Journal of the American Medical Directors Association
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To examine nutrition status and to explore risk factors for malnutrition in an urban veterans' long-term care (LTC) facility in Western Canada to determine whether nutrition should be a higher priority for managers, physicians, and staff. ⋯ Most residents were found to be at risk or actually malnourished. Analyses of the results indicate that managers, physicians, and staff need to focus on residents with depression and dementia, and those whose health is unstable. Ethical considerations are important in choosing appropriate interventions because many LTC residents are at an end-of-life stage. Effective nutrition interventions (eg, adding resources to support residents during meals, changing environmental factors) exist but what has not been well investigated are the methods for translating such knowledge into practice.
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To determine the frequency and diagnoses associated with 7- and 30-day acute hospital readmissions of patients discharged to a skilled nursing facility (SNF) from an acute hospital. ⋯ In this community hospital population, close to 1 in 5 discharges to an SNF resulted in a hospital readmission within 30 days. CHF, renal failure, UTI, pneumonia, and COPD were common index hospital and readmission diagnoses. Care paths and guidelines are available for these conditions that should be helpful to SNFs in initiatives designed to improve transitional care and reduce potentially avoidable hospital readmissions, as well as their associated morbidity and cost.
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Vitamin D deficiency remains a poorly recognized pandemic and is closely linked to increased health care costs in veterans. Projected health care needs in veterans are expected to increase over the next decade. Intensive care unit (ICU) costs contribute significantly to hospital costs and stem from intervention services and management of sepsis including nosocomial infections. Vitamin D has immunomodulating and antimicrobial properties through antimicrobial peptides such as cathelicidin. ⋯ A vitamin D-replete state may reduce costs and confer survival advantages in critical illness. We recommend that 25(OH)D levels be routinely checked and deficiencies treated in ICU patients.