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Background Transitioning from independent living to a residential care facility often results in a significant loss of independence, autonomy, and connectedness, leaving new residents with profound feelings of loss and grief. In light of these challenges, this study explored the potential benefits of a tailored in-house exercise program for new residents. Methods The study took place in an Australian residential care facility and included four new residents (aged 72 to 88, 75% female), who participated in a 12-week tailored exercise program led by an exercise physiologist. A focused ethnographic approach was used to obtain a comprehensive data set, drawing on ongoing observation, informal discussions during the program, and semi-structured interviews conducted at its conclusion. Field notes documenting participants’ interactions, moods, and responses, together with interview transcripts, were compiled into case files and analysed using Braun and Clarke’s thematic analysis. Rigorous coding and collaborative team discussions ensured a thorough and nuanced understanding of transitional experiences. Results The detailed accounts provided by new residents of the profound sense of loss they experienced during their transition offer essential context for understanding the value that exercise programs can provide in residential care settings. Insights from vignettes and thematic analysis show that participation in exercise helped residents regain control, independence, and competence, while also fostering social connection. Two key themes were identified underscoring the transformative role of exercise in supporting the well-being of new residents: (1) fostering empowerment, independence and well-being through exercise engagement, and (2) enhancing overall community and social connectedness via exercise. Conclusion This study indicates that structured exercise programs are instrumental in helping older adults navigate their transition into residential care. By enhancing personal agency, independence, and overall well-being, and fostering a welcoming and friendly environment, an exercise program can assist new residents during their adjustment to supported residential care. Considering the transformative nature of exercise, future research should investigate the mechanisms through which exercise programs facilitate residents’ progression through the stages of transition, and if getting residents involved in exercise prior to moving can encourage earlier participation in exercise programs once they move into residential care.

Background The Royal Commission into Aged Care Quality and Safety (RCAC) recommended a redesign of the Australian aged care system to ensure high quality care, respect, and dignity for residents. Responding to the RCAC recommendations, the Aged Care Quality Standards have been strengthened and continue to guide the delivery of safe, high quality care in Australia. This study investigated the experiences of new residents transitioning into an Australian residential care-facility, concentrating on how their experiences aligned with the core principles of the Aged Care Quality Standards. Methods A focused ethnographic approach was used to address the aim of this study. The research was conducted in a residential care-facility located in a major city in Australia. New residents who had lived there for 6 months or less, along with their family members, were recruited through purposive sampling. The data collection process included a total of 19 residents and two family members, and comprised interviews, observations, and informal conversations with residents and their families. Findings Four themes were identified relating to the value of human connection, addressing new residents’ expectations, the multifunctional role of communication in transition, and the implications of the General Practitioner system for new residents. Conclusion This study highlights the need for aged care providers to consistently follow the Aged Care Quality Standards to support new residents in overcoming challenges, improve their transition, and promote better health outcomes for those in permanent residential care-facilities. Our findings indicate that new residents and their key support person should receive a user-friendly hard copy “How To” guide prior to planned admissions, and upon admission if unplanned. Residential care-facilities should prioritise residents’ sense of privacy, dignity, and respect within medical systems. Additionally, pre-admission protocols should address accessibility of rehabilitation services to prevent further deterioration of new residents’ physical condition.

Transition into residential aged care (RAC) is a challenging process, often characterised by vulnerability, fear, and isolation. This study aimed to provide a contextualised description of transition within a care-facility in Australia to deepen our understanding of this major life event. A focused ethnography was conducted, which included formal interviews with residents during their first 6 months of living in RAC. The findings provide an account of the participants’ views on acceptance, highlight the challenges of loss, and showcase the coping practices new residents used. This paper provides a type of report card for the sector, which reveals that there is relatively slow progress with respect to supporting the needs of new residents during transition. There are opportunities for improvements regarding interventions, initiatives and practices to ensure residents are afforded a healthy transition. Plain Language Summary A description of the transition experience of older adults into residential aged care When older adults move into a residential aged care-facility (nursing home), it presents significant challenges for the individual, and is often marked by feelings of vulnerability, fear, and loneliness. This research sought to offer a detailed description of this transition to enhance our understanding of this significant life change. A focused ethnography research approach was used, which involved formal interviews with residents during their initial 6 months of living in the care-facility. The findings provide an account of the participants’ views on acceptance, highlight the challenges of loss, and showcase the coping practices new residents used. This paper provides a type of report card for the age care sector, which reveals that there is relatively slow progress with respect to supporting the needs of new residents during their transition. There are opportunities for improvement regarding interventions, initiatives, and practices to ensure residents are afforded a healthy transition.

This paper describes a patient with an inoperable gastrointestinal stromal tumour with moderate volume malignant ascites. A large-volume paracentesis caused haemodynamic instability and a myocardial infarction. An indwelling right-sided peritoneal catheter was inserted following further ascites build-up. The patient experienced spontaneous acute rupture of tumour and subsequent loculated ascites. An additional second catheter was inserted to the left side of the abdomen following reaccumulation of ascites following liquefaction of cyst contents and successful one-off drainage on the left side of abdomen. This is the first case report of a patient with two indwelling catheters: we describe learning points pertaining to those as well as the rupture of gastrointestinal stromal tumours. Haemodynamic instability after paracentesis in malignant-related ascites has also not been described

IntroductionTraditional management of malignancy related ascites (MRA) is via large volume paracentesis (LVP). NICE recommends indwelling peritoneal catheters, (IPCs) which are cost effective and patient centred. A service and practice guidelines were set up. Ongoing reviews assess safety and efficacy and inform future pathways.MethodsA single centre retrospective analysis of patients requiring IPCs between October 2018 and August 2020 was performed. Demographics and outcomes were collected. Descriptive statistical methodology was applied. IPCs are placed in theatre or dedicated clean spaces, with pre-operative antibiotics.Results27 patients (14 male, 13 female) underwent 28 IPC placements. [1 patient had 2 IPCs (this will not be discussed as case is published)]. Diagnoses were gastrointestinal (13), breast (2), ovarian (5), prostate (1), thymic (1), unknown primary (4) cancers and 1 mesothelioma. 3 had no preceding LVP; 24 had a mean of 2.2 LVPs before. 6 developed post-operative leaks. 2 patients developed cellulitis. Bacterial colonisation occurred in 1 patient. 4 IPCs were removed: 2 as ascites resolved, 1 for tumour infiltration, 1 for non-resolving site cellulitis. 24 patients have died: mean number of days to death: 56.4 (range 6–262). Integrated Palliative Care Outcome Scale scores collected in 20 patients consistently show sustained reduction in pain, dyspnoea, nausea, vomiting, drowsiness, distension and improvements in body image and appetite.ConclusionsIPCs are safe and efficient. More formal evidence is required on some aspects. A grant application has been submitted to the Royal College of Physicians for the Dorothy Whitney-Wood scholarship to perform a systematic review of the literature, a survey through the APM and an open labelled prospective study to determine if patients with MRA should have an IPC at first presentation and correlate with quality of life outcomes. We also propose sequential analysis of peritoneal fluid to assess bacterial colonisation and effect on outcomes.

FROM a purely selfish point of view, and from those of a former owner and potential buyer, I can happily describe what it is like to drive a Range Rover.

'N Sync performed most of their songs off their album, including the hits I Want You Back (which the audience was singing along to and doing some of the dance movements), Tearin' Up My Heart ([Justin Timberlake] did some mouth percussion for this song, and they got the audience involved by telling them to clap their hands), I Drive Myself Crazy (with a bit of a Capella at the very beginning of the song), and (God Must Have Spent) A Little More Time On You (I enjoyed this performance, because not only is this my favourite song, but because it was funny at the end of the performance with Justin screwing up his part jokingly, and [Chris Kirkpatrick] was posing with this cardboard image of himself as Mr. Muscle Man. Although I really loved the concert (especially when they soaked the audience with water guns, and had the audience involved a lot), there were some things about the concert that I think needs some improvement. First of all, I think that they need to cut down on the costume changes. These changes created a lot of long pauses, and it made it hard sometimes to figure out if they were going to perform some more, or if the show was over (although there was one point where, during one of the pauses, they showed their video You Drive Me Crazy on the screens. This video hasn't been released in Canada yet (or in the U.S.), so it was interesting (and funny) to watch). The other point I would like to address is that while 'N Sync performed, it sounded as if their voices were really high-pitched (actually, their voices reminded me of The Chipmunks, or even Mickey Mouse). Although I am not sure if this was a technical difficulty or not, I believe that it definitely needs some improvement.

A large, randomized trial has shown that the addition of zoledronic acid to adjuvant chemotherapy in patients with early-stage breast cancer does not influence rates of recurrence or survival. Metastasis is a complex process that is dependent on both the biologic features of the primary tumor and cellular interactions within host tissues. In the bone microenvironment, cancer cells stimulate osteoblasts to release receptor activator of nuclear factor κB ligand (RANKL), which binds to its receptor, RANK, on both precursor and mature osteoclasts. The resulting increase in osteoclastic bone resorption leads to the release of bone-derived growth factors that may provide a fertile environment for survival and growth of adjacent cancer cells. 1 Thus, targeting bone-cell function provides a potential additional approach to preventing bone metastases as a component of standard . . .

Allopurinol is a urate-lowering therapy used to treat patients with gout. Previous studies have shown that allopurinol has positive effects on several cardiovascular parameters. The ALL-HEART study aimed to determine whether allopurinol therapy improves major cardiovascular outcomes in patients with ischaemic heart disease. ALL-HEART was a multicentre, prospective, randomised, open-label, blinded-endpoint trial done in 18 regional centres in England and Scotland, with patients recruited from 424 primary care practices. Eligible patients were aged 60 years or older, with ischaemic heart disease but no history of gout. Participants were randomly assigned (1:1), using a central web-based randomisation system accessed via a web-based application or an interactive voice response system, to receive oral allopurinol up-titrated to a dose of 600 mg daily (300 mg daily in participants with moderate renal impairment at baseline) or to continue usual care. The primary outcome was the composite cardiovascular endpoint of non-fatal myocardial infarction, non-fatal stroke, or cardiovascular death. The hazard ratio (allopurinol vs usual care) in a Cox proportional hazards model was assessed for superiority in a modified intention-to-treat analysis (excluding randomly assigned patients later found to have met one of the exclusion criteria). The safety analysis population included all patients in the modified intention-to-treat usual care group and those who took at least one dose of randomised medication in the allopurinol group. This study is registered with the EU Clinical Trials Register, EudraCT 2013-003559-39, and ISRCTN, ISRCTN32017426. Between Feb 7, 2014, and Oct 2, 2017, 5937 participants were enrolled and then randomly assigned to receive allopurinol or usual care. After exclusion of 216 patients after randomisation, 5721 participants (mean age 72·0 years [SD 6·8], 4321 [75·5%] males, and 5676 [99·2%] white) were included in the modified intention-to-treat population, with 2853 in the allopurinol group and 2868 in the usual care group. Mean follow-up time in the study was 4·8 years (1·5). There was no evidence of a difference between the randomised treatment groups in the rates of the primary endpoint. 314 (11·0%) participants in the allopurinol group (2·47 events per 100 patient-years) and 325 (11·3%) in the usual care group (2·37 events per 100 patient-years) had a primary endpoint (hazard ratio [HR] 1·04 [95% CI 0·89–1·21], p=0·65). 288 (10·1%) participants in the allopurinol group and 303 (10·6%) participants in the usual care group died from any cause (HR 1·02 [95% CI 0·87–1·20], p=0·77). In this large, randomised clinical trial in patients aged 60 years or older with ischaemic heart disease but no history of gout, there was no difference in the primary outcome of non-fatal myocardial infarction, non-fatal stroke, or cardiovascular death between participants randomised to allopurinol therapy and those randomised to usual care. UK National Institute for Health and Care Research.