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Abstract: One of the outward signs of the aging process of human skin is the increased appearance of wrinkles on its surface. Clinical studies show that the increased frequency of wrinkles with age may be attributed to changes in the composition of the various layers of skin, leading to a change in mechanical properties. A parameter study was performed on a previously proposed multi-layer finite element model of skin. A region of skin was subject to an in-plane compression, resulting in wrinkling. A number of physical properties of the skin model were changed and the effects these changes had on the size of the subsequent wrinkles were measured. Reducing the moisture content of the stratum corneum by 11% produces wrinkles 25–85% larger. Increasing the dermal collagen fibre density by 67%, results in wrinkles, which are 25–50% larger. A reduction and change in the pre-stress distribution in the skin model, which represents the natural tension and relaxed skin tension lines in real skin, also influences the wrinkle height in a similar manner to real aging skin. Typically, there can be up to a 100% increase in the height of wrinkles as skin ages. This model would be of benefit in the development of cosmetic moisturisers and plastic-surgery techniques to reduce the appearance of aging. [Copyright &y& Elsevier]

Abstract: The healing of wounds is a complex process and the contraction of the resulting scar can have a negative impact on the neighbouring skin. A finite element model of skin simulating the contraction of a scar and deformation of the surrounding skin is presented. The skin is represented by an orthotropic–viscoelastic constitutive law, which is validated against experimental data in the literature. A simplified experimental model of a contracting scar in real skin is also developed. The pattern and size of the wrinkles formed around the contracting scar in the finite element model compare favourably with those formed in the experimental model. The orthotropic nature of skin plays a significant role in the behaviour of skin around scars—the wrinkles have a preferential orientation that corresponds to a direction perpendicular to the Langer''s lines in the skin. The pre-stress in skin (a property that is ignored in many skin models) is shown to be an important factor in wrinkle formation around scars. The proposed model can be used to analyse the suturing and closure of wounds of various shapes. [Copyright &y& Elsevier]

Global health care policy and regulatory requirements indicate that nursing students must be prepared for person-centred practice. Despite this, there is no evidence of a theoretically derived instrument to measure students' perceptions of person-centred practice. To adapt the Person-centred Practice Inventory-Staff instrument for use with healthcare students and to test the adapted instrument. This study involved a two-phased, modified Delphi Technique. In Phase 1 students' views about items in the Person-centred Practice Inventory-Staff were explored to gain consensus about items for inclusion in an adapted student version. In Phase 2, the psychometric properties of the adapted instrument were tested. A UK university. Pre-registration nursing students. Phase 1 involved an iterative process including three focus groups (n = 13) followed by Delphi surveys (Round 1: n = 382; Round 2: n = 144). Thematic analysis was used to analyse students' comments and consensus percentages were calculated after each Delphi round. Phase 2 involved a survey using the adapted instrument (n = 532). The measurement model was analysed using confirmatory factor analysis. The results indicated stability in the measurement model with this sample. Item correlation scores were between 0.22 and 0.74 with no evidence of collinearity and factor loadings ranged from 0.44–0.86. Fit indices indicated goodness of fit between the observed data and the respective domains in the Person-centred Practice Framework (chi-squared to degrees of freedom ratio of <3, root mean square estimations of approximation 0.06 for all domains and between 0.05 and 0.07 at 90% confidence interval. Comparative fit index estimates ranged from 0.90–0.97). This study provides initial validation of the Person-centred Practice Inventory-Student instrument which is offered as a measure of students' perceptions of their person-centred practice. The instrument has utility in assessing the efficacy of curricula in preparing students as person-centred practitioners. [ABSTRACT FROM AUTHOR]

Background: The drive towards person-centred approaches to care delivery has been increasingly promoted. This is in response to the significant challenges within health and social care organisations, which impact on the care experience for patients and their families. Objective: The aim of this paper is to illuminate the experiences of patients of care received in hospital wards during the intervention phase of a programme to develop person-centred practice. Design: A narrative enquiry study was conducted which is a particular way of exploring complex cultural or social patterns. Structural narrative analysis was used to generate explanation and interpretation of in-hospital patients' care experience. Setting: Recruitment was from four different hospital sites in one health care organisation, focussing on patients who were admitted to the nine wards/units where the nursing teams were participating in a practice development programme that had the intention of promoting person-centredness. Participants: Participants were people aged over 18 and receiving care and treatment in the identified wards/units. Twenty-six patients were recruited. Methods: Narrative interviews were audio-recorded at four month intervals and transcribed. The records were subjected to a process of structural analysis. Results: The findings offer insight into patients' experiences of care in a range of clinical settings in which an explicit intervention to promote person-centred practice was underway. There was one overriding theme formulated: Vulnerability at the junctures of systems, care processes and nurses' responses. From this main theme, we derived four sub-themes: (1) confronting vulnerability, (2) experiencing exemplary care, (3) experiencing misalignments in systems, care processes and nurses' responses, and (4) sharing in a sense of belonging with ward nurses. Conclusions: In-hospital patients are exposed to vulnerability in the care experience. They placed value on exemplary care. Experiences of misalignments in systems, care processes and nurses' responses disempower patients and heighten a sense of vulnerability. The ward nursing teams were generating a family like atmosphere. Patients responded by sharing a sense of belonging with ward nurses. These findings confirm components that have influenced the development of person-centred practice, such as the importance of the context and culture of care. They also offer new insights that may contribute to on-going practice development work. [ABSTRACT FROM AUTHOR]

Person-centred palliative healthcare is an important approach to maintaining and improving patients' quality of life living with a chronic non-communicable disease and their partners. Such an approach can reduce unnecessary hospitalisation, holistically address the patient and their partners' needs, and help develop an advance care plan. Assess, analyse, and synthesise the currently existing international guidelines for providing person-centred palliative care and identify the key components for providing a high-quality approach. An umbrella review methodology of systematic reviews with the method of examination, analysis and synthesis of literature and the compilation method. Relevant systematic reviews of guidelines for providing person-centred palliative care in English, German and/or Slovenian language in PubMed, CINAHL, Web of Science and Cochrane Library databases, until November 2020. Out of 3,910 records, we included seven reviews for thematic synthesis. We identified four key elements of flourishing in person-centred palliative healthcare: (i) Healthcare staff prerequisites and traits; (ii) Palliative healthcare environment; (iii) Palliative healthcare processes; and (iv) Palliative healthcare outcomes. We concluded that person-centred palliative healthcare plays an important role in the comprehensive treatment of patients living with a non-communicable disease accompanied by disturbing symptoms. Therefore, it is necessary to raise awareness amongst healthcare professionals and especially general practitioners about the possibilities of including patients with a non-communicable disease in early person-centred palliative healthcare. Tweetable Abstract: #UmbrellaReview of components for providing #personcentredpalliative #healthcare. Components provide healthcare professionals and interdisciplinary #palliative teams with the steps on how to give #personcentredpalliative #healthcare to #patient and #support to #carepartners [ABSTRACT FROM AUTHOR]

Abstract: Objectives: In this study, we sought to measure treatment culture (beliefs, values, and normative practices associated with medication prescribing and administration) in two samples of nursing homes (in Northern Ireland and New Zealand) and to document the range of scoring achieved by staff in both countries. Responses between nurse managers and registered nurses were also compared. Design: A cross-sectional study using an adapted treatment culture questionnaire was distributed by mail (in June and September 2008) to 159 nursing homes in Northern Ireland and completed by the nurse manager and registered nurses. In New Zealand, staff in 14 facilities participated and questionnaires were distributed by a research assistant who visited the homes (March to November 2008). Measurements: Completed questionnaires were scored using a prespecified scoring system, with a higher score indicating a more resident-centered treatment culture and a lower score indicating a more traditional approach to care. The maximum score possible was 75. Scores were compared between countries and between different categories of staff. Views were also sought and knowledge tested (from structured questions) on the use of psychotropic prescribing in the nursing home environment. Results: The response rates for nurse managers and nurses in Northern Ireland were 35.5% and 10.1%, respectively; in New Zealand, the response rate was 90.9% for managers and 71% for nurses. The mean score for the Northern Ireland and New Zealand homes was 39.5 and 39.1, respectively (P > .05). There were also no differences between scores achieved by nurse managers and registered nurses between and across both countries. There were some cross-country differences on the approach to challenging behavior in residents and nurses (in both countries) were more likely than nurse managers to report (incorrectly) that haloperidol is indicated for short-term insomnia. Conclusion: This quantitative assessment has raised interesting issues in relation to the measurement of treatment culture in the nursing home setting in two countries. Further insights into the importance of treatment culture will be pursued in qualitative studies. [ABSTRACT FROM AUTHOR]