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1.
Rebekka M. Lee Catherine M. Giles Angie L. Cradock Karen M. Emmons Cassandra Okechukwu Erica L. Kenney J. Thayer Steven L. Gortmaker 《Journal of the Academy of Nutrition and Dietetics》2018,118(8):1425-1437
Background
Afterschool interventions have been found to improve the nutritional quality of snacks served. However, there is limited evidence on how these interventions affect children’s snacking behaviors.Objective
Our aim was to determine the impact of an afterschool intervention focused at the school district, site, family, and child levels on dietary consumption of foods and beverages served at snack.Design
This was a secondary analysis of a group-randomized controlled trial.Participants/setting
Data were collected from 400 children at 20 afterschool sites in Boston, MA before (fall 2010) and after (spring 2011) intervention implementation.Intervention
The Out-of-School Nutrition and Physical Activity intervention aimed to promote fruits, vegetables, whole grains, and water, while limiting sugary drinks and trans fats. Researchers worked with district foodservice staff to change snack foods and beverages. Teams of afterschool staff participated in three 3-hour learning collaborative sessions to build skills and created action plans for changing site practices. The intervention included family and child nutrition education.Main outcome measures
Research assistants observed dietary snack consumption using a validated measure on 2 days per site at baseline and follow-up.Statistical analyses performed
This study used multivariable regression models, accounting for clustering of observations, to assess the intervention effect, and conducted post-hoc stratified analyses by foodservice type.Results
Children in intervention sites had greater decreases in consumption of juice (–0.61 oz/snack, 95% CI –1.11 to –0.12), beverage calories (–29.1 kcal/snack, 95% CI –40.2 to 18.0), foods with trans fats (–0.12 servings/snack, 95% CI –0.19 to –0.04), total calories (–47.7 kcal/snack, 95% CI –68.2 to –27.2), and increases in consumption of whole grains (0.10 servings/snack, 95% CI 0.02 to 0.18) compared to controls. In post-hoc analyses, sites with on-site foodservice had significant improvements for all outcomes (P<0.001), with no effect for sites with satellite foodservice.Conclusions
Results demonstrate that an afterschool intervention can improve children’s dietary snack consumption, particularly at sites with on-site foodservice. 相似文献2.
Claudia K.Y. Lai Xiaojuan Wan 《Journal of the American Medical Directors Association》2017,18(6):509-514
Objectives
Studies reporting prompted voiding (PV) interventions were of short duration and were delivered by research personnel rather than nursing home staff. This study examined the effectiveness of the use of PV by nursing home staff in managing urinary incontinence among residents over a 6-month period.Design
A randomized controlled trial.Setting
Five nursing homes in Hong Kong.Participants
Data were collected from 52 nursing home residents who had been admitted to the facility for at least 6 months prior to the initiation of the study and whose incontinence had been stable over the 6-month period.Intervention
The PV intervention was delivered by the staff for 6 months. All nursing home staff were trained to ensure that they would be able to correctly deliver the intervention before initiating the intervention. The control group received the usual care.Measurements
Outcomes were defined in terms of wet episodes per day, incontinence rate per day, self-initiated toileting per day, and total continent toileting per day. Data were collected at baseline, 3 months postintervention (T1), and 6 months postintervention (T2).Results
There were significant differences between the two groups in wet episodes per day, incontinence rate per day, and total continent toileting per day at 6 months post-intervention, with positive results found in the intervention group. A decrease of 9.1% was observed in the incontinence rate of the intervention group.Conclusions
PV was shown to have positive effects, although the effects in this study were not as powerful as those found in overseas studies. The intervention delivered by staff was sustainable for a 6-month period. Nursing home operators should promote better continence care through PV, as it is a sustainable noninvasive behavioral intervention that can be mastered by staff with training. 相似文献3.
Jennifer S. Albrecht Lindsay Croft Daniel J. Morgan Mary-Claire Roghmann 《Journal of the American Medical Directors Association》2017,18(2):158-161
Objectives
To explore current use and perceptions of glove and gown use in nursing homes.Design
Qualitative study using focus groups and semi-structured interviews.Setting
Three community-based nursing homes in Maryland.Participants
Direct care staff, administrators, and residents.Methods
We conducted three focus groups among nursing home staff, one focus group among nursing home administrators, and five interviews with residents. Topic guides were created based on our recent study results and a review of the literature. Two investigators separately analyzed the transcribed recordings and identified recurrent themes.Results
Direct care staff reported using gowns and gloves primarily as self-protection against contact with bodily fluids, not to prevent MRSA transmission. Glove use was described as common and more acceptable to staff and residents than gown use. Administrators were surprised that MRSA transmission to health care worker hands and clothing occurred during activities when direct care staff perceives no contact with bodily fluids. Staff and administrators expressed willingness to use gowns and gloves for high-risk care activities, particularly if use is targeted toward specific types of residents such as those with pressure ulcers. There was a knowledge deficit about MRSA transmission and infection among direct care staff and residents.Conclusions
Results from this study will inform a strategy to reduce MRSA transmission in long-term care. 相似文献4.
Ineke J. Gerridzen Cees M.P.M. Hertogh Marja F. Depla Ruth B. Veenhuizen Els M.L. Verschuur Karlijn J. Joling 《Journal of the American Medical Directors Association》2018,19(3):240-247
Objectives
Caring for people with Korsakoff syndrome (KS) residing in specialized long-term care facilities (LTCFs) can be distressing because of challenging neuropsychiatric symptoms (NPS). However, good-quality studies on NPS in this under-researched population are lacking. This study examined the prevalence and severity of NPS in people with KS living in specialized LTCFs and the associated caregiver distress.Design
Cross-sectional, observational study. Data were obtained using structured interviews with care staff, elderly care physicians, and residents.Setting
Nine specialized LTCFs in the Netherlands.Participants
KS residents admitted for at least 3 months.Measurements
The prevalence and severity of NPS were measured with the Neuropsychiatric Inventory–Questionnaire (NPI-Q). The associated caregiver distress was assessed with the NPI Distress Scale (NPI-D) according to the nurse or nurse assistant.Results
Almost all of the 281 residents (96.4%) showed at least 1 NPS and 45.8% showed 5 or more symptoms. Irritability/lability (68.3%), agitation/aggression (58.7%), and disinhibition (52.7%) were most prevalent. Although the mean level of severity for all NPS was relatively low, half of the residents (49.1%) had at least 1 severe NPS. Care staff experienced low levels of distress associated with NPS.Conclusion
NPS are highly prevalent in KS residents. Unexpectedly, these did not have any severe impact on residents and care staff. Acquiring more insight into the persistence and course of NPS, and its associations, among KS residents is important to better understand and reduce these symptoms and, ultimately, improve the quality of care for these residents. 相似文献5.
Vincent Guion Philipe De Souto Barreto Sandrine Sourdet Yves Rolland 《Journal of the American Medical Directors Association》2018,19(12):1118-1123.e2
Objectives
To determine whether an intervention based on education and professional support to nursing home (NH) staff would decrease the number of residents with a pain complaint, and to determine whether the intervention would improve pain management.Design
Nonrandomized controlled trial. NHs were nonrandomly allocated either to a strong intervention group consisting in audit, feedback, and collaborative work on quality indicators with a hospital geriatrician, or to a light intervention group (LIG) consisting in audit and feedback only.Setting
One hundred fifty-nine NHs located in France.Participants
A subgroup of 3722 residents.Measures
Information on pain complaint and pain-related covariates at the resident-related and at the NH level were recorded by NH staff at baseline and 18 months later. These covariates were included in a mixed-effects logistic regression on resident's pain complaint. Pain management was compared between intervention groups by chi-square tests.Results
A greater reduction of residents with a pain complaint after the strong intervention (odds ratio 0.69, 95% confidence interval 0.53, 0.90) and a better pain management (47.6% gold standard, vs 30.6% in the LIG, P < .001) than controls.Conclusion/Implications
Combining educational and organizational measures, evaluating pain as a patient-reported outcome and as a process endpoint, and implementing a broad-spectrum intervention were original approaches to improve quality of care in NHs. Our results support nonspecific, collaborative, educational, and organizational interventions in NHs to decrease residents' pain complaint and improve pain management. 相似文献6.
Lien Van Malderen Patricia De Vriendt Tony Mets Dominique Verté Ellen Gorus 《Journal of the American Medical Directors Association》2017,18(6):495-502
Objectives
This study aimed to examine the effects of introducing participatory action research (PAR) within the nursing home (NH) on residents’ quality of life (QoL) and NH experience and participation, and to explore their experiences with PAR.Design
A mixed methods design was chosen, including a clustered randomized controlled trial (RCT) and qualitative interviews.Setting
For the RCT, 3 NHs were randomly allocated to 3 conditions: an intervention (weekly PAR activity), an active control (weekly reminiscence-activity), or passive control (care as usual). The qualitative study took place in the intervention NH.Participants
Within the RCT, about 30 residents were recruited for assessments per NH, including 9 PAR participants and 10 reminiscence participants. Qualitative interviews were held with all PAR participants (residents and internal moderator).Intervention
PAR is a method to structurally involve residents in the NH operation. Weekly PAR sessions were held with 9 residents and 2 moderators. Here, residents critically analyzed and discussed the NH operation, identified possible problems, suggested improvements, which were further implemented by the NH and monitored by the PAR group.Measurements
Residents’ NH experience (NH Active Aging Survey), QoL (Anamnestic Comparison Self-Assessment), and experienced participation (Impact on Participation and Autonomy) were measured in the RCT at pre-test, post-test (6 months), and follow-up (12 months). The qualitative study took into account interviews with the PAR stakeholders after 6 months.Results
The RCT showed residents’ QoL improving more between pre-test and follow-up in the intervention and active control NH compared with the passive control NH. No other effects were observed. The qualitative data revealed a positive PAR experience. Participants enjoyed the activity and indicated various positive influences. Still, there was room for improvement, including communication toward other residents and between staff.Conclusions
Notwithstanding the modest quantitative effects, PAR led to positive experiences and can have a future in the NH when solving some limitations. 相似文献7.
Jeannette C.L. van Duinen-van den IJssel Ans J.M.J. Mulders Martin Smalbrugge Sandra A. Zwijsen Britt Appelhof Sytse U. Zuidema Marjolein E. de Vugt Frans R.J. Verhey Christian Bakker Raymond T.C.M. Koopmans 《Journal of the American Medical Directors Association》2018,19(7):627-632
Objective
The aims of this study were (1) to investigate the relationship between different neuropsychiatric symptoms (NPS) and the level of distress experienced by nurses caring for residents with young-onset dementia (YOD) and (2) to compare these findings with those for nurses caring for residents with late-onset dementia (LOD).Design/Setting
This is a retrospective study conducted in Dutch long-term care facilities. Data were used from the Behavior and Evolution of Young-ONset Dementia studies (BEYOND) Parts I and II and the WAAL Behavior in Dementia-II (Waalbed-II) study.Participants
A total of 382 nursing home residents with YOD and 261 nursing home residents with LOD were included.Measurements
The Neuropsychiatric Inventory, nursing home version, was used to assess nursing staff distress and the frequency (F) and severity (S) of NPS. Multilevel logistic regression analysis was used to investigate the relationships between nursing staff distress related to NPS and YOD and LOD care units, the F × S score per symptom, gender, dementia subtype, and dementia severity.Results
Nurses working in YOD care units rated sleep and nighttime behavior disorders, delusions, and agitation/aggression most often as highly distressing and euphoria most often as not distressing. Multivariate analyses indicated that the frequency and severity of NPS were significantly associated with staff distress in all symptoms, except for apathy. Comparison of the 2 groups of nurses demonstrated that the odds for distress related to sleep and nighttime behavior disorders were higher for nurses in YOD care units than for nurses in LOD units. For both the YOD and LOD nurses, irritability in male residents had higher impact than similar behavior in female residents.Conclusion
This study provides important insight into distress related to individual NPS and the interaction with residents' characteristics. All NPS result in distress. The frequency and severity of the behavior is an important predictor. Sleep and nighttime behavior disorders are more likely to result in distress in YOD nurses than in LOD nurses. The amount of distress related to NPS emphasizes the urgent need for adequate management of NPS and the support of professional caregivers. 相似文献8.
Deana A. Hildebrand Priscilla Blevins Lillian Carl Barbara Brown Nancy M. Betts Tiffany Poe 《Journal of nutrition education and behavior》2018,50(2):118-124.e1
Objective
Use the Community Readiness Model (CRM) to develop and evaluate a contextually appropriate pilot culinary training program for school nutrition staff members.Design
Mixed methods to guide intervention development.Settings
Six school districts in rural and urban areas of a southwestern state.Participants
School nutrition staff (n = 36; female; <1 to >20 years' experience).Intervention
Pre- and post-training assessments used the CRM. Findings from the pre-assessment were used to develop the pilot culinary training intervention.Main Outcome Measure
Readiness to integrate new food preparation methods into existing practices.Analysis
The researchers used t and Wilcoxon tests to compare overall readiness and dimension scores (P ≤ .05). Thematic analysis was used to identify themes from the discussion component of the assessments.Results
Overall readiness increased from vague awareness to preparation (P = .02). Improved dimensions were knowledge of efforts (P = .004), leadership (P = .05), and knowledge of issues (P = .04). Themes included barriers, leadership, and motivation.Conclusions and Implications
The CRM was useful for developing and evaluating a contextually appropriate and effective culinary training program for school nutrition staff. Future efforts should address the provision of additional resources such as on-site chefs, small equipment grants, and engaging school stakeholders. 相似文献9.
Cathleen S. Colón-Emeric Kirsten N. Corazzini Eleanor S. McConnell Wei Pan Mark P. Toles Rasheeda Hall Melissa Batchelor-Murphy Tracey L. Yap Amber L. Anderson Andrew Burd Sathya Amarasekara Ruth A. Anderson 《Journal of the American Medical Directors Association》2018,19(5):405-410
Objectives
Validated process measures that correlate with patient outcomes are needed for research and quality improvement.Design
Cross-sectional analysis within a cluster-randomized fall prevention study.Setting
Nursing homes in North Carolina (n = 16).Participants
Nursing home staff (n = 541) and residents with 1 or more falls in 6 months (n = 597).Measurements
Fall-prevention process measures in 4 categories derived from Assessing Care of Vulnerable Elders quality indicators were measured in 2 ways: (1) chart abstraction; and (2) staff responses to clinical vignettes of hypothetical residents at risk for falls. Recurrent fall rates (falls/resident/year) were measured. The proportion of the total variation in falls rates explained by the scores for each method (chart abstraction or vignette) was calculated using multilevel adjusted models.Results
Chart and vignette measures of comorbidity management were moderately correlated (Pearson correlation coefficient 0.43), whereas other process measure categories had low or negative correlation between the 2 methods (psychoactive medication reduction 0.13, environmental modification ?0.42, and exercise/rehabilitation ?0.08). Measures of environmental modification and comorbidity management explained a moderate amount of the total variation in recurrent fall fates, vignettes (7%–10% variation explained) were superior to chart abstraction (2%–6% variation explained). Vignette responses from unlicensed staff (nurse aides and rehabilitation aides) explained more variance than registered nurses, licensed practical nurses, or other licensed staff in these categories. Process measures for psychoactive medication reduction and exercise/rehabilitation did not explain any of the variation in fall outcomes. Overall, vignette process measures explained 3.9% and chart abstraction measures explained 0% of the variation in fall outcomes.Conclusions
Clinical vignettes completed by nursing home staff had greater association with resident recurrent fall rates than traditional chart abstraction process measures. 相似文献10.
11.
Sandra F. Simmons Chris S. Coelho Andrew Sandler John F. Schnelle 《Journal of the American Medical Directors Association》2018,19(3):262-269
Purpose
To describe a feasible quality improvement system to manage feeding assistance care processes in an assisted living facility (ALF) that provides dementia care and the use of these data to maintain the quality of daily care provision and prevent unintentional weight loss.Design and methods
Supervisory ALF staff used a standardized observational protocol to assess feeding assistance care quality during and between meals for 12 consecutive months for 53 residents receiving dementia care. Direct care staff received feedback about the quality of assistance and consistency of between-meal snack delivery for residents with low meal intake and/or weight loss.Results
On average, 78.4% of the ALF residents consumed more than one-half of each served meal and/or received staff assistance during meals to promote consumption over the 12 months. An average of 79.7% of the residents were offered snacks between meals twice per day. The prevalence of unintentional weight loss averaged 1.3% across 12 months.Implications
A quality improvement system resulted in sustained levels of mealtime feeding assistance and between-meal snack delivery and a low prevalence of weight loss among ALF residents receiving dementia care. Given that many ALF residents receiving dementia care are likely to be at risk for low oral intake and unintentional weight loss, ALFs should implement a quality improvement system similar to that described in this project, despite the absence of regulations to do so. 相似文献12.
13.
Henry Brodaty Liesbeth Aerts Fleur Harrison Tiffany Jessop Monica Cations Lynn Chenoweth Allan Shell Gordana C. Popovic Megan Heffernan Sarah Hilmer Perminder S. Sachdev Brian Draper 《Journal of the American Medical Directors Association》2018,19(7):592-600.e7
Objectives
Despite limited efficacy and significant safety concerns, antipsychotic medications are frequently used to treat behavioral and psychological symptoms of dementia (BPSD) in long-term residential care. This study evaluates the sustained reduction of antipsychotic use for BPSD through a deprescribing intervention and education of health care professionals.Design
Repeated-measures, longitudinal, single-arm study.Setting
Long-term residential care of older adults.Participants
Nursing staff from 23 nursing homes recruited 139 residents taking regular antipsychotic medication for ≥3 months, without primary psychotic illness, such as schizophrenia or bipolar disorder, or severe BPSD.Intervention
An antipsychotic deprescribing protocol was established. Education of general practitioners, pharmacists, and residential care nurses focused on nonpharmacological prevention and management of BPSD.Measurements
The primary outcome was antipsychotic use over 12-month follow-up; secondary outcomes were BPSD (Neuropsychiatric Inventory, Cohen-Mansfield Agitation Inventory, and social withdrawal) and adverse outcomes (falls, hospitalizations, and cognitive decline).Results
The number of older adults on regular antipsychotics over 12 months reduced by 81.7% (95% confidence interval: 72.4-89.0). Withdrawal was not accompanied by drug substitution or a significant increase in pro-re-nata antipsychotic or benzodiazepine administration. There was no change in BPSD or in adverse outcomes.Conclusion
In a selected sample of older adults living in long-term residential care, sustained reduction in regular antipsychotic use is feasible without an increase of BPSD. 相似文献14.
Kieran A. Walsh Carol Sinnott Aoife Fleming Jenny Mc Sharry Stephen Byrne John Browne Suzanne Timmons 《Journal of the American Medical Directors Association》2018,19(11):948-958.e12
Objectives
Caution is advised when prescribing antipsychotics to people with dementia. This study explored the determinants of appropriate, evidence-based antipsychotic prescribing behaviors for nursing home residents with dementia, with a view to informing future quality improvement efforts and behavior change interventions.Design
Semistructured qualitative interviews based on the Theoretical Domains Framework (TDF).Setting and Participants
A purposive sample of 27 participants from 4 nursing homes, involved in the care of nursing home residents with dementia (8 nurses, 5 general practitioners, 5 healthcare assistants, 3 family members, 2 pharmacists, 2 consultant geriatricians, and 2 consultant psychiatrists of old age) in a Southern region of Ireland.Measures
Using framework analysis, the predominant TDF domains and determinants influencing these behaviors were identified, and explanatory themes developed.Results
Nine predominant TDF domains were identified as influencing appropriate antipsychotic prescribing behaviors. Participants’ effort to achieve “a fine balance” between the risks and benefits of antipsychotics was identified as the cross-cutting theme that underpinned many of the behavioral determinants. On one hand, neither healthcare workers nor family members wanted to see residents over-sedated and without a quality of life. Conversely, the reality of needing to protect staff, family members, and residents from potentially dangerous behavioral symptoms, in a resource-poor environment, was emphasized. The implementation of best-practice guidelines was illustrated through 3 explanatory themes (“human suffering”; “the interface between resident and nursing home”; and “power and knowledge: complex stakeholder dynamics”), which conceptualize how different nursing homes strike this “fine balance.”Conclusions
Implementing evidence-based antipsychotic prescribing practices for nursing home residents with dementia remains a significant challenge. Greater policy and institutional support is required to help stakeholders strike that “fine balance” and ultimately make better prescribing decisions. This study has generated a deeper understanding of this complex issue and will inform the development of an evidence-based intervention. 相似文献15.
Simone J.C. Paulis Irma H.J. Everink Ruud J.G. Halfens Christa Lohrmann Jos M.G.A. Schols 《Journal of the American Medical Directors Association》2018,19(8):646-657
Objectives
To provide an overview of the prevalence rates and risk factors of dehydration among nursing home residents.Design
Systematic literature review.Setting
Nursing homes.Participants
Nursing home residents or institutionalized long-term care residents.Measurements
A systematic literature review was executed on March 15, 2018, using the databases PubMed, CINAHL, and EMBASE to retrieve all articles focused on the prevalence rates and risk factors for acute and chronic dehydration. Studies were included if the target population involved nursing home residents or institutionalized long-term care residents.Results
Nineteen studies were included in this systematic review. Prevalence rates of dehydration varied between 0.8% and 38.5% and were measured using different methods. Furthermore, 49 potential risk factors for dehydration were identified. Of the 12 potential risk factors that were investigated in more than 1 study, cognitive impairment and fever were significantly associated with dehydration among nursing home residents.Conclusions/implications
Dehydration is a relevant and frequently occurring problem among nursing home residents. This systematic review shows that a wide variety of methods are used to assess dehydration and that it is often unclear which type of dehydration (chronic or acute) is measured. This makes it difficult to compare prevalence rates among studies. Moreover, only 2 of 49 potential risk factors (fever and cognitive impairment) were more than once significantly associated with dehydration in the respective studies. Most of the other risk factors were assessed by only 1 study or showed inconsistent results. Therefore, more research into dehydration among nursing home residents is needed. 相似文献16.
17.
Merehau C. Mervin Wendy Moyle Cindy Jones Jenny Murfield Brian Draper Elizabeth Beattie David H.K. Shum Siobhan O&#x;Dwyer Lukman Thalib 《Journal of the American Medical Directors Association》2018,19(7):619-622.e1
Objectives
To examine the within-trial costs and cost-effectiveness of using PARO, compared with a plush toy and usual care, for reducing agitation and medication use in people with dementia in long-term care.Design
An economic evaluation, nested within a cluster–randomized controlled trial.Setting
Twenty-eight facilities in South-East Queensland, Australia.Participants
A total of 415 residents, all aged 60 years or older, with documented diagnoses of dementia.Intervention
Facilities were randomized to 1 of 3 groups: PARO (individual, nonfacilitated 15-minute sessions, 3 afternoons per week for 10 weeks); plush toy (as per PARO but with artificial intelligence disabled); and usual care.Measurements
The incremental cost per Cohen-Mansfield Agitation Inventory–Short Form (CMAI-SF) point averted from a provider's perspective. Australian New Zealand Clinical Trials Registry (BLINDED FOR REVIEW).Results
For the within-trial costs, the PARO group was $50.47 more expensive per resident compared with usual care, whereas the plush toy group was $37.26 more expensive than usual care. There were no statistically significant between-group differences in agitation levels after the 10-week intervention. The point estimates of the incremental cost-effectiveness ratios were $13.01 for PARO and $12.85 for plush toy per CMAI-SF point averted relative to usual care.Conclusion
The plush toy used in this study offered marginally greater value for money than PARO in improving agitation. However, these costs are much lower than values estimated for psychosocial group activities and sensory interventions, suggesting that both a plush toy and the PARO are cost-effective psychosocial treatment options for agitation. 相似文献18.
Sally McCray Kirsty Maunder Renee Krikowa Kristen MacKenzie-Shalders 《Journal of the Academy of Nutrition and Dietetics》2018,118(2):284-293
Background
Room service is a foodservice model that has been increasingly implemented across health care facilities in an effort to improve patient satisfaction and reduce food waste. In 2013, Mater Private Hospital Brisbane, Australia, was the first hospital in Australia to implement room service, with the aim of improving patient nutrition care and reducing costs.Objective
The aim of this study was to comprehensively evaluate the nutritional intake, plate waste, patient satisfaction, and patient meal costs of room service compared to a traditional foodservice model.Design
A retrospective analysis of quality-assurance data audits was undertaken to assess patient nutritional intake between a facility utilizing a traditional foodservice model and a facility utilizing room service and in a pre?post study design to assess plate waste, patient satisfaction, and patient meal costs before and after the room service implementation.Participants
Audit data were collected for eligible adult inpatients in Mater Private Hospital Brisbane and Mater Hospital Brisbane, Australia, between July 2012 and May 2015.Main outcome measures
The primary outcome measures were nutritional intake, plate waste, patient satisfaction, and patient meal costs.Statistical analyses performed
Independent samples t-tests and χ2 analyses were conducted between pre and post data for continuous data and categorical data, respectively. Pearson χ2 analysis of count data for sex and reasons for plate waste for data with counts more than five was used to determine asymptotic (two-sided) significance and n-1 χ2 used for the plate waste analysis. Significance was assessed at P<0.05.Results
This study reported an increased nutritional intake, improved patient satisfaction, and reduced plate waste and patient meal costs with room service compared to a traditional foodservice model. Comparison of nutritional intake between a traditional foodservice model (n=85) and room service (n=63) showed statistically significant increases with room service in both energy (1,306 kcal/day vs 1,588 kcal/day; P=0.005) and protein (52 g/day vs 66 g/day, P=0.003) intake, as well as energy and protein intake as a percentage of requirements (63% vs 75%; P=0.024 and 65% vs 85%; P=0.011, respectively). Total mean plate waste decreased from 29% (traditional foodservice model) to 12% (room service) (P<0.001). Patient satisfaction ratings indicated improvement with room service across all Press Ganey meal scores: 68th to 86th percentile overall; 64th to 95th percentile for “quality of food”; and 60th to 99th percentile for “flavor of food.” Evaluated during comparable times of the year, patient meal costs decreased by 15% with room service.Conclusions
A patient-centered foodservice model, such as room service, can improve patient nutritional intake and enhance patient satisfaction in a budget constrained health care environment. 相似文献19.
Yanli Zeng Xiaoyi Hu Lingling Xie Zengli Han Yun Zuo Ming Yang 《Journal of the American Medical Directors Association》2018,19(8):690-695
Objectives
To investigate the prevalence and associated factors of sarcopenia defined by different criteria in nursing home residents.Design
A cross-sectional study.Setting
Four nursing homes in Chengdu, China.Participants
Elderly adults aged 65 years or older.Measurements
We applied 4 diagnostic criteria [European Working Group on Sarcopenia in Older People (EWGSOP), Asia Working Group for Sarcopenia (AWGS), International Working Group on Sarcopenia (IWGS), and Foundation for the National Institutes of Health (FNIH)] to define sarcopenia. Muscle mass, strength, and function were measured based on bioimpedance analysis, handgrip strength, and walking speed, respectively. Nutrition status, activities of daily living, calf circumference (CC), and other covariates were evaluated.Results
We included 277 participants. The prevalence of sarcopenia was 32.5%, 34.3%, 38.3%, and 31.4% according to the EWGSOP, AWGS, IWGS, and FNIH criteria, respectively. Fifty-eight participants (20.9%) were sarcopenic by all the 4 criteria. Regardless of the diagnostic criteria of sarcopenia, malnutrition was independently associated with sarcopenia [EWGSOP: odds ratio (OR) 4.02, 95% confidence interval (CI) 1.05-15.39; IWGS: OR 2.46, 95% CI 1.23-4.90; AWGS: OR 3.29, 95% CI 1.49-7.28; FNIH: OR 4.52, 95% CI 1.28-16.00], whereas CC was negatively associated with sarcopenia [EWGSOP: OR per standard deviation (SD) 0.32, 95% CI 0.20-0.52; IWGS: OR per SD 0.26, 95% CI 0.15-0.43; AWGS: OR per SD 0.32, 95% CI 0.19-0.52; FNIH: OR per SD 0.39, 95% CI 0.25-0.60]. Furthermore, falls ≥1 time in the past year were associated with AWGS-defined sarcopenia (OR 2.92, 95% CI 1.04-8.22).Conclusion/Implications
Sarcopenia is highly prevalent in elderly Chinese nursing home residents regardless of the diagnostic criteria. Malnutrition and CC are associated with sarcopenia defined by different criteria. Therefore, it is important to assess sarcopenia and malnutrition in the management of nursing home residents. Prospective studies addressing the outcomes of sarcopenia in nursing home residents are warranted. 相似文献20.
Judith L. Poey Linda Hermer Laci Cornelison Migette L. Kaup Patrick Drake Robyn I. Stone Gayle Doll 《Journal of the American Medical Directors Association》2017,18(11):974-979