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Background— Comparison of a multimodal intervention WE CALL (study initiated phone support/information provision) versus a passive intervention YOU CALL (participant can contact a resource person) in individuals with first mild stroke.... more
Background— Comparison of a multimodal intervention WE CALL (study initiated phone support/information provision) versus a passive intervention YOU CALL (participant can contact a resource person) in individuals with first mild stroke. Methods and Results— This study is a single-blinded randomized clinical trial. Primary outcome includes unplanned use of health services (participant diaries) for adverse events and quality of life (Euroquol-5D, Quality of Life Index). Secondary outcomes include planned use of health services (diaries), mood (Beck Depression Inventory II), and participation (Assessment of Life Habits [LIFE-H]). Blind assessments were done at baseline, 6, and 12 months. A mixed model approach for statistical analysis on an intention-to-treat basis was used where the group factor was intervention type and occasion factor time, with a significance level of 0.01. We enrolled 186 patients (WE=92; YOU=94) with a mean age of 62.5±12.5 years, and 42.5% were women. No signific...
Research Interests: Depression, Life Style, Medicine, Anxiety, Mood, and 15 moreAffect, Canada, Humans, Female, Male, Aged, Middle Aged, Public health systems and services research, Disease Progression, Patient Participation, ANXIETY, Combined Modality Therapy, Cardiovascular medicine and haematology, Life support care, and Intention to treat analysis
Research Interests: Psychology, Computed Tomography, Rehabilitation, Laughter, Medicine, and 15 moreComplication, Humans, Male, Clinical Sciences, Mood Disorders, Aged, Middle Aged, Parietal Lobe, Public health systems and services research, Crying, Middle Cerebral Artery, Cerebral Infarction, Pathological, Functional independence measure, and Antidepressive agents
BACKGROUNDFew studies have examined the factors associated with depression in informal caregivers of HIV-infected persons.OBJECTIVETo investigate the relationship between depression and caregiver burden among informal caregivers of... more
BACKGROUNDFew studies have examined the factors associated with depression in informal caregivers of HIV-infected persons.OBJECTIVETo investigate the relationship between depression and caregiver burden among informal caregivers of HIV-infected individuals.DESIGNCross-sectional study using baseline data from an ongoing randomized trial of a supportive telephone intervention.PARTICIPANTSOne hundred seventy-six dyads of HIV patients and their informal caregiver.MEASUREMENTSDepression was defined as a Beck Depression Inventory >10. A Caregiver Strain Index >6 identified informal caregivers with a high caregiver burden. We used logistic regression to identify characteristics that were associated with depression in the informal caregiver.RESULTSInformal caregivers were 42 years old (SD, 13), 53% female, 59% nonwhite, and 30% had education beyond high school. Forty-seven percent of informal caregivers were the patient's partner, 18% a friend, and 35% a family member. Twenty-seven percent of informal caregivers had a high caregiver burden, and 50% were depressed. We found significantly greater odds of informal caregiver depression with high caregiver burden (OR, 6.08; 95% CI, 2.40 to 15.4), informal caregiver medical comorbidity besides HIV (OR, 2.32; 95% CI, 1.09 to 4.92), spending all day together (OR, 3.92; 95% CI, 1.59 to 9.69), having to help others besides the HIV patient (OR, 2.55; 95% CI, 1.14 to 5.74), and duration of the HIV patient's diagnosis (OR, 1.01 per month; 95% CI, 1.00 to 1.01).CONCLUSIONSHigh caregiver burden was strongly associated with depression among HIV-infected individuals' informal caregivers, who themselves had difficult life circumstances. Informal caregivers of HIV patients may be in need of both mental health services and assistance in caregiving.
Research Interests: Depression, General Internal Medicine, Medicine, Logistic Regression, Humans, and 15 moreGeneral, High School, Female, Male, Hiv Infection, Mental health services, Beck Depression Inventory, Caregivers, Caregiver burden, Clinical Sciences, Middle Aged, Adult, Cross sectional Study, Logistic Models, and HIV infections
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Clinical and research attention to stroke care has focused on managing the acute stage of recovery and on evaluating the short-term effectiveness of rehabilitation programs. However, studies suggest that stroke affects the quality of life... more
Clinical and research attention to stroke care has focused on managing the acute stage of recovery and on evaluating the short-term effectiveness of rehabilitation programs. However, studies suggest that stroke affects the quality of life and the well-being of the entire family over much longer time frames. This article reviews the stroke literature as it relates to stroke rehabilitation and the family. Research findings strongly suggest that stroke is a family affair and that more rigorous attention to family assessment, education, advocacy, and counseling is needed along with development of new intervention methods focused on addressing specific family dimensions that have a demonstrated relationship to specific stroke problems. It is clear that health professionals shou Id thi nk farm ly, involvethefamily, and work with the family.
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The use of psychopharmacology for stroke patients requires careful attention to diagnosis, selection of medications for a particular use and avoidance of specific actions that interfere with recovery and function, and careful monitoring... more
The use of psychopharmacology for stroke patients requires careful attention to diagnosis, selection of medications for a particular use and avoidance of specific actions that interfere with recovery and function, and careful monitoring for results and side effects. Any given psychotropic medication may be used to treat a number of psychiatric and other problems. This review focuses on specific clinical implications for the use of antipsychotic, antidepressant, psychostimulant, antimanic, anxiolytic, and other selected agents in stroke.
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To examine the effects of a telephone-delivered intervention, Family Intervention: Telephone Tracking-Caregiver (FITT-C), on community support and healthcare use by dementia caregivers. Randomized, controlled trial. Academic medical... more
To examine the effects of a telephone-delivered intervention, Family Intervention: Telephone Tracking-Caregiver (FITT-C), on community support and healthcare use by dementia caregivers. Randomized, controlled trial. Academic medical center. Dyads (n = 250) of distressed informal dementia caregivers and care recipients. Caregivers were randomly assigned to receive the FITT-C (n = 133) or telephone support (TS; n = 117). Both groups received 16 telephone contacts from a master's-level therapist over 6 months. The FITT-C intervention provided psychoeducation, problem solving, and other directive approaches based on assessment of critical areas (e.g., mood, behavior, family functioning, social support). TS provided supportive therapeutic strategies. Outcome variables were caregiver report of community support service use, number of visits to the emergency department (ED) for caregivers and care recipients, and hospital stays for caregivers during the interventions. Intervention groups did not differ in demographic characteristics, use of support services, or use of healthcare resources at baseline. Caregivers who received the FITT-C used community support services at end of treatment significantly more than those receiving TS (P = .02). FITT-C caregivers had a significantly lower rate of ED visits (rate difference 9.5%, P = .048) and hospital stays (rate difference 11.4%, P = .01) over the 6-month course of the intervention than TS caregivers. Care recipient use of community or medical resources did not differ according to group. An entirely telephone-delivered intervention was effective in increasing caregiver engagement in community resources and reducing caregiver use of hospital-based healthcare resources. Results highlight the potential effect of FITT-C on healthcare use.
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Depression in stroke patients was observed many years ago but only recently has become the subject of systematic study. While estimates of depression vary, some have noted its occurrence in more than half of stroke patients. Our... more
Depression in stroke patients was observed many years ago but only recently has become the subject of systematic study. While estimates of depression vary, some have noted its occurrence in more than half of stroke patients. Our understanding of depression has been facilitated by refinements in diagnostic categories, analysis of contributing factors including the biology of depression, and refinements in evaluation to include cognitive and linguistic impairments that are common after stroke. The ways in which depression may affect rehabilitation and the fate of depression over time have been the subject of recent studies. Management includes sensitizing of caregivers, environmental change, education for patients and families, psychotherapy, and pharmacological interventions.
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Family medicine, in common with most other medical specialties, is passing through a period of lively debate concerning its course and development. This paper discusses that portion of the debate attempting to define the function of the... more
Family medicine, in common with most other medical specialties, is passing through a period of lively debate concerning its course and development. This paper discusses that portion of the debate attempting to define the function of the family physician in overseeing the comprehensive and continuing health care of patients and their families. One consequence of such a definition is the need to understand thoroughly the family in its functional role as a social unit. This knowledge of the family unit will affect some aspects of the practice of family medicine. Some of our approaches to training practitioners in this challenging field are outlined.
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The Problem Centred Systems Therapy of the Family and the McMaster Model of Family Functioning on which it is based have been used by family physicians and a variety of health professionals. This paper outlines aspects of the models that... more
The Problem Centred Systems Therapy of the Family and the McMaster Model of Family Functioning on which it is based have been used by family physicians and a variety of health professionals. This paper outlines aspects of the models that are useful in structuring a family assessment, plus some of the benefits gained through using such a family oriented approach.
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Introduction Evaluations of health care programs are usually directed at one of three components: the organization and development of the program; the processes by which the service is delivered; and the impact of the service. This paper... more
Introduction Evaluations of health care programs are usually directed at one of three components: the organization and development of the program; the processes by which the service is delivered; and the impact of the service. This paper describes a method for evaluating the second, namely, the process of service delivery, but it is safe to assume that if this is not efficient the quality of service and the effectiveness of the total program will be jeopardized. A tool which yields information about intake, individual case loads and the week by week progress of any given patient will be described. This tool allows for coverage of the entire delivery system. Information on the frequency and type of service, number of intakes and status of cases at discharge can be fed back to the staff, allowing for reinforcement of positive trends, while providing data for evolutionary problem solving. When appropriately used these simple data influence future staffing patterns and permit identification of potential areas of fruitful research. The tool used is a Modified Markovian State Model developed by systems analysts in the field of operational research. This model is applicable to any treatment program for which identifiable 'states' from patient entrance to patient exit can be determined. It was applied to the ChedokeMcMaster Child and Family Centre of MeMaster University an outpatient facility serving approximately 450 families at any one time. As its outpatient component this centre has four teams (five to six members in each) which assume responsibility for
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Findings report that hospital inpatients who receive social work intervention present difficult problems and have longer-than-average lengths of stay and that the earlier in the hospitalization that intervention occurs, the shorter the... more
Findings report that hospital inpatients who receive social work intervention present difficult problems and have longer-than-average lengths of stay and that the earlier in the hospitalization that intervention occurs, the shorter the stay will be. A total of 243 patients referred for social services at a 440-bed teaching hospital were evaluated. Paired t-tests indicated a significant difference in the mean length of stay based on normative data. Timing of the intervention accounted for a significant amount of variance (13 percent) in length of hospital stay. The major clinical implications of the study are that social work intervention has the potential to decrease length of hospitalization, and that this methodology may be used reliably to evaluate changes in discharge planning protocol.
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We examined suicidal and nonsuicidal patients with major depression during and subsequent to their hospitalization. Factors associated with suicidality at the index episode included psychosocial variables as well as measures of family... more
We examined suicidal and nonsuicidal patients with major depression during and subsequent to their hospitalization. Factors associated with suicidality at the index episode included psychosocial variables as well as measures of family functioning. Previous suicidality, inter-episodic adjustment, changes in family constellation, and perception of family functioning were instrumental in separating nonsuicidal patients at follow-up from patients exhibiting recurrent suicidal behavior. These results indicate that when assessing patients with major depression for suicidality, particular attention should be paid both to the social environment and to family functioning as perceived by the patient.
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In our study we examined the relationship between the perceived adequacy of social support and post-stroke depression in 76 hospitalized Australian patients. Social support or the perception of its lack, particularly from a spouse... more
In our study we examined the relationship between the perceived adequacy of social support and post-stroke depression in 76 hospitalized Australian patients. Social support or the perception of its lack, particularly from a spouse care-giver, was associated significantly with both the presence and severity of depressive disorder. Furthermore, depressed patients who perceived their support to be inadequate had a longer duration of depressive illness than depressed patients who perceived their support in a more favorable light. We conclude that following stroke, perception of social support from key relationships may mediate the emotional response to this life crisis. The implications of these findings are discussed.
Research Interests: Psychiatry, Depression, Evolution, Marriage, Humans, and 15 moreHospitalization, Female, Male, Attitude, New South Wales, Risk factors, Aged, Risk Factors, Adjustment Disorders, Cerebral Hemorrhage, Cerebrovascular Disorders, Cerebral Infarction, interpersonal relation, Psychology and Cognitive Sciences, and Medical and Health Sciences
Identifying effective and accessible interventions for dementia caregivers is critical as dementia prevalence increases. Examine the effects of a telephone-based intervention on caregiver well-being. Randomized, controlled trial. Academic... more
Identifying effective and accessible interventions for dementia caregivers is critical as dementia prevalence increases. Examine the effects of a telephone-based intervention on caregiver well-being. Randomized, controlled trial. Academic medical center. Two hundred and fifty distressed, family, dementia caregivers. Caregivers randomized to receive 16 telephone contacts over 6 months of either the Family Intervention: Telephone Tracking-Caregiver (FITT-C) or Telephone Support (TS). Primary outcome variables were family caregivers' depressive symptoms, burden, and reactions to care recipients' behavior problems at 6 months. The FITT-C intervention resulted in significantly improved caregiver depressive symptoms (P = .003; 27% net improvement) and less severe reactions to care-recipient depressive behaviors (P = .009; 29% net improvement) compared with the control condition (TS). An entirely telephone-based intervention improves caregivers' depressive symptoms and reactions to behavior problems in the care recipient and is comparable with reported results of face-to-face interventions.
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teristics (i.e. demographics), primary stressors (i.e. participants’ cognitive, functional and behavioural decline over time), subjective stressors (i.e. distress due to participant’s behavioural symptoms and burden related to helping... more
teristics (i.e. demographics), primary stressors (i.e. participants’ cognitive, functional and behavioural decline over time), subjective stressors (i.e. distress due to participant’s behavioural symptoms and burden related to helping with everyday tasks), secondary role strains (i.e. caring for others), protective factors (i.e. coping) and personal stressors (i.e. self-rated health and quality of life). Over four years 37 participants developed dementia (7%), while 133 (24%) met Winblad criteria for mild cognitive impairment (35% incident cases). Our model fitted the data well (c 2/df1⁄42.517; CFI1⁄4.934; PCFI1⁄4.799; SRMR1⁄4.069; RMSEA1⁄4.052; PCLOSE1⁄4.172). Although change on all variables was subtle and informants overall did not experience significant increases in distress longitudinally (slope mean1⁄4-.03, p1⁄4.410), there was significant interindividual variability with respect to distress trajectories (slope variance1⁄4.10, p<.001). Accounting for baseline characteristics and initial symptomatology informants’ psychological distress increased over time if their coping abilities declined, or levels of task-burden, secondary role strain and behaviour distress increased (Table). Increases in distress were also indirectly (via associations with direct predictors) caused by participants’ poorer baseline performance and decline on executive function, decline on memory, worse baseline performance and functional decline on high cognitively demanding everyday tasks, baseline behavioural symptoms and informants’ older age. Increases in informants’ psychological distress were largely predicted by their subjective evaluation of the situation suggesting that there is a role for psychosocial interventions. Objective measures of participant decline only play a secondary role in the emergence of informants’ distress over time.
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In this study, general practitioners participated in a brief and intensive program developed to train them in a systems-oriented approach to family treatment. The family physicians and research staff agreed that following the training... more
In this study, general practitioners participated in a brief and intensive program developed to train them in a systems-oriented approach to family treatment. The family physicians and research staff agreed that following the training program, five families would be selected from each practice, treated by their physicians, and followed by the research staff as part of a treatment outcome study.
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Stroke affects long-term quality of life and well-being for not only the patients themselves but also their families. However, the focus of most rehabilitation programs has been on managing the acute stage of stroke and evaluating the... more
Stroke affects long-term quality of life and well-being for not only the patients themselves but also their families. However, the focus of most rehabilitation programs has been on managing the acute stage of stroke and evaluating the effectiveness of short-term treatments. Families usually share in treatment, especially in the long term, and they are ultimately responsible for the patient&amp;amp;#39;s welfare. This article reviews the literature as it relates to the clinical problems that make rehabilitation a family issue.
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The purpose of the current study was to identify variables near hospital admission that could effectively discriminate patients at risk for nursing home placement, long hospital stay, or readmission. Risk factors reported in the... more
The purpose of the current study was to identify variables near hospital admission that could effectively discriminate patients at risk for nursing home placement, long hospital stay, or readmission. Risk factors reported in the literature were used to predict hospital outcome for 532 admissions. Factors that discriminated type of outcome included: two or more chronic medical conditions, living alone or being admitted from a nursing home, dependent ambulation, poor mental status, psychiatric comorbidity, prior admission, age over 75, and being unmarried. Using these criteria, an index was developed to determine risk for placement, readmission, or lengthy stay. Use of cumulative risk scores can result in accurate prediction of outcome and may be useful in targeting patients for intervention. Performance characteristics of the risk index are discussed.
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Family therapy has become an increasingly popular mode of treatment over the last two decades (Epstein & Bishop, 1973; Group for the Advancement of Psychiatry, 1970; Gurman & Kniskern, 1978, 1981; Haley, 1971; Olson, 1970; Zuk,... more
Family therapy has become an increasingly popular mode of treatment over the last two decades (Epstein & Bishop, 1973; Group for the Advancement of Psychiatry, 1970; Gurman & Kniskern, 1978, 1981; Haley, 1971; Olson, 1970; Zuk, 1971). Its acceptance has not been limited to psychiatry and other mental health fields, for it is increasingly viewed as an important development by family medicine (Comley, 1973; Epstein & McAuley, 1978; McFarlane, Norman, & Spitzer, 1971; McFarlane, O’Connell, & Hay, 1971; Patriarche, 1974; Stanford, 1972), by pediatrics (Finkel, personal communciation, 1974; McClelland, Staples, Weisberg, & Bergin, 1973; Tomm, 1973), and by those working with the disabled (Bishop & Epstein, 1980). Training programs and study curricula in family therapy have grown tremendously in the last 10 years (Bishop & Epstein, 1979; Liddle & Halpin, 1978). Reports of a significant amount of research have also appeared (DeWitt, 1978; Glick & Haley, 1971; Gurman & Kniskern, 1978; Guttman, Spec-tor, Sigal, Rakoff, & Epstein, 1971; Olson, 1970; Santa-Barbara, Woodward, Levin, Streiner, Goodman, & Epstein, 1977, 1979; Wells, Dilkes, & Trivelli, 1972; Woodward, Santa-Barbara, Levin, & Epstein, 1978; Woodward, Santa-Barbara, Levin, & Epstein, 1978; Woodward, Santa-Barbara, Levin, Goodman, Streiner, Muzzin, & Epstein, 1974). Several authors have pointed to the need for clear descriptions of conceptual orientations and the specifics of the therapy process (Epstein & Bishop, 1973; Liddle & Halpin, 1978).
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The factors contributing to the morale of a significant fraction of the population, those over 60, were determined by assessing the effect of family functioning, couple health, and retirement on the morale of 178 couples in their sixties.... more
The factors contributing to the morale of a significant fraction of the population, those over 60, were determined by assessing the effect of family functioning, couple health, and retirement on the morale of 178 couples in their sixties. The effects of socioeconomic and health variables were taken into account when investigating this relationship. We found that family measures, couple health,
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The goal of this study was to preliminarily test the efficacy of a telephone intervention, Family Intervention: Telephone Tracking, designed to assist stroke survivors and their primary caregivers during the first 6 months after stroke.... more
The goal of this study was to preliminarily test the efficacy of a telephone intervention, Family Intervention: Telephone Tracking, designed to assist stroke survivors and their primary caregivers during the first 6 months after stroke. Forty-nine stroke survivors and their caregivers were randomly assigned to treatment as usual or treatment as usual plus the telephone intervention. Global outcomes are reported for health care utilization, family functioning, and general functioning. Family and general functioning were positively and significantly changed at 3 and 6 months. Health care utilization was positively and significantly changed at 3 months. Findings suggest that the model has the potential to decrease health care utilization and improve quality of life for stroke survivors and their caregivers. Further study is warranted.
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The aim of this study was to examine the role of coping on caregiver burden among a heterogeneous group of caregivers of persons living with HIV during the era of highly active antiretroviral therapy. Burden and coping were examined among... more
The aim of this study was to examine the role of coping on caregiver burden among a heterogeneous group of caregivers of persons living with HIV during the era of highly active antiretroviral therapy. Burden and coping were examined among 176 caregivers of persons living with HIV. Three styles of coping were examined using a 7-item scale: active-approach (task), blame-withdrawal (emotion), and distancing (avoidance). A total of 58.8% of the caregivers were women. They had a mean age of 42 years; 61.9% cohabited with the persons living with HIV who had a mean CD4 count of 401. All three styles of coping were significantly positively correlated with caregiver burden. After controlling for demographic variables and caregiver depression, active-approach coping and distancing coping independently moderated the relationship between perceived severity of HIV-related symptoms (stress) and caregiver burden; however, some caregivers experienced burden even at low levels of stress. These results indicate that in the era of highly active antiretroviral therapy, coping mitigates the effect of stress on burden.
Research Interests: Stress, Medicine, Psychosomatic Medicine, Humans, Coping, and 13 moreFemale, Male, Caregivers, Caregiver burden, Middle Aged, Psychosomatic, Adult, Highly Active Antiretroviral Therapy, Cost of Illness, Severity of Illness Index, Psychology and Cognitive Sciences, Medical and Health Sciences, and HIV infections
To determine what effect stroke might have on family interaction, common stroke outcome variables were used to predict family function for a sample of 78 families in which one member had recent onset of stroke. Traditional stroke-outcome... more
To determine what effect stroke might have on family interaction, common stroke outcome variables were used to predict family function for a sample of 78 families in which one member had recent onset of stroke. Traditional stroke-outcome predictors were not useful in accounting for variance in family function. The nature of family dynamics after disability may require additional research because the relationship is complex.
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Research Interests: Personality, Mental Health, Community-Based Mental Health Services, Public Health, Adolescent, and 14 moreProblem Solving, Humans, Child, United States, Female, Male, Patient Compliance, Follow-up studies, Social Environment, Suicide Attempt, Attempted Suicide, Random Allocation, Psychology and Cognitive Sciences, and Medical and Health Sciences
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A growing interest in the role of the family in a variety of medical and psychiatric disorders has led to an increased demand for methods of family assessment. Unfortunately, the psychometric properties of many family assessment... more
A growing interest in the role of the family in a variety of medical and psychiatric disorders has led to an increased demand for methods of family assessment. Unfortunately, the psychometric properties of many family assessment instruments have not been adequately ...
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A case of nonlinear desipramine pharmacokinetics is described. During routine clinical monitoring serum desipramine concentrations appeared to change disproportionately with dose. Following a series of controlled dosage decreases, from... more
A case of nonlinear desipramine pharmacokinetics is described. During routine clinical monitoring serum desipramine concentrations appeared to change disproportionately with dose. Following a series of controlled dosage decreases, from 400 to 50 mg/day, the patient's steady state serum concentrations fit a nonlinear pharmacokinetic model. This curvilinear serum concentration-dose relationship suggests saturation of hepatic metabolism and signals the need for caution when predicting or titrating doses against serum drug concentrations. The implications of this new finding are discussed.
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... Debra S. Herman,1,3,4 Duane Bishop,2 Jennifer L. Anthony,2 William Chase,2 Elizabeth Trisvan,1 Rosalie Lopez,1 and Michael D ... with patients and caregivers, the Cronbach&amp;#x27;s alpha for the CSI is 0.86, and its validity has... more
... Debra S. Herman,1,3,4 Duane Bishop,2 Jennifer L. Anthony,2 William Chase,2 Elizabeth Trisvan,1 Rosalie Lopez,1 and Michael D ... with patients and caregivers, the Cronbach&amp;#x27;s alpha for the CSI is 0.86, and its validity has been demonstrated (Robin-son, 1983; van Exel et al ...
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Sixty-eight depressed patients were subdivided according to their family&#39;s level of family functioning into functional and dysfunctional groups. Patients from dysfunctional families did not differ from those from functional... more
Sixty-eight depressed patients were subdivided according to their family&#39;s level of family functioning into functional and dysfunctional groups. Patients from dysfunctional families did not differ from those from functional families on measures of severity of depression, chronicity of depression, depression subtypes, other nonaffective psychiatric diagnoses, history of depression, or neuroendocrine functioning. Patients from dysfunctional families did have significantly higher levels of neuroticism. A 12-month follow-up of these patients indicated that depressed patients with dysfunctional families had a significantly poorer course of illness, as manifested by higher levels of depression, lower levels of overall adjustment, and a lower proportion of recovered patients. Thus, impaired family functioning appears to be an important prognostic factor in major depression.
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A suspected benefit of paying hospitals per diagnostic related groups (DRGs), i.e. the prospective payment system (PPS), is that lengths of stay (LOS) and costs may be reduced. A potential adverse effect is that providers may discharge... more
A suspected benefit of paying hospitals per diagnostic related groups (DRGs), i.e. the prospective payment system (PPS), is that lengths of stay (LOS) and costs may be reduced. A potential adverse effect is that providers may discharge patients to reduce costs regardless of clinical consequence. The Veterans Administration (VA) is one of the first agencies to adopt PPS for rehabilitation. This study analyzed the effects of PPS on LOS, readmission rate, nursing home placement (NHP), and referral for Home Health Care (HHC) on a 22 bed rehabilitation unit. One hundred and eighty-seven patients discharged in 1987, prior to the program, were compared (using t-tests) with 215 discharges in 1988, after PPS was established. There were no significant differences in demographics, self-care ability, or in readmissions. Referrals for HHC decreased significantly. LOS decreased from 29.3 days (SD = 16.4) in 1987 to 26.4 days (SD = 14.1) in 1988 (t = 5.3, p less than 0.01). However, 24 more patients were discharged to nursing homes in 1988 (N = 54, 25%) than in 1987 (N = 30, 16%), which represents an increase of 64% (p less than 0.05). Findings suggest that PPS may defer home care in favor of placement. Clinicians need to assess whether reducing inpatient LOS justifies increased use of nursing homes. Further research on the effects of PPS is needed to determine: (a) impact on clinical aspects of rehabilitation; and (b) if other funding mechanisms are more appropriate.
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Study the preliminary efficacy of a telephone intervention, Family Intervention: Telephone Tracking-Nursing Home (FITT-NH) for improving dementia... more
Study the preliminary efficacy of a telephone intervention, Family Intervention: Telephone Tracking-Nursing Home (FITT-NH) for improving dementia caregivers&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; adjustment following nursing home placement. Caregivers were enrolled on average 6 weeks following the care-recipients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; placement in a nursing home. Baseline assessment included self-report measures of caregiver emotional functioning, staff-caregiver interactions, placement satisfaction, health-related quality of life, and social support. Caregivers were randomly assigned to FITT-NH (n = 24) or a non-contact control condition (n = 22). Caregivers were urn randomized to balance groups on caregiver gender, relationship (spouse versus other), and facility type (dementia special care versus general). The intervention was entirely telephone-delivered in 10 contacts over 3 months. Caregivers randomized to non-contact control were not prevented from using other community-based mental health or support resources, therefore reflecting standard care. Intervention strategies were based on assessment of caregiver emotional adjustment, family functioning, staff-caregiver interactions, health, and social support. Treatment strategies are based on models of stress and coping process and family functioning. Groups did not differ in caregiver age, education, gender, relationship to the care recipient, length of caregiving, length of dementia diagnosis, or time since placement. Using mixed model analysis of variance, caregivers receiving FITT-NH showed a significant reduction in feelings of guilt related to placement, F(1,43) = 5.00, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05, and reported more positive perceptions of interactions with staff, F(1,43) = 4.59, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05, compared to standard care. Findings provide preliminary evidence for FITT-NH as a potentially efficacious, brief, targeted psychosocial intervention for improving caregiver emotional adjustment following nursing home placement.
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Triathlons of all distances can be considered endurance events and consist of the individual disciplines of swimming, cycling and running which are generally completed in this sequential order. While it is expected that elite triathletes... more
Triathlons of all distances can be considered endurance events and consist of the individual disciplines of swimming, cycling and running which are generally completed in this sequential order. While it is expected that elite triathletes would possess high values for submaximal and maximal measures of aerobic fitness, little is known about how these values compare with those of single-sport endurance