bluuebunny/crossref_metadata_2025_split huggingface dataset:
Does nursing need `the dismal science'? The case for economic evaluations in nursing
Authors: Jenkins-Clarke Susan 
Published: June 2007

This paper assesses the role of economic evaluation in the nursing context and reviews the problems involved in applying standard frameworks used elsewhere in health economics. The UK literature on studies of cost-effectiveness and nursing is reviewed and, as a consequence of the gaps on the topic that were revealed, ways of approaching the issue are suggested. The question is asked whether economic evaluation in the nursing context needs to be addressed at all, following which a framework for analysis is suggested. The paucity of economic appraisals in nursing has been noted by previous authors. In the UK, the majority of these focus on specific areas of care, such as leg ulcer treatments, with more general areas, such as evaluations of case management, home versus hospital deliveries and new nursing roles, being confined to the USA literature. Ways of approaching economic evaluation are outlined by means of a suggested framework for analysis, with a brief discussion on the complexities of measuring costs and outcomes. The final section of the paper introduces the concept of measurement of quality of nursing care into the framework and the difficult questions raised by its inclusion. The paper concludes by suggesting that, in this time of scarce resources and the need to allocate such resources prudently, nurses could work with their colleagues in other disciplines to produce sound evidence in order to inform debate in this area.
What really matters to patients living with chronic obstructive pulmonary disease? An exploratory study
Authors: Williams V. , Bruton A. , Ellis-Hill C. , McPherson K. 
Published: June 2007

There is limited published research into what really matters to people living with chronic obstructive pulmonary disease (COPD). Most previous research in this area focuses on the impact of the symptoms of COPD, rather than on the issues defined as important by patients themselves. This paper describes an exploratory study investigating what is most important to people living with COPD. A qualitative approach employing in-depth interviews with COPD patients was chosen. Thematic analysis was used to code and categorize data. Six patients with `moderate' to `very severe' COPD were recruited. They considered engagement in specific activities to be very important (walking, household maintenance and driving), even though these activities were mainly centred around the home environment, or within confined spaces, due to their physical limitations. This restriction led to feelings of social isolation that these patients tried to overcome through social participation (holidays, social interaction). People with COPD often experience physical restrictions, which can lead to reduced community mobility and social isolation. In this study, despite their physical limitations, these patients had a strong desire to participate and be engaged in various activities. The importance of enabling patients to `participate' rather than just `do' should be considered when planning and delivering patient-centred interventions across the whole spectrum of severity of COPD. Chronic Respiratory Disease 2007; 4: 77—85
Two new intergenerational interventions for Alzheimer's disease patients and families
Authors: Cohen Gene D. 
Published: June 2007

Two new intergenerational interventions for Alzheimer's disease (AD) patients (with moderately severe to severe cognitive impairment) and families are being evaluated, with work to date described. Both interventions share the common goals of: • Introducing a novel long-term care intervention for Alzheimer patients and their families in order to increase the quality of life for both; • Increasing the incentive of family members, significant others, and volunteers to visit and spend time with AD patients; • Increasing staff knowledge of the patient as person; • Effecting a new intergenerational environment at sites providing care for AD patients; and • Providing a new paradigm for innovative budget neutral programs, requiring no new public monies, building upon and leveraging existing resources to enhance the quality of life of older adults coping with dementing disorders. The first intervention uses video biographies; the second involves the first game specifically designed for AD patients and their families. In pilot studies both interventions have been shown to increase patient engagement during visits approximately three-fold. Family and staff interest in both projects has been high.
Donepezil (Aricept®) treatment of multi infarct dementia: The caregivers and clinical impression
Authors: Shua-Haim J. R. , Shua-Haim Vered , Comsti Eric , Ross J. S. 
Published: June 2007

The purpose of this study was to investigate the clinical and caregivers impression of Aricept ® treatment in patients suffering from Multi-Infarct Dementia (MID). In a prospective study 73 MID patients1 were treated with Donepezil (Aricept®) for 16-to 20-weeks. Donepezil was administered as a 5mg tablet once daily at bedtime. After four weeks, patients tolerant of the 5-mg dose were increased to 10 mg daily. All patients satisfied the DSM-III-R criteria for Multi-Infarct Dementia. 2 After 16-to 20-weeks of treatment, the patient's caregiver completed a questionnaire concerning the effectiveness of the drug. Subjective cognitive improvement, MMSE, 3 ADL4 and IADL5 outcomes were all assessed before and after treatment (referred to as Clinical Impression). Behavioral outcomes evaluated included depression, agitation, violence, anxiety, and paranoid thoughts. Functional and overall family satisfaction were also evaluated. Side effects as well as reasons for discontinuation from the study were also reported. Seventy-three patients participated in the study. Twelve patients (16 percent) terminated participation due to side effects. Total adverse events were reported in 34 (46.5 percent) of patients. Cognitive improvement was reported in 31 (42.4 percent) patients. Verbal skills and attention were the most commonly reported cognitive improvement. Average MMSE declined by 2.6 points after 16-weeks of treatment. No behavioral improvement was reported. Behavioral deterioration was reported in 16 (21.9 percent) of patients. Functional improvement was reported in 32 (42.8 percent) patients. Overall positive family satisfaction was reported in 54 (73.9 percent) patients. Although Donepezil treatment was approved by the FDA for the treatment of Alzheimer's Disease (AD), such treatment for MID patients appears to be a reasonably safe and effective treatment from the caregiver and family's point of view.
Inherited Alzheimer's disease PS-1 olfactory function: A 10-year follow-up study
Authors: Nee Linda E. , Lippa Carol F. 
Published: June 2007

This study was undertaken to evaluate smell tests as a clinical marker for identifying mutation carrier status and determining the clinical diagnosis of presenilin-1 Alzheimer's disease (AD) in family members of those afflicted with the disease. Ten years ago, we gave the self-administered, 40-question scratch and sniff University of Pennsylvania Smell Identification Test to 18 atrisk family members, individuals with dominantlyinherited Alzheimer's disease. Testing results were normal 10 years ago except in the case of one individual who had smoked three packs of cigarettes a day for more than 23 years. Four subjects tested in 1990 are now afflicted with Alzheimer's disease, including the smoker. The smell test in 1990 did not demonstrate predictive capabilities before clinical conversion to dementia. At follow-up, two subjects were too impaired to take the test. Two “converted” from normal smell function toabnormal function with a wide range in score. Study findings indicate that the smell test is too variable a measure to be used as a reliable test for predicting or verifying a diagnosis of presenilin-1 Alzheimer's disease.
Apolipoprotein epsilon-4 allele and the two-year progression of cognitive function in Chinese subjects with late-onset Alzheimer's disease
Authors: Lam Linda CW , Tang Nelson LS , Ma Sl , Lui Victor WC , Chan Agnes SY , Leung P Y , Chiu Helen FK 
Published: June 2007

Background: Although the significance of apolipoprotein E4 (Apo E4) in Alzheimer's disease (AD) has been well established in Caucasian populations, its role in determining the rate of cognitive decline in other ethnic groups has yet to be determined This study examined the two-year progression of cognitive decline and its association with Apo E4 allelic status in a group of Chinese elderly subjects with AD. Method: One hundred andfour Chinese subjects with mild and moderate AD as assessed by the Clinical Dementia Rating (CDR 1 and 2) were followed up at a mean (SD) duration of 22.53 (5.21) months. The rate of cognitive decline and its association with Apo E4 allelic status was evaluated. Results: At follow-up, 74 (73 percent) subjects were reassessed. Forty-nine remained stable at the same CDR and 25 had deteriorated The mean (SD) deterioration in the Mini-Mental State Examination (MMSE) was 2.52 (4.38) and in the Mattis Dementia Rating Scale (DRS) was 9.03 (14.98) (paired t-test, p < 0. 001). There was no significant difference in the baseline MMSE and DRS scores between the “stable,” “deteriorated,” or “deceased” groups. Mildly demented subjects with the Apo E4 allele were more likely to have deteriorated to a more severe CDR than subjects without the Apo E4 allele (Pearson χ2 = 5.72, df 1, p = 0.017, Odds ratio = 6.3, CI 1.3 to 30.53). Conclusion: The presence of the Apo E4 allele may influence the rate ofcognitive deterioration, particularly in subjects with mildAD.
Nursing Home Management of Alzheimer's Disease
Authors: Koff Theodore H. 
Published: June 2007

Between now and the year 2050 the number of people with Alzheimer's disease (AD) and related disorders will increase from 2 million to 8.5 million. Conservative estimates project that during this same period, nursing-home residencies of people age 65 and older will rise from 1.1 million to 5.4 million.1 Since people afflicted with Alzheimer's disease frequently require institutionalization, and since it is likely that nursing homes will continue to be an important part of the caring spectrum, how will these facilities deal with large numbers of people with dementia? Currently, there is an absence of industrywide standards defining Alzheimer's care. Nursing homes may identify “specialty care units” even when no special competence exists. To assure AD patients and their families that services consistent with their expectations for Alzheimer's care will be provided, industrywide standards must be established. This paper, presented in May to the American College of Health Care Administrators in San Diego, outlines guidelines for the formulation and eventual adoption of standards of care for Alzheimer's patients.
Alzheimer's Care
Authors: Woerner Louise , Casper Karen 
Published: June 2007

The characteristics of Alzheimer's disease (AD) create specialized problems of care for the Alzheimer's patient. Treatment for AD victims does not only involve medical procedures; rather, Alzheimer's disease is what Kahn termed a bio-psycho-social phenomenon. 1 Since the epidemiology of the disease is not treatable as such, the emphasis of Alzheimer's care is on management of its physical, social, and psychological manifestations. Therefore, nursing home care and home health care are not sufficient for AD victims. Alzheimer's patients need the specialized care we've called Alzheimer's care, which is directed toward meeting the specific needs of AD victims and their families. It is generally agreed that both in stitutional and home settings are appropriate for treating certain characteristics of Alzheimer's disease, depending on the degree to which the disease has progressed, financial circumstances, and the family's ability and willingness to keep the patient at home. The choice between nursing home placement and home care is, of course, ultimately the decision of the primary caregiver or family. If caregivers are unable or unwilling to serve as the primary support for a victim-because of their financial considerations, their own infirmities, or because the responsibility for care becomes overwhelming-a family may feel that the decision to place the patient in a nursing home is the only alternative. In our experience, we have found that specialized Alzheimer's care, delivered in a home setting, can place the responsibility for primary care with home care professionals. The environment or treatment setting is highly significant in the management of Alzheimer's disease. We have found that of the two major settings for treatment ofAD patients-the institution and the home-the home is significantly more adaptable to Alzheimer's care. The home environment is familiar and can, with planning and training, be very helpful in the care plan. Home health personnel assigned to such cases can be specifically selected, trained, and supervised to maximize their effectiveness in providing the highest quality of Alzheimer's care. Under the assumption that many families do have a choice in treatment settings for an AD victim and that the home may be the more effective treatment setting, this article will seek to explain the adaptability of the home health option for Alzheimer's care.
The New York State Department of Health's Alzheimer's disease and other dementias registry first year experience
Authors: Henry Mary Ellen , Gerber Todd M. , Bunn Geraldine , Stacy Andrew , Tsan Linda 
Published: June 2007

The New York State Departm ent of Health established the Alzheimer's Disease and Other Dementias Registry in August 1986. A legal requirement was enacted through Public Health Law that stipulated physicians and facilities must begin reporting the diagnosis or confirmation of Alzheimerls disease beginning January 1, 1987. By September 1987, over4, 000 reports had been submitted to the registry. Analysis of the reporting experience up to September 1987 provided the basis for a revision of the case report form and procedures for reporting, that are intended to improve the validity of the data. The process of revising the confidential case report form involved both consideration of methodologic issues and reporter concerns.
Measuring cognitive and behavior changes in community dwelling Alzheimer's disease patients
Authors: Kumar Vinod , Peterson Kathleen , Kumar Nita , Fulk Linda 
Published: June 2007

Dementia of the Alzheimer's type (DAT) is a disorder that is becoming more common as the population's life expectancy increases. It is essential for health care providers to monitor and help caregivers manage possible stressful symptoms associated with the progression of DAT. We evaluated 38 community dwelling DAT patients with a test battery comprised of several commonly used neuropsychological instruments to see if they could: • detect treatable psychiatric symptoms • predict the course of illness and • predict the likelihood of long term institutionalization in DAT patients Our results showed that the interviewer administered instruments were useful tools for detecting patient deficits and developing treatment strategies. However, we found the self-rating scales to be inappropriate for use with this population.
Variables influencing burden in spousal and adult child primary caregivers of persons with Alzheimer's disease in the home setting
Authors: Price Holly Jane , Levy Kathy Ann 
Published: June 2007

The purpose of this study was twofold: to compare caregiver burden perceived by spouses and adult children providing care to a family member with Alzheimer's disease in the home, and to determine if functional ability of the Alzheimer's victim affects burden experienced by the caregiver. Fifty-five primary caregivers providing care at home for a family member with Alzheimer's disease were invited to participate in this study and asked to complete the Caregiver Data Sheet, Burden Interview, Physical Self-Maintenance Scale (PSMS), and the Instrumental Activities of Daily Living Scale (IADL). Thirty caregivers (55 percent) responded. The mean burden score for all participants was 67 (SD = 15), indicative of severe burden. A t-test performed to compare burden scores of spouse and adult child caregivers showed no significant difference between the two groups (t-value = 1.93, p> .05). The mean scores for the PSMS (1.4; SD = 1.86) and IADL (1.4; SD = 1.59) indicated that the Alzheimer's victims were very dependent. This functional deficit, however, did not correlate significantly with caregiver burden. The Pearson Product Moment Correlation Coefficient (Pearson r) was -.339 for the PSMS and Burden Interview and -.203 for the IADL and Burden Interview. Neither were found significant at the .05 level of significance. This study contributed to nursing knowledge by describing burden experienced by a specific population of primary caregivers; those spouses and adult children providing care for a family member with Alzheimer's disease in the home. A lack of a significant correlation between functional impairment of the Alzheimer's victim and caregiver burden was found. The researcher suggested that perhaps other factors, such as family and community support, had more of an impact on caregiver burden. Future nursing research to further delineate such factors would contribute to the understanding of caregiver burden.
The South Carolina Alzheimer's disease patient registry: A progress report
Authors: Macera Caroline A. , Still Charles N. , Brandes Debra A. , Abramson Ruth K. , Davis Dorothy R. 
Published: June 2007

In April1988, the American Health Assistance Foundation in Rockville, Maryland, provided major funding to establish a registry of persons in South Carolina who have been diagnosed with dementia, particularly Alzheimer's disease (AD). This funding was matched by the state Health and Human Services Finance Commission, and with supplemental funding from the Association of Schools of Public Health, and the Centers for Disease Control. The goals of the registry are as follows: * To collect and report annual prevalence and incidence data; * To assess and to project required health and human services resources; * To study genetic transmission patterns; * To provide a sampling frame for etiologic studies. The first year experience of this project is described, with recommendations for future development.
Criteria for recommending options for the elderly cognitively impaired
Authors: Morrill Elizabeth G. 
Published: June 2007

The plight of the cognitively impaired elderly in the United States deserves great attention as there are glaring deficits in the areas of care and treatment of dementia. This author would like to convey a set of ideas to give the healthcare professional some clear direction on: • What needs to be considered in evaluating the deficits and needs of the demented elderly person and family. • How can we best go about the process of making the determination about what is needed.? • What are the characteristics of the patient that serve as predictors for assignment to services- and what are the characteristics of the caregivers that serve as predictors for services?
Effects of a 'quiet week' intervention on behavior in an Alzheimer boarding home
Authors: Meyer Daniel L. , Dorbacker Beatrice , O'Rourke Jane , Dowling Jim , Jacques Jessie , Nicholas Mary 
Published: June 2007

The objective of this study was to test whether an intervention to reduce noise in an Alzheimer boarding home lowers patient levels of agitation. Hourly behaviors were observed and recorded by nursing staff one week prior to and one week during institution of a 'quiet week' protocol. The changes included lowering voices and reducing fast movements by staff, relocating the entrance out of residents' view, and not using television or playing piano. A sample of 11 of 28 residents of the home was selected to represent three general levels of overall agitation. The number of frantic/violent' behavior observations declined from 38 to 19; overall, there was an average reduction in 'non-calm' sampled observations of 0.441 per day per resident (paired t-test, t = 2.318, 10 df p < .043). Interviews with staff indicated that stafffelt some of the 28 residents definitely benefittedfrom the reduced noise levels while theyfelt others appeared to miss the activity and noise. Results suggest that alterations in staff behavior and facility design can influence agitation levels of Alzheimer patients, but effects are not uniform across patients. Continued research is needed to help identify effective activities and care strategies as well as the most appropriate staffing levels and optimal design features of special care units.
Communication between formal caregivers and individuals with Alzheimer's disease
Authors: Richter Judith M. , Bottenberg Donna , Roberto Karen A. 
Published: June 2007

Dysfunctional communication, behaviorproblems, and the lack of meaningful exchanges make it difficult for the nursing assistant (NA) to establish a relationship with the nursing home resident who has Alzheimer's disease (AD). As a result, the NA may avoid communication. Long term care is inevitable for many persons with AD. Therefore, it is important to understand the impact of verbal and nonverbal communication on the caregiving relationship between the formal caregiver in the nursing home and the person with AD. The purpose of the study was to describe communication barriers and successes identified by NAs. NAs did not understand resident behaviors such as fearfulness, agitation and wandering. They were also frustrated with the demands of family members. Results indicated that NAs did not have the necessary education orsupportto communicate effectively with the individual with AD and the family, and that training NAs to work more effectively should be a priority for nursing homes.
Trigger events that indicate the need for proxy decision-making in cognitively impaired older persons
Authors: Kjervik Diane K. , Weisensee Mary G. , Anderson Joanne B. 
Published: June 2007

The purpose of this exploratory study was to ascertain the primary event or “trigger” that prompted caregivers to initiate planning for a change in monitoring or substitute decision-making needed for the older person receiving their care. Understanding the impetus to make this decision can help caregivers to anticipate needs and plan accordingly. Caregivers from the community who did not choose guardianship (N=39) and caregivers who were court-appointed guardians or conservators (N=22) were compared for their views about the trigger events, the views of their own health, number of hours in caregiving and the circumstances surrounding the decision-making experience. Three categories of trigger events were identified: • Physical; • Emotional/cognitive; and • Situational events with the vast majority of triggers falling into the first two categories. Guardians as a group were younger, provided fewer hours of caregiving and rated themselves healthier than the other caregivers. A variety of situational stressors were identified by respondents with time and financial concerns the primary concerns. Further research with a wider variety of caregiving dyads is recommended to examine the decision-making process involved and to further validate the categorization of trigger events.