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Ellen M. McCreedy Barbara E. Weinstein Joshua Chodosh Jan Blustein 《Journal of the American Medical Directors Association》2018,19(4):323-327
Over the past decade, hearing loss has emerged as a key issue for aging and health. We describe why hearing loss may be especially disabling in nursing home settings and provide an estimate of prevalence using the Minimum Data Set (MDS v.3.0). We outline steps to mitigate hearing loss. Many solutions are inexpensive and low-tech, but require significant awareness and institutional commitment. 相似文献
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Philip D. Sloane Kimberly Ward David J. Weber Christine E. Kistler Benjamin Brown Katherine Davis Sheryl Zimmerman 《Journal of the American Medical Directors Association》2018,19(6):492-496.e1
Objectives
To determine whether and to what extent simple screening tools might identify nursing home (NH) residents who are at high risk of becoming septic.Design
Retrospective chart audit of all residents who had been hospitalized and returned to participating NHs during the study period.Setting and Participants
A total of 236 NH residents, 59 of whom returned from hospitals with a diagnosis of sepsis and 177 who had nonsepsis discharge diagnoses, from 31 community NHs that are typical of US nursing homes overall.Measures
NH documentation of vital signs, mental status change, and medical provider visits 0–12 and 13–72 hours prior to the hospitalization. The specificity and sensitivity of 5 screening tools were evaluated for their ability to detect residents with incipient sepsis during 0–12 and 13–72 hours prior to hospitalization: The Systemic Inflammatory Response Syndrome criteria, the quick Sequential Organ Failure Assessment (SOFA), the 100-100-100 Early Detection Tool, and temperature thresholds of 99.0°F and 100.2°F. In addition, to validate the hospital diagnosis of sepsis, hospital discharge records in the NHs were audited to calculate SOFA scores.Results
Documentation of 1 or more vital signs was absent in 26%–34% of cases. Among persons with complete vital sign documentation, during the 12 hours prior to hospitalization, the most sensitive screening tools were the 100-100-100 Criteria (79%) and an oral temperature >99.0°F (51%); and the most specific tools being a temperature >100.2°F (93%), the quick SOFA (88%), the Systemic Inflammatory Response Syndrome criteria (86%), and a temperature >99.0°F (85%). Many SOFA data points were missing from the record; in spite of this, 65% of cases met criteria for sepsis.Conclusions
NHs need better systems to monitor NH residents whose status is changing, and to present that information to medical providers in real time, either through rapid medical response programs or telemetry. 相似文献10.
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Objectives
To investigate whether caffeine intake is associated with urinary incontinence (UI) among Japanese adults.Methods
A total of 683 men and 298 women aged 40 to 75 years were recruited from the community in middle and southern Japan. A validated food frequency questionnaire was administered face-to-face to obtain information on dietary intake and habitual beverage consumption. Urinary incontinence status was ascertained using the International Consultation on Incontinence Questionnaire-Short Form.Results
Mean daily caffeine intake was found to be similar between incontinent subjects (men 120 mg, women 94 mg) and others without the condition (men 106 mg, women 103 mg), p=0.33 for men and p=0.44 for women. The slight increases in risk of UI at the highest level of caffeine intake were not significant after adjusting for confounding factors. The adjusted odds ratios (95% confidence interval) were 1.36 (0.65 to 2.88) and 1.12 (0.57 to 2.22) for men and women, respectively.Conclusions
No association was evident between caffeine intake and UI in middle-aged and older Japanese adults. Further studies are required to confirm the effect of caffeine in the prevention of UI. 相似文献19.
Esther Meesterberends Ruud J.G. Halfens Marieke D. Spreeuwenberg Ton A.W. Ambergen Christa Lohrmann Jacques C.L. Neyens Jos M.G.A. Schols 《Journal of the American Medical Directors Association》2013,14(8):605-610
ObjectivesTo investigate whether the incidence of pressure ulcers in nursing homes in the Netherlands and Germany differs and, if so, to identify resident-related risk factors, nursing-related interventions, and structural factors associated with pressure ulcer development in nursing home residents.DesignA prospective multicenter cohort study.SettingTen nursing homes in the Netherlands and 11 nursing homes in Germany (around Berlin and Brandenburg).ParticipantsA total of 547 newly admitted nursing home residents, of which 240 were Dutch and 307 were German. Residents had an expected length of stay of 12 weeks or longer.MeasurementsData were collected for each resident over a 12-week period and included resident characteristics (eg, demographics, medical history, Braden scale scores, nutritional factors), pressure ulcer prevention and treatment characteristics, staffing ratios and other structural nursing home characteristics, and outcome (pressure ulcer development during the study). Data were obtained by trained research assistants.ResultsA significantly higher pressure ulcer incidence rate was found for the Dutch nursing homes (33.3%) compared with the German nursing homes (14.3%). Six factors that explain the difference in pressure ulcer incidence rates were identified: dementia, analgesics use, the use of transfer aids, repositioning the residents, the availability of a tissue viability nurse on the ward, and regular internal quality controls in the nursing home.ConclusionThe pressure ulcer incidence was significantly higher in Dutch nursing homes than in German nursing homes. Factors related to residents, nursing care and structure explain this difference in incidence rates. Continuous attention to pressure ulcer care is important for all health care settings and countries, but Dutch nursing homes especially should pay more attention to repositioning residents, the necessity and correct use of transfer aids, the necessity of analgesics use, the tasks of the tissue viability nurse, and the performance of regular internal quality controls. 相似文献
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Objective. To test whether public reporting in the setting of postacute care in nursing homes results in changes in patient sorting. Data Sources/Study Setting. All postacute care admissions from 2001 to 2003 in the nursing home Minimum Data Set. Study Design. We test changes in patient sorting (or the changes in the illness severity of patients going to high‐ versus low‐scoring facilities) when public reporting was initiated in nursing homes in 2002. We test for changes in sorting with respect to pain, delirium, and walking and then examine the potential roles of cream skimming and downcoding in changes in patient sorting. We use a difference‐in‐differences framework, taking advantage of the variation in the launch of public reporting in pilot and nonpilot states, to control for underlying trends in patient sorting. Principal Findings. There was a significant change in patient sorting with respect to pain after public reporting was initiated, with high‐risk patients being more likely to go to high‐scoring facilities and low‐risk patients more likely to go to low‐scoring facilities. There was also an overall decrease in patient risk of pain with the launch of public reporting, which may be consistent with changes in documentation of pain levels (or downcoding). There was no significant change in sorting for delirium or walking. Conclusions. Public reporting of nursing home quality improves matching of high‐risk patients to high‐quality facilities. However, efforts should be made to reduce the incentives for downcoding by nursing facilities. 相似文献