Objetivos: o objetivo do presente estudo é avaliar a resposta molares e não molares a dois protocolos de atenção periodontal na fase de manutenção periódica preventiva (MPP). Métodos: Sessenta e dois pacientes com periodontite moderada ou avançada (idade média 50.97 ± 9.26 anos, 40 mulheres, 24 fumantes) foram tratados de acordo com um protocolo não-cirúrgico. Finalizada a fase terapêutica, os pacientes iniciaram a fase de MPP e foram randomicamente alocados para receber controle supragengival isolado (SPG) ou combinado ao subgengival (SPG+SBG). Exames periodontais, instruções de higiene bucal e as respectivas intervenções experimentais foram realizados em consultas trimestrais. Resultados: não foram observadas diferenças significativas nas variáveis demográficas, número médio de dentes e distribuição média de dentes não-molares/molares e de sítios livres/proximais entre os dois grupos experimentais. Quando do baseline, os dentes molares apresentaram um maior número de sítios positivos para IPV, ISG, SS e maiores valores médios de PS e PI quando comparados aos não-molares (p<0.001). Ao longo da fase de MPP, foi demonstrado que independente da terapia aplicada, tanto para molares e não molares, a resposta para ambos os grupos dentários não foi diferente. Da mesma forma, a perda dentária entre molares e não molares não diferiu ao longo de 24 meses. Conclusões: Molares apresentam semelhante resposta durante a fase de MPP quando comparados a dentes não molares, independente do protocolo de intervenção clínica aportado. / Aim: The objective of the present study was to evaluate the response of molar teeth and non-molar teeth to two periodontal care protocols in the periodic preventive maintenance phase (PMP). METHODS: Sixty-two patients with moderate or advanced periodontitis (mean age 50.97 ± 9.26 years, 40 women, 24 smokers) were treated according to a non-surgical protocol. After the therapeutic phase, the patients started the PMP and were randomly assigned to receive supragingival (SPG) or combined subgengival (SPG + SBG) control. Periodontal examinations, oral hygiene instructions and the respective experimental interventions were performed in quarterly consultations. Results: There were no significant differences in demographic variables, mean number of teeth and mean distribution of non-molar / molar teeth and free / proximal sites between the two experimental groups. At the baseline, molar teeth had a higher number of positive sites for VPI, GBI, BOP and higher mean values of PPD and CAL when compared to non-molars (p <0.001). Throughout the MPP phase, it was demonstrated that regardless of the applied therapy, for both molars and non-molars, the response for both dental groups was not different. Likewise, tooth loss between molars and non-molars did not differ over 24 months. Conclusions: Molars presented a similar response during the PMP when compared to non-molar teeth, independent of the protocol of clinical intervention provided.

Orientador: Cassiana Mendes Bertoncello Fontes / Resumo: Introdução: As Instituições de longa permanência para idosos (ILPIs) podem ser instituições governamentais; ou não; de caráter residencial, destinadas ao domicilio coletivo de pessoas com idade igual ou superior a 60 anos com ou sem suporte familiar; e em condição de liberdade, dignidade e cidadania. Em ILPI o enfermeiro coordena a equipe de enfermagem, composta por auxiliares e técnicos de enfermagem e é responsável pelo gerenciamento e planejamento individual do cuidado aos idosos, educação e treinamento da equipe assim como a execução dos cuidados de maior complexidade.O planejamento da assistência de enfermagem individualizada ao idoso é exigido pela legislação do COFEN 358/2009 e está representado pelo Processo de Enfermagem (PE).A operacionalização do PE se estabelece pelas etapas da Sistematização da Assistência de Enfermagem (SAE) e nesse contexto corrobora para promover a qualidade e segurança do paciente, de forma a conduzir o processo de cuidar na ILPI; Objetivo: O objetivo do estudo foi compreender a experiência dos enfermeiros, que atuam em ILPIs, com o planejamento da assistência representado pela SAE. Tratou-se de um estudo qualitativo, aprovado pelo Comitê de Ética local, Plataforma Brasil, CAAE 65473317.7.0000.5411, Parecer nº 2.154.867. métodos: Utilizou-se como referencial teórico-metodológico a Teoria de Wanda de Aguiar Horta e como referencial metodológico a Análise de Conteúdo de Bardin. A coleta de dados foi realizada pela pesquisadora por meio de entre... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction: Long-term Institutions for the Elderly (ILPIs) can be governmental institutions; or not; of residential character, destined to the collective address of people aged 60 or over with or without family support; and in the condition of freedom, dignity and citizenship. In ILPI, the nurse coordinates the nursing team, composed of nursing auxiliaries and technicians and is responsible for the management and individual planning of care for the elderly, education and training of the team as well as the execution of the more complex care. nursing is required by the COFEN 358/2009 legislation and is represented by the Nursing Process (PE). The operationalization of the EP is established through the Nursing Care Systematization (SAE) stages and, in this context, corroborates the patient safety in order to conduct the caring process in the ILPI. Objective: The objective of the study was to understand the experience of nurses, who work in ILPIs, with the planning of care represented by SAE. This was a qualitative study, approved by the Local Ethics Committee,Brazil Platform, CAAE 65473317.7.0000.5411, Opinion no. 2,154,867. Methods: The Wanda Theory of Aguiar Horta was used as theoretical-methodological reference and as a methodological reference to the Bardin Content Analysis. Data collection was performed by the researcher through semi-structured and recorded audio interviews, with ten ILPI nurses from three municipalities in the interior of São Paulo. The guiding question... (Complete abstract click electronic access below) / Mestre

The Third Chapter: The aim of this research is to study individual choices of precau- tionary saving and long-term care spending when an individual faces the uncertainty of after-retirement health shocks. To do this, an improved two-period life-cycle model is employed. This paper also explores how individual choice affects economic development and capital accumulation in an overlapping generation economy. The study shows that the rise in the possibility of getting after-retirement health shocks will result to an increase in long-term care expenditure and the level of precautionary saving. The steady state will also increase in this case. The Fourth Chapter: The increasing and intensifying long-term care (LTC) demand brings great financial pressures for both governments and individuals. From the public perspective, the underlying economic question is how adequate real resources can be re- distributed to support long-term care need and how efficient the policies targeting is. As many LTC policies are accessed through means tests, individuals saving behaviour can be affected. This paper examines and compares the welfare effects that different means- tested policies have on individuals. We did this by embedding life-cycle models with after-retirement health shocks. Means-tested policies of long-term care, one with a top- up choice, and one without, were then simulated. The results show that the means test regime with a top-up option can bring a higher social welfare. Under this scheme, a higher means test threshold can decrease societys dependency on a social benefit system and increase social welfare. The Fifth Chapter: Attendance Allowance and Disability Living Allowance are the dis- ability cash benefits provided for people who are over 65 in the U.K. As the government plans to divert more public resource from these benefits to means-tested local care ser- vices, it is important to understand the effects and targeting of these cash benefits first. Using the survey data from English Longitudinal Study of Ageing, this study examines the relationship between the receipt of disability cash benefits and recipients’ character- istics among those who are over 65 in England. Although income is not a key factor to decide on the receipt of the benefits in the criteria, the results show that it still has a self- selection process where the benefits are given to those who are both most in need and on low incomes.

Care home admission following acute hospitalisation is a lived reality across Scotland, experienced by over 8,000 people annually. The aim of this thesis was to develop an understanding of new care home admission following acute hospitalisation. Methods and findings from the mixed-methods approach are presented in three parts. Part One: Identifying relevant research - includes a review of quality assessment tools for systematic reviewing; a systematic review and meta-analysis of quantitative data from observational studies of predictors of care home admission from hospital; and a methodological chapter on developing a search filter to improve accessibility of existing research findings supported by the findings of an international survey of care home researchers. The systematic review identified 53 relevant studies from 16 countries comprising a total population of 1,457,881 participants. Quantitative synthesis of the results from 11 of the studies found that increased age (OR 1.02 per year increase; 95%CI 1.00-1.04), female sex (OR 1.41; 95%CI 1.03-1.92), dementia & cognitive impairment (OR 2.14; 95%CI 1.24-3.70) and functional dependency (OR 2.06; 95%CI 1.58-2.69) were all associated with an increased risk of care home admission after hospitalisation. Despite international variation in service provision, only two studies described the model of care provided in the care home setting. The survey identified that there is a lack of shared terminology in the published literature to describe settings for adults who are unable to live independently in their own homes and require care in a long-term institutional setting. A search filter to identify relevant research could help to overcome differences in terminology and improve synthesis of existing research evidence. Part Two: Exploring current clinical practice - reports the findings of a retrospective cohort study of new care home admissions from hospital using case-note review methodology accompanied by findings from inductive thematic analysis of a single dataset from a qualitative case study design exploring the experiences of a patient, their family, and practitioners (n=5). The cohort study (n=100) found a heterogeneous picture with long hospital admissions (range 14-231 days), frequent transfers of care (31% experienced three or more transfers), varied levels of documented assessment and a lack of documented patient involvement in the decision-making processes. The qualitative interviews allowed the patient voice to emerge, alongside the professional and family narrative which dominated case-note documentation. Inductive thematic analysis identified nine major themes exploring how decisions are made to discharge individuals directly into a care home from the acute hospital setting: biography & personality; professional role; family role; limitations in local model of care; ownership of decision; risk; realising preferences; uncertainty of care home admission process; and psychological impact of in-hospital care. Part Three: Harnessing routinely-collected data - includes the challenges of identifying care home residency at admission and discharge from hospital, presenting analysis of the accuracy of Scottish Morbidity Record 1 (SMR01) coding in NHS Fife and the Community Health Index (CHI) Institution Flag in NHS Fife and NHS Tayside. This is followed by a descriptive analysis of the Scottish Care Home Census (2013-16) as a novel social care data source to explore care home admissions from hospital and the methodology for a data linkage study using these data. Identifying care home residents in routine data sources is challenging. In 18,720 admissions to NHS Fife, SMR01 coding had a sensitivity of 86.0% and positive predictive value of 85.8% in identifying care home residents on admission. At discharge the sensitivity was 87.0% and positive predictive value was 84.5%. From a sample of 10,000 records, the CHI Institution Flag had a sensitivity of 58.6% in NHS Fife and 89.3% in NHS Tayside, with positive predictive values of 99.7% and 97.7% respectively. From 2013-16, of 21,368 admissions to care homes in Scotland, 56.7% were admitted from hospital. There was significant regional variation in rates of care home admission from hospital (35.9-64.7%) and proportion of Local Authority funded places provided to admissions from hospital (34.4-73.9%). Those admitted from hospital appeared to be more dependent and sicker than those admitted from home. This thesis has established a series of challenges in how care homes and their residents are identified. It has questioned the adequacy of the evidence to guide practitioners and sought to raise the profile of this vulnerable and complex population and how best to support them in making decisions regarding admission from the acute hospital. It has progressed our understanding of this under-explored area and proposes a programme of future mixed-methods research involving patients, families, practitioners and policy-makers.

The quality of care in United States' nursing homes has been of concern to consumers, government agencies, and researchers for several decades. Nurse staffing has been identified as a key factor influencing the quality of care in nursing homes. The purpose of this quantitative, correlational research was to determine if relationships existed between nurse staffing levels and three quality care outcomes in the state of Georgia. Donabedian's quality conceptual framework guided the study. The framework encompasses three interrelated dimensions of quality including structure, process, and outcomes. Nurse staffing levels and facility bed size represented the structure of nursing homes and pressure ulcers, falls with major injury, and urinary tract infections each represented facility outcomes. The sample included 348 nursing homes in Georgia. Data was collected from the Nursing Home Compare website. The predictor variables in this study were nurse staffing levels of registered nurses, licensed practical nurses, certified nursing assistants, and total nurse staffing levels. The outcome variables were pressure ulcers, urinary tract infections, and falls with major injury. A cross sectional design and multiple regressions were used to analyze the relationship between nurse staffing and quality of care outcomes. While the results of the study did not reveal significant relationships between variables, the study nonetheless offers useful insight on how future studies can be enhanced. These findings have implications for social changes as they may help to inform Georgia policy makers in decisions regarding regulations that mandate minimum nurse staffing standards.

As older adults live longer, demand for supportive care will increase. Older adults will need a form of long-term care to manage their health and quality of life. As older adults age, they’re susceptible to having one or more chronic conditions. In taking measures to manage the chronic conditions of many older adults, in-home supportive services is a supportive program that provides non-medical personal and instrumental services to help older adults with their activities of daily living. An in-home supportive service allows an older adult to receive assistance and remain comfortably living in his or her home. However, an older adult of low-income status may not receive this information on supportive services. Therefore, this study was designed to assess the level of awareness low-income older adults have on in-home supportive services. This research design was quantitative focusing on measuring the level of awareness among low-income older adults. A survey instrument was created and given to older adults at a senior center of the County of San Bernardino. IBM SPSS Manual on Windows Software was used to input and analyze data. The findings of the study found a low level of awareness of the program called In-Home Supportive Services (IHSS) and participants understanding of in-home supportive services was unclear. This study provides recommendations for social workers to address the barriers of low-income older adults acquiring information on in-home supportive services.

The purpose of this study was to investigate depression and psychotherapy for adults who are in long-term care facilities. Depression is a serious problem for the elderly in general and for residents of nursing homes in particular. The current study drew on the dynamic stress vulnerability approach to explain how illness occurs in older people, using evidence obtained from the biological, social, and psychological domains with respect to depression. The research question addressed the difference in posttreatment depressive symptoms among 6 types of psychotherapy as measured by the Hamilton rating scale for depression (HRSD)? The 6 therapy techniques were (a) cognitive behavioral therapy, (b) supportive psychotherapy, (c) life review therapy, (d) reality oriented therapy, (e) mindfulness training, and (f) affect regulation therapy. A 1-group pretest-posttest research design was used with archival data from de-identified medical records. The analysis of this study controlled for pretreatment depressive symptoms as measured by the HRSD. A statistically significant main effect of psychotherapy was found, revealing a difference in posttreatment depressive symptoms as measured by the HRSD between at least 1 pair of the 6 types of psychotherapy after controlling for pretreatment HRSD. The covariate, pretreatment HRSD, was also statistically significant, indicating a relationship between pretreatment HRSD and posttreatment HRSD when controlling for psychotherapy group. This research study contributes to the breadth of information concerning efficacious treatments for depression among the elderly in nursing homes and can assist researchers, nursing homes, and doctors to promote positive social change by better treating the depressive symptoms in a pretreatment environment.

Falls and injuries related to falls are some of the most common and costly incidents that occur in the long-term care environment. Purposeful hourly rounding is a proactive way for nursing staff to identify patient needs and demonstrate positive fall prevention outcomes. This project examined a process improvement endeavor of a long-term care unit that experienced an increase in the number of falls over 3 months. The purpose was to evaluate whether staff education and implementation of an evidence-based hourly rounding program would affect the number of patient falls. The Johns Hopkins nursing evidence-based conceptual model, Kurt Lewin's change model, and the Shewhart cycle process improvement model were used to implement the change process as well as the Studer Group best practice hourly rounding tools. A sample of 40 residents was included in a quantitative descriptive design describing the implementation of hourly rounding. Staff were educated 30 days prior to implementation. Pre and post project fall rates were retrieved from the VA fall data management system and revealed a 55% decrease over 3 months post staff education. The use of evidence-based hourly rounding measures increased over the same time period. Nurse leaders must ensure rounding programs are evidence-based, clearly defined in policies, and include robust education plans. There are limited studies on the relationship between education and hourly rounding; therefore, future studies should focus on outcomes of initial and ongoing education for program success and sustainability. Falls are a healthcare concern nurses must address at any point-of-care to promote public safety through prevention and to facilitate positive social change by providing a safe hospital environment.

Through advancements in modern medicine, human beings worldwide are living longer. The increase in life expectancy creates a need for a more qualified and knowledgeable nursing workforce for the delivery of quality geriatric health care. Although nurses are the primary care providers for vulnerable older adults, they are generally not well trained or prepared in geriatric care. Therefore, the purpose of the project was to develop an education program aimed at improving nursing knowledge of geriatric care in the long-term care (LTC) setting. The goal of the project was to answer the research question: What impact would attendance in the program have on improving nursing geriatric knowledge, retention, and job satisfaction by project end? Guided by the advancing research and clinical practice through close collaboration (ARCC) model for evidence-based practice (EBP), the learning needs of nurses in the LTC setting were assessed. The 6-week education program was designed to provide education on the basics of geriatric care, pharmacology and aging, symptom evaluation, dementia care, and geriatric physical assessment. Project participants consisted of 8 nurses who volunteered to take part in the program. The program was evaluated using a pre-test and post-test method to examine nurse's knowledge before and after the education program. Using a paired t test, the results indicated a significant increase (p<.05) between the mean pre-test (3.75) and mean post-test (4.25) scores of nurse knowledge of geriatric care. The education program improved participant knowledge of geriatric care. Positive social change will be achieved with this scholarly project as nurses with greater knowledge gain confidence, strengthen decision making and clinical skills, and improve patient outcomes in the LTC setting.

Nurse recruitment is a challenge for long-term care (LTC) leaders. Some owners of LTC businesses lack knowledge of how to attract, market, and hire qualified nurses to help ensure success. The purpose of this multiple case study was to explore the methods and strategies LTC leaders used to recruit nurses. The target population consisted of leaders of 3 LTC facilities who were responsible for recruiting nurses. This selection was based on findings that organization leaders experienced a downsizing of more than 20% of their personnel. The conceptual framework was the motivation-hygiene theory. Working conditions were influenced by Herzberg's 2-factor principles of job dissatisfaction. I focused on analyzing the participant data, public documents, and performance outcomes that demonstrated the effectiveness of participant recruitment strategies. Data were collected from semistructured interviews. I compared the motivational hygiene theory factors that influenced employee job satisfaction and dissatisfaction identified with the conceptual framework and any new studies published since beginning my study. Results of data coding and analysis revealed 3 major themes: communicating job descriptions to new LTC recruits, hiring for nurse–position fit to address turnover, and making the position attractive by offering competitive wages and benefits. Successful recruiting strategies included ensuring nurse position fit, contacting qualified candidates, and work conditions designed to meet candidates' needs, expectations, and requirements. Results of this study might contribute to social change by providing recruitment strategies to ensure quality nursing services in LTC and strategies necessary to sustain business operations.