Biomedical subjects

M A Moskowitz

Publications and source records attributed to M A Moskowitz.

366 records · Page 21Linked to original sources

PubMedDate not supplied

Clinical practice guidelines in the nursing home.

Clinical practice guidelines are an important tool for improving quality of care. This study determined whether and how guidelines are being used in nursing homes. We surveyed staff at 36 Department of Veterans Affairs (VA) nursing homes. Employees were asked whether they were familiar with guidelines as well as whether 5 specific guidelines had been read, were available, and had been adopted. Among 1065 respondents (60% of those surveyed), 79% reported familiarity with guidelines. The proportion of staff at a facility reporting adoption was generally less than 50%. Those nursing homes in which a high percentage of the staff reported adoption of one guideline were more likely to have adopted other guidelines. However, staff were not more likely to report adoption of a specific guideline when the nurse manager stated that it was adopted. We conclude that staff at VA nursing homes are familiar with guidelines. Guideline adoption at individual nursing homes, however, is not a systematic process involving the entire staff.

Diffusion of Innovation↗

PubMedDate not supplied

Pressure ulcer development in the VA: characteristics of nursing homes providing best care.

This study identifies structural characteristics of VA nursing homes that are associated with the best patient outcomes. We evaluated risk-adjusted rates of pressure ulcer development in VA nursing homes and related these rates to facility size, staffing patterns, teaching nursing home status, and rural versus urban locale. Higher rates of pressure ulcer development were seen among urban teaching nursing homes and among nursing homes associated with both larger and smaller VA hospitals. Staffing patterns had a complex association with pressure ulcer development, and smaller nursing home staffs were not clearly associated with higher rates. For multivariate modeling, only hospital size and staffing remained significant independent predictors of pressure ulcer development. These results emphasize that while structural characteristics of VA nursing homes can provide insights about care, improving the quality of care in this setting will require a much greater understanding of how nursing homes are organized to meet patient needs.

Aged↗

PubMedDate not supplied

Identifying pre- and postoperative predictors of cost and length of stay for coronary artery bypass surgery.

Prior studies of resource use for coronary artery bypass graft (CABG) surgery have either focused on a limited number of hospitals or have used charges instead of costs. We used a large statewide database (n = 6791) to study predictors of cost and length of stay (LOS) for CABG surgery. We used linear regression to sequentially model (a) specific procedures performed, (b) preoperative patient characteristics, and (c) postoperative events to determine the relative impact of these 3 factors on resource use. We then used the resulting models to calculate adjusted mean hospital costs and LOS. These 3 factors were all significantly associated with resource use. Postoperative events were the greatest determinant of costs, while preoperative characteristics were the greatest determinant of LOS. Despite risk adjustment for these factors, resource use differed significantly across 12 hospitals (mean cost range, $22,200 to $41,900; mean LOS range, 11 to 18 days), suggesting that some institutions may need to reduce their resource use.

Aged↗

PubMedDate not supplied

Effect of a hospital nonsmoking policy on patients' knowledge, attitudes, and smoking behavior.

PURPOSE: To explore patients' knowledge of and attitudes toward a hospital nonsmoking policy and to examine changes in patients' smoking behavior before admission and after discharge. DESIGN: Patients were surveyed by mail 1 week after hospitalization. SETTING: A 379-bed Boston tertiary teaching hospital. SUBJECTS: Seven hundred twenty-six patients were surveyed. There were 337 respondents, yielding a response rate of 59%. OUTCOME MEASURES: Policy knowledge, policy satisfaction, and smoking cessation assistance. Smoking status was assessed retrospectively by self-report 1 week before admission and at the time of the survey. RESULTS: Bivariate and multiple logistic regression techniques were used to explore relationships among explanatory variables and outcomes. Knowledge of the policy was fair, although satisfaction with the policy was high. Twenty percent of patients reported that they had quit smoking at the time of the survey; 53% of quitters said they quit because of the policy. Thirty-nine percent of patients reported receiving assistance from medical providers, and 88% were satisfied with this help. Smoking cessation assistance was not associated with quitting but was related to smoking less (p < 0.02). CONCLUSIONS: A hospital nonsmoking policy was well accepted by patients and may have had a favorable impact on patients' smoking behavior. Because intervention by health care providers was limited but appeared to be effective, smoking cessation assistance programs need to be developed and implemented in other hospitals so that these results can be generalizable.

Female↗

PubMedDate not supplied

The use of cervical cytology to identify women at risk for chlamydial infection.

Testing asymptomatic women for chlamydial infection is advocated for high-risk populations, but testing criteria in low-risk settings are less clear. To determine whether findings from Papanicolaou (Pap) smears could identify women at risk for Chlamydia, we studied 512 women, 18 to 50 years of age, seeking routine gynecologic care. The prevalence of positive cultures for Chlamydia was 4.7%. Three cytologic findings were independently associated with Chlamydia on logistic regression: transformed lymphocytes, polymorphonuclear leukocytes, and squamous metaplasia. The sensitivity and the specificity of the presence of any two of these three findings were 75% and 73.6%, respectively. The prevalence of Chlamydia if two findings were present was 12.2%, nearly three times the population prevalence. Certain findings on cervical cytology may be useful as an adjunct in preventive care for chlamydial cervicitis.

Adolescent↗

PubMedDate not supplied

Vascular head pain: a neurobiologist's approach.

Cephalic blood vessels are invested with a dense network of perivascular fibers of diverse origin. A proportion of these fibers arise from trigeminal neurons and contain chemicals which have vasodilating and pro-inflammatory properties. Evidence suggests that these trigeminovascular neurons may influence both vascular function and neurophysiological activity within the brain. The trigeminovascular system may thus represent a (bi-directional, brain-vessel, vessel-brain) final common pathway for the actions of many chemical, mechanical and neural influences which may have important consequences for the pathogenesis and treatment of headache.

Animals↗