Home About us Contact
|
Home About us Contact | ||
|
|
||
Affairs
Kinds of Affairs Terms modified by Affairs Selected AbstractsIS APOLOGY A SORRY AFFAIR?PHILOSOPHICAL FORUM, Issue 3 2010DERRIDA AND THE MORAL FORCE OF THE IMPOSSIBLE First page of article [source] ORGANIZING THE CORE EXECUTIVE FOR EUROPEAN UNION AFFAIRS: COMPARING FINLAND AND SWEDENPUBLIC ADMINISTRATION, Issue 3 2010KARL MAGNUS JOHANSSON Examining core executive organization for EU affairs in Finland and Sweden, this article uncovers how change agents used European integration deliberately to strengthen their role in the domestic settings through taking control of EU policy co-ordination. In both countries, EU membership was an exogenous factor that enabled the offices of the PM to secure a more powerful position and advance their own institutional agendas. This strengthened their leadership role and weakened the respective foreign ministries, whose legitimacy in EU co-ordination was undermined by the discourse that matters pertaining to this co-ordination should be treated as domestic policy instead of foreign policy. This discourse proved instrumental in the organizational reforms and core executive restructuring. Both countries also provide evidence of intra-Nordic organizational learning since the Finnish co-ordination system was based on lessons drawn from Denmark whereas the subsequent Swedish reform was inspired and legitimized by changes in Finland. [source] A Sordid Affair: The Alliance for Progress and British GuianaDIPLOMATIC HISTORY, Issue 4 2007Piero Gleijeses First page of article [source] British Masculinities on Trial in the Queen Caroline Affair of 1820GENDER & HISTORY, Issue 2 2008Louise Carter This article uses the deluge of pamphlets, public addresses, newspaper articles and sermons addressing the Queen Caroline Affair to construct a case study of the opposing constructions of British masculinity vying for dominance in 1820. The literature surrounding the attempted royal divorce reveals a contest between the libertine example of manhood characterised by George IV and the more sober, chivalrous and respectable image of masculinity increasingly espoused as the British ideal. This episode, therefore, offers an unusually rich insight into contemporary constructions of masculinity and the way in which they were utilised within the public sphere. Moreover, this article argues that such gendered concerns were not only as crucial to motivating opposition to the king's actions as political issues, but that gender concerns and political issues were indivisible, as appropriate manly behaviour in both public and private increasingly came to be seen as a core component of a man's overall reputation and fitness to exercise authority. [source] Leadership and Learning in Political Groups: The Management of Advice in the Iran-Contra AffairGOVERNANCE, Issue 2 2001Paul A. KowertArticle first published online: 17 DEC 200 For over two decades, the theory of groupthink proposed by Irving Janis has remained the most prominent analysis of group dynamics in policy-making. Suffering from its own popularity, groupthink has become a catch-all phrase without a clear meaning. Moreover, theories of group decision-making,even when applied to public policy-making,have typically ignored political variables, focusing almost exclusively on psychological arguments. This article offers three more narrowly construed propositions about policy-making groups: (1) that extremes in the distribution of power within a decision group reduces the integrative complexity of that group's deliberations and, thus, a leader's ability to learn; (2) that extremes in group size produce similar effects; and (3) that the integrative complexity of deliberations is improved when power concentration is appropriate to group size. An examination of the Reagan Administration's decision-making in two phases of the Iran-Contra affair lends support to these hypotheses and reveals the importance of political structure in decision group dynamics. [source] A Strange Affair: The 2002 Presidential and Parliamentary Elections in FranceGOVERNMENT AND OPPOSITION, Issue 3 2002Alistair Cole First page of article [source] The Stock Market Reaction to the Enron-Andersen Affair in SpainINTERNATIONAL JOURNAL OF AUDITING, Issue 1 2006Cristina de Fuentes Barbera This paper investigates whether listed Spanish companies audited by Andersen have suffered any negative economic impact due to the scandal surrounding Andersen's work in Enron Corporation. To that end, we have measured the economic consequences, if any, of Andersen's loss of reputation by examining the reaction in terms of movements in the stock prices of its client companies using an event study methodology. We have analysed abnormal returns on the stock prices of all firms listed in the Spanish Interconnected Market around two event dates: the date of Andersen's public admission that it had destroyed significant financial documents related to Enron Corp. and the date Dynegy Inc. announced the withdrawal of its takeover offer. The results of our empirical analysis do not support the hypothesis that companies audited by Andersen suffered any significant drop in stock price as a result of the scandal affecting their auditor. [source] Keeping an Eye on Patient Safety Using Human Factors Engineering (HFE): A Family Affair for the Hospitalized ChildJOURNAL FOR SPECIALISTS IN PEDIATRIC NURSING, Issue 1 2010Barbara L. Wilson PhD Barbara L. Wilson Column Editor: Bonnie Gance-Cleveland Family-Centered Care provides a forum for sharing information about basic components of caring for children and families, including respect, information sharing, collaboration, family-to-family support, and confidence building. [source] The Politics of Privatization in Russia: From Mass Privatization to the Yukos AffairPACIFIC FOCUS, Issue 1 2006Duckjoon Chang Privatization constitutes one of the most successful achievements in Post-Soviet Russian reform. However, apparent great successes notwithstanding, the privatization program tainted with distortions of its original ideas, political compromises and collusions between political leaders and business elites produced tremendous criticisms and distrust as well. Given those negative aspects of privatization, some people raised the necessity of review of the privatization programs conducted during the 1990s. But despite such criticisms and negative evaluations of the privatization program, as was shown in the case of the Yukos affair, the Russian government never denied the principle of private ownership nor reexamined the privatization results. To explain such a trend in Russian privatization, this paper adopts the concept of policy learning, in which reconceptualization of policy agendas-adopting private property as an essential element of the market economy, for example-take place. [source] Framing the Lewinsky Affair: Third-Person Judgments by Scandal FramePOLITICAL PSYCHOLOGY, Issue 4 2003Mark R. Joslyn Recent studies have documented a "third-person effect" whereby people are found to judge others as more influenced than themselves by the mass media. Meanwhile, contemporary research on issue framing has demonstrated the powerful role of mass media in shaping people's political judgments. But are the perceptual judgments that define third-person effects sensitive to how the media frame an issue? Two studies investigated this question in the context of the Lewinsky-Clinton scandal, one in late August 1998 and the other during spring 1999. Several hundred undergraduates in each study were randomly assigned to one of two media frames. In the 1998 study, the political scandal was depicted as a matter of sexual indiscretion by the president or as legal wrongdoing; in the 1999 study, the recently concluded impeachment process was depicted as the consequence of partisanship or of Clinton's actions. The participants' judgments of media influence on themselves and on the public were then recorded. The results show that third-person effects were sensitive to issue framing, but change occurred primarily in participants' judgments about their own vulnerability to media influence. [source] From Rebellion to Revisionism: The Continuing Debate about the Denmark Vesey AffairTHE JOURNAL OF THE HISTORICAL SOCIETY, Issue 3 2004Robert L. Paquette [source] AESTHETICS AND CULTURAL POLITICS IN THE AGE OF DREYFUS: MAURICE DENIS'S HOMAGE TO CÉZANNEART HISTORY, Issue 5 2007KATHERINE MARIE KUENZLIArticle first published online: 12 DEC 200 This article examines the alliance between painterly modernism and right-wing politics in France at the height of the Dreyfus Affair. Political struggles took on an aesthetic dimension in the cultural battles waged around 1900. Maurice Denis's monumental group portrait Homage to Cézanne (1900) serves as the focus of my inquiry. This painting is often cited and reproduced in histories of French modernism, but has yet to be examined within its historical and political moment. Although Homage does not directly reference contemporary political events, Denis's formal and compositional choices in Homage were informed by Adrien Mithouard's right-wing nationalist cultural politics. [source] Australia's Quest to Enrich Uranium and the Whitlam Government's Loans AffairAUSTRALIAN JOURNAL OF POLITICS AND HISTORY, Issue 4 2008Wayne Reynolds The renewed debate about Australia enriching uranium raises issues associated with a previous attempt thirty-five years ago. The Atomic Energy Commission hatched plans in the mid-1960s to position Australia as a supplier of enriched fuel, especially to the Japanese market. This would be done using centrifuge technology, a cheaper and more efficient method than that used by the United States. That fact, along with concerns in Washington to restrict the proliferation of nuclear weapons, led to opposition to rival enrichment programs. Whitlam and Connor miscalculated here. Ratifying the Nuclear Non-proliferation Treaty was not enough to stay opposition to raising a loan designed mainly to give Australia an enrichment program. [source] Plants and Human Affairs in North AmericaCONSERVATION BIOLOGY, Issue 2 2000Peggy L. Fiedler No abstract is available for this article. [source] A Development Delivery Institution for the Tribal Communities: Experience of the National Rural Employment Guarantee Scheme in IndiaDEVELOPMENT POLICY REVIEW, Issue 4 2010Pulak Mishra This article examines the varied impacts of the National Rural Employment Guarantee Scheme (NREGS) as a development delivery institution for the tribal communities vis-à-vis other social groups across the Indian States, using the framework of new institutional economics. A number of State-specific, socio-economic institutional factors seem to be responsible for these variations. The article therefore suggests institutional reforms and convergence of the development initiatives of the Ministry of Tribal Affairs with the NREGS in order to realise the optimal potential of the scheme, and, in particular, to ensure greater livelihood opportunities for these marginalised groups and their entitlement to productive resources with greater socio-economic and political empowerment. [source] Predictors of injury-related and non-injury-related mortality among veterans with alcohol use disordersADDICTION, Issue 10 2010Sylwia Fudalej ABSTRACT Aims To describe the association between alcohol use disorders (AUDs) and mortality and to examine risk factors for and all-cause, injury-related and non-injury-related mortality among those diagnosed with an AUD. Setting Department of Veterans Affairs, Veterans Health Administration (VHA). Participants A cohort of individuals who received health care in VHA during the fiscal year (FY) 2001 (n = 3 944 778), followed from the beginning of FY02 through the end of FY06. Measurements Demographics and medical diagnoses were obtained from VHA records. Data on mortality were obtained from the National Death Index. Findings Controlling for age, gender and race and compared to those without AUDs, individuals with AUDs were more likely to die by all causes [hazard ratio (HR) = 2.30], by injury-related (HR = 3.29) and by non-injury-related causes (HR = 2.21). Patients with AUDs died 15 years earlier than individuals without AUDs on average. Among those with AUDs, Caucasian ethnicity and all mental illness diagnoses that were assessed were associated more strongly with injury-related than non-injury-related mortality. Also among those with AUDs, individuals with medical comorbidity and older age were at higher risk for non-injury related compared to injury-related mortality. Conclusions In users of a large health-care system, a diagnosis of an AUD is associated significantly with increased likelihood of dying by injury and non-injury causes. Patients with a diagnosis of an AUD who die from injury differ significantly from those who die from other medical conditions. Prevention and intervention programs could focus separately upon selected groups with increased risk for injury or non-injury-related death. [source] SIR ALAN WALTERS' ROLE IN THE REVIVAL OF CURRENCY BOARDS1ECONOMIC AFFAIRS, Issue 2 2009John GreenwoodArticle first published online: 1 JUN 200 In a speech given in 2004, at a meeting held at the Institute of Economic Affairs in honour of Sir Alan Walters who died in 2009, John Greenwood explains Sir Alan's critical role in the creation of a currency board in Hong Kong in 1983. [source] FREE TRADE, ,PAUPER LABOUR' AND PROSPERITY: A REPLY TO PROFESSOR MISHANECONOMIC AFFAIRS, Issue 1 2006John Meadowcroft In an Economic Viewpoint published in the September 2005 edition of Economic Affairs, ,Can Globalisation Depress Living Standards in the West?', Professor E. J. Mishan argued that globalisation may reduce living standards in the West by decreasing the labour,capital ratio in developed countries as firms move production to countries where labour is cheaper and/or migrants to the West from the developing world bid down wage rates. In a reply to Professor Mishan's article, Dr John Meadowcroft argues that this view of globalisation is far too pessimistic and explains why free trade, not protection, will secure the prosperity of developed and developing economies. In a final comment, Professor Mishan responds to this critique of his analysis. [source] Inpatient substance abuse care and the outcome of subsequent community residential and outpatient careADDICTION, Issue 6 2000Rudolf H. Moos Aim. To compare participation in treatment and 1-year substance use, symptom and functioning outcomes between patients with substance use disorders who did versus those who did not have an episode of inpatient care immediately prior to an episode of community residential and outpatient mental health care. Design. Two matched groups of 257 patients each with substance use disorders were assessed at entry to and discharge from a community residential facility (CRF) and at a 1-year follow-up. Findings. Patients in the two treatment groups received a comparable amount of CRF and outpatient mental health care. Nevertheless, patients who had prior inpatient care were more likely to be employed at 1-year follow-up. In addition, when they entered CRF care directly, patients with co-morbid psychiatric disorders were more likely to continue use of alcohol and drugs in the CRF and less likely to complete the program. These patients also experienced more distress and psychiatric symptoms, and were less likely to be employed at the 1-year follow-up. Conclusions. Among patients who seek treatment at Department of Veterans Affairs (VA) facilities, those who have both substance use and psychiatric disorders and enter CRF care directly have somewhat worse outcomes than those who have an immediately prior episode of inpatient care. [source] Democratic Accountability and National Parliaments: Redefining the Impact of Parliamentary Scrutiny in EU AffairsEUROPEAN LAW JOURNAL, Issue 4 2007Katrin Auel Such an evaluation, however, is flawed: Formal mandating rights are usually incompatible with the overall logic of parliamentary systems, which explains why most national parliaments make very little use of them. Even more importantly, it unduly reduces parliamentary functions to the legislative or policy-making function. Drawing on agency theory, it will instead be argued that the functions of public deliberation and of holding the government publicly to account are at least as important and therefore need to be included in a redefined concept of parliamentary strength. In particular, the article proposes a distinction between two different elements of accountability,monitoring and political scrutiny,which recognises parliamentary majority and opposition as two distinct agents of the electorate. [source] Beyond the Trauma of Betrayal: Reconsidering Affairs in Couples TherapyFAMILY PROCESS, Issue 2 2005Michele Scheinkman First page of article [source] Capturing the power of academic medicine to enhance health and health care of the elderly in the USAGERIATRICS & GERONTOLOGY INTERNATIONAL, Issue 1 2004William R Hazzard As in Japan, the US population is aging progressively, a trend that will challenge the health-care system to provide for the chronic, multiple and complex needs of its elderly citizens. and as in Japan, the US academic health enterprise has only belatedly mounted a response to that challenge. Herein is reviewed a quarter of a century of the author's personal experience in developing new programs in gerontology and geriatric medicine from a base in the Department of Internal Medicine at three US academic health centers (AHC): The University of Washington (as Division Head), Johns Hopkins University (as Vice-Chair), and Wake Forest University (as Chair). Rather than to build a program from a new department of geriatrics, this strategy was chosen to capture the power and resources of the department of internal medicine, the largest university department, to ,gerontologize' the institution, beginning with general internal medicine and all of the medical subspecialties (the approach also chosen to date at all but a handful of US AHC). The keystone of success at each institution has been careful faculty development through fellowship training in clinical geriatrics, education and research. Over the same interval major national progress has occurred, including expanded research and training at the National Institute on Aging and the Department of Veterans Affairs, and accreditation of more than 100 fellowship programs for training and certification of geriatricians. However, less than 1% of US medical graduates elect to pursue such training. Hence such geriatricians will remain concentrated at AHC, and most future geriatric care in the USA will be provided by a broad array of specialists, who will be educated and trained in geriatrics by these academic geriatricians. [source] The experiences of non-medical health professionals undertaking community-based health assessments for people aged 75 years and overHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 2 2002Julie E. Byles BMed PhD Abstract Our objective was to explore the perceptions of allied health professionals who conducted over 3000 home-based health assessments within the general-practice-dominated Australian primary healthcare system. A series of semistructured qualitative interviews were carried out within the Department of Veterans' Affairs ,Preventive Care Trial', where health assessments are undertaken by health professionals in the homes of participating veterans and war widows. Health professionals were employed within the Preventive Care Trial to conduct assessments in 10 areas of New South Wales and Queensland. Subjects were mainly registered nurses, but also included a social worker, an occupational therapist, a physiotherapist and a psychologist. The health professionals described positive attitudes towards the health assessments, and showed that they have the broad range of necessary personal and professional skills to undertake them. Home visits were seen as an essential component and the most useful aspects included direct observation of home safety and medications. This study demonstrates that health assessments for older people can be acceptably and competently undertaken by suitably qualified allied health professionals, and that an effective collaborative approach to patient care can be achieved through such a system. [source] Health care funding levels and patient outcomes: a national studyHEALTH ECONOMICS, Issue 4 2007Margaret M. Byrne Abstract Background: Health care funding levels differ significantly across geographic regions, but there is little correlation between regional funding levels and outcomes of elderly Medicare beneficiaries. Our goal was to determine whether this relationship holds true in a non-Medicare population cared for in a large integrated health care system with a capitated budget allocation system. Methods: We explored the association between health care funding and risk-adjusted mortality in the 22 Veterans Affairs (VA) geographic Networks over a six-year time period. Allocations to Networks were adjusted for illness burden using Diagnostic Cost Groups. To test the association between funding and risk-adjusted three-year mortality, we ran logistic regressions with single-year patient cohorts, as well as hierarchical regressions on a six year longitudinal data set, clustering on VA Network. Results: A $1000 increase in funding per unit of patient illness burden was associated with a 2,8% reduction in three-year mortality in cross sectional regressions. However, in longitudinal hierarchical regressions clustering on Network, the significant effect of funding level was eliminated. Conclusions: When longitudinal data are used, the significant cross sectional effect of funding levels on mortality disappear. Thus, the factors driving differences in mortality are Network effects, although part of the Network effect may be due to past levels of funding. Our results provide a caution for cross sectional examinations of the association between regional health care funding levels and health outcomes. Copyright © 2006 John Wiley & Sons, Ltd. [source] Clinical Practice Guideline Implementation Strategy Patterns in Veterans Affairs Primary Care ClinicsHEALTH SERVICES RESEARCH, Issue 1p1 2007Sylvia J. Hysong Background. The Department of Veterans Affairs (VA) mandated the system-wide implementation of clinical practice guidelines (CPGs) in the mid-1990s, arming all facilities with basic resources to facilitate implementation; despite this resource allocation, significant variability still exists across VA facilities in implementation success. Objective. This study compares CPG implementation strategy patterns used by high and low performing primary care clinics in the VA. Research Design. Descriptive, cross-sectional study of a purposeful sample of six Veterans Affairs Medical Centers (VAMCs) with high and low performance on six CPGs. Subjects. One hundred and two employees (management, quality improvement, clinic personnel) involved with guideline implementation at each VAMC primary care clinic. Measures. Participants reported specific strategies used by their facility to implement guidelines in 1-hour semi-structured interviews. Facilities were classified as high or low performers based on their guideline adherence scores calculated through independently conducted chart reviews. Findings. High performing facilities (HPFs) (a) invested significantly in the implementation of the electronic medical record and locally adapting it to provider needs, (b) invested dedicated resources to guideline-related initiatives, and (c) exhibited a clear direction in their strategy choices. Low performing facilities exhibited (a) earlier stages of development for their electronic medical record, (b) reliance on preexisting resources for guideline implementation, with little local adaptation, and (c) no clear direction in their strategy choices. Conclusion. A multifaceted, yet targeted, strategic approach to guideline implementation emphasizing dedicated resources and local adaptation may result in more successful implementation and higher guideline adherence than relying on standardized resources and taxing preexisting channels. [source] The Logic of Access to the European Parliament: Business Lobbying in the Committee on Economic and Monetary AffairsJCMS: JOURNAL OF COMMON MARKET STUDIES, Issue 3 2004Pieter Bouwen This article is an attempt to test empirically a theory of access that investigates the logic behind the lobbying behaviour of business interests in the European Parliament. The theoretical framework tries to explain the degree of access of different organizational forms of business interest representation (companies, associations and consultants) to the supranational assembly in terms of a theory of the supply and demand of ,access goods'. On the basis of 14 exploratory and 27 semi-structured interviews, the hypotheses are checked in the Committee on Economic and Monetary Affairs (ECON) of the European Parliament. Surprisingly, European and national associations enjoy a similar degree of access to the Parliament. Individual companies and consultants have a much lower degree of access than the two collective forms of interest representation. In the conclusion, these results are analysed in the light of the existing literature on party cohesion and coalition formation in the European Parliament. [source] Comparative Effectiveness Research Priorities at Federal Agencies: The View from the Department of Veterans Affairs, National Institute on Aging, and Agency for Healthcare Research and QualityJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 6 2010Timothy J. O'Leary MD In the last year, attention has been focused on translating federally sponsored health research into better health for Americans. Since the passage of the American Recovery and Reinvestment Act (ARRA) on February 17, 2009, ARRA funds to support Comparative Effectiveness Research (CER) have increased this focus. A large proportion of topical areas of interest in CER affects the older segment of the population. The Department of Veterans Affairs (VA), the National Institute on Aging (NIA), and the Agency for Healthcare Research and Quality (AHRQ) have supported robust research portfolios focused on aging populations that meet the varying definitions of CER. This short article briefly describes the research missions of the AHRQ, NIA, and VA. The various definitions of CER as the Congressional Budget Office, the Institute of Medicine, and the ARRA-established Federal Coordinating Council have put forward, as well as important topics for which CER is particularly needed, are then reviewed. Finally, approaches in which the three agencies support CER involving the aging population are set forth and opportunities for future CER research outlined. [source] Use of Medicare and Department of Veterans Affairs Health Care by Veterans with Dementia: A Longitudinal AnalysisJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 10 2009Carolyn W. Zhu PhD The objectives of this study were to examine longitudinal patterns of Department of Veterans Affairs (VA),only use, dual VA and Medicare use, and Medicare-only use by veterans with dementia. Data on VA and Medicare use were obtained from VA administrative datasets and Medicare claims (1998,2001) for 2,137 male veterans who, in 1997, used some VA services, had a formal diagnosis of Alzheimer's disease or vascular dementia in the VA, and were aged 65 and older. Generalized ordered logit models were used to estimate the effects of patient characteristics on use group over time. In 1998, 41.7% of the sample were VA-only users, 55.4% were dual users, and 2.9% were Medicare-only users. By 2001, 30.4% were VA-only users, 51.5% were dual users, and 18.1% were Medicare-only users. Multivariate results show that greater likelihood of Medicare use was associated with older age, being white, being married, having higher education, having private insurance or Medicaid, having low VA priority level, and living in a nursing home or dying during the year. Higher comorbidities were associated with greater likelihood of dual use as opposed to any single system use. Alternatively, number of functional limitations was associated with greater likelihood of Medicare-only use and less likelihood of VA-only use. These results imply that different aspects of veterans' needs have differential effects on where they seek care. Efforts to coordinate care between VA and Medicare providers are necessary to ensure that patients receive high-quality care, especially patients with multiple comorbidities. [source] Do Palliative Consultations Improve Patient Outcomes?JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 4 2008David Casarett MD OBJECTIVES: To determine whether inpatient palliative consultation services improve outcomes of care. DESIGN: Retrospective telephone surveys conducted with family members of veterans who received inpatient or outpatient care from a Department of Veterans Affairs (VA) medical facility in the last month of life. SETTING: Five VA Medical Centers or their affiliated nursing homes and outpatient clinics. PARTICIPANTS: Veterans had received inpatient or outpatient care from a participating VA in the last month of life. One family member completed each survey. MEASUREMENTS: The telephone survey assessed nine aspects of the care the patient received in his or her last month of life: the patient's well-being and dignity (4 items), adequacy of communication (5 items), respect for treatment preferences (2 items), emotional and spiritual support (3 items), management of symptoms (4 items), access to the inpatient facility of choice (1 item), care around the time of death (6 items), access to home care services (4 items), and access to benefits and services after the patient's death (3 items). RESULTS: Interviews were completed with 524 respondents. In a multivariable linear regression model, after adjusting for the likelihood of receiving a palliative consultation (propensity score), palliative care patients had higher overall scores: 65 (95% confidence interval (CI)=62,66) versus 54 (95% CI=51,56; P<.001) and higher scores for almost all domains. Earlier consultations were independently associated with better overall scores (,=0.003; P=.006), a difference that was attributable primarily to improvements in communication and emotional support. CONCLUSION: Palliative consultations improve outcomes of care, and earlier consultations may confer additional benefit. [source] Functional Incidental Training: A Randomized, Controlled, Crossover Trial in Veterans Affairs Nursing HomesJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 7 2005Joseph G. Ouslander MD Objectives: To test the effects of a rehabilitative intervention directed at continence, mobility, endurance, and strength (Functional Incidental Training (FIT)) in older patients in Department of Veterans Affairs (VA) nursing homes. Design: Randomized, controlled, crossover trial. Setting: Four VA nursing homes. Participants: All 528 patients in the nursing homes were screened; 178 were eligible, and 107 were randomized to an immediate intervention group (Group 1; n=52) and a delayed intervention group (Group 2; n=55). Intervention: Trained research staff provided the FIT intervention, which included prompted voiding combined with individualized, functionally oriented endurance and strength-training exercises offered four times per day, 5 days per week, for 8 weeks. Group 1 received the intervention while Group 2 served as a control group; then Group 2 received the intervention while Group 1 crossed over to no intervention. A total of 64 subjects completed the intervention phase of the trial. Measurements: Timed measures of walking or wheeling a wheelchair (mobility), sit-to-stand exercises, independence in locomotion and toileting as assessed using the Functional Independence Measure (FIM), one-repetition maximum weight for several measures of upper and lower body strength, frequency of urine and stool incontinence, and appropriate toileting ratios. Results: There was a significant effect of the FIT intervention on virtually all measures of endurance, strength, and urinary incontinence but not on the FIM for locomotion or toileting. The effects of FIT were observed when Group 1 received the intervention and was compared with the control group and when Group 2 crossed over to the intervention. Group 1 deteriorated in all measures during the 8-week crossover period. Within-person comparisons also demonstrated significant effects on all measures in the 64 participants who completed the intervention; 43 (67%) of these participants were "responders" based on maintenance or improvement in at least one measure of endurance, strength, and urinary incontinence. No adverse events related to FIT occurred during the study period. Conclusion: FIT improves endurance, strength, and urinary incontinence in older patients residing in VA nursing homes. Translating these positive benefits achieved under research conditions into practice will be challenging because of the implications of the intervention for staff workload and thereby the costs of care. [source] | |||||||||||||||||||||||||||||||||||||||||||||||||