Medication prescribing and administration in nursing homes

Objective: to examine the key determinants of pharmaco-epidemiology in Australian nursing homes. Design: a cross-sectional survey of medication use in 998 residents in 15 nursing homes in Southern Queensland and Northern New South Wales, Results: the total, laxative, digoxin/diuretic, benzodiazepine and psycholeptic medication prescribed and administered to residents of nursing homes was affected to differing extents by age and gender, the nursing home, resident functional disability and medical practitioner. Resident Classification Instrument (RCI) category and nursing home were the dominant determinants for prescribing and administration of the total drugs, laxative, benzodiazepine and psycholeptic medications. In contrast, the resident use of digoxin and/or diuretics was dependent on the resident age and on the functional disability (RCI category) of the resident but not medical practitioner or nursing home. Approximately 30% of medications were prescribed on a pro re nata (p.r.n.) basis and administered at the discretion of registered nurses. Conclusion: nursing home culture is a major determinant of the variability in medication use between residents, particularly for those medications often prescribed for p.r.n. use. The nursing home does not account for variation in the use of digoxin and/or diuretics which are prescribed on a non-discretionary basis.

Family advocacy roles and highly dependent residents in nursing homes

A developing critique has questioned the practical utility of user rights policy initiatives for highly dependent residents of nursing homes. This paper seeks to extend this critique to the advocacy roles that families have been accorded within the policy initiatives, The discussion is based on a qualitative research study of family participation in six aged care units, The paper argues that the capacity of families to act as advocates for highly dependent nursing home residents is is limited by the their weak position within the organisations and the complexity of their relations with staff It questions both the applicability and the appropriateness of rights models which do not take sufficient account of the structure and meaning of care.

Explicit evidence-based prescribing criteria - an important step in achieving quality therapeutics in nursing homes

Reaction between 5-(4-amino-2-thiabutyl)-5-methyl-3,7-dithianonane-1, 9-diamine (N3S3) and 5- methyl-2,2-bipyridine-5-carbaldehyde and subsequent reduction of the resulting imine with sodium borohydride results in a potentially ditopic ligand (L). Treatment of L with one equivalent of an iron( II) salt led to the monoprotonated complex [Fe(HL)](3+), isolated as the hexafluorophosphate salt. The presence of characteristic bands for the tris( bipyridyl) iron( II) chromophore in the UV/vis spectrum indicated that the iron( II) atom is coordinated octahedrally by the three bipyridyl (bipy) groups. The [Fe( bipy) 3] moiety encloses a cavity composed of the N3S3 portion of the ditopic ligand. The mononuclear and monomeric nature of the complex [Fe(HL)](3+) has been established also by accurate mass analysis. [Fe(HL)](3+) displays reduced stability to base compared with the complex [Fe(bipy)(3)](2+). In aqueous solution [Fe(HL)](3+) exhibits irreversible electrochemical behaviour with an oxidation wave ca. 60 mV to more positive potential than [Fe(bipy)(3)](2+). Investigations of the interaction of [Fe(L)](2+) with copper( II), iron( II), and mercury( II) using mass spectroscopic and potentiometric methods suggested that where complexation occurred, fewer than six of the N3S3 cavity donors were involved. The high affinity of the complex [Fe(L)](2+) for protons is one reason suggested to contribute to the reluctance to coordinate a second metal ion.

New graptolite faunas from the Llandovery, lower Silurian of the Graveyard Creek Subprovince, Broken River region, Queensland, Australia

A continuous biostratigraphic sequence has been established, possibly from as low as the sedgwickii Biozone but certainly throughout the Telychian Stage (?sedgwickii, turriculatus, ?crispus, griestoniensis and crenulata biozones). Thirty-three taxa have been recorded, including the new genus Wandograptus wandovalensis sp. nov., the new species Pseudostreptograptus queenslandensis and the new subspecies Dictyonema paululum australis and Stimulograptus sedwickii loydelli. A number of species have been recorded from Australia for the first time: Dictyonema cf. geniculatum Bulman, Petalolithus kurcki (Rickards), Pristiograptus initialis (Kirste), Monoclimacis directa Zalasciewicz, Monograptus aff. distans (Portlock), Monograptus sartorius Törnquist, and Torquigraptus pragensis (Bouček). Nine forms have been left under open nomenclature. The type section for the Poley Cow Formation yields a griestoniensis biozone fauna close to the top, and this level can be correlated with a griestoniensis Biozone fauna in the Broken River crossing section, again just below the top of the formation. Further north, griestoniensis Biozone faunas have also been recognized, beyond Diggers Creek, and in the Quinton Formation at Top Hut, enabling a reliable time plane throughout the region. At Top Hut, the highest graptolitic strata yield a crenulata Biozone fauna; and stratigraphically lower sequences, referable to the ?sedgwickii, turriculatus and ?crispus biozones, have been established on the Broken River section. It is likely that a full Telychian (Upper Llandovery) sequence occurs in the Poley Cow and Quinton formations enabling accurate correlation with other parts of the world.

Communicating with the community about grieving: A description and review of the foundations of a broken leg analogy of grieving

With loss permeating the lives of all people throughout the entire life span and its potential for serious long-term deleterious effects, providing effective care for those experiencing situations of loss would be an important element of any preventive community-based mental health promotion approach. The low use of mental health services by those confronted with loss, and the lack of such services in many areas, makes it imperative to enhance the competency of the broader community to provide appropriate care during times of loss. Contributory to such care is a sound knowledge of the literature concerning loss and grieving. The broken leg analogy of grief presented in this article integrates the traditional and emerging grief theories and empirical evidence into an analogy of grieving that can be easily communicated to the general community, is relevant to many losses. and vet upholds the differing positions concerning grieving held by various schools of psychiatric thought.

Factors influencing PRN medication use in nursing homes

Objective: To identify determinants of PRN ( as needed) drug use in nursing homes. Decisions about the use of these medications are made expressly by nursing home staff when general medical practitioners (GPs) prescribe medications for PRN use. Method: Cross-sectional drug use data were collected during a 7-day window from 13 Australian nursing homes. Information was collected on the size, staffing-mix, number of visiting GPs, number of medication rounds, and mortality rates in each nursing home. Resident specific measures collected included age, gender, length of stay, recent hospitalisation and care needs. Main outcome measures: The number of PRN orders prescribed per resident and the number of PRN doses given per week averaged over the number of PRN medications given at all in the seven-day period. Results: Approximately 35% of medications were prescribed for PRN use. Higher PRN use was found for residents with the lower care needs, recent hospitalisation and more frequent doses of regularly scheduled medications. With increasing length of stay, PRN medication orders initially increased then declined but the number of doses given declined from admission. While some resident-specific characteristics did influence PRN drug use, the key determinant for PRN medication orders was the specific nursing home in which a resident lived. Resident age and gender were not determinants of PRN drug use. Conclusion: The determinants of PRN drug use suggest that interventions to optimize PRN medications should target the care of individual residents, prescribing and the nursing home processes and policies that govern PRN drug use.

Mixed order parameters, accidental nodes and broken time reversal symmetry in organic superconductors: a group theoretical analysis

We present a group theoretical analysis of several classes of organic superconductor. We predict that highly frustrated organic superconductors, such as K-(ET)(2)Cu-2(CN)(3) (where ET is BEDT-TTF, bis(ethylenedithio) tetrathiafulvalene) and beta'-[Pd(dmit)(2)](2)X, undergo two superconducting phase transitions, the first from the normal state to a d-wave superconductor and the second to a d + id state. We show that the monoclinic distortion of K-(ET)(2)Cu(NCS)(2) means that the symmetry of its superconducting order parameter is different from that of orthorhombic-K-(ET)(2)Cu[N(CN)(2)] Br. We propose that beta'' and theta phase organic superconductors have d(xy) + s order parameters.