Archive for 'Clinical Notes'

Alzheimer’s Disease Hits More African-Americans and Hispanics Than Whites

Posted on 22. Mar, 2010 by .

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Why? Diabetes and high blood pressure are risk factors for Alzheimer’s.

African-Americans and Hispanics are more at risk of developing Alzheimer’s disease, and less likely to know they have dementia than their Caucasian counterparts, according to a recent report from the Alzheimer’s Association.

The report contains valuable data and forecasts for long-term care professionals charged with caring for many of the estimated 5.3 million Americans who have Alzheimer’s disease, a number that is expected to grow as the population ages. (more…)

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Could Magnesium Supplements Help Fight Dementia, Alzheimer’s?

Posted on 16. Mar, 2010 by .

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Neuroscientists champion new dietary supplement that could help with those so-called ‘senior moments’.

New research suggests that increasing one’s magnesium intake could deter memory loss brought about by aging.

Rats that took a supplement compound that increased their magnesium showed enhanced learning abilities, working memory, and short- and long-term memory, report researchers at the Massachusetts Institute of Technology and Tsinghua University in Beijing.

Older rats improved their ability to perform a variety of learning tasks when given the dietary supplement, which they called magnesium-L-threonate (MgT). The success of the study has prompted Guosong Liu, director of the Center for Learning and Memory at Tsinghua University, to suggest that MgT may have a significant impact on public health if found to be safe and effective in humans. Why do the supplements work? (more…)

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Boost Your Long-Term Care Staff’s Health with These Tips

Posted on 15. Mar, 2010 by .

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To stay on top of your game when working at your SNF, avoid this No. 1 dietary mistake.

To care for others well over the long term, you have to keep your own well-being on the front burner. And a few nutritional strategies and efforts to stay infection-free can help you cover two of the major bases.

Start by avoiding the No. 1 nutritional habit known to backfire: skipping meals due to stressful schedules, advises Sarah-Jane Bedwell, RD,LDN, a nutritional specialist in Nashville, Tenn. Going several hours without eating can lead to low blood sugar, irritability — and slower metabolism, she warns.

Solution: “Eating small frequent snacks every four hours can keep your energy, blood sugar, and metabolism up,” she suggests. What types of snacks are best? Ones that provide lean protein and a complex carbohydrate, says Bedwell. “The carbohydrate gives you a quick burst of energy and the protein helps promote satiety and helps you feel fuller longer.” (more…)

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Nursing Facility Fall Risk Alert: Sedative Hypnotics

Posted on 14. Mar, 2010 by .

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When you’re evaluating your geriatric patients for fall risks, raise a red flag if you see a sedative hypnotic drug listed among their medications.

A new study published in the January 2010 edition of The American Journal of Managed Care revealed that patients receiving sedative hypnotics classified as Beers high-severity (BHS) were 22 percent more likely to suffer a fall or fracture than control subjects, according to a press release.

Sedative-hypnotic drugs slow down the body’s functions, and physicians often prescribe them to treat anxiety or promote sleep. A couple well-known sedative-hypnotics include diazepam (Valium) and secobarbital (Seconal). In addition, patients exposed to these medications had significantly higher adjusted medical and total health care costs than those in the control group.

This study was the first to examine clinical outcomes associated with specific so-called potentially inappropriate medications (PIMs) and is based on electronic pharmacy and medical claims data, the release said.

“These findings demonstrate that elderly patients who take certain PIMs are at increased risk of adverse events and higher health care costs,” said Karen Stockl, PharmD, of Prescription Solutions and lead author of the study.

© Rehab Report

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Here’s a New Baseline Standard for Breast Cancer-Related Lymphedema Rehab

Posted on 05. Mar, 2010 by .

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Waiting in vain for a baseline standard of care exercise program for your post-breast cancer lymphedema patients? Your patience may no longer be required. A new study could provide just that for the estimated 20 percent of patients with breast cancer who develop breast cancer-related lymphedema (BCRL), according to a press release from the American Occupational Therapy Association.

The research, conducted by University of Pittsburgh, revealed that the Breast Cancer Recovery Program© (BCRP) could work as a model exercise program in treating BCRL.

In a study of 32 women with BCRL, researchers found that the BCRP significantly reduced swelling caused by arm lymphedema, increased arm and shoulder movement, promoted weight loss, improved mood and quality of life.

“This is the first evidence-based, controlled study to demonstrate swelling reduction in the affected arm through exercise and relaxation in individuals with BCRL,” said Marjorie K. McClure, OTR/L, CLT-LANA, Irene McLenahan young investigator at the Magee-Womens Research Institute in Pittsburgh. “The role of occupational therapy as it pertains to cancer intervention is to improve the quality of the patient’s life, however they see it,” she added. (more…)

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‘Speak Easy’: The Harmony of Music and Language in Stroke Patients

Posted on 01. Mar, 2010 by .

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Study shows melodic intonation therapy aids in speech recovery.

Singing could well be the most effective way in the future for stroke patients to communicate and regain their speech ability, according to a study presented at the recent annual meeting of the American Association for the Advancement of Science (AAAS) held in San Diego.

Dr Gottfried Schlaug, head of research and associate professor of neurology at Beth Israel Deaconess Medical Center and Harvard Medical School, backs up the important role that music plays in stroke victims, reports a recent Wall Street Journal article. He says that music is a good medium to get parts of the brain responding that are not responding. If you analyze how they speak. Their speech is a little bit more melodic. It has ups and downs. It is almost like they are singing.(more…)

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Nursing Facility Resident Taking an Antihypertensive? Watch Out for These 2 Meds

Posted on 01. Mar, 2010 by .

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Don’t let these drug duos undo your efforts to control hypertension.

If a nursing home resident takes an antihypertensive that should be controlling his blood pressure — but isn’t — take a look at the MAR to identify a couple of common potential culprits.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are known to interfere with antihypertensive agents, causing the person’s blood pressure to go up in some cases, says John Horn, PharmD, at the University of Washington. “Short term use of an NSAID such as aspirin or ibuprofen is not likely to cause much change in blood pressure response,” he says. But if the resident on an antihypertensive requires such a drug for arthritis, for example, monitor the person closely for an increase in blood pressure.

If you see a decrease in control of the person’s hypertension, “you could either change the drug used to treat arthritis inflammation — or switch the person’s antihypertensive regimen,” Horn advises.

Know the options: ACE inhibitors, the ARBs, and diuretics appear to be most sensitive to interference from NSAIDs, warns Horn. “Calcium channel blockers appear to be least affected by NSAIDs.”

Decongestants can also affect antihypertensive medications. “A nasal spray probably would not be that much of a problem, but oral decongestants could be more so,” counsels Horn.

Tip: As part of discharge teaching, make sure the resident on an antihypertensive (or his caregiver in the home) knows to contact the physician before the resident takes an over-the-counter NSAID or decongestant, advises Horn.

1 out of every 10 patients experiences a medical error. How to keep them from happening at your SNF.

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Studies: Vitamin D Reduces Fall Rate in Nursing Facilities

Posted on 20. Feb, 2010 by .

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Researchers who examined data from 41 studies have announced that the one single factor that can reduce the rate of falls in nursing facilities is vitamin D supplementation, according to a review published in the Cochrane Library.

Researchers note that studies found other interventions to be effective, but only when they were combined with multiple interventions and implemented by a well-coordinated healthcare team. The reviewers found evidence that vitamin D could reduce fall rate on its own, perhaps because of its capacity to improve muscle function.

Other interventions present in the 41 trials were review of medication by a pharmacist and exercise.

A total of 25,422 participants were studied during the trials reviewed. Limitations of the review include: 1) the small number of hospital studies, 2) the difficulty of isolating particular variables from all the factors affecting the patients, and 3) the differences among interventions in the facilities studied.

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Cardiac Rehab Can Pay Off for Skilled Nursing Patients and Provider

Posted on 15. Feb, 2010 by .

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If you’re on the fence about recommending (or providing) cardiac rehab, new research from the Duke Clinical Research Institute’s Center for Clinical and Genetic Economics gives you a green light.

Researchers knew that exercise-based cardiac rehab improves survival rates for patients with coronary heart disease and combats risk factors. Their goal, however, was to find the relationship between the number of cardiac rehab sessions patients attended and long-term outcomes.

Researchers took a national 5 percent sample of Medicare beneficiaries and identified 30,161 elderly patients whose claims revealed they attended at least one outpatient cardiac rehab session between Jan. 1, 2000, and Dec. 31, 2005. Subjects were predominantly white and male, and about 60 percent of them were attending cardiac rehab after a coronary artery bypass graft and about 20 percent after a myocardial infarction (MI).

Findings: After adjusting for demographic characteristics, comorbid conditions, and subsequent hospitalization, researchers found that patients who attended 36 sessions had a 14 percent lower risk of death and a 12 percent lower risk of MI than those who attended 24 sessions. Results also revealed a 22 percent lower risk of death and a 23 percent lower risk of MI than those who attended 12 sessions and a 47 percent lower risk of death and a 31 percent lower risk of MI than those who attended 1 session.

Researchers concluded that among Medicare beneficiaries, a strong dose-response relationship existed between the number of cardiac rehabilitation sessions and long-term outcomes. Attending all 36 sessions reimbursed by Medicare was associated with lower risks of death and MI at 4 years compared with attending fewer sessions.

Food for thought: “Beyond finding that more cardiac rehabilitation is better than less, we saw that relatively few people who attend any rehab actually seem to utilize their entire Medicare benefit,” said the study’s lead author Bradley G. Hammill, in PT Bulletin Online’s review of the research.

So, you might encourage your patients to use their full benefit, as doing so may improve their longevity, according to this research.

Resource: Relationship between cardiac rehabilitation and long-term risks of death and myocardial infarction among elderly Medicare beneficiaries. Hammill BG, Curtis LH, Schulman KA, Whellan DJ. Circulation. 2010 Jan 5;121(1):63-70. Epub 2009 Dec 21.

© Rehab Report.

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3 Ways to Head Off Hospital-Acquired Pressure Ulcers

Posted on 01. Feb, 2010 by .

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Synching with the hospital helps keep your nursing home residents’ skin in the clear.

Cooperation is the name of the game for nursing homes and hospitals that want to make sure that elderly patients don’t develop pressure ulcers in either setting. These key strategies can do the trick.

1. Coordinate wound assessment and documentation with the hospital. A physician or nurse manager in the hospital needs to certify the status of the patient’s wound when he goes to the nursing home, says Marty Pachciarz, RN, RACCT, a consultant with The Polaris Group in Tampa, Fla. And the nursing home needs to do the same when the patient is admitted from the hospital. Both care settings should use the same wound terminology and staging parameters.

That way, if the nursing home identifies suspected deep tissue injury (DTI) at admission — or the resident’s skin breaks down within a few days to a stage 3 or 4 pressure ulcer — the hospital can use that information for QA purposes, says Pachciarz. Perhaps the hospital can trace the problem back to a particular unit or to a specific type of surgery where the OR needs to be more proactive to prevent skin breakdown.

What if the nursing home and hospital identify different wound stages and severity? Read on … (more…)

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