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AAA Warman Home Care’s E-Update is intended to bring to you timely and useful articles and information at the click of the mouse. It is sent monthly in an effort to keep you apprised of what is happening across the healthcare continuum of care effecting hospital, hospice and rehabilitation social workers and case managers, as well as Assisted Living, Independent Living and Skilled Nursing facility executives. Warman understands that time is limited and has undertaken to share with you important industry information without your having to search for it.
Program is top priority under new health care imperatives to reduce the rate of 30-day readmissions
In light of health care reform measures, Rush University Medical Center has launched a study of its program to help older adults transition from hospital to home.
The goal of the study is to determine whether the program, first implemented two years ago, succeeds in reducing readmissions within 30 days for seniors. If it does, it could serve as a model for hospitals across the country that are seeking ways to lower their rates of readmission.
On average, one in five Medicare beneficiaries who are discharged from a hospital re-enter the hospital within a month. Reducing the rate of hospital readmissions to improve quality and achieve savings are key components of President Obama's health care reform agenda. Hospital readmissions cost Medicare an estimated $12 billion dollars annually.
"Patients who have been enrolled in our enhanced discharge planning program over the last two years are extremely pleased with the service," said Robyn Golden, LCSW, director of the older adult programs at Rush. "But beyond patient satisfaction, we now need to formally evaluate the program in a randomized, controlled study to determine whether our model-using social workers rather than nurses-not only reduces readmissions, but also reduces emergency room visits, avoids nursing home placements, and improves quality of life."
The program targets seniors 65 years of age and older who are discharged to their homes and have multiple prescribed medications, plus other risk factors.
Within 48 hours of discharge from the hospital, the patient receives a call from a Rush social worker, whose responsibility is to ensure full implementation of the discharge plan, assist with coordinating community resources and follow up appointments, and intervene around any issues that might arise once the patient is back in the community. Those issues may range from transportation to meals and in-home care.
Over the two years of the Rush program, the social workers involved have found several common themes in post-discharge care. Patients reported difficulty getting around after discharge, particularly if their illness affected their mobility. Patients also reported difficulty scheduling medical appointments and getting to their physicians' offices, and delays in home health care services. Caregivers were often overwhelmed.
In other programs to help patients transition from hospital to home, nurses coordinate the after-hospital care, but Golden believes that social workers are ideally trained for the role.
According to Golden, research has shown that 40 to 50 percent of hospital readmissions are linked to social problems and lack of community services - issues that social workers are trained to address.
"Social workers possess extensive knowledge of community resources, expertise in navigating complex social systems, experience using a framework of practice that focuses on the person in the environment, and training in case management and care coordination," Golden said. "Social workers are also able to use psychosocial assessment skills to explore family dynamics or resources that may affect the success of the discharge plan."
In its efforts to find new ways to help patients transition from hospital to home, Rush is also participating in Project BOOST (Better Outcomes for Older Adults through Safe Transition), a national project involving 30 hospitals to redesign the discharge process. Rush is the only hospital in Illinois included in the project. Like Rush's enhanced discharge planning program, Project BOOST, sponsored by the Society of Hospital Medicine, is aimed at reducing readmissions.
Rush University Medical Center includes a 674-bed (staffed) hospital; the Johnston R. Bowman Health Center; and Rush University (Rush Medical College, College of Nursing, College of Health Sciences and the Graduate College).
SOURCE: Rush University Medical Center, July 28, 2009
A particular class of medication used to treat high blood pressure could protect older adults against memory decline and other impairments in cognitive function, according to a newly published study from Wake Forest University School of Medicine. Research A particular class of medication used to treat high blood pressure could protect older adults against memory decline and other impairments in cognitive function, according to a newly published study from Wake Forest University School of Medicine.
Research suggests that some of the drugs classified as angiotensin-converting enzyme (ACE) inhibitors, specifically those types of ACE inhibitors that affect the brain by crossing the blood-brain barrier, may reduce inflammation that could contribute to the development of Alzheimer's disease, a major cause of dementia.
The study appears in the current issue of Archives of Internal Medicine.
"High blood pressure is an important risk factor for Alzheimer's disease and vascular dementia," said Kaycee Sink, M.D., M.A.S., lead author of the study, geriatrician and an assistant professor of internal medicine - gerontology. "Our study found that all blood pressure medications may not be equal when it comes to reducing the risk of dementia in patients with hypertension."
Dementia is the broad term used to describe conditions in the brain that cause loss of brain function. There are several different causes of dementia, but Alzheimer's disease and strokes are two of the most common. People with dementia begin to lose their memory and may not be able to think well enough to do normal activities, such as getting dressed or eating, may lose their ability to solve problems or control their emotions, may experience personality changes and/or may become agitated or see things that are not there.
While memory loss is the hallmark of dementia, it does not, by itself, mean an individual has dementia. People with dementia have serious problems with two or more brain functions, such as memory and problem solving.
Someone is diagnosed with dementia every 70 seconds. It is estimated that the number of people in the United States living with dementia will increase to about 13 million by the year 2050. Therefore, delaying the onset of dementia, even by one year, would have a substantial impact on public health.
Hypertension, or high blood pressure, is a major contributor to the development of all types of dementia. Many of the estimated one in three U.S. adults who have hypertension are treated with ACE inhibitors, a class of drugs that help lower blood pressure by causing the blood vessels to relax and widen.
Some ACE inhibitors are known as "centrally-acting" because they can cross the blood-brain barrier, a specialized system of tiny blood vessels that protects the brain from harmful substances in the blood stream. Centrally-acting ACE inhibitors include captropril (Capoten®), fosinopril (Monopril®), lisinopril (Prinivil® or Zestri®), perindopril (Aceon®), ramipril (Altace®) and trandolapril (Mavik®).
For the study, researchers analyzed data from the Cardiovascular Health Study, a long-term study of cardiovascular risk factors that involved 5,888 people over 65 years old from Forsyth County, N.C.; Sacramento County, Calif.; Pittsburgh, Pa.; and Washington County, Md.
The investigators specifically looked at 1,074 study participants who were free of dementia when they entered the study and who were being treated for hypertension. They evaluated whether exposure to ACE inhibitors in general - and to the centrally-active versus non-centrally active drugs - was related to dementia development and cognitive decline.
Compared to other classes of anti-hypertensive drugs, researchers found no association between exposure to ACE inhibitors as a class and the risk of dementia. There was a significant cognitive benefit, however, seen in those individuals treated with the centrally-active ACE inhibitors specifically.
The study found an association between taking centrally-active ACE inhibitors and lower rates of mental decline as measured by the Modified Mini-Mental State Exam, a test that evaluates memory, language, abstract reasoning and other cognitive functions. The research showed that participants who were exposed to ACE inhibitors that cross the blood-brain barrier saw an average 65 percent less cognitive decline per year of exposure compared to participants taking other blood pressure medications.
Researchers also found that non-centrally active ACE inhibitors were associated with an increased risk of dementia and the people taking them were more likely to develop difficulty performing daily activities. Specifically, participants who, for three years, took ACE inhibitors that do not cross the blood-brain barrier were at a 73 percent greater risk of developing dementia than were the individuals taking other anti-hypertensive drugs.
"ACE inhibitors have been shown to be beneficial to the heart and kidneys, and this study gives evidence that they may also be beneficial to the brain-at least the ones that are able to get into the brain," Sink said. "We already know it is important to treat high blood pressure and keep it under good control. But our study finds that some blood pressure medications, such as the ACE inhibitors that cross the blood brain barrier, may offer benefits to the brain that others do not. If a patient has an indication for an ACE inhibitor, it makes sense to choose one that crosses the blood brain barrier. This is quite different from the typical recommendations for physicians to avoid medications in older adults that get into the brain."
The research was supported by the National Heart, Lung and Blood Institute, the Wake Forest University Pepper Older Adults Independence Center, the Kulynych Center for Research in Cognition at Wake Forest University, the Hartford Geriatrics Health Outcomes Research Scholars Program, the National Institute of Neurological Disorders and Stroke, and the National Institute on Aging.
Co-authors on the study were Xiaoyan Leng, Ph.D., Jeff Williamson, M.D., M.H.S., Stephen B. Kritchevsky, Ph.D., Hal Atkinson, M.D., Mike Robbins, Ph.D., and David C. Goff, Jr., M.D., Ph.D., all from the School of Medicine, Kristine Yaffe, M.D., from the University of California, Lewis Kuller, M.D., Dr.P.H., from the University of Pittsburgh, Sevil Yasar, M.D., from Johns Hopkins University, and Bruce Psaty, M.D., Ph.D., from the University of Washington.
SOURCE: Wake Forrest University Baptist Medical Center, July 23, 2009
A person who has exercised regularly prior to the onset of a stroke appears to recover more quickly, say researchers from Mayo Clinic in Florida, who led a national study.
In the July 2009 issue of the Journal of Neurology, Neurosurgery & Psychiatry, the researchers reported that stroke patients who had previously exercised regularly before a stroke occurred were significantly more likely to have milder impairments and, thus, were better able to care for themselves, compared to patients who rarely exercised.
"It appears that exercise is very beneficial to people at risk of developing a stroke," says Mayo Clinic neurologist James Meschia, M.D., the study's lead investigator. "Many studies have shown that exercise can reduce the risk of developing a stroke in the first place, and this study suggests that if an active person does have a stroke, outcomes can be improved."
Dr. Meschia cautions, however, that a larger study is needed to validate these findings, because this study depended on recall from 673 people who had a stroke. A new study could also help clarify whether moderate or vigorous exercise is necessary to improve outcomes, he says.
"It makes complete sense that a person who exercised before a stroke would recover quicker," Dr. Meschia says. "A brain that generally has good blood and oxygen flow from aerobic exercise will be in a better position to compensate for neurological deficits caused by a stroke."
The findings are potentially important, he adds, because stroke is a common cause of illness, disability, and death among those over age 65 worldwide. In the United States, stroke results in more than 780,000 deaths each year, making it the third leading cause of mortality, and it causes more serious long-term disability than any other disease, according to the National Institutes of Health.
This study is one of the first to examine if the benefits of exercise extend beyond stroke prevention. Researchers looked at data collected by scientists at four centers - Mayo Clinic's campuses in Jacksonville and in Rochester, Minn.; the University of Florida and the University of Virginia - who participated in the Ischemic Stroke Genetics Study. The study was designed to look at inherited risk factors for stroke.
Patients enrolled in the study were treated for acute ischemic stroke - the most common kind of stroke, which results in the death of brain cells due to blockage of blood flow to a part of the brain.
Researchers reviewed a questionnaire patients had completed that asked about exercise before the stroke, and they also looked at measurements of stroke outcome taken after the stroke and then three months later.
Of the 673 patients enrolled, 50.5 percent reported that prior to their stroke, they exercised less than once a week, 28.5 percent exercised one to three times a week, and 21 percent reported aerobic physical activity four times a week or more.
After accounting for different patient variables, such as age, gender, race, body weight and medical history, the researchers found that exercise did not affect the size or severity of a stroke, but did modulate outcomes. Specifically, patients scored better in tests that assessed their ability to perform daily activities involved in living on their own, and determine whether a patient had regained normal functioning.
"We infer that patients who are active may recover more quickly immediately after a stroke, with trends that point to better outcomes at three-month follow-up," says Dr. Meschia.
Researchers could not determine from the data the "dose effect" of the exercise - how much is needed per week for better functioning.
The Ischemic Stroke Genetics Study was supported by a grant from the National Institute of Neurological Disorders and Stroke.
SOURCE: Mayo Clinic, July 18, 2009
New research shows that training your brain may be just as effective as training your muscles in preventing ACL knee injuries, and suggests a shift from performance-based to prevention-based athletic training programs.
The ACL, or anterior cruciate ligament, is one of the four major ligaments of the knee, and ACL injuries pose a rising public health problem as well as an economic strain on the medical system.
University of Michigan researchers studying ACL injuries had subjects perform one-legged squats to fatigue, then tested the reactions to various jumping and movement commands. Researchers found that both legs - not just the fatigued leg - showed equally dangerous and potentially injurious responses, said Scott McLean, assistant professor with the U-M School of Kinesiology. The fatigued subjects showed significant potentially harmful changes in lower body movements that, when preformed improperly, can cause ACL tears.
"These findings suggest that training the central control process - the brain and reflexive responses - may be necessary to counter the fatigue induced ACL injury risk," said McLean, who also has an appointment with the U-M Bone & Joint Injury Prevention Center.
McLean says that most research and prevention of ACL injuries focuses below the waist in a controlled lab setting, but the U-M approach looks a bit north and attempts to untangle the brain's role in movements in a random, realistic and complex sports environments.
The findings could have big implications for training programs, McLean said. Mental imagery or virtual reality technology can immerse athletes to very complex athletic scenarios, thus teaching rapid decision making. It might also be possible to train "hard wired" spinal control mechanisms to combat fatigue fallout.
In a related paper, McLean's group again tested the single leg landings of 13 men and 13 women after working the legs to fatigue. While both men and women suffer an epidemic of ACL injuries, women are two to eight times likelier to tear this ligament than men while playing the same sport. However, the study showed that men and women showed significant changes in lower limb mechanics during unanticipated single leg landings. Again, the findings point to the brain, McLean says.
During testing, a flashing light cued the subjects to jump in a certain direction, and the more fatigued the subjects became, the less likely they were able to react quickly and safely to the unexpected command.
The research suggests that training the brain to respond to unexpected stimuli, thus sharpening their anticipatory skills when faced with unexpected scenarios, may be more beneficial than performing rote training exercises in a controlled lab setting, which is much less random than a true competitive scenario. In this case, expanding the anticipated training to include shorter stimulus-response times could improve reaction time in random sports settings.
"If you expose them to more scenarios, and train the brain to respond more rapidly, you can decrease the likelihood of a dangerous response," he said. It's analogous to how a seasoned stick shift driver versus a novice learner might both respond to a sudden stall. The inexperienced driver might make a slow or even incorrect decision.
The paper, "Fatigue Induced ACL Injury Risk Stems from a Degradation in Central Control," will appear in Medicine and Science in Sports and Exercise in August 2009.
"Difference between Sexes and Limbs in Hip and Knee Kinematics and Kinetics During Anticipated and Unanticipated Jump Landings: Implications for ACL Injury," appears online at the British Journal of Sports Medicine.
SOURCE: University of Michigan, July 27, 2009
Dr. SleepGood, Inc. has announced the release of the SnoreSling™, a non-invasive fabric product that could help millions of sleep apnea and snoring sufferers, as well as their bed partners, finally get a good night's rest.
Sleep apnea and snoring, disorders that disturb millions worldwide, can be debilitating: sleep interruptions multiple times an hour, constant fatigue, embarrassing snoring, weight gain, low libido, and depression are just some of their effects. Additionally, these disorders can be a serious health concern for the sufferer's bed partner. People who share beds and sleeping areas with snorers can experience loss of sleep, irritability, and a diminished quality of life, as well as negative relationship effects.
Sleep apnea and excessive snoring often are caused by the tongue falling back into the throat, thus blocking air and forcing the sleeper to wake up and adjust his or her position. This can occur multiple times every hour and render restful sleep impossible. If a person can somehow close his or her mouth while sleeping, however, then the tongue won't fall back and sleep may not be disturbed.
The SnoreSling™ solves this dilemma with an adjustable snoring chin strap that wraps underneath a person's jaw and over the head. With its comfortable, lightweight, and breathable fabric, the SnoreSling™ distributes tension evenly across the head and alleviates pressure points. As a result, the jaw stays closed, the tongue does not fall back, airways are more open, and sleep can occur without disturbances. It is a simple, low-cost, and non-surgical solution to a debilitating problem.
The unique design of the SnoreSling™ features three flexible adjustment points, machine-washable soft fabric, and cutouts for the ears to comfortably accommodate almost anyone. Additionally, the SnoreSling™ is snug and non-intrusive - wearers can fall asleep and not even know they are wearing it.
The inventor of the SnoreSling™, Scott Hardy, suffered from extreme sleep apnea for most of his life. As he battled through all of the associated conditions and symptoms, he sought every conceivable treatment from dental appliances and humidifiers to breathing strips and throat sprays. But after exhausting nearly every option, his disorder persisted.
Then, after having surgery in 2007 to cure his extreme sleep apnea, Scott had the insight and inspiration to create the SnoreSling™. "I just wanted to develop a simple, comfortable remedy to a condition that almost ruined my life," says Scott. "Sleep is not a luxury - it is a necessity. Now with the SnoreSling™, sleep apnea and snoring sufferers, as well as their bed partners, can consistently enjoy a good night's sleep," he added.
SOURCE: SnoreSling, July 9, 2009
