ABSTRACT
The Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act) addressed the need for uniform, clinical, and demographic data in post-acute care (PAC) settings. Structured, uniform data enables potential interoperable data exchange, quality comparisons across PAC provider types, and the capacity to explore a Medicare unified PAC payment system. Standardized patient assessment data elements were developed for clinical domains such as cognitive function and mental status, special services, treatments, and interventions, and medical conditions and comorbidities to create a common language that can be used to bolster a patient's needs and goals to improve clinical outcomes. Clinical care, decision making, and care planning were at the center of all decisions made to standardize specific data elements. In addition, all standardized data were mapped to nationally accepted vocabulary standards to support electronic health information exchange. The standardized patient assessment data elements present the foundation for uniform language across the PAC continuum to promote a greater quality of care for every patient.
Subject(s)
Medicare , Subacute Care , Aged , Continuity of Patient Care , Humans , United StatesABSTRACT
PURPOSE: The purpose of this study was to determine whether Pilates is more effective than traditional strength and balance exercises for improving balance measures, balance confidence and reducing falls in community dwelling older adults with fall risk. METHOD: Thirty-one participants with fall risk were randomly assigned to the Pilates group (PG) or the traditional exercise group (TG). Both groups participated in 12 weeks of exercise, 2 times/week for 1 h. RESULTS: There was significant improvement in the Fullerton Advanced Balance Scale for both the PG (mean difference = 6.31, p < .05) and the TG (mean difference = 7.45, p = .01). The PG also showed significant improvement in the Activities-Specific Balance Confidence Scale (mean difference = 10.57, p = .008). CONCLUSION: Both Pilates and traditional balance programs are effective at improving balance measures in community dwelling older adults with fall risk, with the Pilates group showing improved balance confidence.
Subject(s)
Accidental Falls/prevention & control , Exercise Movement Techniques/methods , Independent Living , Postural Balance/physiology , Aged , Aged, 80 and over , Aging/physiology , Exercise Therapy/methods , Female , Humans , Male , Muscle Strength/physiologyABSTRACT
Leadership and clinical staff were surveyed to explore communication and leadership in nursing homes. Registered nurses and other professionals perceived communication as better than their nursing colleagues did. Overall, results suggest all factors of communication could improve. In terms of leadership, licensed practical nurses perceived less clarity of expectations, encouragement of initiative, and support than other groups. The study provides insight into what is organizationally necessary to improve quality of care in nursing homes.
Subject(s)
Attitude of Health Personnel , Communication , Leadership , Nursing Assistants/psychology , Nursing Homes/standards , Nursing Staff/psychology , Total Quality Management/organization & administration , Cross-Sectional Studies , Female , Health Knowledge, Attitudes, Practice , Humans , Interprofessional Relations , Male , Motivation , Nurse Administrators/organization & administration , Nurse Administrators/psychology , Nurse's Role , Nursing Assistants/education , Nursing Assistants/organization & administration , Nursing Methodology Research , Nursing Staff/education , Nursing Staff/organization & administration , Nursing, Supervisory/organization & administration , Organizational Culture , Organizational Policy , Qualitative Research , Social Support , United StatesABSTRACT
Heat shock proteins (HSPs) are recognized for their support of protein metabolism. Interaction with viral proteins also enhances the development of innate and adaptive immune responses against the infecting agent. At the level of the infected cell, HSPs are uniquely expressed on the cell surface, where they represent targets of lymphokine activated killer cells. Necrosis of the infected cell releases complexes of HSP and viral protein, which, in turn, binds antigen-presenting cells (APCs). One effect of binding is to stimulate APC maturation and the release of proinflammatory cytokines, an adjuvant effect that prepares the way for adaptive immune responses. A second effect of binding is to direct the antigenic cargo of the HSP into endogenous MHC presentation pathways for priming of naive cytotoxic T cells (CTL) or activation of antigen-specific CTLs. This alternate pathway of antigen presentation is essential to CTL priming following primary brain infection. Using heat shock to elevate brain levels of HSP in a mouse model of measles virus (MV) persistent infection, we provide evidence supporting a role for HSPs in promoting cell-mediated viral clearance from brain. The findings highlight the probable relevance of HSPs to anti-MV immunity, suggesting novel routes of both therapeutic intervention and preventative measures.
