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Background: An analysis of practice is conducted by the American Board of Physical Therapy Specialties (ABPTS) every 10 years to revalidate, update, and revise the description of specialty practice (DSP) for each specialty. The Geriatric Specialty Council recently conducted an analysis of practice and revised its content consistent with established procedures by the ABPTS. Purpose: The purpose of this article is threefold: first, to describe the process of the most recent practice analysis; second, to report revisions to the description of specialty practice based on the analysis of practice; and third, to identify elements of practice that define current specialist practice in geriatric physical therapy. Methods: A 10-member committee of subject matter experts (SM Es) and a psychometric consultant developed a survey instrument addressing geriatric physical therapy specialty practice areas. The survey was initially pilot-tested and subsequently administered online to a sample of 801 board-certified geriatric clinical specialists. The consultant facilitated the consensus process to determine decision rules in selecting the final competencies describing current geriatric physical therapy specialty practice. Results: A total of 372 respondents fully or partially completed the survey, resulting in a response rate of 46.4%. Based on a priori decision rules regarding survey data, consensus of the group of SMEs, and input from the ABPTS, the DSP for geriatric physical therapy specialty practice was revised. Revisions (elimination [-] of prior items and addition [+] of new items) were made in Section 1: Knowledge Areas (-8 and +6), in Section 2: Professional Roles, Responsibilities, and Values (-14 and +4), and Section 3: Practice Expectations (-53 and +28). Conclusion: The revised DSP will be used as the basis for the development of the examination blueprint for the specialist examination in geriatric physical therapy and the curricula for residency programs in geriatric physical therapy. [ABSTRACT FROM AUTHOR]

Primary care clerical staff may experience burnout if not adequately prepared and supported for patient-facing customer service tasks. Guided by the Job Demands-Resources (JD-R) model, we use national survey data from 707 primary care clerks at 349 VA clinics (2018; response rate: 12%) to evaluate associations between clerks' perceptions of tasks, work environment, training, and burnout. We found challenges with customer-facing tasks contribute to higher burnout, and supportive work environment was associated with lower burnout. Although perceptions of training were not associated with burnout, our results combined with the JD-R model suggest that customer service training may protect against burnout. [ABSTRACT FROM AUTHOR]

Using data from the Veterans Assessment and Improvement Laboratory for Patient- Centered Care (VAIL-PCC) Survey, this study investigated the relationship between registered nurses' (RNs') and licensed vocational nurses' (LVNs') report of responsibility for 14 distinct primary care tasks and burnout, taking into account of practice environment contexts. RNs reported higher levels of burnout than LVNs. The task of "following up on referrals" was associated with significantly higher levels of RN burnout, whereas "responding to prescription requests" was associated with higher levels of LVN burnout. "True collaboration" was associated with significantly lower levels of burnout for both RNs and LVNs. [ABSTRACT FROM AUTHOR]

Objectives: The objectives of this study were to determine whether tamoxifen recommendation differs by physician specialty, to determine whether perception affects tamoxifen recommendation, and to investigate the association between the physician's specialty and the perception of risks and benefits of tamoxifen.Methods: We enrolled a cohort of geographically diverse women aged 65 and older with stage I through IIIa breast cancer in a prospective cohort study. We recruited their surgeons and, when applicable, their medical oncologists to provide patient-specific information about their perceptions of the risks and benefits of tamoxifen and whether they recommended tamoxifen. Each physician also completed a questionnaire regarding his or her demographic and practice characteristics. Patient data were collected through medical record review and a patient interview 3 months after definitive breast cancer surgery.Results: We collected physician treatment recommendation forms for 585 women. Oncologists were 2.5 times more likely to recommend tamoxifen, compared with surgeons, after adjusting for patient and tumor characteristics (95% confidence interval, 1.5-4.2). For both specialties, their perceptions of the risks and benefits of tamoxifen were strong predictors of tamoxifen recommendation. However, there were differences in perception by physician specialty. Distant metastases and tolerance of tamoxifen side effects were more important to oncologists, whereas local recurrence and risk of cataracts were more important to surgeons.Conclusion: Physicians' perceptions of the risks and benefits of tamoxifen therapy for older women are important in their decision-making process. [ABSTRACT FROM AUTHOR]

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Patients with end-stage renal disease (ESRD) suffer high rates of heart failure and cardiovascular mortality, and we lack a thorough understanding of what, if any, modifiable factors contribute to cardiac dysfunction in these high-risk patients. To evaluate endothelial function as a potentially modifiable cause of cardiac dysfunction in ESRD, we investigated cross-sectional associations of macro- and microvascular dysfunction with left and right ventricular dysfunction in a well-controlled ESRD cohort. We performed comprehensive echocardiography, including tissue Doppler imaging and speckle-tracking echocardiography of the left and right ventricle, in 149 ESRD patients enrolled in an ongoing prospective, observational study. Of these participants, 123 also underwent endothelium-dependent flow-mediated dilation of the brachial artery (macrovascular function). Microvascular function was measured as the velocity time integral of hyperemic blood flow after cuff deflation. Impaired flow-mediated dilation was associated with higher left ventricular mass, independently of age and blood pressure: per 2-fold lower flow-mediated dilation, left ventricular mass was 4.1% higher (95% confidence interval, 0.49-7.7; P=0.03). After adjustment for demographics, blood pressure, comorbidities, and medications, a 2-fold lower velocity time integral was associated with 9.5% higher E/e' ratio (95% confidence interval, 1.0-16; P=0.03) and 6.7% lower absolute right ventricular longitudinal strain (95% confidence interval, 2.0-12; P=0.003). Endothelial dysfunction is a major correlate of cardiac dysfunction in ESRD, particularly diastolic and right ventricular dysfunction, in patients whose volume status is well controlled. Future investigations are needed to determine whether therapies targeting the vascular endothelium could improve cardiac outcomes in ESRD. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this report is to present the clinical outcomes and patients' satisfaction of full-mouth rehabilitation using computer- aided flapless implant placement and immediate loading of a prefabricated prosthesis. Materials and Methods: The study included 30 consecutive fully edentulous patients who received 312 implants. Mandible and maxilla were treated in the same surgical session with computer-guided flapless approach using the Nobel- Guide protocol. Prefabricated screw-retained fixed prostheses were inserted at the end of surgery. Clinical and radiographic evaluations were assessed at 6, 12, and 36 months. At baseline and 6 months after surgery, patients answered Oral Health Impact Profile in Eden tulous Adults questionnaire to assess satisfaction. Results: The implant survival rate was 97.9%, whereas the average marginal bone loss was 1.9 ± 1.3 mm after 3 years. At 6 months, patients showed significantly greater satisfaction with their fixed rehabilitation when compared with conventional dentures. Conclusions: The results of this study confirm that rehabilitation with a prefabricated fixed prosthesis supported by implants placed with NobelGuide protocol is a viable and predictable treatment and increases patients' satisfaction and improves oral health-related quality of life. [ABSTRACT FROM AUTHOR]

BACKGROUND: : Family-centered care (FCC) has been cited as important to patient care; however, little is known about nurses' perspectives toward FCC. Family presence during resuscitation (FPDR) is an example of the implementation of FCC; however, nurses do not necessarily agree with FPDR, especially those from non-Western countries. It is also unknown whether there is an association between FPDR and FCC. OBJECTIVES: : The objective of the study was to determine (a) the attitudes of nurses toward FCC and FPDR and (b) whether there is an association between FCC and FPDR. SUBJECTS AND METHODS: : A convenience sample of 96 Israeli intensive care unit and cardiovascular registered nurses completed 5 questionnaires: a demographic data questionnaire, Nursing Activities for Communication With Families-Revised, Barriers to Providing Family-Centered Care-Revised (Barriers), Nurses' Experiences of Family-Witnessed Resuscitation, and Attitudes to Family Presence During Resuscitation. Descriptive statistics and Pearson correlations were conducted. RESULTS: : The item mean values for the Nursing Activities for Communication With Families-Revised and the Barriers scales were only 3.7 of 5 and a moderate 2.4 of 4, respectively. Only 19 of the sample (20%) had experienced FPDR, of which 17 reported a negative as opposed to a positive experience. Overall, nurses objected to FPDR (mean item score = 1.8 of 5). No statistically significant relationship was found between FCC and FPDR. A significant negative correlation was found between the Barriers scale and FPDR (r = -0.36, P = .0001). CONCLUSION: : Although FCC has moderate support, objection still remains to FPDR. Family presence during resuscitation has been used as an example of FCC, but at least in certain populations, this example might not be applicable. Increased education and policy changes should be encouraged to promote FCC and FPDR. [ABSTRACT FROM AUTHOR]

One- and 2-year evaluation of a feasibility trial (clinicaltrials.gov registration numbers NCT01057992, NCT01058070, and 01058564) to assess the safety and efficacy of a laparoscopically implanted sphincter augmentation device for the treatment of gastroesophageal reflux disease (GERD).A sphincter augmentation device (LINX Reflux Management System; Torax Medical, Shoreview, MN), designed to prevent reflux due to abnormal opening of the lower esophageal sphincter (LES), was laparoscopically implanted at the gastroesophageal junction in 44 patients. At baseline, all patients had abnormal esophageal acid exposure on 24-hour pH monitoring and improved, but persistent, typical GERD symptoms while on acid suppression therapy with proton pump inhibitors (PPIs). The device comprises a miniature string of interlinked titanium beads, with magnetic cores, placed around the gastroesophageal junction. The magnetic bond between adjacent beads augments sphincter competence. The beads temporarily separate to accommodate a swallowed bolus, allow belching or vomiting, and reapproximate to augment the LES in the closed position. Patients were evaluated after surgery by GERD Health-Related Quality of Life symptom score, PPI usage, endoscopy, esophageal manometry, and 24-hour esophageal pH monitoring.The total mean GERD Health-Related Quality of Life symptom scores improved from a mean baseline value of 25.7 to 3.8 and 2.4 at 1- and 2-year follow-up, representing an 85% and 90% reduction, respectively (P < 0.0001). Complete cessation of PPI use was reported by 90% of patients at 1 year and by 86% of patients at 2 years. Early dysphagia occurred in 43% of the patients and self-resolved by 90 days. One device was laparoscopically explanted for persistent dysphagia without disruption of the anatomy or function of the cardia. There were no device migrations, erosions, or induced mucosal injuries. At 1 and 2 years, 77% and 90% of patients had a normal esophageal acid exposure. The mean percentage time pH was less than 4 decreased from a baseline of 11.9% to 3.1% (P < 0.0001) at 1 year and to 2.4% (P < 0.0001) at 2 years. Patient satisfaction was 87% at 1 year and 86% at 2 years.The new laparoscopically implanted sphincter augmentation device eliminates GERD symptoms without creating undue side effects and is effective at 1 and 2 years of follow-up. [ABSTRACT FROM AUTHOR]

The article presents a study which looked into the contribution of the peptide Endothelin-1 (ET-1) to the pathogenesis and manifestations of transplant coronary arteriosclerosis (TCA). It notes that ET-1 bioactivity in coronary arteries with advanced TCA was examined, and that coronary vasoconstriction in heart transplant recipients with and without advanced TCA was compared. It offers the significant therapeutic implications of the study in defining a possible way of preventing or treating TCA.

PROBLEM: Policymakers and clinicians are concerned that initiatives to improve the quality of care for some conditions may have unintended negative consequences for quality in other conditions. OBJECTIVE: We sought to determine whether a practice redesign intervention that improved care for falls, incontinence, and cognitive impairment by an absolute 15% change also affected quality of care for masked conditions (conditions not targeted by the intervention). DESIGN, SETTING, AND PARTICIPANTS: Controlled trial in 2 community medical groups, with 357 intervention and 287 control patients age 75 years or older who had difficulty with falls, incontinence, or cognitive impairment. INTERVENTION: Both intervention and control practices implemented case-finding for target conditions, but only intervention practices received a multicomponent practice-change intervention. Quality of care in the intervention practices improved for 2 of the target conditions (falls and incontinence). MAIN OUTCOME MEASURES: Percent of quality indicators satisfied for a set of 9 masked conditions measured by abstraction of medical records. RESULTS: Before the intervention, the overall percent of masked indicators satisfied was 69% in the intervention group and 67% in the control group. During the intervention period, these percentages did not change, and there was no difference between intervention and control groups for the change in quality between the 2 periods (P=0.86). The intervention minus control difference-in-change for the percent of masked indicators satisfied was 0.2% (bootstrapped 95% confidence interval, -2.7% to 2.9%). Subgroup analyses by clinical condition and by type of care process performed by the clinician did not show consistent results favoring either the intervention or the control group. CONCLUSION: A practice-based intervention that improved quality of care for targeted conditions by an absolute 15% change did not affect measurable aspects of care on a broad set of masked quality measures encompassing 9 other conditions. [ABSTRACT FROM AUTHOR]

BACKGROUND: One in 4 women is affected by intimate partner violence in her lifetime. This article reports on a cross-sectional survey to estimate community preferences for health states resulting from intimate partner violence.METHODS: A secondary analysis was conducted of data from a convenience sample of 93 abused and 138 nonabused women (231 total) recruited for in-person interviews from hospital outpatient department waiting rooms in metropolitan Boston, Massachusetts. SF-12 data were converted to utilities to describe community-perspective preferences for health states associated with intimate partner violence. Linear regression analysis was used to explore the association between violence and utility while controlling for other health and demographic factors.RESULTS: Median utility for intimate partner violence was between 0.58 and 0.63 on a scale of 0 (equivalent to death) to 1.0 (equivalent to optimal health), with a range from 0.64 to 0.66 for less severe violence to 0.53 to 0.62 for more severe violence. The data do not reveal whether violence itself is responsible for lower utility or whether a constellation of factors contributes to disutility experienced by women victims of abuse.DISCUSSION: The utility of health states experienced by women exposed to intimate partner violence is substantially diminished compared with optimal health and even other health conditions. These values quantify the substantial negative health impact of the experience of intimate partner violence in terms that allow comparison across diseases. They can be used in cost-effectiveness analyses to identify the benefits and potential returns from resources allocated to violence prevention and intervention efforts. [ABSTRACT FROM AUTHOR]

More than 300,000 people are hospitalized each year for the treatment of hip fracture. It has been reported that mortality rates are as high as 25% for the first year following a hip fracture. The probability of a significant decline in functional independence is high. A Cochrane review concluded that reports of randomised controlled trials did not provide robust evidence of the impact of rehabilitation programs for people who had sustained a hip fracture. This article describes the functional outcome in a randomized controlled trial of implementing a high-intensity exercise training program twice a week for 8 weeks for people who underwent surgical repair of a hip fracture following a mechanical fall. [ABSTRACT FROM AUTHOR]

Presents a historical perspectives on functional outcome following total hip and knee arthroplasty in the U.S. Changes in surgical technique, postoperative management and length of stay following total hip arthroplasty; Influence of the application of the fundamental elements of evidence-based practice on the procedures, protocols and standards of care following total hip and knee arthroplasty; Creation of a functional milestone tool for physical therapy practice.

Introduces several articles concerning the art and science of physical therapy in geriatrics.