Care management interventions for older patients with congestive heart failure.

Objectives: To identify interventions and outcome measures that should be included when designing care management programs for older patients with congestive heart failure (CHF) and assessing the overall effectiveness of these programs.

Study Design: Structured literature review and assessment.

Methods: A systematic literature search was conducted to identify articles that described interventions and outcome measures designed to improve care for older patients with CHF.

Improving rates of advance directive discussions among managed care nursing home enrollees.

Background: Discussions about advance directives should be offered to all nursing home residents. Managed Medicare programs for nursing home residents allow for the development of performance improvement initiatives to ensure that these discussions occur and are documented.

Purpose: To assess the effectiveness of an intervention to increase discussion and documentation of advance directives for enrollees in a managed Medicare program for nursing home residents, and to evaluate whether this intervention affected preferences for cardiopulmonary resuscitation (CPR) and hospitalization among enrollees.

Frailty and the older man.

Frailty is a wasting syndrome of advanced age that leaves a person vulnerable to falls, functional decline, morbidity, and mortality. The cause of this syndrome is complex but likely has a biologic basis. Studies by the authors' research group have validated a phenotype of frailty [table: see text] and have established a gender difference in prevalence with women twice as likely to develop the syndrome as men.

Low airloss hydrotherapy versus standard care for incontinent hospitalized patients.

Objective: To determine whether low airloss hydrotherapy reduces the incidence of new skin lesions associated with incontinence in hospitalized patients and results in more rapid healing of existing pressure sores compared with standard care. To assess subjectively patient and nursing satisfaction related to using low airloss hydrotherapy beds.

Design: Randomized, prospective, unblinded study.

Pressure-relieving strategies for preventing and treating pressure sores.

Pressure-relieving strategies remain the foundation for the prevention and treatment of pressure sores. Although the published literature is inadequate, rational treatment decisions can be made if they are based on an understanding of the mechanisms by which pressure relief results with a particular device or strategy. This article reviews the theoretic and practical approaches to managing tissue loads so that rational choices of the most cost-effective strategies for preventing and treating pressure sores can be made when caring for patients.

Omnibus Budget Reconciliation Act of 1987 and its implications for the medical director.

The nursing home reform amendments passed by Congress in 1987 (known as OBRA 87) have several sections that are relevant to medical practice and medical direction in the nursing home. The regulations and interpretive guides specify the medical director's role, physician services, resident assessments, resident rights, and restrictions on the use of chemical and physical restraints. This article provides the nursing home attending physician and medical director with basic information to help bring medical services into regulatory compliance.

Predictors of nursing home placement in community-based long-term care.

Objective: To identify predictors for nursing home placement among a group of frail older patients receiving formal home care services.

Design: Retrospective chart review.

Setting: A geographically defined catchment area of southeast Baltimore, Maryland.

Colonisation with digoxin-reducing strains of Eubacterium lentum and Clostridium difficile infection in nursing home patients.

Stool specimens obtained from 77 residents of a nursing home were analysed to determine the relationship between colonisation with digoxin-reducing strains of Eubacterium lentum and infection with Clostridium difficile. Patients were categorised according to previous antibiotic treatment, prescription of enteral feedings, and pattern of bowel habits. Colonisation with digoxin-reducing E.