bluuebunny/crossref_metadata_2025_split huggingface dataset:
Position statement on the role of health care assistants who are involved in direct patient care activities within critical care areas
Authors:   The British Association of Critical Care Nurses
Published: December 2004

Summary

Intensive care has developed as a speciality since the 1950s, and during this time, there have been major technological advances in health care provision, leading to a rapid expansion of all areas of critical care
The ongoing problem in recruiting qualified nurses in general has affected, and continues to be a problem for, all aspects of critical care areas
During the past decade, nursing practice has evolved, as qualified nurses have expanded their own scope of practice to develop a more responsive approach to the complex care needs of the critically ill patient
The aim of this paper is to present the British Association of Critical Care Nurses (BACCN) position statement on the role of health care assistants involved in direct patient care activities, and to address some of the key work used to inform the development of the position statement
Immediate follow‐up after ICU discharge: establishment of a service and initial experiences
Authors: Strahan Eunice , McCormick Joanna , Uprichard Edith , Nixon Sandra , Lavery Gavin 
Published: December 2004

Summary

Follow‐up of patients discharged from the intensive care unit (ICU) is recommended as a means of service evaluation (Department of Health (2000). Comprehensive Critical Care: a Review of Adult Critical Care Services), in order to monitor the quality of the services provided
Without patient follow‐up, ICU staff have only ‘death’ or ‘discharge alive from hospital’ as clinical outcomes from which to judge practice performance, and limited evidence exists on which to base decisions about improvements to critical care practice (Audit Commission (1999). Critical to Success – the Place of Efficient and Effective Critical Care Services Within the Acute Hospital  )
To address these issues the Regional Intensive Care Unit (RICU) obtained information from patient assessment/interview on problems experienced by patients within 8–9 days (mean), following discharge from RICU
A nurse‐administered questionnaire was used to identify functional outcomes, nutrition and psychological issues such as anxiety and sleep disturbances
Benefits of patient follow‐up introduced and planned include:

patient diaries for long‐term patients
input from clinical psychologist
review of sedation used in RICU
Change in Muscle Strength Explains Accelerated Decline of Physical Function in Older Women With High Interleukin‐6 Serum Levels
Authors: Ferrucci Luigi , Penninx Brenda W. J. H. , Volpato Stefano , Harris Tamara B. , Bandeen‐Roche Karen , Balfour Jennifer , Leveille Suzanne G. , Fried Linda P. , Md Jack M. Guralnik 
Published: December 2004

OBJECTIVES:To test whether accelerated sarcopenia in older persons with high interleukin (IL)‐6 serum levels plays a role in the prospective association between inflammation and disability found in many studies.DESIGN:Cohort study of older women with moderate to severe disability.PARTICIPANTS:Six hundred twenty older women from the Women's Health and Aging Study in whom information on baseline IL‐6 serum level was available.MEASUREMENTS:Self‐report of functional status, objective measures of walking performance, and knee extensor strength were assessed at baseline and over six semiannual follow‐up visits. Potential confounders were baseline age, race, body mass index, smoking, depression, and medical conditions.RESULTS:At baseline, women with high IL‐6 were more often disabled and had lower walking speed. After adjusting for confounders, women in the highest IL‐6 tertile (IL‐6>3.10 pg/mL) were at higher risk of developing incident mobility disability (risk ratio (RR) = 1.50, 95% confidence interval (CI) = 1.01–2.27), disability in activities of daily living (RR = 1.41, 95% CI = 1.01–1.98), and severe limitation in walking (RR = 1.61, 95% CI = 1.09–2.38) and experienced steeper declines in walking speed (P< .001) than women in the lowest IL‐6 tertile (IL‐6 ≤1.78 pg/mL). Decline in knee extensor strength was also steeper, but differences across IL‐6 tertiles were not significant. After adjusting for change over time in knee extensor strength, the association between high IL‐6 and accelerated decline of physical function was no longer statistically significant.CONCLUSIONS:Older women with high IL‐6 serum levels have a higher risk of developing physical disability and experience a steeper decline in walking ability than those with lower levels, which are partially explained by a parallel decline in muscle strength.
Subcortical Vascular Disease and Functional Decline: A 6‐Year Predictor Study
Authors: Bennett Hayley P. , Corbett Alastair J. , Gaden Susan , Grayson David A. , Kril Jillian J. , Broe G. Anthony 
Published: December 2004

OBJECTIVES: To identify predictors of activity of daily living (ADL) and instrumental activity of daily living (IADL) decline in a population with subcortical vascular dementia (SVD) and to evaluate potential mechanism of decline.DESIGN: Longitudinal.SETTING: Hospital‐based.PARTICIPANTS: Computed tomographic (CT) scanning identified 77 participants as having subcortical infarction.MEASUREMENTS: Participants were neurologically, neuropsychologically, behaviorally, and functionally assessed four times over 5.82 years. Baseline data were grouped into four modules: basic demographic and risk factor, CT scan, neurological and other clinical, and neuropsychological and behavioral. Multivariate analysis determined predictors of decline in ADLs and IADLs.RESULTS: Predictors of ADL decline were age, alcohol consumption, coordination, snout reflex, and performance on a neuropsychological test (Block Design). Predictors of IADL decline were predominantly cognitive and included the presence of paratonia and performance on the two neuropsychological tests (attention and memory tasks).CONCLUSION: These findings suggest that cognitive impairments are most likely to have an effect on IADL function, because the skills involved are complex and involve integrative activity, whereas physical and cognitive impairments combined are likely to compromise ADL function, given the more basic and physical nature of the functions involved. These findings indicate that in people with SVD, both ADL and IADL status should be monitored, because, for many, decline in function over time is likely, and thus the provision of appropriate support required.
Attitudinal Barriers to Effective Treatment of Persistent Pain in Nursing Home Residents
Authors: Weiner Debra K. , Rudy Thomas E. 
Published: December 2004

OBJECTIVES: To systematically explore nursing home (NH) resident and staff attitudes that serve as barriers to detection and management of persistent pain.DESIGN: Survey.SETTING: Six community‐based and one Veterans Affairs long‐term care facilityPARTICIPANTS: Seventy‐five NH nurses, 75 certified nursing assistants (CNAs), and 75 communicative NH residents who reported some pain or discomfort “every day or almost every day.”MEASUREMENTS: Three structured pain attitudes questionnaires (one each for NH residents, CNAs, and nurses) that incorporated constructs gleaned from a comprehensive literature review were designed. One‐week test‐retest reliability was calculated on a subsample of 25 residents, 19 CNAs, and 26 nurses. Attitudinal differences between the three groups were evaluated using multivariate analysis of variance (MANOVA).RESULTS: Of 12 constructs evaluated, 10 had fair to excellent reliability indices (residents 0.46–0.80; CNAs 0.57–0.76; nurses 0.62–0.94). Of these 10 reliable constructs, MANOVA indicated significant overall attitude differences between the three groups. Follow‐up analyses indicated that attitudes endorsed most strongly by residents were that chronic pain does not change, belief in external pathology over pain reports, fear of addiction, and fear of dependence. CNAs attitudes endorsed most strongly were lack of time and complaints unheard. The nurse attitude endorsed most strongly was complaints unheard.CONCLUSIONS: These findings suggest that, if residents' fears regarding addiction, worsening dependence, and the immutable nature of persistent pain were quelled, and if CNAs could feel that adequate time is available for pain assessment, perhaps improved pain management in the NH would result.
The Effect of Do‐Not‐Resuscitate Orders on Physician Decision‐Making
Authors: Beach Mary Catherine , Morrison R. Sean 
Published: December 2004

The effect of do‐not‐resuscitate (DNR) orders on physicians' decisions to provide life‐prolonging treatments other than cardiopulmonary resuscitation (CPR) for patients near the end of life was explored using a cross‐sectional mailed survey. Each survey presented three patient scenarios followed by 10 treatment decisions. Participants were residents and attending physicians who were randomly assigned surveys in which all patient scenarios included or did not include a DNR order.Response to three case scenarios when a DNR order was present or absent were measured. Response from 241 of 463 physicians (52%) was received. Physicians agreed or strongly agreed to initiate fewer interventions when a DNR order was present versus absent (4.2 vs 5.0 (P = .008) in the first scenario; 6.5 vs 7.1 (P = .004) in the second scenario; and 5.7 vs 6.2 (P = .037) in the third scenario). In all three scenarios, patients with DNR orders were significantly less likely to be transferred to an intensive care unit, to be intubated, or to receive CPR. In some scenarios, the presence of a DNR order was associated with a decreased willingness to draw blood cultures (91% vs 98%, P = .038), central line placement (68% vs 80%, P = .030), or blood transfusion (75% vs 87%, P = .015). The presence of a DNR order may affect physicians' willingness to order a variety of treatments not related to CPR. Patients with DNR orders may choose to forgo other life‐prolonging treatments, but physicians should elicit additional information about patients' treatment goals to inform these decisions.
A Randomized, Controlled Trial of Quadriceps Resistance Exercise and Vitamin D in Frail Older People: The Frailty Interventions Trial in Elderly Subjects (FITNESS)
Authors: Latham Nancy K. , Anderson Craig S. , Lee Arier , Bennett Derrick A. , Moseley Anne , Cameron Ian D. , For The Fitness Collaborative Group  
Published: December 2004

OBJECTIVES:  To determine the effectiveness of vitamin D and home‐based quadriceps resistance exercise on reducing falls and improving the physical health of frail older people after hospital discharge.DESIGN:   Multicenter, randomized, controlled trial with a factorial design.SETTING:   Five hospitals in Auckland, New Zealand, and Sydney, Australia.PARTICIPANTS:   Two hundred forty‐three frail older people.INTERVENTIONS:   Patients were randomized to receive a single dose of vitamin D (calciferol, 300,000 IU) or placebo tablets and 10 weeks of high‐intensity home‐based quadriceps resistance exercise or frequency‐matched visits.MEASUREMENTS:   The primary endpoints were physical health according to the short‐form health survey at 3 months and falls over 6 months. Physical performance and self‐rated function were secondary endpoints. Assessments took place in the participants' homes at 3 and 6 months after randomization and were performed by blinded assessors.RESULTS:   There was no effect of either intervention on physical health or falls, but patients in the exercise group were at increased risk of musculoskeletal injury (risk ratio = 3.6, 95% confidence interval = 1.5–8.0). Vitamin D supplementation did not improve physical performance, even in those who were vitamin D deficient (<12 ng/mL) at baseline.CONCLUSION:   Neither vitamin D supplementation nor a home‐based program of high‐intensity quadriceps resistance exercise improved rehabilitation outcomes in frail older people after hospitalization. There was no effect of vitamin D on physical performance, and the exercises increased the risk of musculoskeletal injury. These findings do not support the routine use of these interventions at these dosages in the rehabilitation of frail older people. J Am Geriatr Soc 51:291–299, 2003.
Preventing Falls in Community‐Dwelling Frail Older People Using a Home Intervention Team (HIT): Results From the Randomized Falls‐HIT Trial
Authors: Nikolaus Thorsten , Bach Matthias 
Published: December 2004

OBJECTIVES:  To evaluate the effect of an intervention by a multidisciplinary team to reduce falls in older people's homes.DESIGN:   Randomized, controlled trial with follow‐up of subjects for 1 year.SETTING:   University‐affiliated geriatric hospital and older patients' homes.PARTICIPANTS:   Three hundred sixty subjects (mean age ± standard deviation = 81.5 ± 6.4) admitted from home to a geriatric hospital and showing functional decline, especially in mobility.INTERVENTION:   The participants were randomly assigned to receive a comprehensive geriatric assessment followed by a diagnostic home visit and home intervention or a comprehensive geriatric assessment with recommendations and usual care at home. The home intervention included a diagnostic home visit, assessing the home for environmental hazards, advice about possible changes, offer of facilities for any necessary home modifications, and training in the use of technical and mobility aids. An additional home visit was made after 3 months to reinforce the recommendations. After 12 months of follow‐up, a home visit was made to all study participants.MEASUREMENTS:   Number of falls, type of recommended home modifications, and compliance with recommendations.RESULTS:   After 1 year, there were 163 falls in the intervention group and 204 falls in the control group. The intervention group had 31% fewer falls than the control group (incidence rate ratio (IRR) = 0.69, 95% confidence interval (CI) = 0.51–0.97). The intervention was most effective in a subgroup of participants who reported having had two or more falls during the year before recruitment into the study. In this subgroup, the proportion of frequent fallers and the rate of falls was significantly reduced for the intervention group compared with the control group (21 vs 36 subjects with recurrent falls, P = .009; IRR = 0.63, 95% CI = 0.43–0.94). The compliance rate varied with the type of change recommended from 83% to 33% after 12 months of follow‐up.CONCLUSION:   Home intervention based on home visits to assess the home for environmental hazards, providing information about possible changes, facilitating any necessary modifications, and training in the use of technical and mobility aids was effective in a selected group of frail older subjects with a history of recurrent falling.
Predictors of Health Resource Use by Disabled Older Female Medicare Beneficiaries Living in the Community
Authors: Weiner Michael , Fan Ming‐Yu , Johnson Brent A. , Kasper Judith D. , Anderson Gerard F. , Fried Linda P. 
Published: December 2004

OBJECTIVES: To identify specific clinical factors that could best predict resource use by disabled older women.DESIGN:  Cross‐sectional.SETTING:  Urban community in Baltimore, Maryland.PARTICIPANTS:  One thousand two community‐dwelling, moderately to severely disabled, female Medicare beneficiaries aged 65 and older, from the Women's Health and Aging Study I (WHAS).MEASUREMENTS:  WHAS data were merged with participants' 1992–1994 Medicare claims data for the year after baseline evaluation, reflecting inpatient, outpatient, home‐based, and skilled‐nursing services. The independent contributions of factors hypothesized to predict health expenditures were assessed, using chi‐square and regression analyses, with the logarithm of Medicare expenditures as the primary outcome.RESULTS:  Demographic factors were not associated with Medicare expenditures. Factors associated with expenditures in bivariate analyses included heart disease (1.4x), chronic obstructive pulmonary disease (1.3x), diabetes mellitus (1.1x), smoking, comorbidity, and severity of disability, as well as low creatinine clearance, serum albumin, caloric expenditure, or skinfold thickness. Heart disease, diabetes mellitus, and low skinfold thickness remained significant after adjustment for other factors.CONCLUSION:  Heart disease, diabetes mellitus, and low skinfold thickness are important independent predictors of 1‐year Medicare expenditures by disabled older women. Many other variables that reflect disease, disability, nutrition, or personal habits have less predictive ability. Most demographic factors are not predictors of expenditures in this population. Focusing on the best predictors may facilitate more‐effective risk adjustment and creation of related health policies.
Predictors of Alcohol‐Treatment Seeking in a Sample of Older Veterans in the GET SMART Program
Authors: Satre Derek D. , Knight Bob G. , Dickson‐Fuhrmann Elizabeth , Jarvik Lissy F. 
Published: December 2004

OBJECTIVES:  To examine the predictive value of demographic characteristics and substance abuse indicators to explain treatment seeking for substance abuse problems by older male medical patients.DESIGN:   Longitudinal analysis of screening data and treatment‐seeking behavior.SETTING:   Inpatient medical and outpatient substance abuse treatment center.PARTICIPANTS:   Participants in the study were 855 medically ill male veterans aged 55 and older, who were screened for alcohol problems during inpatient medical treatment after clinician referral.MEASUREMENTS:   The CAGE alcohol screen (Cut down on your drinking, Annoyed by criticism of your drinking, Guilty about your drinking, Eye‐opener), drug use, and demographic measures administered at time of screening. Predictors of treatment seeking in the sample were examined using structural equation modeling.RESULTS:   Expressed interest in treatment and later attendance at a pretreatment evaluation were associated with younger age and a higher CAGE alcohol screening score. Being unmarried and using drugs in addition to alcohol were associated with treatment interest but not with evaluation attendance. In the path model tested, the effect of higher CAGE score partially explained the effect of younger age on treatment seeking.CONCLUSION:   The model examined shows utility in predicting alcohol‐treatment seeking in this sample. Age‐related factors may deter treatment seeking by older male medical inpatients.
Cognitive Screening Using a Tape Recorder: A Pilot Study
Authors: Schofield Peter W. , Lee Stephen J. , Davies Graeme C. 
Published: December 2004

OBJECTIVES:  To determine whether a tape recorder can be used to administer cognitive tests efficiently and yield valid results.DESIGN:   Convenience sample. Administration of cognitive test materials by tape recorder and conventional technique.SETTING:   Outpatient clinic.PARTICIPANTS:   Subjects from memory disorder clinic, hostel accommodation, and community.MEASUREMENTS:   Responses to Hopkins Verbal Learning Test–revised, verbal fluency items from the controlled oral word association test, 10‐item naming task, a construction task, and speed writing task.RESULTS:   Performances on the tape‐ and clinician‐administered battery of tests were highly correlated. Memory impairment was accurately detected using the tape battery. Data from 30 minutes of testing via tape were obtained at the cost to the clinician of 2 to 3 minutes of scoring time.CONCLUSION:   Tape‐administration of cognitive test material warrants further study as an efficient means of cognitive screening.
Depression Treatment in a Sample of 1,801 Depressed Older Adults in Primary Care
Authors: Unützer Jürgen , Katon Wayne , Callahan Christopher M. , Williams John W. , Hunkeler Enid , Harpole Linda , Hoffing Marc , Della Penna Richard D. , Noel Polly Hitchcock , Lin Elizabeth H. B. , Tang Lingqi , Oishi Sabine 
Published: December 2004

OBJECTIVES: To examine rates and predictors of lifetime and recent depression treatment in a sample of 1,801 depressed older primary care patientsDESIGN: Cross sectional survey data collected from 1999 to 2001 as part of a treatment effectiveness trial.SETTING: Eighteen primary care clinics belonging to eight organizations in five states.PARTICIPANTS: One thousand eight hundred one clinic users aged 60 and older who met diagnostic criteria for major depression or dysthymia.MEASUREMENTS: Lifetime depression treatment was defined as ever having received a prescription medication, counseling, or psychotherapy for depression. Potentially effective recent depression treatment was defined as 2 or more months of antidepressant medications or four or more sessions of counseling or psychotherapy for depression in the past 3 months.RESULTS: The mean age ± standard deviation was 71.2 ± 7.5; 65% of subjects were women. Twenty‐three percent of the sample came from ethnic minority groups (12% were African American, 8% were Latino, and 3% belonged to other ethnic minorities). The median household income was $23,000. Most study participants (83%) reported depressive symptoms for 2 or more years, and most (71%) reported two or more prior depressive episodes. About 65% reported any lifetime depression treatment, and 46% reported some depression treatment in the past 3 months, although only 29% reported potentially effective recent depression treatment. Most of the treatment provided consisted of antidepressant medications, with newer antidepressants such as selective serotonin reuptake inhibitors constituting the majority (78%) of antidepressants used. Most participants indicated a preference for counseling or psychotherapy over antidepressant medications, but only 8% had received such treatment in the past 3 months, and only 1% reported four or more sessions of counseling. Men, African Americans, Latinos, those without two or more prior episodes of depression, and those who preferred counseling to antidepressant medications reported significantly lower rates of depression care.CONCLUSION: The findings suggest that there is considerable opportunity to improve care for older adults with depression. Particular efforts should be focused on improving access to depression care for older men, African Americans, Latinos, and patients who prefer treatments other than antidepressants.