Resuscitate orders. In turn, these documents should communicate a clear definition of cardiopulmonary resuscitation in policies, procedures and standards. This is important for clinical nurses to ensure patients' consent for cardiopulmonary resuscitation and defibrillation is informed. Impact Currently cardiopulmonary resuscitation is inconsistently defined. Cardiopulmonary resuscitation includes compressions and ventilation. A standardised definition of cardiopulmonary resuscitation supports professional nursing practice and has wider implications for patient consent and research practice. Reporting Method This scoping review adheres to and is reported according to PRISMA‐ScR. Patient or Public Contribution No patient or public contribution.