Archive for 'Clinical Notes'

Alzheimer’s Research Update

Posted on 01. Feb, 2010 by .

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Bottoms Up: Could a brain-boosting brew keep the synapses cracking?

Recent research at Massachusetts Institute of Technology (MIT) that a combination of DHA (a type of omega-3 fatty acid), choline, and uridine helped generate brain synapses in rodents. The rodents that received the nutritional mixture performed better on cognitive tests — ”specifically, the ability to navigate a water maze,” according to an MIT release on the research.

Omega-3 fatty acids exist in a number of foods, including “fish, eggs, flaxseed and meat from grass fed animals,” according to the release. “Choline can be synthesized in the body and obtained through the diet; it is found in meats, nuts and eggs.” You can’t obtain uridine from food, although it is found in human breast milk. And the body can produce it, the release notes.

Clinical studies are now testing the concoction on people with Alzheimer’s disease, a strategy that could hold promise for other brain diseases and injuries, according to the MIT news statement.

Read the news item here.

Available on CD: Game plan for treating cognitively impaired residents at your long-term care facility.

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Music Therapy Playlists for Long-Term Caregivers

Posted on 24. Jan, 2010 by .

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Looking for some fresh ideas to help your dementia patients? Rock on with these links.

Whether someone’s 64, 74 or 84, an iPod might just be able to spark some good memories and brighten the day.

Dr. Concetta Tomaino, who’s long studied music’s therapeutic effects for patients with dementia, has some new ideas for caregivers, reports The Wall Street Journal. Here are some highlights.

iPods: While some critics decry iPods for intensifying social isolation, they can be powerful tools that help people with dementia connect to their memories and to others.

Why? Caregivers can customize playlists for different patients. Research shows that people best remember the music from their teens and early 20s, so that young automobile accident victim needs a different playlist that the 80-something with Alzheimer’s.

Tip: To get playlist ideas for each age group, go to this Institute for Music & Neurologic Function site.

To read more from The Wall Street Journal, go here.

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Pediatric Long-Term Care: New PT Method for Hemiplegic Cerebral Palsy

Posted on 24. Jan, 2010 by .

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Try Something New for Your Pediatric Patients With Hemiplegic Cerebral Palsy

Have you explored constraint-induced movement therapy recently? CIMT could help children with hemiplegic cerebral palsy, according to researchers who analyzed several studies and systematic reviews on this method.

Background: Hemiplegic cerebral palsy affects one arm and leg on the same side of the body. CIMT forces the use of the affected side, specifically the upper extremity, by gently restraining the  unaffected side in a mitt, sling, or cast. The patient then practices moving the affected arm for varying durations of time and intensity, explained the American Physical Therapy Association in a press release.

Findings: In the current study, one outcome measure at the body functions and structure level and four outcome measures at the activity level revealed significant CIMT effects. Previous studies also supported CIMT to improve the frequency of use of the affected arm for children with hemiplegia. And in most studies, positive effects appeared six to eight months after intervention. (more…)

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Predictive Pain Model Flags SNF Residents at Risk for Having Unrelieved Pain

Posted on 18. Jan, 2010 by .

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If a nursing home resident coded without pain has these conditions, take a closer look.

To identify residents who may need more in-depth pain assessment or treatment, compare the pain coding in MDS Section J to certain diagnoses and conditions on the MDS.

That’s what an MDS-driven computerized program provided by the New York Association of Homes & Services for the Aging (NYAHSA) does, although anyone can use the data to perform the double check manually, reported Christie Teigland, PhD, director of Health Informatics and Research at NYAHSA, in a presentation at the recent American Association of Homes & Services for the Aging annual meeting.

Next: How to look for pain’s indirect effects to flag people who need better assessment or Rx … (more…)

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Add This Web Address to Your SNF Pain Management Toolkit

Posted on 10. Jan, 2010 by .

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Photo: Kolossos, Wikimedia Commons

Photo: Kolossos, Wikimedia Commons

Looking for a free resource to improve nursing home residents’ pain management?

Check out a free Web site filled with evidence-based advice and tools, including assessments for people who are cognitively intact and those with dementia. The site, which requires you to register in order to use it, also offers educational videos for healthcare providers, patients, and their families.

According to an American Geriatrics Society Web page posting about the site, those responsible for developing the “one-stop resource” for pain assessment and management include “AGS member Keela Herr, PhD, RN, RAAN, AGSF, the Honor Society of Nursing, Sigma Theta Tau International’s (STTI) Center for Nursing Excellence in Long-Term Care, and nurse leaders who represent five John A. Hartford Centers of Geriatric Nursing Excellence …”

Funding for the Web site came from the University of Iowa and Golden Living and the Mayday Foundation. It also included a grant from the Robert Wood Johnson Executive Nurse Fellows, the AGS reports.

Available on CD: How to Conquer Pain and F309 Survey Deficiencies. Presented by Rena Shephard, MHA, RN, FACDONA, RAC-CT.

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Pain Management & Spiritual Aid at Your SNF: Got Reiki?

Posted on 04. Jan, 2010 by .

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Mikao Usui, founder of Reiki

Get the scoop from long-term care professionals who’ve tried Reiki at their facilities.

Opioids remain the gold standard for treating most types of severe, ongoing pain. But best practice palliative pain management also includes non-pharmacological approaches that promote relaxation and ease spiritual distress and fear.

Case in point: Some hospice and palliative care programs have practitioners certified in Reiki offer that modality as part of a holistic approach to care. Get an overview of Reiki here.

As one example, Harold Bob, MD, a nursing home medical director in Baltimore, Md., incorporates Reiki in his practice with palliative care patients. “Reiki is a form of human contact that helps the patient with spiritual connection at a time when that’s very important to many people,” says Bob. But Reiki isn’t a religion or faith, he’s quick to add. Instead, Reiki is a method with five basic principles, as follows, Bob explains:

1. I will not worry just for today.

2. I will not be angry just for today.

3. I will be grateful just for today.

4. I will work hard just for today.

5. I will give kindness and compassion just for today.

Bob has seen people experience significant pain relief from using Reiki because “their fear is alleviated.”

“If you can use a modality, such as Reiki, to help a person relax and feel connected, that can ease their pain,” agrees Diana Waugh, RN, BSN, a nursing consultant in Waterville, Ohio, who does work with nursing homes and hospices.

HEY – HELP ME HERE: Managing Challenging Behaviors in Long Term Care. An audio training event.

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Rehab: Check In With Your Patient’s Fear Factor

Posted on 14. Dec, 2009 by .

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A simple pre-treatment questionnaire could improve your rehab outcomes.

Researchers found that using the Fear-Avoidance Beliefs Questionnaire (FABQ) at intake could identify elevated levels of fear-avoidance beliefs in patients who were receiving outpatient rehab, according to a press release from the American Physical Therapy Association. The FABQ, a short, self-report questionnaire, assesses pain-related fear in patients with various neuromusculoskeletal conditions.

Researchers collected FABQ data from 17,804 people with common conditions who were receiving outpatient rehab in 121 clinics across the U.S., APTA reported. To minimize measurement error related to short-term tests such as the FABQ, researchers used Item Response Theory (IRT) methods to analyze the FABQ items. IRT methods are psychometric techniques that evaluate whether items mean the same thing to different respondents, also known as differential item functioning (DIF). (more…)

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Does Your SNF Patient Have Epilepsy or Non-Epileptic Attacks?

Posted on 05. Dec, 2009 by .

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Research shows the first 30 minutes of the health-care encounter may provide the key clue.

On the epilepsy detection front: A bit of linguistic sleuthing may pinpoint the difference between the two most common reasons for blackouts, according to a study at the University of Sheffield.

In fact, the patient may be unwittingly telling the clinician whether he has true epileptic seizures, which originate in the brain, or non-epileptic attacks caused by overwhelming stressful situations, emotions or memories, etc., according to a press release on the study. (more…)

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Skilled Nursing Facility Question: Self-Administered OTC and Herbal Medications

Posted on 29. Nov, 2009 by .

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If your staff ask these 2 questions, they’ll get an accurate medical history.

Question: Our nursing staff has found numerous occasions where residents are taking their own over-the-counter or herbal remedies which their families bring them. Sometimes we’ve found residents taking herbal remedies that could interfere with their medications. Last week, a resident’s family member brought in a tea for incontinence that the family member had ordered off the Internet, although she did ask us if we’d give it to the resident.

How should we go about managing these issues? Does the facility have a right to require residents/families to inform us of any OTC or herbal/vitamin remedy they bring in before giving it to the resident? Can we forbid residents from taking such things or is that a resident rights violation? (more…)

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SNF Infection Control: A New Front in the MRSA Battle

Posted on 24. Nov, 2009 by .

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Diagnosis & treatment for ‘hospital-acquired MRSA just got more complicated.

If you’ve got SNF patients going into the hospital for inpatient stays, or even going in for outpatient procedures, your MRSA battles are getting more complicated, a new study says.

The MRSA picture used to be much simpler, explains this NPR story. You basically had two kinds of MRSA in the hospital — those associated with inpatient stays that resists many drugs, and those out in the community that resist only one or two drugs. Not anymore … (more…)

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