A pharmacy led program to review anti-psychotic prescribing for people with dementia

Background: Anti-psychotics, prescribed to people with dementia, are associated with approximately 1,800 excess annual deaths in the UK. A key public health objective is to limit such prescribing of anti-psychotics. Methods: This project was conducted within primary care in Medway Primary Care Trust (PCT) in the UK. There were 2 stages for the intervention. First, primary care information systems including the dementia register were searched by a pharmacy technician to identify people with dementia prescribed anti-psychotics. Second, a trained specialist pharmacist conducted targeted clinical medication reviews in people with dementia initiated on anti-psychotics by primary care, identified by the data search. Results: Data were collected from 59 practices. One hundred and sixty-one (15.3%) of 1051 people on the dementia register were receiving low-dose anti-psychotics. People with dementia living in residential homes were nearly 3.5 times more likely to receive an anti-psychotic [25.5% of care home residents (118/462) vs. 7.3% of people living at home (43/589)] than people living in their own homes (p?home settings. The pharmacist-led medication review successfully limited the prescribing of anti-psychotics to people with dementia.

Digital Collections in Regional Public Library “P. R. Slaveikov” – Veliko Tarnovo in the Context of the National Program for Preservation and Promotion of Literary Heritage

Nowadays the great public libraries in Bulgaria are gaining the appearance of digital centers which provide new informational resources and services in the digital space. The digital conversion as a way of preservation is one of the important priorities of Regional Public Library in Veliko Tarnovo. In the last few years we persistently search for possible ways of financing by national and foreign programs in this direction. In the beginning the strategy was oriented to digitalization of the funds with most urgent conversion – these of the local studies periodicals from 1878 till 1944 year. The digitalization of funds will create conditions of laying the basement of full text database of Bulgarian periodical publications. The technology that is offered gives opportunities for including other libraries in the Unified index, which can develop it into a National Unified index of periodical publications. The integrated informational environment that is created is an attractive, comfortable and useful place for work in home or at work for researchers, historians, art experts, bibliographers. The library readers use very actively all informational services of the library internet page and work competently with the on-line indexes provided there, they find the necessary title, which can be demanded later for usage in home or in the library, using electronic means again.

An after tax economic analysis of home equity conversion for the elderly

The FHA program to insure reverse mortgages has brought additional attention to the use of home equity conversion to increase income to the elderly. Using simulation, this study compares the economic consequences of the FHA reverse mortgage with two alternative conversion vehicles: sale of a remainder interest and sale-leaseback. An FHA insured plan is devised for each vehicle, structured to represent fair substitutes for the FHA mortgage. In addition, the FHA mortgage is adjusted to allow for a 4 percent annual increase in distributions to the homeowner. The viability of each plan for the homeowner, the financial institution and the FHA is investigated using different assumptions for house appreciation, tax rates, and homeowners' initial ages. For the homeowner, the return of each vehicle is compared with the choice of not employing home equity conversion. The study examines the impact of tax and accounting rules on the selection of alternatives. The study investigates the sensitivity of the FHA model to some of its assumptions.^ Although none of the vehicles is Pareato optimal, the study shows that neither the sale of a remainder interest nor the sale-leaseback is a viable alternative vehicle to the homeowner. While each of these vehicles is profitable to the financial institution, the profits are not high enough to transfer benefits to the homeowner and still be workable. The effects of tax rate, house appreciation rate, and homeowner's initial age are surprisingly small. As a general rule, none of these factors materially impact the decision of either the homeowner or the financial institution. Tax and accounting rules were found to have minimal impact on the selection of vehicles. The sensitivity analysis indicates that none of the variables studied alone is likely to materially affect the FHA's profitability. ^

A comparison between homemaker prepared meals and traditional home delivered meals on the dietary intake of frail homebound elders

To frail elders, the consumption of nutrients is a challenge. Individuals participating in home delivered meal programs achieve higher daily intakes of key nutrients over non participants. However many elders require special diet and modifications in food texture, features generally not provided by such programs.^ This study compared a pilot program providing individual homemaker prepared meals based on special needs with the traditional home delivered meal program. Eight participants in the model group and 19 participants in the control group completed the 180 day study. The high drop out rate in the model group was due to scheduling difficulties.^ No significant differences existed between the two groups with respect to weight gain/maintenance, macronutrient intake, intake of most micronutrients and customer satisfaction. Homemaker prepared meals is a viable option for individuals needing dietary adjustments. ^

The effect of a breakfast program on nutritional status, quality of life, and health care use among frail homebound older adults

The population of older adults is rapidly increasing, creating a need for community services that assist vulnerable older adults in maintaining independence and quality of life. Recent evidence confirms the importance of food and nutrition in reaching this objective. The Elderly Nutrition Program (ENP) is part of a system of federally funded community based programs, authorized through the Older Americans Act. ENP services include the home-delivered meals program, which targets frail homebound older adults at nutritional risk. Traditionally, ENP services provide a noon meal 5 days/week. This study evaluated the impact of expanding the home-delivered meals service to include breakfast + lunch, on the nutritional status, quality of life and health care utilization of program participants. ^ This cross-sectional study compared 2 groups. The Breakfast group (n = 167) received a home-delivered breakfast + lunch, 5 days/week. The Comparison group (n = 214) received lunch 5 days/week. Participants, recruited from 5 ENP programs, formed a geographically, racially/ethnically diverse sample. Participants ranged in age from 60–100 years, they were functionally limited, at high nutritional risk, low income, and they lived alone and had difficulty shopping or preparing food. Participant data were collected through in-home interviews and program records. A 24-hour food recall and information on participant demographics, malnutrition risk, functional status, health care use, and applicable quality of life factors were obtained. Service and cost data were collected from program administrators. ^ Breakfast group participants had greater energy/nutrient intakes (p < .05), fewer health care contacts (p < .05), and greater quality of life measured as food security (p < .05) and fewer depressive symptoms (p < .05), than comparison group participants. These benefits were achieved for $1.30/person/day. ^ The study identified links from improvements in nutritional status to enhanced quality of life to diminished health care utilization and expenditures. A model of health, loneliness, food enjoyment, food insecurity, and depression as factors contributing to quality of life for this population, was proposed and tested (p < .01). ^ The breakfast service is an inexpensive addition to traditional home-delivered meals services and can improve the lives of frail homebound older adults. Agencies should be encouraged to expand meals programs to include a breakfast service. ^

An investigation of the effects of mothers' participation in adult literacy classes on interactive literacy activities (ILAs) at home

The National Center for Family Literacy (2003a) and the National Even Start Association (2005) have stated that the single most effective and influential factor in increasing student academic achievement is parental involvement. The purpose of this qualitative study was to determine how participation in adult literacy courses influences parent-child interaction in various educationally related activities known as Interactive Literacy Activities (ILAs). This study investigated ILAs from the mothers? perspective, and examines the changes that occur in parental involvement or ILAs when immigrant parents of a limited educational background participate in an adult education program. The principal method of data collection was key informant interviews (Gall, Borg, & Gall, 1996). Other methods of data collection included observations of parent-child interactions and field observations. Data analysis methods included Memo-ing (Miles & Huberman, 1994), within case analysis and cross-case analysis. ^ Findings demonstrate that changes occurred in the parent-child relationship when mothers of a limited educational background participated in an adult literacy course. When participating in ILAs or English literacy activities related to second language acquisition (including reading and speaking for comprehension and pronunciation), the children of these mothers took on the role of the adult. Participation in literacy activities was often initiated by the child and the children were frequently concerned with their mother's literacy acquisition. Mothers reported that their children were more confident, worked harder on school related activities and were more open to communication. ^ It can be concluded from this study that, in the case of these immigrant families, a mother's participation in adult literacy classes is influential in the relationship between mother and child. These children participated in ILAs for the benefit of their mothers and initiated literacy activities more frequently. The children responded better to their parents during literacy activities because there was a positive change in the relationship between mother and child. The relationship between mother and child appeared to be strengthened by greater trust, a sense of pride and more communication. ^

An examination of the effects of a summer book-reading program on the language and early literacy outcomes of toddlers from high risk environments

The current study examined the impact of an early summer literacy program and the mediating effects of the home literacy environment on the language and literacy outcomes of a group of children at-risk for long-term developmental and academic delays. Participating children (n=54) were exposed to an intensive book-reading intervention each summer (June through mid August) over a 3-year period. The current study implemented an ex post facto, quasi-experimental design. This nonequivalent group design involved a pretest and posttest over three time points for a non-randomized treatment group and a matched non-treatment comparison group. Results indicated that literacy scores did improve for the children over the 3-year period; however, language scores did not experience the same rate of change over time. Receptive language was significantly impacted by attendance, and race/ethnicity. Expressive language was impacted significantly by gestational age and attendance. Results also indicated that language outcomes for young children who are exposed to a literacy program were higher than those who did not participate; however, only receptive language yielded significance at the p<.05 level. These study results also found that activities in the home that support literacy and learning do indeed impact language and literacy outcomes for these children, specifically, the age at which a child is read to, the number of books in the home, a child’s enjoyment of reading, and whether a child looks at books on his or her own impact language scores. This study concluded that at-risk young children do benefit from center-based literacy intervention. This literacy experience, however, is also driven by the children's home environment, their attendance to the program, whether they were premature or not and the type of caregiver.

Hospitality Graduate Students’ Program Choice Decisions: Implications for Faculty and Administrators

Despite rapid growth in the quality and volume of hospitality graduate research and education in recent years, little information is available in the extant body of literature about the program choices of hospitality management graduate students, information that is crucial for program administrators and faculty in their attempts to attract the most promising students to their programs. This paper reports on a study among graduate students in U.S, hospitality management programs designed to understand why they chose to pursue their degrees at their programs of choice. Given the large numbers of international students presently enrolled, the study additionally looked into why international hospitality management students chose to leave their home countries and why they decided to pursue a graduate degree in the U.S. Based on the findings, implications for hospitality administrators and faculty in the U.S. and abroad are discussed and directions for future research are presented.

The review panel visiting TS/Ph-3 during the 2009 Midterm Review

http://digitalcommons.fiu.edu/fce_lter_photos/1265/thumbnail.jpg

Development of an education resource for families and clients navigating through end-of-life care with at-home palliation

Background: Community health nurses (CHNs) play a pivotal role in providing end-of-life care to clients diagnosed with a life-threatening illness. Providing quality end-of-life care is an ethical obligation. Eastern Health’s palliative end-of-life care program (PEOLC) offers nursing care, equipment, services, and support. However, the caregiver’s need for practical information about end-of-life issues is not addressed. Purpose: To develop an educational resource to assist clients and families during end-of-life and to provide a framework for new CHNs in home palliation. Methods: An informal Needs Assessment, a literature review, an environmental scan, and consultations with four CHNs involved with home palliation. Results: An educational resource was developed to address the practical end-of-life issues identified in the literature review and consultations. Conclusion: An improved delivery of care for at-home palliation in the community for clients and families, and a framework for new CHNs.

The Role of Home Practice Engagement in a Mindfulness-Based Intervention

Over the last three decades, there has been a precipitous rise in curiosity regarding the clinical use of mindfulness meditation for the self-management of a broad range of chronic health conditions. Despite the ever-growing body of evidence supporting the use of mindfulness-based therapies for both medical and psychological concerns, data on the active ingredients of these mind-body interventions are relatively scarce. Regular engagement in formal mindfulness practice is considered by many to be requisite for generating therapeutic change; however, previous investigations of at-home practice in MBIs have produced mixed results. The equivocal nature of these findings has been attributed to significant methodological limitations, including the lack of standardized, systematic practice monitoring tools, and a singular focus on practice time, with little attention paid to the nature and quality of one’s practice. The present study used a prospective, observational design to assess the effects of home-based practice on dispositional mindfulness, self-compassion, and psychological functioning in twenty-eight people enrolled in an MBSR or MBCT program. To address some of the aforementioned limitations, the present study collected detailed weekly accounts of participants’ home-based practice engagement, including information about practice time (i.e., frequency and duration), exercise type, perceived effort and barriers to participation, and practice quality. Hierarchical multiple regression was used to examine the relative contribution of practice time and practice quality on treatment outcomes, and to explore possible predictors of adherence to at-home practice recommendations. As anticipated, practice quality and perceived effort improved with time; however, rather unexpectedly, practice quality was not a significant predictor of treatment-related improvements in psychological health. Home practice engagement, however, was predictive of change in dispositional mindfulness, in the expected direction. Results of our secondary analyses demonstrated that employment status was predictive of home practice engagement, with those who were unemployed completing more at-home practice on average. Mindfulness self-efficacy at baseline and previous experience with meditation or other contemplative practices were independently predictive of mean practice quality. The results of this study suggest that home practice helps generate meaningful change in dispositional mindfulness, which is purportedly a key mechanism of action in mindfulness-based interventions.

Iowa Highway Program, Finances and Progress, 1954

(a) Iowa has a total of 101,451 miles of rural roads, both primary and secondary. (b) On January 1, l954, a total of 77,024 miles of these rural roads were surfaced - mostly with gravel and crushed stone. This is 5,53l miles greater than on January l, 1952. (c) Additional roads are being surfaced at the rate of 2766 miles per year. (d) Iowa's highway program provides for a surfaced road to every reasonably located rural home and a paved or other type of dustless surface on all primary roads. (e) Iowa's highway funds come 25.4 per cent from property taxes and special taxes......................................$29,708,546.67 63.7 per cent from road use taxes.......... 74,581,080.30 10.6 per cent from Federal Aid (1952 Act).. 12,424,000.00 0.3 per cent from miscellaneous receipts.. 287,922.86 ---- ------------- 100.0 $117,001,549.83 (f) Annual income under present laws, available for highway construction, is approximately, For primary roads $29,420,000.00 For secondary roads $44,328,000.00 In 19_3, $7,299,000 of secondary road construction funds was transferred to the maintenance fund. (g) Iowa's highway improvements are being paid for as built. No new bonds are being issued.

Safe Visiting, March 20, 2103

For most of us a cold, or even the flu, poses nothing more than a minor inconvenience, some time at home in bed, and maybe a trip to see your physician. For residents and tenants in long-term care settings, however, coming down with the flu can be life threatening. Compromised immune systems and respiratory or cardiac issues can become more than just a challenge. Because of this, it is important to think about how a safe environment can be maintained while at the same time allowing for visitors and social activities.

What is the Medicaid Elderly Waiver Program, 2015

Medicaid Home and Community Based Services (HCBS) Elderly Waiver Program. The Elderly Waiver Program provides services and supports to older Iowans who are medically qualified for the level of care provided at a nursing facility (but do not wish to live in a nursing home); are 65 years of age or older; and eligible for Medicaid.

South Carolina Environmental Public Health Tracking Program : Putting Tracking to Work for You

Most people have come in contact with sources of carbon monoxide (CO). As a result, potential exposure to CO at harmful levels can pose a serious health risk. The objective of this report was to examine if knowledge of CO sources varied in South Carolina by region of the state. Many unintentional CO poisonings in the home are the result of lack of knowledge about potential sources of CO. Per the current study, the odds of incorrectly responding to household gas appliances being a source of CO were significantly different in adjusted analyses for region, marital status, ethnicity and age.