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Bhattacharyya, Kallol Kumar, Lindsay Peterson, John Bowblis, and Kathryn Hyer. "Analyzing Nursing Home Complaints: From Substantiated Allegation to Deficiency Citations." Innovation in Aging 4, Supplement_1 (December 1, 2020): 82–83. http://dx.doi.org/10.1093/geroni/igaa057.271.
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Abstract Complaints provide important information to consumers about nursing homes (NHs). Complaints that are substantiated often lead to an investigation and potentially a deficiency citation. The purpose of this study is to understand the relationship between substantiated complaints and deficiency citations. Because a complaint may contain multiple allegations, and the data do not identify which allegation(s) lead to a complaint’s substantiation, we identified all substantiated single allegation complaints for NHs in 2017. Our data were drawn from federally collected NH complaint and inspection records. Among the 369 substantiated single-allegation complaints, we found most were categorized as quality of care (31.7%), resident abuse (17.3%), or resident neglect (14.1%). Of the deficiency citations resulting from complaints in our sample, 27.9% were categorized as quality of care and 19.5% were in the category of resident behavior and facility practices, which includes abuse and neglect. While two-thirds (N=239) of the substantiated complaints generated from 1 to 19 deficiency citations, nearly one third had no citations. Surprisingly, 28% of substantiated abuse and neglect allegations resulted in no deficiency citations. More surprisingly, a fifth of complaints that were categorized as “immediate jeopardy” at intake did not result in any deficiency citations. We also found a number of asymmetries in the allegation categories suggesting different processes by Centers for Medicare and Medicaid Services (CMS) region. These results suggest that the compliant investigation process warrants further investigation. Other policy and practice implications, including the need for better and more uniform investigation processes and staff training, will be discussed.
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Castle, Nicholas G., Laura M. Wagner, Jamie C. Ferguson, and Steven M. Handler. "Nursing Home Deficiency Citations for Safety." Journal of Aging & Social Policy 23, no. 1 (December 30, 2010): 34–57. http://dx.doi.org/10.1080/08959420.2011.532011.
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Castle, Nicholas. "Nursing Home Deficiency Citations for Abuse." Journal of Applied Gerontology 30, no. 6 (August 4, 2010): 719–43. http://dx.doi.org/10.1177/0733464810378262.
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Sharma, Hari. "Trends in Deficiency Citations in Florida Assisted Living Facilities." Innovation in Aging 4, Supplement_1 (December 1, 2020): 86. http://dx.doi.org/10.1093/geroni/igaa057.283.
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Abstract Despite numerous anecdotal reports of poor quality and residential safety concerns in Assisted Living Facilities (ALFs), there is limited federal oversight of ALFs. Usually, state surveyors conduct inspections of ALFs for compliance with regulations and issue deficiency citations and/or fine non-compliant facilities. Florida is one of the few states that publicly releases inspections data. The aim of this study is to fill the gap in our understanding of ALF quality by examining the trends in deficiency citations in Florida. We obtain data on 1,047 ALFs with 25 or more beds operating in Florida between 2012-2018. We use descriptive methods to examine the trends in citations over time and further stratify by profit status. We also evaluate whether facilities get cited for the same deficiencies repeatedly. Every year, approximately, one third of the facilities were free of any deficiency citations. From 2012 to 2018, fewer facilities were cited for resident care and medication but more facilities were cited for training and staffing. Approximately 45.8% of not-for-profit and 35.1% of for-profit facilities were free of deficiency citations in 2018. A majority of facilities cited for a given deficiency were cited at least once again for that deficiency within the study period. Florida ALFs appear to be improving only in some deficiencies but getting worse in some other deficiencies. Furthermore, repeat citations are common suggesting that facilities fail to improve their care/service patterns to avoid repeat citations. More stringent regulations and stricter enforcements may deter facilities from repeat citations.
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Castle, Nicholas G., Kathryn Hyer, John A. Harris, and John Engberg. "Nurse Aide Retention in Nursing Homes." Gerontologist 60, no. 5 (March 6, 2020): 885–95. http://dx.doi.org/10.1093/geront/gnz168.
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Abstract Background and Objectives The association of nurse aide retention with three quality indicators is examined. Retention is defined as the proportion of staff continuously employed in the same facility for a defined period of time. Research Design and Methods Data used in this investigation came from survey responses from 3,550 nursing facilities, Certification and Survey Provider Enhanced Reporting data, and the Area Resource File. Staffing characteristics, quality indicators, facility, and market information from these data sources were all measured in 2016. Nurse aide retention was measured at 1, 2, and 3 years of employment. The quality indicators examined were a count of all deficiency citations, quality of care deficiency citations, and J, K, L deficiency citations. Negative binomial regression analyses were used to study the associations between the three different retention measures and these three quality indicators. Results The 1-, 2-, and 3-year nurse aide retention measures were 53.2%, 41.4%, and 36.1%, respectively. The regression analyses show low levels of retention to be generally associated with poor performance on the three deficiency citation quality indicators examined. Discussion and Implications The research presented starts to provide information on nurse aide retention as an important workforce challenge and its potential impact on quality. Retention may be an additional staffing characteristic of nursing facilities with substantial policy and practice relevance.
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Ye, Zhiqiu, and Bei Wu. "THE QUALITY OF DENTAL CARE IN NURSING HOMES: VARIATION BY FACILITY AND MARKET CHARACTERISTICS." Innovation in Aging 3, Supplement_1 (November 2019): S606—S607. http://dx.doi.org/10.1093/geroni/igz038.2259.
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Abstract Nursing home (NH) residents are disproportionately affected by poor oral health. But little we known about the root causes. We analyzed the 2000-2016 national inspection survey data for all certified-NHs (n=248,975 facility-years). Dental care performance was measured by two designated deficiency citations. Generalized estimating equation models were used to predict if the NH facility and market characteristics were associated with low performance. The rates of deficiency citation tripled from 1.2% in 2000 to 3.4% in 2016 (p<0.001) with substantial variation across states. NHs with more minority residents and poorer resources (higher share of Medicaid and lack of registered nurse), and NHs with high competing priorities (larger, for profit, chain-affiliated and urban locations) were more likely to receive deficiency citations. Residents in these facilities are at greater risks of poor oral health. This presentation will provide discussion on relevant policy and practice to improve dental care quality in nursing homes.
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McDonald, Shawna M., Laura M. Wagner, and Nicholas G. Castle. "Staffing-Related Deficiency Citations in Nursing Homes." Journal of Aging & Social Policy 25, no. 1 (January 2013): 83–97. http://dx.doi.org/10.1080/08959420.2012.705696.
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Castle, Nicholas, Laura Wagner, Jamie Ferguson, and Steven Handler. "Hand Hygiene Deficiency Citations in Nursing Homes." Journal of Applied Gerontology 33, no. 1 (August 2012): 24–50. http://dx.doi.org/10.1177/0733464812449903.
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Castle, Nicholas G., and John B. Engberg. "Nursing Home Deficiency Citations for Medication Use." Journal of Applied Gerontology 26, no. 2 (April 2007): 208–32. http://dx.doi.org/10.1177/0733464807300223.
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Castle, Nicholas G., Laura M. Wagner, Jamie C. Ferguson-Rome, Aiju Men, and Steven M. Handler. "Nursing home deficiency citations for infection control." American Journal of Infection Control 39, no. 4 (May 2011): 263–69. http://dx.doi.org/10.1016/j.ajic.2010.12.010.
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Castle, Nicholas, Kathryn Hyer, and John A. Harris. "THE INFLUENCE OF STAFF RETENTION ON NURSING HOME QUALITY." Innovation in Aging 3, Supplement_1 (November 2019): S701. http://dx.doi.org/10.1093/geroni/igz038.2578.
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Abstract The association of retention of Nurse Aides (NAs) with nursing home quality of care is examined. Retention is defined as staff continuously employed in the same facility for a defined period of time. Deficiency citations were used as quality indicators. Data used came from a survey of nursing home administrators, the Certification and Survey Provider Enhanced Reporting (CASPER) data, and the Area Resource File. All of the data was from 2015, and included 3,550 facilities. Analyses included negative binomial regression and multivariate logistic regression models (using GEE). The analytic modeling included staffing variables (turnover, agency use, staffing levels), facility factors (size, ownership, occupancy rate), and market characteristics (competition, Medicaid rates). The average number of deficiency citations was significantly lower (p<.01) in facilities with the higher levels of NAs consistently employed for one year or more. The same was found for facilities with the higher levels of NAs consistently employed for two years or more. While the average number of deficiency citations, the quality of care grouping of deficiency citations, and J, K, L deficiency citations were all significantly lower (p<.01) in facilities with the higher levels of NAs consistently employed for three years or more. Staff retention has been promoted as potentially influential based on little empirical evidence. The findings provide some justification for the importance of NA retention.
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Castle, Nicholas G., John Engberg, and Aiju Men. "Variation in the Use of Nursing Home Deficiency Citations." Journal For Healthcare Quality 29, no. 6 (November 2007): 12–23. http://dx.doi.org/10.1111/j.1945-1474.2007.tb00220.x.
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Smith, Kelly M., Kali S. Thomas, Shanthi Johnson, Hongdao Meng, and Kathryn Hyer. "Dietary Service Staffing Impact Nutritional Quality in Nursing Homes." Journal of Applied Gerontology 38, no. 5 (January 26, 2017): 639–55. http://dx.doi.org/10.1177/0733464816688309.
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Objective: To examine the relationship between dietary service staff and dietary deficiency citations in nursing homes (NHs). Method: 2007-2011 Online Survey and Certification and Reporting data for 14,881 freestanding NHs were used to examine the relationship between dietary service staff and the probability of receiving a dietary service–related deficiency citation. An unconditional logit model with random effects was employed. Results: Findings suggest that higher staffing levels for dietitians (odds ratio [OR] = .955; p < .01), dietary service personnel (OR = .996; p < .01), and certified nursing assistants (CNAs; OR = .981; p < .05) decrease the likelihood of receiving a dietary service deficiency citation. Conclusion: Higher levels of dietary service and CNA staffing levels have the potential to improve the quality of nutritional care in NHs. Findings help substantiate the Centers for Medicare and Medicaid Services’ proposed rules for more stringent Food and Nutrition Services in the NH setting and signify the need for further research relative to the impact of dietary service staff on nutritional and clinical outcomes.
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Stone, Patricia W., Carolyn T. A. Herzig, Mansi Agarwal, Monika Pogorzelska-Maziarz, and Andrew W. Dick. "Nursing Home Infection Control Program Characteristics, CMS Citations, and Implementation of Antibiotic Stewardship Policies: A National Study." INQUIRY: The Journal of Health Care Organization, Provision, and Financing 55 (January 1, 2018): 004695801877863. http://dx.doi.org/10.1177/0046958018778636.
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Recently, the Centers for Medicare & Medicaid Services (CMS) final rule required that nursing homes (NHs) develop an infection control program that includes an antibiotic stewardship component and employs a trained infection preventionist (IP). The objectives of this study were to provide a baseline assessment of (1) NH facility and infection control program characteristics associated with having an infection control deficiency citation and (2) associations between IP training and the presence of antibiotic stewardship policies, controlling for NH characteristics. A cross-sectional survey of 2514 randomly sampled US NHs was conducted to assess IP training, staff turnover, and infection control program characteristics (ie, frequency of infection control committee meetings and the presence of 7 antibiotic stewardship policies). Responses were linked to concurrent Certification and Survey Provider Enhanced Reporting data, which contain information about NH facility characteristics and citations. Descriptive statistics and multivariable regression analyses were conducted to account for NH characteristics. Surveys were received from 990 NHs; 922 had complete data. One-third of NHs in this sample received an infection control deficiency citation. The NHs that received deficiency citations were more likely to have committees that met weekly/monthly versus quarterly ( P < .01). The IPs in 39% of facilities had received specialized training. Less than 3% of trained IPs were certified in infection control. The NHs with trained IPs were more likely to have 5 of the 7 components of antibiotic stewardship in place (all P < .05). The IP training, although infrequent, was associated with the presence of antibiotic stewardship policies. Receiving an infection control citation was associated with more frequent infection control committee meetings. Training and support of IPs is needed to ensure infection control and antibiotic stewardship in NHs. As the CMS rule becomes implemented, more research is warranted. There is a need for increase in trained IPs in US NHs. These data can be used to evaluate the effectiveness of the CMS final rule on infection management processes in US NHs.
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Ye, Zhiqiu, and Bei Wu. "RACIAL-ETHNIC DISPARITY IN DENTAL CARE IN NURSING HOMES." Innovation in Aging 3, Supplement_1 (November 2019): S245. http://dx.doi.org/10.1093/geroni/igz038.920.
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Abstract Minority older adults are at higher risks of poor oral health. Little is known about the extent of and the contributing factors to racial/ethnic disparity in dental care quality in the long-term care settings. Previous studies suggest that organizational and system-level factors are key determinants of oral health among minority older adults. We examined the racial/ethnic disparity in dental care delivery in nursing homes (NHs) by facility and market characteristics. We analyzed the 2000-2016 national Inspection Survey data for all certified-NHs (n=248,975 facility-years). Two designated deficiency citations were used to measure dental care performance. Generalized estimating equations were used to compare the rates of deficiency citations among NHs in different quartiles of the share of minority residents, adjusting for facility characteristics, market characteristics, year and state fixed effects. Overall, compared to NHs in the lowest quartile of the share of minority residents (average % minority residents =0.24%), NHs in the highest quartile of the share of minority residents (average % minority residents = 46.5%) and those in the second highest share (average % minority residents=13.9%) had 46.8% and 31.2% higher odds of receiving dental care citations(p<0.001 for both), respectively. The increased citation rates persisted over time (p=0.40) and were greater among for-profit NHs (p=0.02). Our study suggests that minority older adults in NHs are disproportionately affected by poorer dental care performance. There is a great need to improve quality of dental care in NHs, particularly for those that are for-profit and those that disproportionately serve minority residents.
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Castle, Nicholas G. "Nursing Homes With Persistent Deficiency Citations for Physical Restraint Use." Medical Care 40, no. 10 (October 2002): 868–78. http://dx.doi.org/10.1097/00005650-200210000-00005.
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Castle, Nicholas G., and Beaufort B. Longest. "Administrative deficiency citations and quality of care in nursing homes." Health Services Management Research 19, no. 3 (August 2006): 144–52. http://dx.doi.org/10.1258/095148406777888107.
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Castle, N. G. "The Influence of Consistent Assignment on Nursing Home Deficiency Citations." Gerontologist 51, no. 6 (November 4, 2011): 750–60. http://dx.doi.org/10.1093/geront/gnr068.
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Wagner, Laura M., Shawna M. McDonald, and Nicholas G. Castle. "Nursing Home Deficiency Citations for Physical Restraints and Restrictive Side Rails." Western Journal of Nursing Research 35, no. 5 (March 4, 2012): 546–65. http://dx.doi.org/10.1177/0193945912437382.
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Wagner, L. M., S. M. McDonald, and N. G. Castle. "Impact of Voluntary Accreditation on Deficiency Citations in U.S. Nursing Homes." Gerontologist 52, no. 4 (March 5, 2012): 561–70. http://dx.doi.org/10.1093/geront/gnr136.
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Castle, Nicholas G., and Sarah Myers. "Mental Health Care Deficiency Citations in Nursing Homes and Caregiver Staffing." Administration and Policy in Mental Health and Mental Health Services Research 33, no. 2 (March 2006): 215–25. http://dx.doi.org/10.1007/s10488-006-0038-2.
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White, Diana, Tunalilar Ozcan, Serena Hasworth, and Jaclyn Winfree. "Quality in Assisted Living: Does It Lie in the Eyes of the Beholder?" Innovation in Aging 4, Supplement_1 (December 1, 2020): 726–27. http://dx.doi.org/10.1093/geroni/igaa057.2578.
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Abstract Quality is defined in multiple ways and by different stakeholders (e.g., residents, regulators, informed observers). Using a two-stage stratified sampling strategy, we collected data from N=241 residents living in 31 assisted living and residential care communities (AL/RC) in Oregon. Residents rated their overall satisfaction and satisfaction with the AL/RC as a place to live and to receive care. Each interviewer completed a facility profile summarizing their observations about the setting, including quality of staff-resident interactions and physical environment. Residents and interviewers were also asked whether they would recommend the community to others. Finally, we used deficiency citations given during regular inspections by the licensing agency to proxy regulatory perspective. Results show that perceived quality varied by stakeholder (e.g., residents’ assessments differed from deficiency citations). Given this variation, findings suggest that efforts to make quality indicators publicly available should include multiple measures and perspectives, especially residents.
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Jester, Dylan, Kathryn Hyer, and John Bowblis. "Deficiency Citations in Nursing Homes That Predominantly Serve Residents With Serious Mental Illness." Innovation in Aging 4, Supplement_1 (December 1, 2020): 88–89. http://dx.doi.org/10.1093/geroni/igaa057.292.
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Abstract Studies suggest that nursing homes (NHs) that predominantly serve residents with serious mental illness (SMI) are of worse quality due to poor resources (i.e., high Medicaid-paying census) and lower staffing. We used national Certification and Survey Provider Enhanced Reports (CASPER) data to examine the deficiencies issued to NHs from 37,800 recertification inspections of 14,582 unique NHs from 2014 to 2017. NHs were categorized into “low-SMI” and “high-SMI” facilities using the lowest and highest quartiles, respectively, of the proportion of residents in the NH with SMI. Bivariate analyses were used to assess for differences between low-SMI and high-SMI NHs in the number of deficiencies, the deficiency score (a point-based metric developed by the Centers for Medicare & Medicaid Services), and the scope and severity of deficiencies. In total, there were 245,178 deficiencies issued. In comparison to low-SMI NHs, high-SMI NHs received a greater deficiency score and more deficiencies per survey (p<.001). Deficiencies given to high-SMI NHs were associated with greater risk of harm (p<.001) and were of wider scope (p<.001). High-SMI NHs were cited 215% more often for resident abuse or neglect and 61% more often for the policies that prohibit and monitor for risk of abuse and neglect in comparison to low-SMI NHs. In conclusion, high-SMI NHs were documented for providing worse care to residents, with one particular area of concern being the heightened risk of resident abuse and neglect. Implications for policy and practice will be discussed.
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Tang, Kai-Yu, Chun-Hua Hsiao, and Yu-Sheng Su. "Networking for Educational Innovations: A Bibliometric Survey of International Publication Patterns." Sustainability 11, no. 17 (August 24, 2019): 4608. http://dx.doi.org/10.3390/su11174608.
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The emergence of networking has been viewed as a critical educational innovation. To highlight some innovations in educational networking (EN) research, this paper provides a bibliometric overview of international EN research from 2000 to 2018. Based on a keyword search, a total of 1005 journal articles with 13,803 citations were obtained. Through careful bibliometric analyses, three main results were concluded. (1) The growth of EN articles and authors was up by 1.5 times from the first decade (2000–2009) to the current one (2010–2018). (2) The most influential journals (over 300 citations) were identified. The research scope covers education technology, higher education, education policy, and even AIDS (acquired immune deficiency syndrome) education. (3) Based on some popular bibliometric indicators, the changes of research trends can be seen from the comparison of the main streams, which are identified from the most influential articles. Classification of the main research streams was presented, providing a typological understanding of the EN literature. In the first decade of research, the two articles which ranked first in terms of overall citations and average citations are Horvat et al. (2003) (232 times) and Coburn and Russell (2008) (17.6 times), respectively. In the last decade, the article by Roblyer et al. (2010) received both the highest number of citations (407) and average citations (45.2). Finally, the main ideas of highly-cited articles were categorized into three research streams. While the EN research of the earlier decade focused on interpersonal relationships, that of the recent decade emphasized on some innovative networking approaches, such as social media for learning, and network-based methodologies. Further discussions are provided.
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Parmar, Seema, Anil Kumar Siwach, and Ashwani Kumar. "Fifty Years Research Output in Oral Submucous Fibrosis, A Bibliometric Analysis of Publications from 1967 to 2016." DESIDOC Journal of Library & Information Technology 40, no. 02 (March 28, 2020): 470–78. http://dx.doi.org/10.14429/djlit.40.02.14727.
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Oral submucous fibrosis (OSMF) is a precancerous state which affects the oral cavity. The etiology of OSMF is due to various factors like chilies consumption, deficiency of nutrition, areca nut chewing habits, genetic susceptibility, altered salivary constituents, and autoimmunity and collagen disorders. The present study is undertaken to find out the publication trends on OSMF during 1967-2016. The study mainly focus on year and decade wise research output, national and international collaborations, top journals for publications, most prolific authors, authorship pattern, citations pattern and highly cited papers on OSMF. The results indicate that highest growth rate of publications occurred between the years 1997-2006. India’s research share, citation score and h index was highest among all countries. Central South University, China topped the scene among all institutes. The maximum publications were two authored publications. CP Chiang of National Taiwan University was found to be the most prolific author.
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Hansen, Kevin E., Kathryn Hyer, Amanda A. Holup, Kelly M. Smith, and Brent J. Small. "Analyses of Complaints, Investigations of Allegations, and Deficiency Citations in United States Nursing Homes." Medical Care Research and Review 76, no. 6 (December 12, 2017): 736–57. http://dx.doi.org/10.1177/1077558717744863.
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Quality of care in nursing homes has been evaluated from varying perspectives, but few studies analyze complaints made to surveyors. This study analyzed complaints, investigations, and citations for nursing homes nationwide. Using the complaint and survey data sets, analyses match nursing home complaints with findings of investigations conducted. Results showed the average complaint rate was 13.3 complaints per 100 residents and that 43.2% of complaint allegations were substantiated, with complaints about care and services provided being the most prevalent. Variability was noted among the Centers for Medicare and Medicaid Services regions and, on average, 47.5% of facilities had five or more complaints in a given year. While additional research could evaluate the effect of complaint investigations on nursing home quality, results indicated that complaints and subsequent investigations provide further information regarding quality for residents. Results also suggest improvements in the training for surveyors and more consistency across Centers for Medicare and Medicaid Services survey regions.
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Bowblis, John R., and Amy Restorick Roberts. "Cost-Effective Adjustments to Nursing Home Staffing to Improve Quality." Medical Care Research and Review 77, no. 3 (June 8, 2018): 274–84. http://dx.doi.org/10.1177/1077558718778081.
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Health care providers face fixed reimbursement rates from government sources and need to carefully adjust staffing to achieve the highest quality within a given cost structure. With data from the Certification and Survey Provider Enhanced Reports (1999-2015), this study holistically examined how staffing levels affect two publicly reported measures of quality in the nursing home industry, the number of deficiency citations and the deficiency score. While higher staffing consistently yielded better quality, the largest quality improvements resulted from increasing administrative registered nurses and social service staffing. After adjusting for wages, the most cost-effective investment for improving overall deficiency outcomes was increasing social services. Deficiencies related to quality of care were improved most by increasing administrative nursing and social service staff. Quality of life deficiencies were improved most by increasing social service and activities staff. Approaches to improve quality through staffing adjustments should target specific types of staff to maximize return on investment.
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Legg, PhD, RN-BC, CNHA, GNP-BC, CTRS, FACHCA, Timothy J., and Sharon A. Nazarchuk, PhD, MA, MHA, RN. "Professional characteristics of deficiency citations at F-248 in skilled nursing facilities in the United States." American Journal of Recreation Therapy 11, no. 2 (April 1, 2012): 32–38. http://dx.doi.org/10.5055/ajrt.2012.0020.
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In an earlier study, the authors attempted to determine which professional activity group (the certified therapeutic recreation therapist vs certified activity director) received fewer survey deficiencies in the skilled nursing facility. The original study was unable to provide an answer to this question due to low-survey participant response rate. The study was further limited in terms of geographic scope, as it was confined to a single state. The current study replicates that earlier study with an increased sample size and nationwide geographic distribution of participants.
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Cohen, Catherine C., John Engberg, Carolyn T. A. Herzig, Andrew W. Dick, and Patricia W. Stone. "Nursing Homes in States with Infection Control Training or Infection Reporting Have Reduced Infection Control Deficiency Citations." Infection Control & Hospital Epidemiology 36, no. 12 (September 2, 2015): 1475–76. http://dx.doi.org/10.1017/ice.2015.214.
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Eussen, Simone, Martine Alles, Lieke Uijterschout, Frank Brus, and Judith van der Horst-Graat. "Iron Intake and Status of Children Aged 6-36 Months in Europe: A Systematic Review." Annals of Nutrition and Metabolism 66, no. 2-3 (2015): 80–92. http://dx.doi.org/10.1159/000371357.
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Background: Iron deficiency is the most common nutritional disorder in the world. Young children are particularly vulnerable to the consequences of iron deficiency because of their rapidly developing brain. This review evaluates the prevalence of inadequate iron intake and iron deficiency (anaemia) in European children aged 6-36 months. Summary: Computerized searches for relevant articles were performed in November 2013. A total of 7,297 citations were screened and 44 studies conducted in 19 European countries were included in this review. In both infants (6-12 months) and young children (12-36 months), the mean value of iron intakes in most countries was close to the RDA. Nevertheless, proportions of inadequate intakes were considerable, ranging from about 10% in the Netherlands up to 50% in Austria, Finland and the United Kingdom. The prevalence of iron deficiency varied between studies and was influenced by children's characteristics. Two to 25% of infants aged 6-12 months were found to be iron deficient, with a higher prevalence in those who were socially vulnerable and those who were drinking cow's milk as a main type of drink in their first year of life. In children aged 12-36 months, prevalence rates of iron deficiency varied between 3 and 48%. Prevalence of iron deficiency anaemia in both age groups was high in Eastern Europe, as high as 50%, whereas the prevalence in Western Europe was generally below 5%. Key Messages: In most European countries, mean iron intakes of infants and children aged 6 to 36 months were found to be close to the RDA. Nevertheless, high proportions of inadequate intakes and high prevalence rates of iron deficiency were observed. Health programs should (keep) focus(ing) on iron malnutrition by educating parents on food choices for their children with iron-rich and iron-fortified foods, and encourage iron supplementation programmes where iron intakes are the lowest.
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Harrington, Charlene, Steffie Woolhandler, Joseph Mullan, Helen Carrillo, and David U. Himmelstein. "Does Investor-Ownership of Nursing Homes Compromise the Quality of Care?" International Journal of Health Services 32, no. 2 (April 2002): 315–25. http://dx.doi.org/10.2190/ebcn-wecv-c0nt-676r.
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Quality problems have long plagued the nursing home industry. While two-thirds of U.S. nursing homes are investor-owned, few studies have examined the impact of investor-ownership on the quality of care. The authors analyzed 1998 data from inspections of 13,693 nursing facilities representing virtually all U.S. nursing homes. They grouped deficiency citations issued by inspectors into three categories (“quality of care,” “quality of life,” and “other”) and compared deficiency rates in investor-owned, nonprofit, and public nursing homes. A multivariate model was used to control for case mix, percentage of residents covered by Medicaid, whether the facility was hospital-based, whether it was a skilled nursing facility for Medicare only, chain ownership, and location by state. The study also assessed nurse staffing. The authors found that investor-owned nursing homes provide worse care and less nursing care than nonprofit or public homes. Investor-owned facilities averaged 5.89 deficiencies per home, 46.5 percent higher than nonprofit and 43.0 percent higher than public facilities, and also had more of each category of deficiency. In the multivariate analysis, investor-ownership predicted 0.679 additional deficiencies per home; chain-ownership predicted an additional 0.633 deficiencies per home. Nurse staffing ratios were markedly lower at investor-owned homes.
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Yin, Lina, Erica L. Unger, Leslie C. Jellen, Christopher J. Earley, Richard P. Allen, Ann Tomaszewicz, James C. Fleet, and Byron C. Jones. "Systems genetic analysis of multivariate response to iron deficiency in mice." American Journal of Physiology-Regulatory, Integrative and Comparative Physiology 302, no. 11 (June 1, 2012): R1282—R1296. http://dx.doi.org/10.1152/ajpregu.00634.2011.
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The aim of this study was to identify genes that influence iron regulation under varying dietary iron availability. Male and female mice from 20+ BXD recombinant inbred strains were fed iron-poor or iron-adequate diets from weaning until 4 mo of age. At death, the spleen, liver, and blood were harvested for the measurement of hemoglobin, hematocrit, total iron binding capacity, transferrin saturation, and liver, spleen and plasma iron concentration. For each measure and diet, we found large, strain-related variability. A principal-components analysis (PCA) was performed on the strain means for the seven parameters under each dietary condition for each sex, followed by quantitative trait loci (QTL) analysis on the factors. Compared with the iron-adequate diet, iron deficiency altered the factor structure of the principal components. QTL analysis, combined with PosMed (a candidate gene searching system) published gene expression data and literature citations, identified seven candidate genes, Ptprd, Mdm1, Picalm, lip1, Tcerg1, Skp2, and Frzb based on PCA factor, diet, and sex. Expression of each of these is cis-regulated, significantly correlated with the corresponding PCA factor, and previously reported to regulate iron, directly or indirectly. We propose that polymorphisms in multiple genes underlie individual differences in iron regulation, especially in response to dietary iron challenge. This research shows that iron management is a highly complex trait, influenced by multiple genes. Systems genetics analysis of iron homeostasis holds promise for developing new methods for prevention and treatment of iron deficiency anemia and related diseases.
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Wooley, Andrea C., and Jessica L. Kerr. "Monitoring Patients on Metformin: Recent Changes and Rationales." Journal of Pharmacy Technology 34, no. 1 (December 10, 2017): 28–36. http://dx.doi.org/10.1177/8755122517747295.
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Objective: The Food and Drug Administration recently updated metformin prescribing recommendations for patients with diabetes and renal disease. The American Diabetes Association as well as the American Association of Clinical Endocrinologists and American Clinical Endocrinologists also recommend periodic monitoring of vitamin B12 levels for patients using metformin. A review of the literature was conducted to assess data to evaluate the recent updates to metformin usage and provide rationales for these recommendations. Data Sources: PubMed MESH terms “Diabetes Mellitus, Type 2” and “Renal Insufficiency, Chronic” and “Metformin” were searched with an English limitation from 1990 to May 2017. A MEDLINE search was conducted using the terms “metformin” and “renal disease” from 1990 to May 2017. A PubMed search was conducted using the MESH terms “vitamin b12 deficiency” and “metformin” from 1970 to May 2017. A MEDLINE search was conducted using terms “metformin” and “vitamin B12 deficiency” with an English limitation from 1970 to May 2017. Study Selection and Data Extraction: Retrospective and prospective clinical trials, meta-analyses, and systematic reviews were considered for inclusion. Citations from identified articles were also reviewed for inclusion. Data Synthesis: The incidence of metformin-associated lactic acidosis is minimal. Data indicate metformin-treated patients with an estimated glomerular filtration rate above 30 mL/min/1.73 m2 have a reduction in mortality. Additionally, data suggest metformin may lead to vitamin B12 deficiency. Conclusion: Data support recommendations for metformin use in patients with diabetes and renal insufficiency with an estimated glomerular filtration rate above 30 mL/min/1.73 m2. Data also suggest that baseline and periodic testing of vitamin B12 levels are warranted and supported by clinical guidelines due to the risk of vitamin B12 deficiency in metformin-treated patients.
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Gammonley, Denise L., Xiaochuan (Sharon) Wang, and Felicia Bender. "STATE VARIATION IN NURSING HOME CIVIL MONEY PENALTY ENFORCEMENT ACTIONS FOR QUALITY DEFICIENCIES." Innovation in Aging 3, Supplement_1 (November 2019): S158. http://dx.doi.org/10.1093/geroni/igz038.567.
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Abstract States vary in their overall rates of nursing home deficiency citations as well as deficiencies for actual harm or jeopardy (Harrington et al., 2018). Civil Money Penalty (CMP) fines collected by the Centers for Medicare and Medicaid Services (CMS) are one enforcement action imposed to promote nursing home compliance with regulations. Collected CMP funds are redistributed to states for the sole purpose of improving nursing home resident care and quality of life through reinvestment in quality improvement projects. Using CASPER data available for US skilled nursing homes in 2015 and 2016 through the CMS QCOR database we examined the distribution of quality of care (QOC) and quality of life (QOL) deficiencies and CMP enforcement action across states. Guided by the systems framework for evaluating nursing home quality (Unruh & Wan, 2004) we further explored how contextual factors such as state spending for nursing home care, structural characteristics of facilities in states, and inadequate care processes indicated by deficiencies contribute to CMP enforcement actions and fines. Findings indicate that 27% of enforcement actions resulting in a CMP between 2015 and 2016 were imposed for a QOL deficiency while 61.7% represented QOC deficiencies. QOL deficiencies represented only 8% of the highest severity deficiency category but 81.7% of enforcement actions for QOC were for those causing immediate harm or jeopardy. QOC deficiencies are a focus of enforcement actions as they represent critical care processes influencing resident basic needs for hydration, ambulation, skin integrity and care for other special physical and behavioral needs.
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Hamann, Darla J., and Karabi C. Bezboruah. "Outcomes of health information technology utilization in nursing homes: Do implementation processes matter?" Health Informatics Journal 26, no. 3 (January 29, 2020): 2249–64. http://dx.doi.org/10.1177/1460458219899556.
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We examined several outcomes of health information technology utilization in nursing homes and how the processes used to implement health information technology affected these outcomes. We hypothesized that one type of health information technology, electronic medical records, will improve efficiency and quality-related outcomes, and that the use of effective implementation processes and change leadership strategies will improve these outcomes. We tested these hypotheses by creating an original survey based on the case study literature, which we sent to the top executives of nursing homes in seven US states. The administrators reported that electronic medical record adoption led to moderately positive efficiency and quality outcomes, but its adoption was unrelated to objective quality indicators obtained from regulatory agencies. Improved electronic medical record implementation processes, however, were positively related to administrator-reported efficiency and quality outcomes and to decreased deficiency citations at the next regulatory visit to the nursing home. Change leadership processes did not matter as much as technological implementation processes.
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Meurs, M., C. G. B. Maathuis, C. Lucas, M. Hadders-Algra, and C. K. van der Sluis. "Prescription of the First Prosthesis and Later use in Children with Congenital Unilateral Upper Limb Deficiency: A Systematic Review." Prosthetics and Orthotics International 30, no. 2 (August 2006): 165–73. http://dx.doi.org/10.1080/03093640600731710.
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Background: The prosthetic rejection rates in children with an upper limb transversal reduction deficiency are considerable. It is unclear whether the timing of the first prescription of the prosthesis contributes to the rejection rates. Objective: To reveal whether scientific evidence is available in literature to confirm the hypothesis that the first prosthesis of children with an upper limb deficiency should be prescribed before two years of age. We expect lower rejection rates and better functional outcomes in children fitted at young age. Methods: A computerized search was performed in several databases (Medline, Embase, Cinahl, Amed, Psycinfo, PiCarta and the Cochrane database). A combination of the following keywords and their synonyms was used: “prostheses, upper limb, upper extremity, arm and congenital”. Furthermore, references of conference reports, references of most relevant studies, citations of most relevant studies and related articles were checked for relevancy. Results: The search yielded 285 publications, of which four studies met the selection criteria. The methodological quality of the studies was low. All studies showed a trend of lower rejection rates in children who were provided with their first prosthesis at less than two years of age. The pooled odds ratio of two studies showed a higher rejection rate in children who were fitted over two years of age (pooled OR = 3.6, 95% CI 1.6 – 8.0). No scientific evidence was found concerning the relation between the age at which a prosthesis was prescribed for the first time and functional outcomes. Conclusion: In literature only little evidence was found for a relationship between the fitting of a first prosthesis in children with a congenital upper limb deficiency and rejection rates or functional outcomes. As such, clinical practice of the introduction of a prosthesis is guided by clinical experience rather than by evidence-based medicine.
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Sturdevant, Diana L., and Kathleen C. Buckwalter. "LESSONS LEARNED FROM NURSING HOME CIVIL MONETARY PENALTY PROJECTS." Innovation in Aging 3, Supplement_1 (November 2019): S770. http://dx.doi.org/10.1093/geroni/igz038.2832.
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Abstract Nursing homes must comply with numerous federal/state regulations to receive Medicare and Medicaid funding. Failure to comply with these regulations can result in deficiency citations, and depending on the severity of the deficiency, a resulting Civil Monetary Penalty (CMP). Through the Centers for Medicare and Medicaid Services (CMS) Civil Monetary Penalty Reinvestment Program, CMP funds are reinvested to support activities that benefit nursing home residents and that protect or improve their quality of life or quality of care. This symposium presents some of the unique challenges, successes, failures, and surprise findings from CMP-funded nursing home quality improvement projects in two, predominantly rural Midwestern states: Oklahoma and Kansas. Dr. Williams presents findings of a pilot-study testing an adaptation of a successful family caregiver telehealth support intervention in the nursing home setting and implications for future research. Dr. Sturdevant shares successes, challenges, and unanticipated results from the “It’s Not OK to Fall” project, a comprehensive, 3 year fall prevention project implemented in Oklahoma nursing homes. Lastly, Ms. Round’s paper describes the implementation and findings of a Long-term Care Leadership Academy aimed at improving leadership and team building skills of three levels of nursing home staff, including Administrators/Directors’ of Nursing, RN/LPN charge nurses and certified nursing assistants. Discussant, Dr. Kathleen Buckwalter Ph.D., FAAN, RN, will discuss how principles of nursing home culture change provides a common framework for these projects and conclude by offering suggestions on how promotion of these principles might improve the quality of care provided by nursing homes.
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Yoon, Jung Min, Alison Trinkoff, Carla Storr, and Elizabeth Galik. "Nurse Staffing and Nursing Home Deficiency of Care for Inappropriate Psychotropics Use in Residents With Dementia." Innovation in Aging 4, Supplement_1 (December 1, 2020): 207–8. http://dx.doi.org/10.1093/geroni/igaa057.671.
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Abstract Psychotropics use to manage behavioral and psychological symptoms of dementia (BPSD) in nursing homes (NHs) has been the focus of policy attention due to their adverse effects. We hypothesized that NHs with lower nursing staffing would have greater reliance on psychotropics use to control BPSD. A NH deficiency of care can be cited for inappropriate psychotropics use (F-tag 758). The association between the occurrence of F-758 tags and nurse staffing in residents with dementia was examined using the 2017-18 Certification and Survey Provider Enhanced Reporting data (n=14,548 NHs). Staffing measures included nursing hours per resident day (HPRD) and registered nurse (RN) skill-mix. Generalized linear mixed models that included covariates (NH location, bed size, ownership, proportion of residents with dementia/depression/psychiatric disorders and with Medicare/Medicaid) estimated the magnitude of the associations. There were 1,872 NHs with F-758 tags indicating inappropriate psychotropics use for NH residents with dementia. NHs with greater RN and certified nurse assistant (CNA) HPRD had significantly lower odds of F-758 tags (OR=0.59 54, 95% CI=0.47 44-0.73 66; OR=0.87, 95% CI=0.77-0.99, respectively) and similar findings were found in NHs with greater RN skill-mix (OR=0.14 10, 95% CI=0.05 04-0.37 25). There were no significant associations between the occurrence of F-758 tags and licensed practice nurse and unlicensed nurse aide HPRD. This study found that RN and CNA staffing had inverse associations with inappropriate psychotropic use citations among residents with dementia. NHs with higher RN staffing ratios may be better able to implement alternatives to pharmacological approaches for BPSD. It is suggested that NHs be equipped with adequate nurse staffing levels to reduce unnecessary psychotropics use.
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Lewis, Dale P., Don C. Van Dyke, Phyllis J. Stumbo, and Mary J. Berg. "Drug and Environmental Factors Associated with Adverse Pregnancy Outcomes Part I: Antiepileptic Drugs, Contraceptives, Smoking, and Folate." Annals of Pharmacotherapy 32, no. 7-8 (July 1998): 802–17. http://dx.doi.org/10.1345/aph.17297.
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OBJECTIVE: Part I of this review examines the relationship between antiepileptic drugs (AEDs) and pregnancy outcomes. Drug-induced folate deficiency and the role of AED metabolism are emphasized. Part II will discuss periconceptional folate supplementation for prevention of birth defects. Part III will discuss the mechanism of folate's protective effect, therapeutic recommendations, compliance, and cost. DATA SOURCES: A MEDLINE search was conducted for journal articles published through December 1997. Additional sources were obtained from Current Contents and citations from the references obtained. Search terms included phenytoin, carbamazepine, phenobarbital, primidone, valproic acid, oral contraceptives, clomiphene, drug-induced abnormalities, spina bifida, anencephaly, neural tube defect, folate, folic acid, and folic acid deficiency. STUDY SELECTION: Relevant animal and human studies examining the effects of AEDs, smoking, and oral contraceptives on folate status and pregnancy outcome are reviewed. DATA EXTRACTION: Studies and case reports were interpreted. Data extracted included dosing, serum and red blood cell folate concentrations, teratogenicity of anticonvulsant medications, metabolism of AEDs and folate, and genetic susceptibility to AED-induced teratogenicity. DATA SYNTHESIS: Low serum and red blood cell folate concentrations are associated with adverse pregnancy outcomes. Decreases in serum folate are seen with AEDs, oral contraceptives, and smoking. Since similar birth defects are observed with multiple AEDs, metabolism of aromatic AEDs to epoxide metabolites and genetic factors may play a role in teratogenesis. CONCLUSIONS: Adequate prepregnancy planning is essential for women who have epilepsy. Women receiving folate-lowering drugs may be at increased risk of adverse pregnancy outcomes. Therefore, epileptic women contemplating pregnancy should be treated with the minimum number of folate-lowering drugs possible and receive folic acid supplementation.
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Lata Kanyal Butola, Anjali Vagga, Ranjit Ambad, Deepika Kanyal, and Jayshri Jankar. "A systematic review of association between vitamin D levels and pre-eclampsia in pregnant womens - An old problem revisited." International Journal of Research in Pharmaceutical Sciences 11, SPL4 (December 21, 2020): 2910–20. http://dx.doi.org/10.26452/ijrps.v11ispl4.4580.
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The beneficial effects of sunlight in preventing bone-related disorders have been well-known for centuries. Vitamin D is a modified steroid, synthesised under the influence of sunlight in the skin. Low Vitamin D status has associated with a higher risk of pre-eclampsia in pregnant womens. The aim of this study was to undertake a systematic review of different studies investigating the association between Vitamin D levels and pre-eclampsia in pregnant womens. A systematic review was undertaken. MEDLINE, PUBMED, EMBASE, Google Scholar were searched. The review protocol was designed to answer the question. Search terms (Preeclampsia and Vitamin D or 1,25 dihydroxy vitamin D). The search was confined to peer-reviewed articles that were published in English and contained an abstract. Reference list of journal articles were also screened for additional citations fitting our search criteria. Twenty-Seven studies were included in the systematic review that investigates the association between Vitamin D and pre-eclampsia. The present systematic review concludes that maternal vitamin D deficiency in pregnancy is significantly associated with an elevated risk of preeclampsia. Pregnant womens should take vitamin D supplementation, expose themselves into the sunlight, and they should be physically active. Further taking Vitamin D supplementation in early pregnancy may be a simple way to reduce the risk of these adverse pregnancy outcomes.
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Sriram, Swetha, Anargyros Xenocostas, and Alejandro Lazo-Langner. "A Systematic Review Of The Role Of Erythropoietin In The Pathophysiology Of Anemia In Elderly Patients." Blood 122, no. 21 (November 15, 2013): 3432. http://dx.doi.org/10.1182/blood.v122.21.3432.3432.
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Abstract Introduction Anemia is a significant issue in the geriatric population, having an impact on morbidity, mortality and quality of life. However, identifying the etiology of anemia is not possible in ∼30% of patients. Postulated mechanisms of anemia of unknown etiology (AUE) include a blunted response to erythropoietin (EPO) or inadequate EPO production in response to anemia. The latter mechanism is of particular interest since it might be amenable to pharmacological intervention. Therefore, in order to explore the relationship between EPO levels and hemoglobin in elderly individuals with AUE, we conducted a systematic review of observational studies. Methods We searched Medline, EMBASE, Web of Science, Biosis Previews and Dissertations and Theses using the terms erythropoietin, anemia, elderly and diagnosis as MeSH subject headings. Additional relevant articles were identified by hand searching the meeting abstracts of the European Hematology Association (2006 - 2012) and the American Society of Hematology (2004 - 2012). For inclusion into the final review, studies needed to report data on EPO levels in elderly individuals diagnosed with anemia of unknown etiology. No meta-analysis was conducted due to the heterogeneity of the retrieved studies. Results The search identified 4277 potentially relevant citations, of which 31 studies were reviewed in full and 7 cohort studies (2 retrospective, 5 prospective) were included in the final review. The included studies involved 2534 participants ( 1). In general, studies found: 1) lower EPO levels in AUE compared to iron deficiency anemia and other forms of anemia; 2) a lack of correlation between EPO levels and the severity of anemia; and 3) EPO levels in AUE that are in general higher than in non-anemic patients. Conclusion Our findings suggest that EPO levels are generally elevated in elderly individuals with AUE, but remain inappropriately low, particularly when compared to anemia of other etiologies suggesting either a relative EPO deficiency, an abnormal EPO response or an abnormal erythroid cell response to EPO. Further research is required to elucidate the mechanisms involved, and the value of pharmacological interventions. Disclosures: No relevant conflicts of interest to declare.
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Shehata, Nadine, Heather Ann Hume, Valerie Palda, David Anderson, Tom Bowen, Richard Warrington, Bruce Mazer, et al. "Immune Globulin for Patients with Primary Immune Deficiency: An Evidence Based Practice Guideline." Blood 112, no. 11 (November 16, 2008): 4705. http://dx.doi.org/10.1182/blood.v112.11.4705.4705.
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Abstract Background: The original use of immune globulin (IG) was for replacement in patients with primary immune deficiency (PID). The evidence supporting this stems from the 19650s; however there have not been any rigorously developed evidence based clinical practice guidelines (CPGs) for the use of IG for PID. In 2007, Canadian Blood Services and the National Advisory Committee on Blood and Blood Products in Canada convened a panel of Canadian immunologists and a methodologist to develop a CPG for the use of IG in patients with PID. The objectives of this guideline are to examine the evidence for the use of IG in patients who have PID and to provide guidance for practitioners involved in the care of PID patients and transfusion medicine specialists on the use of IG. Methods: The panel identified key clinical questions and a systematic, expert and bibliography literature search up to July 2008 was conducted to ensure all relevant publications were included. The panel generated recommendations based on the evidence. The levels of evidence and grading of recommendations were adapted from the Canadian Task Force on Preventative Health Care. To validate conclusions and recommendations, the practice guideline will be sent to immunologists internationally and to a patient representative in September 2008. The guideline will be disseminated to all immunologists, internists and pediatricians in Canada to aid implementation of the guideline. The National Advisory Committee of Blood and Blood Products in Canada will assess the performance of the guideline and will renew the guideline at timely intervals. Results and Conclusions: The panel identified the following key clinical questions: what is the prevalence of the PIDs that require IG; does treatment with IG improve morbidity and mortality; and what criteria should be used to monitor the effectiveness of IVIG. The literature search was conducted in August 2007 and updated to July 2008. 1087 citations were reviewed. 101 reports, 1 systematic review and 3 consensus documents/guidelines were included. Current estimates suggest PID is under-diagnosed. Although more than 75% of patients require IG at some point in their treatment, the actual incidence of requiring IG is unknown. There is ample evidence that IG reduces infections, hospitalization and days lost from work/school. There is some evidence to suggest that IG may ameliorate chronic illnesses in patients with PID however, there is no data of the effect of IG on malignancy and insufficient data on the effect of IG on autoimmune disease in this patient population to make a recommendation. Quality of life (QoL) has not been adequately assessed in the literature; however the reduction in infections and hospitalizations likely translates to an improved QoL. Although, there is no evidence to suggest clinical superiority of one IVIG formulation over another, for patients with autoimmune manifestations and PID, there is insufficient evidence that subcutaneous IG is equivalent to IVIG. The vaccination of these patients is an evolving field. Due to the complex nature of the management of patients with PID, the panel recommended assessment by an immunologist prior to the initiation of IG and monitoring by a comprehensive care clinic. Clinical outcomes such as frequency of infections, hospitalization, days missed from school/work should be used to monitor the effectiveness of IVIG. Specific recommendations for dosing and interval of IG therapy were made within the guideline based on the literature The development of a national registry for patients with primary immune deficiency, and the development of a surveillance system for adverse events from IG particularly infections were considered priorities for future development.
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Yoon, Jung Min, Alison Trinkoff, Carla Storr, and Elizabeth Galik. "Dementia Care Training Regulations and Deficiencies of Care for Inappropriate Psychotropics Use in Nursing Homes." Innovation in Aging 4, Supplement_1 (December 1, 2020): 161. http://dx.doi.org/10.1093/geroni/igaa057.524.
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Abstract Psychotropics are often used to manage behavioral and psychological symptoms of dementia (BPSD) in nursing homes (NHs), despite their adverse effects and lack of efficacy. NHs can be flagged for inappropriate psychotropics use as a deficiency of care (F-tag 758). To improve dementia care, 15 states require dementia-specific in-service training for NH nursing staff with specific training content and hours. The study aimed to relate the occurrence of F-758 citations to the presence of dementia-specific in-service training regulations, stratified by nurse staffing levels (<75th vs ≥75th percentile of nurse hours per resident day, HPRD). Certification and Survey Provider Enhanced Reporting data (n=14,548 NHs) from 2017-18 were used, containing 1,872 NHs with F-758 tags related to care of residents with dementia. NHs in states specifying training content and hours had significantly lower odds of receiving F-758 tags (OR=0.75, 95% CI=0.60-0.94). Among NHs with lower registered nurse HPRD, those in states regulating training content and hours had significantly lower odds of receiving F-758 tags (OR=0.66, 95% CI=0.49-0.89), with similar findings among NHs with lower certified nurse assistant HPRD (OR=0.69, 95% CI=0.51 52-0.91 92). This study found that required dementia-specific in-service training may be helpful in facilities with lower staffing. It is recommended that states develop more comprehensive, robust dementia care training regulations for NH nursing staff.
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Young, Guy, Frauke Friedrichs, Anthony Chan, Gili Kenet, Paolo Simioni, Helen van Ommen, Anne Krumpel, et al. "Impact of Inherited Thrombophilia on Symptomatic Venous Thrombo-Embolism (VTE) in Children: A Systematic Review & Meta-Analysis of 37 Studies Including 2470 Pediatric Patients." Blood 110, no. 11 (November 16, 2007): 3189. http://dx.doi.org/10.1182/blood.v110.11.3189.3189.
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Abstract Background: Inherited thrombophilia (IT) has been described as a risk factor for venous thromboembolism (VTE) in children. So far the majority of studies performed in the field were either retrospective or prospective on small numbers of patients. Thus, the results are contradictory or inconclusive mainly due to lack of statistical power. The aim of this study was to better estimate the impact of IT on early VTE onset and recurrence in children as a prerequisite to develop primary and secondary treatment options. Methods: A systematic search of publications listed in the electronic databases (Pubmed, Medline, EMBASE, Web of Science, The Cochrane Library) up to August 2007 using key words in combination both as MeSH terms and text words, was conducted. Citations were screened by two independent group members and those meeting the inclusion criteria were retained. Articles were included if published after 1990, when pediatric VTE was started to be systematically investigated. Findings: Twenty case-control and 17 cohort studies from 13 countries met the inclusion criteria. In these studies > 70% of patients had at least one clinical risk factor. The summary odds ratios (OR) and 95% confidence intervals (CI) of included studies under a fixed-effects and random-effects model showed statistically significant associations between the IT traits investigated and VTE onset (table). For the rare event of VTE recurrence, 1227 patients (eight studies) were evaluated: at the present state due to high heterogeneity, a trend towards association with recurrent VTE was found for ≥2 IT traits in the fixed-effects model (0R/CI: 2.8/1.6–4.8). Interpretation: The present meta-analysis gives evidence that the detection of inherited thrombophilia is clincially meaningful in children with VTE and underlines the importance of a pediatric thrombophilia screening program. Summary of Data Risk Factors OR/CI:fixed model OR/CI:random model patients/controls 2470/4119 N/A FV G1691A 3.5/2.9–4.2 3.2/2.3–4.4 FII G20210A 2.2/1.5–3.3 2.2/1.5–3.4 Protein C defiiciency 9.8/5.9–16 9.9/6.1–16.1 Protein S deficiency 7.1/3.9–13.2 6.8/3.7–12.7 Antithrombin deficiency 7.9/3.8–16.6 7.3/3.4–15.3 Lipoprotein(a) 4.4/3,2–5.9 4/2.4–6.6 ≥ 2 risk factors 12.6/7.3–21.8 11.6/6.2–20.2
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Rishniw, Mark, and Maurice Edward White. "The term ‘Pilot Study’ is misused in veterinary medicine: a critical assessment." Veterinary Record 186, no. 2 (August 19, 2019): 65. http://dx.doi.org/10.1136/vr.105377.
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Authors commonly use the term ‘Pilot Study’ in the veterinary literature. The term has a specific definition in medical literature, but is not defined in veterinary literature. Therefore, we sought to examine the frequency of the use of the term and the characteristics of studies using the term in the article title, and derive the intended meaning of the term. We identified all articles in veterinary literature using the term in the article title between 2008 and 2017. We then examined specific characteristics of articles published between 2008 and 2012. We found use of the term is increasing (P<0.0001). Of articles using the term between 2008 and 2012, only 20 per cent led to a larger, more comprehensive verifying study. Most garnered few citations, but 75 per cent were cited in review articles. Pilot studies had a median sample size of 10 subjects. We found comparable studies for each pilot study that did not incorporate the term into their titles. None of the authors of any of the pilot studies defined the term or explained why their study was termed a ‘pilot study’. Journals and authors used the term haphazardly. Our findings indicate that the term ‘Pilot Study’ is meaningless because it meets no specific, consistently adhered-to criteria. We believe that authors use the term as a means of ‘Deficiency signaling’ to editors, reviewers and readers. We recommend that authors and journals abandon the term in veterinary literature because it serves no purpose, is not used consistently and might harm veterinary medicine.
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Buelo, Audrey, Susannah McLean, Steven Julious, Javier Flores-Kim, Andy Bush, John Henderson, James Y. Paton, Aziz Sheikh, Michael Shields, and Hilary Pinnock. "At-risk children with asthma (ARC): a systematic review." Thorax 73, no. 9 (June 5, 2018): 813–24. http://dx.doi.org/10.1136/thoraxjnl-2017-210939.
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IntroductionAsthma attacks are responsible for considerable morbidity and may be fatal. We aimed to identify and weight risk factors for asthma attacks in children (5–12 years) in order to inform and prioritise care.MethodsWe systematically searched six databases (May 2016; updated with forward citations January 2017) with no language/date restrictions. Two reviewers independently selected studies for inclusion, assessed study quality and extracted data. Heterogeneity precluded meta-analysis. Weighting was undertaken by an Expert Panel who independently assessed each variable for degree of risk and confidence in the assessment (based on study quality and size, effect sizes, biological plausibility and consistency of results) and then achieved consensus by discussion. Assessments were finally presented, discussed and agreed at a multidisciplinary workshop.ResultsFrom 16 109 records, we included 68 papers (28 cohort; 4 case-control; 36 cross-sectional studies). Previous asthma attacks were associated with greatly increased risk of attack (ORs between 2.0 and 4.1). Persistent symptoms (ORs between 1.4 and 7.8) and poor access to care (ORs between 1.2 and 2.3) were associated with moderately/greatly increased risk. A moderately increased risk was associated with suboptimal drug regimen, comorbid atopic/allergic disease, African-American ethnicity (USA), poverty and vitamin D deficiency. Environmental tobacco smoke exposure, younger age, obesity and low parental education were associated with slightly increased risk.DiscussionAssessment of the clinical and demographic features identified in this review may help clinicians to focus risk reduction management on the high-risk child. Population level factors may be used by health service planners and policymakers to target healthcare initiatives.Trial registration numberCRD42016037464.
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Hearld, Larry, Akbar Ghiasi, Jeffery Szychowski, and Robert Weech-Maldonado. "KNOWLEDGE MANAGEMENT AND THE ADOPTION OF CULTURE CHANGE INITIATIVES BY HIGH-MEDICAID-CENSUS NURSING HOMES." Innovation in Aging 3, Supplement_1 (November 2019): S697—S698. http://dx.doi.org/10.1093/geroni/igz038.2568.
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Abstract Culture change represents an organizational transformational process to become person-centered, through staff and resident empowerment. Culture change initiatives have been associated with fewer health-related deficiency citations and better psychosocial outcomes. Knowledge management, defined as the process of creating or locating knowledge, and managing the dissemination of knowledge within and between organizations, has been shown to be associated with the adoption of innovations such as culture change initiatives. This study examines the relationship between knowledge management activities of high Medicaid census (70% or higher) nursing homes (NHs) and the adoption of culture change initiatives. This study used facility survey data from approximately 324 nursing home administrators (30% response rate) from 2017- 2018, merged with data from LTCFocus, Area Health Resource File, and Medicare Cost Reports. Binary logistic regression models revealed that the probability of adopting a culture change initiative was 0.12 higher for facilities reporting a one-unit higher level of knowledge management activities. Additional interaction analysis revealed that knowledge management activities were associated with a greater likelihood of adopting a culture change initiative for NHs where the director had been in his/her position fewer years. Similarly, higher levels of overall knowledge management activities were significantly associated with greater adoption of culture change initiatives at intermediate levels of nurse retention. Results suggest that knowledge management activities may help high Medicaid NHs acquire and mobilize informational resources in ways that can support the adoption of patient-centered initiatives. These activities may be particularly effective in nursing homes with leadership and nursing staff instability.
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Thibaudeau, Karen, Martin Robitaille, Victoria Ledsham, and Per Morten Sandset. "Painting the Clinical Picture of Congenital Plasminogen Deficiency (C-PLGD) through a Comprehensive Case Study Review." Blood 136, Supplement 1 (November 5, 2020): 21–22. http://dx.doi.org/10.1182/blood-2020-137690.
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C-PLGD is a rare autosomal recessive multisystem disorder of the fibrinolytic system with a diverse spectrum of clinical manifestations, and is underdiagnosed and difficult to treat. Caused by mutations in thePLGgene, C-PLGD is characterized by extravascular fibrinous deposits on mucous membranes such as the conjunctiva, gingiva, linings of airways and genitourinary tract. The abnormal accumulation or growth of fibrin-rich pseudomembranous lesions have been termed ligneous for their "woody" appearance, and often result in tissue injury and/or organ dysfunction in C-PLGD patients. We present here the results of an exhaustive MEDLINE literature database review undertaken with the PubMed search engine using the key words; 'plasminogen deficiency,' 'hypoplasminogenemia' and 'ligneous conjunctivitis'. Objective:The goal of this review was 1) to achieve a better understanding of the type and prevalence of clinical manifestations of C-PLGD and their outcomes, and 2) to evaluate whether a relationship exists between endogenous plasminogen activity levels and disease manifestations in C-PLGD patients. Methodology: A MEDLINE literature search was conducted by three independent investigators. Publications containing the key words 'plasminogen deficiency,' 'hypoplasminogenemia' and/or 'ligneous conjunctivitis' and reporting human clinical information were selected. Patients' age, sex, endogenous plasminogen levels, and clinical manifestations were tabulated. Results: The search retrieved 414 total citations, and 130 papers with relevant human clinical data were identified for full-length text review. From these, 301 unique C-PLGD patients (237 pediatric and 64 adults) were found to be reported over an 80-year period (from 1957 to 2017) and presented the following outcomes and most common and/or serious clinical manifestations: ligneous conjunctivitis (255 cases), ligneous periodontitis (71 cases), tracheobronchial obstructions (53 cases), hydrocephalus (42 cases), other corneal lesion (15 cases), ligneous vaginitis (24 cases), blindness (6 cases), and death (10 cases). Differences in disease seriousness and prevalence were observed between pediatric and adult patient populations (Table1). Of note, death or hydrocephalus were reported only in pediatric patients. Historical information indicated that 62% of the 301 reported patients were females and 36% males, while 2% of them did not have their gender disclosed. The median age of reported onset of symptoms (and/or diagnosis) was 1 year old for the 176 patients with available data. Of the 130 papers retained and analyzed, 2 studies (Klammt et. al. Thromb Haemost 2011; Tefs et. al. Blood 2006) were selected for additional in-depth analysis. These studies included a subset of 58 C-PLGD patients whose clinical, molecular and plasminogen activity data were available and reliably reported. These patients had a spectrum of plasminogen activity level ranging from 2% to 59% and presented the main following clinical manifestations: ligneous conjunctivitis (52/58), ligneous periodontitis (16/58), tracheobronchial involvement (14/58), ligneous vaginitis (6/58), and hydrocephalus (4/58) (Table 2). Out of this 58-patient cohort, 26 reported a single lesion and had an average plasminogen activity level of 22% while the 32 remaining had 2 or more lesions and an average activity level of 20%, indicating that the level of plasminogen activity may not correlate with the clinical manifestations burden/seriousness. Conclusion:This comprehensive review confirmed that the heterogeneity challenges in clinical evaluation and the overall rarity of C-PLGD can contribute to delayed diagnosis, treatment variability and less than optimal outcomes. With lack of natural history studies or reports of C-PLGD, the data described here can be used to highlight the seriousness of long-term morbidity, promote early and effective management of C-PLGD, and support the ongoing development of novel plasminogen replacement therapy to address the primary underlying drivers of morbidity in C-PLGD. The implementation of natural history studies may play an important role in addressing the knowledge gap in phenotypic expression and long-term impact of C-PLGD on the quality of life of impacted patients. Disclosures Thibaudeau: Liminal BioSciences:Current Employment, Current equity holder in publicly-traded company.Robitaille:Liminal BioSciences:Consultancy, Current equity holder in publicly-traded company, Ended employment in the past 24 months.Ledsham:Liminal BioSciences:Current Employment.Sandset:Liminal BioSciences:Other: Investigator Clinical Trial.
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Rubeor, Amity, Carmen Goojha, Jeffrey Manning, and Jordan White. "Does Iron Supplementation Improve Performance in Iron-Deficient Nonanemic Athletes?" Sports Health: A Multidisciplinary Approach 10, no. 5 (May 24, 2018): 400–405. http://dx.doi.org/10.1177/1941738118777488.
Full textAbstract:
Context: Supplementing iron-deficient nonanemic (IDNA) athletes with iron to improve performance is a trend in endurance sports. Objectives: To investigate the benefits of iron on performance, identify a ferritin level cutoff in IDNA athletes, and determine which iron supplementation regimens are most effective. Data Sources: A search of the PubMed, CINAHL, Embase, ERIC, and Cochrane databases was performed in 2014 including all articles. Citations of pertinent review articles were also searched. In 2017, the search was repeated. Study Selection: Inclusion criteria comprised studies of level 1 to 3 evidence, written in the English language, that researched iron supplementation in nonanemic athletes and reported performance outcomes. Study Design: Systematic review. Level of Evidence: Level 3. Data Extraction: The search terms used included athletic performance, resistance training, athletes, physical endurance, iron, iron deficiency, supplement, non-anemic, low ferritin, ferritin, ferritin blood level, athletes, and sports. Results: A total of 1884 studies were identified through the initial database search, and 13 were identified through searching references of relevant review articles. A subsequent database search identified 46 studies. Following exclusions, 12 studies with a total of 283 participants were included. Supplementing IDNA athletes with iron improved performance in 6 studies (146 participants) and did not improve performance in the other 6 studies (137 participants). In the 6 studies that showed improved performance with iron supplementation, all used a ferritin level cutoff of ≤20 μg/L for treatment. Additionally, all studies that showed improved performance used oral iron as a supplement. Conclusion: The evidence is equivocal as to whether iron supplementation in IDNA athletes improves athletic performance. Supplementing athletes with ferritin levels <20 μg/L may be more beneficial than supplementing athletes with higher baseline ferritin levels.
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Lütkhoff, Lisa K., Manuela Albisetti, Timothy J. Bernard, Mariana Bonduel, Leonardo R. Brandao, Stephane Chabrier, Anthony Chan, et al. "Impact of Thrombophilia On Arterial Ischemic Stroke or Cerebral Venous Sinus Thromboses in Children: A Systematic Review & Meta-Analysis of Observational Studies." Blood 114, no. 22 (November 20, 2009): 3993. http://dx.doi.org/10.1182/blood.v114.22.3993.3993.
Full textAbstract:
Abstract Abstract 3993 Poster Board III-929 Background The incidence of stroke in children is estimated at about 2.6 per 100,000 per year. Risk factors include congenital heart malformations, trauma, hemolytic anemias, collagen tissue diseases, inborn metabolic disorders, and infectious diseases. Apart from acquired thrombophilic risk factors, such as the presence of antiphospholipid antibodies, inherited thrombophilias (IT) have been found to be associated with stroke in infants and children. However, results of single studies on the risk of stroke onset associated with IT have been contradictory or inconclusive, mainly due to lack of statistical power. The aim of this study was to estimate the impact of thrombophilia (IT) on risk of childhood stroke via meta-analysis of published observational studies. Methods and Results A systematic search of electronic databases (Medline, EMBASE, OVID, Web of Science, The Cochrane Library) for studies published from 1970 to 2009 was conducted using key words in combination both as MeSH terms and text words. Citations were independently screened by two authors and those meeting the a priori defined inclusion criteria were retained. Data on year of publication, study design, country of origin, number of patients/controls, ethnicity, stroke type (arterial ischemic stroke [AIS]; cerebral venous sinus thrombosis [CSVT]) were abstracted. Publication bias indicator and heterogeneity across studies were evaluated, and summary odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using both fixed-effects and random-effects models. Twenty-one of 185 references found met inclusion criteria. 1698 patients (AIS: 1291; CSVT: 407) and 2913 controls aged neonate to 18 years were enrolled. No significant heterogeneity was discerned across studies, and no publication bias was detected. A statistically significant association with stroke onset was demonstrated for each IT trait evaluated, with no difference found between AIS (table) and CSVT. Summary ORs/CIs (random-effects model) for AIS & CSVT cohorts were as follows: Protein C-deficiency (8.76/4.53-16.96), FV G1691A (3.34/2.66-4.26), FII G20210A (2.50/1.67-3.74), MTHFR T677T (1.61/1.21-2.14), antiphospholipid antibodies (5.84/3.06-11.18), elevated lipoprotein (a) (6.24/4.51-8.64), and combined ITs (8.85/3.32-23.57). Carrier rates reported for antithrombin- or protein S deficiency among patients were 1.5% and 1.6% as compared with 0.06% (p<0.001) and 0.4% (p=0.003) in healthy controls. Conclusions The present meta-analysis indicates that IT serve as risk factors for incident stroke. However, the impact of IT upon outcome and recurrence risk needs to be further investigated. Disclosures: Manco-Johnson: Baxter BioScience: Honoraria; Bayer HealthCare: Honoraria; CSL Behring: Honoraria; NovoNordisk: Honoraria; Octapharma: Honoraria. Off Label Use: Enoxaparin (LMWH) is used off-label in children to prevent symptomatic thromboembolism.