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Objectives: this prospective, cluster randomised, controlled trial investigated the effect of oral neuromuscular training among older people in intermediate care with impaired swallowing., Methods: older people (≥65 years) with swallowing dysfunction were cluster randomised according to care units for 5 weeks of neuromuscular training of the orofacial and pharyngeal muscles or usual care. The primary endpoint was the change in swallowing rate (assessed with a timed water swallow test) from baseline to the end-of-treatment and 6 months post-treatment. The secondary endpoints were changes in signs of aspiration during the water swallow test, and swallowing-related quality of life (QOL). An intention-to-treat principle was followed, and mixed-effects models were used for data analysis with the clustered study design as a random factor., Results: in total, 385 participants from 36 intermediate care units were screened, and 116 participants were randomly assigned to oral neuromuscular training (intervention; n = 49) or usual care (controls; n = 67). At the end of treatment, the geometric mean of the swallowing rate in the intervention group had significantly improved 60% more than that of controls (P = 0.007). At 6 months post-treatment, the swallowing rate of the intervention group remained significantly better (P = 0.031). Signs of aspiration also significantly reduced in the intervention group compared with controls (P = 0.01). No significant between-group differences were found for swallowing-related QOL., Conclusions: oral neuromuscular training is a new promising swallowing rehabilitation method among older people in intermediate care with impaired swallowing., Trial Registration: ClinicalTrials.gov: NCT02825927., (© The Author(s) 2019. Published by Oxford University Press on behalf of the British Geriatrics Society.)

Background: Methicillin-resistant Staphylococcus aureus (MRSA) is the most common healthcare-associated multidrug-resistant organism. Despite the interconnectedness between acute care hospitals (ACHs) and intermediate- and long-term care facilities (ILTCFs), the transmission dynamics of MRSA between healthcare settings is not well understood., Methods: We conducted a cross-sectional study in a network comprising an ACH and 5 closely affiliated ILTCFs in Singapore. A total of 1700 inpatients were screened for MRSA over a 6-week period in 2014. MRSA isolates underwent whole-genome sequencing, with a pairwise single-nucleotide polymorphism (Hamming distance) cutoff of 60 core genome single-nucleotide polymorphisms used to define recent transmission clusters (clades) for the 3 major clones., Results: MRSA prevalence was significantly higher in intermediate-term (29.9%) and long-term (20.4%) care facilities than in the ACH (11.8%) (P < .001). The predominant clones were sequence type [ST] 22 (n = 183; 47.8%), ST45 (n = 129; 33.7%), and ST239 (n = 26; 6.8%), with greater diversity of STs in ILTCFs relative to the ACH. A large proportion of the clades in ST22 (14 of 21 clades; 67%) and ST45 (7 of 13; 54%) included inpatients from the ACH and ILTCFs. The most frequent source of the interfacility transmissions was the ACH (n = 28 transmission events; 36.4%)., Conclusions: MRSA transmission dynamics between the ACH and ILTCFs were complex. The greater diversity of STs in ILTCFs suggests that the ecosystem in such settings might be more conducive for intrafacility transmission events. ST22 and ST45 have successfully established themselves in ILTCFs. The importance of interconnected infection prevention and control measures and strategies cannot be overemphasized., (© The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.)

The agreement of practicing psychiatrists with medication experts regarding how psychotropic drugs should be used to treat behavioral and psychiatric problems in patients with mental retardation was studied. The medication survey used in developing guidelines on the treatment of behavioral and psychiatric problems in mental retardation was sent to 85 psychiatrists who had been identified as caring for the mentally retarded in the Texas public mental health system. The comparison of these practitioners with the medication experts included first-line and second-line treatment choices. Survey analysis was based on using 95% confidence intervals (CIs) to determine the type of rating. If the 95% CIs for the practitioners' responses overlapped the 95% CIs for experts, the two groups were judged to be in agreement. Thirty-seven practitioners (43.5%) completed and returned the survey. Few differences between the practitioners and the medication experts were found with respect to treatments for specific mental illness diagnoses. However, the practitioners rated venlafaxine and mirtazapine higher than the medication experts. Lithium augmentation of therapy with selective serotonin-reuptake inhibitors for nonpsychotic depression was rated first-line by the practitioners and second-line by the medication experts. Practicing psychiatrists and medication experts generally agreed about the use of psychotropic drugs for mental illness in patients with mental retardation.

Unlike the general U.S. population, which has more than 19,000 nursing facilities available, American Indian communities on reservations have few skilled- and intermediate-care facilities. Also, little research has been done with this population. This article describes qualitative research conducted at a Navajo Nation nursing home in Chinle, Arizona. Events and circumstances resulting in nursing home placement are discussed and illustrated with case vignettes. An overview of Navajo history and traditions provides a context to identify culturally sensitive care principles and practices. Discussion stresses the importance of acknowledging and acting on the significance of culture in all aspects of social work practice.

The clinical features, microbiological characteristics, and outcomes of 163 episodes of bacteremia occurring at a long-term-care facility were evaluated. The rate of nosocomial bacteremia increased from 0.20 to 0.36 cases/1,000 patient-days from 1985 to 1989; there was a parallel increase in the rate of all nosocomial infections combined. Bacteremia was documented in 6.5% of all hospital-acquired infections. The majority of isolates were gram-negative, and Providencia stuartii was the most common gram-negative species. Staphylococcus aureus was the most frequent isolate; one-third of S. aureus strains were resistant to methicillin. Bacteremia was polymicrobial in 36 episodes (22%), 14 of which involved an enterococcal species. Portals of entry included the urinary tract (55%), the respiratory tract (11%), and soft tissue (9%). Overall mortality was 21.5%. Death was significantly associated with residence on the intermediate-care unit, the presence of a respiratory infection, a change in mental status, and relatively recent admission. Optimal management of bacterial infection in a long-term-care setting requires the availability of blood culture results. Initial decisions about antibiotic therapy should be made in light of the likelihood of infection with multiresistant organisms and of polymicrobial infection.

The purpose of this study was to determine whether persons at various age levels in an institutionalized elderly population vary significantly in their musical aptitudes as indicated by their scores on the Primary Measures of Music Audiation test. (Gordon, 1979). Age was not related to either tonal subtest, rhythm subtest, or composite test scores. In addition, this study attempted to determine which of the following variables were related to or predictive of PMMA scores: (a) musical experience and training, along with current musical activity levels; (b) frequency of music listening; (c) general morale; (d) sex; (e) care home classification; (f) location of the care home; (g) duration of institutionalization; and (h) location for the majority of one's life. No attribute variables were found to be related to PMMA scores. This result differs from that found in a study of variables related to Musical Aptitude Profile (Gordon, 1965) scores in noninstitutionalized, Caucasian, elderly female subjects (Gibbons, Note 1).

The authors conducted a prospective six-month study of colonization by gentamicin-resistant Pseudomonas aeruginosa on an intermediate care unit at a Cleveland, Ohio hospital with the use of selective culture techniques, serotyping, and plasmid analysis. Thirty-five of 163 patients (21%) were culture positive at least once for gentamicin-resistant Pseudomonas aeruginosa. Patient samples, environmental cultures, and personnel hand cultures revealed no common source for the organisms. Plasmid profiling added little to the serotyping data. Only nonambulation and length of stay on the unit were significant independent risk factors for colonization with gentamicin-resistant Pseudomonas aeruginosa by multiple logistic regression analysis. Age, use of urinary catheters, exposure to antibiotics, and duration of antibiotic use were correlated with one or both of the independent risk factors, but were not themselves independently associated with colonization by these resistant organisms. Cross-colonization apparently was not an important mode of dissemination of gentamicin-resistant Pseudomonas aeruginosa on this intermediate care unit. The identified risk factors appear to be more important than cross-colonization, and control strategies should address these issues.