bluuebunny/crossref_metadata_2025 huggingface dataset:
Influences on clinical judgement in mental health nursing
Authors: Martin Peter J.
Published: June 2007

The judgements made by nurses in the clinical area will determine the nursing care received by patients. Clinical judgement is, therefore, a critical aspect of professional practice. This paper outlines part of a research study that explored the influences on the clinical judgement of nurses in a mental health setting. The design used a grounded theory approach, and a number of methods were used to collect data in order to identify influences. Through the data analysis a conceptual framework of clinical judgement in mental health nursing was generated. Three inter-related concepts emerged: the self, the client and the social system in which the nurse functions. Also identified were three sub-concepts: professional roles, healthcare roles and the nurse-patient relationship. The findings of the study indicate that clinical judgements made by mental health nurses are time- and situation-dependent and consequently are unique. The implications for nursing practice, research and education are discussed, and recommendations made.
Promoting partnership with older people through quality assurance systems: Issues arising in care homes
Authors: Reed Jan , Cook Glenda , Stanley David
Published: June 2007

This paper reports on a study in which a quality assurance package was introduced into 11 care homes for older people and evaluated. The package (Qual A Sess) has two features. First, it is designed to provide a mechanism for self-regulation, by providing homes with a framework for assessing care and services in a systematic way. Second, it promotes the participation of residents in the quality process, by including them as members of self-assessment teams. A case study methodology was used to evaluate the process of introduction, and this paper focuses on data from older people which describes their views about participation. The paper concludes that skills in communication and assessment, and sensitivity to individual needs and problems is required in order to facilitate meaningful participation from older people.
Trying to get husbands to do more work at home
Authors: Dempsey Ken
Published: June 2007

Few researchers have focused attention on any attempts wives may be making to get their partners to do more at home. This paper reports findings from one such exploratory study of 128 Melbourne marriages. Only three or four wives experienced any lasting success in trying to change existing arrangements in the division of housework. The failure of most women to negotiate successfully with their husbands is due mainly to wider structural and cultural forces and to the superior power of husbands. However, this paper shows that it is also due to women's ambivalence about pressing for change, which is associated with the high priority they give to home-making and the belief that their partners treat them fairly.
Interactivity: a concept explication
Authors: Kiousis Spiro
Published: June 2007

The use of interactivity as a variable in empirical investigations has dramatically increased with the emergence of new communication channels such as the world wide web. Though many scholars have employed the concept in analyses, theoretical and operational definitions are exceedingly scattered and incoherent. Accordingly, the purpose of this project is to engender a detailed explication of interactivity that could bring some consensus to how the concept should be theoretically and operationally defined. Following Chaffee’s (1991) framework for concept explication, we generate new theoretical and operational definitions that may be central to future work in this area. In particular, we suggest that interactivity is both a media and psychological factor that varies across communication technologies, communication contexts, and people’s perceptions.
The ‘Cultural Technology of Clicking’ in the Hypertext Era
Authors: Wilson Tony , Hamzah Azizah , Khattab Umi
Published: June 2007

Electronic journalism offers readers new interpretative possibilities, explored here in Malaysia. Ludic hermeneutic accounts of media reception posit engaging in games as a metaphorical model for an audience creatively forming the meaning of a screen text. Accessing the internet, web users’ comprehension of virtual content is a seriously play-like process. Reading online is fundamentally purposeful or teleological (‘goal-directed’, albeit not by duty); concerned with other than the mundane (‘extracted’ from the everyday); projecting a ‘fore-structure’ for understanding, securing meaning; holistic (moving ‘to and fro’), integrating aspects of a text; and constructing cultural identity and power (‘fortifying’ self and status). But the ludic focus on developing meaning intrinsic to the virtual web co-exists with material world concerns. Marginalizing the former, internet users emphasize securing extrinsic goals: talk of mundane duty is foregrounded. Reading the screen, still productive of understanding (identity and insight), becomes liminally ludic, sometimes laborious.
Embedded-ultrasonics Structural Radar for In Situ Structural Health Monitoring of Thin-wall Structures
Authors: Giurgiutiu Victor , Bao JingJing
Published: June 2007

Embedded-ultrasonics structural radar (EUSR) is a new concept and methodology for in situ nondestructive evaluation (NDE) and structural health monitoring (SHM) of thin-wall structures. EUSR consists of: (a) an array of piezoelectric wafer active sensors (PWAS) embedded into the structure; and (b) electronic modules for signal transmission/reception, processing, and interpretation. EUSR utilizes guided elastic waves (Lamb waves) generated omnidirectionally into the thin-wall structure by surface-mounted permanently attached PWAS. The paper starts with the general concepts of the EUSR algorithm: transmission beamforming, reception beamforming, and time-of-fight (TOF) determination. Next, details of the Lamb wave generation with PWAS, verification of group-velocity dispersion curves, identification of optimal excitation frequency, and confirmation of wave front omnidirectionality are discussed. In the third part of the paper, the actual implementation of the EUSR method in a proof-of-concept demonstration is presented. The construction of the PWAS-phased array is described, and detection of cracks located broadside and offside of the PWAS array is illustrated. The method is shown to be easy to use through a visually interactive LabView™ interface. Very good detection accuracy is observed. The proof-of-concept experiments presented in this paper were illustrated on metallic structures; however, the EUSR concept may also work on composite and hybrid structures, although the range of detection may be reduced by the medium attenuation.
Action Research in a World of Positivist-Oriented Review Boards
Authors: Detardo-Bora Kimberly A.
Published: June 2007

Institutional Review Boards (IRBs) were created with positivistic research designs in mind, making the review process unsuited for most research efforts characterized as action research (AR). With the possibility that more IRBs will be created and that the definition of research will be expanded, certain types of research that falls under the umbrella of AR will be scrutinized. Specifically, the difficulty is for action research characterized by focus group or participatory research settings. The issues examined by the IRB such as voluntary participation, confidentiality, and risk to the participant are debatable for action research and need to be negotiated or perhaps reconsidered. Unless these issues are resolved, researchers may be reluctant to use this model in the future and AR will be marginalized. Recommendations are made to guide future efforts.
Acapella ® versus `usual airway clearance' during acute exacerbation in bronchiectasis: a randomized crossover trial
Authors: Patterson J.E. , Hewitt O. , Kent L. , Bradbury I. , Elborn J.S. , Bradley J.M.
Published: June 2007

Devices such as the Acapella ® may facilitate independent airway clearance, however, few clinical trials have investigated the efficacy of Acapella®. The aim of this study was to compare the effectiveness of Acapella® to `usual airway clearance' in adults during an acute exacerbation of bronchiectasis requiring oral antibiotic therapy. Twenty patients with bronchiectasis and an acute exacerbation requiring oral antibiotic therapy were recruited into a randomized crossover trial. Patients were allocated to one of two groups determined by concealed computer generated randomization. Group 1 (n =10): airway clearance session using Acapella® at home twice daily during oral antibiotic therapy. Group 2 (n = 10): `usual' airway clearance sessions at home during oral antibiotic therapy. Patients recorded duration of each treatment session, volume of sputum produced and perception of breathlessness. An independent assessor performed outcome measures of spirometric lung function, pulse oximetry and breathlessness at the beginning and end of the study period. The mean volume of sputum expectorated during Acapella® sessions was greater than for usual airway clearance sessions although this difference was not significant 2.61 ml (95% CI-1.62 to 6.84). Mean duration of Acapella ® sessions was greater than usual airway clearance sessions and approached significance. There were no significant between group differences in changes in lung function. This study demonstrates that the Acapella® device may offer an acceptable, user-friendly method of airway clearance in patients with bronchiectasis. Chronic Respiratory Disease 2007; 4: 67—74
PREMIER—A Trial of Lifestyle Interventions for Blood Pressure Control: Intervention Design and Rationale
Authors: Funk Kristine L. , Elmer Patricia J. , Stevens Victor J. , Harsha David W. , Craddick Shirley R. , Lin Pao-Hwa , Young Deborah Rohm , Champagne Catherine M. , Brantley Phillip J. , McCarron Phyllis B. , Simons-Morton Denise G. , Appel Lawrence J.
Published: June 2007

Interventions encouraging adoption of healthy diets and increased physical activity are needed to achieve national goals for preventing and treating hypertension, cardiovascular disease, diabetes, and other chronic diseases. PREMIER was a multicenter clinical trial testing the effects of two lifestyle interventions on blood pressure control, compared with advice only. Both interventions implemented established national guidelines for blood pressure control (weight loss, reduced sodium and alcohol intake, and increased physical activity), and one intervention also included the Dietary Approaches to Stop Hypertension (DASH) diet. Both interventions focused on behavioral self-management, motivational enhancement, and personalized feedback. This article describes the design and evaluation approaches for these interventions. Evaluation of multicomponent lifestyle change interventions can help us understand the benefits and difficulties of making multiple lifestyle changes concurrently and the effects such changes can have on blood pressure, particularly in minorities at higher risk for hypertension.
Promoting Healthy People 2010 Through Small Grants
Authors: Hartwig Kari A. , Dunville Richard Louis , Kim Michael H. , Levy Becca , Zaharek Margot M. , Njike Valentine Y. , Katz David L.
Published: June 2007

The Department of Health and Human Services initiated a pilot “microgrant” or small grants program in 2001 to promote Healthy People 2010 (HP 2010) implemented by the Yale-Griffin Prevention Research Center. This article describes the 103 agencies funded under this initiative and 67 control group agencies. It evaluates the HP 2010 focus areas targeted and the effectiveness of promoting HP 2010 objectives through microgrants. Forty-four percent of the grant recipients and 79% of the control group agencies indicated low levels of familiarity with HP 2010 goals. Changes in knowledge of HP 2010 goals for the microgrant group increased significantly from 5.24 ± 3.67 to 7.83 ± 1.86 (p < .05). The results suggest that microgrants can be a useful mechanism to plant the seeds for developing community and organizational capacity to define local health priorities, practice and test new initiatives or expand existing programs and promote knowledge about HP 2010.
Promoting Healthy Lifestyles in Children: A Pilot Program of Be a Fit Kid
Authors: Slawta Jennifer , Bentley Jeff , Smith Joan , Kelly Jessica , Syman-Degler Lucien
Published: June 2007

Be a Fit Kid is a 12-week program aimed at improving physical activity and nutritional habits in children. The physical activity component of the program emphasized cardiovascular fitness, flexibility, muscular strength, and bone development through running, yoga, jumping, and strength exercises. All activities were individualized and noncompetitive. The nutrition component focused on current dietary guidelines that emphasize a diet rich in vegetables, fruits, unsaturated fats, and whole grains, and low in saturated fat and sugar. Following the 12-week intervention, significant improvements were observed in body composition, fitness, nutrition knowledge, dietary habits, and in those who participated 75% of the time, significant reductions in total cholesterol and triglyceride levels were observed. Findings from the pilot trial suggest that health promotion programs can be well received by children and may favorably alter overweight and the development of adult lifestyle-related diseases.
Promoting Health and Innovative Health Promotion Practice Through a Community Arts Centre
Authors: Carson Arlene J. , Chappell Neena L. , Knight Carolyn J.
Published: June 2007

The salubrious effects of participation in and exposure to the arts are well documented. This paper describes the development of a unique arts centre established in a disadvantaged urban school setting as part of a larger community-based health promotion research project. The discussion highlights how community-based arts programming may impact health not only through positive effects on “upstream” non-medical health determinants, particularly aspects of social support, but also through its ability to facilitate the more traditional health-promotion initiatives of the larger parent project. Also discussed is this centre's potential to act as a catalyst to achieve the overarching project goal of enhanced community health by building constitutive capacity around positive aspects of the community, rather than focusing on capacity only as an instrumental resource to solve social or health problems. Greater incorporation of the arts within health-promotion projects offers potential to enhance both health promotion practice and outcomes.
Internet Telehealth for Pediatric Asthma Case Management: Integrating Computerized and Case Manager Features for Tailoring a Web-Based Asthma Education Program
Authors: Wise Meg , Gustafson David H. , Sorkness Christine A. , Molfenter Todd , Staresinic Anthony , Meis Tracy , Hawkins Robert P. , Shanovich Kathleen Kelly , Walker Nola P.
Published: June 2007

This article reports on the development of a personalized, Web-based asthma-education program for parents whose 4- to 12-year-old children have moderate to severe asthma. Personalization includes computer-based tailored messages and a human coach to build asthma self-management skills. Computerized features include the Asthma Manager, My Calendar/Reminder, My Goals, and a tailored home page. These are integrated with monthly asthma-education phone calls from an asthma-nurse case manager. The authors discuss the development process and issues and describe the current randomized evaluation study to test whether the year-long integrated intervention can improve adherence to a daily asthma controller medication, asthma control, and parent quality of life to reduce asthma-related healthcare utilization. Implications for health education for chronic disease management are raised.
Michael Jackson, Television, and Post-Op Disasters
Authors: Gómez-Barris Macarena , Gray Herman
Published: June 2007

This article analyzes Martin Bashir's television documentary Living with Michael Jackson in light of U.S. national preoccupations with the fixity and, conversely, the indeterminacy of racial, sexual, and gendered subjectivities. On one hand, the authors center Bashir's film within the broader context of recent cultural moves by neoconservatives and the broader U.S. public to express a moral core regarding issues of race, gender, family, and sexuality. On the other hand, they look closely at the format, genre, and televisual character of this representation, its timing, and its ability to generate audiences and other media coverage. Specifically, the authors are interested in the ongoing fascination with Michael Jackson as an expression of unresolved social tensions in the U.S. imaginary, especially with regard to notions of indeterminate or unfixable racial and sexual bodies.
The relationship between social interaction and characteristics of aggressive, cognitively impaired nursing home residents
Authors: Chen Yu-Ling , Ryden Muriel B. , Feldt Karen , Savik Kay
Published: June 2007

The extent of social interaction of aggressive, cognitively impaired nursing home residents and the relationship between social interaction and selected resident characteristics were explored in this study, which was part of a larger experimental study of the effect of dementia education for staff on the aggressive behavior of cognitively impaired residents. Staff rated residents using the Social Interaction Scale (SIS),which has two subscales: Institutional Interaction and Family/Community Interaction. Mean SIS scores were low; institutional interaction scores were higher than family/community scores. Marital status, morale, degree of cognitive impairment, dependency, and sexual aggression were significantly associated with social interaction, but gender and age were not.
The use of clinical case management for early stage Alzheimer' patients and their families
Authors: Chu Paul , Edwards Joy , Levin Ron , Thomson Jim
Published: June 2007

A number of studies have investigated the effectiveness of community based interventions to delay placement for persons with Alzheimer's disease (AD) and to ease caregiver burden, with mixed results. However, much of this research involved subjects who were in later stages of AD or the disease stage was not specified. Some researchers have suggested that the timing of interventions in these studies contributed to negative outcomes. This paper presents the results of a project which provided a comprehensive home care program to persons with early stage AD and their primary caregivers over a period of 18 months. Results indicated that caregivers in the treatment group felt less burdened at six months than caregivers in the control group and institutionalization was delayed for patients (with mild to moderate impairment) in the treatment group. These differences seem most attributable to the case management service provided to persons in the treatment group which featured supportive counseling, referral, skill training and education.
Male caregivers of spouses with Alzheimer's disease: Risk factors and health status
Authors: Shanks-McElroy Heather A. , Strobino Jane
Published: June 2007

Caregiving for persons with Alzheimer's disease (AD) has been shown to pose a challenge to the health of the spousal caregiver. Because most of the caregiving literature focuses on the female caregiver, there is some question about the generalizability of such literature to the male caregiver. This report focuses on male caregivers of spouses with AD and represents a subsample from a larger descriptive study that examined the relationship between risk factors and the health status of spousal caregivers. Twenty-nine male caregivers affiliated with Alzheimer's organizations in Pennsylvania and Ontario, Canada, returned mail surveys. On average, physical health symptoms increased by one-third when comparing pre- and post-caregiving data. Caregivers also were experiencing moderate to severe depression and burden. Male caregivers generally rated their physical health as fair to excellent and exhibited fewer than expected physical health symptoms. Caregiver health was related to perceptions of stress surrounding the provision of activities of daily living (ADL) assistance, the frequency of behavioral problems, perceptions of stress associated with the AD spouse's dysfunctional behaviors, and satisfaction with leisure opportunities.

The identification of the role that caregiver perceptions of stressfulness associated with caregiving and the need for leisure satisfaction offer important implications for community-based education and respite services to maintain health status for spousal caregivers.
Obtaining family consent for participation in Alzheimer's research in a Cuban-American population: Strategies to overcome the barriers
Authors: Williams Christine L. , Tappen Ruth , Buscemi Charles , Rivera Richard , Lezcano Jennifer
Published: June 2007

Cultural values and beliefs affect family attitudes toward participation in research. Significant resistance to allowing their elders with dementia to participate in clinical research was encountered in Cuban-American families. These families expressed concern about disturbing the elder's comfort (tranquilidad) and solitude (soledad). Furthermore, most believed that intervention would be futile. Feelings of guilt associated with nursing home placement may have been exacerbated by the suggestion that active intervention could be effective. Strategies to overcome these barriers included reduced emphasis on the potential superiority of the intervention to be tested, reassurance that contact with research staff was usually appreciated by participants, arrangements to talk with the family as a group about the study, and increased use of Spanish-language consent forms.
The Alzheimer's Connections Demonstration Program: Instituting a national case management program
Authors: Cox Carole , Albisu Kara
Published: June 2007

The Alzheimer's Connections Demonstration Program was designed to study the most effective ways of linking families with needed services and resources. The fiveyear demonstration, begun in 1995, funded case management programs in 29 Alzheimer's Association chapters and served 2,313 families. This paper reports on the final two years of the project when all programs were operational. During this period, 800 families were served. The findings indicate that the programs complement the existing chapter services by offering a specific intervention with caregivers. At the end of the demonstration, all chapters planned to continue the program as case management increased their visibility in the community through their ability to offer direct services.
Impact of dining room environment on nutritional intake of Alzheimer's residents: A case study
Authors: McDaniel Jessica H. , Hunt Alice , Hackes Bonnie , Pope Janet F.
Published: June 2007

This case study, in a Veterans Affairs Alzheimer's unit, was conducted to evaluate noise and lighting conditions at mealtimes and to assess the food intake of ambulatory dementia residents. The case study compared the noise, lighting, and nutritional intake of 16 Alzheimer's residents eating the same cycle menu in the extended-care (EC) dining room and the Alzheimer's unit (AU) dining room five weeks later. Noise was significantly lower in the EC (p. 02). Lighting was significantly higher in the EC (p. 001). Intake of calories and protein was slightly higher, with some days significantly higher, in the AU. Total five-day fluid intake at breakfast was significantly higher in the AU (p. 02). Although residents' total food and fluid intake was higher in the AU, the project identified a need to decrease noise and increase lighting in the AU. Lighting enhancement and noise reduction may further improve intake, which, in turn, may promote improved nutritional status.
Progressive dementia: Personal and relational impact on caregiving wives
Authors: Bauer Mary J. , Maddox Melitta K. , Kirk Laura N. , Burns Theressa , Kuskowski Michael A.
Published: June 2007

The purpose of this exploratory study was to examine the perceptions of 115 female spouse caregivers of early to moderate stage dementia patients. Based on patients’ cognitive status, cross-sectional comparisons of two groups of caregiving wives were conducted. No group differences were found in measures of caregiver burden, depression, or personal gain. However, wives of patients with greater cognitive impairment experienced lower levels of mastery and more relational deprivation when compared to wives of patients with higher mental status. Supportive approaches might be directed toward helping early dementia caregivers restructure their understanding of, and participation in, their marital relationships in anticipation of changes ahead. Interventions aimed at enhancing a caregiver's sense of personal mastery may help reduce the negative effects of dementia on caregivers’ well-being.
Effects of the Serial Trial Intervention on Discomfort and Behavior of Nursing Home Residents With Dementia
Authors: Kovach Christine R. , Logan Brent R. , Noonan Patricia E. , Schlidt Andrea Matovina , Smerz Jessica , Simpson Michelle , Wells Thelma
Published: June 2007

This study tested the effectiveness of the Serial Trial Intervention (STI), an innovative clinical protocol for assessment and management of unmet needs in people with late-stage dementia. A double-blinded randomized experiment was conducted in 14 nursing homes with 114 subjects. The treatment group had significantly less discomfort than the control group at posttesting and more frequently had behavioral symptoms return to baseline. The group of nurses using the STI also showed more persistence in assessing and intervening than control group nurses did. There was a statistically significant difference between the groups in the use of pharmacological, but not nonpharmacological, comfort treatments. Results suggest that the STI is effective and that effective treatment of discomfort is possible for people with late-stage dementia.
Correlations Between the Functional-Cognitive Assessment Scale and the Alzheimer's Disease Assessment Scale When Administered to Patients With Dementia Residing in Long-term Care
Authors: Tsolaki M. , Alexiadou A. , Kiosseoglou G. , Kounti F.
Published: June 2007

The Alzheimer Disease Assessment Scale (ADAS) and the Functional Cognitive Assessment Scale (FUCAS) examine the cognitive performance of patients with dementia. ADAS has been widely used as a clinical instrument, mainly in clinical trials. FUCAS is a useful tool in diagnosing early dementia since it examines executive skills. Moreover, it is sensitive to the subtle changes that occur during the progress of the disease. The aim of this study was to examine the possible correlations between FUCAS and ADAS. The 2 neuropsychological scales were administered to 32 patients with dementia residing in long-term care. They were 12 men and 20 women, 65 to 90 years old, with 4 to 12 years of education. Twenty-four patients were reassessed 3 months after the first assessment, with the same scales. Pearson's correlation showed that the total score of FUCAS correlated significantly with the total score of ADAS: r = 0.80 ( P < .01). The t test showed that changes over the 3 months for FUCAS were more significant than ADAS, suggesting that FUCAS is a more sensitive tool.
Systemic Inflammatory Markers and Risk of Dementia
Authors: Dziedzic Tomasz
Published: June 2007

Inflammation plays an important role in the pathogenesis of Alzheimer's disease. This article reviews the results of prospective studies demonstrating that the level of systemic inflammation markers, particularly C-reactive protein and interleukin-6, can predict cognitive decline or dementia. The potential mechanisms linking systemic inflammatory molecules to cognitive decline are also discussed.
Toxic Advanced Glycation End Products (TAGE) Theory in Alzheimer’s Disease
Authors: Sato Takashi , Shimogaito Noriko , Wu Xuegang , Kikuchi Seiji , Yamagishi Sho-ichi , Takeuchi Masayoshi
Published: June 2007

Several epidemiological studies have reported moderately increased risks of Alzheimer’s disease (AD) in diabetic patients compared with general population. In diabetes mellitus, the formation and accumulation of advanced glycation end products (AGEs) progress more rapidly. Recent understanding of this process has confirmed that interactions between AGEs and their receptor (RAGE) may play a role in the pathogenesis of diabetic complications and AD. The authors have recently found that glyceraldehyde-derived AGEs (AGE- 2), which is predominantly the structure of toxic AGEs (TAGE), show significant toxicity on cortical neuronal cells and that the neurotoxic effect of diabetic serum is completely blocked by neutralizing antibody against the AGE-2 epitope. Moreover, in human AD brains, AGE-2 is distributed in the cytosol of neurons in the hippocampus and parahippocampal gyrus. These results suggest that TAGE is involved in the pathogenesis of AD as well as other age-related diseases. In this review, the authors discuss the molecular mechanisms of AD, especially focusing on TAGE-RAGE system.
Treatment Fidelity Plan for an Activity Intervention Designed for Persons With Dementia
Authors: Kolanowski Ann , Buettner Linda , Moeller Joyel
Published: June 2007

The testing of psychosocial interventions in a clinical trial poses many challenges to maintaining a rigorous experimental protocol and to delivering the interventions uniformly throughout the project. These challenges directly affect the reported effectiveness of psychosocial interventions. In this article, the authors describe the treatment fidelity plan developed by an interdisciplinary research team from recreational therapy and nursing for implementing recreational activities during a clinical trial funded by the National Institute of Nursing Research. The trial tests the efficacy of activities for responding to the behavioral symptoms of dementia. The authors report treatment fidelity strategies to allow comparison of their intervention with that of other studies, to improve effect size in similar studies, and to facilitate replication and translation of this work into clinical practice.
The Kingston Standardized Behavioural Assessment
Authors: Hopkins Robert W. , Kilik Lindy A. , Day Duncan J. A. , Bradford Lisa , Rows Catherine P.
Published: June 2007

The Kingston Standardized Behavioural Assessment (KSBA), a behavioral screening tool that assesses the behavioral changes associated with dementia, particularly Alzheimer’s disease (AD), is introduced. Designed to be user friendly for clinicians not trained in specialized behavioral assessment techniques, it addresses some of the problems of existing scales. A group of patients diagnosed with probable AD, vascular dementia, or mixed (AD and vascular) was assessed using the KSBA. A subgroup was also given the Neuropsychiatric Inventory (NPI). Behavioral profiles and scores were obtained for all subjects. Factor analysis revealed 2 factors described as neuropsychiatric and neuropsychological. The KSBA efficiently collects neuropsychological and neuropsychiatric behavioral symptoms of dementia, is easy to score and interpret, and yields a behavioral profile that helps identify target behaviors for intervention. It can be used to facilitate clinical decision making around level of care and can be easily incorporated into clinically based research.
Telehealth Home Monitoring of Solitary Persons With Mild Dementia
Authors: Smith Glenn E. , Lunde Angela M. , Hathaway Julie C. , Vickers Kristin S.
Published: June 2007

Medication safety is a special concern for the 30% to 40% of dementia patients who live alone at the time of diagnosis, and it plays an important part in relocation decisions. Televideo monitoring could improve medication self-administration accuracy and improve mood for persons with mild dementia who live alone or spend a significant amount of their day alone. The authors used 2-way interactive video technology to monitor medication compliance of 8 persons with mild dementia. They conducted more than 4000 contacts with these persons and found adequate technical outcome in 82% of calls. End medication compliance was 81% in the video-monitored group compared to 66% in the controls ( P < .05). Comparison of compliance from initial to end ratings revealed that video-monitored participants’ compliance remained stable while unmonitored patients’ compliance fell 12 percentage points, consistent with expectations for dementia. This difference was also significant. Quantitative and qualitative outcome data from this project are presented.
Stress considered as an etiological factor in Alzheimer's disease
Authors: Haggerty Arthur D.
Published: June 2007

Stress has not been considered as an etiological factor in Alzheimer's disease. However, a synthesis of research data on both stress and A.D. suggests the validity of a role for stress itself as a significant causal factor or at least as a co-factor consistent with current research models for this disease.
A community survey
Authors: Kumar Vinod , Salama Azia A. , Desai Bipin , Kumar Nita
Published: June 2007

In a survey of drug prescribing, we interviewed 41 dementia patients and 37 normal elderly, both groups living in their homes. We found that 83 percent of the dementia patients and more than half (54 percent) of the normal elderly were receiving medications. The use of psychotropic medications was mainly limited to the dementia group, who continued to show psychopathology as measured by the BPRS (Brief Psychiatric Rating Scale) in spite of pharmacotherapy. The degree of dementia measured by Mini-Mental State examination1 was significantly correlated with the degree of psychopathology measured by Brief Psychiatric Rating Scale (BPRS).2 Polypharmacy (use of multiple psychotropic drugs) was not a problem in our sample. There appears to be a resistance of the psychiatric symptoms associated with dementia to respond to prescribed psychotropic medications.
Issues and problems in Alzheimer's disease registry development
Authors: Sayetta Rona Beth
Published: June 2007

The case registry is a system for recording, storing, and updating standardized information about all individuals who acquire a particular disease or class of disorders from a specified date onwards. It may contain personal, familial, social, clinical, and genetic information. To be most informative, cases should be culled from a precisely defined geographical or administrative area.

Registries produce cumulative, chronologically oriented records about people for epidemiologic and other research as well as statistics for health services planning.

The historical development of case registers for cancer, congenital defects, psychiatric conditions, and other disorders has illustrated the diverse, often multipurpose functions that they may serve. Registries are, or can be, populationbased sampling frames for both retrospective and longitudinal studies, and statistical databases.

Creating a registry involves addressing six common problems and issues: 1) defining objectives; 2) determining scope of coverage of populations and conditions; 3) ascertaining cases reliably and validating diagnoses; 4) choosing accurate, efficient data collection methods; 5) maintaining confidentiality of patient records and family privacy; 6) bearing the (growing) financial burden. Sites are unique, so solutions must be individualized.

Registry operations are complex, expensive, and long-term. The key to their success does not lie in technical and statistical details alone, but in an essential spirit of cooperation and commitment among all participants.
Assessment to guide placement, plan care, and track change in individuals with Alzheimer's disease
Authors: McCracken Ann L. , Fitzwater Evelyn
Published: June 2007

Appropriate placement of residents is of critical concern. Multi-dimensional assessment is a complexprocess that could more precisely guide the placement and care of elderly persons withAlzheimer's disease. The use of the HaycoxDementia Rating Scale with 11 individuals withAlzheimer's disease in a closed unit, has assisted staf in the placement of residents in a protective unit at a tine when such a unit could increase or deter functional loss in selected areas of functioning. Moreover, the assessment tool has helped to identify the impact of dementia in the functional capabilities of individuals. Dressing and grooming was most impaired on admission to the unit, but changed very little during the ensuing 12 months. Functions dealing with social skills and awareness tended to increase. Increase of motor coordination impairment heralded a decrease in function for three residents.
Alzheimer's disease and the home: Issues in environmental design
Authors: Zgola Jitka
Published: June 2007

The home or family residence presents a unique challenge in environmental design for persons with Alzheimer's disease. Imbued with memories and deep emotions, the home can represent security and comfort. The familiar surroundings, however, can also act as apersistent reminder of frustration and lost skills or can stimulate activities that are no longer appropriate or even safe for the individual with Alzheimer's disease. Beneficial adaptations in the home can be made in the interests of preserving the functional ability, safety and emotional well-being of those with Alzheimer's disease. It is particularly important that consideration also be given to the needs of the caregiver. No matter how ideal the physical setting may be, its effectiveness as a domicile for the person with Alzheimer's disease usually depends upon the health and emotional integrity of the caregiver.
The therapeutic environment screening scale
Authors: Sloane Philip D. , Mathew Laura J.
Published: June 2007

As part of a study of care for patients with Alzheimer's disease and related disorders in 31 dementia units, (special care units) and 32 traditional units in five states, an observational screening checklist was designed and field tested. That checklist the Therapeutic Environment Screening Scale (TESS) uses 12 items to evaluate the appropriateness of a nursing home unit for residents with dementing disorders. The therapeutic principles evaluated by the instrument are: eliminating potentially noxious stimuli, enhancing mood and self image, promoting safety, accommodating a range of private and social activities, and providing access to the outdoors. Application of the instrument showed that the 63 settings studied did differ in the 12 environmental characteristics studied, and that as a whole, dementia units scored significantly better than traditional nursing home units.
Who's taking care?
Authors: Friss Lynn R. , Whitlatch Carol J.
Published: June 2007

This paper presents a profile of 1,337 caregivers of brain impaired adults in California. The findings are based on the first statewide descriptive study of caregivers and patients across diagnostic categories of brain impairment. Regardless of the type of patient brain impairment, caregivers were found to have similarly high levels of depression, burden, and fair to poor physical health. Implications for long term care policy and service development are discussed.
Day care programs for clients with dementia
Authors: McGovern Connie M. , Barry Patricia P.
Published: June 2007

In order to better define the characteristics of day care programs for clients with dementia, we accomplished an on-site survey of all 29 adult day care programs in two Florida counties. We compared standard adult day care (21 centers) with specialized Alzheimer day care (eight centers). Variables includedfacility, staff, client, program, and service characteristics. Alzheimer centers had higher staff to client ratios, greater staff time and services required, with more impaired functional status and behavior of clients. However, considerable variability was noted amongAlzheimer centers, with sizeable overlap between those adult day care centers serving more impaired clients - and those Alzheimer centers serving less impaired clients. We conclude that significant heterogeneity exists among these centers, making selection and referral difficult. Standards of care are needed to provide criteria for designation of those specialized day care centers serving demented clients.
Pertinent autonomy for residents with dementias: Modification of the physical environment to enhance independence
Authors: Namazi Kevan H. , Johnson Beth DiNatale
Published: June 2007

Autonomy and independence have recently become important issues for the elderly, but have not been applied to Alzheimer's disease patients. This project explores pertinent autonomy for the cognitively disabled by studying exit door behaviors. A specially designed environment satisfied safety and health concerns and enabled residents to have free access to the outdoors during daylight hours. Twenty two residents in early to advanced stages of the disease participated in the project. The results indicate that the number of agitated behaviors in five categories decreased under the unlocked door condition.
Environmental issues related to visibility and consumption of food in an Alzheimer's disease unit
Authors: Namazi Kevan H. , Johnson Beth DiNatale
Published: June 2007

The importance of food and food choices as a physical, social, and psychological component of well-being is well documented. However these issues have not been systematically examined with the cognitively disabled. This study explores how presentation of food and snacks can encourage AD patients in the early and middle stages of the disease to independently satisfy hunger and thirst. Neither visible nor accessible refrigerators greatly increased the incidences of resident independence in snacking. Results suggest that residents' inability to select snacks independently may be inadvertently hampered by caregivers' perceptions of excess disability.
A new approach for physical therapists in the long term care of Alzheimer patients
Authors: Ebel Susan
Published: June 2007

Throughout the progressive stages of dementia, there is a need for an interdisciplinary team approach in the long term care of Alzheimer patients. This article describes the need for a shift in our therapeutic strategies and will address ways in which the physical therapist can positively impact Alzheimer patient care and reduce caregiver burden, whether the patient is at home or in an institution. This can be accomplished in part by:

• Designing a daily exercise program; • Making modifications to the environment to decrease sensory stress andfacilitate autonomy; • Designing appropriate cues to help the patient with activities of daily living; • Evaluating home safety, equipment needs and falls prevention; and finally • Teaching safe transfers and bed-bound care.
Religiosity among Alzheimer's disease caregivers
Authors: Whitlatch Ann M. , Meddaugh Dorothy I. , Langhout Kristen J.
Published: June 2007

During a larger evaluation study of a Midwestern Alzheimer's Disease Association Family Caregiver Support Group Program and using their program objectives as the standard of evaluation, qualitative data was recorded. Caregiver statements were categorized into topic areas based on program objectives and content identified as important to caregiver support including knowledge of AD, caregiving problems and strategies, resources, and feelings. Analysis of these statements revealed religiosity as a pervading theme across all topic areas. The purpose of this paper is to describe religiosity as a possible coping resource expressed by support group members while sharing their family and care giving experiences. Statements are discussed in tenns of the Koenig, et al. (1988a) framework delineated in their Springfield Religiosity Schedule (SRS), categorizing them as either organized religious activity, non-organized religious activity, or intrinsic religiosity. The prominence of religion related discussion among caregivers in this evaluation seems to indicate the need for further research regarding the extent and nature of religiosity as a coping mechanism among caregivers, as well as the investigation of programs that support caregiver access to and participation in religious activity.
Planning for a statewide network of dementia assessment services: A survey of geriatric assessment services in Michigan
Authors: Shope Jean T. , Holmes Sara B. , Sharpe Patricia A. , Goodman Cheryl , Izenson Sanford , Gilman Sid
Published: June 2007

All 38 geriatric assessment service units identified in Michigan were surveyed and responded as a component of planning a statewide network of diagnostic and assessment services for patients with dementia. Most units were outpatient (71 percent), urban (71 percent), and hospital-based (82 percent). Some provided primarily geropsychiatric services (21 percent), while the rest provided general geriatric services. The staff included physicians (95 percent), nurses (100 percent), social workers (95 percent) and other professionals (SO percent) such as nutritionists, neuro psychologists or clinical pharmacists. Assessments performed by most units included physical (92 percent), psychosocial (95 percent), functional (95 percent), neurological (71 percent) mental (95 percent), and financial (89 percent). Patient referral sources were most frequently self/family, followed by physician, community agencies, and community mental health. Reasons for referral were most often confusion! memory loss, followed by behavior change, caregiver stress, depression, and evaluation for placement. Most patients seen were between 65 and 84 years of age (72 percent), lived within 25 miles of the unit (87 percent), and had dementia (62 percent). Urban sites assessed significantly more persons per month (19 percent) than non-urban sites (4 percent). Community-based services spent significantly more time per month on geriatric assessments (68 hours) than did hospital-based services (26 hours). These survey results will aid the development of a statewide network of dementia diagnostic and assessment services.
Effects of a three-year exercise therapy program on cognitive functioning of elderly personal care home residents
Authors: Lindenmuth G. Frank , Lindenmuth Elise B.
Published: June 2007

The purpose of this study was to examine the effects of the Intense Exercise Therapy (IET) on the cognitive levels offunctioning of elderly persons monitored for three years. The study was based on the premise that daily group exercise enhances physiological as well as psychological processes and consequently may improve cognitive abilities for elderly persons. The study hypothesized that the cognitive functioning level of elderly persons participating in the IET would be significantly higher than the level of those persons in the no treatment control group. A previous study by Lindenmuth and Moose' indicated a positive effect of exercise therapy on cognitive functioning for Alzheimer patients.

The sample consisted of 82 elderly (64-98 years old) residents of eight separate personal care facilities in Pennsylvania. Residents who volunteered attended by choice either group exercise therapy or a no treatment control group. A pretest, posttest experimental design was utilized in an attempt to control extraneous variables. Pretreatment, during treatment, and posttreatment measures were collected on the Cognitive Abilities Screening Test (CAST).

After participating in the IET, elderly persons were found to have significantly higher (2 < .001) cognitivefunctioning levels. Thesefindings lead to the conclusion that effects of the IETincluded an improvement in cognitive levels offunctioningfor the elderly participants in the treatment group. In addition, elderly persons in the control group showed Alzheimer-like symptoms and demonstrated CAST scores indicative of moderate impairment and organic brain disease. The implication is that a strategy such as the IET used by personal care homes and other institutions caring for the elderly would be of benefit in assisting elderly residents to maintain and improve cognitive levels. The IET is especially practical due to ease of use, low cost, and brevity of actual exercise sessions.