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Biomedical subjects

Michael J Borrie

Publications and source records attributed to Michael J Borrie.

8 recordsLinked to original sources
PubMed2006

Examining the nurse practitioner role in long-term care: evaluation of a pilot project in Canada.

This study examined the nurse practitioner (NP) role in three long-term care facilities in Ontario, Canada, to identify factors that facilitate or impede the implementation of this role. Facility staff were surveyed about their perceptions of the NP role, and the NP assigned to the facilities was interviewed. Findings indicated the NP had a positive impact on practice activities and staff assessment skills. Ratings of effectiveness and satisfaction with the role were high, although they varied by facility and the frequency of staff interaction with the NP. This study indicated NPs can significantly impact the primary care of residents in long-term care facilities. The NP role can be facilitated by clear delineation of the scope of practice, optimal NP to resident ratios, and organizational support.

Attitude of Health Personnel↗
PubMed2005

Risk factors for falling among community-dwelling veterans and their caregivers.

PURPOSE: To assess the prevalence and strength of association of risk factors for falling in Canadian veterans of World War II and Korea and their caregivers. METHODS: Questionnaires were sent to addresses of 3,000 Canadian veterans (response rate(1/4)70%). Risk factors for falls and the frequency of falls and injurious falls in the past 12 months were collected. RESULTS: Veterans had more risk factors than did caregivers, and more had fallen in the past year (39.8% vs. 29.7%). Risk factors in the logistic model for veterans included lower extremity disability (odds ratio 1.98, 95% confidence interval 1.5-2.6); lower extremity weakness (OR 1.75, 95% CI 1.3-2.3); worse memory than peers (OR 1.67, 95% CI 1.1-2.5); one or more visits to the family doctor in the past month (OR 1.53, 95% CI 1.2-2.0); and worse memory than 5 years ago (OR 1.36, 95% CI 1.0-1.8). CONCLUSIONS: Veterans appear more frail and prone to falling than their caregivers.

Accidental Falls↗
PubMed2003

State of the art in geriatric rehabilitation. Part I: review of frailty and comprehensive geriatric assessment.

OBJECTIVES: To increase recognition of geriatric rehabilitation and to provide recommendations for practice and future research. DATA SOURCES: A CINAHL and 2 MEDLINE searches were conducted for 1980 to 2001. A fourth search used the Cochrane database. STUDY SELECTION: One author reviewed the reference for relevance and another for quality. A total of 336 articles were selected. Excluded articles were unrelated to geriatric rehabilitation or were anecdotal or descriptive reports. DATA EXTRACTION: The following major geriatric rehabilitation subtopics were identified: frailty, comprehensive geriatric assessment, admission screening, assessment tools, interdisciplinary teams, hip fracture, stroke, nutrition, dementia, and depression. Part I describes the first 5 subtopics on concepts and processes in geriatric rehabilitation. Part II focuses on the latter 5 subtopics of common clinical problems in frail older persons. A level-of-evidence framework was used to review the literature. Level 1 evidence was a randomized controlled trial (RCT) or a meta-analysis or systematic review of RCTs. Level 2 evidence included controlled trials without randomization, cohort, or case-control studies. Level 3 evidence involved consensus statements from experts or descriptive studies. DATA SYNTHESIS: Of the 336 articles evaluated, 108 were level 1, 39 were level 2, and 189 were level 3. Recommendations were made for each subtopic. In cases in which several articles were written on the same topic and drew similar conclusions, the authors chose those articles with the strongest level of evidence, reducing the total number of references. CONCLUSIONS: Frail elderly patients should be screened for rehabilitation potential. Standardized tools are recommended to aid diagnosis, assessment, and outcome measurement. The team approach to geriatric rehabilitation should be interdisciplinary and use a comprehensive geriatric assessment. Medication reviews and self-medication programs may be beneficial. Future research should address cost effectiveness, consensus on outcome measures, which components of geriatric rehabilitation are most effective, screening, and what outcomes are sustainable.

Aged↗
PubMed2003

State of the art in geriatric rehabilitation. Part II: clinical challenges.

OBJECTIVES: To examine common clinical problems in geriatric rehabilitation and to make recommendations for current practice based on evidence from the literature. DATA SOURCES: A CINAHL database and 2 MEDLINE searches were conducted for 1980 to 2001. A fourth search was completed by using the Cochrane database. STUDY SELECTION: One author reviewed the references for relevance and another for quality. A total of 336 articles were considered relevant. Excluded articles were unrelated to geriatric rehabilitation or were anecdotal or descriptive reports on a small number of patients. DATA EXTRACTION: The following areas were the major geriatric rehabilitation subtopics identified in the search: frailty, comprehensive geriatric assessment, admission screening, assessment tools, interdisciplinary teams, hip fracture, stroke, nutrition, dementia, and depression. This article focuses on the latter 5 subtopics. The literature was reviewed by using a level-of-evidence framework. Level 1 evidence was a randomized controlled trial (RCT) or meta-analysis or systematic review of RCTs. Level 2 evidence included controlled trials without randomization, cohort, or case-control studies. Level 3 evidence involved consensus statements from experts, descriptive studies, or reports of expert committees. DATA SYNTHESIS: Of the 336 articles evaluated, 108 were level 1, 39 were level 2, and 189 were level 3. Recommendations were made for each subtopic according to the level of evidence in the specific area. In cases in which several articles were written on a topic with similar conclusions, we selected the articles with the strongest level of evidence, thereby reducing the total number of references. CONCLUSIONS: Frail older patients with hip fracture should receive geriatric rehabilitation. They should also be screened for nutrition, cognition, and depression. Older persons should receive nutritional supplementation when malnourished. If severe dysphagia occurs in stroke patients, gastrostomy tube feeding is superior to nasogastric tube feeding.

Aged↗
PubMed2002

Interventions led by nurse continence advisers in the management of urinary incontinence: a randomized controlled trial.

BACKGROUND: The short-term efficacy of combined lifestyle and behavioural interventions led by nurses in the management of urinary incontinence has not been rigorously evaluated by randomized controlled trial. We conducted a 6-month randomized controlled trial to determine whether a model of service delivery that included lifestyle and behavioural interventions led by "nurse continence advisers" in collaboration with a physician with expertise in continence management could reduce urinary incontinence and pad use in an outpatient population. We also aimed to evaluate the impact of this approach on subjects' knowledge about incontinence and their quality of life. METHODS: We used advertising in the mainstream media, newsletters to family physicians and community information sessions in 1991 to invite volunteers who were 26 years of age or older and suffered from incontinence to participate in a randomized controlled trial. Men and women who met the eligibility criteria were randomly allocated to receive either counselling from specialized nurses to manage incontinence using behavioural and lifestyle modification sessions every 4 weeks for 25 weeks or usual care. Symptoms of incontinence and the use of incontinence pads were the primary outcome measures. RESULTS: Using sealed envelopes, 421 patients were randomly allocated to the treatment or control groups. On average, patients in the treatment group experienced 2.1 "incontinent events" per 24 hours before treatment and 1.0 incontinent event per 24 hours at the end of the study. Control patients had an average of 2.4 incontinent events per 24 hours before the study and 2.2 incontinent events per 24 hours at the end of the study. The mean decrease in events in the treatment group was 1.2 and in the control group 0.2 (p = 0.001). Pad use declined from a mean of 2.2 per 24 hours before randomization in the treatment group to 1.2 per 24 hours at the end of the study, compared with 2.6 pads per 24 hours in the control group at the start of the study and 2.4 per 24 hours at the end. Pad use per 24 hours decreased on average by 0.9 pads in the treatment group and 0.1 in the control group (p = 0.021). INTERPRETATION: Behavioural and lifestyle counselling provided by specialized nurses with training in managing incontinence reduces incontinent events and incontinence pad use.

Adult↗
PubMed2002

A novel clinical pharmacy experience for third-year medical students.

A novel, clinical curriculum was developed to teach third-year medical students the principles of prescribing for elderly people. The experience involved a didactic session with a community pharmacist and a home visit to assess a senior citizen volunteer who was over age 75 years and was prescribed more than five medications. The medical students completed pre- and postexperience questionnaires to assess knowledge and opinions. Statistical analysis used paired t tests to compare pre- and postknowledge. The percentage agreeing or disagreeing were calculated for Likert opinion responses by using mean summary scores. Pre- and postexperience results were compared using paired t tests. Students showed improved knowledge scores on recognizing drug-drug (P=0.029) and drug-disease interactions (P=0.012). Knowledge on true/false prescribing questions was improved (P=0.005). Students felt that their current curriculum gave insufficient time to prescribing issues, and wanted more education about the use of medications and appropriate prescribing. The majority of students felt that they learned new things (81%), the experience was enjoyable (65%), important topics were covered (71.4%) and they would be more likely to confer with a community pharmacist because of the experience (75%). The novel curriculum described appears to be effective and warrants further evaluation.

Curriculum↗