A Comparison of Usage and Outcomes Between Nurse Practitioner and Resident-Staffed Medical ICUs.

Objective: To compare usage patterns and outcomes of a nurse practitioner-staffed medical ICU and a resident-staffed physician medical ICU.

Design: Retrospective chart review of 1,157 medical ICU admissions from March 2012 to February 2013.

Setting: Large urban academic university hospital.

What causes near-misses and how are they mitigated?

Objectives: The objectives of this study were to determine the reasons hospital RNs attribute to near-misses and the techniques they used to mitigate these near-misses to prevent serious reportable events.

Background: Our health system developed this definition for the study: A near-miss is a variation in a normal process that, if continued, could have a negative impact on patients.

Methods: Study participants were RNs who completed a survey about a self-reported near-miss or another RN's near-miss they'd witnessed.

What causes near-misses and how are they mitigated?

Objectives: The objectives of this study were to determine the reasons hospital RNs attribute to near-misses and the techniques they used to mitigate these near-misses to prevent serious reportable events.

Background: Our health system developed this definition for the study: A near-miss is a variation in a normal process that, if continued, could have a negative impact on patients.

Methods: Study participants were RNs who completed a survey about a self-reported near-miss or another RN's near-miss they'd witnessed.

Identification of and beliefs about depressive symptoms and preferred treatment approaches among community-living older African Americans.

Objective: To examine older African American's recognition of and beliefs about depressive symptoms, preferred symptom management strategies, and factors associated with willingness to use mental health treatments. Differences between the depressed and nondepressed and men and women were examined.

Design: Cross-sectional survey.

Cost effectiveness of a home-based intervention that helps functionally vulnerable older adults age in place at home.

Evaluating cost effectiveness of interventions for aging in place is essential for adoption in service settings. We present the cost effectiveness of Advancing Better Living for Elders (ABLE), previously shown in a randomized trial to reduce functional difficulties and mortality in 319 community-dwelling elders. ABLE involved occupational and physical therapy sessions and home modifications to address client-identified functional difficulties, performance goals, and home safety.

Effects of substrate composition on the structure of microbial communities in wastewater using fluorescence in situ hybridisation.

The microbial composition in a pulp and paper wastewater aerated lagoon system was analysed using fluorescence in situ hybridisation (FISH) to gain further understanding of the effect of substrate composition on microbial diversity for improved management of wastewater treatment systems. Few experiments have been conducted to tease apart the factors influencing the composition and abundance of certain groups within these wastewaters. Specific probes were used to investigate and enumerate the different bacterial groups present at particular stages through the treatment system over an extended period.

A biobehavioral home-based intervention and the well-being of patients with dementia and their caregivers: the COPE randomized trial.

Context: Optimal treatment to postpone functional decline in patients with dementia is not established.

Objective: To test a nonpharmacologic intervention realigning environmental demands with patient capabilities.

Design, Setting, And Participants: Prospective 2-group randomized trial (Care of Persons with Dementia in their Environments [COPE]) involving patients with dementia and family caregivers (community-living dyads) recruited from March 2006 through June 2008 in Pennsylvania.

Readiness to use compensatory strategies among older adults with functional difficulties.

Background: Compensatory strategies (behavioral/environmental modifications) can reduce the difficulties of performing daily living activities, fear of falling, and mortality risk. However, individuals vary in their readiness to use strategies. We examined characteristics associated with readiness to use compensatory strategies, the extent to which level of readiness changed from participation in an intervention (Advancing Better Living for Elders (ABLE)) providing compensatory strategies, and factors predictive of change in readiness level.

Targeting and managing behavioral symptoms in individuals with dementia: a randomized trial of a nonpharmacological intervention.

Objectives: To test the effects of an intervention that helps families manage distressing behaviors in family members with dementia.

Design: Two-group randomized trial.

Setting: In home.

Assistive devices caregivers use and find helpful to manage problem behaviors of dementia.

Purpose: Use of assistive devices in caring for individuals with dementia has not been systematically examined, particularly as it concerns managing behavioral symptoms. We tested a nonpharmacologic intervention to manage behaviors that involved instructing families in effective communication techniques, simplifying tasks and the home environment and using assistive devices. This paper describes the assistive devices provided to families assigned to intervention, extent of use of issued devices, their perceived helpfulness, and cost.

Preferences for life-prolonging medical treatments and deference to the will of god.

We defined and measured a dimension of religiosity frequently invoked in end-of-life (EOL) research-deference to God's Will (GW)-and examined its relationship to preferences for life-prolonging treatments. In a 35-min telephone interview, 304 older men and women (60 +) were administered the 5-item GW scale, sociodemographic questions, three attitude items regarding length of life, and measures of two health indices, depression, and life-prolonging treatment preferences. The GW scale demonstrated internal consistency (Cronbach's alpha = .

Long-term effect on mortality of a home intervention that reduces functional difficulties in older adults: results from a randomized trial.

Objectives: To evaluate the long-term mortality effect of a home-based intervention previously shown to reduce functional difficulties and whether survivorship benefits differ according to initial mortality risk level.

Design: Two-group randomized trial with survivorship followed up to 4 years from study entry.

Setting: Homes of urban community-living elderly people.

Harvest health: translation of the chronic disease self-management program for older African Americans in a senior setting.

Purpose: We describe the translation of K. R. Lorig and colleagues' Chronic Disease Self-Management Program (CDSMP) for delivery in a senior center and evaluate pre-post benefits for African American participants.

Variation in response to a home intervention to support daily function by age, race, sex, and education.

Background: Functional difficulty is associated with increased frailty and poor life quality, with the oldest old, women, African Americans, and less educated persons at greatest risk of disablement. This study examines whether these at-risk groups benefit differentially from an in-home intervention previously found to effectively reduce functional difficulties.

Methods: Three hundred nineteen community-living, functionally vulnerable adults 70 years old or older were randomized to usual care or an intervention involving occupational and physical therapy home instruction in problem solving, device use, energy conservation, safety, fall recovery, balance, and muscle strengthening.

Tailored activities to manage neuropsychiatric behaviors in persons with dementia and reduce caregiver burden: a randomized pilot study.

Objective: To test whether the Tailored Activity Program (TAP) reduces dementia-related neuropsychiatric behaviors, promotes activity engagement, and enhances caregiver well-being.

Design: Prospective, two-group (treatment, wait-list control), randomized, controlled pilot study with 4 months as main trial endpoint. At 4 months, controls received the TAP intervention and were reassessed 4 months later.

Religiosity and preferences for life-prolonging medical treatments in African-American and white elders: a mediation study.

Research on end-of-life treatment preferences has documented robust racial differences, with African-Americans preferring more life-prolonging treatment than Whites. Although little research has attempted to explain these racial differences systematically, speculation has centered on religiosity. We examined a dimension of religiosity frequently invoked in end-of-life research-guidance by God's will-as a potential mediator of racial differences in such treatment preferences.

A non-pharmacological intervention to manage behavioral and psychological symptoms of dementia and reduce caregiver distress: design and methods of project ACT3.

Project ACT is a randomized controlled trial designed to test the effectiveness of a non-pharmacological home-based intervention to reduce behavioral and psychological symptoms of dementia (BPSD) and caregiver distress. The study targets 272 stressed racially diverse family caregivers providing in-home care to persons with moderate stage dementia with one or more behavioral disturbances. All participants are interviewed at baseline, 4-months (main trial endpoint), and 6-months (maintenance).

Depressive symptoms in older African-American and white adults with functional difficulties: the role of control strategies.

Objectives: To examine whether control-oriented strategies buffer effects of functional difficulties on depressive symptoms over time in older African-American and white adults with disability.

Design: Community-based, prospective study.

Setting: Baseline and 12-month data from a randomized trial.

Predictors of adherence to a skill-building intervention in dementia caregivers.

Background: Treatment adherence is a widely recognized problem in health services but understudied in caregiver intervention research. This study examines caregiver sociodemographic and psychological characteristics, patient illness severity, and treatment implementation factors as predictors of caregiver adherence to a skills training intervention to help families manage dementia care problems at home.

Methods: The sample consisted of 105 caregivers randomized to the Home Environmental Skill-Building Program at the Philadelphia site of the National Institutes of Health (NIH) Resources for Enhancing Alzheimer's Caregiver Health (REACH I).

Assessing perceived change in the well-being of family caregivers: psychometric properties of the Perceived Change Index and response patterns.

The purpose of this study was to evaluate the psychometric properties of the Perceived Change Index (PCI), a 13-item scale that measures caregiver appraisals of self-improvement or decline in distinct areas of well-being, and to examine demographic differences in responses. The scale was administered to 255 care-givers participating at the Philadelphia site of the National Institute of Aging-funded Resources for Enhancing Alzheimer's Caregiver Health initiative. Principal axis analysis with one half of the sample was used to evaluate factor structure.

Enhancing quality of life of families who use adult day services: Short- and long-term effects of the adult day services plus program.

Purpose: This study examined the short- and long-term effects of Adult Day Services Plus (ADS Plus), a low-cost care management intervention designed to enhance family caregiver well-being, increase service utilization, and decrease nursing home placement of impaired older adults enrolled in adult day care.

Design And Methods: We used a quasi-experimental design, to recruit 129 caregivers from three adult day centers. Two centers offered adult day services and ADS Plus (n = 67); the third center (n = 62) offered only routine adult day services.

Effect of an in-home occupational and physical therapy intervention on reducing mortality in functionally vulnerable older people: preliminary findings.

Objectives: To evaluate the effect of a multicomponent intervention on mortality and the role of control-oriented strategy use as the change mechanism.

Design: Two-group randomized design with survivorship followed for 14 months. Participants were randomized to intervention or a no-treatment control group.

A randomized trial of a multicomponent home intervention to reduce functional difficulties in older adults.

Objectives: To test the efficacy of a multicomponent intervention to reduce functional difficulties, fear of falling, and home hazards and enhance self-efficacy and adaptive coping in older adults with chronic conditions.

Design: A prospective, two-group, randomized trial. Participants were randomized to a treatment group or no-treatment group.

Maintenance of effects of the home environmental skill-building program for family caregivers and individuals with Alzheimer's disease and related disorders.

Background: Few studies evaluate whether short-term intervention effects are maintained over time for families caring for persons with dementia. This article examines whether treatment effects found at 6 months following active treatment were sustained at 12 months for 127 family caregivers who participated in an occupational therapy intervention tested as part of the National Institutes of Health Resources for Enhancing Alzheimer's Caregiver Health (REACH) initiative.

Methods: A randomized two-group design was implemented with three assessment points: baseline, 6 months, and 12 months.