Staff Perceptions of Workload and Care Requirements for Incontinent Patients in Long-term Care Settings

In response to the Omnibus Reconciliation Act (OBRA) mandate to ensure that a resident who is incontinent of bladder receives the appropriate treatment and services to restore normal bladder functioning ... (Department of Health and Human Services (DHHS), 1989, p.5333), several studies were designed and implemented to demonstrate that incontinence interventions worked. The research also showed that staff behaviors did not change and toileting programs were not carried forward once studies were completed. What was missing from the research was any mention that certified nursing assistants (CNAs) were asked to participate in the planning phase of an incontinence program. The purpose of this study was to ask CNA what they thought comprised a doable toileting program and how they could incorporate the changes necessary into their schedules to accommodate the amount of work toileting programs entail

Efficacy of the Regular Trivalent Inactivated Influenza Vaccine in an Aging Veteran Population

Background: Through years of observational research it has become accepted that the influenza (flu) vaccination reduces mortality in an older population. However, despite 50 years of targeted administration, the national statistics for influenza-related mortality among the elderly are unchanged. Objectives: We attempt to distinguish vaccine effective from selection bias using data from a California Veterans Medical Centers (n=38,736) age 65 and older. Methods: Two methods were used to differentiate effect from bias. The first method was the development of a 24 month mortality prediction logistic model. The second method was stratification by risk of death into deciles from low risk (0.03) to high risk (0.59) and evaluating the vaccine's effect on mortality within each decile. Results: There was very little change in model concordance between the model with influenza vaccine (77.8%) as a variable and the model without influenza vaccine (77.7%). For the division by risk deciles, we had precision to the third decimal point and could not detect a vaccine effect. Discussion: We evaluated all-cause mortality across 7 years, starting in October of 2002 and ending September 2009, in an elderly California Veteran population. During this time there were 7,944 deaths. Vaccine coverage averaged 42%. We could detect no overt effect of the current vaccine dose given to veterans