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Assisted living residences (ALRs) are increasingly used to deliver services to older adults. Proposed policies for ALRs are gradually evolving. Although families are partners in this process, little is known about their understanding of nursing services available, compared with services needed and desired. A survey was conducted to better inform the inclusion of ALRs in Michigan's regulatory process. A total of 46 respondents reported assistance with activities of daily living as the most frequently offered ALR service. Respondents found all 13 nursing services asked about in the survey highly desirable and, for each category, the current need exceeds the availability of the service. [ABSTRACT FROM AUTHOR]

Objective: Administrative claims are commonly relied upon to identify hypoglycemia. We assessed validity of 14 International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis code assignments to identify medication-related hypoglycemia leading to acute care encounters., Research Design and Methods: A multisite, retrospective medical record review study was conducted in a sample of Medicare beneficiaries prescribed outpatient diabetes medications and who received hospital care between January 1, 2016 and September 30, 2017. Diagnosis codes were validated with structured medical record review using prespecified criteria (clinical presentation, blood glucose values, and treatments for hypoglycemia). Sensitivity, specificity, and positive and negative predictive value (PPV, NPV) were calculated and adjusted using sampling weights to correct for partial verification bias., Results: Among 990 encounters (496 cases, 494 controls), hypoglycemia codes demonstrated moderate PPV (69.2%; 95% confidence interval: 65.0-73.0) and moderate sensitivity (83.9%; 95% confidence interval: 70.0-95.5). Codes performed better at identifying hypoglycemic events among emergency department/observation encounters compared with hospitalizations (PPV 92.9%, sensitivity 100.0% vs. PPV 53.7%, sensitivity 71.0%). Accuracy varied by diagnosis position, especially for hospitalizations, with PPV of 95.6% versus 46.5% with hypoglycemia in primary versus secondary positions. Use of adverse event/poisoning codes did not improve accuracy; reliance on these codes alone would have missed 97% of true hypoglycemic events., Conclusions: Accuracy of International Classification of Diseases, Tenth Revision codes in administrative claims to identify medication-related hypoglycemia varied substantially by encounter type and diagnosis position. Consideration should be given to the trade-off between PPV and sensitivity when selecting codes, encounter types, and diagnosis positions to identify hypoglycemia., Competing Interests: The authors declare no conflict of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: To assess performance of International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) code assignments for identifying bleeding events resulting in emergency department visits and hospitalizations among outpatient Medicare beneficiaries prescribed anticoagulants., Methods: Performance of 206 ICD-10-CM code assignments indicative of bleeding, five anticoagulant adverse effect/poisoning codes, and five coagulopathy codes (according to Medicare Parts A and B claims) as assessed among Medicare fee-for-service beneficiaries prescribed anticoagulants between October 1, 2015 and September 30, 2016 (according to Part D claims). Structured medical record review was the gold standard for validating the presence of anticoagulant-related bleeding. Sensitivity was adjusted to correct for partial verification bias due to sampling design., Results: Based on the study sample of 1166 records (583 cases, 583 controls), 57 of 206 codes yielded the optimal performance for anticoagulant-related bleeding (diagnostic odds ratio, 51; positive predictive value (PPV), 75.7% [95% CI, 72.0%-79.1%]; adjusted sensitivity, 70.0% [95% CI, 63.2%-77.7%]). Codes for intracranial bleeding demonstrated the highest PPV (85.0%) and adjusted sensitivity (91.0%). Bleeding codes in the primary position demonstrated high PPV (86.9%), but low adjusted sensitivity (36.0%). The adjusted sensitivity improved to 69.5% when codes in a secondary position were added. Only one adverse effect/poisoning code was used, appearing in 7.8% of cases and controls (PPV, 71.4% and adjusted sensitivity, 6.8%)., Conclusions: Performance of ICD-10-CM code assignments for bleeding among patients prescribed anticoagulants varied by bleed type and code position. Adverse effect/poisoning codes were not commonly used and would have missed over 90% of anticoagulant-related bleeding cases., (© 2019 John Wiley & Sons, Ltd. This article has been contributed to by US Government employees and their work is in the public domain in the USA.)

The package insert of 4-factor prothrombin complex concentrate (4F-PCC) contains specific dosing recommendations stating to determine the patients dose based on their INR and weight, capping the weight at 100 kg. However, the mean body mass index (BMI) in the 4F-PCC U.S. approval study was 27 kg/m 2 , and there is a lack of literature identifying the ideal dosing strategy in obesity. We conducted a retrospective analysis of obese patients (BMI ≥ 30 kg/m 2 ) who received 4F-PCC for warfarin associated emergent bleeding reversal. Treatment groups were those that received 4F-PCC on adjusted body weight (AdjBW) and those on actual body weight (ActBW). The primary outcome was the percent of patients achieving coagulopathy reversal, defined as a post-treatment INR < 1.4 for neurologic indications and < 1.5 for all others. A total of 78 obese patients were included (28 AdjBW and 50 ActBW). Baseline INR (3.1 vs. 2.8; p = 0.052) and BMI (33.6 vs. 33.6 kg/m 2 ) were similar between groups. Achievement of goal INR was significantly lower in the AdjBW group (36% vs. 68%; p = 0.006). A majority of patients had intracranial hemorrhage (32% vs. 54%; p = 0.06), and the median dose of 4F-PCC was lower in the AdjBW group (2120 vs. 2500 units; p = 0.02). Dosing 4F-PCC using adjusted body weight in obese patients resulted in a significantly lower rate of coagulopathy reversal. ActBW should be used to dose 4F-PCC in obese patients when the 100 kg dose cap is utilized per the package insert recommendations.

The national teen birth rate is higher in rural compared to urban areas. While national data suggest rural areas may present higher risk for adverse sexual health outcomes among adolescents, it is unknown whether there are differences within the state of Florida. Overall, Florida has poorer sexual health indicators for adolescents compared to national rates. The purpose of this study was to assess differences in sexual behaviors among Florida adolescents by rural-urban community location. This study includes baseline data from a randomized controlled trial conducted in Florida high schools. Of the 6316 participants, 74% were urban and 26% were rural. Participants responded to questions on sexual behaviors, sexual behavior intentions, and demographics. We estimated the effect of rural-urban status on risk outcomes after controlling for demographic variables using generalized linear mixed models. More teens from rural areas reported ever having sex (24.0%) compared to urban teens (19.7%). No significant differences were observed for most of sexual behaviors assessed. Nonetheless, urban participants were less likely to intend to have sex without a condom in the next year compared to rural participants (aOR = 0.76, 95% CI 0.63-0.92). Overall, there were no major differences in sexual behaviors between rural and urban adolescents in Florida. However, sexual intentions differed between rural and urban adolescents; specifically, rural adolescents were more likely to intend to have sex without a condom in the next year compared to urban adolescents. Understanding the specific disparities can inform contraception and sexual health interventions among rural youth.

From 2004 to 2014, the overall abortion rate in Texas fell by almost a third from 10.7 to 7.2 abortions per 1000 women aged 10 to 49 years. During this same period, the number of abortion clinics operating at least 6 months in the year fell from 40 to 27. We examined the relationship between the abortion rate and the proximity of abortion facilities. We matched annual, county-level data on abortion rates in Texas from 2004 through 2014 with the distance from the county centroids to the nearest abortion facility in operation. Linear regressions were used to estimate the association between abortion rates and proximity to abortion facilities. The regressions controlled for county-level and state-level characteristics as well as the availability of abortion services in neighboring US states and Mexico. We found that a 100-mile increase in distance to the nearest abortion facility was associated with a 10% decrease in the overall abortion rate. The relationship appeared to be driven largely by distances of 200 miles or more. The overall relationship was generally present for whites and blacks, whereas the pattern was less clear for Hispanics. The analysis indicated that the overall association was driven largely by women aged 20 to 34 years. Decreased access to abortion facilities was associated with decreases in the abortion rate, yet the relationship varied by race/ethnicity and age. As such, regulations that affect the operational status of abortion facilities likely have differential effects on women.

Purpose: We evaluated the impact of a positive youth development program on adolescent pregnancy, sexual behavior, risky sex, and intentions in nonmetropolitan Florida high schools., Methods: Between 2012 and 2014, the Teen Outreach Program (TOP) was compared to standard school curriculum content using a cluster randomized controlled trial design with 7,976 youth in two cohorts. The majority of youth were 14 years old and in the ninth grade at baseline. Treatment group youth received TOP in health-related classes. After using multiple imputation to account for missing data, we analyzed baseline and follow-up survey data using generalized linear mixed-effects models with logit link function., Results: In the cohort 1 sample, compared to the control condition, males and females receiving TOP showed lower odds of engaging in recent sex (odds ratio [OR], .71; 95% confidence interval [CI]: .58-.86) compared to control males and females. Cohort 1 treatment females who did engage in recent sex were less likely to have risky sex (OR, .54; 95% CI: .32-.89). There were fewer significant findings in cohort 2, though TOP females and combined gender had lower odds of risky sex intentions (OR, .53; 95% CI: .33-.84 and OR, .65; 95% CI: .44-.96, respectively). Overall, cohort 1 females in the TOP condition were the group most likely to benefit from TOP., Conclusions: Consistent with previous research, TOP was more effective regarding sexual health outcomes among female versus male youth; this was especially true for the outcome of risky sex. However, results were not consistent across cohorts, prompting questions for future research., (Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Travel abroad provides college students with a unique learning experience. When plans to take undergraduate community health nursing students from the United States to Haiti were cancelled due to health and safety concerns, faculty piloted international videoconferencing with a nursing program in Haiti as an alternative. During this semester-long course, students in both countries assessed a local community using the Community as Partner framework and compared findings during videoconferences with their international peers. Despite communication challenges such as language barriers and limited internet access in Haiti, evaluative data suggests that all students valued learning with their nursing student peers in another country. For future international videoconferencing endeavors, especially with under-resourced communities, we provide recommendations in the following categories: 1) Building relationships with a partner school, 2) Technology, 3) Pedagogy, and 4) Facilitating interactions between students., (© 2016 Wiley Periodicals, Inc.)

Given the expected changes in demography and dependent care ratios, communities are preparing for the needs of older populations. Sometimes, communities form coalitions to address health-care needs. This case study evaluates a coalition/university partnership formed to assess the educational and support needs of nursing staff who are taking care of older adults across all service settings in one geographically defined community. A 17-member community-based coalition contracted with researchers from an external university to determine the perceptions of three key stakeholder groups: older adults and their families, all levels of nursing staff, and agency administrators. By applying principles of Participatory Action Research (PAR), this case study presents the challenges faced in the community-based coalition/university research team partnership. This coalition/research partnership is unique, differing from most academic examples of PAR because nursing professionals initiated the partnership., (© The Author(s) 2014.)

This paper describes the available production technology of hydrogel dressings. Their practical application were tested--solid and semi-liquid--in the daily practice of medical emergency. An analysis was made of risk associated with the application of these type of dressings, and of the ability to apply them in individual prophylactic sets. The aim of the study was to compare commercially available hydrogel dressings--to the conditions and the risk of their use. Anti-burn dressings were used of three different companies, provided for the research in original packaging. The study was conducted in the laboratory. The samples of dressings were placed on a thermally insulating surface, and then for a period of 60 h with a thermocouple the temperature was measured under the dressing. The measured values were compared with measurements effected parallel to the ambient temperature. The implementation of the dressing on the surface resulted in the immediate cooling of the surface (about 10 min). Time after application of the dressing to achieve its full cooling capacity is approximately 60 min for each of the tested dressings. The maximum reduction in temperature of cooled surface was analogous for the three tested dressings and was 4.20 degrees C. Maximum cooling times of dressings differed significantly. In conclusion, the dressings in the form of solid hydrogels are characterized by an easier application, they are safe during oxygen therapy and they provide a longer cooling time.

Background: Regular walking improves overall health and functional ability of older adults, yet most are sedentary. Dog ownership/pet responsibility may increase walking in older adults. Goals of this study were to identify factors that influence older adult walking and compare physical activity, functional ability and psychosocial characteristics by dog ownership status., Methods: In this cross-sectional study, older adults (65-95 years of age, n = 1091) completed and returned questionnaires via postal mail. Measures included: Physical Activity Scale for the Elderly, Physical Functioning Questionnaire and Theory of Planned Behavior Questionnaire., Results: Dog owner/dog walkers (n = 77) reported significantly (P < .05) more total walking, walking frequency, leisure and total physical activity and higher total functional ability than dog owner/nondog walkers (n = 83) and nondog owners (n = 931). Dog owner/nondog walkers reported lower intention and perceived behavioral control and a less positive attitude than dog owner/dog walkers (P < .05)., Conclusions: Dog owner/ dog walkers were significantly different than the nondog walker groups in nearly every study variable. Many dog owners (48.1%) reported walking their dogs regularly and the dog owner/dog walkers participated in nearly 50% more total walking than the 2 nondog walking groups, suggesting that pet obligation may provide a purposeful activity that motivates some older dog owners to walk.

The frequency of external wounds sustained by soldiers on the modern battlefield is not declining. In particular, this concerns participants in humanitarian and stabilization missions in the third world countries, almost daily attacked with improvised booby-traps and firing missiles or multi-caliber weapons. The wound infection rate is high, which requires often the empirical use of antibiotics, both in local dressings, as well as the overall dose. The knowledge of the probable causative agent of a wound infection, its theoretical susceptibility to the antibiotic and spectrum antibiotics that are currently available, is a factor which is conditional in the success of treatment. In order to investigate, how the supply of PKW Afghanistan in antibiotics and chemotherapeutic drugs is presented and whether this supply range is suitable for medical problems, we analyzed the consumption of these drugs. Data for the years: 2010-2011 were available. The supply structure was dominated by antibiotics penicillin, cephalosporin, amino glycoside and macrolide. It was stated that each year the supply and consumption of antibiotics increased by 127.9%, with a stable number of serving people and a stable number of sustained injuries. Compared to 2010, in 2011 there were purchases of antibiotics used in severe, complicated infections caused by opportunistic multi-drug-resistant pathogens. This proves that the epidemiological situation was deteriorating on the area of PKW Afghanistan service mission.

Background: The conditions encountered during military service in Afghanistan create number of different medical problems, resulting in interruptions in the performance of soldiers and even evacuation to the home country. A search of the literature yielded no comprehensive studies of medical problems of any single national contingent now serving in Afghanistan. A review of medical reports was made of the Polish Military Contingent in Operation Enduring Freedom from January 1, 2011 to December 31, 2011. Due to various reasons, 9.1% to 22.8% of all deployed Polish soldiers were unable to continue active duty. Acute respiratory infections and infectious and non-infectious gastrointestinal disorders are the main causes of temporary inability to serve. An important problem in the Polish soldiers is also dental health. Predicting the combat capability of Polish forces in Afghanistan and planning of its medical security requires the inclusion of the seasonality factor., Material/method: This study is a review of medical records of the Polish Military Contingent in Afghanistan, covering the period from January 1, 2011 to December 31, 2011, from records and data maintained by the Armed Forces Operational Command. (changes: IX and X). All cases were soldiers unable to continue active military duty due to health reasons., Results: The analysis shows that among the soldiers of PKW there occurred varied medical events, which directly or through further complications were the cause of temporary inability to serve and which sometimes were the ultimate cause of an evacuation to the home country., Conclusions: Acute respiratory infections and infectious and non-infectious gastrointestinal disorders were the main cause of temporary inability to serve.

Background: Military casualties in Afghanistan arise in part from climatic and natural conditions that are difficult for European soldiers to endure, as well as from intense guerrilla combat with mass use of IEDs (improvised explosive devices), thus posing numerous and diverse medical problems requiring evacuation to the home country. A search of the literature revealed no comprehensive studies of the causes of medical evacuation from this theater of operations., Material/methods: This article is a review of medical reports of the Polish Military Contingent taking part in Operation Enduring Freedom during the period from 01 January 2010 to 31 December 2011, including an analysis of causes of all ROLE 4 medical evacuations (to the military base in Germany or to the home country)., Results: As many as 565 (5.49%) of the total of 10 294 contingent soldiers were evacuated during the analyzed period. Of these, 29% of evacuation cases were due to combat injuries, 23% to complications of respiratory tract infection, 11% to mental health problems, 11% to chronic neuralgias, 12% to complications of acute gastrointestinal infections, 4% to non-combat injuries, 3% to dental and maxillofacial problems, 2% to dermatological problems and 2% to leishmaniasis. The remaining causes included chronic organic/systemic diseases manifested during service., Conclusions: The main causes of medical evacuations to the home country were the consequences of combat injuries, mainly due to IED attacks. Appropriate diagnosis and early treatment of infections is also an important problem in the face of a significant number of complications resulting in evacuation of soldiers to their home country.

Background: The Afghan military theatre is specifically marked by guerilla operations and massive use of IEDs (improvised explosive devices) that pose new types of threats for their victims. At the same time, the relevant literature contains only a single, fragmentary analysis on injuries suffered by soldiers serving in the Afghan mission., Material/methods: This is a review of medical reports of the Polish Military Contingent deployed within Operation Enduring Freedom, from 1 January 2010 to 31 December 2011; the analysis includes all cases of combat and non-combat injuries in terms of their causes., Results: In the period under analysis, 380 Polish soldiers were reported injured; 87.1% of cases were combat and 12.9% non-combat injuries. The structure of injuries caused as a result of IED explosions was dominated by multiple limb injuries, associated most frequently with severe body cavities/spine injuries. In the case of other incidents, both combat and non-combat, the predominant consequences were single and, most commonly, less severe injuries. The average number of injuries suffered from IED attacks (3.37) was significantly higher than the number of injuries from other attacks (1.16), and higher than the number of non-combat injuries (1.43)., Conclusions: IED attacks pose a serious medical problem, considering their high number and the severity of injuries they cause.

In crisis situations, such as transportation catastrophes, terrorist attacks or contamination with chemical warfare agents, it is crucial to properly organize and sensibly conduct rescue operations. Among chemical warfare agents, the most toxic ones are the derivatives of organophosphorus compounds. An individual auto-injector kit 'IZAS-05' contains auto-injectors, which are devices designed for intramuscular administration of drugs in self-aid or buddy-aid on the battlefield. This paper describes in detail the components of the 'IZAS-05' kit, as well as its mode of use and possible contraindications.

The Polish Army is engaged in stabilization activities and peace missions in countries often characterized by completely different customs, culture and religion, as well as different bacterial and viral flora. It might be expected that foreign military operations will be more and more important, as the number of local conflicts is escalating. The safety and health of our citizens in these circumstances is the absolute priority. This article is dedicated to the safety of soldiers in the context of the risks associated with infectious diseases that can be prevented by vaccination. The main goal of this study is to verify the model and condition of immunization in the Polish Army in the context of foreign contingents, as well as presentation of the possibilities to optimize solutions in this field.

The current quandary with the design of existing long term care (LTC) settings results from focus on structures ("institutions") instead of on a system of supports and services that transcends physical and traditional boundaries across settings, including nursing homes, assisted living residences and the home. Supported by analysis of the commonalities, socio-historical and political contexts, core values and fallacies of social and medical models in existing and emerging LTC options, a holistic model is proposed based on new core values which facilitate community and family integration, and which asserts dignity and personhood as universal attributes in an array of settings.

Assisted living residences (ALRs) are increasingly used to deliver services to older adults. Proposed policies for ALRs are gradually evolving. Although families are partners in this process, little is known about their understanding of nursing services available, compared with services needed and desired. A survey was conducted to better inform the inclusion of ALRs in Michigan's regulatory process. A total of 46 respondents reported assistance with activities of daily living as the most frequently offered ALR service. Respondents found all 13 nursing services asked about in the survey highly desirable and, for each category, the current need exceeds the availability of the service.

Flow cytometry, now used routinely to aid in the classification of leukemias, is increasingly being evaluated as a rapid technique for determination of surface antigens on the cells teased from lymph nodes and other masses with suspected lymphoma. The present study reviews biopsy specimens from patients examined during a two year period which were sent for flow cytometry with a diagnosis of suspected lymphoma. Sixteen of 25 samples (64 percent) produced cell suspensions of sufficient quantity and quality to be diagnostically helpful. Results showed that in 9/16 (56 percent) the diagnosis of lymphoma or cancer could be suspected by flow cytometry alone, while 4/16 were consistent with the final tissue diagnosis of normal or reactive hyperplasia. Three samples that came from patients who had morphologic evidence of malignant disease on biopsy (two Hodgkin's disease and one large cell lymphoma) had flow cytometry results that were interpreted as normal. Flow cytometry is rapid and appears to be virtually diagnostic of non-Hodgkin's lymphoma when a majority of cells are B cells with an abnormal kappa/lambda ratio (> 4.0 or < 0.25). Nonhematologic malignancy can be suspected if less than 75 percent of the cells show CD45 (common leukocyte antigen). Hodgkin's disease cannot be detected by flow cytometry as it is currently used, and as many as 15 percent (1/6 in this study) of lymphomas may show normal results. It is extremely helpful when the biopsy sample actually contains the cells of interest in large proportion. Loss of architectural relationships in the course of processing specimens for flow cytometry is a major disadvantage when small foci of lymphoma or tumor cells exist together with large amounts of stroma or normal lymphocytes.