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Dodge HH, Yu K, Wu CY, Pruitt PJ, Asgari M, Kaye JA, Hampstead BM, Struble L, Potempa K, Lichtenberg P, Croff R, Albin RL, Silbert LC. Internet-Based Conversational Engagement Randomized Controlled Clinical Trial (I-CONECT) Among Socially Isolated Adults 75+ Years Old With Normal Cognition or Mild Cognitive Impairment: Topline Results. The Gerontologist 2024; 64:gnad147. [PMID: 37935416 PMCID: PMC10943511 DOI: 10.1093/geront/gnad147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Social isolation is a risk factor for cognitive decline and dementia. We conducted a randomized controlled clinical trial (RCT) of enhanced social interactions, hypothesizing that conversational interactions can stimulate brain functions among socially isolated older adults without dementia. We report topline results of this multisite RCT (Internet-based conversational engagement clinical trial [I-CONECT]; NCT02871921). RESEARCH DESIGN AND METHODS The experimental group received cognitively stimulating semistructured conversations with trained interviewers via internet/webcam 4 times per week for 6 months (induction) and twice per week for an additional 6 months (maintenance). The experimental and control groups both received weekly 10 minutes telephone check-ins. Protocol modifications were required due to the coronavirus disease 2019 pandemic. RESULTS A total of 186 participants were randomized. After the induction period, the experimental group had higher global cognitive test scores (Montreal Cognitive Assessment [primary outcome]; 1.75 points [p = .03]) compared with the control group. After induction, experimental group participants with normal cognition had higher language-based executive function (semantic fluency test [secondary outcome]; 2.56 points [p = .03]). At the end of the maintenance period, the experimental group of mild cognitive impairment subjects had higher encoding function (Craft Story immediate recall test [secondary outcome]; 2.19 points [p = .04]). Measure of emotional well-being improved in both control and experimental groups. Resting-state functional magnetic resonance imaging showed that the experimental group had increased connectivity within the dorsal attention network relative to the control group (p = .02), but the sample size was limited. DISCUSSION AND IMPLICATIONS Providing frequent stimulating conversational interactions via the internet could be an effective home-based dementia risk-reduction strategy against social isolation and cognitive decline. CLINICAL TRIALS REGISTRATION NUMBER NCT02871921.
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Affiliation(s)
- Hiroko H Dodge
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Oregon Center for Aging and Technology (ORCATECH), Oregon Health & Science University, Portland, Oregon, USA
| | - Kexin Yu
- Oregon Center for Aging and Technology (ORCATECH), Oregon Health & Science University, Portland, Oregon, USA
- Layton Aging and Alzheimer's Disease Center, Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Chao-Yi Wu
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Oregon Center for Aging and Technology (ORCATECH), Oregon Health & Science University, Portland, Oregon, USA
| | - Patrick J Pruitt
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Meysam Asgari
- Oregon Center for Aging and Technology (ORCATECH), Oregon Health & Science University, Portland, Oregon, USA
- Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, USA
| | - Jeffrey A Kaye
- Oregon Center for Aging and Technology (ORCATECH), Oregon Health & Science University, Portland, Oregon, USA
- Layton Aging and Alzheimer's Disease Center, Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Benjamin M Hampstead
- Michigan Alzheimer's Disease Center, Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
- Research Program on Cognition and Neuromodulation Based Interventions, Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Laura Struble
- Department of Systems, Populations and Leadership, University of Michigan School of Nursing, Ann Arbor, Michigan, USA
| | - Kathleen Potempa
- Department of Systems, Populations and Leadership, University of Michigan School of Nursing, Ann Arbor, Michigan, USA
| | - Peter Lichtenberg
- Institute of Gerontology and Department of Psychology, Wayne State University, Detroit, Michigan, USA
| | - Raina Croff
- Oregon Center for Aging and Technology (ORCATECH), Oregon Health & Science University, Portland, Oregon, USA
- Layton Aging and Alzheimer's Disease Center, Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Roger L Albin
- Michigan Alzheimer's Disease Center, Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
- GRECC & Neurology Service, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Lisa C Silbert
- Oregon Center for Aging and Technology (ORCATECH), Oregon Health & Science University, Portland, Oregon, USA
- VA Portland Healthcare System, Portland, Oregon, USA
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Potempa K, Calarco M, Flaherty-Robb M, Butterworth S, Marriott D, Potempa S, Laughlin C, Schmidt P, Struble L, Harden K, Ghosh B, Furspan P, Ellis A. A randomized trial of a theory-driven model of health coaching for older adults: short-term and sustained outcomes. BMC Prim Care 2023; 24:205. [PMID: 37798658 PMCID: PMC10552322 DOI: 10.1186/s12875-023-02162-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 09/22/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND Healthy Lifetime, a theoretically driven, personalized health coaching program delivered electronically, including face-to-face videoconferencing, was developed to intervene in early aging to stave off functional decline and minimize the onset/exacerbation of chronic conditions. OBJECTIVE To determine the efficacy of a theoretically driven, personalized health coaching program in participants 50 years and older with one or more chronic conditions using a randomized, controlled, pragmatic clinical trial methodology. METHODS Participants were randomly assigned to the HL (n = 59) or a usual care (n = 63) group. The HL group received health coaching from a trained nurse over eight weeks. Outcomes were measured at baseline, eight weeks, and 20 weeks (after the 12-week no-treatment phase). Regression modeling with fixed-effect repeated measures was used to account for the longitudinal data collection. RESULTS For the HL group, health habits increased at 8 weeks (3.1 units; SE = 1.0; p = .0005; effect size = .15). This difference was sustained at 20 weeks (2.4 units, SE = 0.2; p = .0005). Independent self-care agency improved at 8 weeks in individuals with high blood pressure (13.5 units; SE = 4.37; p = .0023; effect size = .3). However, that difference was not sustained at 20 weeks (p = .47). No significant improvements were shown in the usual care group at 8 weeks or 20 weeks. CONCLUSIONS HL participants significantly improved their health habits at 8 weeks and sustained this improvement at week 20 (after a 12-week no-treatment phase) vs. the usual care group. Changing health habits alone has been shown to reduce all-cause morbidity and mortality in chronic disease. The high-functioning, community-dwelling older adults with chronic diseases we studied is an important target population for primary care practices to intervene early in aging to stave off the complications of chronic disease and functional decline. TRIAL REGISTRATION ClinicalTrials.gov (record NCT05070923, 07/10/2021).
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Affiliation(s)
- Kathleen Potempa
- School of Nursing, University of Michigan, 400 N. Ingalls St., Ann Arbor, MI, 48109, USA
| | - Margaret Calarco
- School of Nursing, University of Michigan, 400 N. Ingalls St., Ann Arbor, MI, 48109, USA
| | - Marna Flaherty-Robb
- School of Nursing, University of Michigan, 400 N. Ingalls St., Ann Arbor, MI, 48109, USA
| | - Susan Butterworth
- The University of Tennessee Health Science Center, 920 Madison Ave., Memphis, TN, 38163, USA
| | - Deanna Marriott
- School of Nursing, University of Michigan, 400 N. Ingalls St., Ann Arbor, MI, 48109, USA
| | - Stacia Potempa
- School of Nursing, University of Michigan, 400 N. Ingalls St., Ann Arbor, MI, 48109, USA
| | - Candia Laughlin
- School of Nursing, University of Michigan, 400 N. Ingalls St., Ann Arbor, MI, 48109, USA
| | - Patricia Schmidt
- School of Nursing, University of Michigan, 400 N. Ingalls St., Ann Arbor, MI, 48109, USA
| | - Laura Struble
- School of Nursing, University of Michigan, 400 N. Ingalls St., Ann Arbor, MI, 48109, USA
| | - Karen Harden
- School of Nursing, University of Michigan, 400 N. Ingalls St., Ann Arbor, MI, 48109, USA
| | - Bidisha Ghosh
- School of Nursing, University of Michigan, 400 N. Ingalls St., Ann Arbor, MI, 48109, USA
| | - Philip Furspan
- School of Nursing, University of Michigan, 400 N. Ingalls St., Ann Arbor, MI, 48109, USA.
| | - Alexis Ellis
- School of Nursing, University of Michigan, 400 N. Ingalls St., Ann Arbor, MI, 48109, USA
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Dodge H, Wu CY, Yu K, Lichtenberg P, Struble L, Potempa K, Silbert L. I-CONECT RESULTS: ENHANCING SOCIAL INTERACTIONS IMPROVES COGNITIVE FUNCTION IN SOCIALLY ISOLATED PARTICIPANTS. Innov Aging 2022. [PMCID: PMC9766228 DOI: 10.1093/geroni/igac059.1585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Epidemiological studies suggest that social isolation is a risk factor of dementia although the underlying mechanisms are not well known. A core component of social isolation is a lack of conversational interactions. We recently completed a NIH-funded multi-center randomized controlled trial called Internet-Based Conversational Engagement Clinical Trial (I-CONECT, ClinicalTrials.gov: NCT02871921), which aimed to examine whether social engagement, specifically conversational interactions through webcam and internet, could improve cognitive function in socially isolated older adults with mild cognitive impairment (MCI) or normal cognition. The data was un-blinded in August, 2021. We found strong evidence of efficacy in the primary (global cognitive function, Cohen’s d = 0.73, p=0.03) and secondary (memory function, Cohen’s d=0.67, p=0.03) outcomes at Month 6 (high-dose post-trial endpoint) and Month 12 (maintenance-dose post-trial-endpoint), respectively, using the mixed model for repeated measures. We will present the background, COVID-19 pandemic related protocol modifications and the primary results of this intervention project.
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Affiliation(s)
- Hiroko Dodge
- Oregon Health & Science University, Portland, Oregon, United States
| | - Chao-Yi Wu
- Oregon Health & Science University, Portland, Oregon, United States
| | - Kexin Yu
- Oregon Health & Science University, Palo Alto, California, United States
| | | | - Laura Struble
- University of Michigan, Ann Arbor, Michigan, United States
| | | | - Lisa Silbert
- Oregon Health & Science University, Portland, Oregon, United States
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Flaherty-Robb M, Calarco M, Butterworth S, Struble L, Harden K, Franklin M, Potempa S, Laughlin C, Schmidt P, Policicchio J, Yakusheva O, Isaman D, Gallagher NA, Furspan P, Potempa K. Healthy Lifetime (HL): An Internet-Based Behavioral Health Coaching Protocol for Older Adults. Front Digit Health 2022; 4:795827. [PMID: 35529316 PMCID: PMC9072965 DOI: 10.3389/fdgth.2022.795827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 03/17/2022] [Indexed: 11/13/2022] Open
Abstract
By 2060, the number of Americans 65 years and older will more than double, comprising nearly one-quarter of the population in the United States. While there are many advantages to living longer, a byproduct of aging is also a growing incidence of chronic illness and functional health limitations associated with a concurrent rise in chronic disease and disability that impair independent living in the community. We describe a personalized, behavioral health coaching protocol for early intervention that is delivered online to enhance a participant's independent functioning and to increase their self-care capacity with a goal to maintain independent living throughout aging. The electronic platform provides secure access to fillable surveys, health tracking, “just in time” communication with coaches and scheduling of two-way videos launched from the platform site. The 2-month protocol used two-way video conferencing which allowed high fidelity communication to sustain a complex behavioral intervention. Participants indicate high satisfaction with the intervention, the use of the platform, and the technology. While many health systems across the U.S. have ramped up virtual delivery of care in a proactive manner with now more than 70% of out-patient visits conducted through virtual delivery modes in some health systems, there remains much unevenness in this capability across the U.S. Our approach is to create a stable, interoperable, virtual outreach system for personalized professional health coaching that is complementary to medically oriented services that supports the health and functioning of participants as they age.
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Affiliation(s)
| | - Margaret Calarco
- School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | | | - Laura Struble
- School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | - Karen Harden
- School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | - Mary Franklin
- School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | - Stacia Potempa
- School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | - Candia Laughlin
- School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | - Patricia Schmidt
- School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | | | - Olga Yakusheva
- School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | - Deanna Isaman
- School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | | | - Philip Furspan
- School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | - Kathleen Potempa
- School of Nursing, University of Michigan, Ann Arbor, MI, United States
- *Correspondence: Kathleen Potempa
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Struble L, Potempa K, Hampstead B, Ellis A, Pedroza J, Lichtenberg P, Dodge H. Not out-of-reach: Engaging the older old isolated African Americans with and without MCI. Innov Aging 2021. [PMCID: PMC8968699 DOI: 10.1093/geroni/igab046.2392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The Internet-Based Conversational Engagement Clinical Trial (I-CONECT, ClinicalTrials.gov: NCT02871921) is a multi-center randomized, 12-month efficacy study. There is converging evidence that social isolation is a risk factor of cognitive decline and dementia. We hypothesized that increasing social interaction in older adults with normal cognition or mild cognitive impairment (MCI) could improve or sustain cognitive function through internet-based conversational engagement. African Americans (AA) are at higher risk for developing dementia but their participation in clinical trials is low. Objectives: (1) discuss the effective outreach process to recruit urban AA older old adults (mean targeted age of 80+); (2) describe how we retained participants in a yearlong study using technology-based interventions. The most successful outreach and recruitment sources were the voter registration mass mailings and the Healthier Black Elders Research Center. Successful recruitment methods included: hiring diverse staff, compensating participants’ time, and adjusting research protocols for opting out of MRIs and genetic saliva samples. Technology intervention strategies included: providing user-friendly Chromebooks and free internet connections, simple instructions with pictures, vision and hearing correction, and in-home training with technology support backup. During the pandemic, we could assists participants in learning to use the laptop remotely. Over 12,000 subjects were contacted, which led to 39 randomized participants. Our retention rate thus far is over 75%. This demonstrates that AA older adults are reachable, willing to participate in research and able to use communication technology with appropriate supports for long-term sustainable interaction that may improve cognition and health equity.
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Affiliation(s)
- Laura Struble
- University of Michigan School of Nursing, Ann Arbor, Michigan, United States
| | - Kathleen Potempa
- University of Michigan, University of Michigan, Ann Arbor, Michigan, United States
| | | | - Alexis Ellis
- University of Michigan, Ypsilanti, Michigan, United States
| | - Jesica Pedroza
- University of Michigan, University of Michigan, Michigan, United States
| | | | - Hiroko Dodge
- Oregon Health & Science University, Portland, Oregon, United States
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Dodge HH, Hampstead BM, Potempa K, Struble L, Asgari M, Silbert LC, Croff R, Wild K, Lahna D, Schwartz DL, Kaye J, McDonald M, Lindsley J, Team I. Behavioral RCT using internet‐based social interactions: Why some gain and some do not. Alzheimers Dement 2020. [DOI: 10.1002/alz.046367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Hiroko H Dodge
- Layton Aging & Alzheimer's Disease Center Oregon Health & Science University Portland OR USA
- Oregon Center for Aging & Technology (ORCATECH) Portland OR USA
| | | | | | - Laura Struble
- School of Nursing University of Michigan Ann Arbor MI USA
| | | | - Lisa C Silbert
- Oregon Center for Aging & Technology (ORCATECH) Portland OR USA
| | - Raina Croff
- NIA‐Layton Aging & Alzheimer's Disease Center Portland OR USA
| | - Katherine Wild
- Oregon Center for Aging & Technology (ORCATECH) Portland OR USA
| | - David Lahna
- Oregon Health & Science University Portland OR USA
| | | | - Jeffrey Kaye
- NIA‐Layton Aging & Alzheimer's Disease Center Portland OR USA
| | | | - Jacob Lindsley
- NIA‐Layton Aging & Alzheimer's Disease Center Portland OR USA
| | - I‐CONECT Team
- Layton Aging & Alzheimer's Disease Center Oregon Health & Science University Portland OR USA
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Desai A, Wharton T, Struble L, Blazek M. Person-Centered Primary Care Strategies for Assessment of and Intervention for Aggressive Behaviors in Dementia. J Gerontol Nurs 2018; 43:9-17. [PMID: 28128394 DOI: 10.3928/00989134-20170111-07] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 12/15/2016] [Indexed: 12/31/2022]
Abstract
With an increase in the number of individuals affected by dementia, it is imperative for health care providers to be well versed in the most effective ways to manage neuropsychiatric symptoms, such as aggression. Aggression can be particularly hard to manage because it creates risk of harm for formal and informal caregivers, and options for medical intervention are complex and situation dependent. Although multiple guidelines for management of aggression in dementia are available in the literature, their scope is widespread and suggested treatments often vary, making decision making difficult to navigate for busy clinicians. Using a composite case as a model, the current article provides guidelines that take outpatient providers through the steps needed to provide effective treatment for aggression in individuals with dementia. Shifting the current focal point of health care for aggressive dementia patients toward a more person-centered approach will have a positive impact on patient care. [Journal of Gerontological Nursing, 43(2), 9-17.].
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Dodge HH, Hampstead BM, Potempa K, Struble L, Lindsley J, Rooney WD, Asgari M, Silbert LC, Kaye JA, Wild K, Croff R, Goodrich E. P1‐639: BEHAVIORAL RANDOMIZED CONTROLLED TRIAL (RCT) USING INTERNET‐BASED SOCIAL INTERACTIONS AS A TOOL TO ENHANCE COGNITIVE RESERVE. Alzheimers Dement 2018. [DOI: 10.1016/j.jalz.2018.06.651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Hiroko H. Dodge
- Oregon Center for Aging & Technology (ORCATECH)PortlandORUSA
- University of MichiganAnn ArborMIUSA
- Oregon Health & Science UniversityPortlandORUSA
- Michigan Alzheimer's Disease CenterAnn ArborMIUSA
- Layton Aging and Alzheimer's Disease CenterPortlandORUSA
| | | | | | - Laura Struble
- School of NursingUniversity of MichiganAnn ArborMIUSA
| | - Jacob Lindsley
- Layton Aging and Alzheimer's Disease CenterPortlandORUSA
| | | | | | | | | | - Katherine Wild
- Layton Aging and Alzheimer's Disease CenterPortlandORUSA
| | - Raina Croff
- Layton Aging and Alzheimer's Disease CenterPortlandORUSA
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Li LW, Harris RE, Tsodikov A, Struble L, Murphy SL. Self‐Acupressure for Older Adults With Symptomatic Knee Osteoarthritis: A Randomized Controlled Trial. Arthritis Care Res (Hoboken) 2017; 70:221-229. [DOI: 10.1002/acr.23262] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 04/18/2017] [Indexed: 11/06/2022]
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Blazek MC, Struble L, Cavalcante A, Masse J. Medical Students in a Dementia Care Facility: an Enhanced Geriatric Psychiatry Experience. Acad Psychiatry 2016; 40:932-934. [PMID: 25930166 DOI: 10.1007/s40596-015-0323-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 03/05/2015] [Indexed: 06/04/2023]
Affiliation(s)
- Mary C Blazek
- University of Michigan Medical School, Ann Arbor, MI, USA.
| | - Laura Struble
- University of Michigan Medical School, Ann Arbor, MI, USA
| | | | - Johanna Masse
- University of Michigan Medical School, Ann Arbor, MI, USA
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Jusela C, Struble L, Gallagher NA, Redman RW, Ziemba RA. Communication Between Acute Care Hospitals and Skilled Nursing Facilities During Care Transitions: A Retrospective Chart Review. J Gerontol Nurs 2016; 43:19-28. [PMID: 27845810 DOI: 10.3928/00989134-20161109-03] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 09/12/2016] [Indexed: 11/20/2022]
Abstract
HOW TO OBTAIN CONTACT HOURS BY READING THIS ARTICLE INSTRUCTIONS 1.3 contact hours will be awarded by Villanova University College of Nursing upon successful completion of this activity. A contact hour is a unit of measurement that denotes 60 minutes of an organized learning activity. This is a learner-based activity. Villanova University College of Nursing does not require submission of your answers to the quiz. A contact hour certificate will be awarded once you register, pay the registration fee, and complete the evaluation form online at http://goo.gl/gMfXaf. To obtain contact hours you must: 1. Read the article, "Communication Between Acute Care Hospitals and Skilled Nursing Facilities During Care Transitions: A Retrospective Chart Review" found on pages 19-28, carefully noting any tables and other illustrative materials that are included to enhance your knowledge and understanding of the content. Be sure to keep track of the amount of time (number of minutes) you spend reading the article and completing the quiz. 2. Read and answer each question on the quiz. After completing all of the questions, compare your answers to those provided within this issue. If you have incorrect answers, return to the article for further study. 3. Go to the Villanova website listed above to register for contact hour credit. You will be asked to provide your name; contact information; and a VISA, MasterCard, or Discover card number for payment of the $20.00 fee. Once you complete the online evaluation, a certificate will be automatically generated. This activity is valid for continuing education credit until February 29, 2020. CONTACT HOURS This activity is co-provided by Villanova University College of Nursing and SLACK Incorporated. Villanova University College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. ACTIVITY OBJECTIVES 1. Discuss problematic barriers during care transitions. 2. Describe the significance of interprofessional collaboration in the delivery of quality health care. DISCLOSURE STATEMENT Neither the planners nor the author have any conflicts of interest to disclose. The purpose of the current project was to (a) examine the type of information accompanying patients on transfer from acute care to skilled nursing facilities (SNFs), (b) discuss how these findings meet existing standards, and (c) make recommendations to improve transfer of essential information. The study was a retrospective convenience sample chart audit in one SNF. All patients admitted from an acute care hospital to the SNF were examined. The audit checklist was developed based on recommendations by local and national standards. One hundred fifty-five charts were reviewed. Transferring of physician contact information was missing in 65% of charts. The following information was also missing from charts: medication lists (1%), steroid tapering instructions (42%), antiarrhythmic instructions (38%), duration/indication of anticoagulant medications (25%), and antibiotic medications (22%). Findings support the need for improved transitional care models and better communication of information between care settings. Recommendations include designating accountability and chart audits comparing timeliness, completeness, and accuracy. [Journal of Gerontological Nursing, 43(3), 19-28.].
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Li LW, Harris RE, Murphy SL, Tsodikov A, Struble L. Feasibility of a Randomized Controlled Trial of Self-Administered Acupressure for Symptom Management in Older Adults with Knee Osteoarthritis. J Altern Complement Med 2016; 22:396-403. [PMID: 27031862 DOI: 10.1089/acm.2015.0231] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES To assess the feasibility of a study to evaluate the efficacy of self-administered acupressure in pain and related symptom management for older people with symptomatic knee osteoarthritis. Feasibility with regard to (1) sample recruitment and retention, (2) treatment fidelity and adherence, and (3) tolerability and adverse events was examined. METHODS The study was a randomized controlled trial. Community-living older adults were recruited and randomly assigned to one of three groups: verum acupressure, sham acupressure, and usual care. Participants in the first two groups learned their respective acupressure protocol during their first center visit and from a set of materials. They were asked to practice the protocol at home once daily, 5 days a week, for 8 weeks. Participants attended three center visits and received weekly phone calls from a research assistant in an 8-week study period. Both quantitative and qualitative data collected from center visits and weekly phone calls were used to examine study feasibility. RESULTS A total of 150 participants (mean age, 73 years; 38% men) were enrolled; 83% completed all three center visits. Among those assigned to verum and sham acupressure groups, 94% passed a fidelity check at the second visit, more than 80% reported performing self-administered acupressure as instructed most of the time, and about 10% reported discomfort from performing the acupressure. Thirty adverse events were reported; most were related to pre-existing health conditions. CONCLUSIONS It is feasible to conduct a study of self-administered acupressure for symptom management in community-living older adults with knee osteoarthritis, although sample recruitment may be challenging.
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Affiliation(s)
- Lydia W Li
- 1 School of Social Work, University of Michigan , Ann Arbor, MI
| | - Richard E Harris
- 2 Department of Anesthesiology, University of Michigan , Ann Arbor, MI
| | - Susan L Murphy
- 3 Department of Physical Medicine and Rehabilitation, University of Michigan , Ann Arbor, MI
| | - Alex Tsodikov
- 4 Department of Biostatistics, School of Public Health, University of Michigan , Ann Arbor, MI
| | - Laura Struble
- 5 School of Nursing, University of Michigan , Ann Arbor, MI
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Steven M, Struble L, Larson JL. Recognizing Pressure Injury in the Darkly Pigmented Skin Type. Medsurg Nurs 2015; 24:342-348. [PMID: 26665871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This case study is an empirical report of a single subject who illus- trates the consequences of inadequate skin assessment in a darkly pigmented patient. This patient was followed for 1 year, from initial hospitalization to death.
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Abstract
ABSTRACTThe mechanical behavior of concrete is thought to be affected by the microstructure of the paste-aggregate interface, which differs in several respects from the microstructure of bulk paste. General aspects of interfacial microstructure, which appear to be fairly well understood, are reviewed. Recent microstructural studies using backscattered electron imaging show that there is a zone along the interface (approximately 50 μm wide) within which there are generally few large unhydrated clinker grains, many large voids (greater than 5 μm), a generally porous microstructure, many hollow-shell hydration grains, and in some cases little calcium hydroxide. The tendency for cracks to develop or grow along the paste-aggregate interface is discussed in relation to specific features of the interfacial microstructure.
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15
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Kim SYH, Uhlmann RA, Appelbaum PS, Knopman DS, Kim HM, Damschroder L, Beattie E, Struble L, De Vries R. Deliberative assessment of surrogate consent in dementia research. Alzheimers Dement 2010; 6:342-50. [PMID: 20188635 PMCID: PMC2889138 DOI: 10.1016/j.jalz.2009.06.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2009] [Revised: 05/08/2009] [Accepted: 06/05/2009] [Indexed: 10/19/2022]
Abstract
BACKGROUND Research involving incapacitated persons with dementia entails complex scientific, legal, and ethical issues, making traditional surveys of layperson views on the ethics of such research challenging. We therefore assessed the impact of democratic deliberation (DD), involving balanced, detailed education and peer deliberation, on the views of those responsible for persons with dementia. METHODS One hundred and seventy-eight community-recruited caregivers or primary decision-makers for persons with dementia were randomly assigned to either an all-day DD session group or a control group. Educational materials used for the DD session were vetted for balance and accuracy by an interdisciplinary advisory panel. We assessed the acceptability of family-surrogate consent for dementia research ("surrogate-based research") from a societal policy perspective as well as from the more personal perspectives of deciding for a loved one or for oneself (surrogate and self-perspectives), assessed at baseline, immediately post-DD session, and 1 month after DD date, for four research scenarios of varying risk-benefit profiles. RESULTS At baseline, a majority in both the DD and control groups supported a policy of family consent for dementia research in all research scenarios. The support for a policy of family consent for surrogate-based research increased in the DD group, but not in the control group. The change in the DD group was maintained 1 month later. In the DD group, there were transient changes in attitudes from surrogate or self-perspectives. In the control group, there were no changes from baseline in attitude toward surrogate consent from any perspective. CONCLUSIONS Intensive, balanced, and accurate education, along with peer deliberation provided by democratic deliberation, led to a sustained increase in support for a societal policy of family consent in dementia research among those responsible for dementia patients.
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Affiliation(s)
- Scott Y H Kim
- Bioethics Program, University of Michigan, Ann Arbor, MI, USA.
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16
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Sabatini LM, Gretebeck KA, Struble L, Ronis D, Black DR, Blue CL, Gretebeck RJ. Body Mass Index, Function, And Physical Activity In Hypertensive Older Adults: Theory Of Planned Behavior. Med Sci Sports Exerc 2009. [DOI: 10.1249/01.mss.0000355809.30809.d6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
Recent recognition of the importance of the human-animal bond has led to the proliferation of programs designed to improve the lives of nursing home residents through the use of animals. Because human-human interaction in the nursing home setting is often of an obligatory nature, we wondered if a visit from a nonjudgmental, outgoing, enthusiastic young adult ("a happy person") could elicit the same positive influence as a visit from a nonjudgmental dog. The purpose of this study was to determine if elderly residents of a midwestern nursing home had a preference for the type of visitor (dog vs. person) when both visits were nonobligatory and nonjudgmental. Behaviors were evaluated to determine if one visitor was more likely to influence prosocial behaviors (moving closer, patting, smiling). Six residents were visited by both the dog and the happy person: 5 of 6 completed the final interview. Residents were equally likely to smile at and move closer to both visitors. Residents were more likely to pat the dog. Three residents liked both visits equally: 1 preferred the dog, and 1 preferred the happy person. These data suggest that nonobligatory visits to nursing home residents from a happy person may be as beneficial to the resident as visits from a dog.
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Affiliation(s)
- Lana Kaiser
- College of Nursing, Michigan State University, East Lansing, USA
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18
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Abstract
Left anterior hemiblock (LAHB) is a relatively common disturbance of ventricular conduction which can be an indicator of early conduction system disease. In an effort to better understand this condition, phase analysis of resting radionuclide ventriculograms (RVG) was used to evaluate five patients with LAHB and six normal patients with particular reference to the phase angle difference between the septum and the postero-lateral wall. All patients had normal ejection fractions and visually normal wall motion on RVG. Visual analysis of phase images showed significant differences between the LAHB and normal patients' LV contraction synergy (p less than 0.03) with a delay in septal contraction versus the postero-lateral wall. Four of five patients with LAHB were outside 2 standard deviations of the normal range. Regional quantitative analysis of phase angle differences between posterolateral and septal walls tended to show this difference between normals and LAHB (p = 0.08) as well. Three of five patients with LAHB were outside 2 standard deviations from the normals' mean. There were no significant differences between the standard deviations, skewness, or kurtoses of phase angle histograms of LAHB versus normal patients. Phase analysis can identify some patients with LAHB by both visual and quantitative analysis. The ability to detect and possibly quantitate subtle conduction abnormalities such as LAHB may result in a better understanding of such conduction system diseases.
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