10 results on '"Zweig, Steven C."'
Search Results
2. Effect of Do-Not-Resuscitate Orders on Hospitalization of Nursing Home Residents Evaluated for Lower Respiratory Infections (See editorial comments by Dr. Joan Teno on pp 159–160).
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Zweig, Steven C., Kruse, Robin L., Binder, Ellen F., Szafara, Kristina L., and Mehr, David R.
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NURSING home patients , *HOSPITAL utilization , *RESPIRATORY infections , *NURSING care facilities , *DO-not-resuscitate orders , *MEDICAL care - Abstract
To determine resident and facility characteristics associated with do-not-resuscitate (DNR) orders and to test the effect of DNR orders on hospitalization of acutely ill nursing home (NH) residents with lower respiratory tract infections (LRIs). Prospective cohort. Thirty-six NHs (almost 4,000 residents) in central and eastern Missouri in the Missouri Lower Respiratory Infection study. NH residents with a LRI (n=1031). Data were obtained from new Minimum Data Set evaluations, resident examination, and chart review. Associations between resident, physician, and facility characteristics and the presence of a DNR order and hospitalization within 30 days from evaluation for an LRI were analyzed. Sixty percent of subjects had a DNR order, and 2% had a do-not-hospitalize order. Resident characteristics associated with a DNR order included older age, white race, having a surrogate decision-maker, NH residence for longer than 3 years, and more-impaired cognition. Residents with DNR orders were more likely to live in facilities with more licensed beds, a lower proportion of Medicaid recipients, and a higher prevalence of influenza vaccination. After controlling for potential confounders, residents with a DNR order before the acute illness episode were significantly less likely to be hospitalized (adjusted odds ratio=0.69, 95% confidence interval=0.49–0.97). DNR orders independently reduce the risk of hospitalization for LRI and may function as a marker for undocumented care limitations or as a mandate to limit care (unrelated to resuscitation) in NH residents with LRI. [ABSTRACT FROM AUTHOR]
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- 2004
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3. Mortality from Lower Respiratory Infection in Nursing Home Residents.
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Mehr, David R., Zweig, Steven C., Kruse, Robin L., Popejoy, Lori, Horman, Darla, Willis, Deanna, and Doyle, M. Elaine
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MORTALITY , *RESPIRATORY infections , *NURSING care facilities , *HOSPITAL care - Abstract
BACKGROUND. Lower respiratory infections (LRI) are an important cause of morbidity, mortality, and hospitalization of nursing home residents, yet treatment recommendations have primarily been based on the minority who are hospitalized. We sought to prospectively evaluate risk factors for mortality from LRI in community nursing home residents. METHODS. We studied residents of 10 central Missouri nursing homes (910 beds) from January 1994 to September 1994. Attending physicians authorized nurse evaluations of ill residents who showed symptoms of an LRI. Those residents who met the study definition of LRI received a more detailed assessment and follow ups at 30 and 90 days. RESULTS. The 231 evaluations identified 141 LRIs in 121 individuals. Sixteen (11%) residents died within 30 days of evaluation. The most important univariate predictor of 30-day mortality was severe activities of daily living (ADL) dependency (relative risk = 8.8, 95% confidence interval, 2.55 - 30.1). Several other clinical and laboratory findings were also significant predictors. In multivariable logistic regression, ADL dependency, respiratory rate, and pneumonia on chest radiograph independently predicted mortality; the model showed good discriminating ability (c=.83). CONCLUSIONS. For nursing home residents with LRI, ADL dependency is an important mortality predictor. Further research with a larger sample should lead to a useful prediction rule for outcome from nursing home-acquired LRI. [ABSTRACT FROM AUTHOR]
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- 1998
4. Physician Recommendations for Mammography in Women Aged 70 and Older.
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Kapp, Julie M., LeMaster, Joseph W., Zweig, Steven C., and Mehr, David R.
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MAMMOGRAMS , *OLDER women , *COMORBIDITY , *GERIATRICS - Abstract
OBJECTIVES: To estimate the percentage of U.S. women aged 70 and older who reported a recent mammography recommendation and to identify whether factors suggesting limited life expectancy, such as comorbidities, are associated with a lower probability of a reported recommendation. DESIGN: A national, population-based, cross-sectional survey. SETTING: United States. PARTICIPANTS: There were 1,782 screen-eligible women 70 and older who responded to the National Health Interview Survey in 2005 and met eligibility criteria, including reporting at least one doctor visit in the previous 12 months. Weighted, these women represented almost 9.3 million women nationally. MEASUREMENTS: Multiple logistic regression was used to examine the relationship between demographic, comorbidity, and health services utilization variables on self-reported physician recommendation for a mammogram. RESULTS: More than half (58.9%) of the sample reported a recent mammography recommendation (63.0% of those aged 70 to 79 and 51.5% of those aged 80 and older). The strongest multivariable association suggested that women who reported a recent clinical breast examination (CBE) had 5.9 times greater odds of reporting a mammography recommendation than women who reported never having a CBE. CONCLUSION: This study failed to find negative associations between factors suggesting limited life expectancy and a recent mammography recommendation. Instead, findings revealed a strong positive association between a recent CBE and mammography recommendation. Findings may suggest that recent clinical interactions weigh more heavily on a decision to recommend mammography to older, screen-eligible women than considerations for the woman's overall long-term health or may reflect a greater perceived or actual recall of physician recommendations from women with a recent CBE. [ABSTRACT FROM AUTHOR]
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- 2008
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5. Using Mortality Risk Scores for Long-term Prognosis of Nursing Home Residents: Caution Is Recommended.
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Kruse, Robin L., Parker Oliver, Debra, Mehr, David R., Petroski, Gregory F., Swenson, Denise L., and Zweig, Steven C.
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COHORT analysis , *LONGITUDINAL method , *NURSING home patients , *PROGNOSIS ,MORTALITY risk factors - Abstract
Background. Determining prognosis for nursing home residents is important for care planning, but reliable prediction is difficult. We compared performance of four long-term mortality risk indices for nursing home residents—the Minimum Data Set Mortality Risk Index (MMRI), a recent revision to this index (MMRI-R), and the original and revised Flacker–Kiely models. Methods. We conducted a prospective cohort study in one 92-bed facility in Missouri. Participants were 130 residents who received a Minimum Data Set assessment from May through October, 2007. We collected the Minimum Data Set variables needed to calculate the mortality risk scores. We determined 6- and 12-month mortality for included residents. Using each mortality risk score as the sole independent predictor in logistic models predicting mortality, we determined discrimination (c-statistic) and calibration (Hosmer–Lemeshow goodness-of-fit statistic) for each model. Results. In our sample, discrimination was 0.59 for both the MMRI and the MMRI-R. Discrimination of the original Flacker–Kiely model was 0.69 for both 6 months and 1 year and 0.71 and 0.70, respectively, for the revised model. Model calibration was adequate for all models. Conclusions. Performance of four models that predict long-term mortality of nursing home residents was fair. In our population, the Flacker–Kiely models had similar and markedly better discrimination than either the MMRI or the MMRI-R. [ABSTRACT FROM PUBLISHER]
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- 2010
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6. Evaluating the Effectiveness of a Senior Mentor Program: The University of Missouri-Columbia School of Medicine.
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Hoffman, Kimberly G., Gray, Peggy, Hosokawa, Michael C., and Zweig, Steven C.
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MENTORING in education , *MEDICAL education , *MEDICAL schools - Abstract
At the University of Missouri-Columbia School of Medicine, we developed a voluntary senior-mentor program, the Senior Teacher Educator Partnership (STEP), for first- and second-year medical students. Using qualitative research methods, we examined the impact of STEP on medical students' attitudes and then assessed the congruence of what is learned through STEP with the knowledge, skills, and attitudes needed to provide care to the elderly patient. STEP was found to be a successful strategy for teaching themes of recognizing the elderly within an ecological context, enhancing sympathy and empathy, emphasizing respect for elderly persons, and gaining an appreciation that aging is an individualized process. New areas identified for student learning experiences included understanding the complexity of the health care system and its impact on elderly patients, understanding the payment system, and developing skills in assessment and care coordination. A model is described for continuous enhancement of educational programs to be used to improve educational experience in geriatrics. doi:10.1300/J021v27n02_05 [ABSTRACT FROM PUBLISHER]
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- 2006
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7. Predictors of short-term functional decline in survivors of nursing home-acquired lower respiratory tract infection.
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Binder EF, Kruse RL, Sherman AK, Madsen R, Zweig SC, D'Agostino R, Mehr DR, Binder, Ellen F, Kruse, Robin L, Sherman, Ashley K, Madsen, Richard, Zweig, Steven C, D'Agostino, Ralph, and Mehr, David R
- Abstract
Background: Scant information exists about the risk of functional decline following treatment of acute illness in the nursing home (NH) setting. The aim of this study was to determine the incidence of short-term (30-day) functional decline among survivors of NH-acquired lower respiratory tract infection (LRI) and the factors that predict such decline, including the role of initial hospitalization.Methods: We used a prospective cohort design to study 781 episodes of LRI in 1044 NH residents in 36 NHs in central Missouri and the St. Louis metropolitan area. Functional decline was defined as a 3-point increase on the Minimum Data Set (MDS) activities of daily living (ADL) long form scale.Results: Of 781 LRI cases who survived to 30 days, the incidence of ADL decline was 28.8%. In a logistic regression model that used generalized estimating equations to adjust for clustering, variables associated with ADL decline included the following: chronic feeding tube use (AOR = 4.54, 95% confidence interval, or CI, 1.61, 12.80), decubitus ulcer (adjusted odds ratio [AOR] = 2.29, 95% CI 1.35, 3.90), shortness of breath (AOR = 2.18, 95% CI 1.44, 3.30), short-term memory problems (AOR = 2.07, 95% CI 1.33, 3.23), decline in self-performance of toilet use in the 24 hours prior to evaluation (AOR = 1.65, 95% CI 1.29, 2.12), age (AOR = 1.02, 95% CI 1.00, 1.05), and baseline ADL score. Addition of treatment variables to the model showed that initial hospitalization was also associated with ADL decline (AOR = 1.90, 95% CI 1.20, 3.00). Residents with ADL decline at 30 days were less likely to recover to their baseline ADL status at 90 days.Conclusions: Many NH residents who survive to 30 days following LRI develop new functional limitations, and such individuals are at risk for ADL decline at 90 days. A limited number of clinical variables may predict short-term functional decline. Initial hospitalization for acute treatment of LRI may increase the risk of subsequent ADL decline among individuals who survive to 30 days. [ABSTRACT FROM AUTHOR]- Published
- 2003
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8. Predictors of Short-Term Functional Decline in Survivors of Nursing Home-Acquired Lower Respiratory Tract Infection.
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Binder, Ellen F., Kruse, Robin L., Sherman, Ashley K., Madsen, Richard, Zweig, Steven C., D'Agostino, Ralph, and Mehr, David R.
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RESPIRATORY infections , *INFECTION , *PATIENTS - Abstract
Presents a study which determined the predictors of short-term functional decline in survivors of nursing home-acquired lower respiratory tract infection. Characteristics of the participants; Methodology; Results and conclusions.
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- 2003
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9. Predicting Mortality in Nursing Home Residents With Lower Respiratory Tract Infection.
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Mehr, David R., Binder, Ellen F., Kuse, Robin L., Zweig, Steven C., Madsen, Richard, Popejoy, Lori, and D'Agostino, Ralph B.
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NURSING home patients , *RESPIRATORY infections , *HEALTH risk assessment , *MORTALITY , *PROGNOSIS , *FORECASTING - Abstract
Identifies patient characteristics predictive of 30-day mortality in nursing home residents with a lower respiratory tract infection (LRI). Design, setting, and patients in the study made in Missouri; Main outcome measures; Results; Conclusion that the research distinguishes those at relatively low risk for mortality due to LRI.
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- 2001
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10. Clinical Findings Associated with Radiographic Pneumonia in Nursing Home Residents.
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Mehr, David R., Binder, Ellen F., Kruse, Robin L., Zweig, Steven C., Madsen, Richard W., and D'Agostino, Ralph B.
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PNEUMONIA , *NURSING home patients , *PERIODIC health examinations , *OLDER people , *RADIOLOGY - Abstract
OBJECTIVE: Subtle presentation and the frequent lack of on-site physicians complicate the diagnosis of pneumonia in nursing home residents. We sought to identify clinical findings (signs, symptoms, and simple laboratory studies) associated with radiographic pneumonia in sick nursing home residents. STUDY DESIGN: This was a prospective cohort study. POPULATION: The residents of 36 nursing homes in central Missouri and the St. Louis area with signs or symptoms suggesting a lower respiratory infection were included. OUTCOME MEASURED: We compared evaluation findings by project nurses with findings reported from chest radiographs. RESULTS: Among 2334 episodes of illness in 1474 nursing home residents, 45% of the radiograph reports suggested pneumonia (possible = 12%; probable or definite = 33%). In 80% of pneumonia episodes, subjects had 3 or fewer respiratory or general symptoms. Eight variables were significant independent predictors of pneumonia (increased pulse, respiratory rate ≥30, temperature ≥38°C, somnolence or decreased alertness, presence of acute confusion, lung crackles on auscultation, absence of wheezes, and increased white blood count). A simple score (range = -1 to 8) on the basis of these variables identified 33% of subjects (score ≥3) with more than 50% probability of pneumonia and an additional 24% (score of 2) with 44% probability of pneumonia. CONCLUSIONS: Pneumonia in nursing home residents is usually associated with few symptoms. Nonetheless, a simple clinical prediction rule can identify residents at very high risk for pneumonia. If validated in other studies, physicians could consider treating such residents without obtaining a chest radiograph. INSET: KEY POINTS FOR CLINICIANS.. [ABSTRACT FROM AUTHOR]
- Published
- 2001
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