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. Thu, 09 Feb 2012 10:13:01 +0100 http://www.medworm.com/index.php?rid=5623803&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861012000084%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=5623803 Tue, 24 Jan 2012 15:20:44 +0100 5623803 http://www.medworm.com/index.php?rid=5623802&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861012000072%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=5623802 Tue, 24 Jan 2012 15:20:44 +0100 5623802 http://www.medworm.com/index.php?rid=5623801&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861012000060%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=5623801 Tue, 24 Jan 2012 15:20:44 +0100 5623801 http://www.medworm.com/index.php?rid=5623800&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861012000059%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=5623800 Tue, 24 Jan 2012 15:20:44 +0100 5623800 http://www.medworm.com/index.php?rid=5623799&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861012000047%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=5623799 Tue, 24 Jan 2012 15:20:44 +0100 5623799 http://www.medworm.com/index.php?rid=5556228&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011004014%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=5556228 Sun, 01 Jan 2012 05:00:00 +0100 5556228 http://www.medworm.com/index.php?rid=5556227&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011004002%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=5556227 Sun, 01 Jan 2012 05:00:00 +0100 5556227 http://www.medworm.com/index.php?rid=5556226&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011003999%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=5556226 Sun, 01 Jan 2012 05:00:00 +0100 5556226 http://www.medworm.com/index.php?rid=5556225&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011003987%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=5556225 Sun, 01 Jan 2012 05:00:00 +0100 5556225 http://www.medworm.com/index.php?rid=5556224&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011003975%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=5556224 Sun, 01 Jan 2012 05:00:00 +0100 5556224 http://www.medworm.com/index.php?rid=5623771&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011003926%2Fabstract%3Frss%3Dyes Falls represent one of the most common harmful occurrences in nursing homes, and injurious falls account for approximately 60% of all liability cases filed against nursing homes. Persons in nursing homes fall three times more frequently than persons living in the community. There are approximately 1.7 (0.6–3.6) falls per nursing home bed per year. Falls are the major cause of hip fractures, head trauma, lacerations, other fractures, and soft tissue injuries. As we age, falls are inevitable; therefore, our goals are to decrease the number of falls and prevent injuries where possible. Among nursing home residents, rates of hip fracture can be as high as 6.2% in women and 4.9% in men. The cost of falls in the United States is estimated to be $40 billion by 2020. Although single intervention... Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=5623771 Thu, 15 Dec 2011 05:00:00 +0100 5623771 http://www.medworm.com/index.php?rid=5556188&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011003744%2Fabstract%3Frss%3Dyes Much of geriatric care involves doing the obvious and involves “high-touch” care with a skilled interprofessional team. Despite this, the Cochrane collaboration meta-analysis showed that comprehensive geriatric assessment reduced institutionalization and death or deterioration and improved cognition. Outcomes were best when carried out in an inpatient environment that is often equivalent to a specialized skilled nursing facility. Subsequently, a comprehensive geriatric assessment for frail patients with heart failure showed a decrease in hospitalization and a cost savings for frail and prefrail patients. Delirium intensive care units have been shown to reduce length of stay in hospitals and improve outcomes for persons with delirium. A simple volunteer-run preventive program limited th... Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=5556188 Mon, 28 Nov 2011 05:00:00 +0100 5556188 http://www.medworm.com/index.php?rid=5623798&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011003902%2Fabstract%3Frss%3Dyes The recent article in the Journal of the American Medical Association, “State policies for the residency of offenders in long term care facilities: Balancing right to care with safety,” outlines an important area of concern for practitioners. Until recently, the complexities of criminal offenders requiring long term care have been largely unexplored. The thought of a vulnerable loved one living in close proximity to a criminal offender is a frightening idea for families, and the public will increasingly look to the long term care medicine community to ensure the protection of residents. To further facilitate the establishment of best practices surrounding this issue, the American Medical Directors Association recently passed a resolution to explore how nursing homes can best address th... Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=5623798 Mon, 21 Nov 2011 05:00:00 +0100 5623798 http://www.medworm.com/index.php?rid=5353858&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011003628%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=5353858 Thu, 27 Oct 2011 17:41:18 +0100 5353858 http://www.medworm.com/index.php?rid=5353857&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011003616%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=5353857 Thu, 27 Oct 2011 17:41:18 +0100 5353857 http://www.medworm.com/index.php?rid=5353856&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011003604%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=5353856 Thu, 27 Oct 2011 17:41:18 +0100 5353856 http://www.medworm.com/index.php?rid=5353855&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011003598%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=5353855 Thu, 27 Oct 2011 17:41:18 +0100 5353855 http://www.medworm.com/index.php?rid=5353845&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS152586101100291X%2Fabstract%3Frss%3Dyes This represents the fifth article in the series on yearly updates of hot topics in long term 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=5353845 Thu, 27 Oct 2011 17:41:13 +0100 5353845 http://www.medworm.com/index.php?rid=5353842&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011003586%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=5353842 Thu, 27 Oct 2011 17:41:12 +0100 5353842 http://www.medworm.com/index.php?rid=5556223&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011003070%2Fabstract%3Frss%3Dyes Hyponatremia, defined as serum sodium (Na) (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=5556223 Wed, 05 Oct 2011 04:00:00 +0100 5556223 http://www.medworm.com/index.php?rid=5353843&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011003057%2Fabstract%3Frss%3Dyes Dementia-related agitation has a prevalence of about 1 in 5 nursing home residents. Over time, nearly half of the patients in nursing homes will have a period of agitation. Other behavioral and psychological symptoms of dementia include irritability, apathy, and depression. All of these symptoms are very common in nursing homes. In this issue of the Journal, Nazir et al show that the highest rate of behavioral problems occurs in those with moderate cognitive impairment. Residents with behavioral problems appear to be more likely to be in special care units. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=5353843 Wed, 05 Oct 2011 04:00:00 +0100 5353843 http://www.medworm.com/index.php?rid=5256236&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011003185%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=5256236 Mon, 26 Sep 2011 19:54:35 +0100 5256236 http://www.medworm.com/index.php?rid=5256235&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011003173%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=5256235 Mon, 26 Sep 2011 19:54:35 +0100 5256235 http://www.medworm.com/index.php?rid=5256234&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011003161%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=5256234 Mon, 26 Sep 2011 19:54:35 +0100 5256234 http://www.medworm.com/index.php?rid=5256233&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS152586101100315X%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=5256233 Mon, 26 Sep 2011 19:54:35 +0100 5256233 http://www.medworm.com/index.php?rid=5256232&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011003148%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=5256232 Mon, 26 Sep 2011 19:54:35 +0100 5256232 http://www.medworm.com/index.php?rid=5556193&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011002738%2Fabstract%3Frss%3Dyes Conclusion: The HIPFIT intervention reduced mortality, nursing home admissions, and ADL dependency compared with usual care. Australian New Zealand Clinical Trials Registry (ACTN12605000164695). (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=5556193 Fri, 23 Sep 2011 04:00:00 +0100 5556193 http://www.medworm.com/index.php?rid=5623786&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011002660%2Fabstract%3Frss%3Dyes Abstract: Historically, many nursing homes in the United States have been established by religious groups. This was done to provide care for the elderly when care could not be furnished in other venues.Despite several attempts reported in the literature, there are currently no Muslim nursing homes in the United States. In the Arab and Muslim world, the acceptance and success of such an institution has been somewhat variable. As the Arab Muslim population in the United States ages and becomes more frail, the Muslim community will have to evaluate the need to establish nursing homes to provide care for 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=5623786 Mon, 05 Sep 2011 04:00:00 +0100 5623786 http://www.medworm.com/index.php?rid=5623796&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011002684%2Fabstract%3Frss%3Dyes Conclusion: Among residents exposed to hurricanes, evacuation significantly exacerbated subsequent morbidity/mortality. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=5623796 Thu, 01 Sep 2011 04:00:00 +0100 5623796 http://www.medworm.com/index.php?rid=5173462&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011002805%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=5173462 Tue, 30 Aug 2011 00:43:08 +0100 5173462 http://www.medworm.com/index.php?rid=5173461&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011002799%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=5173461 Tue, 30 Aug 2011 00:43:08 +0100 5173461 http://www.medworm.com/index.php?rid=5173460&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011002787%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=5173460 Tue, 30 Aug 2011 00:43:08 +0100 5173460 http://www.medworm.com/index.php?rid=5173459&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011002775%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=5173459 Tue, 30 Aug 2011 00:43:08 +0100 5173459 http://www.medworm.com/index.php?rid=5173458&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011002763%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=5173458 Tue, 30 Aug 2011 00:43:08 +0100 5173458 http://www.medworm.com/index.php?rid=5623797&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011002623%2Fabstract%3Frss%3Dyes This article addresses the need for enhanced training and support of social service and interdisciplinary staff in long term care facilities in light of the new Minimum Data Set 3.0 assessment procedures as well as new survey and certification guidelines emphasizing quality of life. A set of recommendations will be made with regard to training, appropriate role functions within the context of interdisciplinary care, and needs for more realistic staffing ratios. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=5623797 Mon, 22 Aug 2011 04:00:00 +0100 5623797 http://www.medworm.com/index.php?rid=5623778&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011002611%2Fabstract%3Frss%3Dyes Conclusions: The present study suggests that among subjects living in a nursing home, sarcopenia is highly prevalent and is associated with a significantly increased risk of all-cause death. The current findings support the possibility that sarcopenia has an independent effect on survival among 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=5623778 Mon, 22 Aug 2011 04:00:00 +0100 5623778 http://www.medworm.com/index.php?rid=5623773&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011002647%2Fabstract%3Frss%3Dyes Despite increasing evidence about its effectiveness, the specificity of geriatric rehabilitation too often remains an elusive question. In fact, the term “geriatric rehabilitation” is used to target a specific population (ie, older patients) rather than a specific approach. Recently in our country, a government guideline failed to indicate specific directions in this field, with negative consequences on the practice of old citizens’ rehabilitation. In this historical period in Italy, the rehabilitation of old persons lacks a scientific background to be followed by different services. In these conditions, because of the limited availability of economic resources and high demand for services with a proven cost-effectiveness, geriatric rehabilitation is at high risk of being overshadowe... Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=5623773 Mon, 22 Aug 2011 04:00:00 +0100 5623773 http://www.medworm.com/index.php?rid=5256214&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011002568%2Fabstract%3Frss%3Dyes Dementia affects over 35 million people worldwide, and the prevalence is expected to increase exponentially, reaching over 115 million by 2050, unless an intervention is found that will slow or prevent the disease. The primary reason for this explosion in prevalence of Alzheimer's disease (AD) is the aging of the population. In France, for example, 22.3 million persons will have reached the age of 60 by 2050 compared to only 12.6 million in 2005, an increase of 80% in a 45-year period. The impact is expected to be even greater in developing countries, where increases of as great as 140% are anticipated by 2030. Moreover, the largest increases are expected among the oldest old, those 85 years of age and older. The size of this population group is expected to expand by 151% worldwide between... Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=5256214 Mon, 22 Aug 2011 04:00:00 +0100 5256214 http://www.medworm.com/index.php?rid=5256212&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011002659%2Fabstract%3Frss%3Dyes This study highlights the risk of functional decline in the frail elderly residing 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=5256212 Mon, 22 Aug 2011 04:00:00 +0100 5256212 http://www.medworm.com/index.php?rid=5556221&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS152586101100257X%2Fabstract%3Frss%3Dyes We thank Dr Corsonello and colleagues for their comments. This group has done important work showing that decreased renal function is a major risk factor for adverse drug reactions in older hospitalized elders. We mostly agree with the 3 major points outlined by this group of investigators; however, we believe it may be useful in the spirit of scientific discourse to share some additional comments. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=5556221 Fri, 12 Aug 2011 04:00:00 +0100 5556221 http://www.medworm.com/index.php?rid=5173448&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011002593%2Fabstract%3Frss%3Dyes The Journal of the American Medical Directors Association (JAMDA) had an excellent 2010, based both on our reader survey and on our impact factor. The readership survey was particularly pleasing. More than 80% of the readership said that they read every issue cover to cover or browsed every issue and read articles of interest. The vast majority of our readership still prefers to read the print version, rather than online. Eighty-five percent read JAMDA to keep up with advances in long-term care and 67.5% found it useful in clinical practice. Clinical practice in long-term care and review articles were the most read articles, but large numbers of readers also regularly read the editorials, “In the Trenches,” and special articles. Our readership also reads the Journal of the American Ge... Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=5173448 Sun, 07 Aug 2011 23:00:00 +0100 5173448 http://www.medworm.com/index.php?rid=5623788&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011002386%2Fabstract%3Frss%3Dyes Conclusion: The differing fall risk patterns in specific subgroups may help to target preventive measures. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=5623788 Fri, 05 Aug 2011 04:00:00 +0100 5623788 http://www.medworm.com/index.php?rid=5556199&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011002556%2Fabstract%3Frss%3Dyes Conclusion and Implications: Some facilities that are in need of improving quality of care and resident outcomes are able to build the organizational capacity to improve while not increasing staffing or costs of care. Improvement requires continuous supportive consultation and leadership willing to involve staff and work together to build the systematic improvements in care delivery needed. Medical directors in collaborative practice with advanced practice nurses are ideally positioned to implement this low-cost, effective intervention nationwide. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=5556199 Fri, 05 Aug 2011 04:00:00 +0100 5556199 http://www.medworm.com/index.php?rid=5623795&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS152586101100212X%2Fabstract%3Frss%3Dyes Conclusions: Hospice enrollment was associated with a lower likelihood of hospital and nursing home admissions, and, thus, may have allowed AL residents in need of palliative care to remain in the AL community. AL providers should support and facilitate hospice care among older frail dual-eligible AL residents. More research is needed to examine the impact of hospice care on resident quality of life and total health care expenditures among AL 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=5623795 Mon, 18 Jul 2011 04:00:00 +0100 5623795 http://www.medworm.com/index.php?rid=5556222&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011002374%2Fabstract%3Frss%3Dyes Despite the importance of alcohol misuse and abuse in elders, very little empirical research exists among institutional settings—and none exists in assisted living (AL). We would like to bring to your readers’ attention some recent information we have collected on alcohol misuse and abuse in AL reported by nurse aides. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=5556222 Mon, 18 Jul 2011 04:00:00 +0100 5556222 http://www.medworm.com/index.php?rid=5556220&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011002350%2Fabstract%3Frss%3Dyes We read with great interest the recently published paper by Hanlon et al. On the basis of their data, they suggest to estimate creatinine clearance using the Cockcroft-Gault (CG) equation for all older nursing home patients being prescribed drugs cleared by the kidney, and to reject the recent recommendations from the Food and Drug Administration, the National Kidney Disease Education Program, and the National Institute of Diabetes and Digestive and Kidney Diseases that the Modification of Diet in Renal Disease (MDRD) equation can be used in place of the CG for dosing renally cleared medications. Hanlon et al observe that studies driving the recommendation to use the MDRD equation are plagued by several methodological problems; however, there are at least 3 other issues that would have d... Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=5556220 Mon, 18 Jul 2011 04:00:00 +0100 5556220 http://www.medworm.com/index.php?rid=5556219&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011002349%2Fabstract%3Frss%3Dyes A clustered randomized controlled trial was previously carried out in long-stay facilities to assess the impact of oral care in the prevention of pneumonia and oral candidosis. However, despite an education program focusing on optimal oral care delivery practices and oral health knowledge improvement in the interventional arm, oral care seemed to be often underperformed or inadequately performed in both groups. Consequently, reluctance of caregivers to perform oral care emphasized the need for an analytical monitoring of the process of oral health care performed by registered nurses (RNs) and certified nursing assistants (CNAs). Therefore, we sought to develop a multivariate conceptual framework of the implicit impediments hampering the process of oral care by caregivers in the elderly. (S... Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=5556219 Fri, 15 Jul 2011 04:00:00 +0100 5556219 http://www.medworm.com/index.php?rid=5623794&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011001940%2Fabstract%3Frss%3Dyes Conclusion: In women >70 years old, raloxifene and tibolone significantly and similarly increased body mass density but not muscle strength. Raloxifene had also positive effects on verbal memory and health status. New research with selective estrogen receptor modulators like raloxifene might be promising on frailty endpoints in elderly women.Trial registration number: Nederlands Trial Register: 1232 (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=5623794 Mon, 11 Jul 2011 04:00:00 +0100 5623794 http://www.medworm.com/index.php?rid=5556190&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011002155%2Fabstract%3Frss%3Dyes “The germ is nothing. It is the terrain in which it is found that is everything.”—Louis Pasteur, 1880. Humans are not germ free. In fact, the number of bacterial cells in our body exceeds the number of all our other cells. We live in relative harmony with our bacterial flora. Therefore, the presence of bacteria alone is not an indication of infection. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=5556190 Mon, 11 Jul 2011 04:00:00 +0100 5556190 http://www.medworm.com/index.php?rid=4974015&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011002234%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=4974015 Tue, 28 Jun 2011 16:47:07 +0100 4974015 http://www.medworm.com/index.php?rid=4974014&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011002222%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=4974014 Tue, 28 Jun 2011 16:47:07 +0100 4974014 http://www.medworm.com/index.php?rid=4974013&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011002210%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=4974013 Tue, 28 Jun 2011 16:47:07 +0100 4974013 http://www.medworm.com/index.php?rid=4974012&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011002209%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=4974012 Tue, 28 Jun 2011 16:47:07 +0100 4974012 http://www.medworm.com/index.php?rid=4974011&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011002192%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=4974011 Tue, 28 Jun 2011 16:47:07 +0100 4974011 http://www.medworm.com/index.php?rid=5556194&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011001927%2Fabstract%3Frss%3Dyes Conclusion: The SNAQ is a poor screening tool to predict older people with an abnormal MNA score. However, an abnormal SNAQ might identify those who will lose weight earlier than will the MNA. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=5556194 Thu, 23 Jun 2011 04:00:00 +0100 5556194 http://www.medworm.com/index.php?rid=5256217&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011001666%2Fabstract%3Frss%3Dyes Apathy can be defined as the reduction in goal-directed behavior. It is one of the most common neuropsychiatric symptoms in patients suffering from dementia. It can often be mistaken for depression; however, there is increasing evidence that the two are different clinical constructs. Apathy is associated with significantly decreased quality of life, as well as higher levels of burden and distress in caregivers. Thus, it is of great benefit to provide health care professionals with some guidance on how best to treat this debilitating illness. The purpose of this evidence-based medicine worksheet is to provide the reader with a summary of some of the most relevant published studies that examine the use of psychostimulants in the treatment of apathy in dementia patients. (Source: Journal of t... Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=5256217 Thu, 23 Jun 2011 04:00:00 +0100 5256217 http://www.medworm.com/index.php?rid=5173457&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011002106%2Fabstract%3Frss%3Dyes The recent editorial titled “Advanced Practice Nurses and Attending Physicians: A Collaboration to Improve Quality Care in the Nursing Home,” highlighted several aspects of nursing home care involving the advanced practice nurse (APN). We would like to make some general comments with respect to this area and then finish with some more specific points addressed to the editorial and clinical 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=5173457 Wed, 22 Jun 2011 23:00:00 +0100 5173457 http://www.medworm.com/index.php?rid=5256227&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011001915%2Fabstract%3Frss%3Dyes Amidst the ubiquitous use of steroids, psychiatric side-effects are not uncommon, though the presentation may be curiously diverse. The case of an elderly lady who had 40 mg of methylprednisolone injected in each knee for treatment of suprapatellar bursitis is presented. After 3 days, she reported visual hallucinations, which resolved without treatment 6 days after the steroid injections. We found considerable interest in this case as there were very few reported cases of adverse psychiatric events triggered by intra-articular steroid administration. We follow with a brief review of the incidence, risk factors, presentation, and treatment of steroid-induced psychiatric side-effects. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=5256227 Mon, 20 Jun 2011 04:00:00 +0100 5256227 http://www.medworm.com/index.php?rid=5623792&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS152586101100168X%2Fabstract%3Frss%3Dyes Conclusions: SSI rendered a valuable metric to conduct quantitative analyses of nursing home deficiency number, scope, and severity across states. Future research should investigate the positive relationship between scope and severity of deficiencies and their number. Better understanding and correction of other factors introducing systematic bias to the survey results (e.g. regional impact) can further improve the accuracy of survey result evaluation. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=5623792 Fri, 17 Jun 2011 04:00:00 +0100 5623792 http://www.medworm.com/index.php?rid=5623787&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS152586101100171X%2Fabstract%3Frss%3Dyes We present a representative case and subsequent literature review of minimal trauma fractures to illustrate the condition, including risk factors, mode of presentation, and patient outcomes. No direct research has been conducted on the pathophysiology of these fractures. Extrapolating from other similar conditions and likely associated comorbid illnesses, we explore possible physiologic explanations for their occurrence. Again, no direct investigation into prevention or treatment of minimal trauma fractures has been published. Instead, we consider a variety of pharmacologic and nonpharmacologic interventions that may modify the risk for minimal trauma fractures considering the previously identified risk factors and probable pathophysiologic changes leading to fracture development. We propo... Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=5623787 Fri, 17 Jun 2011 04:00:00 +0100 5623787 http://www.medworm.com/index.php?rid=5623775&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011001952%2Fabstract%3Frss%3Dyes Conclusion: Blue light treatment led to significant cognitive improvements compared with placebo red light and may be a promising environmental intervention to reduce cognitive symptoms in elderly, long-term care 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=5623775 Fri, 17 Jun 2011 04:00:00 +0100 5623775 http://www.medworm.com/index.php?rid=5623793&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011001691%2Fabstract%3Frss%3Dyes Conclusions: The meta-sensitivity analysis indicates that randomized controlled trials of fall-prevention programs conducted within the past 10 years (2000–2009) are effective in overall reduction of fall rates of 9% with a reduction of fall rates of 10% in multifactorial interventions, 9% in community settings, and 12% in Model I interventions (initial intervention efforts and then subsequent follow-up). (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=5623793 Thu, 16 Jun 2011 04:00:00 +0100 5623793 http://www.medworm.com/index.php?rid=5256229&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011001939%2Fabstract%3Frss%3Dyes We would like to thank the authors for their letter. To clarify, our review was focused on the use of dementia therapies in patients residing in long-term care facilities, which includes patients who progress to the severe or late stages of dementia and end of life. Our review of the data suggests that there can be continued benefit in the late stages of dementia such as in the preservation of ADLs, which can improve quality of life. Our concern is that despite what has been reported in the literature suggesting benefit in the later stages of dementia, there is undertreatment of dementia in the 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=5256229 Thu, 16 Jun 2011 04:00:00 +0100 5256229 http://www.medworm.com/index.php?rid=5256216&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011001903%2Fabstract%3Frss%3Dyes This study used statewide, archival emergency commitment data from July 2000 through June 2008. These data are created by entering data from paper emergency commitment initiation forms of law enforcement, mental health professionals, and judges submitted by facilities as required by Florida law.Results: During the 1 year from July 2007 through June 2008 there were 898 residents of Florida nursing homes with a total of 1032 emergency commitments. Some individuals had more than one emergency commitment from a nursing home during the year, with 9% having between two and five emergency commitments. One-third of the emergency commitments were for residents younger than 65. Some of these individuals also had substantial numbers of emergency commitments in the 7 years from July 2000 through Jun... Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=5256216 Fri, 10 Jun 2011 04:00:00 +0100 5256216 http://www.medworm.com/index.php?rid=4973999&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011001423%2Fabstract%3Frss%3Dyes A consensus conference convened by the Society of Sarcopenia, Cachexia and Wasting Disorders has concluded that “Sarcopenia, ie, reduced muscle mass, with limited mobility” should be considered an important clinical entity and that most older persons should be screened for this condition. “Sarcopenia with limited mobility” is defined as a person with muscle loss whose walking speed is equal to or less than 1 m/s or who walks less than 400 m during a 6-minute walk, and who has a lean appendicular mass corrected for height squared of 2 standard deviations or more below the mean of healthy persons between 20 and 30 years of age of the same ethnic group. The limitation in mobility should not clearly be a result of otherwise defined specific diseases of muscle, peripheral vascular disea... Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=4973999 Sun, 05 Jun 2011 23:00:00 +0100 4973999 http://www.medworm.com/index.php?rid=5623791&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011001678%2Fabstract%3Frss%3Dyes Conclusion: Publicly reported Nursing Home Compare quality ratings of Medicare-certified skilled nursing facilities were modestly associated with 90-day readmission and mortality among Medicare beneficiaries discharged to these facilities after hospitalization for heart failure. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=5623791 Mon, 30 May 2011 04:00:00 +0100 5623791 http://www.medworm.com/index.php?rid=5623790&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011001137%2Fabstract%3Frss%3Dyes Conclusion: These data indicate that eye care professionals should work more closely with the medical team to improve the overall clinical care of older individuals with a history of falls. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=5623790 Mon, 30 May 2011 04:00:00 +0100 5623790 http://www.medworm.com/index.php?rid=5623774&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011001162%2Fabstract%3Frss%3Dyes Conclusion: The simultaneous presence of history of falls and dependency in at least one activity of daily living defines a condition of particular vulnerability of elderly hospitalized patients to adverse drug reactions. Physicians should be aware of this high-risk condition when prescribing new drugs to disabled older people. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=5623774 Mon, 30 May 2011 04:00:00 +0100 5623774 http://www.medworm.com/index.php?rid=5623772&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011001411%2Fabstract%3Frss%3Dyes Nursing homes (NHs) are under increasing pressure to accurately gauge and improve the quality of care they provide to their residents. Higher patient acuity, demand from consumers and policy-makers, and media reports of inadequate care are providing the impetus for change. In response to these pressures, researchers are devising more appropriate indicators of quality, states are creating innovative financial models to reward the delivery of higher quality care, and the American Medical Directors Association (AMDA) is developing strategies to better gauge the performance of NH physicians and medical directors. The interplay of these factors not only has provided new opportunities to impact approaches to quality measurement in the NH but also has rejuvenated interest in measuring the impact ... Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=5623772 Mon, 30 May 2011 04:00:00 +0100 5623772 http://www.medworm.com/index.php?rid=5556214&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011001113%2Fabstract%3Frss%3Dyes Conclusion: These findings suggest that a reduction of hospitalization of nursing home residents could be achieved by providing an adequate amount of care and optimizing the management of chronic diseases and polypharmacy. This hypothesis should be tested in future clinical trials. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=5556214 Mon, 30 May 2011 04:00:00 +0100 5556214 http://www.medworm.com/index.php?rid=5556213&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011001654%2Fabstract%3Frss%3Dyes This study solicited feedback from LTC decision makers in Ontario, Canada, regarding research priorities to guide improvement in the quality of care in LTC homes. Representatives from 134 LTC homes responded (53.6% response rate). Nine thematic areas of research were identified: delivery of care; staffing; organization and structure of homes; funding; indicators, standards, policies, and procedures; managing difficult behaviors; education; safety; and infectious disease control. It is anticipated that these themes will steer research down a path that is responsive to the information needs of practitioners in LTC 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=5556213 Mon, 30 May 2011 04:00:00 +0100 5556213 http://www.medworm.com/index.php?rid=5556201&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS152586101100140X%2Fabstract%3Frss%3Dyes This report is focused on swab culture obtained by the Levine technique, after debridement or cleaning down to viable tissue when an acute purulent skin infection has been diagnosed based on clinical criteria. Swab cultures should not be used to determine IF a wound is acutely infected; rather the role may be to identify potential pathogens when deep tissue biopsy is not elected. The swab culture may identify the pathogen or overlying MDRO colonization, a risk factor for MDRO infection. MDRO isolation should heighten the clinician’s level of concern if the prescribed antibiotic did not “cover” the MDRO or potential pathogen that was isolated. Properly performed swab cultures could play a role in the identification of methicillin-resistant Staphylococcus/MDRO infections treated in nur... Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=5556201 Mon, 30 May 2011 04:00:00 +0100 5556201 http://www.medworm.com/index.php?rid=5556191&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011001150%2Fabstract%3Frss%3Dyes Conclusion: AF is quite prevalent in 85-year-old subjects. A large percentage of patients with AF were receiving chronic anticoagulant therapy. The percentage of patients who were not receiving prophylactic treatment was low. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=5556191 Mon, 30 May 2011 04:00:00 +0100 5556191 http://www.medworm.com/index.php?rid=5256228&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011001459%2Fabstract%3Frss%3Dyes We thank Drs. Kerwin and Claus for an excellent review. However, their recommendation of the continuation of cholinesterase inhibitors and memantine into the late stages of disease and end-of-life care warrants further discussion. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=5256228 Mon, 30 May 2011 04:00:00 +0100 5256228 http://www.medworm.com/index.php?rid=4973995&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011001708%2Fabstract%3Frss%3Dyes Osteoporosis is an almost universal problem in nursing homes with up to 85% of white women in nursing homes being osteoporotic. Osteoporosis, coupled with falls, is the major risk for fractures in the nursing home. Following a hip fracture, 20% of subjects are dead within 1 year, 30% have a permanent disability, and 40% cannot walk independently. Persons with vertebral fractures have back pain, dysphagia, kyphosis, reduced pulmonary function, and diminished quality of life. They also have nearly a doubling in their age-standardized mortality ratio. The impact in hip fractures is particularly severe in frail persons and those with undernutrition. Intentional weight loss leads to a 2.3 increase in hip fracture in older women. Aggressive treatment of osteoporosis and an intensive falls progra... Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=4973995 Sun, 29 May 2011 23:00:00 +0100 4973995 http://www.medworm.com/index.php?rid=4860135&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011001782%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=4860135 Wed, 25 May 2011 21:43:52 +0100 4860135 http://www.medworm.com/index.php?rid=4860134&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011001769%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=4860134 Wed, 25 May 2011 21:43:52 +0100 4860134 http://www.medworm.com/index.php?rid=4860133&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011001770%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=4860133 Wed, 25 May 2011 21:43:52 +0100 4860133 http://www.medworm.com/index.php?rid=4860132&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011001757%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=4860132 Wed, 25 May 2011 21:43:52 +0100 4860132 http://www.medworm.com/index.php?rid=4860131&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011001745%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=4860131 Wed, 25 May 2011 21:43:51 +0100 4860131 http://www.medworm.com/index.php?rid=4973996&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011001174%2Fabstract%3Frss%3Dyes At the last International Association of Gerontology and Geriatrics (IAGG) World Congress, the IAGG Executive Committee underlined the need to develop a research agenda for nursing homes. In the past several decades, the fields of geriatrics and gerontology have focused on creating, organizing, and coordinating geriatrics facilities, and little attention has been given to research that would improve clinical practice. Now it is time to broaden our scope to ensure that high-quality research becomes a priority. Because most nursing home residents suffer from dementia, clinical research on dementia is needed to validate new approaches to deal with the most significant problems encountered by nursing homes that care for those with severe dementia, including aggressive behaviors, problematic vo... Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=4973996 Wed, 18 May 2011 23:00:00 +0100 4973996 http://www.medworm.com/index.php?rid=5353844&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011001393%2Fabstract%3Frss%3Dyes From the astute observations of a veterinary pathologist more than 80 years ago, to cutting-edge applications of warfarin genome-wide association studies in the direct care of patients, this commonly prescribed oral anticoagulant has provided one of the most remarkable stories in the history of modern medicine. In 1924, Schofield described a previously unrecognized bleeding disorder in cattle associated with the ingestion of spoiled sweet clover silage. The hemorrhagic agent was identified as dicoumarol in 1939. In 1948, a synthetic cogener of dicoumarol was introduced and named warfarin for the Wisconsin Alumni Research Foundation, which sponsored the research and held the agent’s patent. Warfarin soon became a popular rat poison, and a young U.S. Army inductee survived a suicide attemp... Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=5353844 Mon, 16 May 2011 04:00:00 +0100 5353844 http://www.medworm.com/index.php?rid=5256230&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011001368%2Fabstract%3Frss%3Dyes This study has shown new evidence on the prognostic value of vitamin D deficiency in critical care patients. McKinney et al's study, however, has some limitations. First, only 37% of the patients had their vitamin D test done before admission; the other patients had their serum 25(OH) vitamin D levels determined a few days after admission to the ICU. Recently, Reid et al demonstrated a large increase in C-reactive protein and a significant decrease in 25(OH) vitamin D levels 2 days after elective surgery, so low 25(OH) vitamin D levels could be the result of systemic inflammatory response. The article by McKinney et al does not mention the cause of ICU admission nor the incidence of sepsis in each group, letting one wonder whether nonsurvivors had, indeed, lower vitamin D as a consequen... Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=5256230 Mon, 16 May 2011 04:00:00 +0100 5256230 http://www.medworm.com/index.php?rid=4974010&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011001381%2Fabstract%3Frss%3Dyes It is paradoxical that at a time of increasing numbers of elderly with complex health care needs, the field of geriatric medicine appears to be disappearing. Geriatricians have advanced training preparing them to care for the most complex older patients. Geriatrics providers typically work within interdisciplinary teams resulting in comprehensive, coordinated care for the elderly. Research suggests this approach can improve outcomes, maintain functional integrity, and at the same time be more cost effective. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=4974010 Sun, 15 May 2011 23:00:00 +0100 4974010 http://www.medworm.com/index.php?rid=5623789&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011001083%2Fabstract%3Frss%3Dyes Conclusion: Frequency of psychotropic and especially antipsychotic medication is substantial in nursing home residents in Germany and Austria. The high number of prescriptions is likely to be an indicator for a perceived or actual lack of strategies to handle behavioral and psychological symptoms of 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=5623789 Mon, 09 May 2011 04:00:00 +0100 5623789 http://www.medworm.com/index.php?rid=5256231&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS152586101100137X%2Fabstract%3Frss%3Dyes We thank Drs Faulhaber, Schulz, and Furlanetto for their interest and comments. Given the cross-sectional nature of our study and the inherent data limitations, it is possible that the decreased vitamin D level was a consequence and not a cause of increased risk in the current sample. However, the sampling interval (timing) of the vitamin D draw between vitamin D deficient and nondeficient groups was not significant, as indicated in the article, and as such we do not believe the time of sampling to be a significant factor in the associations we identified. In addition, our conclusion about decreased vitamin D levels potentially leading to increased risk rather than vice versa is supported by the recent study by Braun et al, which demonstrates that deficiency of vitamin D levels before hos... Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=5256231 Mon, 09 May 2011 04:00:00 +0100 5256231 http://www.medworm.com/index.php?rid=4860117&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011001101%2Fabstract%3Frss%3Dyes The American Medical Directors Association (AMDA) is making a concerted effort to work with medical directors and advanced nurse practitioners around the globe. To this end, the Board of Delegates voted at the March annual meeting to develop a new International Membership Category. At the annual meeting, there was a robust special interest group that discussed outreach of AMDA to participants in other countries. A highly successful tour of a nursing home in Tampa was held for international participants. International members remarked on how useful the meeting was and on the excellence of AMDA products for use in training in nursing homes. The AMDA board is examining the feasibility of extending the highly successful Certified Medical Director program to countries outside of the United S... Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=4860117 Sun, 01 May 2011 23:00:00 +0100 4860117 http://www.medworm.com/index.php?rid=4766981&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011001241%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=4766981 Sat, 30 Apr 2011 09:59:20 +0100 4766981 http://www.medworm.com/index.php?rid=4766980&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011001228%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=4766980 Sat, 30 Apr 2011 09:59:20 +0100 4766980 http://www.medworm.com/index.php?rid=4766979&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS152586101100123X%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=4766979 Sat, 30 Apr 2011 09:59:20 +0100 4766979 http://www.medworm.com/index.php?rid=4766978&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011001216%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=4766978 Sat, 30 Apr 2011 09:59:20 +0100 4766978 http://www.medworm.com/index.php?rid=4766977&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011001204%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=4766977 Sat, 30 Apr 2011 09:59:19 +0100 4766977 http://www.medworm.com/index.php?rid=5256219&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011001071%2Fabstract%3Frss%3Dyes Conclusion: High ARS scores are negatively associated with various components of the Barthel Index and predict in-hospital mortality in the presence of hyponatremia among older patients. The ARS score may be useful in the acute setting to improve risk stratification. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=5256219 Fri, 22 Apr 2011 04:00:00 +0100 5256219 http://www.medworm.com/index.php?rid=5556212&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011001034%2Fabstract%3Frss%3Dyes Conclusion: NHA determinants in dementia are strongly linked to the patient’s own characteristics but also to his or her physical or social environment. Interventions should target both members of the dyad “patient-caregiver” because both are affected by the disease. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=5556212 Thu, 14 Apr 2011 04:00:00 +0100 5556212 http://www.medworm.com/index.php?rid=4860130&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011001046%2Fabstract%3Frss%3Dyes We learn from Dr Bellelli’s response to our article that Italy is yet another country struggling to make accommodations in the health care system for the country’s aging population, and we share his perspective that physicians are essential advocates for older people residing in nursing homes in the United States, the Netherlands, Italy, and elsewhere. Although the well-being of the patient, honoring personal wishes, and developing a relationship between the physician and the patient’s family may result from more physician presence in nursing homes, the reality is that any policy that supports or increases physician presence will be based on evidence that this presence reduces costs. The good news for the nursing home population is that what is most cost-effective is congruent with ... Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=4860130 Wed, 13 Apr 2011 23:00:00 +0100 4860130 http://www.medworm.com/index.php?rid=4974009&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011001022%2Fabstract%3Frss%3Dyes To the Editor: The Hakim-Adams syndrome (normal pressure hydrocephalus; NPH) represents the only condition that mimics neurodegenerative dementias that can be successfully treated with a surgical procedure. As such, it is a saving alternative to an inevitable progression of dementia. The question is, how often is this syndrome the cause of 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=4974009 Thu, 07 Apr 2011 23:00:00 +0100 4974009 http://www.medworm.com/index.php?rid=4974008&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011001010%2Fabstract%3Frss%3Dyes To the Editor: Senior citizens are the most rapidly growing age group worldwide. They are also aging; in 2007, 27% of the 65+ age group were octogenarians or older. More than 20% of those 80+ suffer from a moderate to severe form of dementia, their needs often exceed the resources of their families, and placement in a nursing home is sometimes inevitable. In Israel, approximately 4% of the elderly reside in long-term care institutions. Of the 30,200 total number of beds in the 403 institutions for the elderly, there are 19,900 beds (65.8%) for nursing home and mentally frail patients. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=4974008 Thu, 07 Apr 2011 23:00:00 +0100 4974008 http://www.medworm.com/index.php?rid=5256226&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS152586101100079X%2Fabstract%3Frss%3Dyes Donepezil (Aricept) is a cholinesterase inhibitor approved for the treatment of Alzheimer’s disease. Immediate release formulations of 5- and 10-mg tablets were approved by the Food and Drug Administration in the United States in 1996. In July 2010, the Food and Drug Administration approved a 23-mg sustained release (SR) formulation. The SR formulation may provide additional benefit to patients receiving 10 mg daily but the incidence of adverse reactions is increased. We derived plasma concentration profiles for higher dose immediate-release formulations (15 mg once daily, 10 mg twice daily, and 20 mg once daily) and for the profile anticipated to result from the 23-mg SR formulation. Our model predicts similar steady-state concentration profiles for 10 mg twice daily, 20 mg once daily, ... Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=5256226 Fri, 01 Apr 2011 04:00:00 +0100 5256226 http://www.medworm.com/index.php?rid=5556218&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011000946%2Fabstract%3Frss%3Dyes Conclusion: Influenza coverage among nursing home NAs appears to be similar to nationally reported coverage estimates among health care providers in the United States in general. In addition to individual characteristics, occupational characteristics reflective of working conditions are associated with vaccination status among NAs, suggesting that further research into these types of associations may be useful in identifying which institutions may benefit from outreach efforts and types of interventions to increase vaccination coverage. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=5556218 Thu, 31 Mar 2011 04:00:00 +0100 5556218 http://www.medworm.com/index.php?rid=5556211&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011000958%2Fabstract%3Frss%3Dyes Conclusions: A high number of potentially inappropriate drug prescriptions can be detected at the time of admission to nursing home care by the use of systematic instruments. Both STOPP-START criteria and the Australian criteria performed well in this setting. The impact of this detection on health outcomes and costs should be assessed before they can be widely recommended. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=5556211 Thu, 31 Mar 2011 04:00:00 +0100 5556211 http://www.medworm.com/index.php?rid=5353846&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS152586101100096X%2Fabstract%3Frss%3Dyes Diabetes is common in the elderly population and in nursing home residents. More than 20% of adults aged 65 to 75 years and 40% of adults older than 80 years suffer from diabetes. Physiological changes in elderly individuals, such as decreased physical activity, abdominal obesity, and increased inflammatory state, increase insulin resistance in peripheral tissue and reduce glucose-dependent insulin release, leading to carbohydrate intolerance and diabetes. The clinical presentation in the elderly and nursing home residents is frequently guided by the high rate of comorbidities such as hypertension, depression, and cardiovascular diseases. Treatment recommendations for glycemic control in elderly ambulatory patients are similar to those in long-term care facilities. Healthy patients with di... Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=5353846 Thu, 31 Mar 2011 04:00:00 +0100 5353846 http://www.medworm.com/index.php?rid=4973997&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011000983%2Fabstract%3Frss%3Dyes This issue of the Journal of the American Medical Directors Association includes a report from Young and colleagues documenting that both cognitively nonimpaired and impaired patients with hip fracture, who had surgical repair and received postacute rehabilitation, experienced functional recovery at one year following postacute rehabilitation discharge. However, the pattern of recovery and the level of function regained at one year largely differ between the two groups. In fact, the cognitively nonimpaired group regained most of their functional independence at one year, whereas for the cognitively impaired group the level of function at one year was similar to that of two months following rehabilitation and yet higher than that reported before starting rehabilitation. Findings from this... Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=4973997 Wed, 30 Mar 2011 23:00:00 +0100 4973997 http://www.medworm.com/index.php?rid=4860129&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011001009%2Fabstract%3Frss%3Dyes To the Editor: We read with interest the article by Helton et al on the role of physicians in nursing homes (NHs). (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=4860129 Sun, 27 Mar 2011 23:00:00 +0100 4860129 http://www.medworm.com/index.php?rid=4860128&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011000788%2Fabstract%3Frss%3Dyes To the Editor: I was delighted to read your excellent editorial entitled “Transitions” in the November 2010 issue of the Journal of the American Medical Directors Association. The issue of safe movement for all patients, especially frail elders, has rightly assumed a seat at the table of national health care concerns. The projected annual cost of $17.4 billion in readmissions for 2003–2004 claims data on Medicare hospital readmissions nationally puts a financial price on the problem, but obscures the dreadful human toll inflicted. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=4860128 Thu, 24 Mar 2011 00:00:00 +0100 4860128 http://www.medworm.com/index.php?rid=4766958&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011000995%2Fabstract%3Frss%3Dyes In developing countries, protein undernutrition occurs predominantly in young children, whereas in developed countries, it is most commonly seen in long-term care. Similarly, isolated vitamin deficiencies, such as pellagra, beri-beri, and Wernicke’s encephalopathy, occur in developing countries, whereas these are rare in developed countries, being replaced by vitamin B12 deficiency and hypovitaminosis D and a variety of complex nutritional disorders seen in older persons living in long-term care. In developed countries, there are usually adequate quantities of food, so the development of undernutrition occurs because of disease or poor nutritional choices associated with the anorexia of aging. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=4766958 Thu, 24 Mar 2011 00:00:00 +0100 4766958 http://www.medworm.com/index.php?rid=5556217&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011000934%2Fabstract%3Frss%3Dyes Conclusion: The TMDS was associated with marked improvement in the transfer of essential clinical information. Educational efforts are warranted to increase consistency of usage. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=5556217 Wed, 23 Mar 2011 04:00:00 +0100 5556217 http://www.medworm.com/index.php?rid=5353853&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861010004263%2Fabstract%3Frss%3Dyes Conclusion: In settings where error rates are low, large numbers of observations of an activity must be made to reach acceptable validity of estimates for the true rates of errors. In observing key nursing home functions with current methodology, the State Medicare nursing home survey process does not adhere to well-known principles of valid error determination. Alternate approaches in survey methodology 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=5353853 Wed, 23 Mar 2011 04:00:00 +0100 5353853 http://www.medworm.com/index.php?rid=4974007&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011000776%2Fabstract%3Frss%3Dyes Conclusions: This article is the first to identify the most vulnerable times of a NH stay. For newly admitted residents, our results also show that previous exposure to a hospital environment, and not simply resident illness, at least partially contributes to increased AE risk. This and additional evidence can help clinicians and administrators to better identify periods of high risk for NH residents, and also to develop more targeted care improvement strategies. More robust and frequently obtained measures of resident illness are required to further examine these issues in more detail. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=4974007 Mon, 21 Mar 2011 00:00:00 +0100 4974007 http://www.medworm.com/index.php?rid=4766969&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011000971%2Fabstract%3Frss%3Dyes Glenda, the nurse from the skilled nursing facility where I work, came by my office this morning on her way to work. She dropped off a note at the front desk for me. It was handwritten; not a voice mail, an e-mail, a text, or a tweet. It was folded over and sealed loosely with scotch tape. She wrote it and delivered the note before I made it in to the office. The note simply said:“I wanted you to know that Mrs. Stevenson passed away this morning at 3:30 am. – Glenda” (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=4766969 Mon, 21 Mar 2011 00:00:00 +0100 4766969 http://www.medworm.com/index.php?rid=4766962&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011000703%2Fabstract%3Frss%3Dyes This article reviews the regulatory background and clinical concerns regarding the enforcement of the Controlled Substances Act by the Drug Enforcement Administration within the institutional pharmacies serving long-term care facilities. The article argues that the processes implemented since 2009 in response to concerns about Drug Enforcement Administration enforcement are suboptimal at many levels. A robust solution that meets the needs of all parties involved will require multiple levels of collaboration and respect for several legitimate agendas pertinent to this issue. The comprehensive solution must address at least 4 concerns. It must ensure that (1) residents and patients of long-term care facilities receive appropriate and timely administration of controlled substances when they a... Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=4766962 Mon, 21 Mar 2011 00:00:00 +0100 4766962 http://www.medworm.com/index.php?rid=5556204&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011000818%2Fabstract%3Frss%3Dyes Conclusion: A large proportion of nonagenarians are able to achieve independence in walking ability (with assistive device) after rehabilitation following HF surgery. The achievement of this ability after rehabilitation is also an important prognostic factor for 1-year survival. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=5556204 Fri, 18 Mar 2011 04:00:00 +0100 5556204 http://www.medworm.com/index.php?rid=5173456&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011000715%2Fabstract%3Frss%3Dyes Conclusion: The increased dependency over 20 years directly affects care requirements for 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=5173456 Thu, 17 Mar 2011 00:00:00 +0100 5173456 http://www.medworm.com/index.php?rid=5173450&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011000740%2Fabstract%3Frss%3Dyes This article focuses on common themes evident around the world regarding long-term care of the elderly. Issues related to service delivery, financing, and quality are highlighted. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=5173450 Thu, 17 Mar 2011 00:00:00 +0100 5173450 http://www.medworm.com/index.php?rid=5556210&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011000223%2Fabstract%3Frss%3Dyes Conclusion: The lack of identification and tracking of patients with HF limits SNF ability to care for patients with HF. HF education for staff is likely important to effective HF management in the SNF. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=5556210 Mon, 14 Mar 2011 04:00:00 +0100 5556210 http://www.medworm.com/index.php?rid=5556205&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011000727%2Fabstract%3Frss%3Dyes Conclusions: Internet training can be an effective approach to help staff work with residents with mental illness. In this research, it showed significant positive effects and was well received by NAs and by LHPs. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=5556205 Thu, 10 Mar 2011 05:00:00 +0100 5556205 http://www.medworm.com/index.php?rid=4860122&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011000028%2Fabstract%3Frss%3Dyes Conclusion: Thirteen significant risk factors were identified: age, male gender, lung diseases, dysphagia, diabetes mellitus, severe dementia, angiotensin I-converting enzyme deletion/deletion genotype, bad oral health, malnutrition, Parkinson’s disease, and the use of antipsychotic drugs, proton pump inhibitors, and angiotensin-converting enzyme inhibitors. The contribution of bad oral health seems limited. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=4860122 Thu, 10 Mar 2011 00:00:00 +0100 4860122 http://www.medworm.com/index.php?rid=4766959&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011000739%2Fabstract%3Frss%3Dyes The past year or two has felt for many in the long-term care world like a sea-change in how scheduled medications are ordered, provided, and administered in care facilities. Yet, it is interesting to note that there have been no new regulations or new legislation. All of this is driven by the Drug Enforcement Agency’s (DEA’s) change in interpretation and enforcement practices related to the Controlled Substances Act. Dr Elon et al provided a comprehensive summary of the historical context, regulatory environment, and process of care related to the administration of scheduled medications in the nursing home. Several key concepts in this article are critical to reiterate if there is to be a meaningful dialogue and eventual solution. First, the regulations to which nursing care centers mu... Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=4766959 Thu, 10 Mar 2011 00:00:00 +0100 4766959 http://www.medworm.com/index.php?rid=4766975&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011000673%2Fabstract%3Frss%3Dyes To the Editor: We read with interest the article by Fitzgerald and Bean on the interaction of treatments in the case of comorbidities. We appreciated the provided mathematical model and agree with the statements of the authors, but we would like to add some considerations. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=4766975 Mon, 07 Mar 2011 00:00:00 +0100 4766975 http://www.medworm.com/index.php?rid=4766974&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011000685%2Fabstract%3Frss%3Dyes To the Editor: We thank Dr Gavazzi for sharing results from his study of influenza and pneumococcal immunization among nursing home residents in France. The French study reports substantially higher influenza vaccination coverage during the same time period compared with our study (93.3% for 6 nursing homes versus 63.7% for 1152 nursing homes, respectively). Also, Dr. Gavazzi remarks that our low immunization rate contrasts with other higher rates of influenza vaccination coverage reported in North America, citing studies reported in the MMWR. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=4766974 Mon, 07 Mar 2011 00:00:00 +0100 4766974 http://www.medworm.com/index.php?rid=4766960&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011000193%2Fabstract%3Frss%3Dyes Sarcopenia, the age-associated loss of skeletal muscle mass and function, has considerable societal consequences for the development of frailty, disability, and health care planning. A group of geriatricians and scientists from academia and industry met in Rome, Italy, on November 18, 2009, to arrive at a consensus definition of sarcopenia. The current consensus definition was approved unanimously by the meeting participants and is as follows: Sarcopenia is defined as the age-associated loss of skeletal muscle mass and function. The causes of sarcopenia are multifactorial and can include disuse, altered endocrine function, chronic diseases, inflammation, insulin resistance, and nutritional deficiencies. Although cachexia may be a component of sarcopenia, the 2 conditions are not the same. ... Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=4766960 Mon, 07 Mar 2011 00:00:00 +0100 4766960 http://www.medworm.com/index.php?rid=4589401&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011000491%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=4589401 Tue, 01 Mar 2011 00:00:00 +0100 4589401 http://www.medworm.com/index.php?rid=4589400&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS152586101100048X%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=4589400 Tue, 01 Mar 2011 00:00:00 +0100 4589400 http://www.medworm.com/index.php?rid=4589399&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011000478%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=4589399 Tue, 01 Mar 2011 00:00:00 +0100 4589399 http://www.medworm.com/index.php?rid=4589398&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011000466%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=4589398 Tue, 01 Mar 2011 00:00:00 +0100 4589398 http://www.medworm.com/index.php?rid=4589397&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861011000454%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=4589397 Tue, 01 Mar 2011 00:00:00 +0100 4589397 http://www.medworm.com/index.php?rid=4589396&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861010005098%2Fabstract%3Frss%3Dyes This study evaluated: 1) frequency of wounds; 2) healing time of all types of wounds; 3) number of acquired wounds; and 4) impact when a physician wound care specialist is on site consistently in a long-term care facility. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=4589396 Tue, 01 Mar 2011 00:00:00 +0100 4589396 http://www.medworm.com/index.php?rid=4589395&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861010005086%2Fabstract%3Frss%3Dyes Introduction/Objective: Introduction: Special care units (SCU) were designed to care for patients in a nursing home setting that required a modified environment and staff trained to deal with specific behavioral problems, mainly those with dementia. These units proliferated throughout the 1980's, and lacked a standard definition of which patients are best served by this care and the constitution of care provided; they were generally secured, meaning access and egress was controlled. In 2008, a local nursing home here in Tucson, Arizona closed one of these units, changing it into a subacute care ward, thus allowing the unique opportunity to observe how such patients might be integrated back into a general nursing home population. Objective: To evaluate the outcome of patients transferred fr... Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=4589395 Tue, 01 Mar 2011 00:00:00 +0100 4589395 http://www.medworm.com/index.php?rid=4589394&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861010005074%2Fabstract%3Frss%3Dyes Introduction/Objective: Vitamin D is important in the prevention of falls, fractures and osteoporosis. A recent meta-analyses by Bischoff et.al showed that vitamin D helps to prevent falls and improve bone and muscle strength in older adults with serum levels of vitamin D greater than 60nmol/L and 75 nmol/L (2). A daily intake of 800 International Units (I.U) of vitamin D improves muscle strength in the lower extremities and trunk (3). Vitamin D3 has been found more effective in preventing falls than Vitamin D2 (5). This evidence created the need for a quality improvement project that implemented a change in practice in the prescribing and monitoring of vitamin D supplementation. A change in practice was initiated that included the prescribing of vitamin D (Vit D) and monitoring of 25- hyd... Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=4589394 Tue, 01 Mar 2011 00:00:00 +0100 4589394 http://www.medworm.com/index.php?rid=4589393&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861010005062%2Fabstract%3Frss%3Dyes Introduction/Objective: Vertebral compression fractures commonly occur in the geriatric population with osteoporosis. The subsequent back pain is severe and often requires medications, bed rest, hospitalization to control pain and transition to a subacute rehabilitation to improve mobilization. Calcitonin is one of the medications that can be used in this 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=4589393 Tue, 01 Mar 2011 00:00:00 +0100 4589393 http://www.medworm.com/index.php?rid=4589392&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861010005050%2Fabstract%3Frss%3Dyes This study assessed the cognitive and physical function of LTCF residents with UI who received antimuscarinics versus those who did not receive antimuscarinics. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=4589392 Tue, 01 Mar 2011 00:00:00 +0100 4589392 http://www.medworm.com/index.php?rid=4589391&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861010005049%2Fabstract%3Frss%3Dyes Introduction/Objective: To understand the language, culture and context of quality in rural New England 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=4589391 Tue, 01 Mar 2011 00:00:00 +0100 4589391 http://www.medworm.com/index.php?rid=4589390&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861010005037%2Fabstract%3Frss%3Dyes The objective of this project was to determine the causes and length of time between skilled facility admissions and hospital readmissions. This data will allow an initial exploration of the preventable nature of the reason for readmission and the ability of the facility to manage the diagnosis. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=4589390 Tue, 01 Mar 2011 00:00:00 +0100 4589390 http://www.medworm.com/index.php?rid=4589389&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861010005025%2Fabstract%3Frss%3Dyes Introduction/Objective: Background: One in three American adults lack the ability to obtain, process and understand basic health information and services needed to make appropriate health decisions. Limited health literacy is associated with poor disease–related knowledge, increased risk of hospitalization, medication adherence and disparities in health outcomes. Experts have recommended that health professional schools incorporate health literacy into their curricula, although few health professional educators have themselves received such 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=4589389 Tue, 01 Mar 2011 00:00:00 +0100 4589389 http://www.medworm.com/index.php?rid=4589388&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861010005013%2Fabstract%3Frss%3Dyes Introduction/Objective: Background: Tissue tolerance is the ability of the skin to withstand the effects of unrelieved pressure. The Guidance to Surveyors for Long Term Care Facilities FTag 314 indicates that when assessing pressure ulcer risk, the resident's skin integrity and tissue tolerance are to be observed after pressure over bony prominences is relieved. Nursing facilities have operationalized tissue tolerance testing by documenting the time to erythema [TTE] over bony prominences after lying in bed and chair sitting for specified periods of time (1 – 4 hours). Many facilities utilize the Braden Scale for Predicting Pressure Sore Risk© [Braden Scale] to assess risk and guide the care plan. The purpose of tissue tolerance testing is to individualize repositioning schedules in bed... Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=4589388 Tue, 01 Mar 2011 00:00:00 +0100 4589388 http://www.medworm.com/index.php?rid=4589387&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861010005001%2Fabstract%3Frss%3Dyes Introduction/Objective: Properly diagnosing dementia type allows for expectant management of the syndrome, education of the patient and family, and long term care planning. There is considerable overlap of diagnostic features of the dementia syndromes which can increase the difficulty of accurate diagnosis. This case report presents a patient with clinical features and diagnosis of frontotemporal dementia, yet conflicting autopsy diagnosis of Alzheimer's disease. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=4589387 Tue, 01 Mar 2011 00:00:00 +0100 4589387 http://www.medworm.com/index.php?rid=4589386&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861010004998%2Fabstract%3Frss%3Dyes The objective of this presentation is to analyze both of these failures of transition with specific emphasis on relevant hospitalization criteria and Medicare payment guidelines. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=4589386 Tue, 01 Mar 2011 00:00:00 +0100 4589386 http://www.medworm.com/index.php?rid=4589385&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861010004986%2Fabstract%3Frss%3Dyes Introduction/Objective: The Balance Budget Act resulted in an average decrease in the length of stay in most nursing facilities. With the increase in short “stayers”, attending physicians often face uncertainty when discharging a resident back to the community. Will the resident take their medications as prescribed? Will they reconnect with their primary care physician before their condition deteriorates? Despite home health services many patients return to the hospital within three weeks of discharge and the average wait time for primary care visit is three weeks. Many seniors who want to return home often remain in the nursing facility because of a lack of support in the community. This is a no win situation for the nursing facility and the resident. The nursing facility will lose re... Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=4589385 Tue, 01 Mar 2011 00:00:00 +0100 4589385 http://www.medworm.com/index.php?rid=4589384&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861010004974%2Fabstract%3Frss%3Dyes Introduction/Objective: The purpose of this study was to identify differences in the Braden subscales as it relates to the total Braden score (pressure sore (PS) risk) in a skilled nursing facility (SNF) rehabilitation unit. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=4589384 Tue, 01 Mar 2011 00:00:00 +0100 4589384 http://www.medworm.com/index.php?rid=4589383&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861010004962%2Fabstract%3Frss%3Dyes Introduction/Objective: The purpose of this study was to test the impact of the Function Focused Care for Assisted Living (FFC-AL) intervention on residents' self-efficacy and outcome expectations with regard to function and physical activity (PA), functional performance and time in physical activity, fit between the resident and the environment, and life satisfaction and to evaluate knowledge, beliefs and care behaviors of direct care workers in four different assisted living (AL) communities. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=4589383 Tue, 01 Mar 2011 00:00:00 +0100 4589383 http://www.medworm.com/index.php?rid=4589382&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861010004950%2Fabstract%3Frss%3Dyes Introduction/Objective: In palliative and hospice care, the family and friends often become the focus of care. This is true when transitioning from a curative to palliative approach. It is also true during the final days. The relationship extends beyond the death of the patient into the early period of grief. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=4589382 Tue, 01 Mar 2011 00:00:00 +0100 4589382 http://www.medworm.com/index.php?rid=4589381&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861010004949%2Fabstract%3Frss%3Dyes The objective of this analysis is to evaluate the treatment satisfaction of patients with osteoarthritis pain converted from Vicodin® (hydrocodone/APAP) to Butrans using a Treatment Satisfaction Survey. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=4589381 Tue, 01 Mar 2011 00:00:00 +0100 4589381 http://www.medworm.com/index.php?rid=4589380&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861010004937%2Fabstract%3Frss%3Dyes Introduction/Objective: Medical Director entered a Skilled Nursing Facility who was a QI Outlier in the use of Foleys. Objective was to reduce the use of unnecessary Foleys and implements systematic Foley care 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=4589380 Tue, 01 Mar 2011 00:00:00 +0100 4589380 http://www.medworm.com/index.php?rid=4589379&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861010004925%2Fabstract%3Frss%3Dyes Introduction/Objective: Skin is the biggest organ in the body yet it remains largely overlooked in long term care. Skin cancer is the most common form of cancer in the United States and risk increases with aging. An estimated 2.5 million cases are diagnosed and 10,000 people die secondary to skin cancer annually. Skin cancer in nursing home residents remain under diagnosed despite the high prevalence. Why this occurs remains challenging. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=4589379 Tue, 01 Mar 2011 00:00:00 +0100 4589379 http://www.medworm.com/index.php?rid=4589378&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861010004913%2Fabstract%3Frss%3Dyes Introduction/Objective: Nonsteroidal anti-inflammatory drugs (NSAIDs) are associated with a dose-related risk of cardiovascular, renal, and gastrointestinal adverse events (AEs). Topical NSAIDs produce lower systemic NSAID exposure compared with oral NSAIDs, offering potential benefits. The safety of topical diclofenac sodium 1% gel (DSG) was assessed in patients with symptomatic knee or hand osteoarthritis (OA). (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=4589378 Tue, 01 Mar 2011 00:00:00 +0100 4589378 http://www.medworm.com/index.php?rid=4589377&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861010004901%2Fabstract%3Frss%3Dyes Introduction/Objective: As part of a Lehigh Valley Health Network (LVHN) initiative to examine causes of readmissions to hospital within 30 days of discharge, we performed a chart review of patients readmitted from a single not-for- profit nursing facility (NF) for a six month period in 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=4589377 Tue, 01 Mar 2011 00:00:00 +0100 4589377 http://www.medworm.com/index.php?rid=4589376&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861010004895%2Fabstract%3Frss%3Dyes This article outlines a case report in our hospital when a patient of dementia with RLS was misinterpreted as hyper sexuality. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=4589376 Tue, 01 Mar 2011 00:00:00 +0100 4589376 http://www.medworm.com/index.php?rid=4589375&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861010004883%2Fabstract%3Frss%3Dyes Introduction/Objective: To evaluate the association of warfarin use with characteristics of residents across 2 LTC databases. Design/Methodology: LTC residents from 2 databases, the nationally representative National Nursing Home Survey (NNHS) 2004 and the AnalytiCare™ multistate database, who had a current diagnosis for AF (ICD9=427.3X) were studied. Additional inclusion criteria for the AnalytiCare analysis were age >18 years and the presence of a full Minimum Data Set (MDS) assessment during the period 1/1/07–6/30/08. Comorbidity, current medications, and other resident data were analyzed and potential medication interactions were identified. Potential associations between resident characteristics (demographics, physical function, stroke, and bleeding risk factors) and warfarin use... Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=4589375 Tue, 01 Mar 2011 00:00:00 +0100 4589375 http://www.medworm.com/index.php?rid=4589374&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861010004871%2Fabstract%3Frss%3Dyes This study explores the impact of a new guideline encouraging utilization of pen devices in Medicare A patients prescribed one of four analog basal and short acting insulins in a national chain of skilled nursing facilities. The objective of this study is to determine whether a higher proportion of insulin purchasing in pen delivery systems (vs. vials) results in a lower drug acquisition cost per patient-day for nursing facilities in the Medicare A-covered population with LOS of 30 days or less. Specifically, the relationship between pen utilization as a percentage of total insulin utilization and drug acquisition costs on a cost per patient day basis is explored. (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=4589374 Tue, 01 Mar 2011 00:00:00 +0100 4589374 http://www.medworm.com/index.php?rid=4589373&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS152586101000486X%2Fabstract%3Frss%3Dyes Introduction/Objective: Almost 25 percent of Medicare beneficiaries discharged from the hospital to a nursing home (NH) can expect to be readmitted to the hospital within 30 days.(1) Rehospitalizations cost Medicare $4.34 billion in 2006 and based on expert assessment, 90% may be avoidable.(1,2) The case study presented in this poster describes the impact of one NH Lean Six Sigma (LSS) team's effort to implement a transitional care “bundle” of related processes and resources needed to effectively reduce avoidable rehospitalizations (ARHs). (Source: Journal of the American Medical Directors Association) Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=4589373 Tue, 01 Mar 2011 00:00:00 +0100 4589373 http://www.medworm.com/index.php?rid=4589372&cid=s_38539_51_f&fid=38539&url=http%3A%2F%2Fwww.jamda.com%2Farticle%2FPIIS1525861010004858%2Fabstract%3Frss%3Dyes Introduction/Objective: Review of the literature shows that antipsychotics are overused in nursing homes. Although there is variability in use, nearly one-third of nursing home residents with dementia receive antipsychotic medications. According to the American Society of Consultant Pharmacists, February 2009, use of antipsychotic medications in the United States was at 25.5%. In 2008, utilization of antipsychotics among residents in Florida nursing homes was at 25.4%. Evercare, A Medicare Special Needs Plan for residents in nursing homes, had a national average of 25.4%; Florida Evercare was at 42.3%. Florida Evercare implemented a quality improvement initiative to decrease utilization of antipsychotics. Focus was on caseloads with utilization of >/=30% with the goal of (Source: Journal o... Journal of the American Medical Directors Association journals http://www.medworm.com/rss/comments.php?id=4589372 Tue, 01 Mar 2011 00:00:00 +0100 4589372