Association of high-volume hospitals with greater likelihood of discharge to home following colorectal surgery.

Importance: Discharge disposition is a patient-centered quality metric that reflects differences in quality of life and recovery following surgery. The effect of hospital volume on quality of recovery measured by rates of successful discharge to home remains unclear.

Objective: To test the hypothesis that patients having colorectal surgery at high-volume hospitals would more likely be discharged to home rather than discharged to skilled rehabilitation facilities to complete recovery.

The effect of age and comorbidity on patient-centered health outcomes in patients receiving adjuvant chemotherapy for colon cancer.

Objectives: While the impact of age, comorbidity and receipt of adjuvant chemotherapy on survival are known, less is known about their effect on patient-centered outcomes including living situation and unplanned health care services. The current study describes the impact of age and comorbidity on patient-centered outcomes in patients with colon cancer.

Materials And Methods: Patients with resected stage III colon cancer and high risk stage II colon cancer were identified from a colorectal cancer center database.

Conceptualization of a toolkit to evaluate everyday competence in planning transitions from nursing homes to the community.

Living independently in the community is a primary goal for older adults, particularly for the estimated 10% to 20% of long-stay nursing home residents who have low care requirements. According to the model of person-environment fit, individuals with high levels of everyday competence have the ability to solve problems associated with everyday life. Nursing home residents with high levels of everyday competence and low care needs have poor person-environment fit, placing them at risk for declines in function, maladaptive behavior, and affective disorders.

Depression is associated with prolonged and complicated recovery following colorectal surgery.

Background: There are little data regarding the impact of depression on outcomes after gastrointestinal surgery. We hypothesize that depression would be associated with prolonged hospital stay and changes in discharge disposition for patients undergoing colon and rectal surgery.

Methods: We identified 292,191 patients undergoing colon and rectal surgery using the 2008 Nationwide Inpatient Sample.

A survey of emergency department staff about challenges and recommendations for emergency department care of extended care facility patients.

Objectives: Extended care facility (ECF) patients who transfer to emergency departments (EDs) can pose problems when complicated health problems require extra resources. Higher numbers of older patients are projected to use EDs, so we aimed to identify problems now to implement solutions before they worsen in the future.

Design: This was a prospective survey research study.

Impact of training of traditional birth attendants on the newborn care.

Objective: To study the impact of training of Traditional Birth Attendants (TBAs) on the Newborn care in resource poor setting in rural area.

Methods: A community based study in the Primary Health Center (PHC) area was conducted over one year period between March 2006 to February 2007. The study participants were 50 Traditional Birth Attendants (TBAs)who conduct home deliveries in the PHC area.

Severe self-neglect: an epidemiological and historical perspective.

Older adults with severe self-neglect have multiple deficits in various social, functional and physical domains, and often live insqualor. These individuals often present with poor personal hygiene, domestic squalor and hoarding which results in a threat to their own health as well as personal and public safety. Severe self-neglect occurs along a continuum with older adults often having cognitive and affective disorders compared with younger individuals presenting with psychiatric illnesses.

The utility of the Kohlman Evaluation of Living Skills test is associated with substantiated cases of elder self-neglect.

Purpose: Self-neglect is the most prevalent finding among cases reported to Adult Protective Services (APS) and is characterized by an inability to meet one's own basic needs. The Kohlman evaluation of living skills (KELS) has been validated in geriatric populations to assess performance with both instrumental and basic activities of daily living and as an assessment tool for the capacity to live independently; therefore, the purpose of this analysis was to compare the scores of the KELS between substantiated cases of self-neglect and matched community-dwelling elders.

Data Sources: This is a cross-sectional pilot study of 50 adults aged 65 years and older who were recruited from APS as documented cases of self-neglect and 50 control participants recruited from Harris County Hospital District outpatient clinics.

Will older persons and their clinicians use a shared decision-making instrument?

Objective: To examine experiences of older persons and their clinicians with shared decision making (SDM) and their willingness to use an SDM instrument.

Design: Qualitative focus group study.

Participants: Four focus groups of 41 older persons and 2 focus groups of 11 clinicians, purposively sampled to encompass a range of sociodemographic and clinical characteristics.

Not less but different: psychotropic drug utilization trends in Norwegian nursing homes during a 12-year period. The Bergen District Nursing Home (BEDNURS) Study.

Background And Aims: The use of psychotropic drugs in nursing homes is generally considered to be inappropriately high. The aim of the present survey was to compare psychotropic drug use in nursing homes (NHs) in 1985 relative to 1996/97, and to explore predictors for this drug use.

Methods: Cross-sectional study.

Clinically important renal impairment in various groups of old persons.

Objective: To assess renal function in various groups of elderly persons, and to determine the proportion of patients with clinically important renal impairment.

Design: Cross-sectional study.

Participants: Three geriatric populations aged 70 years and over, representing increasing levels of care/treatment: community-dwelling elderly referred to a geriatric outpatient department, inpatients on a geriatric ward, and nursing home patients.

Nursing-home residents and their drug use: a comparison between mentally intact and mentally impaired residents. The Bergen district nursing home (BEDNURS) study.

Aims: To investigate drug use relative to mental functioning and to explore the use of inappropriate drugs and potentially harmful drug combinations in nursing home residents.

Methods: Cross-sectional study in 15 nursing homes (1042 long-term care residents) in Bergen, Norway. Information on individual patients' scheduled drug use was obtained from drug dispensing cards.

[Mental impairment in nursing home residents].

Background: Nursing homes are the corner stones in long-term institutional care for frail elderly people. Expansion and strengthening of community-based services during the last decade has enabled frail elderly who earlier would have moved into a nursing home to stay in their own home or in service apartments.

Material And Methods: In a cross-sectional, anonymised study, changes in nursing homes in the city of Bergen between 1985 and 1996/97 were analysed with regard to prevalence of mentally impaired residents.

Awareness of urban slum mothers regarding home management of diarrhoea and symptoms of pneumonia.

A total of 635 mothers of under five children from urban slum area of Nanded city were assessed to know their awareness about home management of diarrhoea and symptoms of pneumonia. 48.5% of the mothers were unaware of any method of rehydrating the child with diarrhoea at home level followed by 36.

Drug use in homes for the aged. A comparison between mentally intact and mentally impaired residents.

The aim of this study was to analyze drug use in 347 residents in homes for the aged in Bergen, Norway. All drugs prescribed on a regular schedule were assessed, the prevalence of potentially harmful drug combinations, and inappropriately prescribed drugs were studied and related to mental capacity of the residents. Mental capacity was assessed by means of the Clinical Dementia Rating scale (CDR).

[Changes among residents in homes for the aged in Bergen between 1985-96].

Homes for the aged are intended for elderly people who, by and large, are able to perform basic activities of daily living (ADL) on their own, but who, in spite of this, need or wish to live in an institutional setting, where only minor nursing facilities are available. The present study focuses on the changes in mental capacity and in the altered need for nursing assistance with ADL functions which developed among residents at 13 homes for the aged in the city of Bergen, between 1985 and 1996. In 1985, the average age for residents was 84 years; and in 1996 it was 87 years.