Abstract：
BACKGROUND:More than one-half of nursing home residents experience a complex mix of pain. Despite this, assessment and treatment of pain remain inadequate. METHODS:Using techniques of the Cochrane Collaboration and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we assessed efficacy of interventions aimed at reducing chronic pain in nursing home residents >65 years of age. We searched for controlled trials comparing and measuring pain interventions using standardized pain scales. Two reviewers independently selected included studies, abstracted data, and assessed risk of bias. We performed meta-analyses calculating standardized mean differences (SMDs) using random effect models. RESULTS:Fourteen trials (n = 2293) were included in the meta-analysis: 7 reported nonanalgesic treatments, 4 reported analgesic treatments, 5 reported system modifications, and 2 reported educational interventions. A variety of pain scales were used, reporting outcome measures from 1 week to 1 year. Pooled results at trial completion revealed a statistically significant small treatment effect [SMD -0.33, 95% confidence interval (CI) -0.51, -0.14]. Further subgroup analysis revealed that residents receiving analgesic interventions benefited most (SMD -0.65, 95% CI -1.07, -0.23), followed by those receiving educational interventions (SMD -0.40, 95% CI -0.59, -0.21), and those receiving system modification interventions (SMD -0.26, 95% CI -0.51, -0.02). CONCLUSIONS:Nonanalgesic treatment and control groups showed no statistical differences. Our findings suggest that analgesics are the most effective pain intervention and should be considered first-line therapy. Caution should be used in interpreting findings as few trials were included, risk of bias was variable, sample sizes were small, and pooled treatment effects were small to moderate.
journal_name
J Am Med Dir Assocjournal_title
Journal of the American Medical Directors Associationauthors
Knopp-Sihota JA,Patel P,Estabrooks CAdoi
10.1016/j.jamda.2016.09.016subject
Has Abstractpub_date
2016-12-01 00:00:00pages
1163.e19-1163.e28issue
12eissn
1525-8610issn
1538-9375pii
S1525-8610(16)30432-7journal_volume
17pub_type
杂志文章,meta分析,评审abstract：OBJECTIVES:Patients discharged to a skilled nursing facility (SNF) for post-acute care have a high risk of hospital readmission. We aimed to develop and validate a risk-prediction model to prospectively quantify the risk of 30-day hospital readmission at the time of discharge to a SNF. DESIGN:Retrospective cohort stud...
journal_title：Journal of the American Medical Directors Association
pub_type： 杂志文章
doi：10.1016/j.jamda.2019.01.137
更新日期：2019-04-01 00:00:00
abstract：OBJECTIVES:Paratonia, a form of hypertonia typically seen in dementia, is often associated with difficulties in positioning and daily care. No evidence-based therapy or clinical guideline for management is available. In this study, the short-term effect of harmonic techniques (HT) and supporting cushions (SC) on parato...
journal_title：Journal of the American Medical Directors Association
pub_type： 临床试验,杂志文章,多中心研究
doi：10.1016/j.jamda.2019.04.031
更新日期：2019-12-01 00:00:00
abstract：OBJECTIVES:To evaluate whether STOPP/START v2 potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs) are associated with 6-month mortality and unplanned hospitalization in hospital-discharged older patients. DESIGN:Multicenter prospective cohort observational study. SETTING AND PARTIC...
journal_title：Journal of the American Medical Directors Association
pub_type： 杂志文章
doi：10.1016/j.jamda.2019.03.023
更新日期：2019-11-01 00:00:00
abstract：BACKGROUND/OBJECTIVES:Studies show that in nursing homes (NHs), the prevalence of moderate-to-severe obesity has doubled in the last decade and continues to increase. Obese residents are often complex and costly, and this increase in prevalence has come at a time when NHs struggle to decrease hospitalizations, particul...
journal_title：Journal of the American Medical Directors Association
pub_type： 杂志文章
doi：10.1016/j.jamda.2020.03.009
更新日期：2020-09-01 00:00:00
abstract：INTRODUCTION:Antibiotic stewardship programs (ASPs) are coordinated interventions promoting the appropriate use of antibiotics to improve patient outcomes and reduce microbial resistance. These programs are now mandated in nursing homes (NHs) but it is unclear if these programs improve resident outcomes. This systemati...
journal_title：Journal of the American Medical Directors Association
pub_type： 杂志文章
doi：10.1016/j.jamda.2017.06.019
更新日期：2018-02-01 00:00:00
abstract：OBJECTIVES:The objectives of this study were to identify the barriers to osteoporosis clinical practice guideline use perceived by Medical Directors (MED DIR) and Directors of Nursing (DON) in skilled nursing facilities; and to describe differences in the perceptions of MED DIRs and DONs. DESIGN:The authors conducted ...
journal_title：Journal of the American Medical Directors Association
pub_type： 杂志文章
doi：10.1016/j.jamda.2005.03.024
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abstract：OBJECTIVE:Prognostic information is important for guiding palliative care planning for patients with dementia. We aim to validate a risk score that uses Minimum Data Set (MDS) to estimate 6-month mortality for nursing home residents with advanced dementia. DESIGN:Two cohort studies. SETTING:Six nursing homes in The N...
journal_title：Journal of the American Medical Directors Association
pub_type： 杂志文章,多中心研究
doi：10.1016/j.jamda.2007.05.004
更新日期：2007-09-01 00:00:00
abstract：:Long term care facilities are important sites of care for elderly adults. Despite a growing need and interest in medical direction in nursing homes, there have been limited educational opportunities in this area for geriatric medicine fellows. This article describes a novel medical director's curriculum for first-year...
journal_title：Journal of the American Medical Directors Association
pub_type： 杂志文章
doi：10.1016/j.jamda.2012.10.008
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journal_title：Journal of the American Medical Directors Association
pub_type： 杂志文章
doi：10.1016/j.jamda.2018.07.020
更新日期：2018-11-01 00:00:00
abstract：OBJECTIVES:To assess the effectiveness of a wireless network (WiFi-based) localization system (devices mounted on resident wheelchairs) in decreasing caretaker time spent searching for residents and providing alerts of residents going outdoors in a skilled nursing facility. DESIGN:A controlled study over two 2-month p...
journal_title：Journal of the American Medical Directors Association
pub_type： 杂志文章
doi：10.1016/j.jamda.2012.04.010
更新日期：2012-07-01 00:00:00
abstract：OBJECTIVES:In nursing home settings, providers often think that most percutaneous endoscopic gastrostomy (PEG) tubes are placed in older people, some perhaps inappropriately. We sought to describe the relationships between patient age and the indications for, the decision making behind, and the outcomes of gastrostomy ...
journal_title：Journal of the American Medical Directors Association
pub_type： 杂志文章
doi：10.1016/j.jamda.2005.05.010
更新日期：2005-11-01 00:00:00
abstract：:Suboptimal vitamin D status is common in sick, elderly patients and is associated with secondary hyperparathyroidism, increased bone turnover, and accelerated bone loss. Nutritional supplementation of elderly patients with vitamin D and calcium has been associated with a reduction in fractures and falls. Recently, the...
journal_title：Journal of the American Medical Directors Association
pub_type： 杂志文章
doi：10.1016/j.jamda.2005.12.010
更新日期：2006-03-01 00:00:00
abstract：CONTEXT:Home Hospital is a worldwide phenomenon that provides acute and subacute medical care in the home in an attempt to reduce the need for hospitalization. OBJECTIVE:To evaluate the clinical parameters of a home hospitalization program operating in Jerusalem for 8 years. DESIGN:The Jerusalem Home Hospitalization ...
journal_title：Journal of the American Medical Directors Association
pub_type： 杂志文章
doi：
更新日期：2002-03-01 00:00:00
abstract：OBJECTIVES:To examine costs and effects of care based on comprehensive geriatric assessment (CGA) provided by an ambulatory geriatric care unit (AGU) in addition to usual care. DESIGN:Assessor-blinded, single-center randomized controlled trial. SETTING:AGU in an acute hospital in southeastern Sweden. PARTICIPANTS:Co...
journal_title：Journal of the American Medical Directors Association
pub_type： 杂志文章,随机对照试验
doi：10.1016/j.jamda.2015.01.074
更新日期：2015-06-01 00:00:00
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pub_type： 杂志文章
doi：10.1097/01.JAM.0000028225.84012.3B
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journal_title：Journal of the American Medical Directors Association
pub_type： 杂志文章
doi：10.1016/j.jamda.2010.11.007
更新日期：2011-11-01 00:00:00
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journal_title：Journal of the American Medical Directors Association
pub_type： 杂志文章
doi：10.1016/j.jamda.2007.08.003
更新日期：2008-01-01 00:00:00
abstract：OBJECTIVE:This study examined the impact of hospice enrollment on the probabilities of hospital and nursing home admissions among a sample of frail dual-eligible assisted living (AL) residents. DESIGN:The study used a retrospective cohort design. We estimated bivariate probit models with 2 binary outcome variables: an...
journal_title：Journal of the American Medical Directors Association
pub_type： 杂志文章
doi：10.1016/j.jamda.2011.06.001
更新日期：2012-02-01 00:00:00
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更新日期：2012-11-01 00:00:00
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更新日期：2019-02-01 00:00:00
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journal_title：Journal of the American Medical Directors Association
pub_type： 杂志文章,评审
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更新日期：2012-03-01 00:00:00
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journal_title：Journal of the American Medical Directors Association
pub_type： 杂志文章,随机对照试验
doi：10.1016/j.jamda.2014.12.005
更新日期：2015-03-01 00:00:00
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journal_title：Journal of the American Medical Directors Association
pub_type： 杂志文章
doi：10.1016/j.jamda.2019.12.014
更新日期：2020-01-27 00:00:00
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journal_title：Journal of the American Medical Directors Association
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更新日期：2020-11-19 00:00:00
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journal_title：Journal of the American Medical Directors Association
pub_type： 杂志文章
doi：10.1016/j.jamda.2010.09.003
更新日期：2011-07-01 00:00:00
abstract：:The prevalence of malnutrition ranges up to 50% among patients in hospitals worldwide, and disease-related malnutrition is all too common in long-term and other health care settings as well. Regrettably, the numbers have not improved over the past decade. The consequences of malnutrition are serious, including increas...
journal_title：Journal of the American Medical Directors Association
pub_type： 杂志文章
doi：10.1016/j.jamda.2014.05.011
更新日期：2014-08-01 00:00:00
abstract：OBJECTIVES:To describe end-of-life care in Japanese nursing homes by comparing facility and characteristics of residents dying in nursing homes with those who had been transferred and had died in hospitals, and by comparing the quality of end-of-life care with hospitals and with their respective counterparts in the Uni...
journal_title：Journal of the American Medical Directors Association
pub_type： 杂志文章
doi：10.1016/j.jamda.2013.02.008
更新日期：2013-10-01 00:00:00
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journal_title：Journal of the American Medical Directors Association
pub_type： 杂志文章
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更新日期：2007-07-01 00:00:00
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journal_title：Journal of the American Medical Directors Association
pub_type： 杂志文章
doi：10.1016/j.jamda.2017.05.022
更新日期：2017-11-01 00:00:00
