bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluating Exercise Prescription and Instructional Methods Used in Tai Chi Studies Aimed at Improving Balance in Older Adults: A Systematic Review
Authors: Wu Yin , MacDonald Hayley V. , Pescatello Linda S. 
Published: August 2016

ObjectivesTo develop an evaluation instrument to determine to what extent Tai Chi interventions aimed at improving the balance of older adults disclosed their exercise prescription (Ex Rx) and instructional methods and met best‐practice exercise recommendations for balance improvement.DesignReview.SettingPubMed, Scopus, and CINAHL databases were searched from their inception until August 22, 2014.ParticipantsAdults aged 60 and older without debilitating disease.MeasurementsThree electronic databases were searched to identify randomized controlled trials (RCTs) of Tai Chi interventions aimed at improving balance in older adults without severe debilitating diseases. Three Ex Rx (frequency, time, intervention length) and 10 instructional (e.g., style, number of forms) methods of the included RCTs were evaluated.ResultsTwenty‐seven interventions were identified from 26 RCTs. On average, Tai Chi was performed for a mean 56.5 ± 14.4 minutes per session for 2.8 ± 1.4 sessions per week for 19.7 ± 12.7 weeks. Most interventions reported all three Ex Rx methods items, with a mean reporting rate of 92.6 ± 19.2%. For the 10 instructional methods items, the mean reporting rate was 41.1 ± 18.0%, significantly lower than for the Ex Rx methods items (P < .001). Fewer than half of the interventions reported unsupervised practice (15%), progression (22%), or the use of breathing (30%) and relaxation (15%) techniques. The instructional methods items most important for targeting Tai Chi practice to improve balance were not routinely disclosed, with only 15% reporting names of forms and 52% reporting movement principles.ConclusionMost Tai Chi interventions disclosed their Ex Rx methods yet routinely failed to report instructional methods. To increase the effectiveness of Tai Chi to improve balance in older adults, future RCTs should disclose their Ex Rx and instructional methods, especially methods that target balance.
Racial Differences in Hospitalizations of Dying Medicare–Medicaid Dually Eligible Nursing Home Residents
Authors: Cai Shubing , Miller Susan C. , Mukamel Dana B. 
Published: August 2016

ObjectivesTo examine whether racial differences in end‐of‐life (EOL) hospitalizations vary according to the presence of advance directives, specifically do‐not‐hospitalize (DNH) orders, and individual cognitive status in nursing home (NH) residents.DesignNational data, including Medicare data and Minimum Data Set (MDS) 2.0, between January 1, 2007, and September 30, 2010, were linked. EOL hospitalizations were hospitalizations in the last 30 days of life. Linear probability models with an interaction term (between race and DNH) and NH fixed‐effects were estimated. The analyses were stratified according to cognitive status.SettingNursing homes in the United States.ParticipantsDually eligible Medicare–Medicaid decedents enrolled in Medicare fee‐for‐service plans and long‐stay NH residents (in NHs ≥ 90 days before death) (N = 394,948).MeasurementsRacial difference in EOL hospitalizations from a NH.ResultsEnd‐of‐life hospitalization rate was 31.7% for whites and 42.8% for blacks. For participants without DNH orders, adjusted probability of EOL hospitalization was higher for blacks than for whites: 2.7 percentage points in those with moderate cognitive impairment (P < .001) and 4.7 percentage points in those with severe cognitive impairment (P < .001). For those with DNH orders, adjusted racial differences in EOL hospitalization were not statistically significant in those with moderate (P = .25) or severe (P = .93) cognitive impairment, but blacks had a higher probability of EOL hospitalization than whites if they had relatively intact cognitive status.ConclusionRacial differences in EOL hospitalization varied with DNH orders and cognitive status in dying residents. Future research is necessary to understand the reasons behind these variations.
End‐of‐Life Discussions with Older Adults
Authors: Kale Minal S. , Ornstein Katherine A. , Smith Cardinale B. , Kelley Amy S. 
Published: August 2016

ObjectivesTo determine the prevalence of end‐of‐life (EOL) conversations with older adults.DesignNational Health and Aging Trends Study (NHATS), a prospective, longitudinal survey of Medicare beneficiaries.SettingNationally representative.ParticipantsA sample drawn from Wave 2 of the NHATS.MeasurementsThe main outcome was the report of an EOL planning discussion, based upon the participant's response to the question “Have you talked to anyone about the types of medical treatment you would want or not want if you became seriously ill in the future?”ResultsSixty‐one percent of the sample (n = 1,993 individuals, weighted n = 11,123,910) responded that they had discussed EOL treatment preferences with someone. In multivariate regression, factors associated with reporting an EOL discussion included being younger (adjusted odds ratio (AOR) = 1.70, 95% confidence interval (CI) = 1.17–2.47), having more education (high school degree: AOR = 1.45, 95% CI = 1.02–2.07; some college: AOR = 2.03, 95% CI = 1.40–2.95), and having multiple chronic conditions (AOR = 1.25, 95% CI = 1.01–1.55). Black race was associated with lower odds of reporting a discussion (AOR = 0.46, 95% CI = 0.33–0.65).ConclusionForty percent of a nationally representative sample of Medicare beneficiaries had not discussed their preferences regarding EOL medical treatment. Promoting these conversations in clinical and nonclinical settings will be important to ensure that health care is delivered to individuals in a person‐centered manner.
Potential Effect of Substituting Estimated Glomerular Filtration Rate for Estimated Creatinine Clearance for Dosing of Direct Oral Anticoagulants
Authors: Schwartz Janice B. 
Published: August 2016

ObjectivesTo determine the potential effect of substituting glomerular filtration rate (GFR) estimates for renal clearance estimated using the Cockcroft–Gault method (CrCL‐CG) to calculate direct oral anticoagulant (DOAC) dosing.DesignSimulation and retrospective data analysis.SettingCommunity, academic institution, nursing home.ParticipantsNoninstitutionalized individuals aged 19 to 80 from the National Health and Nutrition Examination Survey (NHANES) (2011/12) (n = 4,687) and medically stable research participants aged 25 to 105 (n = 208).MeasurementsAge, height, weight, sex, race, serum creatinine, CrCL‐CG, and GFR (according to the Modification of Diet in Renal Disease and Chronic Kidney Disease Epidemiology Collaboration equations). Outcome measures were dosing errors if GFR were to be substituted for CrCL‐CG.ResultsRenal clearance estimates according to all methods were highly correlated (P < .001), although at lower clearances, substitution of GFR estimates for CrCL‐CG resulted in failure to recognize needs for dose reductions of rivaroxaban or edoxaban in 28% of NHANES subjects and 47% to 56% of research subjects. At a CrCL‐CG of less than 30 mL/min, GFR estimates missed indicated dosage reductions for dabigatran in 18% to 21% of NHANES subjects and 57% to 86% of research subjects. Age and weight contributed to differences between renal clearance estimates (P < .001), but correction of GFR for body surface area (BSA) did not reduce dosing errors. At a CrCL‐CG greater than 95 mL/min, edoxaban is not recommended, and GFR esimates misclassified 24% of NHANES and 39% of research subjects. Correction for BSA reduced misclassification to 7% for NHANES and 14% in research subjects.ConclusionSubstitution of GFR estimates for estimated CrCl can lead to failure to recognize indications for reducing DOAC dose and potentially higher bleeding rates than in randomized trials.
Dyspnea in Community‐Dwelling Older Persons: A Multifactorial Geriatric Health Condition
Authors: Miner Brienne , Tinetti Mary E. , Van Ness Peter H. , Han Ling , Leo‐Summers Linda , Newman Anne B. , Lee Patty J. , Vaz Fragoso Carlos A. 
Published: August 2016

ObjectivesTo evaluate the associations between a broad array of cardiorespiratory and noncardiorespiratory impairments and dyspnea in older persons.DesignCross‐sectional.SettingCardiovascular Health Study.ParticipantsCommunity‐dwelling persons (N = 4,413; mean age 72.6, 57.1% female, 4.5% African American, 27.2% <high school education, 54.7% ever‐smokers).MeasurementsDyspnea severity (moderate to severe defined as American Thoracic Society Grade ≥2) and several impairments, including those established using spirometry (forced expiratory volume in 1 second (FEV1)), maximal inspiratory pressure (respiratory muscle strength), echocardiography, ankle–brachial index, blood pressure, whole‐body muscle mass (bioelectrical impedance), single chair stand (lower extremity function), grip strength, serum hemoglobin and creatinine, Center for Epidemiologic Studies Depression Scale (CES‐D), Mini‐Mental State Examination, medication use, and body mass index (BMI).ResultsIn a multivariable logistic regression model, impairments that had strong associations with moderate to severe dyspnea were FEV1 less than the lower limit of normal (adjusted odds ratio (aOR) = 2.88, 95% confidence interval (CI) = 2.37–3.49), left ventricular ejection fraction less than 45% (aOR = 2.12, 95% CI = 1.43, 3.16), unable to perform a single chair stand (aOR = 2.10, 95% CI = 1.61–2.73), depressive symptoms (CES‐D score ≥16; aOR = 2.02, 95% CI = 1.26–3.23), and obesity (BMI ≥30; aOR = 2.07, 95% CI = 1.67–2.55). Impairments with modest but still statistically significant associations with moderate to severe dyspnea included respiratory muscle weakness, diastolic cardiac dysfunction, grip weakness, anxiety symptoms, and use of cardiovascular and psychoactive medications (aORs = 1.31–1.71).ConclusionIn community‐dwelling older persons, several cardiorespiratory and noncardiorespiratory impairments were significantly associated with moderate to severe dyspnea, akin to a multifactorial geriatric health condition.
Cognitive Behavioral Therapy for Insomnia in Older Veterans Using Nonclinician Sleep Coaches: Randomized Controlled Trial
Authors: Alessi Cathy , Martin Jennifer L. , Fiorentino Lavinia , Fung Constance H. , Dzierzewski Joseph M. , Rodriguez Tapia Juan C. , Song Yeonsu , Josephson Karen , Jouldjian Stella , Mitchell Michael N. 
Published: August 2016

ObjectivesTo test a new cognitive behavioral therapy for insomnia (CBT‐I) program designed for use by nonclinicians.DesignRandomized controlled trial.SettingDepartment of Veterans Affairs healthcare system.ParticipantsCommunity‐dwelling veterans aged 60 and older who met diagnostic criteria for insomnia of 3 months duration or longer (N = 159).InterventionNonclinician “sleep coaches” delivered a five‐session manual‐based CBT‐I program including stimulus control, sleep restriction, sleep hygiene, and cognitive therapy (individually or in small groups), with weekly telephone behavioral sleep medicine supervision. Controls received five sessions of general sleep education.MeasurementsPrimary outcomes, including self‐reported (7‐day sleep diary) sleep onset latency (SOL‐D), wake after sleep onset (WASO‐D), total wake time (TWT‐D), and sleep efficiency (SE‐D); Pittsburgh Sleep Quality Index (PSQI); and objective sleep efficiency (7‐day wrist actigraphy, SE‐A) were measured at baseline, at the posttreatment assessment, and at 6‐ and 12‐month follow‐up. Additional measures included the Insomnia Severity Index (ISI), depressive symptoms (Patient Health Questionnaire‐9 (PHQ‐9)), and quality of life (Medical Outcomes Study 12‐item Short‐form Survey version 2 (SF‐12v2)).ResultsIntervention subjects had greater improvement than controls between the baseline and posttreatment assessments, the baseline and 6‐month assessments, and the baseline and 12‐month assessments in SOL‐D (−23.4, −15.8, and −17.3 minutes, respectively), TWT‐D (−68.4, −37.0, and −30.9 minutes, respectively), SE‐D (10.5%, 6.7%, and 5.4%, respectively), PSQI (−3.4, −2.4, and −2.1 in total score, respectively), and ISI (−4.5, −3.9, and −2.8 in total score, respectively) (all P < .05). There were no significant differences in SE‐A, PHQ‐9, or SF‐12v2.ConclusionManual‐based CBT‐I delivered by nonclinician sleep coaches improves sleep in older adults with chronic insomnia.
Effect of Primary Care Involvement on End‐of‐Life Care Outcomes: A Systematic Review
Authors: Kim Sion L. , Tarn Derjung M. 
Published: August 2016

ObjectivesTo investigate the relationship between primary care involvement in end‐of‐life (EOL) care and health and utilization outcomes.DesignSystematic review using MEDLINE and Web of Science.SettingAll English literature published between 1994 and August 31, 2014, that included terms related to primary care providers (PCPs), continuity of care, EOL care, and palliative care.ParticipantsIndividuals receiving care from a PCP at the end of life.MeasurementsStudy design, subject characteristics, study outcomes and results.ResultsOf 2,812 studies screened, 13 were included in this study. The studies were mostly conducted in the United States (n = 5) and Canada (n = 4) and analyzed data collected from 1989 to 2010. Almost all studies used different definitions of PCP involvement in care, but in general, individuals who received more care from PCPs were more likely to be discharged or die with supportive care (home or hospice) than those receiving less PCP care. A few studies indicated that individuals seeing a PCP were less likely to have hospital or emergency department admissions, although the evidence for this was mixed. Studies linking PCP involvement to resource use, symptom management, and survival had mixed results or showed no association.ConclusionWhen PCPs are involved in EOL care, people are more likely to die out of the hospital. Thus, the relationship with the PCP may be particularly important in EOL care, because PCPs may help individual establish goals of care and determine treatment preferences.
Framing moving and handling as a complex healthcare intervention within the acute care of older people with osteoporosis: a qualitative study
Authors: Smith Margaret Coulter , O'May Fiona , Tropea Savina , Berg Jackie 
Published: August 2016

Aims and objectivesTo investigate healthcare staff's views and experiences of caring for older hospitalised adults (aged 60+) with osteoporosis focusing on moving and handling. Specific objectives were to explore the composition of manual handling risk assessments and interventions in osteoporosis.BackgroundOsteoporosis is a skeletal disease that reduces bone density and causes increased fracture risk. Incidence rises with age and osteoporotic fractures cause increased morbidity and mortality. It is a major global health problem. In the UK older hospitalised adults are normally screened for falls risk but not necessarily for osteoporosis. As presentation of osteoporosis is normally silent until fractures are evident, it is frequently undiagnosed. Healthcare staff's knowledge of osteoporosis is often suboptimal and specific manual handling implications are under‐researched.DesignAn exploratory qualitative content analysis research design informed by critical realism.MethodsThe purposive sample comprised 26 nursing and allied health professionals. Semi‐structured interviews addressed topics including knowledge of osteoporosis, implications for acute care, moving and handling and clinical guidelines. Qualitative content data analysis was used.ResultsAwareness of osteoporosis prevalence in older populations varies and implications for nursing are indistinct to nonspecialists. In‐hospital fractures potentially linked to suboptimal moving and handling seemed rare, but prospective studies are needed. Categories of ‘Understanding moving and handling as routine care or as a healthcare intervention’, with further categories ‘healthcare practitioners’ capacities and capabilities for dealing with people with osteoporosis’ and ‘the structural and organisational context for moving and handling’ are reported alongside safety, frailty and dependency dimensions.ConclusionsThis study informs moving and handling in higher risk groups such as osteoporosis. Clinical knowledge/expertise is required when adapting generic manual handling guidelines to specific patients/contexts. Patients’ experiences of moving and handling have received limited attention.Relevance to clinical practiceIncreased focus on musculoskeletal conditions and moving and handling implications is required.
Ice compresses aid the reduction of swelling and pain after scleral buckling surgery
Authors: Li Zhuo , Wang Qin 
Published: August 2016

Aims and objectivesTo investigate the therapeutic effects of a local ice compress in alleviating eyelid swelling and errhysis and providing relief from pain after surgery.BackgroundEyelid swelling and pain are the most common postoperative symptoms after scleral buckling surgery. A local ice compress can reduce the severity of swelling, errhysis and pain after acute injury as well as after surgery.DesignA retrospective study.MethodsA total of 100 patients who had undergone scleral buckling surgery for retinal detachment were classified into an ice compress group or a control group. All patients received standard postoperative medical care: a 1% Tropicamide ophthalmic solution (Minims® Tropicamide; Bausch & Lomb, Surrey, UK), a 1% prednisolone acetate (Pred‐Forte; Allergan, Irvine, CA, USA), an ophthalmic tobramycin 0·3%/dexamethasone 0·1% combination ointment (Tobradex®; Alcon, Fort Worth, Texas, USA) and 0·5% Levofloxacin eye drops (Santen Pharmaceutical, Osaka, Japan), plus a homemade ice pack was placed over the operated eye of patients in the ice compress group for 30 minutes, three times a day for two consecutive postoperative days.ResultsThe severity of swelling, pain and errhysis in the operated eyes was significantly lower in the ice compress group.ConclusionsThe local ice compress therapy helped reduce swelling, errhysis and pain in the operated eye after scleral buckling surgery.Relevance to clinical practiceUse of a local ice compress after scleral buckling surgery can reduce swelling and pain on operated eyes, providing greater comfort for patients.
A nurse‐coordinated model of care versus usual care for chronic kidney disease: meta‐analysis
Authors: Xu Haidan , Mou Lisha , Cai Zhiming 
Published: August 2016

AimTo investigate whether a nurse‐led care was more beneficial for implementing chronic kidney disease guidelines and improved multiple risk factors compared with the usual care.BackgroundSeveral independent clinical trials have been carried out to demonstrate the efficiency of a nurse‐led care to improve the outcomes for patients with chronic kidney disease and address the risk factors for renal function decline. However, their results and conclusions were inconsistent.MethodsA meta‐analysis was carried out on September 2015 based on previous studies that evaluated the efficiency of nurse‐led care model for patients with chronic kidney disease. Following quality appraisal, four randomised clinical trials that allocated patients with chronic kidney disease to usual care and nurse‐coordinated care were included. Primary outcomes, such as kidney failure and cardiovascular events, were analysed.ResultsCompared with the usual care group, a nurse‐coordinated care model reduced the risks of composite death, decreased the occurrence rate of end‐stage renal disease and doubled serum creatinine. On the contrary, a slight propulsive effect of nurse‐led interventional care occurred on acute myocardial infarction and heart failure.LimitationsOnly five studies were included and conducted nonstandard evaluating endpoints, causing fewer studies were categorised in each outcome events in this meta‐analysis, subsequently leading to heterogeneity and less persuasive.ConclusionsIntensive interventions delivered by nurse coordinators are expected to benefit patients to attain longer life expectancy and higher life quality as well as to improve controlling risk factors implicated in chronic kidney disease progression.Relevance to clinical practiceMore government and hospitals should modify the traditional nursing routine based on this study, providing a more intensive nurse‐coaching care model for patients with chronic kidney disease, even aged or other chronic diseases, which shall further help to better control the risk factors and delay disease progression.
Gut complex carbohydrates and intestinal microflora in broiler chickens fed with oregano (Origanum vulgare L.) aqueous extract and vitamin E
Authors: Scocco P. , Forte C. , Franciosini M. P. , Mercati F. , Casagrande‐Proietti P. , Dall'Aglio C. , Acuti G. , Tardella F. M. , Trabalza‐Marinucci M. 
Published: August 2016

SummaryOne hundred and seventy one‐day‐old female broiler chicks were randomly divided into three groups fed with different dietary treatments: basal control diet (C); C supplemented (2 g/kg) with an oregano aqueous extract (O); C supplemented (150 mg/kg) with vitamin E (E). Growth performance was evaluated at 21 (T1) and 42 days (T2). On the same days, morphological, histochemical and microbiological analyses were performed. The O group showed the highest (p < 0.01) body weight at T1, while no differences were observed at T2. Light microscopic observation and conventional histochemistry showed no differences with regard to the two sampling times, whereas significant differences emerged among the treatments. The O treatment generally enhanced goblet cell reactivity more than both the C and E treatments. Coliform count was lower in the ileum tract of the O group at both T1 and T2 (p < 0.05) and increased with age in all groups. Escherichia coli showed the lowest values in the caecum of the O group (p < 0.001) at both sampling times. Enterococci, lactobacilli and staphylococci populations showed no differences among the different experimental groups in the caecum. In the ileum, the O group did not exhibit the sharp decline (p < 0.001) in the lactic acid bacteria population observed in the other two experimental groups. In conclusion, oregano aqueous extract supplementation seemed to elicit the best response among treatments, enabling better growth performance, enhancing both the quantity and quality of glycoconjugates involved in indirect defence actions and significantly reducing both the coliform and E. coli counts.