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Center Newsby Joan DeClaire
Exercise plus behavior management training for caregivers benefits Alzheimer's patients, UW/Group Health study finds People with Alzheimer's disease can benefit from a home-based program that trains their caregivers to help patients exercise and to manage patients' behavior problems, according to an article in the October 15 issue of the Journal of the American Medical Association. Researchers from the University of Washington (UW) School of Nursing and Group Health Center for Health Studies conducted the study of 153 patient/caregiver pairs, comparing patients who were enrolled in the program with those in usual care. The study found that patients in the program showed significantly higher levels of physical activity, lower rates of depression, and better physical health and function. While previous research has shown that exercise benefits Alzheimer's patients, this is the first study to show the effectiveness of a home-based program that helps caregivers to deal with behavioral disturbances that can be an obstacle to physical activity. "Alzheimer's disease affects both patients and caregivers," explained principal investigator Linda Teri, PhD, director of the Northwest Research Group on Aging and professor in UW's School of Nursing. "It is a debilitating disease that touches every aspect of daily life. By helping caregivers learn how to treat the problems that arise and how to encourage physical activities, we have the potential to significantly improve function and care." The training in the study consisted of 12 one-hour sessions taught by home-health professionals from Group Health Cooperative who were trained in dementia care. The home-health workers showed the patients how to do aerobic activities, strength training, balance, and flexibility exercises. The staff also taught caregivers how to encourage and help patients with their exercise, and helped the caregivers to develop and implement behavioral plans. The program's goal was to have the patients moderately exercise for 30 minutes each day. In addition, the staff taught caregivers about Alzheimer's-related dementia, how it affects patients' behavior, and how to avoid situations that may distress their patients. Caregivers also learned ways to respond to problems, to identify pleasant activities for their patients, and to encourage positive interactions with the patients. In follow-up evaluations three months and 24 months later, the researchers found that the patients enrolled in the programs had significantly better mood, were more physically active, and did better on physical performance measures. This means they were less at risk for physical disability, which would further impair the quality of their lives. Patients receiving the study intervention were also significantly less likely to be institutionalized for behavior problems, suggesting that caregivers were better able to care for them at home. "Because Alzheimer's is a degenerative, progressive brain disease, people often have a sense of hopelessness about it," said Eric B. Larson, MD, MPH, director of Group Health Center for Health Studies, and a co-investigator on the study. "But this study shows there are relatively simple, low-cost ways to help patients preserve their physical health and have fewer behavioral problems as a result of their disease." Vaccine-related anaphylaxis is rare, CHS study shows Parents and health care providers can be reassured that vaccine-related anaphylaxis, a potentially fatal hypersensitivity reaction, is rare, according to a study CHS investigators published in the October 2003 issue of the journal Pediatrics. CHS Research Associate Kari Bohlke, ScD, was the principal investigator for the study, which is part of the Vaccine Safety Datalink—a research program established by the Centers for Disease Control and Prevention that links information from several large U.S. health plans. Bohlke and her colleagues analyzed data from more than 7.5 million vaccine doses and found just five cases of anaphylaxis, or about 0.65 cases per million doses. None of these cases resulted in death. The researchers cautioned that this risk estimate could be low because of the way sites differ in coding allergic reactions. However, at one site, where they reviewed additional allergy codes, they identified just one case of anaphylaxis after about 650,000 vaccine doses, or about 1.53 cases per million doses. The vaccines administered prior to the anaphylactic episodes in the study were: measles-mumps-rubella, hepatitis B, diphtheria-tetanus, diphtheria-tetanus-pertussis, Haemophilus influenzae type b, and oral polio vaccine. The shots were generally given in combination. "Providers and patients can be reassured that the frequency of vaccine-associated anaphylaxis is very low," the authors concluded. "Nevertheless, providers should be prepared to provide immediate treatment should it occur." This study included data from Group Health as well as Kaiser Permanente heath plans in Northern California, Southern California, and Portland, Oregon. CHS senior investigators Robert L. Davis, MD, and Robert S. Thompson, MD, were among the co-authors of the study. MacColl Institute studies “best practices” in processes of care and coordination for AHRQ A research team from Group Health Center for Health Studies’ MacColl Institute recently completed a task order for the federal Agency on Health Care Research and Quality titled, Improving Processes of Care and Coordination. The project was developed in response to the Institute of Medicine’s Crossing the Quality Chasm report, which calls for significant redesign of the nation’s health care systems. The team, led by Ed Wagner, MD, MPH and Paula Lozano, MD, MPH, solicited national examples of successful system changes, or “best practices” happening in a wide range of care-delivery organizations—from large medical groups to hospitals to small clinics. Those practices that were shown to be replicable and to be improving outcomes were then assessed according to specific criteria outlined in the framework—including whether their services were patient-centered; evidence-based; safe; timely and efficient; and coordinated. The result is a report that includes a new conceptual framework for redesigning care processes, an associated menu of 87 “best practices” from 32 different health care organizations, and a summary of the literature and evidence supporting the framework and each best practice. More research highlights:Although the rate of breast cancer detection is similar in the two countries, US doctors perform two to three times more open surgical biopsies than British doctors, according to a study co-authored by CHS assistant investigator Diana Miglioretti, PhD. In addition, American women are recalled, or referred for further testing, twice as often as British women are, the authors wrote in the October 22 issue of the Journal of the American Medical Association. Led by Rebecca Smith-Bindman, MD, from the University of California–San Francisco, the researchers examined data from 5.5 million mammograms conducted in the US and UK over a four-year period. This data includes nearly 1 million mammograms from the Breast Cancer Surveillance Consortium—a group of eight institutions that combine their data for research to improve breast cancer screening. CHS is part of the Consortium and serves as its Statistical Coordinating Center. The authors credited the UK's "centralized program of continuous quality improvement," for the nation's success at reducing recall rates. "Screening women aged 50 to 69 years biennially and reducing recall rates could substantially decrease the cost of mammography, as well as associated anxiety caused by false-positive diagnosis. Efforts to improve US mammographic screening should be targeted to lowering the recall rate without substantially lowering the cancer detection rate," the authors concluded. Antibiotic prescriptions to children decreased significantly between 1996 and 2000, according to a study published in the September 2003 issue of Pediatrics. The study tracked prescriptions from about 200,000 children in nine health plans, including Group Health Cooperative. The work is part of an ongoing federally funded program of research in pharmacoepidemiology and patient safety at Group Health led by CHS senior investigator Robert L. Davis, MD, MPH, a co-author of the study. The decrease in antibiotic prescribing was concurrent with decreased frequency of diagnosis of potential bacterial ear infections. "Attention by public health and professional organizations and the news media to antibiotic resistance may have contributed to changes in diagnostic thresholds, resulting in more judicious prescribing," the researchers concluded. The risk of suicide attempt and suicide death among patients diagnosed with bipolar disorder is lower during treatment with lithium than during treatment with divalproex. This is according to an article in the September 17 issue of the Journal of the American Medical Association by Group Health psychiatrist and CHS senior investigator Greg Simon, MD, MPH and colleagues from George Washington University Medical Center, MEDTAP International, and Kaiser Permanente. Their study included 20,638 Group Health and Kaiser Permanent members over age 18 who filled prescriptions for lithium, divalproex, or carbamazepine over an eight-year period. What research had the most significant impact on the practice of internal medicine in 2002? CHS Director Eric B. Larson, MD, MPH, joins John V.L. Sheffield, MD, assistant chief of clinical education at Harborview Medical Center, to answer this question in the August 19 issue of Annals of Internal Medicine. Their article, titled "Update in General Internal Medicine," reviews medical breakthroughs related to hormone replacement therapy, statins, exercise, hypertension, prostate cancer, diabetes care, and antioxidant vitamins. Larson and/or Sheffield have presented such updates to the Annual Session of the American College of Physicians regularly for the past decade. Staff News:Health informatics investigator joins the Group Health’s Center for Health Studies: James Ralston, MD, MPH, joined CHS in October as an assistant investigator conducting research in health informatics. A general internist, Ralston recently completed a fellowship in general internal medicine at the University of Washington School of Medicine. His research there focused on the development and evaluation of online healthcare services for the management of chronic illness. His projects have included studying the impact of allowing patients access to their medical records via the Internet, and the impact of Web-based communication between patients and providers. “I came to Group Health because it’s ahead of all other healthcare organizations in the development of a patient-centered, integrated information system,” says Ralston. Group Health’s new, secure, Web-based system allows individual patients and their doctors online access to the same information from the patient’s medical record, he explains. “Through CHS, I’ll be able to test these tools in a large health care system and evaluate if and how they improve patient care. It’s an opportunity that’s not possible in an academic setting.” CHS Director Eric B. Larson, MD, MPH, called Ralston’s arrival “an important milestone in the development of Group Health’s informatics research utility—an effort that will involve many people at CHS and Group Health’s Clinical Information Systems team.” Ralston graduated from UW’s School of Medicine in 1994. He received his master’s degree from UW’s School of Public Health in 2002. In addition to his research, Ralston will work for Group Health Permanente’s Consultative Internal Medicine Group in Redmond, providing outpatient consultation for Group Health patients with complicated medical conditions. New affiliate investigators named: New affiliate investigators named The CHS faculty recently added six new researchers to its roster of affiliate investigators. These are scientists from other organizations who contribute significantly to the CHS mission through their collaborations with Center investigators. Affiliation requires a vote by CHS faculty and endorsement from the CHS director. The new affiliates are:
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