Assessing Symptoms, Concerns, and Quality of Life in Noncancer Patients at End of Life: How Concordant Are Patients and Family Proxy Members?

Context: It has become commonplace to use family caregivers as proxy responders where patients are unable to provide information about their symptoms and concerns to health care providers.

Objectives: The objective of this study was to determine the degree of concordance between patients' and family members' reports of patient symptoms and concerns at end of life.

Methods: Sample dyads included a mix of patients residing at home, in a nursing home, in a long-term care facility, or in hospice.

A Randomized Placebo Controlled Clinical Trial to Determine the Impact of Digestion Resistant Starch on Glucose, Insulin, and Insulin Resistance in Elderly and Mid-Age Adults.

Introduction: Type 2 diabetes (T2D) has reached epidemic proportions in North America. Recent evidence suggests that prebiotics can modulate the gut microbiome, which then plays an important role in regulating lipid metabolism, blood glucose, and insulin sensitivity. As such, prebiotics are appealing potential therapeutic strategies for prediabetes and T2D.

Correction: Dignity and Distress towards the End of Life across Four Non-Cancer Populations.

[This corrects the article DOI: 10.1371/journal.pone.

From 'just the facts' to 'more theory and methods, please': The evolution of the research article in Administrative Science Quarterly, 1956-2008.

This paper analyzes the surface structure of research articles published in Administrative Science Quarterly between 1956 and 2008. The period is marked by a shift from essays that interweave theory, methods and results to experimental reports that separate them. There is dramatic growth in the size of theory, methods and discussion sections, accompanied by a shrinking results section.

A randomized trial to determine the impact of a digestion resistant starch composition on the gut microbiome in older and mid-age adults.

Background: The elderly often have a diet lacking resistant starch (RS) which is thought to lead to gut microbiome dysbiosis that may result in deterioration of gut colonocytes.

Objective: The primary objective was to assess if elderly (ELD; ≥ 70 years age) had microbiome dysbiosis compared to mid-age (MID; 30-50 years age) adults and then determine the impact of daily consumption of MSPrebiotic (a RS) or placebo over 3 months on gut microbiome composition. Secondary objectives included assessment of stool short-chain fatty acids (SCFA) and inflammatory markers in ELD and MID Canadian adults.

Dignity and Distress towards the End of Life across Four Non-Cancer Populations.

Objective: The purpose of this study was to identify four non-cancer populations that might benefit from a palliative approach; and describe and compare the prevalence and patterns of dignity related distress across these diverse clinical populations.

Design: A prospective, multi-site approach was used.

Setting: Outpatient clinics, inpatient facilities or personal care homes, located in Winnipeg, Manitoba and Edmonton, Alberta, Canada.

Coevolution in management fashion: an agent-based model of consultant-driven innovation.

The rise of management consultancy has been accompanied by increasingly marked faddish cycles in management techniques, but the mechanisms that underlie this relationship are not well understood. The authors develop a simple agent-based framework that models innovation adoption and abandonment on both the supply and demand sides. In opposition to conceptions of consultants as rhetorical wizards who engineer waves of management fashion, firms and consultants are treated as boundedly rational actors who chase the secrets of success by mimicking their highest-performing peers.

Profiling the multidimensional needs of new nursing home residents: evidence to support planning.

Introduction: Nursing home (NH) residents have various needs that affect the care they require. This article describes the diverse needs that new NH residents have, emphasizing the proportion of people with milder needs in multiple areas.

Methods: Research was conducted on all older adults newly admitted to not-for-profit NHs in the Winnipeg Health Region, between April 1, 2005, and March 31, 2007, provided that they were assessed using the Resident Assessment Instrument Minimum Data Set (RAI/MDS 2.

Nursing home adverse events: further insight into highest risk periods.

Introduction: Adverse events (AEs) occur frequently in nursing homes (NHs). Although the literature identifies several AE risk factors, the effect of resident transition on AE risk is less well defined. This article is the first to describe how AE risk varies across several NH transition periods and to define the most vulnerable junctures of an NH stay.

Assessing the quality of drug detailing.

This study measured the validity of a new instrument, the Assessment Instrument for Drug Detailing (AIDD), used by doctors to score the quality of drug detailing provided by pharmaceutical representatives in their offices. Five pharmaceutical representatives provided "good, medium, and poor" details to 135 family doctors in their offices, who were blinded to the quality of the details. A "reference standard group" constructed the details and trained the representatives.

Development of a standardized, comprehensive "ideal drug detail".

Objectives: To develop a standardized, comprehensive ideal drug detail for use in face-to-face education about individual drugs.

Methods: A random sample of 603 physicians and pharmacists was selected and stratified to include input from each of the following specialties: family practice, internal medicine, surgery, pediatrics, psychiatry, obstetrics/gynecology, geriatric medicine and clinical pharmacology. Thirty-one potential items were generated by the investigators from a preliminary survey of a local convenience sample of physicians and pharmacists.

Interrater reliability of the Clinical Dementia Rating in a multicenter trial.

Objective: To test the interrater reliability of the Clinical Dementia Rating (CDR) in a multicenter clinical trial.

Design: Observational study.

Setting: Training session for a multicenter trial of milameline, a direct muscarinic agonist, in the treatment of Alzheimer's disease.

Systematic implementation of an advance directive program in nursing homes: a randomized controlled trial.

Context: Although advance directives are commonly used in the community, little is known about the effects of their systematic implementation.

Objectives: To examine the effect of systematically implementing an advance directive in nursing homes on patient and family satisfaction with involvement in decision making and on health care costs.

Design: Randomized controlled trial conducted June 1, 1994, to August 31, 1998.

Assessment of patient capacity to consent to treatment.

Objective: To compare results of a specific capacity assessment administered by the treating clinician, and a Standardized Mini-Mental Status Examination (SMMSE), with the results of expert assessments of patient capacity to consent to treatment.

Design: Cross-sectional study with independent comparison to expert capacity assessments.

Setting: Inpatient medical wards at an academic secondary and tertiary referral hospital.

Predicting outcome in very low birthweight infants using an objective measure of illness severity and cranial ultrasound scanning.

Aim: To investigate the feasibility of developing an objective tool for predicting death and severe disability using routinely available data, including an objective measure of illness severity, in very low birthweight babies.

Method: A cohort study of 297 premature babies surviving the first three days of life was made. Predictive variables considered included birthweight, gestation, 3 day cranial ultrasound appearances and 3 day CRIB (clinical risk index for babies) score.

Capacity to choose place of residence: autonomy vs beneficence?

Health care workers often perceive a conflict between autonomy and beneficence when dealing with clients living at risk in the community. Respect for personal freedom and the desire to help and protect vulnerable people frequently appear to demand opposite interventions. The assessment of decision-making capacity is a vital part of any process that deals with these complicated situations and can resolve some of the apparent conflict.

Measurement properties of the Clinical Risk Index for Babies--reliabilty, validity beyond the first 12 hours, and responsiveness over 7 days.

Objectives: Clinical Risk Index for Babies (CRIB) is a simple instrument used to measure clinical risk and illness severity in very low birth-weight infants. We assessed its reliability, validity beyond the first 12 hrs after birth, and responsiveness to individual change in condition after 7 days.

Design: Cohort study.

Health status assessment of the elderly.

The elderly are a heterogeneous population group who range from well and completely independent individuals to a smaller proportion who are frail, require help and are high users of the healthcare system. Since health is a state of well-being which includes the domains of social, spiritual, psychological and physical function, each of these domains must be evaluated when we are measuring the health of older adults. In this article, we discuss some of the more important aspects of these domains.

National survey on the attitudes of Canadian physicians towards drug-detailing by pharmaceutical representatives.

Objective: Our objective was to study the attitudes of Canadian physicians toward product presentations by pharmaceutical representatives (PRs), the use of inducements by the pharmaceutical industry, and methods to improve the quality of prescribing information provided to physicians.

Design: We used a mailed survey.

Participants: A random sample of 550 Canadian physicians in all settings was chosen.

Improved reliability of the Standardized Alzheimer's Disease Assessment Scale (SADAS) compared with the Alzheimer's Disease Assessment Scale (ADAS).

Objectives: To compare the interrater and intrarater reliability of the Alzheimer's Disease Assessment Scale (ADAS) with the Standardized Alzheimer's Disease Assessment Scale (SADAS).

Design: A randomized, double blind trial. Sixteen university students were randomized to administer either version of the instrument.

Measuring capacity to complete an advance directive.

Objective: To validate reference standards for the assessment of capacity to complete an advance directive and to develop and test three simple screening instruments.

Methods: We administered five measures of capacity to 96 older subjects from nursing homes, retirement homes, and homes for the aged. The measures included two reference standard evaluations: an assessment by a specially trained nurse in collaboration with a multidisciplinary team (Competency Clinic assessment) and geriatrician assessment using a decisional aid.

Quantitation of unintegrated HIV-1 DNA in asymptomatic patients in the presence or absence of antiretroviral therapy.

The objective of this work was to determine the amount of unintegrated human immunodeficiency virus (HIV) DNA (HIV uDNA) in asymptomatic individuals in the presence or absence of antiretroviral therapy. Twenty-one healthy seropositive individuals with no history of any opportunistic infection or previous use of nucleoside antiretrovirals, and 9 similarly asymptomatic individuals who had initiated nucleoside antiretroviral therapy within the last 24 months were studied. All patients had CD4 lymphocyte counts above 400/microliters.

The prevalence of clinically undetected occlusal dentine caries in Scottish adolescents.

During the third examination of a 3-year anti-caries dentifrice study, bitewing radiographs were read to detect occlusal, as well as approximal caries lesions in 2623 subjects aged 14-15 years. These analyses showed that 1.4% of 2107 upper molars and 7.

The prevalence of fissure sealants in Lanarkshire, Scotland. A 3-year study.

Fissure sealant presence was recorded at baseline and annually during a 3-year, double-blind clinical caries trial which involved 3005 children aged 12-13 years at outset. At baseline, initially, 2002 sealants were noted in 431 subjects (14.3%), a figure not dissimilar to that found for Scottish 12-year-olds in the UK National Survey completed in the same year.