Reliability and Validity of the Checklist for Function-Focused Care in Service Plans.

The purpose of this study was to test the reliability and validity of the Checklist for Function-Focused Care in Service Plans. Function-focused care is a care approach that optimizes function and physical activity during all care interactions. This study used baseline data from the first cohort of the study titled Dissemination and Implementation of Function-Focused Care for Assisted Living Using the Evidence Integration Triangle (FFC-AL-EIT). A total of 242 participants were recruited from 26 assisted living facilities. The majority of participants were White, female, and unmarried. There was support for internal consistency with an alpha coefficient of .96, interrater reliability with a correlation of .80, construct validity based on Rasch analysis and INFIT statistics ranging from 0.69 to 1.29, and a significant association with function-focused care activities. Although there is some support for reliability and validity of the measure, modifications are recommended to add more challenging items.

Testing of the Function Focused Environment Assessment and the Function Focused Policy Assessment in Assisted Living.

This study tested two new instruments, the Function Focused Environment Assessment (FF-EA) and the Function Focused Policy Assessment (FF-PA). The measures were developed for clinical evaluation of AL settings to help optimize function and physical activity among residents. A total of 106 AL settings and 242 residents were included. There was evidence of item reliability (0.92) and interrater reliability (kappa=0.40, p=.015; percent agreement 85%) of FF-EA and item reliability (0.89) and interrater reliability (kappa=0.48, p=.001, percent agreement 82%) of the FF-PA, and support for validity of both measures based on INFIT and OUTFIT statistics and hypothesis testing.

Polypharmacy in Assisted Living and Impact on Clinical Outcomes.

OBJECTIVE: The purpose of this study was to describe medication use and polypharmacy in assisted living settings. We hypothesized that: 1) age, gender, race, setting, multi-morbidity, and cognitive status would influence polypharmacy; and 2) polypharmacy would be associated with falls, emergency room visits, and hospitalizations. DESIGN: This was a descriptive study using data from a larger study testing the Dissemination and Implementation of Function Focused Care for Assisted Living (FFC-AL-EIT). SETTING: Participants were recruited from 26 assisted living settings. PARTICIPANTS: A total of 242 individuals for cohort 1 consented and completed baseline data collection. INTERVENTIONS: Data were obtained from participant medical records, observations, and input from staff. MAIN OUTCOME MEASURE(S): Age, gender, race, ethnicity, comorbidities, cognitive status, medications, falls, emergency room visits, hospitalizations, function based on the Barthel Index and physical activity using the MotionWatch 8. RESULTS: Participants had a mean age of 86.86 (standard deviation [SD] = 7.0), the majority were women (n = 179, 74%) and white (n = 233, 96%), with five (SD = 2) diagnoses. The mean number of drugs was seven (SD = 3.56), and 51% were exposed to polypharmacy. The mean Barthel Index score was 63.06 (SD = 20.20), and they engaged in 111,353 (SD = 87,262) counts of activity daily. Fifty-eight residents fell at least once (24%), 22 were sent to the hospital (9%), and 32 (13%) to the emergency room. Neither hypothesis was supported. CONCLUSION: Continued research is needed to explore the factors that influence polypharmacy. Identification of these factors will help guide deprescribing so that medication management does not harm older adults physically or cause unnecessary financial burden.

A Postsurgical Obturator After Cleft Lip Repair in Patients With Holoprosencephaly.

Several factors affect healing of lip repair in children with complete cleft lip and palate in the immediate postoperative period. However, children with holoprosencephaly present a unique challenge. Because of their wide midline clefts and premaxillary agenesis they have protrusive positioning of their tongue, which can adversely affect the surgical result. In these cases we have found a postsurgical obturator made with hard-setting acrylic to be especially useful. Such an appliance may be used for the initial healing period (1-2 weeks). Two cases are presented here where such a device was used successfully.

Relationship between 25-hydoxyvitamin D, muscle strength, and incidence of injury in healthy adults: a systematic review.

The purpose of this systematic review is to answer the following clinical questions in healthy adults: is vitamin D status related to (1) muscle strength? (2) or incidence of injury? A literature search was performed using Pubmed, SPORTDiscus, and Web of Science to capture relevant articles that have examined these outcomes. Inclusion criteria required studies to address at least one of the 2 questions stated above, enroll healthy human subjects with a mean age of 18 to 65 years of age, and include serum 25-hydoxyvitamin D measures. Study characteristics such as vitamin D status, study design, and study population were documented. Measured assessors and outcomes from all studies were extracted to answer at least one of the two questions. When applicable, data were used to compute effect sizes at a 95% confidence interval for comparisons across studies to answer the 2 questions. The results of these studies indicate a weak to moderate effect of higher 25-hydoxyvitamin D levels on greater muscle strength and reduced incidence of injury. Randomized controlled clinical trials examining these questions are scarce when compared with the popularity of vitamin D testing; therefore, future trials are necessary to advance our understanding and to clarify the effect vitamin D has on extraskeletal outcomes in healthy adults.

The effects of season-long vitamin D supplementation on collegiate swimmers and divers.

The purpose of this 6-month randomized, placebo-controlled trial was to determine the effect of season-long (September-March) vitamin D supplementation on changes in vitamin D status, which is measured as 25(OH) D, body composition, inflammation, and frequency of illness and injury. Forty-five male and female athletes were randomized to 4,000 IU vitamin D (n = 23) or placebo (n = 22). Bone turnover markers (NTx and BSAP), 25(OH)D, and inflammatory cytokines (TNF-alpha, IL-6, and IL1-ß) were measured at baseline, midpoint, and endpoint. Body composition was assessed by DXA and injury and illness data were collected. All athletes had sufficient 25(OH)D (> 32 ng/ml) at baseline (mean: 57 ng/ml). At midpoint and endpoint, 13% and 16% of the total sample had 25(OH)D < 32 ng/ml, respectively. 25(OH)D was not positively correlated with bone mineral density (BMD) in the total body, proximal dual femur, or lumbar spine. In men, total body (p = .04) and trunk (p = .04) mineral-free lean mass (MFL) were positively correlated with 25(OH)D. In women, right femoral neck BMD (p = .02) was positively correlated with 25(OH)D. 25(OH)D did not correlate with changes in bone turnover markers or inflammatory cytokines. Illness (n = 1) and injury (n = 13) were not related to 25(OH)D; however, 77% of injuries coincided with decreases in 25(OH)D. Our data suggests that 4,000 IU vitamin D supplementation is an inexpensive intervention that effectively increased 25(OH)D, which was positively correlated to bone measures in the proximal dual femur and MFL. Future studies with larger sample sizes and improved supplement compliance are needed to expand our understanding of the effects of vitamin D supplementation in athletes.

Prevalence of postpartum depression in a native American population.

OBJECTIVES: Data were collected on postpartum depression from 151 women, ages 16-40 years who received postpartum health services from a rural obstetrical clinic in North Carolina between September 2002 and May 2003. Reflective of the racial and socio-economic makeup of the county, 60.9% of the sample were American Indian (Lumbee tribe) 25.8% were African American and 13.3% were Caucasian or other. METHODS: The Postpartum Depression Screening Scale (PDSS) was utilized to explore the prevalence of postpartum depression requiring clinical intervention in a largely unexplored population, minority women. RESULTS: The incidence of postpartum depression symptoms was over 23%, which is significantly higher than even the most liberal estimates in other populations. As with previous literature on risk factors, the sample demonstrates a strong association between symptoms of depression, history of depression and receiving treatment for depression. CONCLUSIONS: The PDSS proved to be a clinically useful tool in this setting. Findings support the importance of implementing routine screening protocols to guide practice and implement support services.