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Facilities
Kinds of Facilities Terms modified by Facilities Selected Abstracts[Commentary] EMERGING ROLE OF SUPERVISED INJECTING FACILITIES IN HUMAN IMMUNODEFICIENCY VIRUS PREVENTIONADDICTION, Issue 4 2009M.-J. MILLOY No abstract is available for this article. [source] CHALLENGES OF NEW GENERATION SEISMIC TESTING FACILITIESEXPERIMENTAL TECHNIQUES, Issue 2 2001G. Benzoni First page of article [source] GEOGRAPHIC DISTRIBUTION OF ASSISTED LIVING FACILITIES IN BALTIMORE, MARYLANDJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 12 2009Theresa Cruthird-Rudd BS No abstract is available for this article. [source] INFECTION CONTROL IN LONG-TERM CARE FACILITIES: THE NEED FOR ENGAGEMENTJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 3 2009Denise R. Flinn MD No abstract is available for this article. [source] HEALTHCARE PROFESSIONAL SURVEYS: JUDICIOUS ANTIBIOTIC USE IN MINNESOTA LONG-TERM CARE FACILITIESJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 3 2007Pamala Gahr MPH No abstract is available for this article. [source] ASSESSMENT OF MICROBIAL CONTAMINANTS PRESENT ON VACUUM LOADERS IN SHELL EGG PROCESSING FACILITIESJOURNAL OF FOOD SAFETY, Issue 3 2008D.R. JONES ABSTRACT This study was conducted to determine the pathogen prevalence on vacuum loader cup surfaces. An off-line (birds housed off-site) and a mixed (birds housed on-site and eggs brought from outside production) operation shell egg processing facility were sampled three times each. Twenty vacuum loader cups were randomly rinsed with sterile saline per visit. Total aerobic microorganisms and Enterobacteriaceae were enumerated, and the prevalence of Salmonella, Campylobacter and Listeria was determined. Aerobic microorganisms were ,5 log cfu/mL, with higher levels noted in the mixed operation. Enterobacteriaceae levels averaged 2.5 log cfu/mL but were higher in the off-line facility. Campylobacter was detected in 1.6% of the samples. Salmonella was detected in 3.3% of the samples with isolates serotyped as Salmonella anatum and Salmonella heidelberg. There was a high prevalence of Listeria (72%). Confirmed isolates were identified as Listeria innocua (98.8%) and Listeria monocytogenes (1.2%). Identification of the populations present on the cup surfaces will allow for the development of more effective cleaning and disinfection programs. PRACTICAL APPLICATIONS Vacuum loaders have previously been determined to be reservoirs for microorganisms in shell egg processing plants. Assessing the prevalence of prominent foodborne pathogens (Salmonella, Campylobacter and Listeria) on the vacuum loader cup surface would allow for more targeted approaches to cleaning and sanitation. High levels of aerobic organisms and Enterobacteriaceae were detected (,5 and 2.5 log cfu/mL, respectively). Furthermore, Campylobacter and Salmonella were also found, but at low prevalence. Listeria was detected in 72% of the samples. Cleaning and sanitation programs currently utilized in shell egg processing facilities need to be reassessed, and new technologies need to be developed to address the presence of Salmonella, Campylobacter and Listeria. [source] MULTIPLE FACILITIES, STRATEGIC SPLITTING AND VERTICAL STRUCTURES: STABILITY, GROWTH AND DISTRIBUTION RECONSIDERED,THE MANCHESTER SCHOOL, Issue 5 2006DAN COFFEY This paper explores comparative cost structures when large firms split operations between separate production facilities in a way that puts pressure on wage rates and worker effort levels: one example of a ,divide and rule' strategy. It differentiates horizontal structures of this kind based on requirements for stability in a context of growing aggregate production vis-à-vis wages and effort. The analysis is formulated within a more general perspective that also considers vertical structures. It considers the implications for contemporary policy debates on desirable industrial forms, and concludes with a discussion of factors that might limit the scope for policies intended to promote industrial stability and redistribution via existing production networks. [source] DEVELOPMENT AND VALIDATION OF A NEW FACILITY FOR LOW EARTH ORBIT THERMAL CYCLING SIMULATIONEXPERIMENTAL TECHNIQUES, Issue 5 2009P. Micciché First page of article [source] MATERIAL PLANNING FOR A REMANUFACTURING FACILITYPRODUCTION AND OPERATIONS MANAGEMENT, Issue 2 2001GERALDO FERRER This article describes the first fully integrated material planning system to facilitate the management of a remanufacturing facility. A number of firms are already engaged in this activity. They remanufacture automobile, truck, and other vehicle components, like starters, alternators, transmissions, and so forth. These firms take in used components, disassemble them, and assemble saleable products from the good parts they find. There is considerable uncertainty in the supply of used components, the good parts in those components, and the demand for remanufactured products. Our system is based on material requirements planning logic, something that many firms in the industry are already familiar with. Meetings with experts in the industry were used to set the parameters of the system and evaluate its approach. [source] Adverse Event Reporting: Lessons Learned from 4 Years of Florida Office DataDERMATOLOGIC SURGERY, Issue 9 2005Brett Coldiron MD, FACP Background Patient safety regulations and medical error reporting systems have been at the forefront of current health care legislature. In 2000, Florida mandated that all physicians report, to a central collecting agency, all adverse events occurring in an office setting. Purpose To analyze the scope and incidence of adverse events and deaths resulting from office surgical procedures in Florida from 2000 to 2004. Methods We reviewed all reported adverse incidents (the death of a patient, serious injury, and subsequent hospital transfer) occurring in an office setting from March 1, 2000, through March 1, 2004, from the Florida Agency for Health Care Administration. We determined physician board certification status, hospital privileges, and office accreditation via telephone follow-up and Internet searches. Results Of 286 reported office adverse events, 77 occurred in association with an office surgical procedure (19 deaths and 58 hospital transfers). There were seven complications and five deaths associated with the use of intravenous sedation or general anesthesia. There were no adverse events associated with the use of dilute local (tumescent) anesthesia. Liposuction and/or abdominoplasty under general anesthesia or intravenous sedation were the most common surgical procedures associated with a death or complication. Fifty-three percent of offices reporting an adverse incident were accredited by the Joint Commission on Accreditation of Healthcare Organizations, American Association for Accreditation of Ambulatory Surgical Facilities, or American Association for Ambulatory Health Care. Ninety-four percent of the involved physicians were board certified, and 97% had hospital privileges. Forty-two percent of the reported deaths were delayed by several hours to weeks after uneventful discharge or after hospital transfer. Conclusions Requiring physician board certification, physician hospital privileges, or office accreditation is not likely to reduce office adverse events. Restrictions on dilute local (tumescent) anesthesia for liposuction would not reduce adverse events and could increase adverse events if patients are shifted to riskier approaches. State and/or national legislation establishing adverse event reporting systems should be supported and should require the reporting of delayed deaths. [source] Adolescent inhalant use, abuse and dependenceADDICTION, Issue 7 2009Brian E. Perron ABSTRACT Aims To compare adolescent inhalant users without DSM-IV inhalant use disorders (IUDs) to youth with IUDs (i.e. abuse or dependence) across demographic, psychosocial and clinical measures. Design Cross-sectional survey with structured psychiatric interviews. Setting Facilities (n = 32) comprising the Missouri Division of Youth Services (MDYS) residential treatment system for juvenile offenders. Participants Current MDYS residents (n = 723); 97.7% of residents participated. Most youth were male (87%) and in mid-adolescence (mean = 15.5 years, standard deviation = 1.2, range = 11,20); more than one-third (38.6%, n = 279) reported life-time inhalant use. Measurements Antisocial behavior, temperament, trauma-exposure, suicidality, psychiatric symptoms and substance-related problems. Findings Among life-time inhalant users, 46.9% met criteria for a life-time DSM-IV IUD (inhalant abuse = 18.6%, inhalant dependence = 28.3%). Bivariate analyses showed that, in comparison to non-users, inhalant users with and without an IUD were more likely to be Caucasian, live in rural or small towns, have higher levels of anxiety and depressive symptoms, evidence more impulsive and fearless temperaments and report more past-year antisocial behavior and life-time suicidality, traumatic experiences and global substance use problems. A monotonic relationship between inhalant use, abuse and dependence and adverse outcomes was observed, with comparatively high rates of dysfunction observed among inhalant-dependent youth. Multivariate regression analyses showed that inhalant users with and without an IUD had greater levels of suicidal ideation and substance use problems than non-users. Conclusions Youth with IUDs have personal histories characterized by high levels of trauma, suicidality, psychiatric distress, antisocial behavior and substance-related problems. A monotonic relationship between inhalant use, abuse and dependence and serious adverse outcomes was observed. [source] Guidelines for Essential Services, Personnel, and Facilities in Specialized Epilepsy Centers in the United StatesEPILEPSIA, Issue 6 2001The National Association of Epilepsy Centers First page of article [source] Incarcerated Mothers and Fathers: A Comparison of Risks for Children and FamiliesFAMILY RELATIONS, Issue 5 2007Danielle H. Dallaire Abstract: The current study investigates differences between inmate mothers' and fathers' reported rates of incarceration for family members, adult children, predictors of adult children's incarceration, and living situations of minor children. Participants included 6,146 inmates who participated in the U.S. Department of Justice Survey of Inmates in State and Federal Correctional Facilities. Mothers were 2.5 times more likely to report that their adult children were incarcerated than fathers; mothers' regular drug use predicted adult child incarceration. Incarcerated mothers reported greater familial incarceration and their minor children were more likely to be in foster and other nonfamilial care situations than incarcerated fathers. As risk factors accumulated, there were greater rates of adult child incarceration, with a more obvious relationship for mothers. [source] A Family of Location Models for Multiple-Type Discrete DispersionGEOGRAPHICAL ANALYSIS, Issue 3 2006Kevin M. Curtin One of the defining objectives in location science is to maximize dispersion. Facilities can be dispersed for a wide variety of purposes, including attempts to optimize competitive market advantage, disperse negative impacts, and optimize security. With one exception, all of the extant dispersion models consider only one type of facility, and ignore problems where multiple types of facilities must be located. We provide examples where multiple-type dispersion is appropriate and based on this develop a general class of facility location problems that optimize multiple-type dispersion. This family of models expands on the previously formulated definitions of dispersion for single types of facilities, by allowing the interactions among different types of facilities to determine the extent to which they will be spatially dispersed. We provide a set of integer-linear programming formulations for the principal models of this class and suggest a methodology for intelligent constraint elimination. We also present results of solving a range of multiple-type dispersion problems optimally and demonstrate that only the smallest versions of such problems can be solved in a reasonable amount of computer time using general-purpose optimization software. We conclude that the family of multiple-type dispersion models provides a more comprehensive, flexible, and realistic framework for locating facilities where weighted distances should be maximized, when compared with the special case of locating only a single type of facility. [source] Self-efficacy, social support and service integration at medical cannabis facilities in the San Francisco Bay area of CaliforniaHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 1 2008Amanda E. Reiman PhD MSW Abstract In an effort to examine and possibly utilise the community-based, bottom-up service design of medical cannabis facilities in the San Francisco Bay area of California, 130 adults who had received medical cannabis recommendations from a physician were surveyed at seven facilities to describe the social service aspects of these unique, community-based programmes. This study used an unselected consecutive sample and cross-sectional survey design that included primary data collection at the medical cannabis facilities themselves. In this exploratory study, individual level data were collected on patient demographics and reported patient satisfaction as gathered by the Patient Satisfaction Questionnaire III. Surveys were filled out onsite. In the case of a refusal, the next person was asked. The refusal rate varied depending on the study site and ranged between 25% and 60%, depending on the facility and the day of sampling. Organisational-level data, such as operating characteristics and products offered, created a backdrop for further examination into the social services offered by these facilities and the attempts made by this largely unregulated healthcare system to create a community-based environment of social support for chronically ill people. Informal assessment suggests that chronic pain is the most common malady for which medical cannabis is used. Descriptive statistics were generated to examine sample- and site-related differences. Results show that medical cannabis patients have created a system of dispensing medical cannabis that also includes services such as counselling, entertainment and support groups , all important components of coping with chronic illness. Furthermore, patients tend to be male, over 35, identify with more than one ethnicity, and earn less than US$20 000 annually. Levels of satisfaction with facility care were fairly high, and higher than nationally reported satisfaction with health care in the USA. Facilities tended to follow a social model of cannabis care, including allowing patients to use medicine onsite and offering social services. This approach has implications for the creation and maintenance of a continuum of care among bottom-up social and health services agencies. [source] Predictors of Chain Acquisition among Independent Dialysis FacilitiesHEALTH SERVICES RESEARCH, Issue 2 2010Alyssa S. Pozniak Objective. To determine the predictors of chain acquisition among independent dialysis providers. Data Sources. Retrospective facility-level data combined from CMS Cost Reports, Medical Evidence Forms, Annual Facility Surveys, and claims for 1996,2003. Study Design. Independent dialysis facilities' probability of acquisition by a dialysis chain (overall and by chain size) was estimated using a discrete time hazard rate model, controlling for financial and clinical performance, practice patterns, market factors, and other facility characteristics. Data Collection. The sample includes all U.S. freestanding dialysis facilities that report not being chain affiliated for at least 1 year between 1997 and 2003. Principal Findings. Above-average costs and better quality outcomes are significant determinants of dialysis chain acquisition. Facilities in larger markets were more likely to be acquired by a chain. Furthermore, small dialysis chains have different acquisition strategies than large chains. Conclusions. Dialysis chains appear to employ a mix of turn-around and cream-skimming strategies. Poor financial health is a predictor of chain acquisition as in other health care sectors, but the increased likelihood of chain acquisition among higher quality facilities is unique to the dialysis industry. Significant differences among predictors of acquisition by small and large chains reinforce the importance of using a richer classification for chain status. [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] A National Study of Efficiency for Dialysis Centers: An Examination of Market Competition and Facility Characteristics for Production of Multiple Dialysis OutputsHEALTH SERVICES RESEARCH, Issue 3 2002Hacer Ozgen Objective. To examine market competition and facility characteristics that can be related to technical efficiency in the production of multiple dialysis outputs from the perspective of the industrial organization model. Study Setting. Freestanding dialysis facilities that operated in 1997 submitted cost report forms to the Health Care Financing Administration (HCFA), and offered all three outputs,outpatient dialysis, dialysis training, and home program dialysis. Data Sources. The Independent Renal Facility Cost Report Data file (IRFCRD) from HCFA was utilized to obtain information on output and input variables and market and facility features for 791 multiple-output facilities. Information regarding population characteristics was obtained from the Area Resources File. Study Design. Cross-sectional data for the year 1997 were utilized to obtain facility-specific technical efficiency scores estimated through Data Envelopment Analysis (DEA). A binary variable of efficiency status was then regressed against its market and facility characteristics and control factors in a multivariate logistic regression analysis. Principal Findings. The majority of the facilities in the sample are functioning technically inefficiently. Neither the intensity of market competition nor a policy of dialyzer reuse has a significant effect on the facilities' efficiency. Technical efficiency is significantly associated, however, with type of ownership, with the interaction between the market concentration of for-profits and ownership type, and with affiliations with chains of different sizes. Nonprofit and government-owned facilities are more likely than their for-profit counterparts to become inefficient producers of renal dialysis outputs. On the other hand, that relationship between ownership form and efficiency is reversed as the market concentration of for-profits in a given market increases. Facilities that are members of large chains are more likely to be technically inefficient. Conclusions. Facilities do not appear to benefit from joint production of a variety of dialysis outputs, which may explain the ongoing tendency toward single-output production. Ownership form does make a positive difference in production efficiency, but only in local markets where competition exists between nonprofit and for-profit facilities. The increasing inefficiency associated with membership in large chains suggests that the growing consolidation in the dialysis industry may not, in fact, be the strategy for attaining more technical efficiency in the production of multiple dialysis outputs. [source] Standing Facilities and Interbank Borrowing: Evidence from the Federal Reserve's New Discount WindowINTERNATIONAL FINANCE, Issue 3 2003Craig Furfine Standing facilities are designed to place an upper bound on the rates at which financial institutions lend to one another overnight, reducing the volatility of the overnight interest rate, typically the rate targeted by central banks. However, improper design of the facility might decrease a bank's incentive to participate actively in the interbank market. Thus, the mere availability of central-bank-provided credit may lead to its use being greater than what would be expected based on the characteristics of the interbank market. By contrast, however, banks may perceive a stigma from using such facilities, and thus borrow less than what one might expect, thereby reducing the facilities' effectiveness at reducing interest rate volatility. We develop a model demonstrating these two alternative implications of a standing facility. Empirical predictions of the model are then tested using data from the Federal Reserve's new primary credit facility and the US federal funds market. A comparison of data from before and after recent changes to the discount window suggests continued reluctance to borrow from the Federal Reserve. [source] Variation in Perspective: The Employment Success of Ethnic Minority Males in the Netherlands, 1988,2002INTERNATIONAL MIGRATION, Issue 4 2004Pieter Bevelander This article investigates the job chances of ethnic minority males in the Dutch labour market. Using information from the Social Position and Use of Facilities by Immigrants (SPVA) surveys for the years 1988, 1991, 1994, 1998, and 2002, we trace the employment pattern of various ethnic minority groups and Dutch natives, and study some determining factors for the job chances in the Netherlands during this period. The analysis reveals a clear variation in the employment patterns for different ethnic minority groups. Individual characteristics, such as marital status and especially educational level, turn out to be important factors in explaining the job chances for all groups. Moreover, support is found for the effect of the regional demand for labour on the employment chances for most of the analysed ethnic groups, which implies that no support is found for the queuing theory. [source] Psycho-social factors affecting elders' maltreatment in long-term care facilitiesINTERNATIONAL NURSING REVIEW, Issue 1 2010M. Ben Natan rn Natan M.B., Lowenstein A. & Eisikovits Z. (2010) Psycho-social Factors Affecting Elders' Maltreatment in Long-term Care Facilities. International Nursing Review57, 113,120 Aim:, To examine and analyse major variables affecting maltreatment of elderly nursing home residents. The study was based on two theoretical paradigms: the theoretical model for predicting causes of maltreatment of elderly residents developed by Pillemer, and the Theory of Reasoned Action developed by Ajzen & Fishbein. Methods:, The study employed a correlational quantitative method. The research population consisted of the staff of 22 nursing homes in Israel. Six hundred questionnaires were distributed in these facilities and 510 were completed and returned (85%). In addition, 24 questionnaires were distributed among directors of the facilities and 22 were returned (91.6%). Findings:, Slightly more than half of the staff sampled reported abuse of elderly residents over the past year, as manifested in one or more of types of maltreatment. The total number of various types of maltreatment reported was 513. About two-thirds of the cases were incidents of neglect. Seventy per cent of respondents reported that they had been present at incidents in which another staff member abused an elderly resident in one or more types of maltreatment, and in such situations mental abuse and mental neglect were the most prevalent forms of maltreatment. Conclusion and Recommendations:, This is the first study to examine elder maltreatment in the long-term care population of Israel. The research findings produce an expanded and improved research model investigating elder maltreatment in long-term nursing homes. [source] The Three-Hierarchical Location-Allocation of Banking Facilities with Risk and UncertaintyINTERNATIONAL TRANSACTIONS IN OPERATIONAL RESEARCH, Issue 4 2001H. Min The location-allocation of commercial banking facilities often involves providing three layers of services (automatic teller machines, branch bank offices, and main banks) to non-homogeneous population centers. As such, the bank location-allocation problem is hierarchical in nature. Nevertheless, the existing literature to date has neglected to consider the internal dynamics and functional dependence of different hierarchies of banking services. To help the commercial banking organization formulate viable location-allocation strategies in the ever-uncertain and volatile banking industry, this paper proposes a stochastic, three-hierarchical location-allocation model for successively arranging the spatial patterns of banking facilities. [source] Randomized Trial of a Delirium Abatement Program for Postacute Skilled Nursing FacilitiesJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 6 20100000], [See editorial comments by Dr. Steven A. Levenson on pp 0000 OBJECTIVES: To determine whether a delirium abatement program (DAP) can shorten duration of delirium in new admissions to postacute care (PAC). DESIGN: Cluster randomized controlled trial. SETTING: Eight skilled nursing facilities specializing in PAC within a single metropolitan region. PARTICIPANTS: Four hundred fifty-seven participants with delirium at PAC admission. INTERVENTION: The DAP consisted of four steps: assessment for delirium within 5 days of PAC admission, assessment and correction of common reversible causes of delirium, prevention of complications of delirium, and restoration of function. MEASUREMENTS: Trained researchers screened eligible patients. Those with delirium defined according to the Confusion Assessment Method were eligible for participation using proxy consent. Regardless of location, researchers blind to intervention status re-assessed participants for delirium 2 weeks and 1 month after enrollment. RESULTS: Nurses at DAP sites detected delirium in 41% of participants, versus 12% in usual care sites (P<.001), and completed DAP documentation in most participants in whom delirium was detected, but the DAP intervention had no effect on delirium persistence based on two measurements at 2 weeks (DAP 68% vs usual care 66%) and 1 month (DAP 60% vs usual care 51%) (adjusted P,.20). Adjusting for baseline differences between DAP and usual care participants and restricting analysis to DAP participants in whom delirium was detected did not alter the results. CONCLUSION: Detection of delirium improved at the DAP sites, but the DAP had no effect on the persistence of delirium. This effectiveness trial demonstrated that a nurse-led DAP intervention was not effective in typical PAC facilities. [source] The Effect of a High-Intensity Functional Exercise Program on Activities of Daily Living: A Randomized Controlled Trial in Residential Care FacilitiesJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 10 2009Håkan Littbrand PT OBJECTIVES: To evaluate whether a high-intensity functional weight-bearing exercise program reduces dependency in activities of daily living (ADLs) in older people living in residential care facilities, focusing on people with dementia. DESIGN: Randomized, controlled trial. SETTING: Nine residential care facilities. PARTICIPANTS: One hundred ninety-one older people dependent in ADLs and with a Mini-Mental State Examination score of 10 or greater. One hundred (52.4%) of the participants had dementia. INTERVENTION: A high-intensity functional weight-bearing exercise program or a control activity consisting of 29 sessions over 3 months. MEASUREMENTS: The Barthel ADL Index; follow-up at 3 months (directly after the intervention) and 6 months with intention-to-treat analyses. RESULTS: There were no statistically significant differences between the groups regarding overall ADL performance. Analyses for each item revealed that a smaller proportion of participants in the exercise group had deteriorated in indoor mobility at 3 months (exercise 3.5% vs control 16.0%, P=.01) and 6 months (7.7% vs 19.8%, P=.03). For people with dementia, there was a significant difference in overall ADL performance in favor of the exercise group at 3 months (mean difference 1.1, P=.03) but not at 6 months. CONCLUSION: A high-intensity functional weight-bearing exercise program seems to reduce ADL decline related to indoor mobility for older people living in residential care facilities. The program does not appear to have an overall effect on ADLs. In people with dementia, the exercise program may prevent decline in overall ADL performance, but continuous training may be needed to maintain that effect. [source] Clinical Practice Guideline for the Evaluation of Fever and Infection in Older Adult Residents of Long-Term Care Facilities: 2008 Update by the Infectious Diseases Society of AmericaJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 3 2009Kevin P. High MD Residents of long-term care facilities (LTCFs) are at great risk for infection. Most residents are older and have multiple comorbidities that complicate recognition of infection; for example, typically defined fever is absent in more than one-half of LTCF residents with serious infection. Furthermore, LTCFs often do not have the on-site equipment or personnel to evaluate suspected infection in the fashion typically performed in acute care hospitals. In recognition of the differences between LTCFs and hospitals with regard to hosts and resources present, the Infectious Diseases Society of America first provided guidelines for evaluation of fever and infection in LTCF residents in 2000. The guideline presented here represents the second edition, updated by data generated over the intervening 8 years. It focuses on the typical elderly person institutionalized with multiple chronic comorbidities and functional disabilities (e.g., a nursing home resident). Specific topic reviews and recommendations are provided with regard to what resources are typically available to evaluate suspected infection, what symptoms and signs suggest infection in a resident of an LTCF, who should initially evaluate the resident with suspected infection, what clinical evaluation should be performed, how LTCF staff can effectively communicate about possible infection with clinicians, and what laboratory tests should be ordered. Finally, a general outline of how a suspected outbreak of a specific infectious disease should be investigated in an LTCF is provided. [source] Transitioning Residents from Nursing Facilities to Community Living: Who Wants to Leave?JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 1 2008(See editorial comments by Dr. Rosalie Kane, 165)., pp 16 OBJECTIVES: To examine nursing facility residents' or their legal proxies' perspectives on transitioning out of nursing facilities by assessing residents' perceptions of their ability to live more independently, their preferences regarding leaving the facility, and the feasibility of transitioning with community support. DESIGN: Analysis of survey findings from the California Nursing Facility Transition Screen (CNFTS). SETTING: Eight nursing facilities in southern California. PARTICIPANTS: All chronic maintenance, long-stay residents receiving Medi-Cal (California's Medicaid program) were eligible for the study (n=218). Of these, 121 (56%) self-consenting residents or legal proxies were interviewed. No presumptions were made as to which residents were appropriate candidates for transition based on health or functional capacity. MEASUREMENTS: CNFTS contains 27 open- and closed-ended questions on preference, ability, and feasibility of transitioning. RESULTS: Twenty-three percent of residents and proxies believed that the resident had the ability to transition; 46% indicated a preference to transition; and after discussing potential living arrangements and services, 33% thought that transitioning would be feasible. Of those who consented to allow access to their Minimum Data Set 2.0 (MDS) information (n=41; 34% of the sample), agreement in the assessment of preference was found in 39% of cases. CONCLUSION: Transition decisions are complex and include preference, as well as perceptions of the resident's ability to live in a more independent setting and the feasibility of transitioning. Compared with the MDS, the screen identified a higher proportion of residents who want to transition, suggesting that a systematic approach to assessing the complex decision to transition is needed. [source] Collaborative Clinical Quality Improvement for Pressure Ulcers in Nursing HomesJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 10 2007(See editorial comments by Dr. George Taler on pp 167, 1675) The National Nursing Home Improvement Collaborative aimed to reduce pressure ulcer (PU) incidence and prevalence. Guided by subject matter and process experts, 29 quality improvement organizations and six multistate long-term care corporations recruited 52 nursing homes in 39 states to implement recommended practices using quality improvement methods. Facilities monitored monthly PU incidence and prevalence, healing, and adoption of key care processes. In residents at 35 regularly reporting facilities, the total number of new nosocomial Stage III to IV PUs declined 69%. The facility median incidence of Stage III to IV lesions declined from 0.3 per 100 occupied beds per month to 0.0 (P<.001) and the incidence of Stage II to IV lesions declined from 3.2 to 2.3 per 100 occupied beds per month (P=.03). Prevalence of Stage III to IV lesions trended down (from 1.3 to 1.1 residents affected per 100 occupied beds (P=.12). The incidence and prevalence of Stage II lesions and the healing time of Stage II to IV lesions remained unchanged. Improvement teams reported that Stage II lesions usually healed quickly and that new PUs corresponded with hospital transfer, admission, scars, obesity, and immobility and with noncompliant, younger, or newly declining residents. The publicly reported quality measure, prevalence of Stage I to IV lesions, did not improve. Participants documented disseminating methods and tools to more than 5,359 contacts in other facilities. Results suggest that facilities can reduce incidence of Stage III to IV lesions, that the incidence of Stage II lesions may not correlate with the incidence of Stage III to IV lesions, and that the publicly reported quality measure is insensitive to substantial improvement. The project demonstrated multiple opportunities in collaborative quality improvement, including improving the measurement of quality and identifying research priorities, as well as improving care. [source] Effect of an Educational Intervention on Optimizing Antibiotic Prescribing in Long-Term Care FacilitiesJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 8 2007(See Editorial Comments by Dr. Lona Mody on pp 130, 1302) OBJECTIVE: To assess the effect of an educational intervention aimed at optimizing antibiotic prescribing in long-term care (LTC) facilities. DESIGN: Cluster randomized, controlled trial. SETTING: Eight public LTC facilities in the Montreal area. PARTICIPANTS: Thirty-six physicians. INTERVENTION: The educational intervention consisted of mailing an antibiotic guide to physicians along with their antibiotic prescribing profile covering the previous 3 months. Targeted infections were urinary tract, lower respiratory tract, skin and soft tissues, and septicemia of unknown origin. In the prescribing profile, each antibiotic was classified as adherent or nonadherent to the guide. Physicians in the experimental group received the intervention twice, 4 months apart, whereas physicians in the control group provided usual care. MEASUREMENTS: Data on antibiotic prescriptions were collected over four 3-month periods: preintervention, postintervention I, postintervention II, and follow-up. A generalized estimating equation (GEE) model was used to compare the proportion of nonadherent antibiotic prescriptions of the experimental and control groups. RESULTS: By the end of the study, nonadherent antibiotic prescriptions decreased by 20.5% in the experimental group, compared with 5.1% in the control group. Based on the GEE model, during postintervention II, physicians in the experimental group were 64% less likely to prescribe nonadherent antibiotics than those in the control group (odds ratio=0.36, 95% confidence interval=0.18,0.73). CONCLUSION: An educational intervention combining an antibiotic guide and a prescribing profile was effective in decreasing nonadherent antibiotic prescriptions. Repetition of the intervention at regular intervals may be necessary to maintain its effectiveness. [source] Do-Not-Resuscitate and Do-Not-Hospitalize Directives of Persons Admitted to Skilled Nursing Facilities Under the Medicare BenefitJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 12 2005Cari R. Levy MD Objectives: To determine prevalence and factors associated with do-not-resuscitate (DNR) and do-not-hospitalize (DNH) directives of residents admitted under the Medicare benefit to a skilled nursing facility (SNF). To explore geographic variation in use of DNR and DNH orders. Design: Retrospective cohort study. Setting: Nursing homes in the United States. Participants: Medicare admissions to SNFs in 2001 (n=1,962,742). Measurements: Logistic regression was used to select factors associated with DNR and DNH directives and state variation in their use. Results: Thirty-two percent of residents had DNR directives, whereas less than 2% had DNH directives. Factors associated with having a DNR or DNH directive at the resident level included older age, cognitive impairment, functional dependence, and Caucasian ethnicity. African-American, Hispanic, Asian, and North American Native residents were all significantly less likely than Caucasian residents to have DNR (adjusted odds ratio (OR)=0.35, 0.51, 0.61, and 0.62, respectively) or DNH (adjusted OR=0.26, 0.41, 0.43, and 0.67, respectively) directives. In contrast, residents in rural and government facilities were more likely to have DNR or DNH directives. After controlling for resident and facility characteristics, significant variation between states existed in the use of DNR and DNH directives. Conclusion: Ethnic minorities are less likely to have DNR and DNH directives even after controlling for disease status, demographic, facility, and geographic characteristics. Wide variation in the likelihood of having DNR and DNH directives between states suggests a need for better-standardized methods for eliciting the care preferences of residents admitted to SNFs under the Medicare benefit. [source] Economic Evaluation of Oseltamivir Phosphate for Postexposure Prophylaxis of Influenza in Long-Term Care FacilitiesJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 3 2005Nancy A. Risebrough MPhil Candidate Objectives: To compare the cost-effectiveness of oseltamivir postexposure prophylaxis during influenza A outbreaks with that of amantadine postexposure prophylaxis or no postexposure prophylaxis in long-term care facilities (LTCFs). Design: Cost-effectiveness analysis based on decision analytic model from a government-payer perspective. Setting: A Canadian LTCF, with high staff vaccination, at the beginning of influenza season. Participants: Elderly, influenza-vaccinated patients living in a Canadian LTCF. Measurements: Incremental costs (or savings) per influenza-like illness case avoided compared with usual care. Results: From a government-payer perspective, this analysis showed that oseltamivir was a dominant strategy because it was associated with the fewest influenza-like illness cases, with cost savings of $1,249 per 100 patients in 2001 Canadian dollars compared with amantadine and $3,357 per 100 patients compared with no prophylaxis. Costs for amantadine dose calculation and hospitalization for adverse events contributed to amantadine being a more-expensive prophylaxis strategy than oseltamivir. Both prophylaxis strategies were more cost-effective than no prophylaxis. Conclusion: Despite high influenza vaccination rates, influenza outbreaks continue to emerge in LTCFs, necessitating cost-effective measures to further limit the spread of influenza and related complications. Although amantadine has a lower acquisition cost than oseltamivir, it is associated with more adverse events, lower efficacy, and individualized dosing requirements, leading to higher overall costs and more influenza-like illness cases than oseltamivir. Therefore the use of oseltamivir postexposure prophylaxis is more cost-effective than the current standard of care with amantadine prophylaxis or no prophylaxis. [source] | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||