Lisa Tamres

Assessing Fidelity to an Intervention in a Randomized Controlled Trial to Improve Medication Adherence

Background:Behavioral intervention effectiveness in randomized controlled trials requires fidelity to the protocol. Fidelity assessment tools tailored to the intervention may strengthen intervention research. Objective:The aim of this study was to describe the assessment of fidelity to the structured intervention protocol in an examination of a nurse-delivered telephone intervention designed to improve medication adherence. Methods:Fidelity assessment included random selection and review of approximately 10% of the audiorecorded intervention sessions, stratified by interventionist and intervention session. Audiotapes were reviewed along with field notes for percentage of agreement, addressing whether key components were covered during the sessions. Visual analog scales were used to provide summary scores (0 = low to 5 = high) of interaction characteristics of the interventionists and participants with respect to engagement, demeanor, listening skills, attentiveness, and openness. Results:Four nurse interventionists delivered 871 structured intervention sessions to 113 participants. Three trained graduate student researchers assessed 131 intervention sessions. The mean percentage of agreement was 92.0% (±10.5%), meeting the criteria of 90% congruence with the intervention protocol. The mean interventionist interaction summary score was 4.5 ± 0.4, and the mean participant interaction summary score was 4.5 ± 0.4. Discussion:Overall, the interventionists successfully delivered the structured intervention content, with some variability in both the percentage of agreement and quality of interaction scores. Ongoing assessment aids in ensuring fidelity to study protocol and having reliable study results.

Characterizing Caregiver Mediated Medication Management in Patients with Memory Loss

Increasingly, family members are assisting with the complex task of medication management when patients are experiencing cognitive decline. To date, limited published research addresses caregiver-mediated medication management of patients with impaired cognition. Thus, the purpose of this study was to describe the characteristics and correlates of caregiver-mediated medication management in community-dwelling patients with memory loss. We used baseline data from the 91 patient-caregiver dyads participating in a randomized controlled trial designed to assist caregivers of patients with memory loss with medication management. The patients level of cognitive impairment was not related to medication errors; however, the number of medications that patients were prescribed and taking was related to medication errors. Important factors to consider when discussing medication management with caregivers of patients with memory loss include the caregivers age, cognitive ability, and depressive symptoms, as well as the caregivers perception of the impact of the patients behavioral problems.

Assessing usual care in clinical trials.

Researchers designing clinical trials often specify usual care received by participants as the control condition expecting that all participants receive usual care regardless of group assignment. The assumption is that the groups in the study are affected similarly. We describe the assessment of usual care within the 16 studies in Multisite Adherence Collaboration in HIV (MACH 14), a multisite collaboration on adherence to antiretroviral therapy. Only five of the studies in MACH 14 assessed usual care. Assessment protocols varied as did the timing and frequency of assessments. All usual care assessments addressed patient education focused on HIV, HIV medications, and medication adherence. Our findings support earlier work that calls for systematic assessments of usual care within the study design, inclusion of descriptions of usual care in reports of the study, and the influence of usual care on the experimental condition in clinical trials.

Stressors and Caregivers' Depression: Multiple Mediators of Self-Efficacy, Social Support, and Problem-Solving Skill.

Caring for an older adult with memory loss is stressful. Caregiver stress could produce negative outcomes such as depression. Previous research is limited in examining multiple intermediate pathways from caregiver stress to depressive symptoms. This study addresses this limitation by examining the role of self-efficacy, social support, and problem solving in mediating the relationships between caregiver stressors and depressive symptoms. Using a sample of 91 family caregivers, we tested simultaneously multiple mediators between caregiver stressors and depression. Results indicate that self-efficacy mediated the pathway from daily hassles to depression. Findings point to the importance of improving self-efficacy in psychosocial interventions for caregivers of older adults with memory loss.

An intervention to maximize medication management by caregivers of persons with memory loss: Intervention overview and two-month outcomes

Overseeing medication-taking is a critical aspect of dementia caregiving. This trial examined a tailored, problem-solving intervention designed to maximize medication management practices among caregivers of persons with memory loss. Eighty-three community-dwelling dyads (patient + informal caregiver) with a baseline average of 3 medication deficiencies participated. Home- and telephone-based sessions were delivered by nurse or social worker interventionists and addressed basics of managing medications, plus tailored problem solving for specific challenges. The outcome of medication management practices was assessed using the Medication Management Instrument for Deficiencies in the Elderly (MedMaIDE) and an investigator-developed Medication Deficiency Checklist (MDC). Linear mixed modeling showed both the intervention and usual care groups had fewer medication management problems as measured by the MedMaIDE (F = 6.91, p < .01) and MDC (F = 9.72, p < .01) at 2 months post-intervention. Reduced medication deficiencies in both groups suggests that when nurses or social workers merely raise awareness of the importance of medication adherence, there may be benefit.

THE ASSOCIATION BETWEEN COPING STYLES AND MOOD IN PERSONS WITH MILD COGNITIVE IMPAIRMENT AND THEIR CARE PARTNERS: A DYADIC ANALYSIS

(TMS) scores, 4 which measures negative emotions (depression, anger, fatigue, tension, and confusion) and positive emotions (vitality). After creating the caregiving map, the participants described on the self-administered questionnaire what they noticed with caregiving emotions, caregiving environments, and the tasks to be resolved earliest. These data were extracted from both self-administered questionnaire and electronic medical records. Results:Of the 73 caregivers, 61 were female, and 32were in over 60s. The average number of caregiving years was 3.662.3, and the average age of the people with dementia (N1⁄473) was 75.269.5 years. The underlying diseases included AD (N1⁄450); the mean MMSE score was 18.565.6. The average time from the initial diagnosis of dementia was 3.864.3 years. The Japanese version of the Zarit Caregiver Burden Interview (ZBI) sore was 32.667.2, and the Dementia Behavior Disturbance Scale (DBD) was 26.466.5. The five TMS scores (negative emotions of depression, anger, fatigue, and confusion and positive emotions of vitality) changed after lecture. The score of negative emotions was significantly reduced, and the score of positive emotion was significantly increased. As the effect of creating caregiving map and interaction through group work, the participants’ self-administered questionnaires, 42.0% of participants noticed self-awareness of non-isolation, 21.0% of them felt empathy with other caregivers as the effect of creation caregiving map and interaction. Conclusions: The creating of caregiving map and interaction enhanced emotion-focused coping skills of demented family caregivers.

Health literacy and its correlates in informal caregivers of adults with memory loss

ABSTRACT This secondary analysis examined health literacy among informal caregivers of community‐dwelling older adults with memory loss and assessed correlates of caregiver health literacy using the Abilities, Skills and Knowledge Model. Caregiver health literacy (n = 91) was assessed by the Newest Vital Sign. Limited health literacy presented in 38.5% caregivers, with significantly low document literacy. Health literacy was associated bivariately with age, education, global cognitive function, executive function, and working memory (all ps < 0.001), as well as medication knowledge (p = 0.015). Hierarchical regression analyses revealed that older age (p = 0.017), and lower global cognitive function (p < 0.001), working memory (p = 0.001), and academic skills (years of education) (p = 0.004), independently predicted lower health literacy (R2 = 0.54). Medication knowledge, however, was not found to be an independent predictor in the model. Findings suggest limited health literacy is a potential issue among informal caregivers of adults with memory loss. Appropriate assessment and personalized support are needed for informal caregivers who are at high risk for poor health literacy. HIGHLIGHTSLimited health literacy presented in more than one‐third of informal caregivers of older adults with memory loss.Caregiver cognitive abilities and academic skills (education years) independently predicted caregiver health literacy.Medication knowledge was associated with health literacy among informal caregivers engaged in patient medication management.

Medication reconciliation: A vital process to correct medication mismanagement

use mix. APOE ε4 carriers showed larger increases in ventricle volume and decreases in right-hippocampal volumes if living in neighborhoods with low street intersection density and land use mix, respectively. Significant increases in amyloid b burden were found only in APOE ε4 carriers from areas with below-average dwelling and intersection densities (Table 2). Conclusions: These preliminary findings indicate possible associations of urban environment characteristics with brain imaging measures, especially in those with a higher genetic risk. Further investigations are warranted.

The Pituitary Axis

Pituitary disease manifests itself with a variety of different signs and symptoms, any of which can be the impetus for the patient to seek help. Disease may come to attention because of growth retardation in youth, amenorrhea, visual disturbances, headache, other evidence of hormone deficiencies, or even emotional symptoms. Pituitary disease may be related to tumors of various types or to defects of hypothalamic stimulation. Because the pituitary is made up of different cell types, many of which are associated with the secretion of specific hormones, the types of diseases and related symptoms are dependent on how hypothalamic function is disrupted. In the case of a tumor, symptoms depend on the nature, location, and treatment of the mass.