Helping You Find Full Text Journal Articles

Search Results:

Author: Philip D Sloane (144)



View Full Text PDF Listings View primary source full text article PDFs.

Jan
2018

Family caregivers of people with dementia must attend to medical care needs of their relative, yet few available resources address comorbidities in dementia. Consequently, caregivers feel ill-equipped when medical concerns arise. In response, an educational resource-Alzheimer's Medical Advisor ( AlzMed)-was developed in 2 forms (website and book) and evaluated.

View Full Text PDF Listings View primary source full text article PDFs.

View Full Text PDF Listings View primary source full text article PDFs.

Nov
2017

The poor oral hygiene of nursing home (NH) residents is a matter of increasing concern, especially because of its relationship with pneumonia and other health events. Because details and related risk factors in this area are scant and providers need to be able to easily identify those residents at most risk, this study comprehensively examined the plaque, gingival, and denture status of NH residents, as well as readily available correlates of those indicators of oral hygiene, including items from the Minimum Data Set (MDS).
Oral hygiene assessment and chart abstract conducted on a cross-section of NH residents.

View Full Text PDF Listings View primary source full text article PDFs.

Feb
2018

Antibiotic stewardship programs (ASPs) are coordinated interventions promoting the appropriate use of antibiotics to improve patient outcomes and reduce microbial resistance. These programs are now mandated in nursing homes (NHs) but it is unclear if these programs improve resident outcomes. This systematic review evaluated the current evidence regarding outcomes of ASPs in the NH.

View Full Text PDF Listings View primary source full text article PDFs.

Sep
2017

Pneumonia is the leading infectious cause of hospitalization and death for nursing home (NH) residents; however, diagnosis is often delayed because classic signs of infection are not present. We sought to identify NH residents at high risk for pneumonia, to identify persons to target for more intensive surveillance and preventive measures.
Based on a literature review, we identified key risk factors for pneumonia and compiled them for use as prediction tool, limiting risk factors to those available on the Minimum Data Set (MDS).

View Full Text PDF Listings View primary source full text article PDFs.

Nov
2017

Evaluation of efforts to support family caregivers of people with dementia in their daily medical management responsibilities requires a measure of caregiver self-efficacy (confidence). This article describes the development and psychometric properties of the Caregiver Confidence in Sign/Symptom Management (CCSM) scale, the only available instrument in this area. Measurement development included literature and expert panel review, cognitive testing, and field testing.

View Full Text PDF Listings View primary source full text article PDFs.

Aug
2017

Due to the high rates of inappropriate antibiotic prescribing for presumed urinary tract infections (UTIs) in nursing home (NH) residents, we sought to examine the antibiotic prescribing pathway and the extent to which it agrees with the Loeb criteria; findings can suggest strategies for antibiotic stewardship.
Chart review of 260 randomly-selected cases from 247 NH residents treated with an antibiotic for a presumed UTI in 31 NHs in North Carolina. We examined the prescribing pathway from presenting illness, to the prescribing event, illness work-up and subsequent clinical events including emergency department use, hospitalization, and death.

View Full Text PDF Listings View primary source full text article PDFs.

Dec
1969

Antibiotic overuse causes antibiotic resistance, one of the most important threats to human health. Older adults, particularly those in nursing homes, often receive antibiotics when they are not indicated.
To understand knowledge, attitudes, and behaviors of nursing home (NH) nurses and community-dwelling older adults towards antibiotic use, especially in clinical situations consistent with antibiotic overuse, we conducted a mixed-method survey in two NHs and one Family Medicine clinic in North Carolina, among English-speaking nurses and community-dwelling, cognitively intact adults aged 65 years or older.

View Full Text PDF Listings View primary source full text article PDFs.

Mar
2017

To develop and validate the Dental Activities Test (DAT), a clinical tool for measuring dentally related function in cognitively impaired older adults.
Cross-sectional study design.
Three assisted living residences in North Carolina.

View Full Text PDF Listings View primary source full text article PDFs.

Apr
2017

To understand the range of symptoms that present to family caregivers of community-dwelling persons with Alzheimer's disease and related dementias (ADRD).
Six-month longitudinal prospective study to identify the incidence of new or worsening symptoms and their association with acute care medical service use.
Community-based sample of volunteers from multiple states.

View Full Text PDF Listings View primary source full text article PDFs.

Dec
1969

OBJECTIVE To describe current practice around urine testing and identify factors leading to overtreatment of asymptomatic bacteriuria in community nursing homes (NHs) DESIGN Observational study of a stratified random sample of NH patients who had urine cultures ordered in NHs within a 1-month study period SETTING 31 NHs in North Carolina PARTICIPANTS 254 NH residents who had a urine culture ordered within the 1-month study period METHODS We conducted an NH record audit of clinical and laboratory information during the 2 days before and 7 days after a urine culture was ordered. We compared these results with the urine antibiogram from the 31 NHs. RESULTS Empirical treatment was started in 30% of cases.

View Full Text PDF Listings View primary source full text article PDFs.

Feb
2017

Efforts at preventing pneumococcal disease are a national health priority, particularly in older adults and especially in post-acute and long-term care settings The Advisory Committee on Immunization Practices recommends that all adults ≥65 years of age, as well as adults 18-64 years of age with specific risk factors, receive both the recently introduced polysaccharide-protein conjugate vaccine against 13 pneumococcal serotypes as well as the polysaccharide vaccine against 23 pneumococcal serotypes. Nursing facility licensure regulations require facilities to assess the pneumococcal vaccination status of each resident, provide education regarding pneumococcal vaccination, and administer the appropriate pneumococcal vaccine when indicated. Sorting out the indications and timing for 13 pneumococcal serotypes and 23 pneumococcal serotypes administration is complex and presents a significant challenge to healthcare providers.

View Full Text PDF Listings View primary source full text article PDFs.

Jan
2017

To examine perspectives on antibiotic use and antibiotic stewardship of nurses and medical providers in nursing homes (NHs).
Cross-sectional survey.
NHs in North Carolina (N = 31).

View Full Text PDF Listings View primary source full text article PDFs.

Mar
2017

Antibiotic stewardship has been called for across all sites of health care, including nursing homes (NHs). Skin and soft tissue infections (SSTIs) are the third most common indication for antibiotics in the NH, and so should be a focus of stewardship. This study audited medical records to identify signs and symptoms of SSTIs treated with antibiotics in relation to the McGeer criteria for surveillance, the Loeb minimum criteria for antibiotic initiation, and prescribing recommendations of the Infectious Disease Society of America.

View Full Text PDF Listings View primary source full text article PDFs.

Dec
2016

Pneumonia is a leading cause of morbidity and mortality in nursing home (NH) residents. Chest x-ray evidence is considered a key diagnostic criterion for pneumonia by the Infectious Disease Society of America (IDSA) diagnostic guidelines, the modified McGeer diagnostic criteria, and the Loeb criteria for initiating antibiotics; however, x-ray interpretation is often equivocal. We conducted chart audits of patients in NHs who had chest x-rays for new respiratory symptoms to determine the degree of ambiguity in the radiology reports and their relationship to antibiotic prescription decisions.

View Full Text PDF Listings View primary source full text article PDFs.

Dec
2016

Residents of assisted living (AL) communities are at high risk for falls, which result in negative outcomes and high health care costs. Adapting effective falls prevention programs for AL quality improvement (QI) has the potential to reduce falls, improve resident quality of life, and reduce costs. This project tested the feasibility and outcomes of an evidence-based multi-component QI program, the Assisted Living Falls Prevention and Monitoring Program (AL-FPMP).

View Full Text PDF Listings View primary source full text article PDFs.

Dec
2016

Antibiotic stewardship is becoming a requirement for nursing homes. Programs should be interdisciplinary and multifaceted; should have support from nursing home administrators; and should aim to promote antibiotics only when needed, not just in case. Recommended components include use of evidence-based guidelines; ongoing monitoring of antibiotic prescriptions, cultures, and study results; monitoring of health outcomes; use of nursing home-specific antibiograms; regular reporting and feedback to medical providers and nurses; and education of residents and families.

View Full Text PDF Listings View primary source full text article PDFs.

Dec
1969

Pneumonia is a leading cause of death among nursing home residents; consequently, prevention and treatment are important for quality improvement. To be pragmatic, quality improvement depends on sensitive case identification using nursing home records; however, no studies have examined the reliability of different methods of pneumonia case finding from records. The current authors compared three established strategies for defining pneumonia using records from 1,119 residents across 16 nursing homes: recorded diagnosis of pneumonia, modified McGeer criteria (chest x-ray infiltrate plus specified signs/symptoms), and antibiotic prescription plus pneumonia-specific signs.

View Full Text PDF Listings View primary source full text article PDFs.

View Full Text PDF Listings View primary source full text article PDFs.

Sep
2015

The emerging crisis in antibiotic resistance and concern that we now sit on the precipice of a post-antibiotic era have given rise to advocacy at the highest levels for widespread adoption of programmes that promote judicious use of antibiotics. These antibiotic stewardship programmes, which seek to optimize antibiotic choice when clinically indicated and discourage antibiotic use when clinically unnecessary, are being implemented in an increasing number of acute care facilities, but their adoption has been slower in nursing homes. The antibiotic prescribing process in nursing homes is fundamentally different from that observed in hospital and clinic settings, with formidable challenges to implementation of effective antibiotic stewardship.

View Full Text PDF Listings View primary source full text article PDFs.

Sep
2015

Near-miss events represent an opportunity to identify and correct errors that jeopardize patient safety. This study was undertaken to assess the feasibility of a near-miss reporting system in primary care practices and to describe initial reports and practice responses to them.
We implemented a web-based, anonymous near-miss reporting system into 7 diverse practices, collecting and categorizing all reports.

View Full Text PDF Listings View primary source full text article PDFs.

Feb
2016

Motor vehicle crashes are the second most common form of trauma among older adults. We seek to describe the incidence, risk factors, and consequences of persistent pain among older adults evaluated in the emergency department (ED) after a motor vehicle crash.
We conducted a prospective longitudinal study of patients aged 65 years or older who presented to one of 8 EDs after motor vehicle crash between June 2011 and June 2014 and were discharged home after evaluation.

View Full Text PDF Listings View primary source full text article PDFs.

View Full Text PDF Listings View primary source full text article PDFs.

Jul
2015

To evaluate the effect of tailored interventions on the appropriateness of decisions to prescribe or withhold antibiotics, antibiotic use and guideline-adherent antibiotic selection in nursing homes (NHs).
We conducted a quasi-experimental study in 10 NHs in the Netherlands. A participatory action research (PAR) approach was applied, with local stakeholders in charge of selecting tailored interventions based on opportunities for improved antibiotic prescribing that they derived from provided baseline data.

View Full Text PDF Listings View primary source full text article PDFs.

Feb
2015

Develop self-administered questionnaires of person-centeredness for completion by residents and staff in assisted living (AL), in response to concerns that AL is not person-centered; also, demonstrated person-centeredness is necessary for Medicaid support as a home- and community-based services provider.
Community-based participatory research partnership among a research team, a consortium of 11 stakeholder organizations, and others. Methods included literature review, item generation and reduction, cognitive testing, field testing, exploratory factor analysis, and convergent and discriminant validity testing.

View Full Text PDF Listings View primary source full text article PDFs.

Feb
2015

Many innovative long-term care models can now be found in nursing homes, assisted living, and community home care settings. Key forces that will shape the future include the aging of the baby-boomer generation, personal choice, concerns about quality, new technologies, dementia research, payment issues, financial pressures, and workforce needs.

View Full Text PDF Listings View primary source full text article PDFs.

Oct
2014

To describe the prevalence, characteristics, and appropriateness of systemic antibiotic use in assisted living (AL) and to conduct a preliminary quality improvement intervention trial to reduce inappropriate prescribing.
Pre-post study, with a 13-month intervention period.
Four AL communities.

View Full Text PDF Listings View primary source full text article PDFs.

Apr
2015

The two primary residential options for older adults who require supportive care are nursing homes and residential care/assisted living. More than one-quarter of all deaths in the U.S.

View Full Text PDF Listings View primary source full text article PDFs.

Jan
2014

To provide empirically based recommendations for incorporating body temperature into clinical decision-making regarding diagnosing infection in nursing home (NH) residents.
Retrospective.
Twelve North Carolina NHs.

View Full Text PDF Listings View primary source full text article PDFs.

Jul
2014

Most primary care clinicians lack the skills and resources to offer effective lifestyle and medication (L&M) counseling to reduce coronary heart disease (CHD) risk. Thus, effective and feasible CHD prevention programs are needed for typical practice settings.
To assess the effectiveness, acceptability, and cost-effectiveness of a combined L&M intervention to reduce CHD risk offered in counselor-delivered and web-based formats.

View Full Text PDF Listings View primary source full text article PDFs.

May
2014

To create data-driven typologies of licensed nurse staffing and health services in residential care and assisted living (RC/AL).
Cluster analysis was used to describe the patterns of licensed nurse staffing and 47 services and the extent to which these clusters were related.
RC/AL communities in the United States.

View Full Text PDF Listings View primary source full text article PDFs.

Apr
2014

Assisted living residences have become prominent sites of long-term residential care for older adults with dementia. Estimates derived from national data indicate that seven out of ten residents in these residences have some form of cognitive impairment, with 29 percent having mild impairment, 23 percent moderate impairment, and 19 percent severe impairment. More than one-third of residents display behavioral symptoms, and of these, 57 percent have a medication prescribed for their symptoms.

View Full Text PDF Listings View primary source full text article PDFs.

May
2014

To determine whether antibiotic prescribing can be reduced in nursing homes using a quality improvement (QI) program that involves providers, staff, residents, and families.
A 9-month quasi-experimental trial of a QI program in 12 nursing homes (6 comparison, 6 intervention) conducted from March to November 2011.
Nursing homes in two regions of North Carolina, roughly half of whose residents received care from a single practice of long-term care providers.

View Full Text PDF Listings View primary source full text article PDFs.

May
2014

To evaluate the effectiveness of the Bathing Without a Battle intervention in reducing physical and verbal aggressive behaviors for nursing home residents with dementia.
A randomized crossover diffusion study, with one group receiving the intervention after one round of baseline observations and a delayed intervention group receiving the intervention after two rounds of baseline observations.
Six nursing home facilities in the state of New York.

View Full Text PDF Listings View primary source full text article PDFs.

Aug
2014

To better understand the process and outcomes of family involvement for long-term care residents with varying stages of dementia, we analyzed family and staff data for 467 residents of 24 residential care/assisted living and nursing-home settings. Adjusted analyses found that although the amount of family visitation did not significantly vary by resident cognitive status (15 versus 20 visits/month to persons with and without dementia, respectively), the nature of the visit did. Families of cognitively intact residents spent more time in activities related to social and community engagement, such as taking residents on trips and calling and writing letters (p<.

View Full Text PDF Listings View primary source full text article PDFs.

View Full Text PDF Listings View primary source full text article PDFs.

Feb
2014

Culture change aims to fundamentally improve care provision in a manner consistent with individual preferences. However, few studies of culture change have focused on the quality of daily care, despite the fact that system-wide efforts are important to assure the effectiveness, adoption, and sustainability of person-centered care to meet daily needs. This paper describes a new culture change practice, Mouth Care Without a Battle.

View Full Text PDF Listings View primary source full text article PDFs.

Dec
2013

Primary care physicians routinely provide dementia care, but may lack the clinical skills and awareness of available resources to provide optimal care. We conducted a community-based pilot dementia training intervention designed to both improve clinical competency and increase utilization of local dementia care services.
Physicians (N = 29) and affiliated staff (N = 24) participated in a one-day training program on dementia screening, diagnosis and management that included direct engagement with local support service providers.

View Full Text PDF Listings View primary source full text article PDFs.

Oct
2013

Retirement migration from northern countries to southern countries is increasing in both Europe and North America, and retiree experiences will impact future migration and health services utilization. We therefore sought to describe the healthcare experiences and perceptions of retired U.S.

View Full Text PDF Listings View primary source full text article PDFs.

Sep
2013

The authors sought to describe the frequency of short-term side effects experienced by older adults initiating treatment with opioid-containing analgesics for acute musculoskeletal pain.
This was a cross-sectional study of individuals age 65 years or older initiating analgesic treatment following emergency department (ED) visits for acute musculoskeletal pain. Patients were called by phone 4 to 7 days after their ED visits to assess the intensity of six common opioid-related side effects using a 0 to 10 scale and to assess medication discontinuation due to side effects.

View Full Text PDF Listings View primary source full text article PDFs.

Nov
2013

Although lifestyle and medications are effective for coronary heart disease (CHD) risk reduction, few studies have examined the comparative effectiveness of various strategies for delivering high quality CHD risk reduction. In this paper, we report on the design and baseline characteristics of participants for just such a trial.
We conducted a randomized trial of the same lifestyle and medication intervention delivered in two alternate formats: counselor-delivered or web-based.

View Full Text PDF Listings View primary source full text article PDFs.

Aug
2013

In response to the need for an evidence-based review of factors within long-term care settings that affect the quality of care, this review compared characteristics of nursing homes and other residential long-term care settings for people with dementia and their informal family caregivers with respect to health and psychosocial outcomes.
Databases were searched for literature published between 1990 and March 2012 that met review criteria, including that at least 80% of the subject population had dementia.
Fourteen articles meeting review criteria that were of at least fair quality were found: four prospective cohort studies, nine randomized controlled trials (RCTs), and one nonrandomized controlled trial.

View Full Text PDF Listings View primary source full text article PDFs.

Dec
1969

Nursing homes and residential care/assisted living settings provide care to 2.4 million individuals. Few studies compare the experience of, and relationships between, family and staff in these settings, despite ongoing family involvement and evidence that relationships are problematic.

View Full Text PDF Listings View primary source full text article PDFs.

Jul
2013

To develop and test a person-centered, evidence-based mouth care program in nursing homes.
Pre-post assessment, with an 8-week intervention period and a pilot 6-month extension at one site.
Three North Carolina nursing homes.

View Full Text PDF Listings View primary source full text article PDFs.

View Full Text PDF Listings View primary source full text article PDFs.

Apr
2013

To better understand the antibiotic prescribing process in assisted living (AL) communities given the growing rate of antibiotic resistance.
Cross-sectional survey.
Four AL communities in North Carolina.

View Full Text PDF Listings View primary source full text article PDFs.

Apr
2013

The Loeb minimum criteria (LMC), developed by a 2001 consensus conference, are minimum standards for initiation of antibiotics in long term care settings, intended to reduce inappropriate prescribing. This study examined the relationship between nursing home prescriber adherence to the LMC and antibiotic prescribing rates, overall and for each of three specific conditions (urinary tract infections, respiratory infections, and skin and soft tissue infections).
We performed a cross-sectional analysis at the resident-day level.

View Full Text PDF Listings View primary source full text article PDFs.

Dec
1969

This group-randomized trial implemented and evaluated an intervention to reduce staff burden and improve family and resident outcomes by helping families create meaningful roles for themselves in residential care/assisted living and nursing homes. Across 24 sites, families (= 490) and staff (= 397) provided data over six months about family involvement, family and staff well-being and attitudes, and resident quality of life. Intervention subjects participated in workshops and created service plans to identify family roles.

View Full Text PDF Listings View primary source full text article PDFs.

Jul
2012

Motor vehicle collisions (MVCs) are the second most common cause of nonfatal injury among U.S. adults age 65 years and older.

View Full Text PDF Listings View primary source full text article PDFs.

Back to top