Nicole Brandt

Prevalence of Potentially Inappropriate Medication Use in Older Adults Using the 2012 Beers Criteria

To use the most recently available population‐based data to estimate potentially inappropriate medication (PIM) prevalence under the 2012 update of the Beers list of PIMs and to provide a benchmark from which to measure future changes.

American geriatrics society identifies another five things that healthcare providers and patients should question

Since 2012, the American Geriatrics Society (AGS) has also been collaborating with the American Board of Internal Medicine (ABIM) Foundation, joining its “Choosing Wisely” campaign on two separate lists of Five Things Healthcare Providers and Patients Should Question. The campaign is designed to engage healthcare organizations and professionals, individuals, and family caregivers in discussions about the safety and appropriateness of medical tests, medications, and procedures. Participating healthcare providers are asked to identify five things—tests, medications, or procedures—that appear to harm rather than help. Providers then share this information in a published article about these things on the ABIM campaigns website (www.choosingwisely.org). The first AGS list was published in February 2013.

A review of educational outcomes in the children's mental health treatment literature

We examined the measurement of educational outcomes related to childrens mental health treatments. A total of 85 papers describing 88 randomized controlled trials that included at least one educational outcome and one mental health outcome were included in these analyses. Forty-five different measures were identified as the primary educational outcome of interest in these studies. Educational measures reflected academic achievement (64.2%), academic and behavioural skills (20.1%), attendance (11.2%), quality of the learning environment (3.4%) and academic self-efficacy (1.1%). Positive educational outcomes were demonstrated by treatments delivered in school and non-school settings. There was a significant association between improvement on educational and mental health outcomes. Within the literature of childrens mental health treatments, few studies (14.86%) measure educational outcomes. Of those that do, there is significant diversity in measurement methods. Nevertheless, these results offer promise that mental health treatments can succeed in improving both mental health symptoms and educational performance.

Algorithm for Identifying Nursing Home Days Using Medicare Claims and Minimum Data Set Assessment Data.

Background:No consensus exists about methods of measuring nursing home (NH) length-of-stay for Medicare beneficiaries to identify long-stay and short-stay NH residents. Objectives:To develop an algorithm measuring NH days of stay to differentiate between residents with long and short stay (≥101 and <101 consecutive days, respectively) and to compare the algorithm with Minimum Data Set (MDS) alone and Medicare claims data. Research Design:We linked 2006–2009 MDS assessments to Medicare Part A skilled nursing facility (SNF) data. This algorithm determined the daily NH stay evidence by MDS and SNF dates. NH length-of-stay and characteristics were reported in the total, long-stay, and short-stay residents. Long-stay residents identified by the algorithm were compared with the NH evidence from MDS-alone and Medicare parts A and B data. Results:Of 276,844 residents identified by our algorithm, 40.8% were long stay. Long-stay versus short-stay residents tended to be older, male, white, unmarried, low-income subsidy recipients, have multiple comorbidities, and have higher mortality but have fewer hospitalizations and SNF services. Higher proportions of long-stay and short-stay residents identified by the MDS/SNF algorithm were classified in the same group using MDS-only (98.9% and 100%, respectively), compared with the parts A and B data (95.0% and 67.1%, respectively). NH length-of-stay was similar between MDS/SNF and MDS-only long-stay residents (mean±SD: 717±422 vs. 720±441 d), but the lengths were longer compared with the parts A and B data (approximately 474±393 d). Conclusions:Our MDS/SNF algorithm allows the differentiation of long-stay and short-stay residents, resulting in an NH group more precise than using Medicare claims data only.

Program and Practice Elements for Placement Prevention: A Review of Interventions and Their Effectiveness in Promoting Home-Based Care

Preventing unnecessary out-of-home placement for youth with behavioral and emotional needs is a goal of several public child-serving services, including child welfare, juvenile justice, and child mental health. Although a small number of manualized interventions have been created to promote family driven and community-based services and have empirical support, other less established programs have been initiated by local jurisdictions to prevent out-of-home placement. To synthesize what is known about efforts to prevent placement, this article describes the common program and practice elements of interventions described in 37 studies (published in 51 articles) that measured placement prevention outcomes for youth at risk for out-of-home care because of behavioral or mental health needs. The most common program elements across published interventions were program monitoring, case management, and accessibility promotion. The most common clinical practice elements for working with youth were assessment and individual therapy; for caregivers, problem solving skills were most frequently included; and family therapy was most common for the family unit. Effect size estimates for placement-related outcomes (decreased out-of-home placement, decreased hospitalization, decreased incarceration, and decreased costs) were calculated to estimate the treatment effectiveness of the interventions in which the program components and clinical practices are embedded.

Quality of Psychopharmacological Medication Prescribing and Mortality in Medicare Beneficiaries in Nursing Homes

To examine the influence of quality measures of psychopharmacological medication (PPM) prescribing on all‐cause mortality in a Medicare long‐stay nursing home (NH) population.

Funding Expanded School Mental Health Programs

Mental health services for students across the developmental spectrum are often limited and difficult to access (National Scientific Council on the Developing Child, 2008). For example, about 70 % of school-aged children and adolescents with a mental health disorder do not receive treatment (Greenberg et al., 2003). Because education in the USA is an entitlement for all children, schools have been identified by the federal government as a natural setting and best site to provide mental health treatment and prevention services due to the large number of children and adolescents who can be reached in a school location (Anglin, 2003). In recognition of the value of providing services directly where students are, over the past 20 years, policies and programs that integrate mental health services into schools have flourished, and research continues to demonstrate their positive impacts on educational and mental health outcomes of students. The Surgeon General’s report on Children’s Mental Health (US Department of Health and Human Services, 2000) and the President’s New Freedom Commission on Mental Health (New Freedom Commission on Mental Health, 2003) while identifying schools as a major setting for providing mental healthcare utilization children and adolescents did not address funding issues related to how to finance these recommended services. Developing and sustaining funding streams to support the delivery of school mental health services and prevention programs continues to be an obstacle at local, state, and national levels (Evans et al., 2003).

Medications and Dysphagia: How Do They Impact Each Other?

Gastroesophageal reflux disease (GERD) is a motility disorder that occurs more frequently in children with neurological disease and in children with congenital esophageal anomalies or diaphragmatic hernia. Feeding difficulties and asthma may be caused by GER. Pharmacological and surgical treatment are successful in most cases. The authors describe 6 children with severe GER and asthma, who were treated with long-term jejunostomy feeding. Median length of treatment was 6 months (range, 5–12), for a total of 44 months. The parents were trained to replace dislodged jejunostomy tubes. All replacements of tubes at home by the parents were successfully carried out. Vomiting and emergency admissions for asthma were decreased in all children.

Fall and Fracture Risk in Nursing Home Residents With Moderate-to-Severe Behavioral Symptoms of Alzheimer’s Disease and Related Dementias Initiating Antidepressants or Antipsychotics

Background Both antidepressants and antipsychotics are used in older adults with behavioral symptoms of Alzheimers disease and related dementias. Despite the prevalent use of these agents, little is known about their comparative risks for falls and fractures. Methods Using 2007-2009 Medicare claims data linked to Minimum Data Set 2.0, we identified new users of antidepressants and antipsychotics among nursing home residents with Alzheimers disease and related dementias who had moderate-to-severe behavioral symptoms. Separate discrete-time survival models were used to estimate risks of falls, fractures, and a composite of both among antidepressant group versus antipsychotic group. Results Compared to antipsychotic users, antidepressant users experienced significantly higher risk for fractures (adjusted hazard ratio = 1.35, 95% confidence interval = 1.10-1.66). The overall risk of falls or fractures remained significant in the antidepressant versus antipsychotic group (adjusted hazard ratio = 1.16, 95% confidence interval = 1.02-1.32). Conclusions Antidepressants are associated with higher fall and fracture risk compared to antipsychotics in the management of older adults with Alzheimers disease and related dementias who experience moderate-to-severe behavioral symptoms. Clinicians need to assess the ongoing risks/benefits of antidepressants for these symptoms especially in light of the increasingly prevalent use of these agents.

Key priorities, challenges and opportunities to advance an integrated mental health and education research agenda

A critical priority for the fields of education and mental health is to develop an integrated research agenda to advance empirical and practical progress towards the goal of reducing a significant research to practice gap. This study presents qualitative findings from an intensive dialogue meeting held with a multidisciplinary sample of 35 leaders in education, childrens mental health and related fields. Comprehensive data from the meeting by three independent notetakers were analysed and integrated to fully capture the discussion of research priorities for education and mental health. Synthesized content represented the three categories of key priorities, challenges and opportunities towards an integrated mental health and education research agenda. Themes identified by qualitative analysis of the notes, as well as suggestions, current progress and future directions for reducing the research-to-practice gap, are described.