The cost of recruiting Alzheimer's disease caregivers for research.

OBJECTIVES: This study examined the cost and outcomes associated with multiple recruitment strategies used to enroll participants in an Alzheimer's disease (AD) caregiver study. METHODS: Recruitment data were collected as part of an AD caregiving intervention study and examined for number of referrals and participants, yield, personnel cost, materials cost, total cost, and cost per participant. RESULTS: Recruitment rates varied by method implemented and referral source. Overall, 100 participants were enrolled for a total cost of $10,127, yielding an average per participant cost of $101.00. The Formal Recruitment Method, used at agencies with large participant pools, emerged as the most cost-effective strategy. DISCUSSION: Recruitment costs varied greatly, depending on the referral sites and their available pool of participants. Substantial time, money, and personnel need to be budgeted for recruitment efforts given the expected costs, the competing pressures in the health care region, and the variability of participant response.

A computer-mediated intervention for Alzheimer's caregivers.

This article describes the background and development of an automated telecommunications system, REACH for TLC (Telephone Linked Care), for family caregivers of people with Alzheimer's disease. Caregivers press designated keys on the touch-tone keypad of their home telephones to communicate with TLC and the system speaks to caregivers using a human voice controlled by an Interactive Voice Response computer system. REACH for TLC (1) monitors the primary caregiver's stress level on a weekly basis and makes recommendations and referrals if necessary, (2) provides a voice mail caregiver support network, (3) offers access to an Alzheimer's expert panel, and (4) provides an automated distraction conversation individualized for the person with Alzheimer's disease to allow caregivers a minirespite break or to use as a tool to divert troublesome behaviors. The system is being tested in a randomized controlled feasibility study and the results will provide insight into the potential of this informatics technology to help sustain primary caregivers in their vital role.

Employer resistance to state authorized prescriptive authority for NPs. Results from a pilot study.

For many years NPs have worked to change the state regulations that restricted their ability to prescribe medications. Now, as the majority of states have removed sanctions against NP prescribing, attention is needed to monitor the implementation of the regulatory changes. Findings from this study indicate that some employers continue arbitrary practice restrictions on NP prescribing even after legislative reforms.

Analysis of restraint-free nursing homes.

Administrators and key informants in restraint-free nursing homes participated in a telephone survey to improve understanding of the process, resources, and measures for successful adoption of restraint-free care. Respondents expressed a strong opinion that each facility must develop its own individualized approach to restraint removal. However, similar approaches were found which suggest that efficiencies in conversion may be gained through application of change theory informed by restraint removal experience.

Training family caregivers of older adults: a program model for community nurses.

A community-based program for family caregivers of impaired older adults was designed and implemented to teach caregiving skills and techniques. The purpose of the program was to enhance caregivers' sense of competency in performing caregiving tasks and to reduce their risk of physical strain. A gerontological nurse specialist facilitated the group process, taught, and then demonstrated the caregiving skills. Participants highly valued the opportunity to discuss specific health concerns and practice caregiving skills with a professional nurse. Similar community-based programs managed by nurses are recommended to support nonprofessional caregivers.

Marketing health care programs to older adults: strategies for success.

Sensitivity to older adults as consumers will ensure the development of programs that are targeted appropriately to fill a need in the marketplace. Programs should be designed on the basis of information gained in the programmatic needs assessment. Health professionals who assume they know the needs, wants, and desires of older consumers because they treat so many ill elderly people risk program failure. By contrast, those that listen to older consumers and heed the signals from the geriatric marketplace are most likely to succeed.

Appropriateness of geriatric prescribing decisions made by nurse practitioners and physicians.

Legislators' concerns about the ability of nurse practitioners (NPs) to appropriately prescribe medications underlie the regulatory policies governing prescribing in the United States. As a result, state legislation varies concerning whether prescriptive authority is granted to NPs. The prescribing decisions of NPs and physicians were compared using three standardized geriatric case vignettes. NPs scored higher on an index of appropriateness than physicians a difference that remained whether or not the nurse had regulatory support to prescribe. Recommendations are made for more equitable state prescription policies.

Cerumen impaction. Prevalence and detection in nursing homes.

1. Many people, including health care professionals, believe that hearing loss is a normal part of aging and that little can be done to improve older adults' hearing. If the staff and physicians believe that hearing loss among nursing home residents is expected due to advanced age, then the likelihood of further evaluation of hearing impairments is minimal. 2. Hearing loss is a serious health problem among the elderly. Social isolation, depression, acting out inappropriately, and paranoia have been related to impaired hearing. Cerumen impaction is a reversible, frequently overlooked cause of a conductive hearing loss. 3. Twenty-five percent of nursing home residents were found to have impacted cerumen. One of the nursing homes in the study differed from the others because no residents had cerumen impaction. This was the only home that employed two nurses who had specialty preparation in gerontological nursing. If that home had been excluded, the impaction rate would have been 34%.

Hearing loss among nursing home residents: perceptions and realities.

Audiometric examinations were conducted on a random sample of 104 elderly Massachusetts' nursing home residents. The testing revealed that the majority of the participants were hearing impaired. The participants, however, consistently reported satisfaction with their hearing ability and no related hearing problems. Qualitative observations of communication among the participants, staff, and visitors documented that the elderly were negatively affected by their hearing loss. Recommendations are made to improve the quality of care for residents with hearing impairment in the nursing home setting.

A comparative analysis of nurse practitioners with and without prescriptive authority.

This article reports findings from a national random sample of nurse practitioners (NPs) who were actively practicing in adult primary care settings during 1986. An analysis of their demographic and practice characteristics revealed a statistically significant association between certain characteristics and the NPs' prescribing status. Nurse practitioners with prescriptive authority had more years of experience and were more likely to practice in rural or suburban areas and work in nongroup settings than NPs without prescriptive authority. These findings suggest that giving NPs' prescriptive authority may be an enabling factor that supports NP practice in medically underserved locations.

Nurse practitioners as prescribers: past research trends and future study needs.

Nurse practitioners in many states still struggle to gain prescriptive authority, while those who have this authorization often face complex regulations governing their prescriptive privileges. Forward progress calls for NPs with prescriptive authority to participate in studies that provide policymakers with relevant data promoting regulatory reforms. This article reviews the literature on NP prescribing, presents a model of trends in NP-prescribing research, and alerts NPs to areas in need of further study.

Enzyme immunoassay for macrolide antibiotics: characterization of an antibody to 23-amino-O-mycaminosyltylonolide.

An enzyme-linked immunosorbent assay was developed for the detection of macrolide antibiotics by using a polyclonal antibody generated in rabbits immunized with 23-amino-O-mycaminosyltylonolide (23-amino-OMT) covalently linked to keyhole limpet hemocyanin. The specificity and sensitivity of this antibody were characterized by using 23-amino-OMT coupled to alkaline phosphatase as an enzyme-linked label in a direct competitive enzyme-linked immunosorbent assay. The assay sensitivity was as low as 0.3 ng/ml for 23-amino-OMT, with a 50% inhibitory concentration of 8 ng/ml. This antibody exhibited good reactivity with 12-, 14- or 16-membered macrolides possessing amino-substituted sugar moieties, regardless of the presence of neutral sugar residues. Little or no cross-reactivity was observed with the macrocyclic lactone ring structure (tylactone) or macrolides containing only neutral sugars. No cross-reaction was observed with polyenes or nonmacrolide antibiotics. Known macrolide-producing cultures grown in fermentation broth also showed good reactivity, indicating that this assay is useful in detecting this class of metabolites in fermentation.

An economic analysis of the nurse practitioner role.

Today's rapidly changing health care environment directly affects nurse practitioners. NPs will be practicing in increasingly competitive situations and with mounting pressures for cost-effective services. Ignoring the issues in the health care marketplace can threaten NP survival. This article will analyze the changes in the health care system, relate the economic effects of these changes to nursing practice, and apply a homeostatic model of interprofessional competitive behavior. As NPs gain perspective on the dynamics of competition and the influence of economics, they will be better able to successfully position themselves in the health care marketplace.

An enzyme linked immunosorbent assay to diagnose Babesia bovis infection in cattle.

The optimum gel filtration fraction from lysate of Babesia bovis infected erythrocytes was determined for use as an antigen in an ELISA to diagnose B. bovis infection in cattle. Of four enzyme labels tested, horseradish peroxidase was the most suitable. The assay is both sensitive and specific in detecting antibody for 2-4 years after a single infection. False positive reactions were obtained only with some sera from some Anaplasma marginale infected cattle.