Omissions of Care in Nursing Homes: A Uniform Definition for Research and Quality Improvement

Omission of care in US nursing homes can lead to increased risk for harm or adverse outcomes, decreased quality of life for residents, and increased healthcare expenditures. However, scholars and policymakers in long-term care have taken varying approaches to defining omissions of care, which makes efforts to prevent them challenging. Subject matter experts and a broad range of nursing home stakeholders participated in iterative rounds of engagement to identify key concepts and aspects of omissions of care and develop a consensus-based definition that is clear, meaningful, and actionable for nursing homes. The resulting definition is “Omissions of care in nursing homes encompass situations when care—either clinical or nonclinical—is not provided for a resident and results in additional monitoring or intervention or increases the risk of an undesirable or adverse physical, emotional, or psychosocial outcome for the resident.” This concise definition is grounded in goal-concordant, resident-centered care, and can be used for a variety quality improvement purposes and for research.     

Rationale and design of the Kidney Precision Medicine Project

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Migraine-Associated Common Genetic Variants Confer Greater Risk of Posterior vs. Anterior Circulation Ischemic Stroke☆

ObjectiveTo examine potential genetic relationships between migraine and the two distinct phenotypes posterior circulation ischemic stroke (PCiS) and anterior circulation ischemic stroke (ACiS), we generated migraine polygenic risk scores (PRSs) and compared these between PCiS and ACiS, and separately vs. non-stroke control subjects.MethodsAcute ischemic stroke cases were classified as PCiS or ACiS based on lesion location on diffusion-weighted MRI. Exclusion criteria were lesions in both vascular territories or uncertain territory; supratentorial PCiS with ipsilateral fetal posterior cerebral artery; and cases with atrial fibrillation. We generated migraine PRS for three migraine phenotypes (any migraine; migraine without aura; migraine with aura) using publicly available GWAS data and compared mean PRSs separately for PCiS and ACiS vs. non-stroke control subjects, and between each stroke phenotype.ResultsOur primary analyses included 464 PCiS and 1079 ACiS patients with genetic European ancestry. Compared to non-stroke control subjects (n=15396), PRSs of any migraine were associated with increased risk of PCiS (p=0.01–0.03) and decreased risk of ACiS (p=0.010–0.039). Migraine without aura PRSs were significantly associated with PCiS (p=0.008–0.028), but not with ACiS. When comparing PCiS vs. ACiS directly, migraine PRSs were higher in PCiS vs. ACiS for any migraine (p=0.001–0.010) and migraine without aura (p=0.032–0.048). Migraine with aura PRS did not show a differential association in our analyses.ConclusionsOur results suggest a stronger genetic overlap between unspecified migraine and migraine without aura with PCiS compared to ACiS. Possible shared mechanisms include dysregulation of cerebral vessel endothelial function.     

Effect of brief exercise on urges to smoke in men and women smokers

IntroductionAlthough smoking urges have been demonstrated to vary by gender and also be influenced by exercise, it is unknown if exercise has a differential effect on smoking urges by gender. This study aimed to explore gender-specific effects of an acute bout of exercise on cessation-related symptoms in men and women smokers during acute abstinence.MethodsWe enrolled smokers (≥ 5 cigarettes/day) who were 18–40 years old for a study on exercise and smoking behavior. Participants abstained from smoking for at least 3 h, prior to measurement of their maximal oxygen consumption tested, which was the acute bout of exercise. Prior to and after the exercise, participants completed the Questionnaire of Smoking Urges – Brief and the Minnesota Nicotine Withdrawal Scale.ResultsParticipants (n = 38; 61% women) were, on average, 30.0 ± 0.9 years old and smoked 13.0 ± 0.8 cigarettes/day. All measured aspects of cessation-related symptoms significantly improved after the exercise in both men and women. In women there was a significant decline in anticipated relief from negative affect after the exercise (women: − 0.45 ± 0.20, p = 0.0322; men: − 0.41 ± 0.26, p = 0.1312). In men there was a significant decline in the intention to smoke after the exercise (men: − 0.77 ± 0.23, p = 0.0053; women: − 0.66 ± 0.37, p = 0.0909).ConclusionsAn acute bout of exercise reduced smoking urges in both men and women smokers during an acute state of abstinence. Additional research is needed to replicate these observations in a larger, more diverse sample, and to explore the implication of these observations on cessation.     

A mosque-based methadone maintenance treatment strategy: Implementation and pilot results

BackgroundThis paper describes the rationale, implementation and operation of a “world first” Islamic inspired methadone maintenance treatment project delivered in a mosque setting and presents the outcome for the first group of participants. The project explored the viability of expanding addiction recovery services through the network of mosques in Muslim communities.MethodsThe project combined methadone maintenance with peer and religious counseling. Participants consisted of 36 male Muslim heroin users who went through the project. Urine tests and self-reported measures on various dimensions relevant to drug use and quality of life were collected at baseline and 12 months.ResultsThe project had a 12 month retention rate of 80%. At 12 months all but one participant tested negative for opioids and other substances. Self-report measures showed significant reductions in the degree and variety of drug use, improvements in general health, and psychological and social functioning of participants. Qualitative data showed that availability of methadone, convenient location and religion were the main reasons drawing participants to the program.ConclusionsMosques are viable venues for offering medication assisted recovery services and offer an alternative approach for managing addiction in Muslim communities. The prospect of mobilizing community resources to offer community-oriented long-term recovery management programs in mosques and other places of worship deserves consideration.