Search

Objective: To evaluate the feasibility and usability of an assistive technology (AT) prototype designed to be operated with conventional/alternative input channels and a P300-based brain-computer interface (BCI) in order to provide users who have different degrees of muscular impairment resulting from amyotrophic lateral sclerosis (ALS) with communication and environmental control applications. Design: Proof-of-principle study with a convenience sample. Setting: An apartment-like space designed to be fully accessible by people with motor disabilities for occupational therapy, placed in a neurologic rehabilitation hospital. Participants: End-users with ALS (N=8; 5 men, 3 women; mean age ± SD, 60±12y) recruited by a clinical team from an ALS center. Interventions: Three experimental conditions based on (1) a widely validated P300-based BCI alone; (2) the AT prototype operated by a conventional/alternative input device tailored to the specific end-user's residual motor abilities; and (3) the AT prototype accessed by a P300-based BCI. These 3 conditions were presented to all participants in 3 different sessions. Main Outcome Measures: System usability was evaluated in terms of effectiveness (accuracy), efficiency (written symbol rate, time for correct selection, workload), and end-user satisfaction (overall satisfaction) domains. A comparison of the data collected in the 3 conditions was performed. Results: Effectiveness and end-user satisfaction did not significantly differ among the 3 experimental conditions. Condition III was less efficient than condition II as expressed by the longer time for correct selection. Conclusions: A BCI can be used as an input channel to access an AT by persons with ALS, with no significant reduction of usability. [ABSTRACT FROM AUTHOR]

Purpose: Urinary incontinence (UI) is common but inadequately assessed and treated in nursing facility (NF) residents. The purpose of this study is two-fold: (1) to determine perceptions about the importance of UI and its management in the NF setting compared with other geriatric syndromes and (2) to compare barriers to UI care as perceived by physicians, geriatric nurse practitioners (GNPs), directors of nursing and other nurses in administrative positions (DONs), and nursing assistants (NAs). Methods: Computer-based surveys of physicians and DONs and a hard copy survey of NAs at their national meetings; an online survey of GNPs. Results: Responses included 395 physicians (31% response rate), 152 DONs (34%), 118 GNPs (23%), and 277 NAs (60%). Physicians, GNPs, and DONs evaluated and managed UI significantly less often than 5 other geriatric syndromes (behavioral symptoms of dementia, falls, unintended weight loss, pain, and delirium). In contrast, NAs were more likely to be involved in UI care than in care provided for residents with any of the other 5 syndromes. All 4 groups agreed that UI has less effect on clinical outcomes than the other 5 syndromes. However, DONs rated UI first with respect to cost of care; NAs third behind falls and pain; and physicians and GNPs rated UI fourth behind falls, behavioral symptoms, and delirium. With respect to quality of life effects, physicians and GNPs rated UI fifth and fourth respectively and DONs fourth. In contrast, NAs rated UI second only to pain with respect to its effect on quality of life. Perceived barriers differ among the 4 groups with physicians relatively more concerned that drug treatment alone is ineffective (P = .002); GNPs relatively more concerned with lack of effective nondrug interventions (P = .001); and DONs relatively more concerned about sufficient time to assess and manage UI (P = .001). NA respondents rated concern about anticholinergic drug effects lower than did respondents in the other 3 groups (P = .001). Conclusion: Physicians, GNPs, and DONs are more likely to be involved in evaluating and managing behavioral symptoms of dementia, pain, falls, delirium, and unintended weight loss than UI in the NF setting. This leaves NAs as first-line managers for a condition that they perceive to have an important impact on quality of life. Perceived barriers to improving UI care differ among the 4 groups suggesting that approaches to overcoming the barriers should be multi-faceted. [Copyright &y& Elsevier]

Objectives: To describe practice patterns regarding diabetes management among nursing home (NH) physicians and to identify variation in this practice based on patient characteristics. Design: Mailed survey. Participants: Nursing home physicians from the American Medical Directors Association (AMDA) Foundation Long-Term Care Research Network (n = 142), as well as other members of AMDA who were Certified Medical Directors (CMD) (n = 68) and members who were not CMD certified (n = 45). Response rates to the survey were 51%, 33%, and 23%, respectively. Measurements: Physician and facility characteristics were queried. Responses to 12 items pertaining to diabetes management and 5 items pertaining to use of specific oral diabetes medications were evaluated in the context of 3 different patient profiles that reflected different combinations of functional and cognitive impairment. Responses were based on the physicians’ perception of how they manage diabetes under these specified patient profiles. Results: Responses from members of the Research Network indicated highly significant variability (P < .01) between the 3 patient profiles for all of the 12 management items. Ordering a special diet, monitoring lipid panel, and ordering routine ophthalmology was less likely for the patient profile with both functional and cognitive impairment (P < .01). These differences among the patient profiles for these 3 interventions were present in the responses from all 3 categories of physicians (Research Network, CMD, and non-CMD members of AMDA). There was no statistically significant variability among the 3 patient profiles for any of the 3 physician groups regarding the likelihood of using of any of the 5 classes of oral diabetic medications. Non-CMD physicians were more likely to have less NH experience; otherwise, there were no differences among the 3 physician groups. Conclusions: Nursing home physicians appear to alter the approach to diabetes management based on the functional and/or cognitive status of the patient. This was particularly true for those physicians who were members of the AMDA Foundation Research Network. These findings have implications for initiatives designed to guide clinical practice as well as efforts by regulatory bodies to evaluate appropriate care. Further research is needed to measure the actual impact of different approaches to diabetes management on relevant outcomes in this population. [Copyright &y& Elsevier]