Changing trends in health orientation among older adults: A scoping review.

Older people's health condition is not uniform, and the components of their health are interrelated. Concepts regarding the health of older people have emerged and changed over time. However, the transition of concepts and influencing factors are not well examined through research. We have conducted a scoping review of the changes over time in the concept of health for older people and the factors influencing these changes. The public websites of international organizations and academic societies related to older people's health and research paper database were searched, and the extracted data were summarized in a chronological table. Consequently, this study revealed changing trends in health orientation after health had been defined by WHO, namely, successful aging, productive aging, active aging, and healthy aging, and their components, not the concept of health. The emergence and changes of health orientation among older people may have accompanied proposals and measures of international organizations and academic societies developed in response to changes in the demographic structure, and changes in how society perceives and supports older people. With the changing eras that bring about advances in health technology, prolongation of life expectancy, and changes in lifestyles, the needs of older people, society's perceptions of aging and older people, and how to support them will also change. Our findings may provide a valuable basis for understanding aging and older people, reconsidering their health orientation based on the health issues of older people and their significance, and formulating policies for older people in the future. Geriatr Gerontol Int 2024; 24: 5-17.

[Linguistic validation of Japanese version of Prolapse/Urinary Incontinence Sexual Questionnaire, IUGA-Revised (PISQ-IR)].

PURPOSE: To translate the Prolapse/Urinary Incontinence Sexual Questionnaire, IUGA-Revised (PISQ-IR) into Japanese and evaluate the linguistic validation of the translated PISQ-IR. METHODS: The translation and evaluation of PISQ-IR were performed through 3 steps: forward translation based on 2 urologists and discussed by another 4 urologists, 1 pharmacoeconomist and 1 nurse; the community review process consists of conducting one-on-one cognitive interviews with 20 patients by a professional interviewer; backward translation by a native English speaker, which was negotiated with the PISQ-IR Working Group comprised original authors in International Urogynecological Association (IUGA). RESULTS: The PISQ-IR Working Group generally approved our translation and had 2 major concerns in the Japanese version; 1) "disagree" in every sentence of English version was not translated into Japanese, and 2) the Japanese expression in "sexual desire" should be more emotional. The former concern was approved by explaining that Japanese does not have the word which is the equivalent of "disagree", and "don't agree" is always used instead of "disagree". The latter concern was compromised by switching to a translation using emotional words. CONCLUSION: The Japanese version of PISQ-IR was translated in a linguistically valid manner. It would be equivalent to the original English questionnaire. It may provide a tool to assess sexual function for Japanese women with prolapse, urinary incontinence and/or fecal incontinence in an internationally harmonized fashion.

Whole genome analysis from microdissected tissue revealed adult supratentorial grade II-III gliomas are divided into clinically relevant subgroups by genetic profile.

BACKGROUND: Gliomas are classified into pathologically defined subgroups. However, the tumors in the same entity could show varied 'clinical courses. Recently, various studies revealed that genetic analyses of gliomas can provide clinically relevant information. OBJECTIVE: To investigate the correlation between genetic characterization and clinical information of adult supratentorial grade II-III gliomas to establish a genetic classification of these tumors. METHODS: We analyzed the genetic profile of tumor samples microdissected from formalin-fixed archival tissue sections based on the defined selection criteria of tumor region using a comparative genomic hybridization method. We collected genetic and clinical data from 140 adult supratentorial gliomas of World Health Organization grade II-III and classified the tumors analyzed into subgroups according to chromosomal copy number aberrations. The relationship between histologic or genetic subclassification and clinical features was analyzed. RESULTS: The tumors were classified into subgroups based on the genetic profiles. Tumors with +7q and those with -1p/19q showed long progression-free survival, and loss of 10q in association with gain of 7p (+7/-10q) appeared to predict poor outcome. Most tumors with histologic diagnosis of glioblastoma showed +7/-10q; however, World Health Organization grade II-III gliomas contained a variety of genetic subgroups that correlated well with the clinical course, and this might explain why these tumors do not respond uniformly to therapies. CONCLUSION: Our pilot study suggests that care must be taken in clinical studies of these tumors because, unlike glioblastoma, grade II-III tumors may contain genetically distinct subgroups with different sensitivity to the therapies.

Validity of retrospective review of medical records as a means of identifying adverse events: comparison between medical records and accident reports.

AIMS: This study was undertaken to investigate whether the adverse events recorded in accident reports could be properly identified by a retrospective review of medical records. METHODS: In an acute-care hospital, a retrospective review of 200 medical records, consisting of the medical records for the 100 cases for which accident reports were reported and an additional 100 cases extracted at random from the medical records of patients discharged in FY 2002, was conducted. The retrospective review of the medical records consisted of two stages. In the first stage, the medical records were screened by a nurse leader (Review A) and by a group of nurses trained by the nurse leader (Review B). In the second stage, a doctor review team determined the presence of adverse events. RESULTS: Of the 61 accident reports that satisfied at least one of the 18 criteria to screen potential adverse events, 28 were ultimately judged to be adverse events in this study. Of these 28 events, Review A identified 25 (89.3%) and Review B identified 24 (85.7%). One adverse event was overlooked during Review A, and two events were overlooked during Review B. The two adverse events not identified by either Review A or Review B were not adequately described in the medical records. CONCLUSIONS: Some adverse events could not be identified by retrospective reviews of medical records, partly because of inadequate descriptions. However, when adequate information was available, adverse events could be identified with a very high degree of accuracy.

Economic evaluation of drug-eluting stents in Japan.

Stenting with a sirolimus-eluting stent (SES) dramatically reduces the risk of restenosis compared to bare metal stent (BMS) implantation. However, before SES can be widely adopted in clinical practice, it is essential to conduct an economic evaluation of this effective but expensive device. Our study was undertaken to estimate the three-year cumulative medical costs of stenting using SES compared to BMS. The data on clinical sequelae of stenting using BMS were derived from our previous study, based on data collected from three Japanese hospitals. We estimated that the probability of PTCA required for revascularization would be 0.224 times in SES implantation compared than in BMS implantation based on the SIRIUS study result. The medical costs for procedures were obtained from published articles and were adjusted to the March 2005 level. Our simulation showed the expected three-year cumulative medical cost per patient to be approximately 200,000 yen lower in the SES group(2,233,000 yen ) than in the BMS group (2,431,000 yen ). Sensitivity analyses with different presumptions confirmed that the economic advantage of SES over BMS was quite robust. We concluded that the use of SES would be a cost-saving option as compared with BMS implantation within the context of the Japanese healthcare system.

Gerontological nursing content in baccalaureate nursing programs: comparison of findings from 1997 and 2003.

In 2003, the John A. Hartford Foundation Institute for Geriatric Nursing (Hartford Institute), in collaboration with the American Association of Colleges of Nursing, conducted a survey of baccalaureate schools of nursing in the United States to compare gerontological content to baseline data collected by the Hartford Institute in 1997. Since last surveyed in 1997, baccalaureate nursing programs have been the recipients of substantial new resources and initiatives focused on gerontological curriculum enhancement. While these initiatives are ongoing, and some are in an early stage of development, resurveying baccalaureate programs was seen as a means of taking a midcourse "pulse" as to the effectiveness of these efforts. Data suggest that there has been a fundamental shift in baccalaureate curriculum toward incorporation of a greater amount of gerontological content, integration of gerontological content in a greater number of nursing courses, and more diversity of clinical sites used for gerontological clinical experiences. As baccalaureate programs increasingly address the need to enhance gerontological nursing curricula, there continues to be an obligation to address the growing shortage of faculty with qualifications in gerontological nursing.

[Methodology of retrospective chart review to detect adverse events: the reliability of physician judgment].

PURPOSE: To establish a scientific basis for promoting patient safety, basic information related to the incidence of adverse events (AEs) is needed. In studies in several other countries, trained nurses screened for potential AEs using explicit criteria in the first stage, and physicians reviewed selected charts in the second stage. To assure the accuracy of retrospective chart review, it is important to verify the reliability of AE judgments by physician reviewers. The purpose of this study was to test this reliability of judgment of AEs (their presence, causation of healthcare management and preventability) by three physician reviewers. METHODS: This study used 100 selected charts of non-psychiatric inpatients in an acute care hospital. Three physicians independently assessed AEs and discussed their judgments with the physician who created the manual for judging AEs. We considered judgments of the AEs agreed on by the four physicians to be final AE judgments and compared the reliability of each measure related to AE judgments among the physician reviewers using the kappa statistic. RESULTS: The number of AE cases each physician reviewer judged ranged from 18 to 27. Agreement on the presence of an AE ranged from 83.0% to 90.0% (kappa=0.52-0.70). Ultimately, AEs were judged to have occurred in 16 cases while 7 cases were deferred. The agreement on the presence of an AE between the physician's and the final judgment ranged from 86.0% to 96.8% (kappa = 0.56-0.88). However, agreement on the causation of healthcare management and preventability between the physician's and the final judgment was not in the acceptable range. CONCLUSION: The reliability of each physician's judgments regarding the presence of an AE was satisfactory. However, the reliability of judgments related to the causation of health care management and preventability was not necessarily satisfactory. Therefore, it is considered important to judge causation and preventability based on discussion with clinical experts in the relevant field.

Assessing pain as a fifth vital sign in long-term care facilities: Recommendations from the field.

In long-term care facilities, pain management is complex because dementia, delirium, and other reasons for residents' altered communication ability are a significant barrier to pain assessment. The purpose of this study was to explore the status of implementation of pain as a fifth vital sign in a sample of long-term care facilities. A three-round Delphi survey was used to obtain consensus from personnel in 60 long-term care facilities in NY State. Findings are presented in terms of recommendations related to pain criteria, assessment methods, frequency of pain assessment, responsibility for pain assessment, monitoring strategies, education, documentation, and pain management education. The results of this study highlight many important considerations in the treatment of pain as a fifth vital sign in long-term care facilities. Evidence-based practice will be facilitated by further research related to underexplored aspects of pain assessment and management, and further attention to care delivery systems that support continued knowledge acquisition and the implementation of best practices.

Nurses Improving Care to Health System Elders (NICHE): implementation of best practice models.

Nurses Improving Care to Health System Elders (NICHE) is a comprehensive program that hospitals use to foster system-wide improvements in the care of older patients. The authors report on a survey of 103 NICHE hospitals to determine perceptions of the NICHE program, the adoption of NICHE models and protocols, and the educational outcomes, policy changes, and benchmarks related to care of older patients established by the participating NICHE hospitals.

Utilization of nurse practitioners in long-term care: findings and implications of a national survey.

OBJECTIVES: The objective of this study was to determine the national practice patterns of nurse practitioners (NPs) providing care in long-term care (LTC) facilities, including the number and characteristics of LTC facilities that use NPs for any portion of care to residents, NP activities, and employment arrangements between NPs, physicians, and facilities. DESIGN: Mailed survey. PARTICIPANTS: Participants included all physicians who are members of the American Medical Directors Association (AMDA). MEASUREMENT: The survey instrument was constructed to obtain information in the following six domains: (1) the number of LTC facilities that have NPs involved in providing care; (2) the number of NPs engaged in care at these facilities; (3) the types of employment/financial arrangements between NPs and LTC facilities; (4) the types of services provided by the NPs; (5) the effectiveness of the NPs as perceived by the medical directors; and (6) the perceived future demand for NPs in LTC. RESULTS: Of a total of 870 respondents (response rate 19%), 546 respondents (63%) reported the involvement of NPs in the care of residents in their facilities. In total, respondents identified 1160 NPs involved in care, with a median of two NPs per responding facility (range, 1-10). Respondents reported that NPs make sick/urgent resident visits (96%), provide preventive care to long-stay residents (88%), and perform alternating required regulatory 30/60 (88%), hospice care (80%), and wound care (78%). Significant variations in practice patterns were found between NPs employed by a LTC facility (19% of respondents) as compared with those NPs employed in other arrangements. Large majorities of medical directors stated that NPs are particularly effective in maintaining physician satisfaction (90%), resident satisfaction (87%), and family satisfaction (85%). An additional 34% of the respondents projected an increased need for NPs in nursing homes in the future. CONCLUSION: NPs involved in LTC are more likely to be involved in the care of residents in the nation's larger (>100-bed) LTC facilities. The substantial number and types of services provided by these NPs, coupled with the high resident, family, and physician satisfaction with their services, suggests the need for educational, policy, and reimbursement strategies to encourage the further involvement of NPs in the care of residents in nursing homes.