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Purpose: Motivating and enabling formal caregivers to provide individualized resident care has become an increasingly important objective in long-term care (LTC) facilities. The current study set out to examine the structure of responses to the individualized care inventory (ICI). Design and Methods: Samples of 242 registered nurses (RNs)/ licensed practical nurses (LPNs) and 326 care aides were recruited from 54 LTC facilities in 3 of 5 British Columbia health authorities. Baseline confirmatory factor analytic (CFA) models were computed separately for RNs/LPNs and care aides; invariance analyses were next undertaken to compare these CFA models. Results: For both RNs/LPNs and care aides, support was found for a 4-factor model of ICI responses mapping onto a higher order individualized care (IC) construct. This model was largely equivalent between formal caregiver groups, although the relative contribution of certain first-order factors differed between the two. Of further note, both groups appear to interpret and respond to 31 of 35 ICI items in a similar manner. Implications: The results of this study provide further sup port for the psychometric properties of ICI responses. Although further research is required, the ICI appears to be an appropriate self-report measure. This instrument may be used by researchers, policymakers, administrators, and practitioners alike to assess strengths as well as areas for improving the delivery of IC to LTC residents by formal caregivers. Key Words: Dementia care, Formal caregivers, Individualized care, Long-term care, Scale reliability, Scale validation doi: 10.1093/geront/gnp053

Primary care is increasingly geared toward standardized care and decision-making for common chronic conditions, combinations of medical and mental health conditions, and the behavioral aspects of care for those conditions. [...]

This article describes a residency educational process that considers the reciprocal impact doctors and patients have on each other, using a modified "MegaClinic" conference model. Specific description of the 1-hr, [...]

For older adults, acute-care hospital stays can result in functional decline that leads to increased risk of hospitalization, nursing home admission, or mortality. This study describes functional trajectories in hospitalized older adults and identifies risk factors associated with those trajectories. Respondents (N = 45) exhibited five of six possible functional trajectory patterns. The largest change in functional status was a decline in activities of daily living (ADL) from baseline at 2 weeks before admission to the time of admission; ADL did not return to baseline during the first 4 days in the hospital. Depression scores were significantly higher in respondents who reported experiencing ADL decline before admission. Respondents whose ADL scores declined during hospitalization (regardless of baseline status) were more likely than others to die within 3 months of discharge. Functional trajectory in hospitalized elderly patients is an important and underappreciated prognostic concept requiring further attention. Keywords: aging: hospitals; functional status; patient assessment: veterans

OBJECTIVE: To determine whether cellular telephones used in a normal way would cause interference with medical devices located in patient care areas of hospitals. METHODS: Two cellular telephones from different [...]

Background. Disease-specific beliefs may impact patients' perceptions of the efficacy of various treatment options, thus, it is important to understand these beliefs. We examined the relationship between patients' demographic characteristics and arthritis-specific beliefs related to aging. Methods. We performed a cross-sectional survey of 591 elderly primary care patients, who had symptomatic osteoarthritis (OA) of the knee and/or hip, at the Louis Stokes VA Medical Center in Cleveland, Ohio. Data were collected on age, race, educational level, income, and whether patients agreed or disagreed with four statements regarding aging and arthritis. We also assessed OA symptom severity using the Western Ontario McMaster Universities Index (WOMAC) and depressive symptoms using the Geriatric Depression Scale, We used logistic regression analyses to examine relationships between patients' age, race, and educational level and arthritis-specific health beliefs, while adjusting for OA symptom severity, radiographic confirmation of OA, OA joint burden, depressive symptoms, and income. Results. Patients 70 years old or older, as compared to patients 50-59 years old, were more likely to believe that: arthritis is a natural part of growing old; people should expect that when they get older, they won't be able to walk as well, and people should expect to live with pain as they grow older. Conclusion. Among older, male veterans, health beliefs regarding the relationship between aging and arthritis vary by age. Clinicians should consider these differences when discussing treatment strategies with their patients with knee and/or hip OA.

Objectives. We examined time trends of hospitalization, a main outcome measure in health care, in the diabetic and nondiabetic populations in Germany and their associations with sociodemographic variables. Methods. Using data from 2 national health surveys, we estimated hospital days per person-year in the diabetic and nondiabetic populations in 1998 (n = 5422) and 1990-1992 (n=7363) in Germany. We used Poisson regression to estimate relative risks and interaction of secular time with age, gender, and educational level, considering the cluster sample design of the study. Results. Hospital days per person-year decreased between 1990-1992 and 1998--from 3.59 (95% confidence interval [CI]=2.59, 4.97) to 3.14 (95% CI=2.16, 4.56) for the diabetic population and from 1.38 (95% CI = 1.23, 1.55) to 1.33 (95% CI = 1.17, 1.51) for the nondiabetic population--but the decrease was not statistically significant. In the diabetic population, the decrease tended to be more pronounced (interaction year x time not significant; P=.756). Also, there was a notable decrease in men and in the group aged 25 to 39 years, and a decrease in both high- and low-educational-level subjects. Conclusions. There seems to have been a larger decrease in hospitalization in the diabetic population than in the nondiabetic population in Germany. An increase in social disparity in this health outcome measure in the diabetic population could not be confirmed. doi:10.2105/AJ PH. 2005.063339

Classifying patients as 'active' or 'passive' with regard to healthcare decision making is misleading, since patients have different desires for different components of the decision-making process. Distinguishing patient' desired roles is an essential step towards promoting care that respects and responds to individual patients' preferences. We included items on the 2004 Wisconsin Longitudinal Study mail survey measuring preferences for four components of the decision-making process: physician knowledge of patient medical history, physician disclosure of treatment choices, discussion of treatment choices, and selection of treatment choice. We characterized preference types for 5199 older adults using cluster analysis. Ninety-six percent of respondents are represented by four preference types, all of which prefer maximal information exchange with physicians. Fifty-seven percent of respondents wanted to retain personal control over important medical decisions ('autonomists'). Among the autonomists, 81% preferred to discuss treatment choices with their physician. Thirty-nine percent of respondents wanted their physician to make important medical decisions ('delegators'). Among the delegators, 41% preferred to discuss treatment choices. Female gender, higher educational attainment, better self-rated health, fewer prescription medications, and having a shorter duration at a usual place of care predicted a significantly higher probability of the most active involvement in discussing and selecting treatment choices. The overwhelming majority of Older adults want to be given treatment options and have their physician know everything about their medical history; however, there are substantial differences in how they want to be involved in discussing and selecting treatments. Keywords: US; Decision making; Patient preferences; Communication; Survey research; Cluster analysis

Irritable bowel syndrome (IBS) is a functional gastrointestinal illness, characterized by potentially debilitating symptoms without pathologic findings, often associated with psychological conditions. Little is known about the psychosocial aspects of this condition on an international scale. A total of 239 patients in eight countries were given a series of psychological and medical questionnaires, including IBS activity, relationships with significant others, beliefs regarding the etiology of symptoms, and assessment of quality of life. There were highly significant associations between IBS severity and all other measures. Symptoms were worse if relationship conflict was high and if attributions about illness were physiological rather than psychological. Symptoms were less severe if relationship depth and support were high, and illness was viewed as psychological. Implications for treatment are discussed. Keywords: Irritable bowel syndrome; Family dynamics; Cross-cultural; Mind-body

Introduction In dementia care the concept of person-centred care (Kitwood, 1997) is accepted by many as representing what constitutes 'good practice'. Research in dementia care is often concerned with person-centred [...]

Objective. Although privately owned practices provide the majority of primary care for children, little is known about the organizational characteristics of these practices or how these characteristics affect the quality of care for children. The purpose of this study was to describe selected organizational characteristics and preventive service delivery features that might affect the quality of primary care for children in private practices. Methods. A cross-sectional study of 44 private pediatric and family medicine practices in 2 regions of North Carolina was performed. Preventive service performance was assessed through chart abstraction for 60 randomly selected children between 24 and 30 months of age, for evaluation of immunizations and anemia, tuberculosis, and lead screening delivery by 2 years of age. Organizational characteristics were determined through surveys of all physicians and staff members. We used descriptive statistics and scatter plots to describe variations in organizational characteristics and preventive services. Results. Overall, practices demonstrated low levels of preventive service performance, with substantial variation among practices. Only 39% of children received 3 of the 4 recommended preventive services measured (practice range: 2-88%). Few practices demonstrated evidence of a systematic approach to prevention. For example, only 12 (27%) of the 44 practices used >1 of 5 recommended preventive service delivery strategies. Furthermore, practices varied greatly with respect to many of the measured organizational characteristics, which were consistent with organizational stress in some cases. For example, turnover of clinicians and staff members was remarkably high, with practices losing an average of 27% of their clinicians every 4 years (range: 0-170%) and 39% of their office staff members every 2 years (range: 0-170%). Conclusions. Private practices caring for children in North Carolina demonstrated low overall performance for the 4 recommended preventive services examined, with large variations among practices. Few practices had evidence of comprehensive systems for prevention. There was also evidence of substantial variation in many organizational characteristics. Some organizational characteristics were at levels that might impede delivery of high-quality primary care for children. These findings suggest a growing need for research that examines the impact of organizational characteristics on the quality of care in private practices. Pediatrics 2005;115:1704-1711; private practices, preventive services, organizational management. ABBREVIATIONS. FTE, full-time equivalent; RCT, randomized, controlled trial; OSI, Office Systems Index., In a recent report on health care quality, the Institute of Medicine recommended fundamental change in the US health care system, citing remarkable variation as well as shortcomings in many [...]

In this era of shared doctor-patient decision-making, clicking and incorporating patients' treatment choices is essential to ensure all patients receive the treatment that is right for them. Clinicians and researchers should fully understand the many factors that influence and guide patients in their preferences for treatment. One of these influences is an individual's general risk propensity or willingness to take risks, yet there is little in the literature about methods for measuring risk propensity. A systematic review was undertaken to identify instruments that measure risk propensity and to appraise their validity and relevance for a clinical setting. Of 3546 articles, 139 were potentially relevant. From these, 14 instruments were identified. Eight measured risk propensity, whereas six measured personality traits associated with risk propensity. Most instruments demonstrated good internal reliability but their appropriateness for patients, particularly older adults, remains unclear. While no instrument was specific to or tested in a clinical setting, instruments that directly measured risk propensity were considered to be the most useful for clinical populations. The further adaptation and validation of these instruments among older adults are important avenues for future research. Keywords. Risk propensity; Patient preferences; Systematic review

The effectiveness of an overheard ceiling lift programme at reducing the risk of injury from resident handling was evaluated by comparing injury data and staff perceptions before and after implementation of the programme. A significant reduction was observed in the perceived risk of injury and discomfort to the neck, shoulders, back, hands, and arms of care staff.

The study aims to address whether studies of care rendered to patients prior to their death produce an accurate portrait of care provided to patients who are dying. It concluded that studying care received prior to death could lead to invalid conclusions about the quality or type of care provided to dying patients.

The changes in Length of Stay (LOS), functional status, living setting, and mortality in patients completing inpatient rehabilitation is examined. The findings provide a baseline to compare future LOS, effectiveness, efficiency, mortality, and other outcomes important to health care professionals, researchers, and consumers to help evaluate the reasons behind change in LOS influences patient care and outcomes.

Byline: Alexander Karmann (1), Gunnar Dittrich (1), Jochen Vaillant (2) Keywords: Patient hospital careers; Inpatient sector; Intrasectoral integration; Health care density; Hospital planning Abstract: This study focuses on the question of to what extent patient hospital careers take place in a coordinated way. So, nearly 60,000 hospitalizations with a diagnosis within the same diagnosis spectrum were analysed. The hospitalizations took place in a large regional area within Saxony, Germany. The patient catchment areas were hierarchically ordered (rural/urban) so that a representative sample of all hospitals was obtained. We conclude that in general there is a high degree of intrasectoral coordination in the acute inpatient sector. This applies especially for regions that are near a hospital of a higher care level. Observable problems in the process reflect a weak structure of outpatient care, problems related to rural areas, strategic incentives to pass on cost-intensive cases, or existing informal networks. Author Affiliation: (1) Faculty of Business Management and Economics, Dresden University of Technology, 01062, Dresden, Germany (2) German Hospital Federation, Wegelystrasse 6, 10623, Berlin, Germany Article History: Registration Date: 15/07/2004 Received Date: 15/01/2004 Accepted Date: 04/06/2004 Online Date: 14/08/2004

Purpose: Although persons with Alzheimer's disease (AD) require increasingly more assistance with activities of daily living as their disease progresses, the caregiving environment has received little attention as a source of predictors of their survival time. We report here on a study to determine whether variation in survival time of persons with AD can be better explained by including caregiver variables such as coping style and depressive symptoms as predictors. Design and Methods: A sample of 193 persons with AD residing in the community and their family caregivers was used to estimate the parameters of a Cox regression model of survival time that included both caregiver characteristics and care-recipient impairments as covariates. Results: Caregiver wishfulness-intrapsychic coping was related to shorter care-recipient survival time, but instrumental and acceptance coping and caregiver depressive symptoms were not associated with survival time. Care-recipient impairments (dependency in activities of daily living, low score on the Mini-Mental State Examination, and problematic behaviors) were associated with shorter survival time. Implications: Because this study is the first to report the link between caregiver coping and care-recipient survival, further study to understand the dynamics is required. We discuss several possible mechanisms, including the possibility that caregivers engaging in wishfulness-intrapsychic coping are less psychologically available to the person with dementia. These caregivers may therefore provide less person-centered care that is responsive to the true capacities of the person with dementia, and thus they may inadvertently contribute to excess disability and consequent accelerated decline. Because wishfulness-intrapsychic coping was uncorrelated with instrumental or acceptance coping, our findings suggest that interventions to enhance coping skills among caregivers, which have focused primarily on increasing problem solving and acceptance coping, also may have to include specific attempts to reduce wishfulness-intrapsychic approaches to benefit not only the caregiver but the care recipient as well. Key Words: Dementia, Depression, Cox regression, Coping, Family caregiving

Byline: Fulop Scheibler (1,2), Dominique Freise (1), Holger Pfaff (1) Keywords: Shared decision-making; Partnerschaftliche Entscheidungsfindung; Perceived involvement in care; Wahrgenommene Einbeziehung in die Behandlungsentscheidungen; Attitude to Health; Patient Participation; Physician-Patient Relations; Shared decision-making; Perceived Involvement in Care Abstract (German): Die partnerschaftliche Einbeziehung von Patienten in Diagnoseerstellung und Behandlungsentscheidungen gewinnt auch in Deutschland zunehmend an Bedeutung. Unter dem Begriff Shared decision-making konnte in zahlreichen internationalen Studien gezeigt werden, dass Patienten, die sich in ihre Behandlung einbezogen fuhlen, zufriedener sind und bessere Ergebnisse erzielen, als jene, die lediglich passiv die Anweisungen des medizinischen Personals befolgen. Fur den deutschsprachigen Raum existiert derzeit noch kein validiertes Messinstrument, um das Konzept des Shared decision-making adaquat zu erfassen. Ziel vorliegender Studie war es daher, ein amerikanisches Instrument zu ubersetzen und anhand einer deutschen Stichprobe zu validieren. Die aperceived involvement in care scales' (PICS) messen die wahrgenommene Einbeziehung von Patienten in die Therapie. Die drei Subskalen der deutschen PICS-Version erfassen die aPatientenaktivierung durch die Arzte' (PAA), das aaktive Informationsverhalten des Patienten' (AIP) und die aEntscheidungsteilnahme des Patienten' (ETP) aus dessen subjektiver Perspektive. Die auf den Daten einer reprasentativen Befragung von 230 Patienten des Universitatsklinikums zu Koln (131 Manner und 97 Frauen) im Alter von 19 bis 89 Jahren basierende teststatistische Uberprufung zeigt, dass die deutschen PICS reliable, valide und okonomisch einsetzbare Erhebungsinstrumente darstellen. Lediglich die Plausibilitatstests der dritten Subskala lieferten mit unseren Erwartungen inkonsistente Ergebnisse, die wahrscheinlich auf kulturelle Unterschiede zwischen der Arzt-Patienten-Interaktion in den USA und in Deutschland zuruckzufuhren sind. Die Entscheidungsteilnahme des Patienten-Skala wurde daher in einer veranderten Fassung an einer Stichprobe von 720 Patienten aus vier Krankenhausern erneut getestet und erwies sich in dieser Untersuchung ebenfalls als valide. Die mit den PICS erfasste awahrgenommene Einbeziehung' erweist sich als weitestgehend unabhangig von soziodemographischen, soziookonomischen oder krankheitsspezifischen Variablen. Abstract: Patients as partners in diagnostic and treatment decisions are recently gaining importance in Germany. Several international studies on shared decision making have shown positive effects of perceived involvement in care on patient satisfaction and other important outcomes. As no valid measuring-instrument exists for the German-language yet the aim of this study was to translate an American instrument and validate it on the base of a German sample. The German 'Perceived Involvement in Care Scales' (PICS) examine three relatively distinct factors: doctor facilitation of patient involvement, level of information exchange and patient participation in decision making. The questionnaire was sent to a sample of in-house patients of the University Hospital of Cologne. The 230 returned questionnaires have been filled out by 131 men and 97 women in an age-range between 19 and 89 years. The statistical analyses proved the German PICS to be reliable, valid and effectively applicable instruments. Only the tests of plausibility for the third subscale produced results that were not consistent with our expectations. These results are probably due to cultural differences between the patient-physician-interaction in the USA and Germany. The patient-decision-making-subscale was therefore modified and tested on the base of a sample of 720 patients of four hospitals. The results indicate validity of this instrument. We did not find any correlation between perceived involvement and socio-demographic, socio-economic or illness-specific variables, in our data. Author Affiliation: (1) Universitat Koln, Institut und Poliklinik fur Arbeits- und Sozialmedizin, Abt. Medizinische Soziologie (2) Abteilung Medizinische Soziologie, Institut und Poliklinik fur Arbeits- und Sozialmedizin der Universitat zu Koln, Eupener Strasse 129, 50933 , Koln Article History: Registration Date: 04/03/2004 Received Date: 03/03/2003 Accepted Date: 14/07/2003 Online Date: 28/04/2004