Ralf Habermann

Delirium in the Nursing Home Patients Seen in the Emergency Department

OBJECTIVES: To determine whether nursing home patients are more likely than non‐nursing home patients to present to the emergency department (ED) with delirium and to explore how variations in their delirium risk factor profiles contribute to this relationship.

Pain reports and pain medication treatment in nursing home residents with and without dementia

The purpose of this pilot study was to determine if a diagnosis of dementia influenced pain self‐reports and pain medication use in a group of verbally communicative nursing home (NH) residents.

Prevalence of Constipation Symptoms in Fecally Incontinent Nursing Home Residents

OBJECTIVES: To determine the prevalence of constipation symptoms and the effects of a brief toileting assistance trial on constipation in a sample of fecally incontinent nursing home (NH) residents.

High-performance concanavalin A affinity chromatography of liver and hepatoma membrane proteins.

Although the separation of water-soluble glycoproteins by high-performance (HP) concanavalin A (ConA) affinity chromatography (AC) is feasible, irregularities may be encountered with hydrophobic glycoproteins. The separation of plasma membrane glycoproteins from liver and Morris hepatoma 7777, used as a model, showed that not only the interaction between the lectin and the oligosaccharide portion of the glycoproteins plays a role in the chromatographic process, but also the hydrophobic interactions between sample and lectin and between sample and support. In this, the characteristics of the support, such as surface hydrophobicity and pore size, play an important part. It was found that a portion of the ConA is not covalently bound to the column, especially when elution is carried out with buffers containing detergents. Moreover, some extremely hydrophobic proteins could only be eluted from the column when high concentrations of detergents [1% (w/v) or higher] were applied. Despite these difficulties, four membrane glycoproteins from the liver with apparent molecular weights of 60, 80, 100 and 110-120 kilodaltons could be highly enriched by ConA HPAC. These proteins were further fractionated according to their strength of binding to the ConA and their different hydrophobic characteristics, using various detergents as eluents.

Calcium-binding proteins 33 kDa, 35 kDa, and 65/67 kDa in normal rat and morris hepatoma tissues

SummaryPolyclonal antibodies were raised against membrane-associated calcium-binding proteins (apparent molecular masses 65000 and 67000 (CBP 65/67) and 33000 and 35000 (CBP 33 and CBP 35)), which were isolated from rat liver and Morris hepatoma. Using immunoblotting, various amounts of CBP 33 and CBP 35 as well as CBP 65/67 were detected in most rat organs. Using alkaline phosphatase and monoclonal-anti-alkaline phosphatase antibodies (APAAP), all the calcium-binding proteins were detected by immunohistochemical techniques in the plasma membranes of many cells, such as vascular endothelial cells, lymphocytes, epididymal principal cells, secretory and excretory duct cells of certain exocrine glands, straight distal tubular cells of the kidney, and in the cytoplasm of muscle cells and fibres as well as nerve cells and chondrocytes, and in connective tissue elements. Immunohistochemical analysis also showed that in polarized epithelial cells, e.g., renal tubular cells, epididymal principal cells or excretory duct cells, these calcium-binding proteins are present exclusively or mostly in the luminal plasma membrane.

Pneumococcal Vaccination in Nursing Homes: Does Policy Change Practice?

OBJECTIVE To describe the impact of a Tennessee Department of Health regulation amendment requiring that all nursing home residents 65 years of age or older demonstrate documentation of pneumococcal vaccination, or documented medical contraindication, or patient refusal. DESIGN Cross-sectional descriptive study of nursing homes using a mailed self-administered survey instrument. RESULTS Of 354 Tennessee nursing homes, 304 homes were targeted for the survey, after excluding hospital-based rehabilitation and skilled care facilities, and facilities with fewer than 50 beds. Pneumococcal immunization rates improved from 32% to 42% from 1998 to 1999, coincident with the new policy. Homes reporting high immunization rates (>/=75%) increased from 21% to 28%. These facilities were more likely to be larger (>100 beds) and urban; to have a computerized or chart-based vaccine record; to have a standing order policy; and high influenza immunization rates. Overall, only 23% of homes reported that the policy was helpful in increasing immunization rates, and only 38% of facilities reported an increase in rates of at least 5%. However, 58% of facilities that found the policy useful improved pneumococcal vaccination rates at least 5% compared with 32% that did not find it useful. No other factors were strongly associated with improved vaccine rates. CONCLUSION Pneumococcal immunization rates of at least 75% were associated with facility size, location, and record-keeping practices. Pneumococcal vaccination rates improved only modestly between 1998 and 1999, coincident with the health department amendment. Those who found the policy useful had the greatest improvement in rates.

Reducing Antipsychotic Medication Use in Nursing Homes: A Qualitative Study of Nursing Staff Perceptions

Background and Objectives The purpose of this study was to use qualitative methods to explore nursing home staff perceptions of antipsychotic medication use and identify both benefits and barriers to reducing inappropriate use from their perspective. Research Design and Methods Focus groups were conducted with a total of 29 staff in three community nursing homes that served both short and long-stay resident populations. Results The majority (69%) of the staff participants were licensed nurses. Participants expressed many potential benefits of antipsychotic medication reduction with four primary themes: (a) Improvement in quality of life, (b) Improvement in family satisfaction, (c) Reduction in falls, and (d) Improvement in the facility Quality Indicator score (regulatory compliance). Participants also highlighted important barriers they face when attempting to reduce or withdraw antipsychotic medications including: (a) Family resistance, (b) Potential for worsening or return of symptoms or behaviors, (c) Lack of effectiveness and/or lack of staff resources to consistently implement nonpharmacological management strategies, and (d) Risk aversion of staff and environmental safety concerns. Discussion and Implications Nursing home staff recognize the value of reducing antipsychotic medications; however, they also experience multiple barriers to reduction in routine clinical practice. Achievement of further reductions in antipsychotic medication use will require significant additional efforts and adequate clinical personnel to address these barriers.

Incorporating evidence into clinical teaching: enhanced geriatrics specialty case-based residency presentations.

INTRODUCTION Case-based presentations are widely used in medical education and are a preferred education modality to teach about the care of geriatric patients across a range of medical specialties. METHODS We incorporated evidence-based materials from topical literature syntheses into case-based presentations on the care of geriatric patients for use by specialty residents. These enhanced case-based presentations were used to augment learning and to facilitate detection of additional educational needs for future resident training sessions. RESULTS Forty case-based presentations were presented to 11 specialty programs during a 4-year period. The program was popular, and program directors and residents requested additional presentations. Geriatric evidence-based summaries were viewed online 375 times during the course of the project. Geriatric clinical consults increased from an average of 10 consults a year to 141 from 64 different providers during the first year. DISCUSSION Case-based presentation, enhanced with evidence-based summaries of research literature generated by information specialists, is a feasible and effective approach to teaching clinical content. These presentations can be used to target geriatrics educational competencies for resident trainees in nongeriatric specialties.

Delirium in the Nursing Home Emergency Department Patient

OBJECTIVES: To determine whether nursing home patients are more likely than non‐nursing home patients to present to the emergency department (ED) with delirium and to explore how variations in their delirium risk factor profiles contribute to this relationship.

Delirium in the Nursing Home Patients Seen in the Emergency Department: ED DELIRIUM IN NURSING HOME PATIENTS

OBJECTIVES: To determine whether nursing home patients are more likely than non‐nursing home patients to present to the emergency department (ED) with delirium and to explore how variations in their delirium risk factor profiles contribute to this relationship.