Publications by authors named "Heidi Wierman"

Delirium prevention in hospitalized older adults is important due to delirium's high prevalence and negative impact on outcomes. Today, there are evidence-based programs with well-documented effectiveness aimed at preventing delirium, such as the Hospital Elder Life Program (HELP); however, approximately 4% to 5% of patients develop delirium regardless of implemented prevention interventions. It remains unknown why some patients develop delirium.

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Background: Delirium is a common complication of hospitalization and is associated with poor outcomes. Multicomponent delirium prevention strategies such as the Hospital Elder Life Program (HELP) have proven effective but rely on face-to-face intervention protocols and volunteer staff, which was not possible due to restrictions during the COVID-19 pandemic. We developed the Modified and Extended Hospital Elder Life Program (HELP-ME), an innovative adaptation of HELP for remote and/or physically distanced applications.

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Background/objectives: To describe the Mobility Action Group (MACT), an innovative process to enhance implementation of hospital mobility programs and create a culture of mobility in acute care.

Design: Continuous quality improvement intervention with episodic data review.

Setting: Inpatient units including medical, surgical, and intensive care settings.

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The aim of this study was to explore and describe the characteristics of the Hospital Elder Life Program (HELP) sites and how they mobilize patients with volunteers in the United States and other countries. The purpose was to describe: the number of enrollments, modalities, fall and injury rates, and to identify barriers to mobilization. A survey was distributed to 228 international sites.

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Aim And Objectives: To describe and compare identification of delirium, length of stay and discharge locations in two patient samples of falls, before and after an organisation-wide interprofessional delirium education and practice change along with implementation of a policy.

Background: Delirium is a common and severe problem for hospitalised patients, with occurrence ranging from 14%-56%, morbidity and mortality from 25%-33%. Recent studies report that 73%-96% of patients who fell during a hospital stay had symptoms of delirium; however, the delirium went undiagnosed and untreated in 75% of the cases.

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Context: Timely hospice referral is an indicator of high-quality end-of-life care for cancer patients. Variations in patient characteristics associated with hospice utilization and length of stay have been demonstrated in studies of other malignancies but not melanoma.

Objectives: We sought to understand hospice utilization and patient characteristics associated with variability in use for the older melanoma population.

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Background: Delirium has been previously implicated as a risk factor for patient falls. This is a replication study of a 2009 investigation examining the prevalence of diagnosed and undiagnosed delirium in patients who fell during their hospital stay.

Objective: To determine the prevalence of delirium at our institution and to examine the relationship of falls with delirium, advanced age, and hospital procedures.

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Objective: To describe decision process and quality for common cancer screening and medication decisions by age group.

Methods: We included 2941 respondents to a national Internet survey who made at least one decision about colorectal, breast, and prostate cancer screening, blood pressure or cholesterol medications. Respondents were queried about decision processes.

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Aim: This project's purpose was to promote and sustain a practice change focusing on delirium utilising the clinical nurse specialist (CNS) in a leadership role.

Background: Delirium is an altered state of consciousness accompanied by an acute change in cognition that tends to have a fluctuating course. Delirium is strongly associated with negative outcomes and is often unrecognised.

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Background: Intraperitoneal combined with intravenous chemotherapy (IV/IP) for primary treatment of epithelial ovarian cancer results in a substantial survival advantage for women who are optimally debulked surgically, compared with standard IV only therapy (IV). Little is known about the use of this therapy in the Medicare population.

Methods: We used the Surveillance, Epidemiology, and End Results (SEER)-Medicare database to identify 4665 women aged 66 and older with epithelial ovarian cancer diagnosed between 2005-2009, with their Medicare claims.

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Background: Recent studies of ventilated, critically ill patients have shown early mobilization to be safe and resulting in better functional outcomes at discharge but have not focused on older adults.

Objectives: The objectives of this pilot study were to examine the feasibility of and to describe functional outcomes associated with providing early mobilization to critically ill, older adult patients.

Methods: This is a prospective cohort study that took place in the medical and surgical intensive care units of a tertiary, academic medical center.

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Background: Timely hospice referral is an essential component of quality end-of-life care, although a growing body of research suggests that for patients with various types of cancer, hospice referrals often occur very late in the course of care, and are marked by sociodemographic disparities. However, little is known about the ovarian cancer patient population specifically. We examined the extent and timing of hospice referrals in ovarian cancer patients over age 65, and the factors associated with these outcomes.

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Purpose: This analysis identifies factors associated with completion of adjuvant chemotherapy for patients with ovarian cancer and subsequent use of health services.

Patients And Methods: We used the Surveillance, Epidemiology, and End Results (SEER) -Medicare database to identify 4,617 women age 65 years or older with ovarian cancer diagnosed from 2001 to 2005. By using multivariable analyses with completion of chemotherapy as the outcome of interest, we describe factors associated with completion of treatment, including age, race, marital status, comorbidities, and sociodemographic factors.

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This article reports on the use of Simple Pleasures interventions to minimize agitation in hospitalized patients with late-stage dementia. The pilot project was not able to demonstrate statistical significance; however, the positive response to the education and provision of interventions has led to a hospital-wide dissemination of the interventions in the form of an activity box. No adverse effects of the interventions were found, and some patients experienced a significant decrease in agitation and use of sedative medications after exposure to the interventions.

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Objective: To demonstrate the level of compliance to metformin-prescribing guidelines and to evaluate the effectiveness of 2 pharmacy-based interventions.

Methods: Retrospective chart review of all inpatients who had received at least 2 doses of metformin while hospitalized. Two cohorts of patients had chart audits-one group (group A) hospitalized between March and August of 2003 (487 patients) and one group (group B) hospitalized between August of 2005 and January of 2006 (370 patients).

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