Certification Survey Research Articles

Does Dialysis Therapy Cause Cognitive Impairment in Older Adults? A Propensity Score Matching Retrospective Study From a Japanese Long-Term Care Insurance Certification Survey.

This study explored the longitudinal connection between dialysis therapy in older adults and the incidence of cognitive impairment, and trends of general abilities. We conducted a retrospective propensity score matching (PSM) analysis of data from the care-needs certification survey in City A, Japan, spanning 2017 to 2021. Our sample comprised 11 443 initially cognitively intact older adults from the baseline year 2017. Among them, individuals had received dialysis therapy at baseline, and 216 individuals were included after PSM. The dialysis group had a significantly lower incidence of cognitive impairment during follow-up than the control group (P = 0.02). The competing risk of death was significantly higher in the dialysis group than in the control group (P < .001). Both groups showed a decline in their comprehensive ability over the time. There have been several reports of a negative association between dialysis and cognitive impairment, but more detailed investigation of the longitudinal relationship may be needed. Comprehensive support remains critical for both dialysis and non-dialysis older adults.

Earthquake damage detection and level classification method for wooden houses based on convolutional neural networks and onsite photos

AbstractThe results of earthquake damage certification (EDC) surveys are the basis of support measures for improving the lives of disaster victims. To address issues such as a limited workforce to perform EDC surveys and difficulties in judging the level of damage, a damage detection and level classification method for wooden houses using multiple convolutional neural network models is proposed. The proposed method, including detection, filtering, and classification models, was trained and validated based on photographs collected from EDC surveys in Uki City, Kumamoto Prefecture. Then, a software system, which deployed these models, was developed for the onsite EDC surveyors to detect damages shown in the photographs of the surveyed house and classify damage levels. The test results based on 32 target buildings indicate that the detection model achieved high recall in detecting damage. Moreover, the redundant detected regions can be precisely filtered by the filtering model. Finally, the classification model achieved relatively high overall accuracy in classifying the damage level.

NURSING HOME CLOSURES DURING THE COVID-19 PANDEMIC

Abstract Nursing homes experienced unprecedented financial challenges during the COVID-19 pandemic, raising concerns about closures. This study identified closures from 2020-2021 using certification surveys and examined characteristics associated with closures using multivariate analysis. We interviewed nursing home industry experts and providers about pandemic-related challenges and policies affecting closure. Closures did not increase in 2020 and 2021 relative to 2011-2019. However, nursing homes with more staff shortages and COVID-19 infections were more likely to close. Additional characteristics associated with closure include smaller size, lower occupancy rate, and fewer Medicare residents. Interviews noted the following financial challenges: costly contract staffing, increased PPE and COVID-19 testing costs, reduced occupancy rates, and increased internal resources needed to implement new infection guidance. Interviews suggested that strategies to mitigate staffing shortages and federal and state monetary assistance may have prevented closures in 2020 and 2021, but continuing attention to closures is needed in 2022 and 2023 as funding ends.

Evaluation of the Influence of Clinical History on the Occurrence of Dementia Using the Database of National Health Insurance in Japan

The global incidence of dementia has been rising for the past several years, posing significant health challenges regarding its management and prevention. Dementia is associated with a substantial burden on patients and their families. Therefore, effective, evidence-based preventive strategies are required for dementia. To achieve this, the predisposing factors for dementia and their relationship with other diseases need to be determined. Japan has a universal health insurance system and these data have been stored in their respective databases since 2008. Herein we explored the influence of clinical history on the occurrence of dementia based on data collected by the National Health Insurance in Japan and Municipal Care Certification Survey over the past 10 years. Multivariate logistic regression analysis was used to determine the factors from clinical history that affect the risk of dementia development. A significant odds ratio was observed for the development of dementia in 5-year data, involving the clinical history of osteoporosis, depression, internal carotid artery occlusion, schizophrenia, and Parkinson’s disease. In addition, a significant odds ratio was observed for the development of dementia in 10-year data, involving the clinical history of osteoporosis, cataracts, and schizophrenia.

Exploring Nurses' Perceptions of Specialty Certification.

The strategic nursing plan for a large Midwestern health care system includes achievement of the American Nurses Credentialing Center's Magnet® recognition for all their hospitals. This study explored the barriers to and perceived value of certification among nurses employed by the same health care system across eight facilities in a metropolitan region. One of these facilities holds Magnet® recognition. Subjects were recruited by direct email to collect demographic data and complete a barrier to certification survey and the Perceived Value of Certification Tool-12. There were statistically significant differences in the perception that lack of institutional support is a barrier to certification both in aggregate and when comparing the Magnet® hospital with the others. As an initial exploration into barriers and perceived value, this study provides data for this health care system to plan strategies to promote certification. This study also serves as an exemplar for other organizations considering evaluation of certification barriers and value among their nursing staff. [J Contin Educ Nurs. 2023;54(12):567-573.].

Backscattering Characteristics of SAR Images in Damaged Buildings Due to the 2016 Kumamoto Earthquake

Most research on the extraction of earthquake-caused building damage using synthetic aperture radar (SAR) images used building damage certification assessments and the EMS-98-based evaluation as ground truth. However, these methods do not accurately assess the damage characteristics. The buildings identified as Major damage in the Japanese damage certification survey contain damage with various characteristics. If Major damage is treated as a single class, the parameters of SAR images will vary greatly, and the relationship between building damage and SAR images would not be properly evaluated. Therefore, it is necessary to divide Major damage buildings into more detailed classes. In this study, the Major damage buildings were newly classified into five damage classes, to correctly evaluate the relationship between building damage characteristics and SAR imagery. The proposed damage classification is based on Japanese damage assessment data and field photographs, and is classified according to the dominant damage characteristics of the building, such as collapse and damage to walls and roofs. We then analyzed the backscattering characteristics of SAR images for each classified damage class. We used ALOS-2 PALSAR-2 images observed before and after the 2016 Kumamoto earthquake in Mashiki Town, where many buildings were damaged by the earthquake. Then, we performed the analysis using two indices, the correlation coefficient R and the coherence differential value γdif, and the damage class. The results indicate that the backscattering characteristics of SAR images show different trends in each damage class. The R tended to decrease for large deformations such as collapsed buildings. The γdif was likely to be sensitive not only to collapsed buildings but also to damage with relatively small deformation, such as distortion and tilting. In addition, it was suggested that the ground displacement near the earthquake fault affected the coherence values.

Risk factors for nursing home admission among older adults: Analysis of basic movements and activities of daily living.

This retrospective study aimed to clarify the risk of older adults' nursing home placement in terms of basic movements and activities of daily living (ADLs) by analyzing data from a long-term care insurance certification survey in 2016‒2018 in City A. Of the 21,520 people certified as needing care, 16,865 could be followed up until 2018. Data on sex, age, household structure, and level of care required were obtained. Those who lived at home and at nursing homes were categorized as the "Unchanged group" and the "Changed group," respectively. Multivariate binomial logistic regression analysis was performed, with group type as the dependent variable and basic movement and ADL scores as the independent variables. For factor analysis according to care level, participants were classified into support need levels 1 and 2, care need levels 1 and 2, and care need levels 3, 4, and 5. For those categorized into support need levels 1 and 2, standing on one leg and transferring (basic movements) and urination and face cleaning (ADLs) were associated with nursing home placement. For those in care need levels 1 and 2, getting up and transferring (basic movements) and bathing, urination, face cleaning, and hair styling (ADL) were significantly associated with nursing home placement. For those in care need levels 3, 4, and 5, sitting and transferring (basic movements) and self-feeding and defecation (ADL) were significant. Occupational therapists must focus on older adults' declining ADLs and basic movements and relay the necessary information to patients, families, and other healthcare professionals to ensure appropriate and prompt care delivery.

ASSESSING THE FACTORS ASSOCIATED WITH NURSING HOME CLOSURES

Abstract The media has reported recent increases in nursing home closures. This study examined closures from 2011-2019, identified facility and market characteristics associated with closures, and assessed the impact of closures on quality and access. We identified closures using termination dates and gaps in certification surveys and conducted descriptive and multivariate analysis. We identified 1,220 closures, with large increases in closure rates in 2018 and 2019 and geographic clusters. Chain facilities, urban facilities and smaller facilities were more likely to close, as were facilities with higher percentages of non-white and Medicaid residents. Staffing and quality five-star ratings had a nonlinear relationship with closure, which suggests Medicaid funding may impact closures rates. We found both the number of beds per 1,000 elderly and occupancy rates decreased, including in high-quality facilities. Closures should be examined further in the context of the COVID-19 pandemic.

ASCP Board of Certification Survey of Medical Laboratory Science Education 2020: Faculty.

ASCP Board of Certification Survey of Medical Laboratory Science Education 2020: Faculty.

ASCP Board of Certification Survey of Medical Laboratory Science Education 2020: Programs.

ASCP Board of Certification Survey of Medical Laboratory Science Education 2020: Programs.

Factors Affecting Care-Level Deterioration among Older Adults with Mild and Moderate Disabilities in Japan: Evidence from the Nationally Standardized Survey for Care-Needs Certification.

This study aims to investigate the factors of care-level deterioration in older adults with mild and moderate disabilities using nationally standardized survey data for care-needs certification. We enrolled people aged 68 years or older, certified as support levels 1–2 (mild disability) or care levels 1–2 (moderate disability) with no cancer. The outcome was care-level deterioration after two years. The possible factors were physical and mental functions which were categorized as the following five dimensions according to the survey for care-needs certification: body function, daily life function, instrumental activities of daily living (IADL) function, cognitive function, and behavioral problems. A multivariate logistic regression analysis was conducted after stratifying the care level at baseline. A total of 2844 participants were included in our analysis. A low IADL function was significantly associated with a risk of care-level deterioration in all participants. In addition, low cognitive function was linked to care-level deterioration, except for those with support level 1 at baseline. Participants with more behavioral problems were more likely to experience care-level deterioration, except for those with care level 2 at baseline. Our study showed the potential utility of the care-needs certification survey for screening high-risk individuals with care-level deterioration.

Long-Term Changes in Older Adults' Independence Levels for Performing Activities of Daily Living in Care Settings: A Nine-Year Follow-Up Study.

This study aimed to clarify the variability in the independence profiles of specific activities of daily living (ADL) among older men and women. The research subjects were 5872 older adults (1143 men and 4729 women) certified as requiring nursing care or support (based on data obtained from the nursing care insurance certification survey database) who could be surveyed in both 2009 and 2018. Using item response theory, this study compared longitudinal data of difficulties faced by older adults during ADL. The results indicated that among the long-term care insurance-certified persons, in 2009, men had higher ADL difficulty than women in all ADL items, and in 2018, there was no significant difference in items other than dressing and excretion. Furthermore, the difference in the rate of ADL difficulty level over 9 years was significantly higher in women than in men. It was shown that the progression of ADL disability due to aging is faster in men on a yearly basis, but it increases in women with aging. Therefore, it was suggested that the rate of ADL difficulty varies depending on age and sex.

Nursing home care under Medicaid managed long-term services and supports.

To measure the impact of Medicaid managed long-term services and supports (MLTSS) on nursing home (NH) quality and rebalancing. This study analyzes secondary data from annual NH recertification surveys and the minimum dataset (MDS) in three states that implemented MLTSS: Massachusetts (2001-2007), Kansas and Ohio (2011-2017). We utilized a difference-in-difference approach comparing NHs in border counties of states that implemented MLTSS with a control group of NHs in neighboring border counties in states that did not implement MLTSS. Sensitivity analyses included a triple-difference model (stratified by Medicaid payer mix) and a within-state comparison. We examined changes in six NH-level outcomes (percentage of low-care NH residents, facility occupancy, and four NH quality measures) after MLTSS implementation. For each state, all freestanding NHs in border counties were included, as were NHs in neighboring counties located in other states. Information on low-care residents was aggregated to the NH level from MDS data, then combined with Online Survey Certification and Reporting (OSCAR) and Certification and Survey Provider Enhanced Reporting (CASPER) data. MLTSS had no statistically significant effects on NH quality outcomes in Massachusetts or Kansas. In Ohio, MLTSS led to an increase of 0.21 nursing hours per resident day [95% CI: 0.03, 0.40], and a decrease of 1.47 deficiencies [95% CI: -2.52, -0.42] and 9.38 deficiency points [95% CI: -18.53, -0.24] per certification survey. After MLTSS, occupancy decreased by 1.52 percentage points [95% CI: -2.92, -0.12] in Massachusetts, but increased by 3.17 percentage points [95% CI: 0.36, 5.99] in Ohio. We found no effect on low-care residents in any state. Findings were moderately sensitive to the choice of comparator group. The study provides little evidence that MLTSS reduces quality of care, occupancy, or the percentage of low-care residents in NHs.

Risk Factors for Dementia Incidence Based on Previous Results of the Specific Health Checkups in Japan.

Dementia is a common disease in elderly people, with its prevalence expanding rapidly worldwide. Longitudinal and cohort studies on lifestyle and health conditions are needed to identify the risk of dementia. This study aimed to identify the risk factors for dementia incidence in Japan and to clarify the strategy for its primary care. In this study, an analysis was performed to investigate the association between the cognitive faculty level of the long-term care certification survey and the previous results of the specific health checkups in Japan. To investigate the risk factor for dementia incidence, a multivariable logistic regression analysis was performed, which showed a significant odds ratio for the incidence of dementia for two items, including abdominal circumference and insulin injections or oral hypoglycemic medications. The findings of our study suggested that a lower abdominal circumference had a higher risk for dementia incidence, and individuals who received insulin injections or oral hypoglycemic medications had a higher risk for dementia incidence based on the results of the health checkups conducted 10 years previously. Further, longer duration study with a larger sample is needed to identify the items from the specific health checkups that are associated with the risk of dementia.

Causes of changes in basic activities of daily living in older adults with long-term care needs.

To elucidate basic activities of daily living (BADL) changes, and the causes, in older adults with long-term care needs. This retrospective study utilised long-term care insurance (LTCI) certification survey data from 2010 to 2017 in City A. In decreasing likelihood of requiring assistance, BADL items were grooming, bathing, getting dressed/undressed, mobility, toilet hygiene, functional mobility and self-feeding. Cox proportional hazard regression indicated that age correlated with need for assistance for all BADL items. Male sex corresponded to needing assistance with BADL items other than grooming and functional mobility. Shared living corresponded to needing assistance with BADL items other than grooming and bathing. Visual acuity corresponded to needing assistance with grooming. The most significant result was using survival curves to visualise the changes in BADL items of older adults with LTCI. These findings could help develop rehabilitation programs to prevent the need for BADL assistance in older adults.

Allostatic load in the association of depressive symptoms with incident coronary heart disease: The Jackson Heart Study

African Americans are at heightened risk for coronary heart disease (CHD), with biologic pathways poorly understood. We examined the role of allostatic load (AL) in the association of depressive symptoms with incident CHD among 2,670 African American men and women in the prospective Jackson Heart Study. Depressive symptoms were quantified using the Center for Epidemiologic Studies Depression Scale (CES-D). Incident CHD was ascertained by self-report, death certificate survey, and adjudicated medical record surveillance. Baseline AL was quantified using biologic parameters of metabolic, cardiovascular, immune, and neuroendocrine subsystems and as a combined meta-factor. Sequential models adjusted for demographic, socioeconomic, and behavioral covariates, stratified to examine differences by sex. Greater depressive symptomatology was associated with greater metabolic, cardiovascular, and immune AL (p-values≤0.036) and AL meta-factor z-scores (p = 0.007), with findings driven by observations among females. Each 1-point increase in baseline depressive symptomatology, and 1-SD increase in metabolic AL, neuroendocrine AL, and AL meta-factor z-scores was associated with 3.3%, 88%, 39%, and 130% increases in CHD risk, respectively (p-values <0.001). Neuroendocrine AL and AL meta-factor scores predicted incident CHD among males but not females in stratified analyses. Metabolic AL partially mediated the association of depressive symptoms with incident CHD (5.79% mediation, p = 0.044), a finding present among females (p = 0.016) but not males (p = 0.840). Among African American adults, we present novel findings of an association between depressive symptomatology and incident CHD, partially mediated by metabolic AL. These findings appear to be unique to females, an important consideration in the design of targeted interventions for CHD prevention.

ASCP Board of Certification Survey of Medical Laboratory Science Faculty.

ASCP Board of Certification Survey of Medical Laboratory Science Faculty.

ASCP Board of Certification Survey of Medical Laboratory Science Education Programs.

ASCP Board of Certification Survey of Medical Laboratory Science Education Programs.

Impact of Outpatient Rehabilitation Service in Preventing the Deterioration of the Care-Needs Level Among Japanese Older Adults Availing Long-Term Care Insurance: A Propensity Score Matched Retrospective Study.

Outpatient rehabilitation (OR) and outpatient day long-term care (ODLC) services are frequently used by older adult patients in Japan. However, there is a need to clarify that OR service, which has more rehabilitation professionals than ODLC, has the role of providing rehabilitation. This retrospective study examined the impact of OR services by comparing the two services based on City A data from the care-needs certification survey conducted between 2015 to 2017. We performed a propensity score matched analysis to compare the changes in the care level and function of OR and ODLC users after two years. The results showed that OR users showed a lower deterioration in care levels and less decline in the activities of daily living (ADL) in dementia and adaptation to social life. In the analysis of older adults requiring support, OR users had a lower deterioration in care levels and less decline in the ADL in dementia and behavioral and psychological symptoms than ODLC users did. There was no difference between the two services with respect to older adults requiring long-term care. The OR service has had an increasingly preventive effect on the deterioration of care levels compared to the ODLC service, which was particularly evident in older adults requiring support.

Abstract WP504: Utilizing a Nurse Driven Hand off Tool to Improve Neuro Interventional Post Procedural Documentation

Introduction: In preparation for Comprehensive Stroke Certification (CSC) survey, auditing of pre-, intra-, and post-procedural documentation of neuro-interventional (NIR) angiograms was performed. Auditing identified post-procedural documentation was not consistent with physician orders or clinical practice guidelines (CPG) designated by the Joint Commission. Nursing developed a post-procedure tool to improve nurse to nurse hand-off and documentation compliance. Methods: A post-procedure tool was developed for nurse hand-off when transferring patients from NIR to Critical Care. The one-page tool contained the type of procedure performed, post procedure orders, time of sheath removal, type of required documentation (vital signs, neurological and neurovascular exams), and time-frame grid when documentation was due. Also included was criteria for issues requiring physician notification and management of groin hematoma flow chart. Results: Initial audits revealed virtually no post assessments were documented 100% correctly per order. After implementation and during time of CSC survey, auditing revealed an improvement to only 31%, but demonstrated a significant improvement from having substantial assessments missing to only 1-2 items. The CSC designation was granted with a requirement for improvement (RFI) to improve documentation. Additional focused auditing identified at-risk time frames, and specific assessments and staff locations to target further education. Editing of the tool was made with suggestions from nursing. Jan-Jun 2017 auditing demonstrated &gt;80% compliance in all three assessment requirements with June having 91% neuro assessments documented, and 100% with neurovascular and vital signs documented appropriately for the required six hours of focused assessments. Nurses feel the tool has improved communication and provides a better hand-off between NIR and Critical Care. Conclusions: Compliance with orders and CPG required documentation, as well as improved nurse to nurse hand-off can be achieved utilizing a comprehensive tool identifying the type of assessment and designated time assessments are required.