The 4% Fallacy: A Methodological and Empirical Critique of Extended Care Facility Population Statistics

1973 ◽  
Vol 4 (1) ◽  
pp. 15-21 ◽  
Author(s):  
Robert Kastenbaum ◽  
Sandra E. Candy
Keyword(s):  
Terminal Care ◽  
Empirical Studies ◽  
Care Facility ◽  
Population Data ◽  
Death Certificates ◽  
Cross Sectional ◽  
Population Statistics ◽  
Extended Care ◽  
Care Facilities ◽  
Detroit Area

Much use has been made of population statistics which indicate that only 4% of those over 65 are in nursing homes and other extended care facilities (ECF). These data are misleading, however, for they are cross-sectional and seriously underestimate the probability of a person coming to an ECF sooner or later. Two small empirical studies are reported using, respectively, published obituary notices and death certificates for the metropolitan Detroit area during 1971. It was found that a minimum of 20% of all men and women over 65 who died in the study year were residents of a nursing home, and 24% were residents of one or another kind of ECF. Clearly, more people died in ECFs than are usually thought to be there in the first place. Discussion focuses upon the magnitude of the terminal care problem and the need to recognize the full scope of ECF difficulties which have often been underestimated because of careless use of the population data.

scholarly journals Intranasal Antiseptic and Universal Antiseptic Baths Are Effective in Reducing MRSA Acquisition in Extended-Care Facilities

2020 ◽  
Vol 41 (S1) ◽  
pp. s304-s305
Author(s):  
Angela Chow ◽  
Wei Zhang ◽  
Joshua Wong ◽  
Brenda Ang
Keyword(s):  
Hand Hygiene ◽  
Hand Hygiene Compliance ◽  
Compliance Rate ◽  
Care Facility ◽  
Clinical Problem ◽  
Clinical Samples ◽  
Extended Care ◽  
Care Facilities ◽  
The Mean ◽  
Hygiene Compliance

Background: Methicillin-resistant Staphylococcus aureus (MRSA) is a growing clinical problem in rehabilitation hospitals, where patients stay for extended periods for intensive rehabilitation therapy. In addition to cutaneous sites, the nares could be a source for nosocomial MRSA transmission. Decolonization of nasal and cutaneous reservoirs could reduce MRSA acquisition. We evaluated the effectiveness of topical intranasal octenidine gel, coupled with universal chlorhexidine baths, in reducing MRSA acquisition in an extended-care facility. Methods: We conducted a quasi-experimental before-and-after study from January 2013 to June 2019. All patients admitted to a 100-bed rehabilitation hospital specialized in stroke and trauma care in Singapore were screened for MRSA colonization on admission. Patients screened negative for MRSA were subsequently screened at discharge for MRSA acquisition. Screening swabs were obtained from the nares, axillae, and groin and were cultured on selective chromogenic agar. Patients who tested positive for MRSA from clinical samples collected >3 days after admission were also considered to have hospital-acquired MRSA. Universal chlorhexidine baths were implemented throughout the study period. Intranasal application of octenidine gel for MRSA colonizers for use for 5 days from admission was added to the hospital’s protocol beginning in September 2017. An interrupted time series with segmented regression analysis was performed to evaluate the trends in MRSA acquisition before the intervention (January 2013–July 2017) and after the intervention (September 2017–June 2019) with intranasal octenidine. August 2017 was excluded from the analysis because the intervention commenced midmonth. Results: In total, 77 observational months (55 before the intervention and 22 after the intervention) were included. The mean monthly MRSA acquisition rates were 7.0 per 1,000 patient days before the intervention and 4.4 per 1,000 patient days after the intervention (P < .001), with a mean number of patient days of 2,516.3 per month before the intervention and 2,427.2 per month after the intervention (P = .0172). The mean monthly number of MRSA-colonized patients on admission to the hospital decreased from 24.8 before the intervention to 18.7 after the intervention (P < .001). Mean monthly hand hygiene compliance rate increased significantly from 65.7% before the intervention to 87.4% after the intervention (P < .001). After adjusting for the number of MRSA-colonized patients on admission and hand hygiene compliance rates, a constant trend was observed from January 2013 to July 2017 (adjusted mean coefficient, 0.012; 95% CI, −0.037 to 0.06), with an immediate drop in September 2017 (adjusted mean coefficient, −2.145; 95% CI, −0.248 to −0.002; P = .033), followed by a significant reduction in MRSA acquisition after the intervention from September 2017 through June 2019 (adjusted mean coefficient, −0.125; 95% CI, -4.109 to -0.181; P = .047). Conclusions: Topical intranasal octenidine, coupled with universal chlorhexidine baths, can reduce MRSA acquisition in extended-care facilities. Further studies should be conducted to validate the findings in other healthcare settings.Funding: NoneDisclosures: None

Opioid underuse in terminal care of long-term care facility residents with pain and/or dyspnoea: A cross-sectional PACE-survey in six European countries

2020 ◽  
Vol 34 (6) ◽  
pp. 784-794 ◽  
Author(s):  
Marc Tanghe ◽  
Nele Van Den Noortgate ◽  
Luc Deliens ◽  
Tinne Smets ◽  
Bregje Onwuteaka-Philipsen ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Terminal Care ◽  
Long Term Care ◽  
Care Facility ◽  
Term Care ◽  
Opioid Prescription ◽  
Term Care Facility ◽  
Long Term Care Facility ◽  
Care Facilities

Background/objectives: Opioids relieve symptoms in terminal care. We studied opioid underuse in long-term care facilities, defined as residents without opioid prescription despite pain and/or dyspnoea, 3 days prior to death. Design and setting: In a proportionally stratified randomly selected sample of long-term care facilities in six European Union countries, nurses and long-term care facility management completed structured after-death questionnaires within 3 months of residents’ death. Measurements: Nurses assessed pain/dyspnoea with Comfort Assessment in Dying with Dementia scale and checked opioid prescription by chart review. We estimated opioid underuse per country and per symptom and calculated associations of opioid underuse by multilevel, multivariable analysis. Results: Nurses’ response rate was 81.6%, 95.7% for managers. Of 901 deceased residents with pain/dyspnoea reported in the last week, 10.6% had dyspnoea, 34.4% had pain and 55.0% had both symptoms. Opioid underuse per country was 19.2% (95% confidence interval: 12.9–27.2) in the Netherlands, 25.2% (18.3–33.6) in Belgium, 29.3% (16.9–45.8) in England, 33.7% (26.2–42.2) in Finland, 64.6% (52.0–75.4) in Italy and 79.1% (71.2–85.3) in Poland ( p < 0.001). Opioid underuse was 57.2% (33.0–78.4) for dyspnoea, 41.2% (95% confidence interval: 21.9–63.8) for pain and 37.4% (19.4–59.6) for both symptoms ( p = 0.013). Odds of opioid underuse were lower (odds ratio: 0.33; 95% confidence interval: 0.20–0.54) when pain was assessed. Conclusion: Opioid underuse differs between countries. Pain and dyspnoea should be formally assessed at the end-of-life and taken into account in physicians orders.

scholarly journals Covid-19 Vaccine Hesitancy in Nursing Home Staff and the Need for Ongoing Education and Vaccine Access

2022 ◽  
Vol 4 (1) ◽  
pp. 01-05
Author(s):  
Ammu Thampi Susheela ◽  
Dheeraj Mahajan ◽  
Lori Porter
Keyword(s):  
Health Care ◽  
Health Care Workers ◽  
Long Term Care ◽  
Care Facility ◽  
Vaccine Hesitancy ◽  
Cross Sectional ◽  
Term Care ◽  
Care Workers ◽  
Care Facilities

Objective: To study vaccine hesitancy among health care workers who provide direct care in nursing homes and long term care facilities which cater to the most vulnerable population of the community. Design: This is a cross sectional cohort study Setting and participants: The study was conducted on the front line healthcare workers who work in long term care facilities. Methods: A nationwide survey was conducted on the certified nurse assistants on November 16th 2020 which reached 7000 survey recipients. Results: Out of 7000 survey recipients, 3119 responded (45% response rate). There was 71.6% (2,233) negative response about taking the covid19 vaccine due to lack of trust and education of information Conclusions and implications: Our study concluded that the vaccine hesitancy is high among the health care workers of long-term care facility and that ongoing education and interactive dialogue with certified nurse assistants and ongoing access to vaccine is critical as the willingness improves.

scholarly journals Utilization of public health care facilities in Lucknow district

2018 ◽  
Vol 5 (5) ◽  
pp. 1835
Author(s):  
Vinita Shukla ◽  
Monika Agarwal ◽  
M. Z. Idris ◽  
Naim Ahmed ◽  
Pratibha Gupta
Keyword(s):  
Public Health ◽  
Health Care ◽  
Health Facility ◽  
Waiting Time ◽  
Care Facility ◽  
Health Care Facilities ◽  
Public Health Care ◽  
Long Distance ◽  
Cross Sectional ◽  
Care Facilities

Background: Health has been declared a fundamental human right. Governments all over the world are striving to expand and improve their health care services. Though there is scarcity of health care resources in India, yet utilization of the Govt. Health care facilities reveal that their outreach was not only poor but even where they are within the reach of population they remained under utilization. In view of the facts stated above this study was planned to assess the extent of utilization of available health facility, the purpose of visit to health care facility and the reasons for non-utilization of public health care facility.Methods: Sample of 1024 was drawn from rural and urban population of Lucknow district. Cross sectional study was conducted in one-year period using the stratified multistage sampling. Data was analyzed using the stata software version -8 for windows.Results: Most of the respondents in rural (73.66%) and in urban (87.44%) visited the health facility for treatment of illnesses. Majority 55.28% in rural and 67.15% in urban area visited private health facility. The most common reason for non-utilization of public health facility in rural respondents (63.5%) was the long distance to health facility and for urban respondents it was long waiting time (56.46%).Conclusions: Most of the people prefer private health care facilities over public. The two most common reasons were long distance and long waiting time. These issues can be dealt by mobile clinics and strengthening the already existing health centres etc.

“Music First”

GeroPsych ◽  
2018 ◽  
Vol 31 (1) ◽  
pp. 17-30 ◽  
Author(s):  
Dane L. Shiltz ◽  
Tara T. Lineweaver ◽  
Tim Brimmer ◽  
Alex C. Cairns ◽  
Danielle S. Halcomb ◽  
...  
Keyword(s):  
Usual Care ◽  
Psychological Symptoms ◽  
Care Facility ◽  
Care Group ◽  
Music Listening ◽  
Term Care ◽  
Antipsychotic Medications ◽  
Risk Of Death ◽  
Extended Care ◽  
Individualized Music

Abstract. Existing research has primarily evaluated music therapy (MT) as a means of reducing the negative affect, behavioral, and/or cognitive symptoms of dementia. Music listening (ML), on the other hand, offers a less-explored, potentially equivalent alternative to MT and may further reduce exposure to potentially harmful psychotropic medications traditionally used to manage negative behavioral and psychological symptoms of dementia (BPSD). This 5-month prospective, naturalistic, interprofessional, single-center extended care facility study compared usual care (45 residents) and usual care combined with at least thrice weekly personalized ML sessions (47 residents) to determine the influence of ML. Agitation decreased for all participants (p < .001), and the ML residents receiving antipsychotic medications at baseline experienced agitation levels similar to both the usual care group and the ML patients who were not prescribed antipsychotics (p < .05 for medication × ML interaction). No significant changes in psychotropic medication exposure occurred. This experimental study supports ML as an adjunct to pharmacological approaches to treating agitation in older adults with dementia living in long-term care facilities. It also highlights the need for additional research focused on how individualized music programs affect doses and frequencies of antipsychotic medications and their associated risk of death and cerebrovascular events in this population.

Faktor yang Berhubungan dengan Penggunaan Partograf dalam Persalinan oleh Bidan Praktik Mandiri

2020 ◽  
Vol 2 (2) ◽  
pp. 72-80
Author(s):  
Niluh Nita Silfia
Keyword(s):  
Total Population ◽  
Sampling Technique ◽  
Population Data ◽  
Statistical Test ◽  
Influential Factor ◽  
Test Results ◽  
Cross Sectional ◽  
Factors Associated ◽  
Survey Results ◽  
Research Criteria

Partographs are guidelines for childbirth observations that will facilitate labor assistants in first identifying emergency cases and complications for mothers and fetuses. Preliminary survey at the Sigi Community Health Sub-Center (Pustu) of the 8 Pustu midwives found two midwives (25%) to complete a complete partograph, six midwives (75%) incomplete. The purpose of this study was to determine the determinant factors associated with the use of partographs in labor. The design of this study used observational analytic methods with a cross-sectional approach. 24 BPM survey results were obtained with 30 samples of midwives who met the research criteria and data completeness. The sampling technique was by the total population. Data analysis used logistic regression. The multivariate analysis results showed that APN training was the most influential factor in the use of partographs in labor by midwives. Statistical test results obtained a POR value of 37.7 (95% CI 12.1 - 60.2). This study suggests that midwives must have APN certificates to be valid in providing services.

FIRST AID AND TREATMENT FOR CHILDREN ACCIDENT INJURY IN BUON MA THUOT CITY, DAK LAK PROVINCE 2014

2017 ◽  
pp. 69-74
Author(s):  
Van Hung Nguyen ◽  
Van Thang Vo
Keyword(s):  
Health Care ◽  
Intervention Program ◽  
First Aid ◽  
Cross Sectional Study ◽  
Health Care Facilities ◽  
Health Staff ◽  
Cross Sectional ◽  
Care Facilities ◽  
Accident Injuries ◽  
Accident Injury

Background: Accident injuries caused has been serious heatlth problem in developing coutries. Children is vulnerable group with accident injury beucase of lacking knowlegde and exposing with risk factors in eviromental household. The treatment outcome for accident injury of children usually has more serious than other groups. The aims of this study to describle some characteristics of first aid and the outcome of treatment for children accident in Buon Ma Thuot, Dak Lak provice in 2014. Methodology: A cross-sectional study was conducted total 2,273 household which was 4,505 children aged under 16 in 8 communes, Buon Ma Thuot city, Daklak province. Interview technique with structural questionnaire and household observation methods were used for data collection. Results: The propotion of first aid was 75.9%; not received any first aid (23.8%); mortality at accident place (0.3%). At the time accident: The highest personal involving first aid was pedestrians 54.1%; 25% of health staff, self- first aid was 14.5%. Two main of first aid methods were hemostasis and bandeged with 45.5%; 28% respectiviely. After first aid, there was 80% delivering to health care facilities. The transport methods were motocycle (91.8%), car (5.6%) and ambulance (0.4%). The rate of approach health care facilities around early 6 hours were 86.7%. The characteristics of damages: sub-damages (scratches, dislocations, sprains...) were 36.9 %, deep damages (fractures, open wounds) accounted for 44.6%. Inpatient treatment was 23.9%; 91.5% medical therapy, surgery of 8.2%. The outcome of treatment were good (97.2%), sequelae/disability 2.6%. Conclusion: First aid activities for children at time and properly right were demonstrated effectively for prevented seriously outcome. There should be an intervention program for children with the appropriate models to reduce accident injuries in children; improvement first aid to communities and health care worker. Key words: accident injury, first aid, capacity first care, children under 16 years old

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