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Biomedical subjects

D R Zimmerman

Publications and source records attributed to D R Zimmerman.

At least 37 records · Page 2Linked to original sources
PubMed1999

Stability of nursing home quality indicators over time.

BACKGROUND: Nursing home quality indicators (QIs) provide a way to support quality assurance and improvement activities and to help ensure that cost savings are based on increased efficiency and not on decreased quality of care. OBJECTIVES: QIs values are expected to change over time. However, to be good indicators of quality, they should be reasonably stable over "short" periods. This paper discusses theoretical and measurement issues affecting stability and examines the stability of QIs over each of two 3-month periods and one 6-month period. SUBJECTS: The study sample included 512 nursing facilities from two states, Kansas and South Dakota. QIs were measured for the first 3 quarters of 1996. MEASURES: Facility level QIs were constructed using three different metrics that each provide a unique perspective of facility performance as follows: the proportion of residents in the facility with the QI condition; the facility's percentile rank in its state; and a variable indicating whether the facility's rank exceeded the 90th percentile in its state. QI stability was assessed using Pearson correlation coefficients, Spearman rank order correlation coefficients, and Cohen's Kappa, as appropriate for the metric. RESULTS: Results indicated high levels of stability for most QIs, with lower levels of stability found to be in keeping with theoretical and measurement considerations. CONCLUSIONS: QIs are reasonably stable over short periods of time. Quality improvement efforts may best be focused on facilities that are consistently poor performers over time, and those that show a large decrease in quality from one quarter to the next.

Cost Savings↗
PubMed1999

You can make a difference: increasing breastfeeding rates in an inner-city clinic.

Breastfeeding is endorsed in the United States as the ideal infant feeding method, but initiation rates are far behind U.S. national goals, and are generally lower in poorer socioeconomic groups. The goal of the project described was to increase breastfeeding rates in an inner-city clinic. The intervention consisted of prenatal breastfeeding education for all pregnant women, postpartum gift packs, and support groups. During the study, the breastfeeding initiation rate rose from 36% to 66% (p < 0.05) and the proportion still breastfeeding at 2 weeks postpartum increased from 35% to 57% (p < 0.05). The cost of the project was minimal. The biggest expense was the discharge packets. We conclude that relatively inexpensive interventions can have a significant impact on breastfeeding initiation, even in a population at high risk of not breastfeeding.

Breast Feeding↗
PubMed1998

The epidemiology of pediatric visits to New Jersey general emergency departments.

OBJECTIVE: To describe the epidemiology of pediatric visits to the emergency departments (EDs) of 10 general hospitals by age and gender. DESIGN: Review of ICD-9 codes from the billing database of a practice of emergency physicians. SETTING: Ten hospitals in north/central New Jersey. PATIENTS: All children <18 years treated by group physicians in EDs of study hospitals. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Diagnoses and visits. RESULTS: There were 319,430 diagnoses recorded for 241,839 children (18.9% of the 1,277,233 total visits by all ages). The number of visits was highest in the <2 and >14 years age groups, with males predominating in all age groups. The number of visits from trauma increased with age. Otitis accounted for over 3% of all ED visits in this sample, over 7000 visits. CONCLUSIONS: Children account for a significant portion of ED visits in general hospitals. EDs need to be equipped and staffed to handle this clientele.

Adolescent↗
PubMed1998

Impact of feeding regimen on behavioral and physiological indicators for feeding motivation and satiety, immune function, and performance of gestating sows.

The effect of daily or interval (every 3 d) feeding on body weight change, blood glucose and cholecystokinin (CCK) concentrations, immune function, and behavioral activity were determined during the gestation period of sows. Sows were fed a corn-soybean meal diet either 2 kg daily or 6 kg once every 3rd d (interval). Body weight changes for the 42-d trial period were not different (P > .05) between regimens. Blood glucose concentrations were similar before feeding (P > .05). Two hours after feeding, glucose concentrations increased in interval-fed sows but not in daily-fed sows (P < .05). Premeal plasma CCK concentrations were greater for daily-fed sows than for interval-fed sows (P < .05). The CCK concentrations in sows of both regimens increased after feeding above premeal levels (P < .05), and interval-fed sows exhibited higher concentrations than daily-fed sows (P < .05). Immune function as evaluated through mitogen-induced proliferation of T cells was greater in daily-fed sows than in interval-fed sows (P < .05). Daily-fed sows were more active overall and on any given day than interval-fed sows (P < .05) and thus seemed to expend more energy. Further, daily-fed sows exhibited higher levels of mouth-based activities (i.e., sham chewing, licking, appetitive and consummatory feeding behavior, and excess drinking) than sows restricted to consumption of one large meal every 3rd d. These indicators suggest that feeding motivation significantly affected overall performance of sows. This study emphasizes the need for evaluating the impact of feeding regimens and meal size on feeding motivation and, ultimately, on the well-being of the gestating sows.

Animals↗
PubMed1998

Nursing home quality indicators and quality improvement initiatives.

Quality indicators and a quality monitoring system developed for use in the regulatory survey process offer a quality improvement tool for nursing home staff. The systematic use of resident assessment data can aid in the identification of quality of care problems and the determination of the nature of those problems. The approach is particularly useful in routine and special quality assurance efforts.

Nursing Homes↗
PubMed1997

Risk adjustment of nursing home quality indicators.

The purpose of this study was to develop a method for risk adjusting nursing home quality indicators (QI's). The QI's measure incidence and prevalence of resident-level care processes and outcomes which are indicative of care quality. Risk adjustment was carried out by stratifying residents into risk groups (high and low), calculating QI rates within groups, and then drawing comparisons across facilities. The method was examined through analysis of data from over 800 nursing homes in four states. Results showed that facilities differed substantially in QI rates even after risk had been taken into account. Also, results suggested differences in care quality which may not have been apparent without controlling for risk.

Activities of Daily Living↗
PubMed1997

The effect of dietary active dry yeast supplement on performance of sows during gestation-lactation and their pigs.

Thirty crossbred sows and their pigs were evaluated through two parities to determine any reproductive or growth performance effects of an active dry yeast supplement added to corn-soybean meal diets. Sow reproductive performance from d 93 of gestation through d 21 of lactation and sow milk composition were evaluated. Pig growth performance was measured from birth to 28 d after weaning. Active dry yeast was added at 0, 1, or .2% of the sow gestation diet, 0, .15, or .3% of the sow lactation diet, 0, .2, or .4% of the pig prestarter diet, 1 wk before and 1 wk after weaning, and 0, .125, or .25% during the last 3 wk in the nursery. The yeast source consisted of a concentrate of live yeast cells of the Saccharomyces cerevisiae strain containing more than 15 x 10(9) live cells/g. Sow body weight at d 93 of gestation, at farrowing, and at d 21 of lactation did not differ (P > .10) among treatment groups. Milk from sows fed active dry yeast contained higher amounts of total solids (P < .05), crude protein (P < .10), and gamma globulin (P < .06) than milk from sows fed the control diet. Sow feed intake during lactation was not affected (P > .10) by treatment, nor were there differences in litter size at birth, litter birth weight, or litter weight at d 21 after farrowing. Active dry yeast supplementation to the sow and pig diets resulted in improved postweaning pig daily gain (P < .05) and gain-to-feed ratio (P < .05) but did not affect (P > .10) feed intake. Based on these data, active dry yeast supplement during late gestation, lactation, and before and after weaning does not alter litter weight at birth or weaning but does increase gamma globulin content of sow's milk and improves postweaning rate and efficiency of weight gain of pigs.

Animals↗
PubMed1997

Effect of chronic immune system activation on the rate, efficiency, and composition of growth and lysine needs of pigs fed from 6 to 27 kg.

The influence of a low and a high level chronic immune system (IS) activation on growth and dietary nutrient needs of pigs was evaluated. All pigs were of a single genetic strain and geographical site of origin, and the low and high IS pigs were created by physically isolating pigs from or continuously exposing pigs to major vectors of environmental antigen transmission. In each IS group, four littermate barrows in each of six litters were allotted at 25 +/- 2 d of age to one of four dietary amino acid regimens (.60, .90, 1.20, or 1.50% dietary lysine. Dietary lysine concentrations were achieved by altering the ratio of corn to soybean meal resulting in lysine being the first-limiting amino acid in each diet. Pigs were individually penned in facilities maintained at 25.6 +/- 2 degrees C and allowed to freely consume feed from 6.2 to 26.5 kg BW. On the basis of the differences in serological antibody titers, lymphocyte CD4+:CD8+ ratios, and serum alpha-1-acylglycoprotein concentrations, low and high levels of IS activation were established and maintained during the study. Minimizing the degree of chronic IS activation resulted in greater feed intakes (P < .09), body weight and protein gains (P < .01), gain:feed ratios (P < .01), and body leanness (protein:lipid, P < .01). The level of IS activation did not influence the partial efficiency of energy utilization for body protein and lipid accretion. To allow their greater capacity for body growth and protein accretion to be expressed, the low IS pigs required greater dietary lysine concentrations and daily lysine intakes than high IS pigs.

Animals↗
PubMed1997

Effect of chronic immune system activation on body nitrogen retention, partial efficiency of lysine utilization, and lysine needs of pigs.

The influence of a low and high level of chronic immune system (IS) activation on body nitrogen retention, partial efficiency of dietary lysine utilization, and lysine needs of pigs at three body weights was determined. All pigs were of a single genetic strain and geographical site of origin, and the low and high IS pigs were created by physically isolating pigs from or continuously exposing pigs to major vectors of antigen transmission. In each IS group, four littermate barrows in each of six litters were allotted at 25 d of age to one of four dietary amino acid regimens (.60, .90, 1.20, or 1.50% dietary lysine). Pigs were individually penned and allowed to freely consume feed from 6.2 to 26.5 kg BW. Nitrogen balance during 4-d periods was determined for each pig at BW of 10, 17.5, and 25 kg. Minimizing the level of chronic IS activation resulted in 4.7 to 7.7 g/d greater body nitrogen retention, 147 to 201 g/d greater BW gain, and 101 to 147 g more gain per kilogram of feed in pigs at the three BW. Dietary lysine intakes needed to maximize each of these criteria at BW of 10, 17.5, and 25 kg were a minimum of 2, 2, and 3 g/d greater in the low vs high IS pigs. However, the partial efficiency of lysine utilization for body nitrogen retention was similar between IS groups. On the basis of these data, the greater dietary lysine needs of the low IS pigs are due to their greater biological capacity for body nitrogen accretion and not to differences in their efficiency of dietary lysine utilization.

Animals↗
PubMed1997

Effect of level of chronic immune system activation on the growth and dietary lysine needs of pigs fed from 6 to 112 kg.

The effect of a low and a high level of chronic immune system (IS) activation on the rate, efficiency, and composition of body growth and dietary lysine needs of pigs fed from 6 to 112 kg body weight was evaluated. All pigs were of a single genetic strain and geographical site of origin, and the low and high IS pigs were created by physically isolating pigs from and continually exposing pigs to major vectors of environmental antigen transmission. In each IS group, five littermate barrows from each of seven litters were individually penned and randomly allotted to one of five dietary amino acid regimens (.6, .9, 1.20, 1.50, and 1.80% lysine from 6 to 27 kg BW and .45, .60, .75, .90, and 1.05% lysine from 27 to 112 kg BW). Dietary lysine concentrations were achieved by altering the ratio of corn to soybean meal in the diets, and diets were formulated such that lysine was the first-limiting amino acid. Low IS pigs possessed lower (P < .01) T lymphocyte CD4+:CD8+ ratios and serum alpha-1-acylglycoprotein concentrations. Low IS pigs also consumed more (P < .01) feed, gained body weight faster (P < .01), required less (P < .01) feed per unit of gain, and at 112 kg BW produced bodies with more (P < .12) muscle and less (P < .10) fatty tissue and offal than high IS pigs. To allow their elevated capacities for proteinaceous tissue to be expressed, low IS pigs required .15 to .30 percentage units greater dietary lysine concentrations and 2 to 5 g higher daily lysine intakes at each 14-kg BW increment from 6 to 112 kg BW.

Animals↗
PubMed1997

A controlled letter intervention to change prescribing behavior: results of a dual-targeted approach.

OBJECTIVE: To determine the effectiveness of a drug utilization review (DUR) letter intervention sent only to physicians, sent only to pharmacists, or sent to both physicians and pharmacists in changing physician prescribing behavior for dipyridamole. DATA SOURCES/STUDY SETTING: A Wisconsin Medicaid prescription drug database for data from March 1991 through May 1992 related to both long-term care and ambulatory patient settings. STUDY DESIGN: The effects of a DUR letter intervention were tested using a field study, pre-post, nonequivalent control group, quasi-experimental design. The effects of the letter intervention in terms of dipyridamole expenditures (dollars reimbursed to pharmacies by Medicaid), expenditures for related drugs (aspirin, ticlopidine, sulfinpyrazone) and numbers of patients for whom dipyridamole was discontinued were examined across three experimental groups and a control group. DATA COLLECTION/EXTRACTION METHODS: Dipyridamole expenditures for each study patient during a six-month preintervention and six-month postintervention period were collected from Medicaid prescription drug claims. Patients who had zero dipyridamole expenditures throughout the six-month postintervention period were classified as having had dipyridamole discontinued. PRINCIPAL FINDINGS: Letters sent to both physicians and pharmacists resulted in a greater percentage of patients discontinuing dipyridamole relative to controls and statistically significant differences in postintervention dipyridamole expenditures relative to controls in both the long-term care and ambulatory patient populations. CONCLUSIONS: Interventions that focus on another person in the drug use process in addition to the physician may have greater effects on a change in the prescribing of a targeted drug than letters to physicians alone.

Aged↗
PubMed1996

Repeat pediatric visits to a general emergency department.

STUDY OBJECTIVE: To determine the rate of repeat visits among children cared for in a general emergency department and associated demographic and clinical variables. METHODS: We carried out a chart review of patients seen in the ED of a general hospital serving both inner-city and suburban populations. Our subjects were all children younger than 18 years seen in the study ED between July 1, 1992, and June 30, 1993 (N = 4,276). RESULTS: We found 291 repeat visits (defined as a subsequent visit within 14 days) n 245 children. Among the 242 repeat visits for related complaints, 200 were unanticipated and most without a clear medical need. Mantel-Haenszel adjusted odds ratios (MHORs) showed a significantly increased risk of repeat visit with public insurance (controlled for age: MHOR, 2.57, and 95% confidence interval [CI], 1.93 to 3.43; controlled for race: MHOR, 2.70, and 95% CI, 1.99 to 3.66) and age younger than 2 years (controlled for insurance MHOR, 1.67, and 95% CI, 1.27 to 2.19; controlled for race: MHOR, 1.89, and 95% CI, 1.47 to 2.47. CONCLUSION: Repeat visits were more likely for respiratory diagnoses and less likely for minor trauma. Both visits and repeat visits were more likely in patients from poorer census tracts than in those from equidistant, more affluent ones.

Adolescent↗
PubMed1996

Using indicators to structure quality improvement initiatives in long-term care.

Quality indicators and a quality-monitoring system developed for use in the regulatory survey process offer a quality improvement tool for nursing home staff. The systematic use of resident assessment data can aid in the identification of quality of care problems and the determination of the nature of those problems. This approach is particularly useful for continuous quality improvement efforts.

Aged↗
PubMed1996

Standing feeding orders in a well-baby nursery: "water, water everywhere...".

The objective of this study was to examine standing physician orders affecting healthy breastfeeding newborns for items not in concert with the "Ten Steps to Successful Breast-feeding." All order sets of physicians or physician groups (n = 22) at a mid-sized hospital in central New Jersey (USA) (approximately 1200 deliveries/year) were reviewed. Seventeen orders called for water to be offered routinely as the first feeding. Five order sets called for two or more such feeds. Twelve orders gave infants nothing by mouth (NPO) for more than 2 hours and six mandated 4-hour intervals between feedings. Practices that undermine successful breastfeeding are still ubiquitous. Physician orders, in addition to hospital policy, should be targeted for improvement.

Breast Feeding↗
PubMed1996

Lysine requirement of the lactating sow determined by using plasma urea nitrogen as a rapid response criterion.

The dietary lysine requirement of adult sows nursing 10 pigs was estimated by using plasma urea nitrogen (PUN) concentration as a rapid response criterion. A preliminary experiment indicated that a 3-d feeding time is required to re-equilibrate PUN concentrations after a change in the dietary concentration of lysine. In the main experiment, 12 sows (BW = 219 +/- 5 kg; parity = 4.5 +/- .3; ultrasound backfat = 21.3 +/- .9 mm) were used in two 6 x 6 Latin squares. Treatments consisted of dietary lysine intakes (30.2, 36.9, 43.6, 50.3, 57.0, and 63.7 g/d) that were assigned to six 4-d periods and to six sows in each square. Diets provided adequate levels of all nutrients other than lysine. The treatment periods started on d 5 of lactation and ended on d 29. Plasma urea N concentrations were determined on the 3rd and 4th d of each of the six 4-d treatment periods. Plasma urea N concentrations decreased quadratically (P < .02) with, increasing dietary lysine intakes. A two-slope, broken-line regression model was used to estimate the dietary lysine intake that minimizes PUN concentrations. The results indicated that adult sows nursing 10-pig litters with an average growth of 2.22 kg/d required 55.3 g/d of dietary total lysine to minimize PUN concentrations and, therefore, presumably to minimize body protein mobilization.

Animals↗
PubMed1996

Issues in the medical care of the lactating woman.

Breastfeeding provides health advantages for mothers as well as babies, and it should be encouraged by physicians who care for women in the childbearing years. Accurate medical information regarding lactation will facilitate this process as will referral to support services.

Bacterial Infections↗
PubMed1995

Marked deterioration in glycemic control with change in brand of lactulose syrup.

Lactulose is a poorly absorbed synthetic disaccharide frequently used in the treatment of portasystemic encephalopathy. Because lactulose syrup contains small amounts of absorbable sugars, it may cause hyperglycemia in diabetic individuals, but is usually well tolerated. We report the case of a patient with diet-controlled diabetes and cirrhosis who experienced a marked deterioration in glycemic control, requiring insulin use, when he began using a different brand of lactulose syrup. The hyperglycemia resolved and insulin was discontinued after use of the original brand of lactulose syrup was resumed.

Aged↗