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Abstract Health and social care professionals meet ethical dilemmas constantly. Being able to make clinical decisions based on sound ethical principles is central to compassionate care and should underpin all the topics covered in this book. The decline in health, and wellbeing that often follows a fragility fracture threatens wellbeing, especially when we have limited capacity or and diminished power over their own lives and decisions. These challenges make a person vulnerable because they may be unable to take care of themselves and/or to protect themselves from loss of dignity, harm, or exploitation. The aim of this chapter is to provide practitioners with information about ethical principles and dilemmas in caring for patients with fragility fractures so that they can provide ethically sensitive care, including at the end of life.

Abstract Older people with fragility fractures are a diverse group, and their care needs are complex. Although some have comparatively few health problems, many have several interconnected illnesses alongside psychological and social problems, requiring a range of interventions. The primary focus of care is to meet these needs throughout the care pathway and ensure that they receive the same high standard of specialist care within orthopaedic services as they would within a setting specialising in the care of older people. The central philosophy is holistic care with a person-centred approach that brings the various aspects of specialist care together. ‘Geriatric syndrome’ is a term often used to refer to common health problems in older adults that do not fit into distinct organ-specific disease categories and that have multifactorial causes. This includes frailty, cognitive impairment, delirium, incontinence, malnutrition, falls, gait disorders, pressure ulcers, sleep disorders, sensory deficits, fatigue and dizziness. These are common in older adults and can have a major impact on quality of life (QoL) and disability. Identifying problems specific to ageing so that interventions can be tailored to meet the needs of patients with fragility fractures needs a detailed and comprehensive assessment that can help clinicians manage these conditions and prevent or delay their complications. This needs to be a collaboration of the whole interdisciplinary team so that the skills of each team member can contribute to building a picture of the patient’s needs. Nursing assessment is a significant part of this whole. A term often used in relation to the assessment of older people with medical needs is comprehensive geriatric assessment (CGA). The aim of this chapter is to explore the nature of comprehensive geriatric assessment (CGA) for the patient with a fragility fracture and discuss how this can be applied to nursing assessment and care.

Higher education for health care professionals faces numerous challenges. It is important to develop and apply methods supporting education, especially the practical skills. This scoping review aimed to explore the activities and learning outcomes of digital technology in practical skills teaching and learning in higher education for the social and health professions. Scoping review recommendations and the PRISMA-ScR checklist were applied. Randomized controlled trials published between 2016 and 2021 involving students in higher education who were taking courses in the social sciences and health care and reported interventions with digital technology activities and practices in practical teaching and learning were included. The CINAHL Plus, PubMed, Scopus, ERIC, and Sociological Abstracts/Social Services Abstracts databases were searched. Teaching methods were blended, e-learning or other online-based, and digital simulation-based activities. Teaching and learning environments, methods, resources, and activity characteristics varied, making a summary difficult. Interventions were developed in a face-to-face format prior to digitalization. The outcomes were measured at the knowledge level, not at the performance level. One-third of the studies showed a significant improvement in practical skills in the intervention group in comparison to the control conditions. The use of digital technology in the learning and teaching process have potential to develop of students' skills, knowledge, motivation, and attitudes. The pedagogy of technology use is decisive. The development of new digital methods for teaching and learning practical skills requires the engagement of students and teachers, in addition the researchers.

This study aimed to determine the predictors of spiritual wellbeing of non-terminal stage cancer patients hospitalized in oncology units in Lithuania. An exploratory cross-sectional study design was employed. During structured face-to-face interviews, 226 cancer patients hospitalized in oncology units responded about their spiritual wellbeing, perception of happiness, satisfaction with life, pain intensity, levels of education and physical functioning, and length of inpatient stay. A set of standardized tools were used: spiritual wellbeing scale SHALOM, brief multidimensional life satisfaction scale, Oxford Happiness Questionnaire, Barthel Index questionnaire, and verbal pain intensity scale. Additionally, social- and health-related factors were included in data analyses. Structural equation modeling was adapted for a comprehensive assessment of the mediating effect of spiritual wellbeing on the relationship between different health- and value-related factors. The overall fit of the structural model was generally good: 2 (29) = 66.94 (χ2/df = 2.31), CFI = 0.94, RMSEA = 0.08, and SRMR = 0.06. Data were analyzed using the Statistical Package for Social Sciences (IBM SPSS Statistics) version 24.0 and Mplus version 8.2. Level of happiness, life satisfaction, and spiritual wellbeing scored in the moderate upper range. The communal domain of spiritual wellbeing rated with the highest mean score and transcendental domain with the lowest score. Education (b = 0.208, p = 0.004), physical functioning (b = 0.171, p = 0.025), and hospital duration (b = − 0.240, p = 0.001) were significant predictors of spiritual wellbeing. Happiness and life satisfaction were negatively influenced by pain intensity, which ranged from mild to moderate. Levels of education, physical functioning, and length of hospital stay predict spiritual wellbeing of non-terminally ill cancer patients. Happiness, as well as life satisfaction, was negatively predicted by pain intensity [...].

This paper presents an analysis of narratives drawn from research that examined the views of clergy in regard to the provision of spiritual care in Lithuanian hospitals. The purpose of this research was to examine the shared responsibilities between what nurses do in the provision of holistic care and that of the clergy who are employed to provide spiritual care. A thematic analysis was undertaken, guided by questions related to how spirituality was perceived by the clergy; how spiritual care was defined; clergy's perceptions to nurses' provision of spiritual care, and whether there was a delineation between these two roles. Findings showed that although the clergy believed that their role was important in the provision of spiritual care, both nurses and clergy acknowledged that both played a role in spiritual support. However, scope of practice for each role was not yet defined. For nurses and clergy to understand their roles and the boundaries between them, clear standards of practice need to be developed.

BACKGROUND: Thyroid hormone (TH) metabolism can have prognostic significance in brain tumors. We studied the association of common variations in three deiodinase gene single-nucleotide polymorphisms (SNPs) with circulating TH concentrations and prognosis of brain tumor patients. METHODS: Patients admitted for glioma and meningioma surgery between January, 2010 and September, 2011 were evaluated for functional status (Barthel Index or BI) and circulating free tri-iodothyronine (FT3), free thyroxine (FT4), and thyroid-stimulating hormone (TSH) concentrations. Ten common SNPs in the DIO1 gene; five SNPs in the DIO2 gene; and one SNP in the DIO3 gene were genotyped. Follow-up continued until November, 2017. RESULTS: In glioblastoma patients, the DIO1 SNP rs2235544 CC genotype was associated with significantly lower risk of death at 2 years when compared to AA + CA genotypes after adjusting for patient gender, age, pre-operative functional status, adjuvant therapy, and extent of resection (HR = 0.34, 95% CI: 0.13-0.84, p = 0.019). The TT genotype vs. CC + TC genotypes of the DI02 SNP rs12885300 was associated with increased mortality risk after adjusting for patient gender, age, pre-operative functional status, adjuvant therapy, extent of resection, and FT3/FT4 (HR = 3.13, 95% CI: 1.20-8.16, p < 0.019). The C-allele of the DI01 SNP rs2235544 was related to increased circulating free T3/ free T4 ratio in glioma and meningioma patients, indicating greater T4 to T3 conversion. CONCLUSIONS: SNPs of DIO1 gene (rs2235544) and DIO2 gene (rs12885300) have independent prognostic significance in glioblastoma patients. The C-allele of the DIO1 (rs2235544) is associated with greater T4 to T3 conversion.

Aims/hypothesis Against a background of a near-universally increasing incidence of childhood type 1 diabetes, recent reports from some countries suggest a slowing in this increase. Occasional reports also describe cyclical variations in incidence, with periodicities of between 4 and 6 years. Methods Age/sex-standardised incidence rates for the 0- to 14-year-old age group are reported for 26 European centres (representing 22 countries) that have registered newly diagnosed individuals in geographically defined regions for up to 25 years during the period 1989–2013. Poisson regression was used to estimate rates of increase and test for cyclical patterns. Joinpoint regression software was used to fit segmented log-linear relationships to incidence trends. Results Significant increases in incidence were noted in all but two small centres, with a maximum rate of increase of 6.6% per annum in a Polish centre. Several centres in high-incidence countries showed reducing rates of increase in more recent years. Despite this, a pooled analysis across all centres revealed a 3.4% (95% CI 2.8%, 3.9%) per annum increase in incidence rate, although there was some suggestion of a reduced rate of increase in the 2004–2008 period. Rates of increase were similar in boys and girls in the 0- to 4-year-old age group (3.7% and 3.7% per annum, respectively) and in the 5- to 9-year-old age group (3.4% and 3.7% per annum, respectively), but were higher in boys than girls in the 10- to 14-year-old age group (3.3% and 2.6% per annum, respectively). Significant 4 year periodicity was detected in four centres, with three centres showing that the most recent peak in fitted rates occurred in 2012. Conclusions/interpretation Despite reductions in the rate of increase in some high-risk countries, the pooled estimate across centres continues to show a 3.4% increase per annum in incidence rate, suggesting a doubling in incidence rate within approximately 20 years in Europe. [...].

Many diseases can be early detected from eye fundus images by several different features. One of the features is the artery and vein ratio. Width measurement is made on the main vessels. The aim of this automatization process is to create a fully automated method for eye fundus analysis. The fully automated system consists of blood vessel tree extraction and optic nerve disc detection in order to perform measurements at the standard place. Vessel tree extraction is complicated in some situations, so the vessel measurement algorithm is developed independently of the extracted blood vessel tree, and the tree is used only for direction enhancement and only when it is available. Vessel measurements are compared with manual measurements, performed by an expert. Automated measurements are not different from the expert’s measurements with the confidence level of 95%. For this investigation, the Optomed OY digital mobile eye fundus camera Smartscope M5 PRO was used, but the algorithm can be used on any type of eye fundus images.[...].

An innovative absolute intracranial pressure (ICP) value measurement method has been validated by multicenter comparative clinical studies. The method is based on two-depth transcranial Doppler (TCD) technology and uses intracranial and extracranial segments of the ophthalmic artery as pressure sensors. The ophthalmic artery is used as a natural pair of "scales" that compares ICP with controlled pressure Pe, which is externally applied to the orbit. To balance the scales, ICP = Pe a special two-depth TCD device was used as a pressure balance indicator. The proposed method is the only noninvasive ICP measurement method that does not need patient-specific calibration.