Writing Manuscript Bookends : Strategies to Effectively Frame Science

The introduction and discussion sections play pivotal roles in peer-reviewed manuscripts, yet many authors struggle with these sections. This commentary describes the significance of the introduction and discussion sections for successful publishing, identifies essential components of these sections, and provides recommendations for writing quality introductions and discussions. The introduction defines the problem to be addressed, identifies what is known and unknown about the problem, and states the study purpose. It begins broadly by introducing the area of interest, narrows to identify the specific focus and gap in knowledge, and finally ends with the aim of the present study, seamlessly leading to the methods and results sections. Discussion sections restate the study purpose, interpret the most compelling findings, situate them within the context of existing literature and frameworks, describe study limitations, and provide recommendations for future research and practice. The discussion ends with a brief conclusion paragraph explaining the study’s relevance and implications to the field. The introduction and discussion sections are the “bookends” of the scientific manuscript. Successful bookends increase the chances of framing science, getting manuscripts published, and contributing to scientific literature

Provider Staffing Effect on a Decision Aid Intervention

This study examined the association between Nurse Practitioner (NP) and Physician Assistant (PA) staffing in nursing homes and the effect of a decision-aid regarding feeding options in dementia on the frequency of surrogate- provider discussions and on surrogates’ decisional conflict. We compared these outcomes for facilities that had no NP/PAs, part-time only NP/PA staffing, and full-time NP/PA staffing. The sample included 256 surrogate decision-makers from 24 nursing homes. The decision aid was associated with significant increases in discussion rates in facilities with part-time or no NP/PA staffing (26% v. 51%, p <.001 and 13% v. 41%, p < .001, respectively) and decreases in decisional conflict scores (−0.08 v. −.47, p = .008 and −0.30 v. −.0.68, p = .014, respectively). Sites with full-time NP/PA staffing had high baseline rates of discussions (41%). These findings suggest that the decision aid and full-time NP/PA staffing can enhance surrogate decision-making in nursing homes

Reframing and Advancing Academic Mentorship to Support New and Early Career Faculty Members

Mentorship is critical to fostering professional growth and career development in academia. However, academic mentorship is often an informal activity that is overlooked and under researched. There is much ambiguity and uncertainty surrounding mentorship roles and strategies in academia. This paper provides recommendations and strategies to reframe and advance academic mentorship to support new and early career faculty

Identifying Distinct Risk Profiles to Predict Adverse Events among Community-Dwelling Older Adults

Preventing adverse events among chronically ill older adults living in the community is a national health priority. The purpose of this study was to generate distinct risk profiles and compare these profiles in time to: hospitalization, emergency department (ED) visit or death in 371 community-dwelling older adults enrolled in a Medicare demonstration project. Guided by the Behavioral Model of Health Service Use, a secondary analysis was conducted using Latent Class Analysis to generate the risk profiles with Kaplan Meier methodology and log rank statistics to compare risk profiles. The Vuong-Lo-Mendell-Rubin Likelihood Ratio Test demonstrated optimal fit for three risk profiles (High, Medium, and Low Risk). The High Risk profile had significantly shorter time to hospitalization, ED visit, and death (p \u3c 0.001 for each). These findings provide a road map for generating risk profiles that could enable more effective targeting of interventions and be instrumental in reducing health care costs for subgroups of chronically ill community-dwelling older adults

A Multi-Methods Observational Study of Persistent Vocalizations in Nursing Home Residents with Advanced Dementia

Persistent vocalizations (PVs), otherwise known as disruptive vocalizations or problematic vocalizations, are commonly exhibited by nursing home residents (NH) with advanced dementia. Older adults exhibiting this behavioral symptom of dementia can have detrimental outcomes such as physical exhaustion. PVs also cause distress to others in the same environment including other residents, NH staff, and visitors. The purpose of this body of work was to describe PVs in persons with advanced dementia in relation to observational and physiological variables prior to, during and after an episode of PVs. The Need-driven Dementia-compromised Behavior model informed this work. A systematic review was completed to learn the state of the science on the phenomenon of NH residents with dementia and PVs. Field observations of nine NH residents with advanced dementia and PVs were conducted. This was followed by combining physiological measures (heart rate and respiration rate) and directed observations from video recordings and sound meter readings on three of the participants. The state of the science reveals that there is limited available knowledge on this phenomenon, particularly around non-pharmacological interventions that are effective at minimizing PVs. A conventional content analysis was completed on field notes from the directed observations and three themes emerged: Routine of Staying in Room was identified for participants considered “disruptive” to others; Caregivers Interactions as Triggers to PVs (providing care without communicating and personal care); and Depends on the Day. Analysis of video recordings and physiological data revealed that the three participants had high heart rates prior to, during and after a PV episode compared to baseline heart rates. This body of work represents the only known research to look at the combination of PV characteristics and physiological characteristics of the NH residents with dementia exhibiting PVs

A Multi-Methods Observational Study of Persistent Vocalizations in Nursing Home Residents with Advanced Dementia

Persistent vocalizations (PVs), otherwise known as disruptive vocalizations or problematic vocalizations, are commonly exhibited by nursing home residents (NH) with advanced dementia. Older adults exhibiting this behavioral symptom of dementia can have detrimental outcomes such as physical exhaustion. PVs also cause distress to others in the same environment including other residents, NH staff, and visitors. The purpose of this body of work was to describe PVs in persons with advanced dementia in relation to observational and physiological variables prior to, during and after an episode of PVs. The Need-driven Dementia-compromised Behavior model informed this work. A systematic review was completed to learn the state of the science on the phenomenon of NH residents with dementia and PVs. Field observations of nine NH residents with advanced dementia and PVs were conducted. This was followed by combining physiological measures (heart rate and respiration rate) and directed observations from video recordings and sound meter readings on three of the participants. The state of the science reveals that there is limited available knowledge on this phenomenon, particularly around non-pharmacological interventions that are effective at minimizing PVs. A conventional content analysis was completed on field notes from the directed observations and three themes emerged: Routine of Staying in Room was identified for participants considered “disruptive” to others; Caregivers Interactions as Triggers to PVs (providing care without communicating and personal care); and Depends on the Day. Analysis of video recordings and physiological data revealed that the three participants had high heart rates prior to, during and after a PV episode compared to baseline heart rates. This body of work represents the only known research to look at the combination of PV characteristics and physiological characteristics of the NH residents with dementia exhibiting PVs

Advance care planning and outpatient visits among older adults across cognitive levels

Advance care planning (ACP) can help reduce end-of-life care challenges for persons with Alzheimer's disease and related dementia and their care partners. Building on our previous work, we examined the impact of ACP on outpatient/doctor visits in older adults with dementia/impaired cognition and normal cognition. Using datasets from the 2014 Health and Retirement Study (HRS), we conducted a cross-sectional study of 17,698 participants aged 51 years and older. Our analyses included survey descriptive and logistic regression procedures. Our findings indicated that having at least one ACP measure was significantly associated with a higher mean number of outpatient visits in both cognition groups. Based on our findings, we recommend considering healthcare access and use as an intervening variable in future ACP research

Provider Staffing Effect on a Decision Aid Intervention

This study examined the association between Nurse Practitioner (NP) and Physician Assistant (PA) staffing in nursing homes and the effect of a decision-aid regarding feeding options in dementia on the frequency of surrogate- provider discussions and on surrogates’ decisional conflict. We compared these outcomes for facilities that had no NP/PAs, part-time only NP/PA staffing, and full-time NP/PA staffing. The sample included 256 surrogate decision-makers from 24 nursing homes. The decision aid was associated with significant increases in discussion rates in facilities with part-time or no NP/PA staffing (26% v. 51%, p <.001 and 13% v. 41%, p < .001, respectively) and decreases in decisional conflict scores (−0.08 v. −.47, p = .008 and −0.30 v. −.0.68, p = .014, respectively). Sites with full-time NP/PA staffing had high baseline rates of discussions (41%). These findings suggest that the decision aid and full-time NP/PA staffing can enhance surrogate decision-making in nursing homes