Veterans Home Research Articles

The effects of a Simplified Tai-Chi Exercise Program (STEP) on the physical health of older adults living in long-term care facilities: A single group design with multiple time points

Background Studies support the positive effects that Tai Chi has on the physical health of older adults. However, many older adults residing in long-term care facilities feel too weak to practice traditional Tai Chi, and a more simplified style is preferred. Objective To test the effects of a newly-developed, Simplified Tai-Chi Exercise Program (STEP) on the physical health of older adults who resided in long-term care facilities. Design A single group design with multiple time points: three pre-tests, one month apart; four post-tests at one month, two months, three months, and six months after intervention started. Settings Two 300–400 bed veteran homes in Taiwan. Participants The 51 male older adults were recruited through convenience sampling, and 41 of them completed six-month study. Inclusion criteria included: (1) aged 65 and over; (2) no previous training in Tai Chi; (3) cognitively alert and had a score of at least eight on the Short Portable Mental Status Questionnaire; (4) able to walk without assistance; and (5) had a Barthel Index score of 61 or higher. Participants who had dementia, were wheel-chair bound, or had severe or acute cardiovascular, musculoskeletal, or pulmonary illnesses were excluded. Methods The STEP was implemented three times a week, 50 min per session for six months. The outcome measures included cardio-respiratory function, blood pressure, balance, hand-grip strength, lower body flexibility, and physical health actualization. Results A drop in systolic blood pressure ( p = . 017 ) and diastolic blood pressure ( p<.001) was detected six months after intervention started. Increase in hand-grip strength from pre to post intervention was found (left hand: p<.001; right hand: p = . 035 ). Participants also had better lower body flexibility after practicing STEP ( p = . 038 ) . Conclusions Findings suggest that the STEP be incorporated as a floor activity in long-term care facilities to promote physical health of older adults.

A Multifaceted Intervention to Implement Guidelines Improved Treatment of Nursing Home–Acquired Pneumonia in a State Veterans Home

To assess the feasibility of a multifaceted strategy to translate evidence-based guidelines for treating nursing home-acquired pneumonia (NHAP) into practice using a small intervention trial. Pre-posttest with untreated control group. Two Colorado State Veterans Homes (SVHs) during two influenza seasons. Eighty-six residents with two or more signs of lower respiratory tract infection. Multifaceted, including a formative phase to modify the intervention, institutional-level change emphasizing immunization, and availability of appropriate antibiotics; interactive educational sessions for nurses; and academic detailing. Subjects' SVH medical records were reviewed for guideline compliance retrospectively for the influenza season before the intervention and prospectively during the intervention. Bivariate comparisons-of-care processes between the intervention and control facility before and after the intervention were made using the Fischer exact test. At the intervention facility, compliance with five of the guidelines improved: influenza vaccination, timely physician response to illness onset, x-ray for patients not being hospitalized, use of appropriate antibiotics, and timely antibiotic initiation for unstable patients. Chest x-ray and appropriate and timely antibiotics were significantly better at the intervention than at the control facility during the intervention year but not during the control year. Multifaceted, evidence-based, NHAP guideline implementation improved care processes in a SVH. Guideline implementation should be studied in a national sample of nursing homes to determine whether it improves quality of life and functional outcomes of this debilitating illness for long-term care residents.

Prevalence and risk factors for depressive symptoms among veterans home elders in Eastern Taiwan

Depression in the elderly has become a serious health care issue worldwide. However, no studies have determined the prevalence and risk factors for depressive symptoms among a representative sample of veterans home elders in Taiwan. To determine the prevalence and risk factors for depressive symptoms among veterans home elders in eastern Taiwan. Elderly veterans (n = 947) were recruited from four veterans homes in eastern Taiwan. The prevalence of depressive tendency was 35.5%. Logistic regression analysis demonstrated that depressive status in this sample was significantly predicted by poorer functional status, dissatisfaction with living situation, poorer perceived health status, and lower education level. The risk factors for depressive symptoms identified in this study need to be considered when assessing the health of elderly veterans. In addition, strategies to improve elderly veterans' perception of health status, physical function and living situation should be considered in interventions to reduce their depressive symptoms.

Severe hypercalcemia after transition from calcium carbonate to calcium citrate in an elderly woman treated with ergocalciferol 50,000 IU per day

Background: Absorption of calcium carbonate in the fasting state has been reported to be significantly compromised in subjects with achlorhydria. Although calcium carbonate malabsorption in the fasting state cannot be predicted, it might be corrected if the compound is administered with meals. However, administering calcium carbonate with meals is logistically challenging in long-term care facilities. Objective: The aim of this study was to report the case of a woman who was transitioned to calcium citrate and subsequently experienced symptomatic severe hypercalcemia. Methods: An 89-year-old female resident of the Wisconsin Veterans Home, a skilled nursing facility in King, Wisconsin, was receiving long-term treatment with ergocalciferol (vitamin D 2) 50,000 IU/d. The patient also was receiving calcium carbonate supplements in the morning, and she rarely ate breakfast (fasting state). The patient was transitioned from 2000 mg/d of elemental calcium as carbonate to 1230 mg/d as citrate. Results: After being switched from calcium carbonate to calcium citrate, the patient developed severe symptomatic hypercalcemia (16.8 mg/dL), the primary cause of which was the administration of an inappropriately high dose of vitamin D. Conclusions: We report a case of symptomatic severe hypercalcemia in a skilled nursing facility resident treated with an inappropriately high daily dose of vitamin D. Hypercalcemia manifested when calcium carbonate was replaced with calcium citrate. .

Use of the Quality Improvement Process in Assessing End-of-Life Care in the Nursing Home

To report on the process and effect of a quality improvement project on end-of-life (EOL) care in a state veterans' home. The design uses survey data from representatives of the deceased, continuous quality improvement (QI) techniques, and interdisciplinary team activities. Representatives of the deceased were surveyed using a tool that assessed symptom management, emotional states, hospice use, and satisfaction with the care provided by the home and the hospice. Using the results of the survey, the interdisciplinary EOL care team used continuous QI methods to improve EOL care. Representatives of the deceased of the Thomas Fitzgerald State Veterans Home (TFVH) and the interdisciplinary EOL care team of TFVH, which included staff of TFVH and the hospices serving TFVH. The compiled survey results were compared from year to year to assess trends in the following areas: overall quality of care, pain, dyspnea, other uncomfortable symptoms, emotional need, and spiritual needs. We also assessed the degree of depression, agitation and anxiety, loneliness, and preparation and preparedness of the member for death. We surveyed for ratings on the satisfaction with staff, clergy and hospice, clarity of explanations and information provided by TFVH staff, what disciplines provided the emotional and spiritual support for the resident, whether discussions were held about advance directives, if they would recommend TFVH to other families, and use of/satisfaction with the hospice that served their loved one. The survey return rate was 8 (38%) (2000), 22 (73%) (2001), and 25 (55%) (2002). The specific areas that were improved per the survey results (which also correlated with staff perceptions) were the following: overall quality of care, spiritual care, distribution of work load, and patients' preparedness for death. The prevalence of symptoms was reduced by 22% (pain), 25% (dyspnea), and 30% (uncomfortable symptoms of dying). A marked improvement of involvement of clergy in the spiritual care was also noted. The survey process also identified areas that did not improve or worsened such as management of depression, agitation, anxiety, loneliness, family education, and discussions. During the 2000-2002 time period, an average of 83% of the representatives responded that they would recommend the TFVH to another family. EOL care in nursing homes is rated lower than care in all other venues and must be improved. EOL care can be improved using patient representative surveys as the springboard for staff and hospice interdisciplinary team QI processes. The interdisciplinary team must include the care staff of the home along with hospices serving the institution. We present here one process that we have found effective in improving EOL care. The critical issue is the dedication of the institution and staff to improve EOL care rather than the manner in which it is accomplished.

Use of the Quality Improvement Process in Assessing End-of-Life Care in the Nursing Home

<h3>Objective</h3> To report on the process and effect of a quality improvement project on end-of-life (EOL) care in a state veterans' home. <h3>Design</h3> The design uses survey data from representatives of the deceased, continuous quality improvement (QI) techniques, and interdisciplinary team activities. Representatives of the deceased were surveyed using a tool that assessed symptom management, emotional states, hospice use, and satisfaction with the care provided by the home and the hospice. Using the results of the survey, the interdisciplinary EOL care team used continuous QI methods to improve EOL care. <h3>Participants</h3> Representatives of the deceased of the Thomas Fitzgerald State Veterans Home (TFVH) and the interdisciplinary EOL care team of TFVH, which included staff of TFVH and the hospices serving TFVH. <h3>Measurements</h3> The compiled survey results were compared from year to year to assess trends in the following areas: overall quality of care, pain, dyspnea, other uncomfortable symptoms, emotional need, and spiritual needs. We also assessed the degree of depression, agitation and anxiety, loneliness, and preparation and preparedness of the member for death. We surveyed for ratings on the satisfaction with staff, clergy and hospice, clarity of explanations and information provided by TFVH staff, what disciplines provided the emotional and spiritual support for the resident, whether discussions were held about advance directives, if they would recommend TFVH to other families, and use of/satisfaction with the hospice that served their loved one. <h3>Results</h3> The survey return rate was 8 (38%) (2000), 22 (73%) (2001), and 25 (55%) (2002). The specific areas that were improved per the survey results (which also correlated with staff perceptions) were the following: overall quality of care, spiritual care, distribution of work load, and patients' preparedness for death. The prevalence of symptoms was reduced by 22% (pain), 25% (dyspnea), and 30% (uncomfortable symptoms of dying). A marked improvement of involvement of clergy in the spiritual care was also noted. The survey process also identified areas that did not improve or worsened such as management of depression, agitation, anxiety, loneliness, family education, and discussions. During the 2000-2002 time period, an average of 83% of the representatives responded that they would recommend the TFVH to another family. <h3>Conclusion</h3> EOL care in nursing homes is rated lower than care in all other venues and must be improved. EOL care can be improved using patient representative surveys as the springboard for staff and hospice interdisciplinary team QI processes. The interdisciplinary team must include the care staff of the home along with hospices serving the institution. We present here one process that we have found effective in improving EOL care. The critical issue is the dedication of the institution and staff to improve EOL care rather than the manner in which it is accomplished.

Use of the Quality Improvement Process in Assessing End-of-Life Care in the Nursing Home

To report on the process and effect of a quality improvement project on end-of-life (EOL) care in a state veterans' home. The design uses survey data from representatives of the deceased, continuous quality improvement (QI) techniques, and interdisciplinary team activities. Representatives of the deceased were surveyed using a tool that assessed symptom management, emotional states, hospice use, and satisfaction with the care provided by the home and the hospice. Using the results of the survey, the interdisciplinary EOL care team used continuous QI methods to improve EOL care. Representatives of the deceased of the Thomas Fitzgerald State Veterans Home (TFVH) and the interdisciplinary EOL care team of TFVH, which included staff of TFVH and the hospices serving TFVH. The compiled survey results were compared from year to year to assess trends in the following areas: overall quality of care, pain, dyspnea, other uncomfortable symptoms, emotional need, and spiritual needs. We also assessed the degree of depression, agitation and anxiety, loneliness, and preparation and preparedness of the member for death. We surveyed for ratings on the satisfaction with staff, clergy and hospice, clarity of explanations and information provided by TFVH staff, what disciplines provided the emotional and spiritual support for the resident, whether discussions were held about advance directives, if they would recommend TFVH to other families, and use of/satisfaction with the hospice that served their loved one. The survey return rate was 8 (38%) (2000), 22 (73%) (2001), and 25 (55%) (2002). The specific areas that were improved per the survey results (which also correlated with staff perceptions) were the following: overall quality of care, spiritual care, distribution of work load, and patients' preparedness for death. The prevalence of symptoms was reduced by 22% (pain), 25% (dyspnea), and 30% (uncomfortable symptoms of dying). A marked improvement of involvement of clergy in the spiritual care was also noted. The survey process also identified areas that did not improve or worsened such as management of depression, agitation, anxiety, loneliness, family education, and discussions. During the 2000-2002 time period, an average of 83% of the representatives responded that they would recommend the TFVH to another family. EOL care in nursing homes is rated lower than care in all other venues and must be improved. EOL care can be improved using patient representative surveys as the springboard for staff and hospice interdisciplinary team QI processes. The interdisciplinary team must include the care staff of the home along with hospices serving the institution. We present here one process that we have found effective in improving EOL care. The critical issue is the dedication of the institution and staff to improve EOL care rather than the manner in which it is accomplished.

WHOQOL-BREF as predictors of mortality: A two-year follow-up study at veteran homes

The main purpose of this study was to evaluate the effectiveness of the brief version of the World Health Organization Quality of Life (WHOQOL-BREF) questionnaire as a predictor of mortality amongst the elderly. A total of 689 male residents of veteran homes, all above the age of 65 years, were randomly selected in 2001. The Taiwan version of the WHOQOL-BREF was administered as the baseline, with each of these subjects being interviewed and subsequently followed up for mortality until the end of 2003. Data on self-reported global health, life satisfaction, medical status, physical performance and health behavior was also collected. Following the death of 105 of the 689 subjects during the 2-year follow-up period, the relative risk (RR) of death was subsequently assessed using Cox's proportional hazard regression analyses. After adjusting for other predictors (age group, chronic diseases, emergency visits, hospitalization, physical performance, regular exercise, self-reported global health and life satisfaction), almost all of the WHOQOL-BREF items and domains failed to predict mortality; the one exception was working capacity levels (score 1-2 vs. score 4-5) which, after adjusting for other predictors, did demonstrate the ability to predict mortality (RR = 1.96, p < 0.05).

RISK OF ACQUIRING INFLUENZA B IN A NURSING HOME FROM A CULTURE‐POSITIVE ROOMMATE

To the editor: It was recently reported that influenza A was cultured in 62 double rooms at the Wisconsin Veterans Home over six seasons. The roommate was infected in 12 (19.4%). During 3,294 resident-seasons, influenza was cultured in 208 single rooms (6.3%). Those who lived in double rooms with a culture-positive roommate had a 3.07 relative risk (95% confidence interval=1.61–5.78) of acquiring influenza A.1 Identical methodology was used to analyze the 1992/1993 influenza season, in which influenza B was encountered. Case finding was based on intense prospective surveillance by research staff and has been previously described.2 This study compared the relative risk of influenza B in residents whose roommate had a positive culture with that of those who resided in single rooms. It is possible that a second infected roommate became infected outside of the room. To control for this possibility, the number of single rooms and the number of cases in single rooms each year were determined for comparison. Influenza B was introduced to 29 double rooms. A second culture-confirmed case was noted in 10 (34%). The second cases occurred 0 to 11 days (mean 3.9 days) after the initial case. Seven of these second cases had been vaccinated (70%). Overall, 85% of residents were vaccinated. During 489 resident-seasons in single rooms, influenza was cultured in 65 rooms (13%). Those who lived in a double room with a culture-positive roommate had a relative risk of 2.6 (95% CI=1.2–5.6) of acquiring influenza B compared to those who resided in single rooms As expected, the data confirm a greater relative risk of acquiring influenza B in roommates of residents with influenza B than in residents who did not have roommates. The excess risk associated with having a culture-positive roommate is troublesome because it has been demonstrated that culture-confirmed influenza B was associated with an excess 30-day mortality of 3.9% over baseline mortality (1.5%/30 days) in nursing home residents.3 A private room is optimal, but this is not possible in most nursing homes. Other interventions might include using any curtain or barrier that may exist between roommates. The roommates should be counseled to maintain hand hygiene and 3-foot separation with extra environmental hygiene provided by staff. The unaffected roommate should probably be offered chemoprophylaxis with a neuraminidase inhibitor, even if the entire unit is not placed on chemoprophylaxis. Financial Disclosure(s): PF Krause, LJ Nest, and BM Goodman received no financial support for research, consultantships, or speakers forum and have no company holdings (e.g., stocks) or patents. Dr. Stefan Gravenstein has received financial grants from the National Institutes of Health (NIH) for influenza research (AG 09632 and AG 00584). Dr. Paul Drinka and Dr. Gravenstein previously received financial support from Glaxo Wellcome Laboratories for influenza research. Dr. Drinka was previously on the speakers bureau for influenza for Roche Laboratories. Author Contributions: PJ Drinka, PF Krause, and S Gravenstein have contributed to all aspects of the study concept and design, acquisition of subjects and data, analysis and interpretation of data, and preparation of manuscript. Lori Nest, RN, contributed to the acquisition of subjects and data, as well as analysis and preparation of the manuscript. Brian Goodman, PhD, contributed to the design, analysis, and interpretation of the manuscript. Sponsor's Role: The NIH helped sponsor influenza research (Grants AG 09632 and AG 00584) through Dr. Stefan Gravenstein.

Housing Preferences of Homeless Veterans With Dual Diagnoses

Previous research indicates that most homeless persons with mental illness prefer independent living, while most clinicians recommend group housing. This study compared residential preferences of 141 homeless veterans with dual diagnoses with those of 62 homeless nonveterans with dual diagnoses. Clinicians rated both groups while they were in transitional shelters before they were placed in housing. Both samples strongly rejected group home living, but a majority of nonveterans desired staff support. Clinicians recommended staffed group homes for most veterans and nonveterans. This survey underscores the disjuncture between consumers' and clinicians' preferences as well as the need to provide a range of housing options to accommodate varied preferences.

Emergence and Transmission of Amantadine‐Resistant Influenza A in a Nursing Home

To prospectively detect amantadine-resistant influenza when amantadine was used for influenza A outbreak control. Prospective clinical surveillance and viral culture of all new respiratory illnesses during the course of amantadine prophylaxis. A 721-bed, 14-ward nursing home for veterans and spouses during an influenza A outbreak (1993-94). Residents of a veterans hospital and their spouses. Nasopharyngeal and throat viral culture. All residents with positive cultures who developed new respiratory symptoms while receiving or residing on a unit receiving amantadine prophylaxis had antiviral-resistance testing and polymerase chain reaction restriction analyses performed. Amantadine prophylaxis was administered sequentially on nine of 14 wards to all well residents for 14 to 31 days/ward to control influenza outbreaks between December 9, 1993, and January 28, 1994. Amantadine treatment was simultaneously provided to 29 ill residents. Between December 3, 1993, and January 22, 1994, 68 culture-positive cases of influenza A were detected. Twenty subjects were receiving or residing on units receiving amantadine prophylaxis. Amantadine sensitivity testing could be performed on 16 residents; 12 residents had amantadine resistant strains. Four of the 12 had not received any antiviral treatment. Illness onset ranged from 1 to 22 days after amantadine prophylaxis was begun on the individual's unit. Two ribonucleic acid (RNA) mutations in the gene coding the M2 protein transmembrane region were observed that were clustered in time and space. Isolates from two roommates, one receiving amantadine for 18 days and one on no antiviral, had identical RNA sequences. Antiviral resistance may be responsible for failure of prophylaxis in nursing home outbreaks. Strategies that use different classes of antivirals for prophylaxis and treatment may limit emergence and transmission of resistant virus.

Geriatric Assent

Previous articleNext article No AccessGeriatric AssentVictor Molinari, Laurence B. McCollough, Richard Workman, and John CoverdaleVictor MolinariUniversity of South Florida, Tampa Search for more articles by this author , Laurence B. McColloughBaylor College of Medicine Search for more articles by this author , Richard WorkmanMountain Home Veterans Affairs Medical Center Search for more articles by this author , and John CoverdaleBaylor College of Medicine Search for more articles by this author PDFPDF PLUS Add to favoritesDownload CitationTrack CitationsPermissionsReprints Share onFacebookTwitterLinkedInRedditEmail SectionsMoreDetailsFiguresReferencesCited by Volume 15, Number 3Fall 2004 Published on behalf of the MacLean Center for Clinical Medical Ethics Article DOIhttps://doi.org/10.1086/JCE200415307 © 2004 The University of Chicago. All rights reserved.PDF download Crossref reports no articles citing this article.

Antimicrobial Use and Methicillin-Resistant Staphylococcus aureus in a Large Nursing Home

Introduction In 1997, 18% of Staphylococcus aureus clinical isolates at the Wisconsin Veterans Home were resistant to methicillin. By 2002, 51% were resistant. Methods We determined the antibiotic sensitivity pattern of our methicillin-resistant S. aureus (MRSA) isolates as well as changes in utilization of specific antibiotics between two time periods. We reasoned that antibiotics with activity against methicillin-sensitive S. aureus (MSSA), but not MRSA, might be driving the overgrowth of MRSA. Results In our facility, MRSA is usually resistant to quinolones; MSSA is usually sensitive. Both MSSA and MRSA are usually sensitive to TMP-sulfa. An increased percentage of S. aureus resistant to methicillin (18%) was associated with a 42% increase in quinolone use and a 37% decrease in TMP-sulfa use. Conclusion Our analysis and previous reports suggest that replacement of TMP-sulfa by quinolones could be selecting MRSA in our facility. This conclusion, however, is speculative, based on association, and requires confirmation. In 1997, 18% of Staphylococcus aureus clinical isolates at the Wisconsin Veterans Home were resistant to methicillin. By 2002, 51% were resistant. We determined the antibiotic sensitivity pattern of our methicillin-resistant S. aureus (MRSA) isolates as well as changes in utilization of specific antibiotics between two time periods. We reasoned that antibiotics with activity against methicillin-sensitive S. aureus (MSSA), but not MRSA, might be driving the overgrowth of MRSA. In our facility, MRSA is usually resistant to quinolones; MSSA is usually sensitive. Both MSSA and MRSA are usually sensitive to TMP-sulfa. An increased percentage of S. aureus resistant to methicillin (18%) was associated with a 42% increase in quinolone use and a 37% decrease in TMP-sulfa use. Our analysis and previous reports suggest that replacement of TMP-sulfa by quinolones could be selecting MRSA in our facility. This conclusion, however, is speculative, based on association, and requires confirmation.

Antimicrobial use and methicillin-resistant Staphylococcus aureus in a large nursing home.

In 1997, 18% of Staphylococcus aureus clinical isolates at the Wisconsin Veterans Home were resistant to methicillin. By 2002, 51% were resistant. We determined the antibiotic sensitivity pattern of our methicillin-resistant S. aureus (MRSA) isolates as well as changes in utilization of specific antibiotics between two time periods. We reasoned that antibiotics with activity against methicillin-sensitive S. aureus (MSSA), but not MRSA, might be driving the overgrowth of MRSA. In our facility, MRSA is usually resistant to quinolones; MSSA is usually sensitive. Both MSSA and MRSA are usually sensitive to TMP-sulfa. An increased percentage of S. aureus resistant to methicillin (18%) was associated with a 42% increase in quinolone use and a 37% decrease in TMP-sulfa use. Our analysis and previous reports suggest that replacement of TMP-sulfa by quinolones could be selecting MRSA in our facility. This conclusion, however, is speculative, based on association, and requires confirmation.

Beyond the basics. Effects of the Eden Alternative model on quality of life issues.

In Life Worth Living, Thomas (1996) proposed that in long-term care facilities for elderly individuals, loneliness, helplessness, and boredom are out of control and are steadily decaying the residents' spirits, adversely affecting quality of life. While Thomas' contention appeals to common sense, no empirical evidence is offered in its support. The purpose of this quasi-experimental study was to assess the impact of implementation of the Eden Alternative model on levels of loneliness, boredom, and helplessness of older residents of a long-term care facility. The model was introduced into the experimental facility on May 1, 1998. The final sample for the experimental group included 21 cognitively intact older adults from a state veterans home (13 men, 8 women, mean age = 76.1). The final control group was composed of 13 residents in a private long-term care facility (11 women, 2 men, mean age = 85.7). A Background Data Sheet, the Geriatric Depression Scale (includes yes or no questions related to helplessness and boredom), and the UCLA Loneliness Scale (Version 3) were administered by an interviewer at baseline and 1-year post-implementation of the Eden Alternative model. Data analysis from the post-implementation phase revealed significant differences between the groups on levels of boredom (z = -2.6, p = .01) and helplessness (z = -2.2, p = .03). Lower levels of distress were found in the experimental group on both boredom and helplessness, but not loneliness. Findings suggest health care professionals and researchers have an opportunity to take a leading role in impacting services related to quality-of-life issues for this important, but often overlooked, population.

Dixie's Daughters: The United Daughters of the Confederacy and the Preservation of Confederate Culture (review)

Dixie's Daughters The United Daughters of the Confederacy and the Preservation of Culture By Karen L. Cox University Press of Florida, 2003 218 pp. Cloth, $55.00 Many young southerners today may have heard of the United Daughters of the Confederacy (UDC). If they have, they probably did so when Congress refused to renew a patent on its insignia or when the Daughters defended the flying of the flag. A century ago, however, most southerners knew of the UDC and its activities; it was the largest independent organization of women in the region. Despite the UDC's historical importance, however, Dixie's Daughters is the first (other than official histories) book-length study of the group. Author Karen L. Cox traces the origins of the United Daughters of the Confederacy to the Civil War relief efforts of southern women and, more directly, to the numerous Ladies Memorial Associations that formed right after the war. These local organizations cared for graves and established Memorial Day, thereby shaping the South's initial memory of the Civil War. In 1894 the UDC organized and soon established chapters across the South, indeed across the nation. By the end of World War I, it boasted a membership of 100,000, made up primarily of upper-class women, both those women who had lived through the war and those descended from veterans. The group undertook various progressive benevolent projects, including college scholarships and homes for veterans and women, but the UDC's major goal always remained vindicating the Confederacy. They erected monuments across the South and in various other ways helped establish a historical record of the war. Most important, the UDC tried to indoctrinate the young with what Cox calls Confederate culture. They created an organization for them--the Children of the Confederacy--sponsored essay contests, ensured state adoption of school textbooks with a southern view of the war, and placed flags and pictures of Robert E. Lee and Jefferson Davis in southern schools. Through its efforts, the UDC sought not just to ensure that future generations of white southerners agreed with them but also to secure vindication from the Yankees. The group had always promoted an American patriotism, conditioned on the North's respect for the South, and in World War I southern support for the war effort evoked a northern response that the Daughters felt constituted that vindication. After the war, Cox argues, the group never again exerted the public influence it had. Dixie's Daughters provides a much-needed institutional history of the UDC at the height of its influence; that alone would be a major contribution. …

Shell shock: traumatic neurosis and the British soldiers of the First World War

Preface Acknowledgements Introduction PART I: DISCOVERIES Shocking Modernity: Hysteria, Technology and Warfare Casualties: On the Western Front PART II: WARTIME Enlistment: Army Policy, Politics and the Press Treatment: On the Home Front Patients: The Other Ranks Patients: The Officer Ranks PART II: LEGACIES Demobilization: On Returning Home Veterans: War Neurotic Ex-Servicemen Recall: The Great War in the Twentieth Century Conclusion Notes Bibliography Index

International field test results of the Observable Indicators of Nursing Home Care Quality instrument.

Researchers at the University of Missouri-Columbia developed the Observable Indicators of Nursing Home Care Quality instrument to measure the dimensions of nursing home care quality during a brief on-site visit to a nursing home. The instrument has been translated for use in Iceland and used in Canada. Results of the validity and reliability studies using the instrument in 12 nursing homes in Reykjavik, in a large Veterans Home in Ontario with 14 units tested separately, and in 20 nursing homes in Missouri, are promising. High-content validity was observed in all countries, together with excellent inter-rater reliability and coefficient alpha. Test-retest reliabilities in Iceland and Missouri were good. Results of the international field test of the Observable Indicators of Nursing Home Care Quality instrument points to the usefulness of such an instrument in measuring nursing home care quality following a quick on-site observation in a nursing facility. The instrument should be used as a facility-wide assessment of quality, rather than for individual units within a facility. We strongly recommend its use by practising nurses in nursing homes to assess quality of care and guide efforts to improve care. We recommend its use by researchers and consumers and further testing of the use of the instrument with regulators.

Sputum Bacteriology in Nursing Home Pneumonia: A Retrospective Study

Introduction Pneumonia is the most lethal infection in nursing homes. The Infectious Disease Society of America recommends that attempts be made to obtain quality sputum to focus antibiotic therapy. This is especially important within the enclosed space of a nursing home, where constant pressure from broad spectrum, empiric antibiotics sets the stage for the emergence of resistant organisms. Methods We reviewed all cases of radiographic pneumonia diagnosed on-site at the Wisconsin Veterans Home, a 721-bed facility, for the recording of sputum bacteriology and 30-day mortality. Results Ninety-nine cases of radiographic pneumonia diagnosed on-site were identified over 1 year. Mortality was 10% within 30 days. Fourteen quality sputum specimens were obtained and processed microbiologically. None of the individuals who had a sputum specimen died within 30 days, probably because the ability to obtain a sputum specimen is a marker of higher functional status. Discussion Even if empiric therapy continues in the majority of cases, cultures in individual cases may alert clinicians to noncovered, resistant pathogens, and allow focused antibiotic therapy with agents like amoxicillin that might extend the usefulness of empiric, broad spectrum antibiotics. Institutions may also sum the results of sputum bacteriology to assist in the choice of empiric antibiotic therapy. Sputum bacteriology may benefit both the individual resident and the entire population of the institution. Pneumonia is the most lethal infection in nursing homes. The Infectious Disease Society of America recommends that attempts be made to obtain quality sputum to focus antibiotic therapy. This is especially important within the enclosed space of a nursing home, where constant pressure from broad spectrum, empiric antibiotics sets the stage for the emergence of resistant organisms. We reviewed all cases of radiographic pneumonia diagnosed on-site at the Wisconsin Veterans Home, a 721-bed facility, for the recording of sputum bacteriology and 30-day mortality. Ninety-nine cases of radiographic pneumonia diagnosed on-site were identified over 1 year. Mortality was 10% within 30 days. Fourteen quality sputum specimens were obtained and processed microbiologically. None of the individuals who had a sputum specimen died within 30 days, probably because the ability to obtain a sputum specimen is a marker of higher functional status. Even if empiric therapy continues in the majority of cases, cultures in individual cases may alert clinicians to noncovered, resistant pathogens, and allow focused antibiotic therapy with agents like amoxicillin that might extend the usefulness of empiric, broad spectrum antibiotics. Institutions may also sum the results of sputum bacteriology to assist in the choice of empiric antibiotic therapy. Sputum bacteriology may benefit both the individual resident and the entire population of the institution.

Sputum Bacteriology in Nursing Home Pneumonia: A Retrospective Study

Pneumonia is the most lethal infection in nursing homes. The Infectious Disease Society of America recommends that attempts be made to obtain quality sputum to focus antibiotic therapy. This is especially important within the enclosed space of a nursing home, where constant pressure from broad spectrum, empiric antibiotics sets the stage for the emergence of resistant organisms. We reviewed all cases of radiographic pneumonia diagnosed on-site at the Wisconsin Veterans Home, a 721-bed facility, for the recording of sputum bacteriology and 30-day mortality. Ninety-nine cases of radiographic pneumonia diagnosed on-site were identified over 1 year. Mortality was 10% within 30 days. Fourteen quality sputum specimens were obtained and processed microbiologically. None of the individuals who had a sputum specimen died within 30 days, probably because the ability to obtain a sputum specimen is a marker of higher functional status. Even if empiric therapy continues in the majority of cases, cultures in individual cases may alert clinicians to noncovered, resistant pathogens, and allow focused antibiotic therapy with agents like amoxicillin that might extend the usefulness of empiric, broad spectrum antibiotics. Institutions may also sum the results of sputum bacteriology to assist in the choice of empiric antibiotic therapy. Sputum bacteriology may benefit both the individual resident and the entire population of the institution.