Biomedical subjects

A M Medina-Walpole

Publications and source records attributed to A M Medina-Walpole.

3 recordsLinked to original sources

PubMed2000

Implementation of an interdisciplinary Behavior Management Program.

OBJECTIVE: To describe the establishment and utilization of an interdisciplinary Behavior Management Program in a Transitional Care Unit as a new model of Geriatrics Practice. DESIGN: Descriptive Study. SETTING: A 50-bed Transitional Care Unit in a Veterans Affairs Medical Center in Syracuse, New York. PARTICIPANTS: All residents admitted to the Transitional Care Unit were observed for a 6-month period under the Behavior Management Program. PROGRAM STRUCTURE: The Behavior Management Program involved an interdisciplinary team approach to the management of behavioral disturbances. This included development of a Behavior Team and a comprehensive Behavior Observation Record, which readily assisted caregivers in determining and monitoring target behaviors that required modification. Both nonpharmacological and pharmacological interventions were employed to assist in the modification of behavioral disturbances. RESULTS: The Behavior Management Program enhanced the overall care of Transitional Care Unit residents with behavioral disturbances. The more appropriate use of medications for specific target behaviors led to a reduction in behavioral disturbance episodes and increased the earlier diagnosis and treatment of depression. The interdisciplinary nature of the Behavior Management Program promoted educational efforts and camaraderie among staff and created a stronger liaison between the Transitional Care Unit and the Psychiatry Service. In addition, several management improvements were identified as a result of the implementation of the Behavior Management Program. CONCLUSIONS: An interdisciplinary Behavior Management Program can prove to be a valuable asset in the management of behaviors for people with dementia, psychiatric illness, and other medical illnesses. More effective use of nonpharmacological and psychopharmacological interventions enhances the quality of life in a frail older population. This approach has strong potential for successful use in a variety of clinical settings by providers and caregivers alike.

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PubMed1999

Nursing home-acquired pneumonia.

Nursing Home-Acquired Pneumonia is a significant infection that is often seen in the long-term care setting. It is associated with substantial morbidity, healthcare expenditure, and mortality rates as high as 44%. Uniform diagnosis and therapeutic strategies have not been specifically established for pneumonia in the nursing home setting. This paper will update the long-term care provider with the unique features and challenges of pneumonia in this setting and review the approaches to the diagnosis and treatment of this important illness. The discussion will conclude with details regarding overall prevention of nursing home-acquired pneumonia and the critical role played by the nursing home medical director in this process.

Anti-Bacterial Agents↗

PubMed1998

Provider practice patterns in nursing home-acquired pneumonia.

OBJECTIVE: To describe provider practice patterns in the diagnosis and treatment of Nursing Home-Acquired Pneumonia (NHAP) and to document associations with cure, mortality, and transfer. DESIGN: A retrospective cohort. SETTING: Six nursing homes in Seattle, Washington. PARTICIPANTS: A total of 94 patients, 65 years of age or older (mean 83 +/- SD 9), in whom the diagnosis of pneumonia was documented in the nursing home medical record between July 1, 1994, and June 6, 1995. MEASUREMENTS: Multivariate logistic regression was used to assess the relationship between descriptive, diagnostic, or therapeutic measures and three outcomes, cure, 30-day mortality, and hospital transfer. RESULTS: Ninety-four episodes of pneumonia were identified. Allowing for more than one outcome per patient, there were 71 (75.5%) cures, 16 (17%) deaths, and nine (9.6%) transfers. Eighty-five percent of patients identified as having NHAP by their providers had chest X-rays (CXRs), and 69% had physical examinations. Sputum examination was ordered in 5%, blood cultures in 6%, and white blood cell counts in 33% of patients. In multivariate analysis, patients with functional decline were more likely to die (Odds Ratio (OR) 36.5 (95% CI 6.1, 220)). Cognitive decline was a risk factor for mortality (OR 6.8 l (CI 1.8, 26)) and transfer (OR 7.5 (CI 1.2, 46)). Those patients receiving only oral antibiotics (OR 3.2 (CI 1.1, 9.7)) were more likely to be cured. Length of therapy >1 week was also associated with cure (OR 2.9 (CI 1.0, 8.6)). Providers with Certificate of Added Qualifications (CAQ) in Geriatric Medicine were more likely to achieve cure (OR 3.1 (CI 1.0, 9.0)). CONCLUSIONS: Most patients with NHAP had diagnostic CXRs and physical examinations. In multivariate analysis, death was more likely to occur in patients with cognitive or functional decline. Cure was associated with the use of oral antibiotics alone and with care by providers with CAQ in Geriatric Medicine.

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