Use of the Physician Orders for Scope of Treatment Program in Indiana Nursing Homes

OBJECTIVES: To assess the use of the Indiana Physician Orders for Scope of Treatment (POST) form to record nursing home (NH) resident treatment preferences and associated practices. DESIGN: Survey. SETTING: Indiana NHs. PARTICIPANTS: Staff responsible for advance care planning in 535 NHs. MEASUREMENTS: Survey about use of the Indiana POST, related policies, and educational activities. METHODS: NHs were contacted by telephone or email. Nonresponders were sent a brief postcard survey. RESULTS: Ninety-one percent (n=486) of Indiana NHs participated, and 79% had experience with POST. Of the 65% of NHs that complete POST with residents, 46% reported that half or more residents had a POST form. POST was most often completed at the time of admission (68%). Only 52% of participants were aware of an existing facility policy regarding use of POST; 80% reported general staff education on POST. In the 172 NHs not using POST, reasons for not using it included unfamiliarity with the tool (23%) and lack of facility policies (21%). CONCLUSION: Almost 3 years after a grassroots campaign to introduce the voluntary Indiana POST program, a majority of NHs were using POST to support resident care. Areas for improvement include creating policies on POST for all NHs, training staff on POST conversations, and considering processes that may enhance the POST conversation, such as finding an optimal time to engage in conversations about treatment preferences other than a potentially rushed admission process

Stationarity Condition for AR Index Process

The stationarity conditions for an autoregressive (AR) process in general are reduced to a remarkably simple inequality if the lag coefficients are restricted to be identical. The condition is not only analytically elegant but also applicable in checking the validity of the stationarity conditions for such a restricted AR process of any order

A Portfolio Approach To Economic Development

In this paper we introduce and empirically demonstrate a new model of economic development that we call Portfolio Economic Development.  Our approach borrows from portfolio theory in finance and focuses on the risk-return nature of development projects.    The paper examines how the loss of a dominant industry group from an island economy causes significant economic problems and how those problems might be mitigated by developing the economy in a portfolio context. The approach can help planners select optimal mixes of projects for development of any economy experiencing a transitional period.&nbsp

Cold atom gas at very high densities in an optical surface microtrap

An optical microtrap is realized on a dielectric surface by crossing a tightly focused laser beam with an horizontal evanescent-wave atom mirror. The nondissipative trap is loaded with $\sim$$10^5$ cesium atoms through elastic collisions from a cold reservoir provided by a large-volume optical surface trap. With an observed 300-fold local increase of the atomic number density approaching $10^{14}{\rm cm}^{-3}$, unprecedented conditions of cold atoms close to a surface are realized

First record of a plasmodiophorid parasite in grapevine

In the context of an interdisciplinary project on grape pests and pathogens in Rheingau (Germany), the fine root system of grafted rootstocks has been screened for pathogenic fungi associated with root galls induced by grape phylloxera (Daktulosphaira vitifoliae (Fitch)). In several insect-induced galls, masses of resting spores of a plasmodiophorid could be seen. An additional selective screening revealed the occurrence of the plasmodiophorid parasite also in samples of gall-free rootlets: cortical cells of small necrotic areas were crowded with resting spores or other developmental stages of its life cycle. According to current taxonomic concepts, this plasmodiophorid could be identified as a member of the genus Sorosphaera Schroeter, resembling S. veronicae Schroeter. This is the first record of a plasmodiophorid parasite in grapevine

The POLST program: a retrospective review of the demographics of use and outcomes in one community where advance directives are prevalent

OBJECTIVES: Determine the use and utility of the Physician Orders for Life-Sustaining Treatment (POLST) program in a community where powers of attorney for health care (POAHCs) are prevalent. METHODS: A retrospective review of medical record and death certificate data of 400 adults who died between September 1, 2007, and March 31, 2008, in the La Crosse County, Wisconsin community. Demographic and cause-of-death data were collected from death certificates. Information about POAHC, POLST forms, and medical treatments provided in the last 30 days of life were abstracted from decedents' medical records. RESULTS: Sixty-seven percent of decedents had a POLST form, whereas 22% had POAHC alone. In comparison with decedents with POAHC alone, decedents with a POLST form were significantly older (83 versus 77 years, p<0.001), more likely to die in a nursing home than in a hospital (p<0.001), and more likely to die from a terminal or chronic illnesses (97%). Decedents with POLST orders for higher levels of medical treatment received more treatment, and in only two cases was there evidence that treatment was discrepant with POLST orders. In 31% of all POLST forms, the person appointed in the POAHC consented to the POLST orders. CONCLUSIONS: POLST can be a highly effective program to ensure that patient preferences are known and honored in all settings. POAHCs are valuable because they identify appropriate surrogates when patients are incapacitated

A complex regional intervention to implement advance care planning in one town's nursing homes: Protocol of a controlled inter-regional study

<p>Abstract</p> <p>Background</p> <p>Advance Care Planning (ACP) is an emerging strategy to ensure that well-reflected, meaningful and clearly documented treatment preferences are available and respected when critical decisions about life-sustaining treatment need to be made for patients unable to consent. In Germany, recent legislation confirms that advance directives (AD) have to be followed if they apply to the medical situation, but implementation of ACP has not yet been described.</p> <p>Methods/Design</p> <p>In a longitudinal controlled study, we compare 1 intervention region (4 nursing homes [n/hs], altogether 421 residents) with 2 control regions (10 n/hs, altogether 985 residents). Inclusion went from 01.02.09 to 30.06.09, observation lasted until 30.06.10. Primary endpoint is the prevalence of ADs at follow-up, 17 (12) months after the first (last) possible inclusion. Secondary endpoints compare relevance and validity of ADs, process quality, the rate of life-sustaining interventions and, in deceased residents, location of death and intensity of treatment before death. The regional multifaceted intervention on the basis of the US program Respecting Choices^®comprises training of n/h staff as facilitators, training of General Practitioners, education of hospital and ambulance staff, and development of eligible tools, including Physician Orders for Life-Sustaining Treatment in case of Emergency (POLST-E).</p> <p><it>Participation data: </it>Of 1406 residents reported to live in the 14 n/hs plus an estimated turnover of 176 residents until the last possible inclusion date, 645 (41%) were willing to participate. Response rates were 38% in the intervention region and 42% in the control region. Non-responder analysis shows an equal distribution of sex and age but a bias towards dependency on nursing care in the responder group. <it>Outcome analysis </it>of this study will become available in the course of 2011.</p> <p>Discussion</p> <p>Implementing an ACP program for the n/hs and related health care providers of a region requires a complex community intervention with the effect of nothing less than a cultural shift in this health care sector. This study is to our knowledge the first to develop a strategy for regional implementation of ACP, and to evaluate its feasibility in a controlled design.</p> <p>Trial Registration</p> <p>ISRCTN: <a href="http://www.controlled-trials.com/ISRCTN99887420">ISRCTN99887420</a></p

A situação da cultura e o desenvolvimento da produção integrada do morangueiro no Estado de São Paulo.

O Estado de São Paulo teve grande importância para o início do desenvolvimento da cultura do morango no Brasil, tanto em termos de produção científica, quanto no cultivo comercial. Hoje é o segundo maior pólo produtor do Brasil, mas vem diminuindo a área cultivada nos últimos anos. Sofre forte concorrência com os produtores do Sul de Minas Gerais, além de necessitar contornar as novas preocupações dos consumidores com a segurança do produto, buscando sistemas de cultivo mais sustentáveis que o convencional. Algumas tentativas para obtenção de selos de qualidade do morango foram realizadas no passado, mas os programas não perduraram. Há três anos, foi iniciado o Programa de Produção Integrada de Morangos (PIMo) na região de Atibaia e Jarinu. No primeiro ano priorizou-se o desenvolvimento da educação ambiental no grupo, usando a metodologia da Macroeducação. No segundo ano, o enfoque foi nos treinamentos técnicos e na adoção de documentos de registro de procedimentos no campo. No ano de 2008, o enfoque será na validação do sistema nas áreas dos produtores parceiros, tendo uma Unidade Demonstrativa Central como área modelo para validação, realização de aulas práticas e demonstrações do sistema para os produtores e sociedade em geral. Este artigo tem o objetivo de apresentar a atual situação da cultura do morangueiro no Estado de São Paulo em termos de área cultivada, produção, principais municípios produtores e comercialização. Um histórico dos primórdios da cultura no Estado é apresentado, bem como a metodologia usada para desenvolvimento da Produção Integrada no Estado

Just when you thought it was safe to go into the membrane: the growing complexities of extra-nuclear progesterone signaling

The diversity of membrane-initiated progesterone actions has made characterization and establishment of its biological importance a complicated endeavor. A new study by Zuo and colleagues shows that progesterone via endogenous membrane progesterone receptor-α acts as a negative regulator of proliferation and epithelial to mesenchymal transition in a breast cancer cell line. These progesterone-mediated actions appear to be regulated through epidermal growth factor receptor and phosphatidylinositol 3-kinase signaling localized in caveolae. Moreover, the study shows expression of membrane progesterone receptor-α in benign and malignant breast cancer tissues. These data bring forth novel concepts with regard to progesterone actions in the breast; however, further work is warranted to fully characterize the physiologic actions of extra-nuclear progesterone signaling in the breast