bluuebunny/crossref_metadata_2025_split huggingface dataset:
Health care assistants’ role, function and development: results of a national survey
Authors:   The British Association of Critical Care Nurses
Published: December 2004

Summary

Intensive care has developed as a speciality since the 1950s; 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 of recruiting appropriately qualified nurses has affected staffing levels in many units and continues to be a national problem. For many, the answer lies in employing health care assistants to support the work of registered nurses
A key aim of the British Association of Critical Care Nurses is to promote the art and science of critical care nursing by providing representation for its members, by responding to political and professional change and by producing and publishing position statements
A primary component of the work surrounding the development of this second position statement was the gathering of contemporary information in relation to the role of health care assistants within critical care units throughout the UK, through a survey of 645 critical care units within the UK
At present the impact upon the role of the critical care nurse is not fully understood, with research in this area suggesting that although there is a role for the health care assistant in the critical care environment, this should only be undertaken with a full analysis of this impact upon the work of the registered nurse
Effects of Exercise Training on Frailty in Community‐Dwelling Older Adults: Results of a Randomized, Controlled Trial
Authors: Binder Ellen F. , Schechtman Kenneth B. , Ehsani Ali A. , Steger‐May Karen , Brown Marybeth , Sinacore David R. , Yarasheski Kevin E. , Holloszy John O. 
Published: December 2004

OBJECTIVES: Although deficits in skeletal muscle strength, gait, balance, and oxygen uptake are potentially reversible causes of frailty, the efficacy of exercise in reversing frailty in community‐dwelling older adults has not been proven. The aim of this study was to determine the effects of intensive exercise training (ET) on measures of physical frailty in older community‐dwelling men and women.DESIGN: Randomized controlled trial.SETTING: Medical school research center.PARTICIPANTS: One hundred fifteen sedentary men and women (mean age ± standard deviation = 83 ± 4) with mild to moderate physical frailty, as defined by two of the following three criteria: Modified Physical Performance Test (modified PPT) score between 18 and 32, peak oxygen uptake (.VO2 peak) between 10 and 18 mL/kg/min, and self‐report of difficulty or assistance with one basic activity of daily living (ADL), or two instrumental ADLs.INTERVENTION: Participants were randomly assigned to a control group that performed a 9‐month low‐intensity home exercise program (control) or an exercise‐training program (ET). The control intervention primarily consisted of flexibility exercises. ET began with 3 months of flexibility, light‐resistance, and balance training. During the next 3 months, resistance training was added, and, during the next 3 months, endurance training was added.MEASUREMENTS: Modified PPT score, .VO2 peak, performance of ADLs as measured by the Older Americans Resources and Services instrument, and the Functional Status Questionnaire (FSQ).RESULTS: ET resulted in significantly greater improvements than home exercise in three of the four primary outcome measures. Adjusted 95% confidence bounds on the magnitude of improvement in the ET group compared with the control group were 1.0 to 5.2 points for the modified PPT score, 0.9 to 3.6 mL/kg/min for .VO2 peak, and 1.6 to 4.9 points for the FSQ score.CONCLUSIONS: Our results show that intensive ET can improve measures of physical function and preclinical disability in older adults who have impairments in physical performance and oxygen uptake and are not taking hormone replacement therapy better than a low‐intensity home exercise program.
Heterogeneity in Older People: Examining Physiologic Failure, Age, and Comorbidity
Authors: Gray Lawrence K. , Smyth Kathleen A. , Palmer Robert M. , Zhu Xiaofeng , Callahan Joyce M. 
Published: December 2004

OBJECTIVES: To derive a clinically relevant age‐independent physiologic failure scoring system and to use this system to examine aspects of the association of physiologic failure, age, and comorbidity with inpatient mortality.DESIGN: Retrospective, secondary analysis of a derivation and validation cohort selected from the Cleveland Health Quality Choice Coalition data set.SETTING: Thirty hospitals in greater Cleveland.PARTICIPANTS: Thirty‐one thousand nine hundred seventy‐six inpatients aged 50 and older discharged in 1993 with a diagnosis of congestive heart failure, pneumonia, or stroke.MEASUREMENTS: The Inpatient Physiologic Failure Score (IPFS) was developed and used to calculate physiologic failure. Forty‐four candidate variables were examined for their association with inpatient mortality, and 12 were selected. A point value (2, 3, 4, or 6) based on adjusted odds ratio was assigned for an abnormal result for each of the 12 common physiologic variables. Each patient's abnormal physiology points were summed to produce a physiologic failure score (range 0–39). Comorbidity was quantified using the Patient Management Category Severity Scale. The association between mortality and increasing physiologic failure, increasing age and comorbidity, and distribution of physiologic failure with increasing age and comorbidity were examined. A threshold age was sought. Models for predicting inpatient mortality were developed.RESULTS: Twelve physiologic variables constitute the IPFS. Increasing physiologic failure, age, and comorbidity were associated with increasing mortality. Increasing physiologic failure was not associated with increasing age or comorbidity. We did not find a threshold age. The area under the receiver operating characteristic (ROC) curve for predicting inpatient mortality for IPFS was 0.730, and for comorbidity was 0.741 (not significant). The area under the ROC curve for a mortality prediction model based on age was significantly less (0.603). Accounting for patient age did not significantly improve the predictive ability of the IPFS model (area = 0.752, P < .05). The complete model best predicted mortality (0.829).CONCLUSIONS: The IPFS represents a clinically relevant method for scoring physiologic failure. Physiologic failure, age, and comorbidity are independently and differently associated with inpatient mortality. Physiology fails independent of age and comorbidity.
Cognitive and Functional Decline in Adults Aged 75 and Older
Authors: Black Sandra A. , Rush Ronald D. 
Published: December 2004

OBJECTIVES: To simultaneously examine the influence of functional disability on the development of cognitive impairment and the influence of cognitive status on the development of functional disability over time and compare findings across ethnic groups.DESIGN: A population‐based longitudinal study.SETTING: Galveston County, Texas.PARTICIPANTS: Three hundred sixty‐five community‐dwelling Hispanic Americans, African Americans, and non‐Hispanic whites, aged 75 and older.MEASUREMENTS: Baseline measures included demographics, self‐reported chronic medical conditions, functional disability, and cognitive status. Longitudinal measures included functional decline and cognitive decline.RESULTS: Substantial functional decline was associated with each additional error on the mental status measure; substantial cognitive decline was associated with each additional antecedent disability. These findings were evident across all three ethnic groups, even when taking into account the effects of demographic factors and chronic health conditions, although the specific chronic health conditions that influenced cognitive and functional decline were found to vary across the three ethnic groups.CONCLUSION: Our findings suggest that, rather than simply being correlated markers of increasing frailty, cognitive and functional decline appear to influence the development of one another. Clinicians need to be aware of these associations, which may affect the direction of preventive care and rehabilitation in the oldest old. Appropriate intervention may result in the prevention or delay of functional disability and cognitive decline. Awareness of the specific chronic health conditions that increase the risk for cognitive or functional decline in various ethnic groups, and the effect of comorbid disease, may also help efforts to prevent decline in older adults.
Nursing Home Facility Risk Factors for Infection and Hospitalization: Importance of Registered Nurse Turnover, Administration, and Social Factors
Authors: Zimmerman Sheryl , Gruber‐Baldini Ann L. , Hebel J. Richard , Sloane Philip D. , Magaziner Jay 
Published: December 2004

OBJECTIVES: Determine the relationship between a broad array of structure and process elements of nursing home care and (a) resident infection and (b) hospitalization for infection.DESIGN: Baseline data were collected from September 1992 through March 1995, and residents were followed for 2 years; facility data were collected at the midpoint of follow‐up.SETTING: A stratified random sample of 59 nursing homes across Maryland.PARTICIPANTS: Two thousand fifteen new admissions aged 65 and older.MEASUREMENTS: Facility‐level data were collected from interviews with facility administrators, directors of nursing, and activity directors; record abstraction; and direct observation. Main outcome measures included infection (written diagnosis, a course of antibiotic therapy, or radiographic confirmation of pneumonia) and hospitalization for infection (indicated on medical records).RESULTS: The 2‐year rate of infection was 1.20 episodes per 100 resident days, and the hospitalization rate for infection was 0.17 admissions per 100 resident days. Except for registered nurse (RN) turnover, which related to both infection and hospitalization, different variables related to each outcome. High rates of incident infection were associated with more Medicare recipients, high levels of physical/occupational therapist staffing, high licensed practical nurse staffing, low nurses' aide staffing, high intensity of medical and therapeutic services, dementia training, staff privacy, and low levels of psychotropic medication use. High rates of hospitalization for infection were associated with for‐profit ownership, chain affiliation, poor environmental quality, lack of resident privacy, lack of administrative emphasis on staff satisfaction, and low family/friend visitation rates. Adjustment for resident sex, age, race, education, marital status, number of morbid diagnoses, functional status, and Resource Utilization Group, Version III score did not alter the relationship between the structure and process of care and outcomes.CONCLUSIONS: The association between RN turnover and both outcomes underscores the relationship between nursing leadership and quality of care in these settings. The relationship between hospitalization for infection and for‐profit ownership and chain affiliation could reflect policies not to treat acute illnesses in house. The link between social factors of care (environmental quality, prioritizing staff satisfaction, resident privacy, and facility visitation) and hospitalization indicates that a nonmedical model of care may not jeopardize, and may in fact benefit, health‐related outcomes. All of these facility characteristics may be modifiable, may affect healthcare costs, and may hold promise for other, less‐medical, forms of residential long‐term care.
Total Plasma Homocysteine, Age, Systolic Blood Pressure, and Cognitive Performance in Older People
Authors: Budge Marc M. , De Jager Celeste , Hogervorst Eva , Smith A. David , The Oxford Project To Investigate Memory Ageing (OPTIMA)  
Published: December 2004

OBJECTIVES: To investigate the relationship between total plasma homocysteine (tHcy) levels, blood pressure (BP) variables, renal function, and measures of cognitive performance in older people.DESIGN: Initial cross‐sectional analysis of a prospective cohort.SETTING: United Kingdom (Oxfordshire) community sample.PARTICIPANTS: One hundred fifty‐eight community‐dwelling volunteers aged 60 to 91.MEASUREMENTS: Neuropsychological tests (Cambridge Examination for Mental Disorders of the Elderly—Cognitive Section (CAMCOG), Mini‐Mental State Examination (MMSE), and Geriatric Depression Scale), biochemical studies (tHcy, serum folate, vitamin B12, and serum cystatin C), BP, and other vascular risk factors.RESULTS: tHcy, age, systolic BP (SBP), and CAMCOG performance were significantly interrelated. tHcy was negatively associated with total CAMCOG score independent of years of education, serum folate, vitamin B12, and cystatin C levels. Older participants with higher tHcy levels had lower CAMCOG scores—especially men aged 70 and older. Higher tHcy levels were associated with poorer performance on the memory and perception subscores of CAMCOG but not with the other cognitive subscales or MMSE score. SBP also demonstrated a significant negative association with total CAMCOG and MMSE scores.CONCLUSIONS: These results suggest independent associations between tHcy (modified by age and sex) and SBP and cognitive performance in older people. Further longitudinal study will define whether optimization of tHcy and systolic BP contributes to the maintenance of cognitive performance with successful aging.
Managing End‐of‐Life Care: Comparing the Experiences of Terminally Ill Patients in Managed Care and Fee for Service
Authors: Slutsman Julia , Emanuel Linda L. , Fairclough Diane , Bottorff Debra , Emanuel Ezekiel J. 
Published: December 2004

There have been no published empirical studies comparing the experiences of terminally ill patients in managed care organizations (MCOs) and those in fee for service (FFS). This investigation represents the first empirical study to systematically compare substantive outcomes between populations of terminally ill patients enrolled in MCO and FFS healthcare delivery systems. The investigators interviewed 988 patients whose physicians judged them to be terminally ill and 893 of their caregivers. Outcomes assessments were made in six domains: patient‐physician relationship; access to care and use of health care; prevalence of symptoms; and planning for end‐of‐life care, care needs, and economic burdens.Overall, the two populations of terminally ill patients were found to have comparable outcomes, but several significant differences were present. MCO patients were more likely than their FFS counterparts to use an inconvenient hospital (P = .02), spend more than 10% of their income on medical care (P = .02), and have been bedridden more than 50% of the time during the last 4 weeks of life (P = .03). Caregivers of MCO patients were as likely as the caregivers of FFS patients to report a substantial caregiving burden (P = .59). Despite concerns about the threats of MCOs to the physician‐patient relationship, few differences in the quality of the relationship between the two cohorts were found. Finally, terminally ill patients in MCOs did not show better experiences than those in FFS on any outcome measure. Additional research is required to explore how MCOs may improve upon the care available to dying patients.
Effectiveness of a Multifaceted Intervention on Falls in Nursing Home Residents
Authors: Becker Clemens , Kron Martina , Lindemann Ulrich , Sturm Elisabeth , Eichner Barbara , Walter‐Jung Barbara , Nikolaus Thorsten 
Published: December 2004

OBJECTIVES:   To evaluate the effectiveness of a multifaceted, nonpharmaceutical intervention on incidence of falls and fallers.DESIGN:   Prospective, cluster‐randomized, controlled 12‐month trial.SETTING:   Six community nursing homes in Germany.PARTICIPANTS:   Long‐stay residents (n = 981) aged 60 and older; mean age 85; 79% female.INTERVENTIONS:   Staff and resident education on fall prevention, advice on environmental adaptations, progressive balance and resistance training, and hip protectors.MEASUREMENTS:   Falls, fallers, and fractures.RESULTS:   The incidence density rate of falls per 1,000 resident years (RY) was 2,558 for the control group (CG) and 1,399 for the intervention group (IG) (relative risk (RR) = 0.55, 95% confidence interval (CI) = 0.41–0.73). Two hundred forty‐seven (52.3%) fallers were detected in the CG and 188 (36.9%) in the IG (RR = 0.75, 95% CI = 0.57–0.98). The incidence density rate of frequent fallers (>2/year) was 115 (24.4%) for the CG and 66 (13.0%) for the IG (RR = 0.56, 95% CI = 0.35–0.89). The incidence density rate of hip fractures per 1,000 RY was 39 for the CG and 43 for the IG (RR = 1.11, 95% CI = 0.49–2.51). Other fractures were diagnosed with an incidence density rate of 52 per 1,000 RY for CG and 41 per 1,000 RY for IG (RR = 0.78, 95% CI = 0.57–1.07).CONCLUSION:   The incidence density rate of falls and fallers differed considerably between the control and intervention groups. The study was underpowered to demonstrate a significant difference of hip or nonhip fractures. Because of a low fracture rate in both groups, the investigation of fracture rates would have required a larger sample size to detect an effect of the intervention.
Baseline Balance and Functional Decline in Older Adults with Knee Pain: The Observational Arthritis Study in Seniors
Authors: Marsh Anthony P. , Rejeski W. Jack , Lang Wei , Miller Michael E. , Messier Stephen P. 
Published: December 2004

OBJECTIVES: To examine the cross‐sectional and longitudinal effect of baseline balance, independent of multiple covariates (sociodemographic variables, comorbidities), on self‐reported disability and several measures of functional performance.DESIGN:  Observational Arthritis Study in Seniors was a community‐based longitudinal study.SETTING:  Data collection was conducted at an exercise science research laboratory.PARTICIPANTS:  A cohort of 245 women and 235 men, aged 65 and older, with self‐reported knee pain.MEASUREMENTS:  Measurements of balance, self‐reported disability, functional performance, strength, sociodemographic characteristics, disease burden (including radiographic knee osteoarthritis (OA)), and functional limitations were obtained on participants at baseline and 30 months. The four outcome measures (self‐reported disability, stair climb time, car time, preferred walking speed) were also collected at 15 months.RESULTS:  In cross‐sectional analyses, baseline balance was significantly associated with each of the four outcome measures before adjusting for baseline knee strength. After adjusting for knee strength, baseline balance remained significantly associated with all functional performance outcomes and self‐reported disability. In longitudinal analyses, baseline balance had a significant effect on car‐time performance, whereby individuals in the lowest quartile of baseline balance scores declined in a quadratic manner from baseline to Month 30.CONCLUSION:  Baseline balance, independent of strength and various other covariates, is an important component of performance for transfer and ambulatory tasks and for self‐reported disability. Balance was predictive of change in performance over time only in a task that presented a significant challenge to the lateral mobility/stability of participants. Balance was not predictive of decline in ambulatory performance‐based tasks or in self‐reported disability.
Effect of Low‐Dose Thiazide Diuretics on Plasma Lipids: Results from a Double‐Blind, Randomized Clinical Trial in Older Men and Women
Authors: Ott Susan M. , LaCroix Andrea Z. , Ichikawa Laura E. , Scholes Delia , Barlow William E. 
Published: December 2004

OBJECTIVES:  To determine the effects of low doses of hydrochlorothiazide (HCTZ) on plasma lipids in healthy older men and women.DESIGN:   Randomized, double‐blind, placebo‐controlled clinical trial for 3 years followed by a 1 year extension without medication.SETTING:   Research clinic of a nonprofit health maintenance organization.PARTICIPANTS:   Two hundred five women and 115 men aged 60 to 79 with normal blood pressure, bone density within two standard deviations of mean for age, and low‐density lipoprotein cholesterol (LDL‐C) levels less than 190 mg/dL.INTERVENTION:   Placebo or HCTZ 12.5 or 25 mg/d.MEASUREMENTS:   Plasma cholesterol, LDL‐C, high‐density lipoprotein cholesterol, triglycerides.RESULTS:   There were no significant differences in the change in the plasma lipids between placebo and either group. The mean changes ± standard deviation in LDL‐C after 3 years in men were −5.2 ± 3.9 mg/dL (placebo), −4.6 ± 3.7 (12.5 mg), and 1.1 ± 3.8 (25 mg) and in women were 1.3 ± 2.8 (placebo), −1.1 ± 2.8 (12.5 mg), and −6.8 ± 2.8 (25 mg). No significant differences were seen when analysis was done only for subjects who adhered to study medication.CONCLUSION:   This study provides evidence that low doses of thiazide diuretics have minimal effects on cholesterol metabolism in healthy older adults. Therefore, effects on lipid levels need not limit use of thiazides for prevention of osteoporotic fractures.
The Effects of an Exercise and Incontinence Intervention on Skin Health Outcomes in Nursing Home Residents
Authors: Bates‐Jensen Barbara M. , Alessi Cathy A. , Al‐Samarrai Nahla R. , Schnelle John F. 
Published: December 2004

OBJECTIVES:  To examine skin health outcomes of an exercise and incontinence intervention.DESIGN:   Randomized controlled trial with blinded assessments of outcomes at three points over 8 months.SETTING:   Four nursing homes (NHs).PARTICIPANTS:   One hundred ninety incontinent NH residents.INTERVENTION:   In the intervention group, research staff provided exercise and incontinence care every 2 hours from 8:00 a.m. to 4:30 p.m. (total of four daily care episodes) 5 days a week for 32 weeks. The control group received usual care from NH staff.MEASUREMENTS:   Perineal skin wetness and skin health outcomes (primarily blanchable erythema and pressure ulcers) as measured by direct assessments by research staff, urinary and fecal incontinence frequency, and percentage of behavioral observations with resident engaged in standing or walking.RESULTS:   Intervention subjects were significantly better in urinary and fecal incontinence, physical activity, and skin wetness outcome measures than the control group. However, despite these improvements, differences in skin health measures were limited to the back distal perineal area, which included the sacral and trochanter regions. There was no difference between groups in the incidence rate of pressure ulcers as measured by research staff, even though those residents who improved the most on fecal incontinence showed improvement in pressure ulcers in one area.CONCLUSION:   A multifaceted intervention improved four risk factors related to skin health but did not translate into significant improvements in most measures of skin health. Even if they had adequate staffing resources, NHs might not be able to improve skin health quality indicators significantly if they attempt to implement preventive interventions on all residents who are judged at risk because of their incontinence status.