Water-aided colonoscopy: a systematic review.

Background: Water-aided methods for colonoscopy are distinguished by the timing of removal of infused water, predominantly during withdrawal (water immersion) or during insertion (water exchange).

Objective: To discuss the impact of these approaches on colonoscopy pain and adenoma detection rate (ADR).

Design: Systematic review.

Validating an evidence-based, self-rated fall risk questionnaire (FRQ) for older adults.

Background: Falls are a common, serious, and often unrecognized problem facing older adults. The objective of this study was to provide an initial clinical and statistical validation for a public health strategy of fall risk self-assessment by older adults using a Fall Risk Questionnaire (FRQ).

Methods: Adults age 65+ (n=40) were recruited at a Los Angeles Veterans Affairs (VA) medical facility and at a local assisted living facility.

Development of a fall prevention survey to determine educational needs for primary care providers.

Quality indicators are standardized measures of health care quality. We designed a survey to assess how knowledge, attitude, and organizational practices might affect healthcare provider behaviors in meeting quality indicators for fall prevention to plan curricula for a continuing educational intervention. The survey was pilot tested in the Veterans Affairs (VA) in a small stratified sample.

A proof-of-principle, prospective, randomized, controlled trial demonstrating improved outcomes in scheduled unsedated colonoscopy by the water method.

Background: An observational study in veterans showed that a novel water method (water infusion in lieu of air insufflation) enhanced cecal intubation and willingness to undergo a repeat scheduled unsedated colonoscopy.

Objective: To confirm these beneficial effects and significant attenuation of discomfort in a randomized, controlled trial (RCT).

Design: Prospective RCT, intent-to-treat analysis.

Health care for American Indian and Alaska native women.

Background: Many American Indian and Alaska Native (AIAN) women serve in the military and are eligible for healthcare from both the Veterans Health Administration (VHA) and the Indian Health Service (IHS). Little was known about these women's patterns of health care utilization when VHA and IHS executed a resource-sharing agreement in 2003 to improve access and health outcomes.

Objective: We sought to describe women's healthcare utilization in VHA and IHS.

Sleep in assisted living facility residents versus home-dwelling older adults.

Background: Sleep problems among assisted living facility (ALF) residents are not well understood, and sleep-related differences between ALF residents and home-dwelling older adults have not been examined.

Methods: We compared sleep patterns in 19 ALF residents to sleep patterns in 19 matched home-dwelling older people (age > or =65 years). All were participating in the follow-up portion of a longitudinal study of sleep and functional outcomes following post-acute rehabilitation.

The relationship of reported pain severity to perceived effect on function of nursing home residents.

Background: We examined whether questions addressing the effect of pain on day-to-day function add unique information to the standardized verbal descriptor scale for pain severity in nursing homes (NHs).

Methods: Interviews were conducted with 123 residents in two Veterans Affairs NHs. All participants were asked about pain presence.

More daytime sleeping predicts less functional recovery among older people undergoing inpatient post-acute rehabilitation.

Study Objectives: To study the association between sleep/wake patterns among older adults during inpatient post-acute rehabilitation and their immediate and long-term functional recovery

Design: Prospective, observational cohort study.

Setting: Two inpatient post-acute rehabilitation sites (one community and one Veterans Administration).

Participants: Older patients (aged > or = 65 years, N = 245) admitted for inpatient post-acute rehabilitation.

A statistical model to allow the phasing out of the animal testing of demineralised bone matrix products.

Demineralised bone matrix (DBM) products are complex mixtures of proteins known to influence bone growth, turnover, and repair. They are used extensively in orthopaedic surgery, and are bioassayed in vivo prior to being used in clinical applications. Many factors contribute to the osteogenic potency of DBM, but the relative contributions of these factors, as well as the possibility of interactive effects, are not completely defined.

A randomized trial of a screening, case finding, and referral system for older veterans in primary care.

Objectives: To test whether a system of screening, assessment, referral, and follow-up provided within primary care for high-risk older outpatients improves recognition of geriatric conditions and healthcare outcomes.

Design: Controlled clinical trial with 3-year follow-up; intervention versus control group allocation based on practice group assignment.

Setting: Department of Veterans Affairs (VA) ambulatory care center.

A multicomponent nonpharmacological intervention improves activity rhythms among nursing home residents with disrupted sleep/wake patterns.

Background: Sleep and circadian rhythms are disrupted among many nursing home (NH) residents. We examined the impact of a multicomponent nonpharmacological intervention on 24-hour rest/activity rhythms among long-stay NH residents.

Methods: The study was a randomized controlled trial in which, following a 3-day baseline, participants received 5 days of either usual care (control condition) or the active intervention.

The complexity of care for patients with rheumatoid arthritis: metrics for better understanding chronic disease care.

Background: Patients with rheumatoid arthritis (RA) provide an important opportunity for understanding care of patients with a serious chronic condition.

Objectives: We sought to characterize the complexity of care for patients with RA, including metrics describing the patient, the disease, and use of the health care system across time and place.

Methods: We undertook a prospective cohort study of 568 community-dwelling patients with RA by using observational data from clinically detailed telephone interviews at baseline and 2 years later in addition to medical record abstraction.

Identification of American Indian and Alaska Native veterans in administrative data of the Veterans Health Administration and the Indian Health Service.

We sought to determine the extent to which the Indian Health Service (IHS) identified enrollees who also use the Veterans Health Administration (VHA) as veterans. We used a bivariate analysis of administrative data from fiscal years 2002-2003 to study the target population. Of the 32259 IHS enrollees who received care as veterans in the VHA, only 44% were identified by IHS as veterans.

Daytime sleeping, sleep disturbance, and circadian rhythms in the nursing home.

Objective: This study reports the frequency of abnormal daytime sleeping and identifies factors related to daytime sleeping, nighttime sleep disturbance, and circadian rhythm abnormalities among nursing home residents.

Methods: The authors conducted secondary analysis of data collected under usual care conditions within a nonpharmacologic sleep intervention trial. All residents from four Los Angeles nursing homes were screened for daytime sleeping (asleep>or=15% of observations, 9:00 am-5:00 pm).

Depression in older patients admitted for postacute nursing home rehabilitation.

Objectives: To describe the prevalence, recognition, and persistence of depression in older adults undergoing postacute rehabilitation in a nursing home (NH) setting and to explore the effect of depression on rehabilitation outcomes.

Design: Prospective cohort study.

Setting: One rehabilitative NH in the Los Angeles area.

Randomized, controlled trial of a nonpharmacological intervention to improve abnormal sleep/wake patterns in nursing home residents.

Objectives: Abnormal sleep/wake patterns are common in nursing home residents. Lifestyle and environmental factors likely contribute to these poor sleep patterns. The objective of this study was to test a multidimensional, nonpharmacological intervention to improve abnormal sleep/wake patterns in nursing home residents.

Effect of preventive home visits for ambulatory housebound elders in Japan: a pilot study.

Background And Aims: Programs of preventive home visits for ambulatory housebound elders have not yet become established in Japan. The aim of this randomized pilot study was to investigate effects of such visits by public health nurses in Japan.

Methods: A randomized controlled study with 18-month follow-up was conducted in a small Japanese agricultural town.

Development and evaluation of a patient self-report case-finding method for rheumatoid arthritis.

Objective: To describe the development and evaluation of a patient self-report case-finding method for rheumatoid arthritis (RA) not dependent on direct contact with the treating physicians.

Methods: The American College of Rheumatology criteria for RA diagnosis were adapted for patient self-report using a questionnaire, and alternative scoring algorithms were evaluated to balance case-finding sensitivity and specificity. Positive rheumatoid factor tests were used to identify 1053 individuals in 2 large healthcare organizations; 440 agreed to receive study materials.

Spanish Arthritis Empowerment Program: a dissemination and effectiveness study.

Objective: To evaluate the effectiveness of the Spanish Arthritis Empowerment Program as presented by the Arthritis Foundation, Southern California Chapter, in Orange County, California.

Methods: Participants with arthritis (n = 141) enrolled in the program between October 1999 and May 2001. All materials were in Spanish.

Case finding for population-based studies of rheumatoid arthritis: comparison of patient self-reported ACR criteria-based algorithms to physician-implicit review for diagnosis of rheumatoid arthritis.

Objective: To evaluate the interrater reliability of rheumatologist diagnosis of rheumatoid arthritis (RA) and the concordance between rheumatologist and computer algorithms for assessing the accuracy of a diagnosis of RA.

Methods: Self-reported data regarding symptoms and signs for a diagnosis of RA were considered by a panel of rheumatologists and by computer algorithms to assess the probability of a diagnosis of RA for 90 patients. The rheumatologists' review was validated through medical record.

The yield, reliability, and validity of a postal survey for screening community-dwelling older people.

Objectives: To assess the yield, reliability, and validity of a postal survey developed to identify older persons in need of outpatient geriatric assessment and follow-up services.

Design: A longitudinal cohort study.

Setting: Outpatient primary care clinic at a Department of Veterans Affairs teaching ambulatory care center.

Arthritis beliefs and self-care in an urban American Indian population.

Objective: To describe beliefs and self-care strategies of American Indians with chronic arthritis joint pain.

Method: In-depth interviews were conducted with a convenience sample of urban-dwelling American Indians (n = 56) concerning self-care and beliefs about arthritis; objective measures of arthritis disease activity were obtained through standardized interview protocols.

Results: Joint pain was not generally assumed to be arthritis nor directly related to aging.

Descriptions of joint pain by American Indians: comparison of inflammatory and noninflammatory arthritis.

Objective: To improve assessment of arthritis joint pain in American Indians by describing how symptoms are communicated.

Method: In-depth interviews were conducted with American Indians who experience chronic joint pain (n = 56), to elicit descriptions and self-reported ratings of pain, disability, and beliefs associated with the pain for affected joints (n = 326).

Results: Discrete sets of specific verbal descriptions distinguished inflammatory arthritis (n = 20 terms) from noninflammatory arthritis (n = 22 terms), and indicated levels of pain intensity.