In order to manage the patient with a cervical spine injury, one must be familiar with a diagnostic classification of these injuries and be able to apply this classification to the individual patient. When a cooperative effort is made between orthopedists and neurosurgeons, we have found that most cervical spine injuries can be managed successfully without operative means using Cheshire's classification for predicting late instability. We have been able to identify (1) those patients who would not substantially benefit from surgical intervention; (2) certain types of injuries where relative indications for surgery may be considered; and (3) we have confirmed the danger and risk of early operative intervention following cervical spine trauma in the neurologically damaged spinal cord.

Athletic Injuries↗

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The RAI-PC: an assessment instrument for palliative care in all settings.

Large numbers of persons in most types of healthcare settings have palliative care needs that have considerable impact on their quality of life. Therefore, InterRAI, a multinational consortium of researchers, clinicians, and regulators that uses assessment systems to improve the care of elderly and disabled persons, designed a standardized assessment tool, the Resident Assessment Instrument for Palliative Care (RAI-PC). The RAI-PC can be used for both the design of individual care plans and for case mix and outcomes research. Some elements of this instrument are taken from the resident assessment instrument (RAI) mandated for use in all nursing homes in the United States and widely used throughout the world. The RAI-PC can be used alone or in counjunction with the other assessment tools designed by the InterRAI collaboration: the RAI for homecare (RAI-HC), for acute care (RAI-AC), and for mental health care (RAI-MH). The objective of this study was to field test and carry out reliability studies on the RAI-PC. After appropriate approvals were obtained, the RAI-PC instrument was field tested on 151 persons in three countries in more than five types of settings. Data obtained from 144 of these individuals were analyzed for reliability. The reliability of the instrument was very good, with about 50 percent of the questions having kappa values of 0.8 or higher, and the average kappa value for each of the eight domains ranging from 0.76 to 0.95. The 54 men and 95 women had a mean age of 79 years. Thirty-four percent of individuals suffered pain daily. Eighty percent tired easily; 52 percent were breathless on exertion; and 19 to 53 percent had one or more other symptoms, including change in sleep pattern, dry mouth, nausea and vomiting, anorexia, breathlessness at rest, constipation, and diarrhea. The number of symptoms an individual reported increased as the estimated time until death declined. The "clinician friendly" RAI-PC can be used in multiple sites of care to facilitate both care planning and case mix and outcomes research.

Adult↗

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Informal support resources for vulnerable elderly persons: can they be counted on, why do they work?

The issue of informal support system resiliency is analyzed for approximately 700 vulnerable elderly persons in a variety of communities (e.g., urban age-segregated housing, ethnic urban age-integrated community, rural age-integrated, etc.). These samples, while geographically specific, are diverse, and a case can be made for generalizing the conclusions originating in this study to the larger population of vulnerable elderly persons in this country. There is a reexamination of the following questions: 1) Do informal support systems generally exist for vulnerable elderly persons; 2) Are significant levels of help being given by these helpers? An examination is also made of the following questions: 1) Can we depend upon these informal systems to continue to provide care now being given, and to respond to new needs that may arise in the future; 2) How is this helping behavior initiated? Within this study, the vulnerable elderly persons were generally found to have informal support systems characterized by active communication. The central role of the informal system is the transmittal of knowledge. Network members pick up information about the individual in regular ongoing communication of a noninstrumental character, interpret this information, act in ways that are responsive to the individual's needs, and are generally prepared to continue to act as new needs arise.

Aged↗

PubMedDate not supplied

Pressure ulcers: the Minimum Data Set and the Resident Assessment Protocol.

As Americans age and live longer with chronic disabilities, more elderly citizens will reside in nursing homes. The nationally mandated Minimum Data Set (MDS) and Resident Assessment Protocol (RAP) were designed to help plan for the care of the frail elderly residing in nursing homes. One of the areas specifically targeted was pressure ulcers. This study was designed to describe the prevalence, incidence, and current management practices relating to pressure ulcers in nursing homes based on MDS data. In addition, a cross-sectional investigation was performed to examine the MDS items found in the pressure ulcer RAP. The MDS data for 2,011 nursing home residents, aged 60 or older, who lived in 270 facilities from 10 states were evaluated. The results found a prevalence of 11.2% for Stage II-IV lesions and a 6-month incidence of 6.2%. Logistic regression analysis determined that dependence in transfer or mobility, being bedfast, having diabetes mellitus, and having had a pressure ulcer in the past were significantly associated with a Stage II-IV pressure ulcer. The MDS and its associated RAP for pressure ulcers provide the data to begin devising a care plan for patients with pressure ulcers.

Aged↗