Background: Experience in trials of implementing quality improvement (QI) programs in nursing homes (NHs) has been variable. Understanding the characteristics of NHs that demonstrate improvements during these trials is critical to improving NH care.
Design: Secondary analysis of a randomized controlled trial of implementation of a QI program to reduce hospital transfers.
Background/objectives: Evidence on the effectiveness of inpatient hospital geriatric consultation is scant, and it is unknown whether adherence to specific recommendations will improve care and patient outcomes. This study was conducted to provide insights from a quality improvement project that may help guide further improvements in the effectiveness of these consultations made as a component of a care transitions program (CTP).
Design: Secondary analysis of the implementation of a multicomponent CTP for high-risk hospitalized patients aged 75 and older.
To date, the antimicrobial activity of arachidonic acid (AA) with regard to pathogenesis of Brucella in macrophages is unknown. We found that AA is highly toxic to B. abortus in a time- and dose-dependent manner.
View Article and Find Full Text PDFTo date, the implications of prostaglandin I2 (PGI), a prominent lipid mediator for modulation of immune responses, has not been clearly understood in Brucella infection. In this study, we found that cyclooxygenase-2 (COX-2) was significantly expressed in both infected bone marrow-derived macrophages (BMMs) and RAW 264.7 cells.
View Article and Find Full Text PDFBackground: The majority of patients require postacute care (PAC) after a hip fracture. Despite its importance, there is no established consensus regarding the standards of care provided to hip fracture patients in PAC facilities.
Methodology: A writing group was created by professionals from the International Geriatric Fracture Society (IGFS) with representation from other organizations.
In this study, two recombinant proteins encoded by Brucella abortus genes Adk and SecB were evaluated as single subunit vaccine (SSV) as well as combined subunit vaccine (CSV) against B. abortus infection in BALB/c mice. These genes were cloned into pcold-TF expression system and recombinant proteins were expressed in Escherichia coli DH5α.
View Article and Find Full Text PDFObjectives: To describe the causes of 30-day hospital readmissions among high-risk older adults during implementation of a multicomponent care transitions program.
Design: Secondary analysis of data from the evaluation of a multicomponent care transitions program for hospitalized high-risk older adults.
Setting: A 400-bed community teaching hospital.
Despite the current understanding of the pathophysiology of sepsis and advances in its treatment, the rate of sepsis is increasing globally. Sepsis is a common cause of hospitalization in older adults, and infections are among the most common diagnoses among residents transferred to the hospital from long-term care facilities (LTCFs). LTCFs and hospitals are facing financial and regulatory requirements to reduce potentially preventable emergency department visits, hospitalizations, and hospital readmissions due to infections and other causes.
View Article and Find Full Text PDFObjectives: To test the effectiveness of a multicomponent care transition intervention targeted at hospitalized patients, aged 75 years and older, at high risk for hospital readmissions, return emergency department (ED) visits, and related complications.
Design: Implementation as a quality improvement program with propensity-matched preintervention and concurrent comparison groups over a 12-month period.
Setting: A 400-bed community teaching hospital.
In many countries around the world, including the United States, care for vulnerable older people is fragmented, especially at the time of hospital discharge and in the postacute hospital period. Thus, a major challenge for health care systems is to deliver the right type of post-acute care, in the right setting, by the right health care professionals, and for the right length of time. Care transition programs should avoid unnecessary harm related to poor transfer of care between settings, and address common problems as care transitions occur.
View Article and Find Full Text PDFGeriatric screening and assessment allows clinicians to care for older patients in an efficient, patient-centered manner. This framework includes standard screening questions that may trigger the use of standard geriatric assessment tools and/or other interventions. Additionally, it serves to complement the history and physical examination, and is critical for maximizing the health, function, safety, and quality of life of older patients.
View Article and Find Full Text PDFObjectives: To describe the presentation and management of acute changes in condition in skilled nursing facilities (SNFs) during implementation of a program designed to reduce unnecessary emergency department visits and hospitalizations.
Design: Secondary analysis of data from a randomized controlled trial involving 264 SNFs.
Participants: One hundred thirty-three of the 264 participating SNFs that provided data on acute changes in condition: 55 in the intervention group, 78 in the control group.
The discovery of antimicrobial peptides (AMPs) in recent years has been promising for the treatment of multidrug resistant pathogenic microbes. Brucellosis is still considered one of the most common zoonoses in the world. In this study, we evaluated the effect HPA3P peptide in the bacterial uptake and intracellular growth of Brucella abortus (B.
View Article and Find Full Text PDFThe first evidence in humans that a safe and effective preventive vaccine for HIV is possible came from the phase III HIV clinical trial RV144 in Thailand. This trial was based on a prime/boost combination of a recombinant canarypox vaccine and two glycoprotein 120 proteins (ALVAC-HIV and AIDSVAX B/E). A pivotal phase IIb/III trial has recently commenced in the Republic of South Africa, for which the infectious titer assay was applied as the quantitative release test for the ALVAC-HIV vaccine.
View Article and Find Full Text PDFObjectives: To determine whether degree of implementation of the Interventions to Reduce Acute Care Transfers (INTERACT) program is associated with number of hospitalizations and emergency department (ED) visits of skilled nursing facility (SNF) residents.
Design: Secondary analysis from a randomized controlled trial.
Setting: SNFs from across the United States (N=264).
Objectives: To determine the most common clinical conditions associated with older adults visiting Urgent care centers (UCCs) and the potential need for further resource use.
Design: Cross-sectional retrospective study.
Setting: Nonprofit academic medical center with campuses and multiple satellite offices in Ohio and Florida.
Currently, there are several serodiagnostic tools available for brucellosis, however, it is difficult to differentiate an active infection from vaccination. Hence, there is a great need to develop alternative means that can distinguish between these two conditions without utilizing lipopolysaccharide (LPS). This study was an attempt to determine the efficacy of combined recombinant Brucella (B.
View Article and Find Full Text PDFIntroduction: Current guidelines based on clinical trials may have inadvertently excluded a representative cohort of older adults. As a result, little is known about the predictors of stroke among elderly patients undergoing coronary artery bypass surgery (CABG). The purpose of this study was to determine how a lower than normal ejection fraction (EF) predicted post surgery stroke among elderly patients undergoing CABG when compared with younger populations.
View Article and Find Full Text PDFThe role of hypothermia in the improvement of outcomes among patients suffering severe head injury remains controversial. The "National Acute Brain Injury Study: Hypothermia (NABIS:H)" is a series of prospective trials trying to determine if this therapy provides a beneficial effect. This report describes the case of a patient ejected from a motor vehicle, who presented with a decreased level of consciousness (Glasgow Coma Scale of 5).
View Article and Find Full Text PDFJ Matern Fetal Neonatal Med
April 2009
Objective: To determine if missing paternal information in birth certificates is associated with an increased risk of low birth weight (LBW).
Methods: This was a retrospective single cohort analysis including all live births at our institution between April 1999 and May 2002. We created two study groups, one with father's information complete (FIC) and one with father's information missing (FIM).