The role of professional development and learning in the early adoption of the New Zealand curriculum by schools.

This paper is set in the context of Phase One of the Ministry of Education Curriculum Implementation Exploratory Studies (CIES) project. The schools selected for this study were considered early adopters of the revised New Zealand Curriculum (NZC) (Ministry of Education, 2007). The paper provides theoretical insights and research evidence related to the role of professional development and learning in the early stages of implementation of the revised curriculum. A key finding common to most schools was the progressive development of a professional learning culture led by the principal that focused on pedagogy and student achievement prior to the introduction of the curriculum. The establishment of this culture involved processes that were task-oriented, reflective, consultative and collaborative. While there are strong parallels between the experiences of primary and secondary schools in the study, some important differences have also been noted

An Evidence-Based Update On Vitamins

American adults take many types of vitamin supplements, despite limited evidence of their efficacy, especially in preventing chronic diseases such as cardiovascular disease and cancer. Supplements contain significant amounts of vitamins when consumed from multiple sources. Excess consumption of some vitamins may have detrimental health effects. Use of MMVM products appears to be safe; however, clinical outcomes have not been established. Although vitamin D and preconception folic acid may be appropriate for self care, a health care provider should monitor other vitamin supplements for disease prevention, such as niacin. Beyond supplementation as treatment for vitamin deficiencies, evidence is lacking

Prescription analgesia and adjuvant use by pain severity at admission among nursing home residents with non-malignant pain

Objective: We estimated the use of prescribed analgesics and adjuvants among nursing home residents without cancer who reported pain at their admission assessment, in relation to resident-reported pain severity. Methods: Medicare Part D claims were used to define 3 classes of analgesics and 7 classes of potential adjuvants on the 21st day after nursing home admission (or the day of discharge for residents discharged before that date) among 180,780 residents with complete information admitted between January 1, 2011 and December 9, 2016, with no cancer diagnosis. Results: Of these residents, 27.9% reported mild pain, 46.6% moderate pain, and 25.6% reported severe pain. The prevalence of residents in pain without Part D claims for prescribed analgesic and/or adjuvant medications was 47.3% among those reporting mild pain, 35.7% among those with moderate pain, and 24.8% among those in severe pain. Among residents reporting severe pain, 33% of those ≥ 85 years of age and 35% of those moderately cognitively impaired received no prescription analgesics/adjuvants. Use of all classes of prescribed analgesics and adjuvants increased with resident-reported pain severity, and the concomitant use of medications from multiple classes was common. Conclusion: Among nursing home residents with recognized pain, opportunities to improve the pharmacologic management of pain, especially among older residents, and those living with cognitive impairments exist

Prescription analgesia and adjuvant use by pain severity at admission among nursing home residents with non-malignant pain

OBJECTIVE: We estimated the use of prescribed analgesics and adjuvants among nursing home residents without cancer who reported pain at their admission assessment, in relation to resident-reported pain severity. METHODS: Medicare Part D claims were used to define 3 classes of analgesics and 7 classes of potential adjuvants on the 21st day after nursing home admission (or the day of discharge for residents discharged before that date) among 180,780 residents with complete information admitted between January 1, 2011 and December 9, 2016, with no cancer diagnosis. RESULTS: Of these residents, 27.9% reported mild pain, 46.6% moderate pain, and 25.6% reported severe pain. The prevalence of residents in pain without Part D claims for prescribed analgesic and/or adjuvant medications was 47.3% among those reporting mild pain, 35.7% among those with moderate pain, and 24.8% among those in severe pain. Among residents reporting severe pain, 33% of those \u3e /= 85 years of age and 35% of those moderately cognitively impaired received no prescription analgesics/adjuvants. Use of all classes of prescribed analgesics and adjuvants increased with resident-reported pain severity, and the concomitant use of medications from multiple classes was common. CONCLUSION: Among nursing home residents with recognized pain, opportunities to improve the pharmacologic management of pain, especially among older residents, and those living with cognitive impairments exist

Alternatives to potentially inappropriate medications for use in e-prescribing software: triggers and treatment algorithms

Objective: To describe the development of evidence-based electronic prescribing (e-prescribing) triggers and treatment algorithms for potentially inappropriate medications (PIMs) for older adults. Design: Literature review, expert panel and focus group. Setting: Primary care with access to e-prescribing systems. Participants: Primary care physicians using e-prescribing systems receiving medication history. Interventions: Standardised treatment algorithms for clinicians attempting to prescribe PIMs for older patients. Main outcome measure: Development of 15 treatment algorithms suggesting alternative therapies. Results: Evidence-based treatment algorithms were well received by primary care physicians. Providing alternatives to PIMs would make it easier for physicians to change decisions at the point of prescribing. Conclusion: Prospectively identifying older persons receiving PIMs or with adherence issues and providing feasible interventions may prevent adverse drug events

Resident and Facility-level Correlations of Long-term Opioid Use in United States Nursing Homes

Background: There is limited information on the prevalence and multilevel risk factors of long-term opioid use in older nursing home residents despite their high burden of pain and vulnerability to adverse drug events. Objectives: To estimate the prevalence and correlates of long-term opioid use in United States (US) nursing homes. Methods: We used comprehensive administrative/claims data (Minimum Data Set 3.0; Medicare Part D) from 2012 to conduct a cross-sectional study of 369,180 long-stay nursing home residents who were Medicare beneficiaries, ≥65 years old, and had no cancer. Resident factors of interest included demographics and physical/cognitive impairment, and facility factors included US census region and structural characteristics (eg, bed size, ownership). Long-term opioid use was defined as ≥90 cumulative days of opioid use during a 120 day observation window - defined using fill dates and days’. Modified Poisson models were used to estimate adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) between resident/ facility-level characteristics and long-term opioid use. Results: Nearly one third of long-stay residents used any opioid, with 14.5% using opioids long-term. Among long-term users, 35.3% received a long-acting opioid, with 17.1% receiving high (≥90 mg/day oral morphine equivalents) daily doses. Hydrocodone (49.0%), tramadol (31.3%), and fentanyl (24.8%) were most commonly used. The prevalence of long-term use was higher in women (vs. men; aPR=1.20, 95% CI: 1.18-1.23) and those with no/mild cognitive impairment (vs. other; aPR=1.18, 95% CI: 1.16-1.20) or severe physical impairment (aPR=1.25; 95% CI: (1.22-1.27), and in government-owned nursing homes (vs. for-profit; aPR=1.10, 95% CI: 1.05-1.16). Long-term use varied by region (10.6% [Northeast] to 17.7% [Midwest]) and across facilities (median: 13.3% interquartile range: 6.7%-21.3%). Conclusions: Long-term opioid use is substantially higher in nursing home residents than what has been previously reported in community-dwelling older adults. Further investigations of opioid safety in this frail population are needed

A systematic review of integrative medicine for opioid withdrawal

Introduction: The United States has been battling an opioid epidemic for decades. As substance use disorders have grown, so too has investigation into treatment options, including integrative medicine approaches, for managing opioid withdrawal symptoms (OWS). Objectives: This systematic review sought to assess the use of integrative medicine approaches for the alleviation of OWS in patients dependent on opioids and to summarize the available data. Methods: The authors searched using synonyms for opioids, substance use disorder, and integrative medicine and standardized searches in Embase, PubMed, and Cochrane Library. We also hand searched references for systematic reviews. This review did not include articles that could not be obtained as full-text publications via interlibrary loan. The review also excluded studies with interventions involving acupuncture because multiple systematic reviews on this approach already exist. In addition, we also excluded studies of therapy for opioid maintenance. We evaluated studies for inclusion based on the Jadad criteria. We compared opioid withdrawal outcomes of the studies to determine the efficacy of integrative medicine approaches. Results: The authors identified a total of 382 unique publications initially for possible inclusion through systematic searches. After applying inclusion and exclusion criteria, five studies met Jadad criteria. The authors identified an additional two studies for inclusion via hand searching. A total of seven studies included interventions consisting of passionflower, weinicom, fu-yuan pellet, jinniu capsules, tai-kang-ning, dynorphin, and l-tetrahydropalmatine. Analyzing the articles was difficult given the varied scoring methods they used to quantify opioid withdrawal symptoms and the small sample sizes in the trials. Most showed evidence that supported integrative medicine approaches for OWS, although the strength of evidence was limited because of sample sizes. Conclusions: This review found evidence of multiple integrative medicine approaches for opioid withdrawal symptoms. Well-designed randomized controlled trials should assess the efficacy of integrative medicine for improvement in OWS

Changes in Anticoagulant Utilization Among United States Nursing Home Residents With Atrial Fibrillation From 2011 to 2016

Background: Nursing home residents with atrial fibrillation are at high risk for ischemic stroke and bleeding events. The most recent national estimate (2004) indicated less than one third of this high-risk population was anticoagulated. Whether direct-acting oral anticoagulant ( DOAC ) use has disseminated into nursing homes and increased anticoagulant use is unknown. Methods and Results: A repeated cross-sectional design was used to estimate the point prevalence of oral anticoagulant use on July 1 and December 31 of calendar years 2011 to 2016 among Medicare fee-for-service beneficiaries with atrial fibrillation residing in long-stay nursing homes. Nursing home residence was determined using Minimum Data Set 3.0 records. Medicare Part D claims for apixaban, dabigatran, edoxaban, rivaroxaban, and warfarin were identified and point prevalence was estimated by determining if the supply from the most recent dispensing covered each point prevalence date. A Cochran-Armitage test was performed for linear trend in prevalence. On December 31, 2011, 42.3% of 33 959 residents (median age: 85; Q1 79, Q3 90) were treated with an oral anticoagulant, of whom 8.6% used DOACs. The proportion receiving treatment increased to 47.8% of 37 787 residents as of December 31, 2016 ( P \u3c 0.01); 48.2% of 18 054 treated residents received DOAC s. Demographic and clinical characteristics of residents using DOAC s and warfarin were similar in 2016. Half of the 8734 DOAC users received standard dosages and most were treated with apixaban (54.4%) or rivaroxaban (35.8%) in 2016. Conclusions: Increases in anticoagulant use among US nursing home residents with atrial fibrillation coincided with declining warfarin use and increasing DOAC use

Pharmacotherapy Use in Older Patients with Heart Failure and Reduced Ejection Fraction Living in Skilled Nursing Facilities

Background: Little is known about the use of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) and β-blockers among older adults with heart failure and reduced ejection fraction (HFrEF) in skilled nursing facilities (SNFs). Methods: Using national data Minimum Data Set 3.0 cross-linked with Medicare data (2011-2012), we studied 31,675 patients with HFrEF (ICD-9 codes: 428.2 or 428.4) aged ≥65 years admitted to 9,659 SNFs. We estimated the prevalence of a Part D claim for ACEIs/ARBs or β-blockers during 3 months before the SNF stay and used log-binomial models to evaluate correlates of use by estimating prevalence ratios (PR) and 95% confidence intervals (CI). Results: The median age of the study population was 83 years, 60% were women, and 10% and 4% were African Americans and Hispanics, respectively. Approximately 46% had ≥3 important risk factors for HFrEF. Fifty-seven percent received an ACEI/ARB and 47% a β-blocker; 25% received neither. Older age was inversely associated with receipt of these therapies: adjusted PRs were 0.94 (95% CI: 0.91-0.96) for ACEIs/ARBs and 0.86 (95% CI: 0.84-0.89) for β-blockers for patients aged ≥85 years compared with those aged 65-74 years. Compared with Whites, use of these therapies was higher among African Americans (adjusted PRs were 1.07 [95% CI: 1.04-1.10] for ACEIs/ARBs and 1.11 [95% CI: 1.08-1.15] for β-blockers) and Hispanics (adjusted PRs were 1.13 [95% CI: 1.09-1.18] for ACEIs/ARBs and 1.12 [95% CI: 1.07-1.18] for β-blockers). The prevalence of ACEI/ARB use was greater in patients with ≥3 important risk factors than in those with ≤1 factor: adjusted PR was 1.16 (95% CI 1.13-1.19). Conclusions: Use of guideline-directed medications may be suboptimal in older patients with HFrEF receiving SNF care. Whether this is a result of adverse drug events from prior use or insufficient evidence in vulnerable populations needs to be examined. Acknowledgements: Lin Li has received funding from a National Institutes of Health Ruth L. Kirschstein National Research Service Award Institutional Research Training Grant (5T32HL120823-02

Curriculum implementation exploratory studies: Final report

Throughout the history of schooling in New Zealand the national curriculum has been revised at fairly regular intervals. Consequently, schools are periodically faced with having to accommodate to new curriculum. In between major changes other specifically-focused changes may arise; for example, the increased recent emphasis upon numeracy and literacy