Journal of the American Medical Directors Association
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Comparative Study
A comparison of the nursing home evacuation experience between hurricanes katrina (2005) and gustav (2008).
One of the tragic legacies of Hurricane Katrina was the loss of life among Louisiana (LA) nursing home (NH) residents. Katrina revealed a staggering lack of emergency preparation and understanding of how to safely evacuate frail populations. Three years later, LA braced for Hurricane Gustav, a storm heralded to rival Katrina's power. Although its magnitude of destruction ultimately paled to Katrina, the warnings and predicted path preceding Gustav yielded a process of NH evacuations similar to Katrina. The goal of this article was to ascertain whether NH administrative directors (ADs) felt more prepared to evacuate before Gustav. ⋯ NH ADs felt more prepared to evacuate their residents for Gustav, owing partly to improved communication and collaboration with state agencies; however, significant morbidity and logistical problems remain with evacuating frail NH residents before hurricanes.
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Randomized Controlled Trial
Using video images to improve the accuracy of surrogate decision-making: a randomized controlled trial.
When patients are unable to make important end-of-life decisions, doctors ask surrogate decision makers to provide insight into patients' preferences. Unfortunately, multiple studies have shown that surrogates' knowledge of patient preferences is poor. We hypothesized that a video decision tool would improve concordance between patients and their surrogates for end-of-life preferences. ⋯ Patients and surrogates viewing a video decision support tool for advanced dementia are more likely to concur about the patient's end-of-life preferences than when solely listening to a verbal description of the disease.
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To examine the psychometric properties and clinical utility of the CPAT, an instrument to assess pain in nursing home residents with dementia. ⋯ This study provides evidence that the CPAT is a reliable and valid pain assessment instrument when used in nursing home residents with dementia. It has also been shown to be a tool with suitable clinical utility and feasibility. Further study is warranted to ascertain if its use will lead to improved resident function and quality of life and whether the results of this study are reproducible in other dementia populations. The CPAT's ability to quantify pain and measure treatment response has not been determined.
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This study tests the research hypothesis that certified medical directors are able to use their training, education, and knowledge to positively influence quality of care in US nursing homes. ⋯ The presence of certified medical directors is an independent predictor of quality in US nursing homes.