Archive for 'Clinical Notes'

Physical Rehab and Exercise Offers More Than Meets the Eye

Posted on 12. Jun, 2010 by .

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Not all patients do their homework, but now you can give them more reasons to stick to an exercise program.

Here’s some news that may be music to the ears of people with hearing problems or worried about developing them.

 The American Journal of Audiology published research earlier this year reporting that cardiovascular health positively impacts hearing over time, according to a press release from the American Speech-Language Hearing Association.

And the benefits were particularly notable among older adults. Many people naturally lose some hearing acuity as they grow older, but aging is only one of many factors that contribute to the decline, researchers pointed out.

The study reports evidence that cardiovascular fitness has a protective role in hearing loss prevention, the release reported. Other health and fitness determinants, body composition, blood pressure, and blood lipids displayed no significant relation to hearing sensitivity, whereas muscle strength was inversely related, researchers noted.

Why It Works …

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FDA: Proton Pump Inhibitors Could Increase Fracture Risk

Posted on 04. Jun, 2010 by .

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PPIs linked to wrist, hip, spine fractures.

Putting residents on proton pump inhibitors long-term or at high doses may be fraught with fracture risk.

Recently, the Food and Drug Administration  (FDA) has ordered a revision to the prescription and over-the-counter [OTC] labels for proton pump inhibitors (PPIs).

The FDA warns of an increased risk of fractures of the hip, wrist, and spine associated with the prolonged use of PPIs, including Nexium, Dexilant, Prilosec, Zegerid, Prevacid, Protonix, Aciphex, and Vimovo.

What the evidence further shows …

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Heading Off Delirium Could Prevent Permanent Cognitive Loss

Posted on 26. May, 2010 by .

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The MDS 3.0 Confusion Assessment Method could be a tool to help prevent dementia.

Clinicians often spell out the ways to tell dementia from delirium. But are the two actually linked so that preventing delirium could help protect a person’s cognitive capacity?

One esteemed researcher in the delirium field thinks that could be the case: Sharon K. Inouye, MD, MPH, who addressed geriatric healthcare professionals at the recent American Geriatrics Society’s (AGS’) Annual Scientific Meeting.

“Delirium may provide the unique opportunity for early intervention and prevention of permanent cognitive damage,” said Dr. Inouye, who is the director of the Aging Brain Center, Hebrew SeniorLife and a professor of medicine at Harvard Medical School, in a press statement from the AGS.

Dr. Inouye and colleagues developed the Confusion Assessment Method (CAM), which the MDS 3.0 incorporates to do a better job of picking up early signs of delirium than the MDS 2.0 does.

Research Could Provide the Linkage

Dr. Inouye hopes to conduct research to look at whether “education or other activities that build ‘cognitive reserve capacity,’ can protect against delirium, and further investigate the relationship between delirium and dementia,” according to the release. “If the two are linked, preventing and effectively managing delirium could help lower risks of dementia.”

Resources: Read “Help Keep Residents Delirium-Free With These 3 Key Strategies” and “Ready, Set: Detect Address, Prevent Delirium” in MDS Alert, Vol. 7, No. 9. To subscribe, which will give you access to all past issues online, click here.

Also check out this unique audioconference  to learn the best game plan for managing dementia in long-term care settings.

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Poor Sleep Troubles Older People in ALFs

Posted on 21. May, 2010 by .

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Study suggests abnormal sleep predicts worsening quality of life.

Older people living in Assisted Living Facilities (ALFs) suffer from sleeping problems, a study published in the Journal of the American Geriatrics Society claimed. Poor sleep is associated with declining quality of life and increased depression, researchers said.

Subjects of the study included 121 older residents of ALFs in Los Angeles who slept six hours a night on average, and about one and a half hours in the day. Researchers found that 65 percent of the participants suffered “trouble sleeping,” which they commonly attribute to factors including waking up in the middle of the night or early morning (60.3 percent), and failing to doze off within 30 minutes (59.5 percent).

Initially, sleeping poorly were associated with declining health-related quality of life, needing more assistance with daily activities (e.g., bathing, dressing, grooming), and increased symptoms of depression. After three months, researchers found that sleeping poorly at the initial visit predicted a worsening of quality of life – with the participants becoming more helpless with their daily living routines and becoming more depressed.

“We cannot conclude that poor sleep truly causes these negative changes; however, future studies should evaluate ways to improve sleep in ALFs to see if sleeping better might improve quality of life, delay functional decline and reduce risk of depression,” says lead author Jennifer Martin, PhD, of the University of California, Los Angeles and VA Greater Los Angeles Healthcare System.

She adds that sleep disturbance may have a negative effect on older residents of ALFs, who are often at very vulnerable period in their lives, and at high risk for further functional decline and subsequent nursing home placement.

Now for the good news …

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Tune Up Patients’ Stooping, Crouching, Kneeling Abilities

Posted on 15. May, 2010 by .

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Get the inside scoop on how rehab therapists can help older adults with these functional limitations.

Documenting strength measurements may be especially important when working with elderly rehab patients. Recent research published in Physical Therapy suggests that decreased muscle strength is linked to difficulty performing functional activities such as stooping, crouching, or kneeling (SCK) in older adults.

The study’s purpose was to compare trunk and lower-extremity muscle strength differences in older adults who had difficulty with stooping, crouching, or kneeling with older adults who did not have these difficulties.

“As with standing up from a chair, stooping, crouching, and kneeling movements require coordination of the whole-body center of mass over a wide range of postures in order to prevent a loss of balance or fall,” said researcher Allon Goldberg, PT, PhD, assistant professor in the Department of Health Care Sciences, Program in Physical Therapy, Mobility Research Laboratory, at Wayne State University in Detroit, in an American Physical Therapy Association press  statement.   “More research is needed, but it is reasonable to predict that a physical therapy program to improve strength in older adults who have difficulty performing basic stooping, crouching, or kneeling movements could lead to improvements in performing these activities, and these improvements could be associated with reduced number of falls.”

Findings Suggest This Key Problem Is the Culprit

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FDA Approves Prostate Cancer Vaccine to Treat Metastatic Disease

Posted on 30. Apr, 2010 by .

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Add this novel option to the prostate cancer Rx list.

When patients with hormonally-resistant metastatic prostate cancer or their families ask you about their next treatment step, be prepared to let them know about a new vaccine. 

What it is:  The Food and Drug Administration recently gave the green light to Provenge (sipuleucel-T), to treat men whose prostate cancer has spread but is producing no or minimal symptoms. The cancer also has to be resistant to hormonal treatments.

Provenge “is designed to induce an immune response against prostatic acid phosphatase (PAP), an antigen expressed in most prostate cancers,” according to a PRNewswire  release.

“The approval of Provenge … represents a significant scientific and clinical advancement for the treatment of prostate cancer,” said Philip Kantoff, MD, Director of the Lank Center for Genitourinary Oncology, Chief of the Division of Solid Tumor Oncology, and Chief Clinical Research Officer at Dana-Farber Cancer Institute, Professor of Medicine at Harvard Medical School, in the release. “Cancer immunotherapies that use the patient’s own immune system will likely create an entirely new treatment paradigm for patients with cancer.”

Tailoring the vaccine to each patient …

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Integrate Liberal Doses of Nonpharmacological Remedies in Your Pain Managment Toolkit

Posted on 22. Apr, 2010 by .

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Think inside the box for making the most of what you have to combat pain.

If notions of non-medication pain management bring to mind aromatherapy, biofeedback, and acupressure — those modalities are definitely on the list. But a pain management care plan can incorporate traditional treatments, such as rehab therapy.

Selection of a PT modality depends on what’s causing the pain, says Pauline Franko, PT, MCSP, in Tamarac, Fla. But options include ultrasound and e-simulation, and manual therapy for muscle tension, such as massage and relaxation. You can also use an ice cube and work it over the skin surface as part of massage, Franko adds.

Also get restorative nursing on the case. “Restorative interventions that may help include active or passive ROM, a splinting program, bed mobility, transfer, walking, dressing and grooming,” advises Rita Roedel, RN, in Milwaukee.

Some nontraditional pain remedies may have psychosocial effects that improve a person’s ability to tolerate pain. For example, some pain management programs incorporate Reiki. And that modality “provides a warm interpersonal exchange with another person so the person in pain realizes he’s not alone.,” says Diana Waugh, BSN, RN. ” Reiki can also help someone relax, easing the muscle tightness that can occur due to pain, she adds.

Remember:  The MDS 3.0 includes a question asking you whether the resident received non-medication intervention for pain. To stay on top of the MDS 3.0, subscribe to MDS Alert now and access all of the past issues for free online.

Resource:  Sharpen your pain management to improve residents’ comfort levels and eliminate  F309 tags. Tune in to  to an audioconference  by MDS and nurse expert Rena Shephard.

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New Research Boosts Hope on the Breast Cancer Front

Posted on 21. Apr, 2010 by .

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If your post-acute patients with breast cancer ask you for the latest Rx news, here it is.

Researchers have found that two types of commonly used medications — beta blockers and aspirin — appear to have a positive impact on breast cancer outcomes.  A study at Nottingham’s Breast Institute showed that beta-blockers, which many people take for hypertension, could help prevent the spread of breast cancer in the body, reported one of the study’s researchers at the recent seventh European Breast Cancer Conference in Barcelona

The research study included 466 cancer patients. Ninety-two of the patients had taken blood pressure-lowering medications, 43 of whom were on beta blockers at the time of their cancer diagnosis. Those who were on beta blockers had a 71 percent reduced risk of death from breast cancer during the study compared to those who were not in the drug, according to an article on Medline Plus. The study also revealed a 57 percent reduced risk of getting a secondary cancer.  

Researchers surmise the drugs prevent cancer-cell stimulation by stress hormones, according to the article. “Beta- blocker drugs compete with stress hormones and bind to the same target receptors [on a cellular level], but unlike stress hormones, do not activate cancer cells,” said one of the researchers, Dr. Des Powe, in the article. Powe is a senior healthcare research scientist at Queen’s Medical Centre, Nottingham University Hospital NHS Trust, in Nottingham, England.

As for aspirin: A team of Harvard scientists concluded that aspirin use decreased risk of breast cancer recurrence and death, the Journal of Clinical Oncology reports.  That conclusion was based on a research study involving 4,164 female registered nurses in the Nurses’ Health Study who were diagnosed with different stages of breast cancer between 1976 and 2002; the nurses were followed until death or until June 2006, whichever came first. Among the 4,164 subjects, 341 died. Nevertheless, the longer the women were administered with aspirin, the lower their risk of cancer recurrence or death.

Researchers and other clinical experts caution that the study findings on beta blockers and aspirin aren’t ready for prime time in terms of recommending the drugs for breast cancer prevention or treatment.

 ISPY Trial Sets Sights on Aggressive Breast Cancers

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Sleep Apnea Identified As a Stroke Risk Factor

Posted on 15. Apr, 2010 by .

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Study shows that men are at higher risk than women.

People who habitually snore and breathe abnormally through the night — especially middle-aged and older men— are more in danger of suffering from a stroke, according to a news release from the National Institutes of Health.

A large study of men and women who have obstructive sleep apnea found that the disorder more than doubles the risk of stroke in men. The landmark research is dubbed the Sleep Heart Health Study (SHHS), and is supported by the NIH’s National Heart, Lung, and Blood Institute (NHLBI).

Why the study is different …

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FDA Update: Osteoporosis Drugs and Fracture Risks

Posted on 22. Mar, 2010 by .

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3 items for your facility’s medication management action plan for patients taking Fosamax, Actonel, Boniva, and Reclast

The Food and Drug Administration is warning the public about the possibly raised fracture risks for patients with osteoporosis who take bisphosphonate drugs, but admits finding no direct connection between bisphosphonate use and a risk of atypical subtrochanteric femur fractures or fractures in the bone just below the hip joint.

In 2008, FDA tapped drug manufacturers about reports of femur fractures, which it linked to bisphosphonate brands such as Fosamax. This prompted pharmaceutical company Merck to later add patients’ reports of femur fractures to the list of possible side effects reported by patients included in the drug’s package insert.

Two years after, the federal agency has released a statement that rules out such a risk. “At this point, the data that FDA has reviewed have not shown a clear connection between bisphosphonate use and a risk of atypical subtrochanteric femur fractures,” the FDA announces in its Drug Safety Communication on March 10. (more…)

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