Try a new search

Format these results:

Searched for:

person:lestep01

in-biosketch:true

Total Results:

35


Evaluation of Housestaff Knowledge and Perception of Competence in Palliative Medicine [Meeting Abstract]

Lester, Paula
ISI:000279280400049
ISSN: 0885-3924
CID: 3538282

Nursing home procedures on transitions of care

Lester, Paula; Stefanacci, Richard G; Chen, Ding-Geng
OBJECTIVE:To identify nursing home standards through a nationwide survey of directors of nursing regarding transitions of care for residents transferred from acute care hospitals to skilled nursing facilities (SNFs). METHODS:A national survey was distributed online and was completed by 241 directors of nursing of SNFs. The directors of nursing were asked about communication methods, transfer of records, and staff involvement with admissions from acute care hospitals. RESULTS:The results of the survey demonstrated widespread use of an admission coordinator in the nursing home to direct admissions to the facility. Admission nurses consistently had the most responsibility for ascertaining the correct medication regimen on admission to the facility. Although there was a variation in types of records received from the hospitals, more than 80% received medication administration record or discharge/transfer sheet within 1hour of a patient's arrival. CONCLUSION/CONCLUSIONS:The results of this survey demonstrate that although direct verbal communication is not the norm, communication via paper documentation of transfer information is highly common. There was a statistically significantly increased likelihood of the SNF receiving the discharge/transfer sheet and the last medication list when it was directly affiliated with the transferring hospital. These affiliations would increase as a result of proposed payment changes that would bundle Medicare Part A acute hospital payments with the SNF payment.
PMID: 19883886
ISSN: 1538-9375
CID: 3538092

Nursing home policies on items brought in from the outside for facility residents

Stefanacci, Richard G; Lester, Paula E; Kohen, Izchak; Feuerman, Martin
OBJECTIVE:To identify nursing home standards related to items brought in from the community for residents through a nationwide survey of directors of nursing. Specifically we examined the policies with regard to food, cigarettes, alcoholic beverages, and over-the-counter medications. METHODS:A national survey was distributed online and was completed by 299 directors of nursing of skilled nursing facilities. The directors of nursing were asked about policies regarding whether family and friends of residents are permitted to bring in items such as food, cigarettes, alcohol, and over-the-counter medications. Specifically, questions were related to monitoring, staff involvement, safety precautions, and policy implementation. RESULTS:The results of the survey demonstrated a consistent policy practiced among facilities. Items commonly restricted for all residents included over-the-counter medications, alcohol, and cigarettes. On the other hand, food was significantly less likely to be restricted. CONCLUSION/CONCLUSIONS:Despite overall strict policies regarding the monitoring of access to over-the-counter medications, alcohol, and cigarettes by nursing home residents, ingestion of outside food remains fairly unrestricted. This is especially concerning given the growing number of residents with end-stage congestive heart failure, diabetes, dysphagia, or food allergies where access to outside food could result in an adverse event. Perhaps, facilities need to identify at-risk residents and better communicate to residents and their families regarding dietary restrictions on outside food.
PMID: 19560720
ISSN: 1538-9375
CID: 3538082

Do geriatricians practice what they preach?: geriatricians' personal establishment of advance directives

Lester, Paula E; Sykora, Alzbeta; Wolf-Klein, Gisele P; Pekmezaris, Renee; Auerbach, Charles; Feuerman, Martin
Previous research has been conducted regarding preferences of physicians for life-sustaining treatments for themselves, but there is a dearth of data on personal use of advance directives (ADs) by geriatricians specifically. Using a phone survey, we contacted all graduates of the geriatric fellowship program to assess their personal use of advance directives and their personal preferences for life-sustaining treatment. Of the 124 living graduates of the Parker Jewish Institute for Health Care and Rehabilitation, 70 agreed to participate. One third of respondents had established ADs for themselves, with higher rates in women than men (p = .054). Older geriatricians were significantly more likely to have advance directives (exact trend test yields, p < .0001). In general, respondents did not inform their health care providers about their desires for end-of-life care. This study revealed that the majority of fellowship-trained geriatricians did not formally establish advance directives for themselves. Further research is needed to determine whether physicians who establish advance directives for themselves are more likely to encourage their patients to do so.
PMID: 19214847
ISSN: 1545-3847
CID: 3426262

Quetiapine-associated dysphagia [Case Report]

Kohen, Izchak; Lester, Paula
We report a case of quetiapine-induced dysphagia in a geriatric patient which improved with discontinuation of the antipsychotic. The patient had developed dysphagia while being treated with antipsychotics for bipolar disorder. The patient's dysphagia showed significant improvement when she was taken off quetiapine. We review the available literature on antipsychotic-related dysphagia and suggest that clinicians need to be aware of the potential for this syndrome even with lower potency antipsychotics.
PMID: 18615368
ISSN: 1814-1412
CID: 3538052

Falls in the nursing home setting: does time matter?

Lester, Paula; Haq, Mahenaaz; Vadnerkar, Amruta; Feuerman, Marty
OBJECTIVES/OBJECTIVE:Falls increase morbidity and mortality among nursing home residents and have varied causes and risk factors. The purpose of this study was to assess whether falls in nursing home residents were more prevalent at particular times of the day. DESIGN/PARTICIPANTS/METHODS:This study was a retrospective chart review for falls in a skilled nursing facility in New York from January to June, 2007. RESULTS:There were 220 falls during the 6-month period. Most falls (66%) occurred in the resident's room and almost half (48%) resulted in an injury. Falls during the evening were likely to result in a more serious injury than daytime falls (P = .03). A statistically significant higher percentage of falls (27%) occurred between 4 pm and 8 pm (compared with expected number in a 4-hour period, P < .001). Among the 3 nursing shifts, the lowest percentage of falls occurred during the 11 pm to 7 am night shift (16%). CONCLUSION/CONCLUSIONS:This study reveals a variation in the prevalence of falls in the nursing home based on time of day that is different from the pattern of falls in the hospital setting. More research is needed to evaluate possible causes of this temporal pattern of falls in the nursing home. Perhaps these data can be used to implement specific interventions at times when falls are more common to reduce the risk of falls.
PMID: 18992702
ISSN: 1538-9375
CID: 3538062

Exenatide-induced depression in a geriatric patient [Letter]

Kohen, Izchak; Lester, Paula
PMID: 18383195
ISSN: 0885-6230
CID: 3538042

Falls in the Nursing Home: Does Time Matter? [Meeting Abstract]

Kohen, Izchak; Lester, Paula E.; Mahenaaz, Haq; Vadnerkar, Amruta
ISI:000207905800095
ISSN: 1064-7481
CID: 3538202

THE HIDDEN DANGERS OF DEMENTIA: ASSESSING RISK FACTORS IN THE OFFICE BASED SETTING [Meeting Abstract]

Lester, Paula; Kohen, Izehak
ISI:000207905800045
ISSN: 1064-7481
CID: 3538192

Smoking in the nursing home: a case report and literature review [Case Report]

Lester, Paula E; Kohen, Izchak
We report a case of second- and third-degree burns in an elderly nursing home resident with dementia who was smoking in her room. This case highlights the risks of smoking by residents in long-term care settings. It also raises awareness to the issues involving smoking cessation and restriction of smoking privileges in the long-term care setting.
PMID: 18294605
ISSN: 1538-9375
CID: 3538032