Two‐year effects of an interdisciplinary intervention on recovery following hip fracture in older Taiwanese with cognitive impairment

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/91216/1/gps2750.pd

Medicare Expenditures for Nursing Home Residents Triaged to Nursing Home or Hospital for Acute Infection

To compare Medicare payments of nursing home residents triaged to nursing home with those of nursing home residents triaged to the hospital for acute infection care

Discussion as a Factor in the Racial Disparity in Advance Directive Completion at Nursing Home Admission

Studies have consistently shown racial disparities in advance directive completion among nursing home residents but have not examined whether this disparity is due to differences in interactions with healthcare providers. This study had two aims: to determine whether the racial disparity in advance directive completion by nursing home residents is related to differences in discussion of treatment restrictions with healthcare providers, and to examine if there is a racial disparity in perceptions of residents’ significant others that additional discussions would be helpful. Participants were 2,171 white or black (16% of sample) residents newly admitted to 59 nursing homes. Data were collected from structured interviews with residents’ significant others and review of nursing home charts. Questions included whether advance directives were completed, whether treatment restrictions were discussed with the resident and/or family, and whether more discussion would have been helpful. Frequencies by race were determined for each question; p-values and logistic regression models were obtained using SAS. Black residents were less likely to have completed any advance directives (p<0.001). Also, black residents (p<.001) and their family members (p<.001) were less likely than whites to have discussed treatment restrictions with healthcare providers. Logistic regression models indicated that disparity in treatment restrictions narrowed when these discussions occurred. Significant others of black residents were more likely to consider further discussion helpful (p<0.001), especially with physicians. Racial disparity in treatment restrictions may be due in part to a difference in discussion with healthcare providers; increasing discussion may narrow this disparity

Physical Performance Characteristics of Assisted Living Residents and Risk for Adverse Health Outcomes

Little is known about the physical performance ability of residential care/assisted living (RC/AL) residents and its relationship to adverse outcomes such as fracture, nursing home placement, functional decline, and death. The purposes of this paper are to: 1) describe the functional characteristics of RC/AL residents; 2) examine the relationships between resident- and facility-characteristics and physical performance; and 3) determine the predictive value of physical performance for adverse outcomes

Short-Stay Nursing Home Rehabilitation Patients: Transitional Care Problems Pose Research Challenges

We conducted a NIH-funded clinical intervention pilot study to improve depression care for short-stay nursing home Medicare-reimbursed rehabilitation patients. Despite a solid theoretical and clinical grounding and the support of a large nursing home company, we encountered several roadblocks to implementation, including 1) involving patients and families, 2) communication between providers, 3) involving community primary care physicians (PCP), 4) staff time constraints, and 5) conducting research with short-stay patients. While frustrating from a research standpoint, these roadblocks closely reflect problems identified by the American Geriatrics Society (AGS) as impeding the delivery of high quality transitional care in geriatrics. We describe these research roadblocks as we encountered them in the clinical setting and place each within the larger context of challenges associated with care transitions, especially for older persons with complex health needs receiving nursing home rehabilitation. Finally, we offer recommendations for researchers conducting much needed research within geriatric transitional care settings, including starting early in the care transition chain and assisting patients and families to provide continuity across care settings

Psychotropic use and associated neuropsychiatric symptoms among patients with dementia in the USA

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/136003/1/gps4452_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/136003/2/gps4452.pd

Performance of the LHCb muon system with cosmic rays

The LHCb Muon system performance is presented using cosmic ray events collected in 2009. These events allowed to test and optimize the detector configuration before the LHC start. The space and time alignment and the measurement of chamber efficiency, time resolution and cluster size are described in detail. The results are in agreement with the expected detector performance.Comment: Submitted to JINST and accepte

Performance of the LHCb muon system

The performance of the LHCb Muon system and its stability across the full 2010 data taking with LHC running at ps = 7 TeV energy is studied. The optimization of the detector setting and the time calibration performed with the first collisions delivered by LHC is described. Particle rates, measured for the wide range of luminosities and beam operation conditions experienced during the run, are compared with the values expected from simulation. The space and time alignment of the detectors, chamber efficiency, time resolution and cluster size are evaluated. The detector performance is found to be as expected from specifications or better. Notably the overall efficiency is well above the design requirementsComment: JINST_015P_1112 201

Hospital Discharge Instructions: Comprehension and Compliance Among Older Adults

BACKGROUND: Little is known regarding the prevalence or risk factors for non-comprehension and non-compliance with discharge instructions among older adults. OBJECTIVE: To quantify the prevalence and identify patient characteristics associated with non-comprehension and non-compliance with discharge instructions. RESEARCH DESIGN: Prospective cohort study SUBJECTS: 450 adults aged ≥65 admitted to medical and surgical units of a tertiary care facility and meeting inclusion criteria. MEASURES: We collected information on demographics, psycho-social factors, discharge diagnoses, and medications using surveys and patient medical records. Domains within discharge instructions included medications, follow-up appointments, diet, and exercise. At 5 days post-discharge, we assessed comprehension by asking patients about their discharge instructions and compared responses to written instructions from medical charts. We assessed compliance among patients who understood their instructions. RESULTS: Prevalence of non-comprehension was 5% for follow-up appointments, 27% for medications, 48% for exercise and 50% for diet recommendations. Age was associated with non-comprehension of medication (odds ratio (OR) 1.07; 95% confidence interval (CI) 1.04, 1.120) and follow-up appointment (OR 1.08; 95% CI 1.00, 1.17) instructions. Male sex was associated with non-comprehension of diet instructions (OR 1.91; 95%CI 1.10, 3.31). Social isolation was associated with non-comprehension of exercise instructions (OR 9.42; 95%CI 1.50, 59.11) Depression was associated with non-compliance with medication (OR 2.29; 95% CI 1.02, 5.10) and diet instructions (OR 3.30; 95% CI 1.24, 8.83). CONCLUSIONS: Non-comprehension of discharge instructions among older adults is prevalent, multi-factorial, and varies by domain.Keywords: Older adults, Comprehension, Hospital discharge instructions, ComplianceKeywords: Older adults, Comprehension, Hospital discharge instructions, Complianc