MedWorm.com provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest items from the 'Journal of the American Medical Directors Association' source. Fri, 12 Mar 2010 16:01:02 +0100 http://www.medworm.com/index.php?rid=3305731&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861010000459%2Fabstract%3Frss%3Dyes (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305731 Thu, 25 Feb 2010 16:11:58 +0100 3305731 http://www.medworm.com/index.php?rid=3305730&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861010000447%2Fabstract%3Frss%3Dyes (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305730 Thu, 25 Feb 2010 16:11:58 +0100 3305730 http://www.medworm.com/index.php?rid=3305729&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861010000435%2Fabstract%3Frss%3Dyes (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305729 Thu, 25 Feb 2010 16:11:58 +0100 3305729 http://www.medworm.com/index.php?rid=3305728&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861010000794%2Fabstract%3Frss%3Dyes (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305728 Thu, 25 Feb 2010 16:11:58 +0100 3305728 http://www.medworm.com/index.php?rid=3305727&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861010000423%2Fabstract%3Frss%3Dyes (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305727 Thu, 25 Feb 2010 16:11:58 +0100 3305727 http://www.medworm.com/index.php?rid=3305726&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009005167%2Fabstract%3Frss%3Dyes Introduction/Objective: In the past decade, there has been growing scientific evidence of the clinical impact of vitamin D supplementation on a multiplicity of chronic medical conditions affecting the elderly, as well as reduction of institutionalization rates. Yet, underutilization of vitamin D has been demonstrated in nursing home and rehabilitation facilities. We sought to study the reasons for physicians' vitamin D prescribing patterns in long-term care settings. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305726 Thu, 25 Feb 2010 16:11:58 +0100 3305726 http://www.medworm.com/index.php?rid=3305725&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009005155%2Fabstract%3Frss%3Dyes Introduction/Objective: Vitamin D deficiency has been identified in the long-term care population but little is known about the risk of this deficiency in patients admitted to subacute care following hospitalization. This is a preliminary study to estimate the frequency and risk of vitamin D deficiency in this population. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305725 Thu, 25 Feb 2010 16:11:58 +0100 3305725 http://www.medworm.com/index.php?rid=3305724&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009005143%2Fabstract%3Frss%3Dyes Introduction/Objective: Excessive weight loss in long term care is common and is frequently targeted as a quality measure. It has been demonstrated previously that food consumption in patients with advanced Alzheimer's disease can be increased through use of brightly colored dinnerware to overcome diminished sensitivity to visual contrast. Our pilot program seeks to generalize the findings to all patients in long term care including those without dementia. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305724 Thu, 25 Feb 2010 16:11:58 +0100 3305724 http://www.medworm.com/index.php?rid=3305723&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009005131%2Fabstract%3Frss%3Dyes Introduction/Objective: Cachexia/dehydration may be the immediate cause of death in the end stage of dementia in as many as 35% of nursing home residents. Cachexia is associated with suppressed appetite, food intake and body weight while proinflammatory cytokines are increased. Proinflammatory cytokines directly result in feeding suppression and lower intake of nutrients and cachexia is nearly always accompanied by anorexia. IL-1 beta and tumor necrosis factor alpha (TNFa) act on the glucose-sensitive neurons in the satiety and hunger sites in the hypothalamus. An association between high levels of circulating TNFa and unexplained weight loss in AD has been shown. Serum TNFa has been shown to be lower in mild-moderate Alzheimer's disease (AD) compared to severe AD.12 The levels of TNFa, IL... Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305723 Thu, 25 Feb 2010 16:11:58 +0100 3305723 http://www.medworm.com/index.php?rid=3305722&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS152586100900512X%2Fabstract%3Frss%3Dyes Introduction/Objective: Long term care residential facilities house older adults at increased risk of infection by Mycobacterium tuberculosis (TB); in addition, direct care providers are often born in countries with endemic TB. Thus, the Centers for Disease Control and Prevention (CDC, 2005) deem residents and employees in long-term care to be at high risk of TB infection. Routine tuberculosis screening, through PPD (purified protein derivative) testing, identifies individuals who may have latent TB or TB disease. Whereas most illness screening protocols use venipunctures, tuberculosis protocol relies on skin testing. Thus, we studied physicians' knowledge and practice patterns of PPD tests. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305722 Thu, 25 Feb 2010 16:11:58 +0100 3305722 http://www.medworm.com/index.php?rid=3305721&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009005118%2Fabstract%3Frss%3Dyes Introduction/Objective: It has been suggested that 2 major cost containment strategies were implemented at a time in which an increase of transfers from the hospital to the NH occurred, including DRG prospective payment system & increased managed care reductions in hospital LOS. One consequence of this strategy was the birth of transitional care, sometimes defined as a "set of actions designed to ensure the coordination and continuity of health care as patients transfer between locations or different levels of care or within the same location".(Coleman et al. J Am Geriatric Soc 2003). Problems inherent in this model arise secondary to poor, or no communication, and fragmentation, leading to known increases in rehospitalization, morbidity, and mortality. Additionally, poor or inappropriate ... Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305721 Thu, 25 Feb 2010 16:11:58 +0100 3305721 http://www.medworm.com/index.php?rid=3305720&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009005106%2Fabstract%3Frss%3Dyes Introduction/Objective: Introduction: Residents in NH develop acute problems and are sent to EDs of acute hospitals. These transfers are clinical indicators for Singapore NH. This particular NH is studying the problem with a view to working with the local acute hospital to reduce future transfers. Aim: To describe the characteristics and outcomes of transfers of residents from a NH to the ED of a hospital. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305720 Thu, 25 Feb 2010 16:11:58 +0100 3305720 http://www.medworm.com/index.php?rid=3305719&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS152586100900509X%2Fabstract%3Frss%3Dyes Introduction/Objective: A recent study by Korbstein et al. showed the devastating functional impact of prolonged bed rest on healthy older adults as evidenced by substantial loss of lower extremity strength, power, and aerobic capacity. Significant losses in performance measures in frail, hospitalized long term care (LTC) residents can be anticipated with possibly more severe and prolonged consequences. The time commitment to regularly walk these patients often overwhelms nursing and physical therapy staff. This 6-month pilot Safety Walker Program was designed to train non-licensed staff to provide extra ambulation time to hospitalized elderly to help prevent the well known complications of immobility, including falls, pressure ulcers, delirium and functional decline. (Source: Journal of t... Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305719 Thu, 25 Feb 2010 16:11:58 +0100 3305719 http://www.medworm.com/index.php?rid=3305718&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009005088%2Fabstract%3Frss%3Dyes Introduction/Objective: Background and Purpose: Drugs delivered by Metered-Dose Inhalers (MDIs) and various types of Dry Powder Inhalers (DPIs) are a mainstay in the treatment of chronic lung disease. However, previous studies suggest cognitive impairment hinders proper use of inhalers, thereby compromising their potential benefit for people with Alzheimer's disease and related dementias. Since chronic lung disease is a common co-morbidity in people with dementia, predicting success of inhaler use based on cognitive function should be an important part of clinical decision making in the treatment of chronic lung disease. The purpose of this study is to determine the relationship between the score on the Mini-Mental Sate Exam (MMSE) and the ability to successfully complete the steps require... Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305718 Thu, 25 Feb 2010 16:11:58 +0100 3305718 http://www.medworm.com/index.php?rid=3305717&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009005076%2Fabstract%3Frss%3Dyes Introduction/Objective: To evaluate the prevalence of anemia and anemia treatment in anemic LTCF residents. Design/Methodology: Data were derived from the AnalytiCare(SM) long term care database containing laboratory results, Minimum Data Set (MDS) reports, and pharmacy fills for residents of 27 LTCFs in Colorado. Study timeframe was 1/1/2007-9/15/2008. Residents were included based on: residence in LTCF >90 days, an index hemoglobin (Hb) and serum creatinine values ±90 days of the earliest MDS. Residents were excluded if they had cancer, chemotherapy, end-stage renal disease, dialysis, (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305717 Thu, 25 Feb 2010 16:11:58 +0100 3305717 http://www.medworm.com/index.php?rid=3305716&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009005064%2Fabstract%3Frss%3Dyes Introduction/Objective: This exploratory study is to identify the components of a clinicians visit in the nursing home, to evaluate the time required to complete each task and identify opportunities to improve the efficiency of the work process. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305716 Thu, 25 Feb 2010 16:11:58 +0100 3305716 http://www.medworm.com/index.php?rid=3305715&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009005052%2Fabstract%3Frss%3Dyes This study evaluates the impact of the MPD DH on Parkinson's Disease (PD) patients medication usage and drug costs. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305715 Thu, 25 Feb 2010 16:11:58 +0100 3305715 http://www.medworm.com/index.php?rid=3305714&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009005040%2Fabstract%3Frss%3Dyes Introduction/Objective: Age-related physiologic changes, along with inappropriate medication use, can lead to significant adverse consequences. One of the medication classes with the greatest potential for adverse events in elder nursing home residents are the psychotropics, anxiolytics and sedative/hypnotics. F-Tag 329 mandates that “each resident's medication regimen must be free from unnecessary drugs.” This F-tag prohibits excessive doses, excessive duration, and inadequate monitoring practices. AMDA's policy states that only an interdisciplinary team can make facility level decisions to reduce inappropriate medication use, such as psychoactive medications. The purpose of this study was to evaluate the effectiveness of an interdisciplinary team approach to address F-Tag 329. (Sourc... Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305714 Thu, 25 Feb 2010 16:11:58 +0100 3305714 http://www.medworm.com/index.php?rid=3305713&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009005039%2Fabstract%3Frss%3Dyes Introduction/Objective: Post Traumatic Stress Disorder (PTSD) is common among Somali Refugee population. About 50% of Somali elders come to US alone. The high Prevalence of PTSD among elderly immigrant groups contribute to their burden of disease and affects their quality of life. Objective: To screen for PTSD among Elderly Somali population using PC-PTSD tool and determine its contributing factors. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305713 Thu, 25 Feb 2010 16:11:57 +0100 3305713 http://www.medworm.com/index.php?rid=3305712&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009005027%2Fabstract%3Frss%3Dyes Introduction/Objective: Current osteoarthritis (OA) guidelines recommend topical nonsteroidal anti-inflammatory drugs (NSAIDs) for relief of OA pain ahead of oral NSAIDs on the basis of efficacy and safety. (Osteoarthritis: the care and management of osteoarthritis in adults, 2008) Topical NSAIDs may mitigate the risk of adverse events (AEs) by minimizing systemic NSAID exposure. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305712 Thu, 25 Feb 2010 16:11:57 +0100 3305712 http://www.medworm.com/index.php?rid=3305711&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009005015%2Fabstract%3Frss%3Dyes Introduction/Objective: There is a continued increase in our elderly population both in terms of size and lifespan. The number of patients that are choosing ventilator assistance for chronic respiratory failure is rising and their stay on a machine is longer in duration. For those patients who are unweanable, there are options available for discharge other than institutionalization. Many patients would prefer to be cared for at home due to emotional, financial or logistical reasons. The benefits for patients living in their own home with a chronic ventilator includes better quality of life, less exposure to infection and decreased cost to insurance and patient/family. The Extended Care Department of a regional medical center was able to successfully transition patients home from 3 differen... Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305711 Thu, 25 Feb 2010 16:11:57 +0100 3305711 http://www.medworm.com/index.php?rid=3305710&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009005003%2Fabstract%3Frss%3Dyes Introduction/Objective: Recently the Masonic Village's occupational medicine department instituted the use of the QuantiFERON blood test to screen all positive PPDs of recently employed staff. Our goal was to determine how many of our positive PPDs of newly employed staff has a positive QuantiFERON blood test. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305710 Thu, 25 Feb 2010 16:11:57 +0100 3305710 http://www.medworm.com/index.php?rid=3305709&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS152586100900499X%2Fabstract%3Frss%3Dyes This study was conducted to document the successful implementation of a restraint free policy. Physical restraint use was decreased from four times state and national averages, 17.5%, to 4.5% and has been consistently maintained for over one year. Prevalence of fall also decreased from 11.5% to 6.1% over the same period. We describe the change process and the experiences of staff, residents and family before, during and after the implementation of the program. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305709 Thu, 25 Feb 2010 16:11:57 +0100 3305709 http://www.medworm.com/index.php?rid=3305708&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009004988%2Fabstract%3Frss%3Dyes Introduction/Objective: Antipsychotic medications used for treatment of dementia-associated behaviors pose increased risk of stroke and death and also carry black box warnings. In addition, research suggests this type of drug therapy has limited effectiveness and adverse effects outweigh the benefits. Despite this evidence, antipsychotics are frequently used in demented elderly nursing home residents for management of behavioral problems. Through its quality improvement (QI) process, our 103-bed nursing facility identified higher prevalence of antipsychotic use compared to state and national averages. We organized an interdisciplinary team to achieve the goal of promoting the highest quality of resident life with minimal use of antipsychotic medications. (Source: Journal of the American Me... Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305708 Thu, 25 Feb 2010 16:11:57 +0100 3305708 http://www.medworm.com/index.php?rid=3305707&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009004976%2Fabstract%3Frss%3Dyes Introduction/Objective: Recently there has been a lot of interest at CMS regarding the re-admission rate of Medicare hospitalized patients to the community and nursing homes within one year. The Masonic Village at Elizabethtown, Pennsylvania has been successful in effectively reducing the number of patient admissions to our local hospitals each year since 2005. Due to our success in reducing hospital admissions yearly, we examined those multiple factors that contributed to our success. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305707 Thu, 25 Feb 2010 16:11:57 +0100 3305707 http://www.medworm.com/index.php?rid=3305706&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009004964%2Fabstract%3Frss%3Dyes We present a case study of an elderly patient with OSA syndrome, and severe functional impairment who improved with treatment. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305706 Thu, 25 Feb 2010 16:11:57 +0100 3305706 http://www.medworm.com/index.php?rid=3305705&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009004952%2Fabstract%3Frss%3Dyes Introduction/Objective: Elderly nursing home residents are at high risk for falls, which can lead to fractures. Several randomized controlled trials showed that vitamin D supplementation reduces falls in nursing home residents. For instance, one meta-analysis of vitamin D supplementation in elderly nursing home residents found a 22% fall reduction; a second meta-analysis found that 700-800IU vitamin D is needed for fracture reduction. In our nursing home, review of medication administration records of all patients (101) revealed that 27 (26.7%) patients received no vitamin D supplementation, 39 (31.3%) received inadequate vitamin D ( (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305705 Thu, 25 Feb 2010 16:11:57 +0100 3305705 http://www.medworm.com/index.php?rid=3305704&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009004940%2Fabstract%3Frss%3Dyes Introduction/Objective: Unintentional weight loss in the nursing home is an important clinical problem that warrants early identification and intervention. The accurate identification of residents with true weight loss is imperative so that efforts and resources may be focused on those who need them the most. In our facility, we undertook a quality improvement project with the goals of improved accuracy of weight collection and documentation, reliable identification of residents with true weight loss, improved accuracy and documentation of meal and supplement intake, and to increase caloric intake from meals and snacks, rather than from liquid nutritional supplements. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305704 Thu, 25 Feb 2010 16:11:57 +0100 3305704 http://www.medworm.com/index.php?rid=3305703&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009004939%2Fabstract%3Frss%3Dyes The objective of this exploratory study is to determine whether SNF residents undergoing psychotropic therapy who regularly participated in a high quality recreational program experienced a reduction of psychotropic medication use. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305703 Thu, 25 Feb 2010 16:11:57 +0100 3305703 http://www.medworm.com/index.php?rid=3305702&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009004927%2Fabstract%3Frss%3Dyes Introduction/Objective: Clostridium difficile (C diff) is a spore forming bacillus causing illness ranging from diarrhea to death. Risk factors associated with C diff infection include antibiotic usage, advanced age, percutaneous endoscopic gastrostomy, increased number of comorbidities and hospitalization. It is more commonly seen in patients residing in long term care facilities (LTCF). Up to 20% of LTCF residents may be asymptomatic carriers of C diff, likely related to two emerging factors: the evolution of increasingly virulent and resistant strains and the increased use of gastric acid suppression medications, particularly proton pump inhibitors (PPIs). Current data indicates the adjusted rate ratio of acquired C diff infection with concurrent PPI use is at 2.9. We attempted to corro... Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305702 Thu, 25 Feb 2010 16:11:57 +0100 3305702 http://www.medworm.com/index.php?rid=3305701&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009004915%2Fabstract%3Frss%3Dyes This report summarizes current practices to prevent VTE in 17 LTCF after phase 1 of a 3-phase educational project aimed at improving practice patterns consistent with CPGs. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305701 Thu, 25 Feb 2010 16:11:57 +0100 3305701 http://www.medworm.com/index.php?rid=3305700&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009004903%2Fabstract%3Frss%3Dyes Introduction/Objective: Diabetic peripheral neuropathy (DPN) is one of the most common long-term complications of diabetes. The primary objective of this research was to determine the prevalence of painful DPN (pDPN). The secondary objective was to evaluate medications used to treat other related comorbidities. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305700 Thu, 25 Feb 2010 16:11:57 +0100 3305700 http://www.medworm.com/index.php?rid=3305699&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009004897%2Fabstract%3Frss%3Dyes Introduction/Objective: Antipsychotic drug prescription in most long term care (LTC) facilities is prevalent and common. However, specific indications for antipsychotic medications (APM) is oftentimes lacking when the APM order is written. The purpose of the study is to examine the prevalence of APM orders without documentation of specific target indication or diagnosis in the LTC medical record/chart. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305699 Thu, 25 Feb 2010 16:11:57 +0100 3305699 http://www.medworm.com/index.php?rid=3305698&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009004885%2Fabstract%3Frss%3Dyes Introduction/Objective: To estimate the prevalence of CKD in Hawaii's LTC population based on laboratory data and the degree to which a corresponding diagnosis of CKD is identified in the resident's chart. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305698 Thu, 25 Feb 2010 16:11:57 +0100 3305698 http://www.medworm.com/index.php?rid=3305697&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009004873%2Fabstract%3Frss%3Dyes Introduction/Objective: Considering the high rates of pain in long-term care (LTC) settings, research is needed to explore innovations in health services delivery, including the emerging nurse practitioner (NP) role. The purpose of this study was to explore the perceptions of LTC health care providers and administrators around the NP role in pain management with an emphasis on elucidating barriers and facilitators to optimizing the use of NPs in LTC around pain management. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305697 Thu, 25 Feb 2010 16:11:57 +0100 3305697 http://www.medworm.com/index.php?rid=3305696&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009004861%2Fabstract%3Frss%3Dyes The objectives of study were: 1- To assess initial pain score based on a standardized Pain Assessment Form with scores 1-10, with a score above 5 indicating severe pain; 2- To compare initial pain score among patients admitted with diagnoses grouped into three categories: medical, surgical and trauma; and 3- Is the pain control improving over time? (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305696 Thu, 25 Feb 2010 16:11:57 +0100 3305696 http://www.medworm.com/index.php?rid=3305695&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS152586100900485X%2Fabstract%3Frss%3Dyes The objective of this quality care improvement project is to evaluate the state of oral care in the Atlanta VA CLC. RESEARCH QUESTIONS: (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305695 Thu, 25 Feb 2010 16:11:57 +0100 3305695 http://www.medworm.com/index.php?rid=3305694&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009004848%2Fabstract%3Frss%3Dyes Introduction/Objective: This is a case presentation of a patient who presented with progressive muscle weakness. Differential diagnosis will be discussed. Design/Methodology: This is a 59 year old male with a history of Hepatitis C who presented with progressive weakness. He had been in a nursing home for short term rehabilitation after an ankle fracture following a fall. After three weeks of short term rehabilitation he was felt to have progressed sufficiently for transfer to an assisted living facility. There he was noted to develop progressive functional decline over one week, to the point that he was unable to walk, unable to transfer independently, had almost unintelligible speech, and experienced dysphagia. He also had difficulty lifting objects with his hands and holding up his hea... Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305694 Thu, 25 Feb 2010 16:11:56 +0100 3305694 http://www.medworm.com/index.php?rid=3305693&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009004836%2Fabstract%3Frss%3Dyes We present a case that illustrates this problem with a review of the available literature. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305693 Thu, 25 Feb 2010 16:11:56 +0100 3305693 http://www.medworm.com/index.php?rid=3305692&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009004824%2Fabstract%3Frss%3Dyes Introduction/Objective: To outline the steps in developing a plan to incorporate culture change into mealtime. Design/Methodology: Documentation of actual steps to use to evaluate, create a plan and redesign a food service department and delivery system in a long term care setting. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305692 Thu, 25 Feb 2010 16:11:53 +0100 3305692 http://www.medworm.com/index.php?rid=3305691&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009004812%2Fabstract%3Frss%3Dyes Introduction/Objective: To demonstrate the outcomes achieved through disease management, standardized nursing processes, outcomes measurement, and staff performance improvement applied to 3,000 residents in 10 skilled nursing facilities (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305691 Thu, 25 Feb 2010 16:11:53 +0100 3305691 http://www.medworm.com/index.php?rid=3305690&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009004800%2Fabstract%3Frss%3Dyes In this study, we analyzed LTCF residents to determine if those with peripheral inflammation (defined pressure ulcers) also had intestinal inflammation (defined as elevated levels of quantitative fecal lactoferrin, qLF). We further examined to see if residents with multiple sites of inflammation would be sicker (defined as more hospitalization or emergency department (ED) transfer) or more frail (defined as weight loss) as compared to those without. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305690 Thu, 25 Feb 2010 16:11:53 +0100 3305690 http://www.medworm.com/index.php?rid=3305689&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009004782%2Fabstract%3Frss%3Dyes Introduction/Objective: Care preferences at the end of life continues to receive substantial attention. Less understood are end of life attitudes of specific Hispanic subgroups. The purpose of our study was to examine the relationship between sociodemographic factors on personal attitudes towards life extending treatments during a hypothetical terminal state among community dwelling older Mexican Americans. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305689 Thu, 25 Feb 2010 16:11:53 +0100 3305689 http://www.medworm.com/index.php?rid=3305688&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009004770%2Fabstract%3Frss%3Dyes Introduction/Objective: Background: More than 25% of older adults require SNF care after acute hospitalization but it is unclear whether Internal Medicine residents have sufficient knowledge about the type of care that can be provided at this site. We assessed knowledge about SNFs among Internal Medicine trainees prior to a mandatory SNF rotation during their first year and either 2nd or 3rd year of training. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305688 Thu, 25 Feb 2010 16:11:53 +0100 3305688 http://www.medworm.com/index.php?rid=3305687&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009004769%2Fabstract%3Frss%3Dyes Introduction/Objective: PACE (Program for the All-inclusive Care of the Elderly) programs have a wide variety of audiences with whom to share data. Medical Directors and Team members need to know if processes to keep participants safe are functioning. Physicians and Medical Directors are interested in Participant outcomes. Administrators want to assure that resources are being allocated as needed. Participants, Family Members, and Community Advocates who serve on advisory boards need an easily understandable report that communicates the quality of services. Regulators want to assure that processes are meeting requirements. To meet the variety of expectations it is necessary to develop a Key Quality Indicator Report that tells that story. (Source: Journal of the American Medical Directors A... Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305687 Thu, 25 Feb 2010 16:11:53 +0100 3305687 http://www.medworm.com/index.php?rid=3305686&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009004757%2Fabstract%3Frss%3Dyes Introduction/Objective: Culture Change has had a major positive impact on the social environment in long-term care (LTC) facilities providing residents with more control of their lives and increasing quality of life and independence. However, despite the great strides in expanding the social environment of LTC residents, many medical models have lagged behind in terms of an “integrated medical care” focus that would support and enhance resident control of their own health care decisions. In response to this need, the Integrated Medical Model was developed with the following principles: (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305686 Thu, 25 Feb 2010 16:11:53 +0100 3305686 http://www.medworm.com/index.php?rid=3305685&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009004745%2Fabstract%3Frss%3Dyes Introduction/Objective: The insulin sliding scale is a very frequently used method to help control blood sugar levels in patients in nursing home settings. Many of the patients on sliding scale may not have blood sugars that are well controlled, and physicians many times may be unaware of the lack of glycemic control as coverage will be as per sliding scale. We wanted to look and see how many patients on sliding scales had adverse events defined as blood sugars less than 60 or greater than 400. Secondly we wanted to see how often nursing intervention in terms of orange juice or glucagon was required for sliding scale patients. Finally we wanted to see how often physicians make adjustments to the sliding scale based on adverse events. (Source: Journal of the American Medical Directors Assoc... Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305685 Thu, 25 Feb 2010 16:11:53 +0100 3305685 http://www.medworm.com/index.php?rid=3305684&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009004733%2Fabstract%3Frss%3Dyes This study evaluates the diagnosis and treatment patterns in the US of newly identified PD patients by describing the timing and type of initial treatments. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305684 Thu, 25 Feb 2010 16:11:53 +0100 3305684 http://www.medworm.com/index.php?rid=3305683&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009004721%2Fabstract%3Frss%3Dyes This report summarizes current practices addressing VTE in 17 LTCFs after phase 1 of a 3-phase educational project aimed to improve practice patterns consistent with CPGs. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305683 Thu, 25 Feb 2010 16:11:53 +0100 3305683 http://www.medworm.com/index.php?rid=3305682&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS152586100900471X%2Fabstract%3Frss%3Dyes Introduction/Objective: Nursing's mandate is to provide compassionate care and dignity to persons at the EOL. Approximately, 25% of US deaths occur in nursing homes and the proportion increases with age of residents. The ELNEC Project is a partnership of the City of Hope and the American Association Colleges of Nursing (AACN). ELNEC's Geriatric train-the-trainer program is a synthesis of knowledge in EOL care and teaching methodology to develop expertise and skills for nurses responsible for care of older adults in nursing homes, skilled nursing facilities, hospices, home care, assisted living, etc., as well as in staff education programs. In 2003, Robert Wood Johnson Foundation funded a report, Means to a Better End, grading states on their ability to provide end-of-life care. Most states... Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305682 Thu, 25 Feb 2010 16:11:53 +0100 3305682 http://www.medworm.com/index.php?rid=3305681&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009004708%2Fabstract%3Frss%3Dyes Introduction/Objective: Nursing homes (NH) face many challenges. The frail elderly residents may have potentially treatable conditions like recent decline, medication side-effects, pain, and mood disorders besides acute illness episodes. There is increased expectation from healthcare funders and the public for higher standards of care and more efficient use of resources. Acute hospitals want them to take more complex and sicker patients. Doctors generally are not keen to do NH visits. Those who do provide medical services come from various backgrounds and practices. For several reasons including lack of time and know-how they often focus on acute care. NHs may not be prepared to deal with many of these issues including palliative care for end stage conditions. The author, a community aged ... Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305681 Thu, 25 Feb 2010 16:11:53 +0100 3305681 http://www.medworm.com/index.php?rid=3305680&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009004691%2Fabstract%3Frss%3Dyes Introduction/Objective: Re-hospitalization within 30 days of discharge to skilled rehabilitation facilities is common and occurs in over 20% of cases per CMS. These re-admissions increase cost, prevent functional recovery and are becoming performance indicators. Preventing re-hospitalization is challenging due to the many potential contributing factors that are not well identified. Objective: To conduct a preliminary review of re-hospitalization within 30 days of discharge to one of 3 skilled geriatric rehabilitation units (GRUs) and identify correlates that could be targeted to reduce re-admissions. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305680 Thu, 25 Feb 2010 16:11:53 +0100 3305680 http://www.medworm.com/index.php?rid=3305679&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS152586100900468X%2Fabstract%3Frss%3Dyes Introduction/Objective: Congestive heart failure (CHF) is a common syndrome among skilled nursing facilities (SNF) patients. Exacerbations of CHF leading to hospital admissions are common. We use the case of a 35 pound weight gain in a SNF patient with CHF to illustrate risk factors for CHF exacerbations despite the presence of skilled nursing. The goal of this poster is to highlight the need for standardized care of SNF patients with heart failure such as the DEFEAT protocol. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305679 Thu, 25 Feb 2010 16:11:53 +0100 3305679 http://www.medworm.com/index.php?rid=3305678&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009004678%2Fabstract%3Frss%3Dyes Introduction/Objective: Using the Centers for Medicare and Medicaid Services pressure ulcers guidelines (CMS, 2008), we designed a study to examine attitudes and knowledge of pressure ulcers among health care personnel in hospitals and long-term care facilities. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305678 Thu, 25 Feb 2010 16:11:52 +0100 3305678 http://www.medworm.com/index.php?rid=3305677&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009004666%2Fabstract%3Frss%3Dyes Introduction/Objective: In 2006, the New York Department of Health approved the MOLST form, as an actionable medical order to transition patients through all health care settings statewide. We evaluated the impact of health care providers on MOLST implementation in long term care facilities. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305677 Thu, 25 Feb 2010 16:11:52 +0100 3305677 http://www.medworm.com/index.php?rid=3305676&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009004654%2Fabstract%3Frss%3Dyes The objective of this research was to determine total APAP dose burden from stand-alone orders and combination analgesics in residents with diabetes. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305676 Thu, 25 Feb 2010 16:11:52 +0100 3305676 http://www.medworm.com/index.php?rid=3305675&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009004642%2Fabstract%3Frss%3Dyes Introduction/Objective: Epilepsia partialis continua is a type of focal motor epilepsy characterized by persistent clonic movements of a muscle group with repetition at fairly regular intervals every few seconds, continuing for hours, days, weeks, or months without generalization. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305675 Thu, 25 Feb 2010 16:11:52 +0100 3305675 http://www.medworm.com/index.php?rid=3305674&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009004630%2Fabstract%3Frss%3Dyes Introduction/Objective: For this study a cross-sectional mailed survey to explore next of kin's perspectives on end-of-life care in the nursing home setting was developed. It tested the feasibility of the method in terms of recruitment and response rate, and pilot tested the survey instrument. Decedents who received Hospice services in addition to traditional nursing home care were compared to those who received traditional care alone. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305674 Thu, 25 Feb 2010 16:11:52 +0100 3305674 http://www.medworm.com/index.php?rid=3305673&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009004629%2Fabstract%3Frss%3Dyes Introduction/Objective: The department of geriatric medicine of an acute hospital has been providing regular orthogeriatric services for care of elderly patients with falls and fractures. One of the interventions includes a transfer of selected cases to a new community based step-down ward for optimization of geriatric problems. This 10 bed ward is staffed by senior community family physicians with special training and interest in eldercare and a multidisciplinary team of gerontology-trained nurses and allied health workers. This is a preliminary audit of the outcomes of this ward. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305673 Thu, 25 Feb 2010 16:11:52 +0100 3305673 http://www.medworm.com/index.php?rid=3305672&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009004617%2Fabstract%3Frss%3Dyes Introduction/Objective: To evaluate the feasibility and efficacy of incorporating a consultant pharmacist (CP) into an IDT approach to psychotropic medication reduction and comprehensive care planning for SNF residents receiving psychotropic medications, exhibiting disruptive behaviors, or identified as 'at risk' for undesirable clinical outcomes. All residents of a 150 bed SNF in Hendersonville, NC, receiving psychotropic drugs or identified by facility staff as having or exhibiting weight loss, psychotropic drug use, disruptive behaviors, pressure ulcers, or falls between January 1 and June 30, 2009 had their medical records and care plans reviewed by facility staff in an IDT meeting comprised of a CP, nurse, social worker, dietician, therapy staff and activity staff. The team met twice ... Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305672 Thu, 25 Feb 2010 16:11:52 +0100 3305672 http://www.medworm.com/index.php?rid=3305671&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009004605%2Fabstract%3Frss%3Dyes The objective of this quality improvement project was to determine the impact of a point-of-care handheld charge capture program on the number of charges submitted, payments received, charge lag, and return on investment in a group of long-term care providers. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305671 Thu, 25 Feb 2010 16:11:52 +0100 3305671 http://www.medworm.com/index.php?rid=3305670&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009004599%2Fabstract%3Frss%3Dyes Introduction/Objective: Current ACCP guideline suggests a grade (1A) recommendation for high risk medically ill patients, but its use in clinical practice is unknown. Several studies show a large gap between ideal and real-world practice, despite the theoretical possibility that physician awareness might increase use of VTE prophylaxis. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305670 Thu, 25 Feb 2010 16:11:52 +0100 3305670 http://www.medworm.com/index.php?rid=3305669&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009004587%2Fabstract%3Frss%3Dyes This study was designed to test the theory that in order to improve compliance with diabetic practice guidelines in LTC, providers must be: 1) Educated on the diabetic guidelines; and 2) Given specific recommendations on guideline practice outages for their specific patients utilizing a comprehensive diabetic health risk assessment tool. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305669 Thu, 25 Feb 2010 16:11:52 +0100 3305669 http://www.medworm.com/index.php?rid=3305668&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009004575%2Fabstract%3Frss%3Dyes Introduction/Objective: We are currently evaluating elderly nursing home residents who are on antiepileptic drug (AED) therapy and assessing for a number of problems including depression. This abstract gives an updated report on depression as recorded by the Geriatric Depression Scale (GDS-5) and Depression Rating Scale (DRS). (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305668 Thu, 25 Feb 2010 16:11:52 +0100 3305668 http://www.medworm.com/index.php?rid=3305667&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009004563%2Fabstract%3Frss%3Dyes Introduction/Objective: Background. Increasing numbers of older adults live in assisted living residences (ALRs). Primary care medical practices focusing on the care of older adults who dwell in ALR are developing to meet these patient's special needs. To our knowledge, the types of patients in an ALR medical practice and the use of acute medical care by ALR dwellers have not been previously characterized. Objectives: To characterize the patients participating in an ALR primary care program and their use of acute medical care services. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305667 Thu, 25 Feb 2010 16:11:52 +0100 3305667 http://www.medworm.com/index.php?rid=3305666&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009004551%2Fabstract%3Frss%3Dyes Introduction/Objective: How fictional characters (Medical Director and Interdisciplinary Team) in 3 Nursing Homes determine survey compliance and quality improvement systems, and subsequent consequences. This is based upon a training manual for practical application of regulatory requirements: Surveyor MO for Nutritional Status (Regulation F 325), 2009. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305666 Thu, 25 Feb 2010 16:11:52 +0100 3305666 http://www.medworm.com/index.php?rid=3305665&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS152586100900454X%2Fabstract%3Frss%3Dyes We report a case of Megestrol acetate (MA) use in a NH resident associated with potentially life threatening complications. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305665 Thu, 25 Feb 2010 16:11:52 +0100 3305665 http://www.medworm.com/index.php?rid=3305664&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009004538%2Fabstract%3Frss%3Dyes The objective is description of a medical director's experience with informal interdisciplinary interaction for institutionalization of American Medical Directors Association's (AMDA's) Resolution A06 and Pain Management Clinical Practice Guideline for potential enhancement of compliance with F309 (pain) and F501 in a nursing home with non-academic staff. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305664 Thu, 25 Feb 2010 16:11:52 +0100 3305664 http://www.medworm.com/index.php?rid=3305663&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009004526%2Fabstract%3Frss%3Dyes Introduction/Objective: Contemporary medical practice presents increasing challenges to fundamental provider well-being, often experienced on both personal and professional levels. Failure to institute self-care measures often exacts a significant and sometimes life-threatening toll, suggesting a loss of "balance" which impacts overall quality of life. Thus, an increasing task demand for LTC providers is the development of creative skills and strategies to ensure ongoing job satisfaction, work empowerment, and resiliency, conceptualized as "survival skills for self-preservation." (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305663 Thu, 25 Feb 2010 16:11:51 +0100 3305663 http://www.medworm.com/index.php?rid=3305662&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009004514%2Fabstract%3Frss%3Dyes Introduction/Objective: Tissue load management is essential in preventing and treating pressure ulcers. While repositioning every two hours is the main stay of relieving pressure, different support surfaces (mattress, beds, and overlays) are also used to redistribute body weight over a wider area and help relieve/reduce pressure. There are few accessible materials available to help choose the proper support surface. The goal of this quality improvement project was to develop an algorithm for clinical decision making for support surface selection based on a description of characteristics, costs, and patient-related risk factors, and to perform a pilot project in a single VA nursing home (community living center) to assess the degree to which surfaces being used agreed with the algorithm rec... Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305662 Thu, 25 Feb 2010 16:11:51 +0100 3305662 http://www.medworm.com/index.php?rid=3305661&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009004502%2Fabstract%3Frss%3Dyes Introduction/Objective: Innovation renders hearing aids inconspicuous so they are able to fit small auricular spaces, and have better cosmetic appeal. Long-term care providers strive to augment and correct sensory deficits. Apart from enhancing quality of life, intact hearing helps mitigate risk of delirium and depression. Hearing aids – unlike eyeglasses, are designed to be camouflaged by adaptation to skin color and miniaturization. When fractured, hearing aid parts may get concealed in constricted spaces like the ear canal. Furthermore, earwax can cover and cement broken parts, with potential for complications like otitis or perforation. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305661 Thu, 25 Feb 2010 16:11:51 +0100 3305661 http://www.medworm.com/index.php?rid=3305660&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009004496%2Fabstract%3Frss%3Dyes Introduction/Objective: Published research estimates that 45%-83% of nursing home residents experience pain. However, data suggests that clinicians tend to underestimate pain and often fail to recognize it in some individuals. This may be problematic for some nursing homes because of recently released pain management guidance that provides direction for surveyors known as F-Tag 309. This research was conducted to assess readiness for F-Tag 309 using a survey administered to nursing personnel. This survey was also designed to evaluate current practices related to the key components of pain management. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305660 Thu, 25 Feb 2010 16:11:51 +0100 3305660 http://www.medworm.com/index.php?rid=3305659&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009004484%2Fabstract%3Frss%3Dyes Introduction/Objective: Nursing home medical directors and primary care providers are often called about residents exhibiting rejection of care behaviors. Rejection of care behaviors are among the most difficult and labor-intensive behavioral problems observed in nursing homes (NHs). Such behaviors can strain caregiver and NH resident interaction and frustrate caregivers, leading to reduced interactions, withdrawal from the resident or ongoing confrontation. This strained relationship also frustrates residents and families. We aimed to identify potentially mutable resident-level factors associated with rejection of care. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305659 Thu, 25 Feb 2010 16:11:51 +0100 3305659 http://www.medworm.com/index.php?rid=3305658&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009004472%2Fabstract%3Frss%3Dyes Introduction/Objective: The use of restraints in long term care was reduced extensively over the last two decades. The process has been evolving to restraint free environments for residents and to the use of alternatives in long term care. Restraints are still used frequently and readily in the acute care setting. Few studies exist about the attitudes of providers toward the use of restraints. Most of the literature about attitudes exists in the nursing realm despite the fact that orders from physicians are required by law for use of the devices or chemicals. There are many references in the literature to legal disputes but few qualitative studies concerning education of providers. The lack of literature suggests that there is a need for provision of education to providers about this impor... Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305658 Thu, 25 Feb 2010 16:11:51 +0100 3305658 http://www.medworm.com/index.php?rid=3305657&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009004460%2Fabstract%3Frss%3Dyes Introduction/Objective: Fraser Health serves a population of 2.6 million with 8,000 nursing home residents. The study presents detailed information on unscheduled transfers from nursing homes to the local hospital emergency departments and ascertains opportunities to decrease the number of transfers. It will form the basis for ideal target rate for transfers and be a performance indicator for facilities. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305657 Thu, 25 Feb 2010 16:11:51 +0100 3305657 http://www.medworm.com/index.php?rid=3305656&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009004459%2Fabstract%3Frss%3Dyes Introduction/Objective: With the growth of the aging population, providing care services for this segment of the population has become popular. The U-care project is an innovative model of care services for the aged in the Chang Gung Health and Culture Village, in coordination with the Chang Gung Memorial Hospital, the Chang Gung University, and the Ministry of Economic Affairs of ROC, Taiwan. Through the use of information technology, the U-care project aims to build a healthy, dignified, and happy environment for the aged as well as to slow the aging process and decrease illness, thus improving their quality of life. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305656 Thu, 25 Feb 2010 16:11:51 +0100 3305656 http://www.medworm.com/index.php?rid=3305655&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009004447%2Fabstract%3Frss%3Dyes Introduction/Objective: Pain management for older adults in long-term care (LTC) has been recognized as a national and international problem. Untreated pain can lead to depression, loneliness, impaired mobility, sleep disturbances, and decreased quality of life. The purpose of this study was to develop an interdisciplinary approach to improve pain management in long-term care (LTC) in light of the barriers and facilitators that exist within the current system. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305655 Thu, 25 Feb 2010 16:11:51 +0100 3305655 http://www.medworm.com/index.php?rid=3305654&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009004435%2Fabstract%3Frss%3Dyes Introduction/Objective: The purpose of this study was to characterize after hours telephone communications with health care providers in community-based nursing homes (NH's), including skilled nursing facilities (SNF's) as well as assisted living facilities (AL's) in metropolitan San Antonio. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305654 Thu, 25 Feb 2010 16:11:51 +0100 3305654 http://www.medworm.com/index.php?rid=3305653&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009004423%2Fabstract%3Frss%3Dyes Introduction/Objective: Extended care facility (ECF) patients who transfer to emergency departments can pose problems when complicated health problems require extra resources, without easy resolution. Higher numbers of older patients are projected to use emergency departments, so health researchers recommend that health care professionals prepare for an increasing aging population who may present with multiple special needs. Our aim was to solicit views and opinions of emergency department personnel about key issues related to emergency care of ECF residents and to identify top problems to explore possible solutions and plan for the future. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305653 Thu, 25 Feb 2010 16:11:51 +0100 3305653 http://www.medworm.com/index.php?rid=3305652&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861010000538%2Fabstract%3Frss%3Dyes (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305652 Thu, 25 Feb 2010 16:11:51 +0100 3305652 http://www.medworm.com/index.php?rid=3305651&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861010000526%2Fabstract%3Frss%3Dyes (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305651 Thu, 25 Feb 2010 16:11:51 +0100 3305651 http://www.medworm.com/index.php?rid=3305650&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009004204%2Fabstract%3Frss%3Dyes To the Editor: The Department of Elder Affairs is responsible for administering human service programs for the elderly population in an effort to try to help them keep their self-sufficiency and self-determination in all possible ways. These services include case management, home-delivered meals, adult day care, caregiver support and training, medical equipment and supplies, respite care, assisted living, and many others. It is estimated that more than 20% of the US population is now 60 years of age and older. As baby boomers continue to age, this percentage is expected to rise. Some individuals suffer from chronic conditions that began long before they reach age 60, whereas others may be able to live their entire lives without needing long-term medical or social services. However, some c... Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305650 Thu, 25 Feb 2010 16:11:50 +0100 3305650 http://www.medworm.com/index.php?rid=3305649&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009004149%2Fabstract%3Frss%3Dyes To the Editor: A startling trend in the US population threatens the quality of care available in the long-term care setting. The proportion of nursing home residents who are obese (body mass index > 30) is increasing and now represents approximately 25% of the US nursing home population. Obese residents require specialized bariatric equipment and supplies, which are costly and unavailable in many facilities, and extensive personal care assistance to perform activities of daily living. These equipment and staffing needs present significant challenges for nursing homes now and in the future as the US population ages. This problem is exacerbated in an economic context because, unlike costs, daily reimbursement rates do not vary systematically with size of the resident. (Source: Journal of th... Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305649 Thu, 25 Feb 2010 16:11:50 +0100 3305649 http://www.medworm.com/index.php?rid=3305646&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009002904%2Fabstract%3Frss%3Dyes Conclusions: The uncertainty over the appropriateness of EBM for the nursing home patient has led to a widespread bias toward undertreatment that has reached alarming proportions. It is true that most elderly patients do not wish to extend their life expectancy, but most do wish to avoid medical complications and unnecessary hospitalizations. Rejecting treatments that extend life expectancy often results in rejection of the very treatments that would improve the probability of achieving their wish to retain fair health. Practitioners do not reject meaningful treatments because of lack of knowledge or lack of concern. They do so because of an incomplete education regarding the biases and cognitive pitfalls that are encountered when planning care for the elderly. (Source: Journal of the Amer... Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305646 Thu, 25 Feb 2010 16:11:48 +0100 3305646 http://www.medworm.com/index.php?rid=3305642&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009005180%2Fabstract%3Frss%3Dyes While many aspects of nursing home care have improved over time, numerous issues persist. Presently, a potpourri of approaches and a push to “fix” the problem have overshadowed efforts to correctly define the problems and identify their diverse causes.This fourth and final article in the series (divided between last month's issue and this one) recommends strategies to make sense of improvement and reform efforts. This month's concluding segment covers additional proposed approaches. Despite the challenges of the current environment, all of the proposed strategies could potentially be applied with little or no delay.Despite having brought vast increases in knowledge, the research effort may be losing its traction as a formidable force for meaningful change. It is necessary to rethink th... Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305642 Thu, 25 Feb 2010 16:11:48 +0100 3305642 http://www.medworm.com/index.php?rid=3305641&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861010000344%2Fabstract%3Frss%3Dyes The article by Barbara Zarowitz and colleagues on the risk of venous thromboembolism (VTE) in long-term care (LTC) is a brave attempt to stratify thrombotic risk in LTC. Their systematic review of more than 8 years of data identified a total of 1165 publications relating to VTE and immobility. Rating these publications according to accepted quality criteria resulted in selection of 4 articles relating to thrombotic risk, and 1 article (1 of these 4, actually) relating to immobility. Eight mobility-related statements and 30 VTE risk statements were derived from these articles. The authors' final recommendations (reached by modified Delphi method of analysis of the mobility and VTE risk statements) include baseline thrombotic risk screening on admission; prophylaxis for up to 35 days if high... Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305641 Thu, 25 Feb 2010 16:11:48 +0100 3305641 http://www.medworm.com/index.php?rid=3305640&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009005234%2Fabstract%3Frss%3Dyes Dr Levenson's 5-article treatise on improving and reforming health care is a call to action for all health care professionals committed to nursing home (NH) practice. Dr Levenson has laid bare many of our current administrative, regulatory, and clinical practices and processes, calling for approaches that are truly evidence based and person centered. Dr Levenson admonishes us to eschew fragmentated care and to reward those holistic approaches that are evidenced by “flexibility, comprehensiveness, and sensitivity.”p600 In addition, we are encouraged to critically evaluate extant quality metrics upon which we are currently judged. Overemphasizing outcomes at the expense of processes of care may not be the optimum approach to improving quality of care. (Source: Journal of the American Me... Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305640 Thu, 25 Feb 2010 16:11:48 +0100 3305640 http://www.medworm.com/index.php?rid=3305638&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009005179%2Fabstract%3Frss%3Dyes “A man is as old as his arteries.”Thomas Sydenham17th century physician The reason to have experts in geriatrics and certified medical directors is, in part, because we understand that an 80-year-old frail nursing home resident often does not need the same aggressive medication as a young person. Polypharmacy is a geriatric syndrome where decreasing rather than increasing medications is likely to improve outcomes. Decreased physiological reserve in older persons makes them particularly at danger of developing side effects to drugs. Frail older persons are particularly vulnerable to the side effects of overtreatment of hypertension. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305638 Thu, 25 Feb 2010 16:11:48 +0100 3305638 http://www.medworm.com/index.php?rid=3305648&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009004095%2Fabstract%3Frss%3Dyes Conclusions: A risk stratification tool for VTE and immobility was developed to assist clinicians in caring for residents of LTC facilities. A prospective trial is needed to validate the tool. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305648 Mon, 08 Feb 2010 00:00:00 +0100 3305648 http://www.medworm.com/index.php?rid=3305644&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009005192%2Fabstract%3Frss%3Dyes Conclusion: This study in muscle-wasted COPD patients with moderate airflow obstruction shows a prolonged positive response to nutritional support integrated in a community-based rehabilitation program. Clinical trial.gov: NCT00840892. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305644 Mon, 08 Feb 2010 00:00:00 +0100 3305644 http://www.medworm.com/index.php?rid=3226905&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861010000125%2Fabstract%3Frss%3Dyes (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3226905 Mon, 01 Feb 2010 00:00:00 +0100 3226905 http://www.medworm.com/index.php?rid=3226904&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861010000113%2Fabstract%3Frss%3Dyes (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3226904 Mon, 01 Feb 2010 00:00:00 +0100 3226904 http://www.medworm.com/index.php?rid=3226903&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861010000101%2Fabstract%3Frss%3Dyes (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3226903 Mon, 01 Feb 2010 00:00:00 +0100 3226903 http://www.medworm.com/index.php?rid=3226902&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861010000095%2Fabstract%3Frss%3Dyes (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3226902 Mon, 01 Feb 2010 00:00:00 +0100 3226902 http://www.medworm.com/index.php?rid=3226901&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861010000083%2Fabstract%3Frss%3Dyes (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3226901 Mon, 01 Feb 2010 00:00:00 +0100 3226901 http://www.medworm.com/index.php?rid=3305647&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009003016%2Fabstract%3Frss%3Dyes Conclusion: Nurses and medical providers from both emergency and NH settings agree that transitional communication is poor between NHs and EDs and support a role for verbal communication during the ED transitions of care of NH residents. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305647 Mon, 18 Jan 2010 00:00:00 +0100 3305647 http://www.medworm.com/index.php?rid=3305645&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS152586100900276X%2Fabstract%3Frss%3Dyes Conclusion: In healthy elderly people relatively large amounts of fat increase the satiety signal from GLP-1 and lower the acylated to desacylated ratio of ghrelin, consequently decreasing hunger. This condition may lead to a reduction in calorie intake. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305645 Mon, 18 Jan 2010 00:00:00 +0100 3305645 http://www.medworm.com/index.php?rid=3305643&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009001996%2Fabstract%3Frss%3Dyes This article identifies and explores the institutional, staff, patient and medication-related factors that contribute to the complexity of delivering optimal diabetes care in the LTC setting, and focuses on how insulin analogs, and the pens used for their delivery, can simplify and improve care delivery while, in many cases, reducing institutional costs. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305643 Mon, 18 Jan 2010 00:00:00 +0100 3305643 http://www.medworm.com/index.php?rid=3305639&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009003028%2Fabstract%3Frss%3Dyes This study, in conjunction with others, contributes significantly to our pool of knowledge about anorexia of aging, an area that remains substantially poorly studied. Nonetheless, a number of issues related to definition of secondary anorexia and possible interventions for elderly subjects with anorexia need to be addressed. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3305639 Mon, 18 Jan 2010 00:00:00 +0100 3305639 http://www.medworm.com/index.php?rid=3226898&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009004101%2Fabstract%3Frss%3Dyes Conclusions: Functional recovery patterns in elderly hip fracture patients are heterogeneous. To foster functional independence, health care professionals should consider individual recovery trajectories using a modeling approach appropriate for longitudinal or repeated measurement data such as a linear mixed-effects model when designing individualized rehabilitation and postacute rehabilitation care plans. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3226898 Mon, 18 Jan 2010 00:00:00 +0100 3226898 http://www.medworm.com/index.php?rid=3226892&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009001595%2Fabstract%3Frss%3Dyes Contractures represent a common but preventable source of excess disability among nursing home residents. They result in many negative consequences such as pain, increased fall risk and decreased functional ability. Studies of prevalence vary in the definition of contracture and thus the exact enumeration, but consistently report the commonality in the nursing home setting. In this population, the clinician should focus on tertiary prevention and/or treatment. Methods such as those consistent with restorative care nursing have shown improvement in function and are a reasonable recommendation as a preventive measure for contractures. Assessment, prevention, and treatment approaches are discussed. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3226892 Mon, 18 Jan 2010 00:00:00 +0100 3226892 http://www.medworm.com/index.php?rid=3226900&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009004009%2Fabstract%3Frss%3Dyes Monday morning at We Care Assisted Living Facility, Nursing Supervisor Gail Jones is being bombarded with the usual onslaught of requests: the new Admissions intern wants to know how to explain to a family the difference between dementia and delirium; HR is asking if she knows an easy way to explain “time management” to a new aide whose first language is not English; the Resident Safety coordinator wants help preparing a hand-out for tomorrow's committee meeting…. Being called upon to be the resident “expert” in so many areas can be daunting! Fortunately, Ms Jones can confidently turn to her copy of Assisted Living Nursing: A Manual for Management and Practice knowing that she can quickly find accurate and useful information to help her coworkers. (Source: Journal of the American... Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3226900 Wed, 13 Jan 2010 00:00:00 +0100 3226900 http://www.medworm.com/index.php?rid=3226897&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009004071%2Fabstract%3Frss%3Dyes Conclusion: Clinicians may have a seasonal bias, favoring testing for vitamin D status in the latter part of the year even though the lowest vitamin D levels are observed in the first part of the year. Although an argument could be made to check for peak 25(OH) vitamin D levels in September and trough levels in March, the seasonal contribution to vitamin D deficiency is overshadowed by ongoing vitamin D deficiency throughout the year. Thus, it may be prudent to test for vitamin D deficiency in patients presenting with fatigue, myalgias, and arthralgias regardless of the season of presentation. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3226897 Wed, 13 Jan 2010 00:00:00 +0100 3226897 http://www.medworm.com/index.php?rid=3226896&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009003673%2Fabstract%3Frss%3Dyes Conclusion: APs appear to increase the risk of hip fracture among older adults with dementia residing in an NH. Hip fractures may be a contributory mechanism to the increased risk mortality observed among AP users. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3226896 Wed, 13 Jan 2010 00:00:00 +0100 3226896 http://www.medworm.com/index.php?rid=3226891&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009004083%2Fabstract%3Frss%3Dyes The use of cameras in medical care and teaching is not new. There is a long history of videotaping surgical procedures and of dermatologists and pathologists photographing lesions and specimens. Good textbooks are replete with gross and microscopic photos as well as pictures of x-rays (photos of photos in a sense), EKGs, and so on. However, these generally involved significant amounts of equipment and often a considerable professional expertise. At the minimum they required toting about a Polaroid camera and the photos themselves. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3226891 Wed, 13 Jan 2010 00:00:00 +0100 3226891 http://www.medworm.com/index.php?rid=3226890&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009004125%2Fabstract%3Frss%3Dyes While many aspects of nursing home care have improved over time, numerous issues persist. Presently, a potpourri of approaches and a push to “fix” the problem have overshadowed efforts to correctly define the issues and identify their diverse causes.Together, the two segments of this fourth and final article (divided between this month's issue and the next one) in the series identify strategies that should tie reform efforts together. This Segment 1 of Article 4 discusses the need to judge initiatives and proposals by how well they support and/or promote critical elements such as the care delivery process and clinical problem solving and decision making activities. It also covers the need to critically scrutinize and modify the conventional wisdom and to suppress “political correctne... Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3226890 Wed, 13 Jan 2010 00:00:00 +0100 3226890 http://www.medworm.com/index.php?rid=3226889&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009004162%2Fabstract%3Frss%3Dyes Falls are the major reason for lawsuits in the nursing home. This is mainly because they lead to hip fractures and other injuries. Ninety percent of hip fractures occur in persons who fall. The causes of fragility fractures are a result of loss of bone, a decline in bone strength, and an increase in falls (). Persons with weight loss, sarcopenia, and frailty are particularly vulnerable to fracturing a hip. This issue of the Journal focuses on hip fractures. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3226889 Wed, 13 Jan 2010 00:00:00 +0100 3226889 http://www.medworm.com/index.php?rid=3226899&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009002527%2Fabstract%3Frss%3Dyes Conclusions: Elders living in assisted living facilities had significantly lower 25-OH vitamin D levels and walked shorter distances during the 6-minute walk. These variables can be used to predict the probability of an elder living in an assisted living facility. The lack of effect of nutrition suggests that the role of vitamin D in this setting is in physical function. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3226899 Wed, 06 Jan 2010 00:00:00 +0100 3226899 http://www.medworm.com/index.php?rid=3226895&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009002564%2Fabstract%3Frss%3Dyes Conclusions: Our study suggests no difference in HFx-adjusted mortality rates between the VHA and Medicare facilities. Given the institutional factor differences between Medicare and the VHA, future study and comparison of health outcomes for nursing home HFx patients and related costs between these two health care programs may contribute to the on-going health care reform debate. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3226895 Wed, 06 Jan 2010 00:00:00 +0100 3226895 http://www.medworm.com/index.php?rid=3226894&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009003466%2Fabstract%3Frss%3Dyes Conclusion: Efforts to increase adherence to the use of HPs should focus on facilities with more Medicaid case-mix to reduce disparities in care, and those that have less of a culture of training. Staff may need support to increase adherence, and when adherence cannot be maintained, HP use should be targeted to those who remain adherent. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3226894 Wed, 06 Jan 2010 00:00:00 +0100 3226894 http://www.medworm.com/index.php?rid=3226893&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009003041%2Fabstract%3Frss%3Dyes Conclusion: In spite of worse physiological and IADL impairments, once the women recovered from hip fracture surgery, they did not necessarily use more health care resources than non–hip fracture patients. To prevent functional deterioration, interventions need to focus on knee strength and mobility training. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3226893 Wed, 06 Jan 2010 00:00:00 +0100 3226893 http://www.medworm.com/index.php?rid=3148305&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009004290%2Fabstract%3Frss%3Dyes (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3148305 Fri, 01 Jan 2010 00:00:00 +0100 3148305 http://www.medworm.com/index.php?rid=3148304&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009004289%2Fabstract%3Frss%3Dyes (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3148304 Fri, 01 Jan 2010 00:00:00 +0100 3148304 http://www.medworm.com/index.php?rid=3148303&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009004277%2Fabstract%3Frss%3Dyes (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3148303 Fri, 01 Jan 2010 00:00:00 +0100 3148303 http://www.medworm.com/index.php?rid=3148302&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009004265%2Fabstract%3Frss%3Dyes (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3148302 Fri, 01 Jan 2010 00:00:00 +0100 3148302 http://www.medworm.com/index.php?rid=3148301&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009004253%2Fabstract%3Frss%3Dyes (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3148301 Fri, 01 Jan 2010 00:00:00 +0100 3148301 http://www.medworm.com/index.php?rid=3148300&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009002977%2Fabstract%3Frss%3Dyes During the past several presidential terms, important ethical issues have been raised and vigorously discussed in the media. The most controversial of these topics include abortion, artificial reproduction, stem cell research, and health care reform. The Penn Center for Bioethics at the University of Pennsylvania in Philadelphia has created a textbook that serves as a guide to ethics in the current era of politically influenced health care decision making. This university is a pioneer in the teaching of medical ethics and this work reflects their ongoing dedication to the field. The Penn Center Guide to Bioethics provides an introduction to the principles of bioethics, an overview of traditional ethical issues, and a discussion of emerging ethical dilemmas. This text highlights the key poi... Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3148300 Fri, 01 Jan 2010 00:00:00 +0100 3148300 http://www.medworm.com/index.php?rid=3148299&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009003296%2Fabstract%3Frss%3Dyes To the Editor: We appreciate Drs Rozzini and Trabucchi raising some of the questions we often hear from skeptics of the culture change movement, and are grateful to have the opportunity to respond. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3148299 Fri, 01 Jan 2010 00:00:00 +0100 3148299 http://www.medworm.com/index.php?rid=3148298&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009003284%2Fabstract%3Frss%3Dyes To the Editor: We read with interest the article by White-Chu et al on the cultural revolution in long-term care (LTC). We express some doubts on their optimistic approach to the revolution in LTC; in particular, we would be more prudent in the emphatic use of this word, reminiscent of errors performed to change human condition. The respect for the dignity of elderly persons does not belong to a peculiar vision of caring, but should naturally belong to any act directed to frail persons. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3148298 Fri, 01 Jan 2010 00:00:00 +0100 3148298 http://www.medworm.com/index.php?rid=3148297&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009001133%2Fabstract%3Frss%3Dyes This article discusses (1) prevention of recurrent aspiration events caused by 2 common motility disorders: neurogenic dysphagia and gastro esophageal reflux; (2) mechanical source control (debridement/drainage) of sites that may harbor large collections of bacteria protected from antibiotics in biofilm including dental plaque, coated tongue, and chronic sinusitis. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3148297 Fri, 01 Jan 2010 00:00:00 +0100 3148297 http://www.medworm.com/index.php?rid=3148294&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009002539%2Fabstract%3Frss%3Dyes Conclusion: Most respondents reported decision making with a doctor about life-sustaining treatments, but those decisions were not consistently heeded. Being older and living in a NH were risk factors for decisions not being heeded. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3148294 Fri, 01 Jan 2010 00:00:00 +0100 3148294 http://www.medworm.com/index.php?rid=3148286&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009004022%2Fabstract%3Frss%3Dyes This article intends to point out the ability of current screening tools to detect MCI and dementia, and to summarize 3 aspects of these conditions: prognosis, diagnosis, and treatment, in the community as well as nursing home settings. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3148286 Fri, 01 Jan 2010 00:00:00 +0100 3148286 http://www.medworm.com/index.php?rid=3148296&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009003272%2Fabstract%3Frss%3Dyes Conclusion: MDS immunization data can be used as surveillance to work with states to improve coverage. Further research to examine racial disparities in vaccination among LTC residents is needed. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3148296 Fri, 11 Dec 2009 00:00:00 +0100 3148296 http://www.medworm.com/index.php?rid=3148295&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009002758%2Fabstract%3Frss%3Dyes Objective: To determine the demographic and clinical predictors of in-hospital mortality among hospitalized nursing home (NH) residents.Design: Retrospective analysis of the public-use copies of the 2005–2006 National Hospital Discharge Survey (NHDS) datasets.Setting: Non-federal acute-care, short-stay hospitals in all 50 states and the District of Columbia.Participants: Participants were 1904 and 1752 NH residents, 45 years or older, hospitalized in 2005 and 2006, respectively.Measurements: In-hospital mortality.Methods: A multivariable logistic regression model was developed to determine independent predictors of in-hospital mortality using the 2005 dataset. The model was then applied to the 2006 dataset to determine the generalizability of the predictors.Results: Significant independe... Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3148295 Thu, 26 Nov 2009 00:00:00 +0100 3148295 http://www.medworm.com/index.php?rid=3148292&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009003478%2Fabstract%3Frss%3Dyes Conclusion: No significant modifications in physical performance and muscle strength were reported after 6 months of fosinopril use in older persons with high cardiovascular risk profile. Given these negative findings, it is possible that the beneficial effects of ACE inhibitors on physical function might be attributable to the activation of a virtuous cycle determined by an improved cardiovascular system. Further specifically designed studies are needed to confirm our findings, and expand them to different populations and ACE inhibitors. If our findings will be confirmed, the extracardiovascular properties of ACE inhibitors in older persons might be substantially resized. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3148292 Thu, 26 Nov 2009 00:00:00 +0100 3148292 http://www.medworm.com/index.php?rid=3148291&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009002588%2Fabstract%3Frss%3Dyes Conclusion: The perception that home health services before death did not meet the decedent's needs may contribute to greater nursing home use. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3148291 Thu, 26 Nov 2009 00:00:00 +0100 3148291 http://www.medworm.com/index.php?rid=3148290&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009001364%2Fabstract%3Frss%3Dyes Nutritional problems are frequent in nursing homes including undernutrition, obesity, and diabetes mellitus, mainly related to disability and behavior troubles. Adequate nutritional care relies both on the quality of menus for regular and modified diet (texture-modified and enriched food) and on the staff knowledge of nutritional problems, particularly undernutrition. Self-assessment of professional practices for all staff categories that are involved in this area can be used to increase training of staff and quality of nutritional care. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3148290 Thu, 26 Nov 2009 00:00:00 +0100 3148290 http://www.medworm.com/index.php?rid=3148288&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009003090%2Fabstract%3Frss%3Dyes The study by Dr Biola et al is one of those good-news-bad-news pieces that certainly points out some areas for growth and improvement, while on a positive note demonstrating that both skilled nursing facilities and assisted living facilities are doing a decent job of at least discussing residents' preferences with respect to end-of-life care and life-sustaining treatment (LST). Although this study is of limited scope with about 300 residents from a small sample of facilities in 4 states, there are lessons to be learned from its results. Perhaps most importantly, this work highlights the need for improved processes to ensure that we do indeed provide care that is in keeping with our patients' wishes. We should also be cautious when we use the words “life-sustaining treatment” because t... Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3148288 Thu, 26 Nov 2009 00:00:00 +0100 3148288 http://www.medworm.com/index.php?rid=3148287&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009003077%2Fabstract%3Frss%3Dyes Given the inevitability and importance of death, it may seem obvious that we, as individuals and societies, should all be planning for it. However, a laissez-faire approach is all too common. If this approach made no difference, or improved the outcome, such blithe nonchalance could be justified. But the end result is, all too often, death in an institutional setting. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3148287 Thu, 26 Nov 2009 00:00:00 +0100 3148287 http://www.medworm.com/index.php?rid=3148289&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009004010%2Fabstract%3Frss%3Dyes We offer this brief report to inform other nursing home medical directors and attending physicians of a possible change in the profile of persons susceptible to H1N1 influenza. If a significant number of cases appear in older persons, the recommendations for H1N1 vaccination may need to be changed to include the elderly. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3148289 Mon, 23 Nov 2009 00:00:00 +0100 3148289 http://www.medworm.com/index.php?rid=3148293&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009002503%2Fabstract%3Frss%3Dyes Conclusions: In this representative sample of 794 US NH residents, 50% had clinical evidence of CKD. Patients with CKD, particularly those at later stages, were more likely to have cardiovascular comorbidities and anemia. The co-occurrence of these conditions in institutionalized populations may have important implications for the clinical management of this patient population, particularly as it relates to the potential for further renal complications. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=3148293 Mon, 09 Nov 2009 00:00:00 +0100 3148293 http://www.medworm.com/index.php?rid=2950065&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009003570%2Fabstract%3Frss%3Dyes (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=2950065 Sun, 01 Nov 2009 00:00:00 +0100 2950065 http://www.medworm.com/index.php?rid=2950064&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009003557%2Fabstract%3Frss%3Dyes (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=2950064 Sun, 01 Nov 2009 00:00:00 +0100 2950064 http://www.medworm.com/index.php?rid=2950063&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009003569%2Fabstract%3Frss%3Dyes (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=2950063 Sun, 01 Nov 2009 00:00:00 +0100 2950063 http://www.medworm.com/index.php?rid=2950062&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009003545%2Fabstract%3Frss%3Dyes (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=2950062 Sun, 01 Nov 2009 00:00:00 +0100 2950062 http://www.medworm.com/index.php?rid=2950061&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009003533%2Fabstract%3Frss%3Dyes (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=2950061 Sun, 01 Nov 2009 00:00:00 +0100 2950061 http://www.medworm.com/index.php?rid=2950060&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009003764%2Fabstract%3Frss%3Dyes (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=2950060 Sun, 01 Nov 2009 00:00:00 +0100 2950060 http://www.medworm.com/index.php?rid=2950059&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009003752%2Fabstract%3Frss%3Dyes (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=2950059 Sun, 01 Nov 2009 00:00:00 +0100 2950059 http://www.medworm.com/index.php?rid=2950058&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009002928%2Fabstract%3Frss%3Dyes We report our experience with the recent use of glargine in older diabetic patients and the development of persistent and intractable hypoglycemia, including delayed recovery; the presentations varied markedly. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=2950058 Sun, 01 Nov 2009 00:00:00 +0100 2950058 http://www.medworm.com/index.php?rid=2950056&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009002217%2Fabstract%3Frss%3Dyes Conclusion: These findings are thought to be important and of benefit for health care professionals and caregivers as indicating the areas that need to be supported for the elderly living at home (functional mobility and independence) and in the nursing home (depressive symptoms and quality of life). (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=2950056 Sun, 01 Nov 2009 00:00:00 +0100 2950056 http://www.medworm.com/index.php?rid=2950054&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009002965%2Fabstract%3Frss%3Dyes Conclusion: Vitamin D levels were measured infrequently in long-term care patients. Among those monitored, the rate of vitamin D deficiency/insufficiency is high. Few patients with low vitamin D status received proper treatment and follow-up. These data support the need to educate physicians regarding the high prevalence of vitamin D insufficiency/deficiency among long-term care patients to ensure that patients with low vitamin D levels are identified and treated appropriately. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=2950054 Sun, 01 Nov 2009 00:00:00 +0100 2950054 http://www.medworm.com/index.php?rid=2950047&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009001765%2Fabstract%3Frss%3Dyes Erythropoiesis-stimulating agents (ESAs) have been in use for 2 decades. After the initial introduction for their use in anemia of end-stage renal disease, indications for the use of ESAs have widened to anemia of predialysis chronic kidney disease, cancer chemotherapy, HIV disease and orthopedic surgery. Along with the considerable benefits associated with the use of ESAs, adverse events have become apparent, in large part from overcorrection of the anemia. Data from recent studies have prompted several FDA warnings imposing the health provider to follow stringent criteria for the use of ESAs; these include close follow-up of patients, along with use of specific laboratory tests and criteria for dosing. Although adverse effects may partly relate to misuse, when appropriately administered,... Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=2950047 Sun, 01 Nov 2009 00:00:00 +0100 2950047 http://www.medworm.com/index.php?rid=2950045&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009002606%2Fabstract%3Frss%3Dyes Dr. Ouslander and colleagues' study in this issue is on a subject near and dear to all of our hearts in long-term care; namely, how to reduce unnecessary hospitalizations and emergency department (ED) visits for the residents under our care. I use the term apple pie because (like Mom and God) everybody loves it: Truly, what's not to love about helping avoid transfer trauma, pressure ulcers from lying on a gurney in the emergency room for 12 hours, delirium in an otherwise reasonably well-compensated dementia patient, often unnecessary and ill-advised treatments and medications, IV and Foley catheter placement, and all of those other nasty eventualities that often befall our patients when they get sent to the acute care hospital? The problem is that nobody really knows the right recipe for ... Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=2950045 Sun, 01 Nov 2009 00:00:00 +0100 2950045 http://www.medworm.com/index.php?rid=2950044&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009002497%2Fabstract%3Frss%3Dyes Interventions to reduce the risk of falls have a long history in geriatrics and gerontology. This concern is appropriate because falls remain a central problem in geriatric management and a key threat to health and function for older adults. Often-cited statistics show how difficult it is to avoid falls. About a third of people older than 65 fall each year, about half of people older than 80, about half of nursing home residents, and more than half of people older than 90. Falls remain a major risk factor for nursing home admission, injuries and emergency department admissions, hip fracture, and death. Hospital stays are longer for people admitted because of falls, and thus falls are costly. Not surprisingly, falling is a marker of frailty and is associated with functional decline. Critica... Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=2950044 Sun, 01 Nov 2009 00:00:00 +0100 2950044 http://www.medworm.com/index.php?rid=2950043&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009002990%2Fabstract%3Frss%3Dyes Nearly 3 years ago, in an editorial in the Journal, we asked “Should all long-term care residents receive vitamin D?” In this issue, Braddy et al address this question in a Department of Veterans Affairs long-term care population. They found that 51% of the residents had values less than 30 ng/dL. Based on these findings we would suggest that all nursing home residents need to have a 25(OH) vitamin D level measured before being treated. Other studies published in the Journal have confirmed the high prevalence of vitamin D deficiency in nursing homes. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=2950043 Sun, 01 Nov 2009 00:00:00 +0100 2950043 http://www.medworm.com/index.php?rid=2950055&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009003004%2Fabstract%3Frss%3Dyes Conclusion: The oral care educational program did not result in improvement in the delivery of routine oral care to nursing home residents. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=2950055 Mon, 12 Oct 2009 00:00:00 +0100 2950055 http://www.medworm.com/index.php?rid=2950053&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009002485%2Fabstract%3Frss%3Dyes Conclusion: The quality improvement strategies and tools tested in this pilot project show promise for assisting NHs in reducing potentially avoidable hospitalizations. The results must be interpreted cautiously because this was not a controlled study, and was conducted in only 3 highly selected NHs. Refinement of the tools and implementation strategies and testing in a larger and more diverse sample of NHs is under way. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=2950053 Mon, 12 Oct 2009 00:00:00 +0100 2950053 http://www.medworm.com/index.php?rid=2950052&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009002473%2Fabstract%3Frss%3Dyes Conclusions: NH ADs felt more prepared to evacuate their residents for Gustav, owing partly to improved communication and collaboration with state agencies; however, significant morbidity and logistical problems remain with evacuating frail NH residents before hurricanes. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=2950052 Mon, 12 Oct 2009 00:00:00 +0100 2950052 http://www.medworm.com/index.php?rid=2950051&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS152586100900245X%2Fabstract%3Frss%3Dyes Conclusion: The results of this survey demonstrate that although direct verbal communication is not the norm, communication via paper documentation of transfer information is highly common. There was a statistically significantly increased likelihood of the SNF receiving the discharge/transfer sheet and the last medication list when it was directly affiliated with the transferring hospital. These affiliations would increase as a result of proposed payment changes that would bundle Medicare Part A acute hospital payments with the SNF payment. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=2950051 Mon, 12 Oct 2009 00:00:00 +0100 2950051 http://www.medworm.com/index.php?rid=2950050&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861009002436%2Fabstract%3Frss%3Dyes Conclusion: Behavioral treatment of risk factors related to falls within a structured delivery using Internet-based intervention may be an effective and efficient mechanism for treating fall risk in long-term care settings. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=2950050 Mon, 12 Oct 2009 00:00:00 +0100 2950050