bluuebunny/crossref_metadata_2025 huggingface dataset:
The health resort sector in Australia: A positioning study
Authors: Bennett Michelle , King Brian , Milner Laura
Published: June 2007

This study provides a profile of the health resort sector in Australia. The study was based on resort directories, an analysis of promotional materials produced by each of the resorts within the population and discussions with representatives of Australia’s various state tourism organisations. It was found that most properties in the health resort category may be described as being mainstream and offering a tourism focus. The smallest number are found in the alternative and medical treatment focus categories, though these components of the health resort sector do appear to be dynamic and innovative. The development of a dynamic and innovative health resort sector may owe something to the absence of a strong tradition of spas in Australia.
The increasing role of public relations as a crisis management function: An empirical examination of communication restrategising efforts among destination organisation managers in the wake of 11th September, 2001
Authors: Fall Lisa T.
Published: June 2007

The 11th September terrorist attacks on the USA have greatly impacted on the tourism industry, causing managers to restrategise their communication programmes. This national investigation illustrates the increasing role of public relations as a crisis management function. The study sought to determine if public relations activities are increasing and advertising activities are decreasing among tourism managers in the wake of 9/11. Examined within a crisis communication framework, the situational theory developed by Grunig served as the theoretical underpinning for the study. In particular, the study examines how messages are being restructured, primary publics are being refocused and communication tactics (channels) are being retooled among convention and visitors’ bureau (CVB) managers (destination organisation managers). Employing a web-based survey to randomly selected CVB communication managers throughout the USA, findings indicate that since the attacks use of public relations tactics for promotional purposes has increased while use of advertising tactics has decreased. Additionally, more than one-quarter of the tourism managers have redirected their primary public focus and nearly half have redesigned their promotional messages to support revamped organisational objectives.
Shopping as a destination attraction: An empirical examination of the role of shopping in tourists’ destination choice and experience
Authors: Moscardo Gianna
Published: June 2007

Shopping as a tourist activity has only recently been subjected to academic analysis and discussion. To date much of the published literature is focused on shopping as an activity. The present paper reports on a survey of 1,630 tourists to a popular Australian tourist destination. The present study extended previous research by studying shopping as a factor in destination choice with a sample of both shoppers and non-shoppers, and with the aim of understanding the role of shopping in the total destination experience. Four types of shopper were identified based on a combination of the importance of shopping in destination choice and actual participation in shopping activities. These four groups were then compared and profiled on a series of socio-demographic, travel behaviour, destination choice, activity participation and attraction visitation variables. The paper then examines the links between these findings and previous research results before discussing the implications of the results for both management and marketing of the destination and for developing a model to explain tourists’ shopping behaviour.
Destination competitiveness: An exploratory examination of South Australia’s core attractions
Authors: Faulkner Bill , Oppermann Martin , Fredline Elizabeth
Published: June 2007

Competitive analysis of destinations is rapidly gaining in importance in the strategic positioning and marketing planning of destinations. Thus far, relatively few tourism studies have utilised competitiveness as an assessment tool. This paper uses a qualitative approach toward evaluating South Australia’s competitiveness in the Australian domestic tourism context. Based on interviews with travel agents, who are traditionally information gatekeepers and a crucial component of the distribution channel, this paper reveals that South Australia is only in a strong position with respect to two out of eight core attractions emphasised in that state’s tourism promotion material. Apart from the wine industry and the ‘big river’ theme associated with the Murray River, none of the state’s other tourism features is recognised within the market.
Communication in healthcare: A review of some key issues
Authors: Johnson Mark
Published: June 2007

Research into communication in health has so far had a low priority. What there is, has been targeted at immediate perceived problems; that is, attention has been focused on where there is prima facie evidence of a barrier to communication which might be attributable to, for example, language or culture. Clearly, most health professionals do not see themselves as being different from those they care for and serve. However, even when skin colour, language, religion and place of upbringing are identical, there will still remain differences of imagination, of class, and of experience. While the following paper draws primarily on the research literature of communication with minorities, it should be read as having a wider applicability. The model of ethnicity (which, fortunately, has replaced the more positivist, absolutist and normalising model of `race') can be applied to any community or group which shares close common interests.
Effective communication in mental health nurses: Did social support save the psychiatric nurse?
Authors: Carson Jerome , Cavagin Joanne , Bunclark Jane , Maal Sukwinder , Gournay Kevin , Kuipers Elizabeth , Holloway Frank , West Maria
Published: June 2007

A randomised controlled trial was conducted to test the effectiveness of a social support-based intervention against a feedback-only condition. Fifty-three mental health nurses were randomly allocated and assessed on a range of measures of the stress process. Stressors were measured by the DCL Stress scale, mediating variables by the Rosenberg Self-Esteem scale, the Pearlin Mastery scale and the Significant Others scale and stress outcomes by the General Health Questionnaire and the Maslach Burnout Inventory. Following a successful pilot of the social support package, it was hypothesised that the social support intervention would be more effective in reducing stress and burnout in mental health nurses. Participants in both groups were assessed prior to randomisation, post-treatment and at six months follow-up. Attrition rates were similar in both conditions, at around 30%. The social support groups were run for five consecutive weeks for two hours. In all, three separate groups were conducted by two facilitators. The members of the feedback-only group received detailed written feedback on their stress questionnaires, as well as a small stress management booklet developed by two of the authors. Results of the study show no benefits for participants of the social support groups on the study's dependent variables and indeed there was a trend for the feedback-only group to do slightly better on some of the measures. The reasons for this negative outcome are discussed and suggestions are made for future studies. Methodological difficulties are pointed out with studies that attempt to reduce staff stress.
Measuring the sleep of older people: Tool development and use in the evaluation of therapeutic massage
Authors: Ersser Steven , Wiles Anne , Taylor Heidi , Wade Sian , Walsh Rosemary , Bentley Theresa
Published: June 2007

This paper examines the measurement of sleep in nursing care settings, within the context of a pilot study which aimed to assess the effect of therapeutic back massage by nurses on the quality and pattern of sleep in older people in nursing homes and a community hospital. Sleep is an important factor in effective recovery and rehabilitation from illness and for the quality of life of older people in care settings. Issues are raised concerning the measurement of the sleep of older people for the purposes of evaluation research. New instruments are introduced, some building on existing tools. The value of self-reported and observed sleep data are discussed. Issues of the feasibility and rigour of these instruments are examined and recommendations are made for their further refinement and use.
Managing violence and aggression towards NHS staff working in the community
Authors: Beale Diane , Leather Phil , Cox Tom , Fletcher Bridgette
Published: June 2007

This paper presents a brief overview of the research project conducted during the preparation of the national guidance document Safer Working in the Community: A guide for NHS managers and staff on reducing the risks from violence and aggression. (RCN and NHS Executive, 1998). An integrated organizational approach was adopted, seeking risk reduction measures at the levels of the organisation, the work team and the individual, and encompassing prevention and preparation before incidents occur, timely reaction when incidents happen, and rehabilitation and learning after incidents have occurred. Five main domains were considered: trust policies and organizational arrangements; normal working practices; emergency action procedures; post-incident procedures, and staff training. Information was gathered from academic, professional and guidance literature, documentation from healthcare trusts, trades unions and professional associations, and interviews with practitioner, managerial and support staff in a wide range of disciplines.

Findings indicated that matters requiring particular attention were: commitment of senior management; generation and communication of policies; discrepancies in perception between managers and practitioners; provision for risk assessment; training provision; staffing, resources and equipment; ability to meet patient expectations; sharing of safety information; traceability and communication away from base; accessing help; emergency procedures; incident reporting; post-incident support; and trauma debriefing and counselling.
Clinical governance: An opportunity for nurses to influence the future of healthcare development
Authors: Scott Irene
Published: June 2007

This paper highlights the key issues and components of clinical governance and offers discussion on the implications for nurses and nursing. The key challenges for the profession in meeting this new change agenda are discussed, together with the approach taken by one organisation. The need for nursing to develop methodological approaches within its research agenda which have an impact on clinical effectiveness is highlighted.
Public involvement in primary care: Implications for primary care groups
Authors: McIver Shirley
Published: June 2007

The focus of healthcare is changing to primary care in many countries, including the UK. One aspect of this development is a community orientation, which can be defined in a number of different ways. This paper examines community involvement in the UK, and reports some of the findings of a survey of public participation in primary care, discussing the implications for primary care groups. The survey findings and discussion concentrate on three main issues: methods and approaches to public participation; difficulties identified and ways of addressing them; achievements and outcomes of public participation.
The impact of Scope-practitioners' views on its relevance and potential for service development
Authors: Jowett Sandra , Peters Mark , Reynolds Heidi , Wilson-Barnett Jenifer
Published: June 2007

The United Kingdom Central Council for Nursing, Midwifery and Health Visiting (UKCC) published The Scope of Professional Practice (Scope) in 1992. The research reported here is one strand of a large study commissioned by the UKCC to investigate the document's impact. This stage involved interviews with 53 practitioners, selected because they had reported that Scope had had an impact on their work. It focused on the nature of this impact on service delivery, how it operated in a multi-professional setting, how the Scope principles were viewed and what support was required to implement them effectively.

It was clear that the practitioners interviewed had a great deal to say about how Scope was influencing their practice and about how it could enhance their work in the future. Their attitudes towards, and perceptions of, Scope were overwhelmingly positive. A small number detailed precisely how it was having an impact on their work and on the ways they were able to deliver care. Others were aware of the principles and were exploring what their potential might be. Scope, it was felt, could empower practitioners, facilitate personal and professional development and result in constructive levels of accountability. It could encourage innovation and provide safeguards for service development.
A Symposium on the Clinton-Lewinsky Affair
Authors: Stein Arlene
Published: June 2007

The Clinton Affair raises so many issues around sexuality that a new journal on sexualities could hardly afford to ignore it. In this symposium, six prominent commentators provide brief analyses. Arlene Stein examines the role of the Clinton-Lewinsky Affair within the debate in the US known as ‘culture wars’. Stevi Jackson ponders why US feminists were so quiet on the issue, and provides her own analysis. Stephen O. Murray and Laurie Shrage both look at the issues raised around ‘sexual meaning’ - or ‘what is sex?’ Rob Stones discusses why and how people increasingly seem to be capable of becoming so involved with ‘abstract figures’, and draws some parallels with the concern over Princess Diana. Finally, Jeff Hearn links the affair to the growing interest in sex in organizations.
Anyone Speak Spanish?
Authors: Axelsson Ann-Sofie , Abelin Åsa , Schroeder Ralph
Published: June 2007

In this study we investigated how people using different languages interact and communicate in an internet-based virtual environment, Active Worlds. The focus was on situations where a new language is introduced in a conversation held in another language. With this we wanted to establish an understanding of: (1) the intentions of introducing a new language; (2) the response to this language introduction; (3) the consequences of language introduction; and (4) the factors influencing rejection or acceptance of language introduction. We found that the response to language introduction depends mainly on: (1) type of language; (2) character of the setting; and (3) perceived intention of language introducers. We found that non-English speakers and regular English-speaking users in less public, ‘themed’ settings are most tolerant to other languages. Apart from national languages, we also studied encounters between users familiar with ‘insider’ jargon - as against users not familiar with it.
Principles shaping grammatical practices: an exploration
Authors: A. Fox Barbara
Published: June 2007

This article explores the principles of interaction that shape grammatical practices of conversational speech cross-linguistically. Seven such principles are explored, and the grammatical practices they give rise to are illustrated. The role of these principles in shaping non-linguistic behavior is also touched on.
`Look'-prefaced turns in first and second position: launching, interceding and redirecting action
Authors: Sidnell Jack
Published: June 2007

This article examines turns prefaced by `look'. Analysis indicates that `look'-prefaced turns in first position (e.g. a sequence initiating question) are used to launch (or relaunch) a course of action. In second position, prefacing by `look' serves to mark a disjunction and redirection of the talk away from the conditionally relevant next action and towards some alternative. Examples from recorded conversations and news interviews reveal participants' own orientation to these functions of `look'-prefaced turns. Moreover, comparison with turns prefaced by `listen', which also launch courses of action, suggests that `look'-prefaced turns have an intercessionary function.
The Matrix and business @ the speed of thought
Authors: Danahay Martin A.
Published: June 2007

This article argues that the 1998 film The Matrix raises crucial questions about the status of workers in the new digital workplace, especially in texts such as Bill Gates' Business @ the Speed of Thought. The development of new electronic media has lead to the development of hypercapitalism. This article argues that the crucial feature of hypercapitalism is the control of time rather than space. Using the theories of Paul Virilio and urban geographer David Harvey, it is argued that, despite its flaws, The Matrix is in fact a compelling critique of hypercapitalism. However, while The Matrix calls into question the status of the networked worker, this article concludes that it does not take into account the 'network effect'.
Theodore Levitt: The Ultimate Writing Machine
Authors: Brown Stephen
Published: June 2007

Professor Theodore Levitt is widely regarded as the Poet Laureate of the marketing academy. His seminal, occasionally controversial, articles owe as much to their racy writing style as their provocative content. Although the content of Levitt’s publications have been debated at length, his style has attracted much less academic attention. Academics, however, are writers. They publish or perish. Placing compelling words on a page is a core scholarly competence. This article examines the great guru’s published work from a literary perspective. It specifies his signature stylistic device, shows how it pervades his manifold publications and, in the belief that everyone can learn from Levitt, reveals the inner workings of the ultimate writing machine.
Simon Litman (1873-1965): Pioneer marketing scholar
Authors: Jones D.G. Brian
Published: June 2007

This article presents a biographical sketch of Simon Litman, whose academic career in marketing began in 1902 at the University of California - Berkeley and developed over several decades at the University of Illinois. Litman is known only for teaching one of the first university marketing courses, but he made several other important contributions to marketing thought which have gone unnoticed by marketing historians until now. Among other distinctions, Litman was a pioneer in the study of international marketing.
Changing our Destination or the Route?
Authors: Levesque Laurie L. , Rousseau Denise M. , Ho Violet T.
Published: June 2007

Based on a four year study of a newly founded research and development unit in a large corporation, this article addresses the difficulties inherent in studying a start-up organization. It addresses how the research relationship evolves in conjunction with changes in organizational structure, personnel make up, and strategic concerns. Ethical dilemmas and practical challenges arose as the researchers’ motives became intertwined with those of the firm’s founder, managers, and workers. The relationship migrated towards action research due to internal and external pressures, including a desire to increase the validity of the data collected. Practical suggestions are offered to field researchers planning longitudinal studies to anticipate and manage this process effectively.
Involving Salient Stakeholders
Authors: Scholl Hans J.
Published: June 2007

Business process change involving information technology has become notorious for high failure rates. Apparently, the larger the project scope and size, the higher the failure rate. Also, as a major factor among others associated with failure, past research has identified an overemphasis on technical validity and functionality at the expense of the social and institutional process side in change projects. Yet, even if important factors had been correctly and completely identified, the social process, within which they interact, might have remained obscured. Furthermore, long-term, large-scale change projects, particularly when they encompass IT components as major building blocks, defy the conventional start-to-closeout, detailed project planning. Rather, they unfold in a stepwise fashion with alternative paths towards a coarse goal, particularly in environments with distributed powers, as in the public sector. For this process and this environment, the author proposes that participatory action research (PAR) has the capacity to provide a holistic methodological and social-process frame and a mode of joint inquiry. This article gives an account of the approach based on a large government change project in its early stages. In this project, practitioners and researchers formed a joint team, which strove to lay foundations to a multi-year, IT-enabled change initiative meant to become a state-wide exemplar for similar projects. During this early project stage, salient stakeholders and their needs were identified, which helped launch a highly inclusive process. However, as found in this project, external influences impacted this public-sector project in a way that the build-up of consensus remained incomplete, underscoring the need for ongoing stakeholder involvement within the project.
REVIEW SERIES: The Politics of TB: The politics, economics and impact of directly observed treatment (DOT) in India
Authors: Udwadia Z.F. , Pinto L.M.
Published: June 2007

India harbors approximately one-third of the world's tuberculosis cases. The disease being multi-factorial; various political, social and economic factors play pivotal roles in causation and control. The country's policy-makers, via the Revised National Tuberculosis Programme (RNTCP), have embraced DOTS, i.e. Directly Observed Treatment; short course, as a means of combating the disease. Today, a decade after being launched, the DOTS programme in India is the largest in the world. The achievements of the programme have been significant in reaching out to the millions and having impressive cure rates, but the disease is far from eradicated. Social taboos, economic obstacles, and deficient infrastructure are impediments that hamper the success of the programme. With multidrug-resistant TB and HIV co-infection complicating the management of TB; the task has become more daunting. In a country as heterogeneous as India, novel holistic strategies that address individual needs will have to be developed to successfully curb the spread of the disease in the future. Chronic Respiratory Disease 2007; 4: 101—106
Confined to barracks: The effects of indoor confinement on aggressive behavior among inpatients of an acute psychogeriatric unit
Authors: McMinn Bryan G. , Hinton Lorraine
Published: June 2007

While there is evidence to suggest that in long term residential care settings the provision of more choices and better designed environments have a positive effect on agitation and disturbed behaviors, there are no controlled studies on the effect of imposed confinement in these settings or in acute units.

The effect of mandatory confinement indoors on the incidence of verbal and physical aggression and psychotropic medication use among patients with dementia and associated psychiatric and behavioral disturbance was studied. The setting was an acute psychogeriatric admission unit accommodated in a colonial building originally built as a military barracks. A convenience sample was studied to assess changes in levels of aggression and nurse-initiated psychotropic medication use during and after a 32-day period of indoor confinement. Correlations with gender, diagnosis, pre-admission disturbed behavior and ultimate discharge outcome were examined.

Release from mandatory confinement indoors was correlated with decreases in both verbal and physical aggression as well as medication use. Correlations could be identified between decreases in aggression and male gender, pre-admission aggressive behavior and discharge outcome. Decreased medication use was correlated with discharge outcome. The freedom to go outdoors or have access to extra space should be an important component of the environmental design and care philosophy for the acute admission of people who experience dementia and associated psychiatric and behavioral disturbance.
Health-related quality-of-life and service utilization in Alzheimer's disease: A cross-sectional study
Authors: Leon Joel , Neumann Peter J. , Hermann Richard C. , Hsu Ming-Ann , Cummings Jeffrey L. , Doraiswamy P. Murali , Marin Deborah
Published: June 2007

The objective of this study was to explore the relationships between the severity of Alzheimer's disease (AD) in different care settings, health-related quality-of-life (HQoL), service utilization, and caregiver time and burden.

Data were from a 1996 cross-sectional study of 679 AD patient/caregiver pairs. Patients met NINCDS/ADRDA criteria for probable Alzheimer's, were staged with the Clinical Dementia Rating Scale, and recruited from managed care plans, academic medical centers, nursing homes, and assisted living facilities. Patient data included: demographics, MMSE, co-morbidities, health-related quality-of-life, health status, and service utilization. Family caregiver data included demographics, caregiver time and burden.

Significant findings included: patient HQoL scores were better for community patients, but worsened with disease severity; regardless of setting, patient SF-36 scores showed worse physical functioning and better mental health scores as disease severity increased; inpatient stays and ER visits were rare regardless of severity or setting, and for community patients, day care and in-home services use increased with AD severity. Family caregivers spent 18 hours per month on ADLs and 32 hours on IADLs. Hours increased for community patients and those with greater disease severity. Caregiver burden levels were higher for those serving community patients and increased with disease severity. Burden was lowest for mild and moderate patients in assisted living.

Greater patient AD severity was related to increased morbidity, poorer health status, lower health-related quality-of-life, greater family caregiver time and burden, and greater service use regardless of setting. Findings reinforce the need for an AD continuum of care.
Levels of aggression and alcohol use in populations with dementia
Authors: Messner Suzanne Elayne
Published: June 2007

This study investigated levels of aggression and alcohol use in populations with dementia. The hypothesis was that there would be a positive relationship between levels of harm and alcohol use as reported by the caregiver. One hundred caregiver/respondents returned surveys which inquired about the level of alcohol use and frequency of verbal or physical harm to the caregiver or anyone else. A two (gender) by six (type of drinker) ANOVA was used to analyze the results, with verbal and physical harm as the dependent measures. Significance (p = <.05; F = 2.37) was noted for all six levels regarding type of drinker and verbal or physical harm. For gender differences, significance was noted in the “physical harm, anyone” variable (p = <.05; F = 4.00). This outcome was of particular interest, in view of the lack of literature on female alcohol abuse associated with verbal or physical harm.
Monotherapy with Lamotrigine in patients with Alzheimer's disease and seizures
Authors: Tsolaki Magda , Kourtis Anastasios , Divanoglou Daniel , Bostanzopoulou Maria , Kazis Aristides
Published: June 2007

We used Lamotrigine LTG (50-600mg /24h) in 12 patients, 58-to 95-years-old (A Group) and other antiepileptics in nine patients (B Group) with the diagnosis of probable Alzheimer's disease (AD) and seizures. We also administered LTG (50-700mg/24h) in 16 patients (C Group) and other antiepileptics in nine patients (D Group) with other neurological disorders with cognitive disorders and seizures. The results showed that in eight from 12 patients with AD, and in nine from 16 with other neurological disorders, seizures stopped after treatment with LTG—while in five from nine patients with AD and six from 18 with other neurological disorders, seizures stopped after treatment with other antiepileptic drugs. Side effects in 28 patients treated with LTG included only three mild rashes, while side effects in 18 patients treated with other antiepileptic drugs included—six patients with fatigue, two with rashes, one with dizziness, one with low platelets, one with sleepiness and one with loss of hair. Conclusively, this study shows that LTG is an effective and safe monotherapy in patients with cognitive disorders and AD.
Everyday ethics of dementia care in nursing homes: A definition and taxonomy
Authors: Powers Bethel Ann
Published: June 2007

Too often the attention of formalized ethical decision making in health care settings turns to hard to deal with life and death issues. Consequently, consideration of the ethical aspects of ordinary everyday issues affecting nursing home residents with dementia and those who care for them remains limited. The purpose of this twoyear anthropological study was to develop a taxonomy of commonplace ethical issues, taking into account resident, family member, and nursing home staff member points of view. This paper defines the guiding concept of everyday ethics as it has been used in the research and describes the taxonomy, of which there are four domains:

• Learning the limits of intervention;

• Tempering the culture of surveillance and restraint;

• Preserving the integrity of the individual; and

• Defining community norms and values.

Discussion considers the usefulness of the taxonomy as a framework for thinking about what may be involved in understanding the ethics of the ordinary and resolving common types of issues and concerns.
Driving cessation and AD: Issues congronting patients and family
Authors: Adler Geri , Rottunda Susan , Bauer Mary , Kuskowski Michael
Published: June 2007

This study surveyed older drivers with Alzheimer's disease (AD), collaterals familiar with the patient's driving, and a control group for the purpose of obtaining information about driving habits and plans for driving cessation. Drivers with dementia are at a greater risk for getting lost and having crashes than other older drivers. Family members are concerned about crashes to the extent that they are trying to prevent the AD driver from driving. Despite their concerns, many AD drivers and their families have not made plans for driving cessation. These results can assist health care professionals in developing approaches to assist AD drivers and their families as they make the transition to non-driving status.
Early stage dementia group: An innovative model of support for individuals in the early stages of dementia
Authors: Goldsilver Pamela M. , Gruneir Marilyn R. B.
Published: June 2007

Traditionally, supports and services for people diagnosed with Alzheimer's disease have focused on the caregivers. The increase in early diagnosis of Alzheimer's disease has resulted in greater numbers of older adults that have some insight and awareness of their deficits and are capable of dealing with the ramifications of their illness. Yet there are few places to turn for support and education. Circle of Care, a community-based home support agency in Toronto, has developed a support group for individuals with early stage dementia. Comprehensive Rehabilitation and Mental Health Services (COTA), a community-based rehabilitation agency, was invited to provide a co-facilitator for this group. To date, three groups have been held, each one having a fixed membership and meeting for eight sessions of one and a quarter hours. Topics focused on causation, coping with memory problems, loss, grief, and daily living skills. Positive themes emerged to reveal feelings of affirmation, camaraderie, and improved confidence, while feelings of helplessness and frustration were also raised. Implications for future planning and interventions also will be discussed in this paper.
Using music therapy to help a client with Alzheimer's disease adapt to long-term care
Authors: Kydd Paulette
Published: June 2007

The purpose of this case study is to illustrate how music therapy can be used to help the elderly successfully adjust to living in a long-term care (LTC) facility. LTC residents, particularly those with Alzheimer's disease or related dementia, may exhibit behaviors such as depression, withdrawal, anxiety, emotional liability, confusion, and memory difficulties, frequently related to the disorder, but often exacerbated by difficulty in adjustment to the change in lifestyle. The subject of this case study demonstrated these symptoms. Music therapy helped him adjust to life in a LTC setting by improving his quality of life and enhancing his relationships with those around him. As chronicled in this study, music therapy may facilitate a resident's adjustment to life in a LTC facility.

N.B. Names and identifying information have been changed to protect privacy.
Characteristics of assaultive psychiatric inpatients: Updated review of findings, 1995-2000
Authors: Flannery Raymond B.
Published: June 2007

The present paper reviewed the studies of the characteristics of assaultive psychiatric inpatients from 1994 to the present. These studies partially confirmed earlier findings that assaultive patients are older persons with a diagnosis of active psychosis or other neurological abnormality and histories of violence toward others and substance-use disorder. However, the recent studies also document the profile of a second group of assaultive patients: younger females with personality disorders and histories of violence toward others, substance-use disorder, and personal victimization. Since there is a paucity of published empirical research on Alzheimer's and dementia patients for this topic, the implications from the present findings for long-term care and clinical intervention are examined.
Impact of family visits on agitation in residents with dementia
Authors: Martin-Cook Kristin , Hynan Linda , Chafetz Paul K. , Weiner Myron F.
Published: June 2007

In an investigation of the impact of family visits on the behavior of 30 residents in dementia special care units, we found on direct observation that agitation decreased significantly during visits, but returned to the previous level within 30 minutes. No significant differences were found between visits by spouses or adult children. The premorbid quality of relationship was unrelated to family visitor enjoyment of visits or to differences between agitation level before and after visits. While 70 percent of visitors reported that they found visits pleasant (mean number of visits: 12.72 per month), 20 percent found visits unpleasant. Visitors' enjoyment or displeasure was significantly related to the difference between the number of pre-visit and post-visit agitated behaviors. Visitors indicated that the resident's mental status (33 percent) or difficulty communicating with the resident (30 percent) had the most negative impact on their visits. However, these factors appear amenable to education, suggesting that the quality of visits can be improved for visitor and resident with possibly greater positive impact on both.
A day care program and evaluation of animal-assisted therapy (AAT) for the elderly with senile dementia
Authors: Kanamori Masao , Suzuki Mizue , Yamamoto Kiyomi , Kanda Masahiro , Matsui Yoshimi , Kojima Emi , Fukawa Hirono , Sugita Tomomi , Oshiro Hajime
Published: June 2007

We conducted a survey to clarify the evaluation methods of animal-assisted therapy (AAT) for the elderly with senile dementia in an adult day care center. AAT was implemented for a total of six biweekly sessions. The AAT group consisted of seven subjects and the control group numbered 20 subjects. In a comparison between Mini-Mental State Exam (MMSE) scores at baseline and those measured three months later, the average MMSE score before AAT (baseline) was 11.43 (± 9.00), and three months later it was 12.29(± 9.69). In the AAT group, the average score on Nishimura's Activities of Daily Living (N-ADL) at baseline was 28.43(± 14.00), and after ATT it was 29.57(± 14.47). In the AAT group, the average baseline score on behavioral pathology of Alzheimer's disease (Behave-AD) was 11.14(± 4.85), and three months after AAT it was 7.29(± 7.11) (p < 0.05). In the control group, the average baseline score was 5.45(± 3.27) and three months later it was 5.63(± 3.59). The evaluation of salivary CgA, as a mental stress index, showed a decreasing tendency in the AAT group. Our findings demonstrate the usefulness of using several methods for evaluation of the changes in patients given AAT.
Onset of tuberculosis disease: New converters in long-term care settings
Authors: Schultz Marilyn , Hernández José M. , Hernández Norma E. , Sanchez Rebecca O.
Published: June 2007

Elders living in communal settings, such as nursing homes or other types of long-term care facilities have a tuberculosis (TB) incidence rate of 39.2 per 1,000, nearly four times the rate of TB in the general population. This fact mandates routine screening, reporting, and strict follow-up of TB in long-term care facilities as well as recognizing and addressing barriers to worker and resident protection. As healthcare in this country evolves from acute care facilities to alternative ambulatory care settings, the focus for infection control personnel is to develop effective TB control plans appropriate to the care setting using current clinical guidelines set forth by the Centers for Disease Control and Prevention (CDC) or other agencies, the main goal of which is to reduce the number of infections and exposures to this disease. As the incidence of TB continues in long-term care settings, away from acute care facilities, public health officials, administrators, and infection control personnel need to develop TB control plans, risk assessment procedures, and appropriate followup on positive converters among the workers and the residents. The case study presented herein is a good example of an individual being offered a screening test for an infectious airborne disease and positive test results being disregarded.
Therapeutic kitchens for residents with dementia
Authors: Marsden John P. , Meehan Rebecca A. , Calkins Margaret P.
Published: June 2007

Long-term care facilities are increasingly incorporating some sort of kitchen, often referred to as a therapeutic kitchen, for resident, staff, and family use through remodeling efforts or new construction. A study, consisting of five site visits and a questionnaire mailed to 631 facilities providing dementia care, was conducted to identify physical features that are typically included in therapeutic kitchen design and to explore how these features support daily use in relation to activities programming and food service systems. Findings indicate that universal design features should be incorporated to a greater extent and certain features are more common, reinforce homelike imagery, or enhance safety. Results also suggest that a higher number of residents participate in more recreational activities, such as baking, than they do in household chores, such as meal set-up, and therapeutic kitchens are not always linked to food service systems.
Effects of educational attainment on the clinical expression of Alzheimer's disease: Results from a research registry
Authors: Fritsch Thomas , McClendon McKee J. , Smyth Kathleen A. , Lerner Alan J. , Chen Chien Hsiun , Petot Grace J. , Debanne Sara M. , Soas Amir , Friedland Robert P.
Published: June 2007

The “reserve” hypothesis suggests that education should affect the clinical expression of Alzheimer's disease (AD), but results from studies examining this idea are not consistent. In a single study, we evaluated the effects of educational attainment on three aspects of the clinical expression of AD: age at symptom onset, rate of cognitive decline, and survival. Subjects were 258 persons with mild-or moderate-stage Alzheimer's, drawn from our AD Research Registry. With statistical adjustment for confounding variables present in a clinic-based design, we found that higher educational attainment was associated with slightly earlier reports of symptom onset and a slower rate of cognitive decline on the Mini-Mental State Exam (MMSE). Education did not affect time of survival until death. We conclude that, for subjects in our sample, education had modest effects on aspects of the clinical expression of AD. These effects were not fully consistent with predictions derived from the “reserve” hypothesis.
A training workshop on late-stage dementia care for family caregivers
Authors: Lai Claudia K. Y. , Wong Fanny L. F. , Liu Kit Han
Published: June 2007

Training workshops have been considered a useful intervention in helping family caregivers of people with dementia to cope with the stress of caregiving. However, there are no reports in the literature with regard to training and support of families specifically looking after individuals who are in the late stage of dementia. This paper reports the experience and evaluation of a training workshop aimed at preparing family caregivers for late-stage dementia care. Eighty-eight percent of the participants completed the client satisfaction questionnaire. The results from the questionnaire gave a very positive response, showing 90.9 percent of respondents were satisfied with the workshop, and 77.3 percent of respondents indicated that their caregiving needs were met. Eleven participants who attended this workshop joined a focus group feedback session. The Kruskal-Wallis test found no significant differences between the overall profile of the participants and that of the focus group in terms of age, gender, educational background, whether they were primary caregivers, for whom they cared (e.g., parents or spouse), or whether the care recipient stayed at home or in a nursing home. Findings from the focus group session provide a somewhat different picture from that of the questionnaire. Three focus group participants provided more critical comments of the workshop. Although the majority of the focus group agreed that the workshop had been useful, they disagreed on whether it is necessary to discuss psychosocial issues in this workshop. Findings from the focus group have enabled the project team to reflect on their design and operation of the workshop and provided valuable insight for future development as well as for further study.
The Significance of Thyroid-Stimulating Hormone and Homocysteine in the Development of Alzheimer’s Disease in Mild Cognitive Impairment
Authors: Annerbo Sylvia , Wahlund Lars-Olof , Lökk Johan
Published: June 2007

Mild cognitive impairment (MCI) represents a transition between normal aging and Alzheimer’s disease (AD). The aim of this study was to investigate the predictive value of vitamin B12/folate, homocysteine, standard laboratory parameters, and concomitant diseases for development of AD in persons with an MCI diagnosis. Development of dementia was followed for 6 years in 93 consecutively recruited MCI persons. Information concerning the above factors was obtained from medical journals. Thirty-four percent of participants converted to AD within 6 years. A forward stepwise logistic regression was performed. The odds ratio (OR) for the Mini-Mental State Examination (MMSE) was 0.777; for age, 1.084; and for thyroid stimulating hormone (TSH), 0.287. The OR for homocysteine was 1.287 at 60 years of age and 1.087 at 65 years of age. Lower TSH levels together with the more established factors lower MMSE, higher homocysteine levels, and age were found to be predictive factors of AD. This may have clinical implications with regard to monitoring TSH levels and thyroxin substitution in MCI patients.
Analysis of Serum of Patients With Alzheimer’s Disease for the Level of Advanced Glycation End Products
Authors: Leszek Jerzy , Małyszczak Krzysztof , Bartyś Adam , Staniszewska Magda , Gamian Andrzej
Published: June 2007

Data on the serum level of advanced glycation end products (AGEs) in Alzheimer’s disease (AD) patients are scarce, although a specific biochemical marker easy to detect in body fluids is desired for an early diagnosis of disease and to monitor the effects of therapeutic treatment. In the current study, the content of AGEs was examined with an immunochemical assay in the sera of AD patients, in the frame of a search for a biochemical marker of disease. Subjects with AD and vascular dementia (VaD) were included in the study (n = 30; age range, 68-70 years). The results were compared to the healthy control groups. The enzyme-linked immunosorbent assay (ELISA) inhibition test for the determination of AGEs is based on a rabbit anti-AGE, affinity-purified antibody and a model AGE-myoglobin antigen, in which a serum sample treated with proteinase K is used as an inhibitor. For the measurement of immune complexes and anti-AGE antibodies, the corresponding ELISA tests have been applied. The AGE level in the VaD group (49.5 UAGE) was higher than in AD patients (46.1 UAGE). The level of total AGEs in the sera of AD patients was significantly lower than in the control group (50/51.6 UAGE). These relations were not observed with regard to the immune complexes and anti-AGE antibody levels in AD (70.2 UIC/0.027 UIgG) and VaD (83 UIC/0.034 UIgG) patients because the levels of these parameters were similar to the controls (76.2 UIC/0.042 UIgG). The work revealed the lower level of circulating serum AGEs in patients with AD in relation to healthy controls.
Sensory Gating in Patients With Alzheimer’s Disease and Their Biological Children
Authors: Ally Brandon A. , Jones Gary E. , Cole Jack A. , Budson Andrew E.
Published: June 2007

Research has shown that sensory gating is largely modualted by acetylcholine. Diminished levels of acetylcholine and sensory gating deficits have been reported in research involving Alzheimer’s disease (AD) patients. However, there has been little investigation into those with a family history (FH+) of AD. The rationale of this study was to determine whether sensory gating impairments could distinguish those with early AD from individuals with increased risk for the disease while replicating previous findings of gating abnormalities in AD patients. Using the paried-click paradigm, evoked potentials were recorded from 4 groups of 20 subjects per group (AD, older controls, FH+, FH-). The results showed that while the AD group demonstrated sensory gating abnormalities, the FH+ group did not when compared to their peers with no family history of the disease (FH-). These results are discussed in relation to previous findings reporting P300 abnormalities in the FH+ group.
Using Magnetoencephalography to Study Patterns of Brain Magnetic Activity in Alzheimer’s Disease
Authors: Criado Josè R. , Amo Carlos , Quint Patti , Kurelowech Lacey , Otis Shirley M.
Published: June 2007

The use of magnetoencephalography to study neurophysiologic abnormalities associated with Alzheimer’s disease is reviewed. The most consistent observation is that Alzheimer’s disease patients exhibit an increase in focal slow-wave activity that covaried with cognitive performance. It is still unclear whether generation of focal slow-wave activity precedes or is a consequence of Alzheimer’s disease-related neuropathology. Also reviewed is the use of magnetoencephalography to identify early functional changes preceding the diagnosis of dementia. Magnetoencephalography detected neurophysiologic abnormalities associated with cognitive deficits before the diagnosis of mild cognitive impairment. This is supported by evidence presented suggesting that some patients with subjective cognitive complaints, without evidence of dementia, show an increase in focal slow-wave generators. Further research is needed to determine whether the outstanding spatial and temporal resolution of the magnetoencephalography technique could complement other neuroimaging techniques in identifying neurophysiologic abnormalities preceding the diagnosis of Alzheimer’s disease and mild cognitive impairment.