bluuebunny/crossref_metadata_2025 huggingface dataset:
Cross‐species amplification of microsatellite loci in aphids: assessment and application
Authors: Wilson Alex C. C. , Massonnet Blandine , Simon Jean‐Christophe , Prunier‐Leterme Nathalie , Dolatti Lotfali , Llewellyn Kate S. , Figueroa Christian C. , Ramirez Claudio C. , Blackman Roger L. , Estoup Arnaud , Sunnucks Paul
Published: December 2004

Despite the relative ease of isolating microsatellites, their development still requires substantial inputs of time, money and expertise. For this reason there is considerable interest in using existing microsatellites on species from which markers were not cloned. We tested cross‐species amplification of 48 existing aphid loci in species of the following genera: Aphidinae: Aphidini: Aphis and Rhopalosiphum; Aphidinae: Macrosiphini: Acyrthosiphum, Brevicoryne, Diuraphis, Illinoia, Macrosiphoniella, Macrosiphum, Metopeurum, Metapolophium, Myzus, Phorodon, Sitobion and Uroleucon and Neuquenaphidinae: Neuquenaphis. Our results show cross‐species application of known microsatellite loci is a highly promising source of codominant markers for population genetic and evolutionary studies in aphids.
The UWCDot colour vision test and low vision
Authors: Hovis Jeffery K. , Leat Susan J. , Epp Karen
Published: December 2004

Purpose: Previous studies have shown that colour vision defects are common in the low vision population even when properly designed tests are used. However, there are very few clinical tests available that are suitable for this group of patients. One of the more common is the Jumbo D‐15 (JD15). Although this test uses caps more suitable for the reduced acuity, it requires the patient to have some knowledge of colour order and sufficient dexterity to manipulate the caps. We compared the JD15 with the University of Waterloo Colored Dot test (UWCDot), which has neither of these requirements, to determine whether the UWCDot test could be used as a substitute for the JD15.

Methods: The colour vision of 40 consecutive low vision patients was evaluated with both tests. Acuities ranged from 6/6 to 6/1600 with a median value of 6/30.

Results:  All subjects could perform both tests. The κ coefficient of agreement between tests was high at 0.85 when any major crossing was a failure on the JD15 and any mistake was a failure on the UWCDot. Classification of the type of defect was also reasonable when the defect was relatively severe.

Conclusions: The UWCDot can be used as a substitute for the JD15 in the low vision clinic. Both tests identify individuals with moderate‐to‐severe deficiencies, but the UWCDot does not require any manual dexterity and it does not require knowledge of colour‐order.
Evaluating anxiety in patients attending optometric practice
Authors: Margrain Tom H. , Greenland Katy , Anderson Jane
Published: December 2004

Although anxiety is a well‐established obstacle to the delivery of effective health care, there have been no attempts to measure it in the optometric consulting room. In this paper, we introduce physiological and psychological techniques that may be used to evaluate anxiety and arousal in the consulting room and present data from a small group of patients attending for a routine eye examination. Specifically, arousal was assessed before, during, and after the examination by measuring skin conductance in five patients. Anxiety was evaluated using the State–Trait Anxiety Inventory. Our data confirm the ability of these techniques to quantify arousal and anxiety in the optometric consulting room and reveal a previously unknown but important facet of the eye examination. We conclude that these techniques are suitable for use in further experimental work and may be used to identify factors capable of reducing anxiety in the optometric consulting room.
AlamarBlue bioassay for cellular investigation of UV‐induced crystalline lens damage
Authors: Oriowo Olanrewaju M.
Published: December 2004

Purpose: The use of the alamarBlue fluorescence dye for cellular study of UV‐induced photodamage in cultured ocular lenses was examined by comparing the results from the fluorometric assay to lens optical quality using a scanning laser system to measure the focal lengths of the lenses following UVB treatment.

Methods: Excised porcine lenses were cultured in M199 supplemented with 1% antibiotics and 4% porcine serum. After 1 week of pre‐incubation at 37°C, baseline measurements were taken. Treated lenses were irradiated with a range of UVB radiant exposures from 0.019 to 0.076 J cm−2. The lenses were maintained for a further 4 weeks, with measurements carried out every 48 h in the first 9 days post‐UVB treatment and then once each week. At each measurement session, treated and control lenses were transferred into a 24‐well plate, one lens per well containing the assay. The lenses were incubated for 50 min, after which fluorescence readings were taken with a plate reader.

Results: Analyses showed significant (p < 0.05) inhibition of lens metabolic activity and optical function in the 0.038 and 0.076 J cm−2 UVB treated lenses. Lenses treated with 0.019 J cm−2 UVB did not exhibit any photodamage.

Conclusions: These results suggest that the alamarBlue assay is useful for the in vitro study of UV‐induced lens damage. The decrease in the capacity of treated lenses to reduce alamarBlue over time confirms that UVB photo‐oxidation can cause diminution of viable lens epithelial and fibre cells. The results also suggest that the energy threshold for broadband UVB induced cataractogenesis in vitro ranges between 0.019 and 0.038 J cm−2.
The effect of axial length on ocular blood flow assessment in anisometropes
Authors: Lam Andrew K. C. , Chan Suk‐tak , Chan Ben , Chan Henry
Published: December 2004

Background: Pulsatile ocular blood flow (POBF) assessment measures the choroidal circulation and therefore provides data with diagnostic value in certain ocular diseases, such as glaucoma. The technique assumes a constant pressure–volume relationship. The current study investigated the effect of axial length on POBF from subjects with axial anisometropia. Ocular blood supply in the ophthalmic artery was also determined using colour Doppler ultrasonography.

Methods: Thirty‐one normal, anisometropic subjects were recruited, whose ages ranged from 20 to 34 years. They had axial anisometropia (expressed by spherical equivalent) of at least 2 D. After Goldmann tonometry, the POBF of each eye was measured in a supine posture by one examiner, followed by a measurement of the blood flow velocity in the ophthalmic artery using colour Doppler ultrasonography in the same posture by another examiner. There was a 10 min rest between the two techniques. All the measurements were made at around the same time to eliminate any effect from diurnal variation.

Results: The mean anisometropia (expressed by spherical equivalent) was 3.89 ± 1.96 D and the mean inter‐ocular axial length difference was 1.49 ± 1.00 mm. The anisometropia and axial length were significantly different between the two eyes (paired t‐tests: p < 0.001). However, the intra‐ocular pressure was similar between the two eyes (paired t‐test: p = 0.41). The POBF was significantly lower in the eye with the longer axial length (459.3 μL min−1) than the fellow eye (590.8 μL min−1), paired t‐test: p < 0.001. The pulse amplitude was also significantly lower in the eye with the longer axial length (1.61 mmHg) than the fellow eye (1.89 mmHg), paired t‐test: p < 0.001. However, the blood flow velocity from colour Doppler ultrasonography did not demonstrate any significant difference between the two eyes (paired t‐test: p > 0.05).

Conclusions: The POBF and pulse amplitude were found to be reduced in the eye with the longer axial length but colour Doppler ultrasonography did not show any significant difference. This suggests that a new pressure–volume relation should be considered in deriving POBF. Practitioners should measure the axial length in POBF assessment.
Optical performance in eyes wearing two multifocal contact lens designs
Authors: Pujol J. , Gispets J. , Arjona M.
Published: December 2004

The optical performance of eyes wearing soft multifocal contact lenses was studied using the double‐pass technique. Retinal image quality was measured in a group of six eyes wearing two different designs of multifocal lenses: an aspheric design and a spheric multicurve design. Measurements were performed for far, intermediate and near vision conditions and with two different pupil diameters: 3 and 5 mm. The results show that the best optical performance is obtained for far vision conditions when no lens is worn. For near vision conditions, the optical performance when the lens is worn is, in general, better than when no lens is worn. When the lens is worn, the optical performance for far and intermediate vision conditions is similar for the aspherical design, but it decreases for near vision conditions. For the spherical multicurve design, the optical performance obtained for far vision conditions is similar to that obtained for intermediate vision conditions for low values of object vergence, but decreases when the object vergence is high and therefore also for near vision. In general, the differences in optical performance are greater for small pupil diameters (3 vs 5 mm). The general trends of the results obtained by computing the modulation transfer function of the contact lens–eye system can also be shown qualitatively by means of double‐pass images or quantitatively by computing the Imax/Imed of the image.
The S‐cone electroretinogram: a comparison of techniques, normative data and age‐related variation
Authors: Chiti Zohreh , North Rachel V. , Mortlock Katharine E. , Drasdo Neville
Published: December 2004

The blue sensitive mechanism in human colour vision is highly susceptible to damage in ocular disease. There is a need for objective methods to assess this and several methods of recording the blue cone (S‐cone) electroretinogram (ERG) have been described. We therefore compared a silent substitution technique (SST) and a selective adaptation technique (SAT) using a novel combination of optical filters, on 24 normal subjects. The age‐related variation in the S‐cone ERG was also investigated in a further 73 normal subjects. S‐cone ERGs elicited by SAT were of higher amplitude, (p < 0.001) with smaller coefficients of variation than those elicited with SST. The SST method has already been shown to be highly sensitive in primary open angle glaucoma and, unlike SAT, has no significant age related variation. However, the results of this study suggest that the new, SAT method may prove to be more convenient and effective in clinical practice, provided that age norms are applied.
A comparison of manual and automated methods of measuring conjunctival vessel widths from photographic and digital images
Authors: Owen Christopher G. , Ellis Timothy J. , Woodward E. Geoffrey
Published: December 2004

We investigated the application of a fully automated computer algorithm for identifying vessels of the conjunctiva from their scleral surround, and compared measures of vessel width with established methods. Vessel widths at 101 locations (ranging from 20 to 140 μm), from 12 patients, were measured from film and digital images, using a variety of methods, and compared. Widths were measured manually, by semi‐automated methods using grey level (densitometric) profiles taken from digital images, and by automated techniques set at different operating levels. Good intra‐session repeatibility was obtained using the automated method with an operating sigma value of 3 pixels (16 μm) (mean difference 0.5 μm, 95% CI −8.5 to 9.4 μm) and manual calliper measurements from digitally created photographic slides (mean difference 0.4 μm, −9.3 to 10.1 μm). For comparison with other measures of width, the latter was used as the gold standard. Widths measured from film were slightly larger than those measured directly from digital images, although this effect was small (5 μm) for most vessels. Overall widths measured using the automated method, with a sigma value of 3 pixels, agreed best with the gold standard (inter‐method repeatibility; mean difference 1.4 μm, −32.5 to 35.2 μm) although the automated method overestimated small widths (<40 μm) and underestimated larger vessel widths (>40 μm). Automated detection of vessels of the conjunctiva from digital images avoids manual and operator involved measures which are time consuming, and which preclude large patient studies. The resulting data may help in monitoring the vascular response of the conjunctiva to surgical or pharmacological intervention, and in describing vascular changes in response to ocular or systemic disease. The application of this algorithm to the study of retinal vessels is yet to be realised.
Assessment of delays in presentation of patients with retinal detachment to a tertiary referral centre
Authors: Quinn Shauna M. , Qureshi Farhan , Charles Stephen J.
Published: December 2004

The referral pathway of patients with retinal detachment from primary care providers to a tertiary care ophthalmic unit was examined, in order to determine the length and source of any delays between the onset of symptoms and arrival at the hospital. A prospective survey of all symptomatic patients (n = 60) admitted for primary rhegmatogenous retinal detachment surgery was carried out over an 8 week period. Twenty‐one patients were referred by their optometrists and 18 by their general practitioners. The remainder were referred by local accident and emergency and ophthalmic departments or presented directly to the tertiary referral centre. Patients who presented to their optometrists were symptomatic for an average of four times longer. More than half the patients thought that the time to initial presentation was the most significant delay. Referral from optometrists via general practitioners and local ophthalmic clinics was considerably longer. Increased awareness of symptoms, necessity of urgent referral and knowledge of available services locally may reduce delay for those who require emergency sight‐saving surgery.
How do intensive care nurses assess patients’ pain?
Authors: Aslan Fatma Eti , Badir Aysel , Selimen Deniz
Published: December 2004

Identification and evaluation of pain in critical care patients may be difficult because of communication problems. Moreover, at present there are very few nursing studies that examine the attitudes of critical care nurses towards the assessment of patients’ pain

This study was designed to determine the approach of critical care nurses towards assessing patients’ pain levels, and to evaluate the problems in nursing diagnosis of those having difficulty in articulating their pain symptoms

We used a questionnaire to assess nurses attitudes to patients’ pain. The study sample consisted of 91 critical care nurses who were recruited between January and February 2002. The results suggest that patient pain was considered undesirable by 44% of nurses. About 70·3% of the nurses reported resorting to administering analgesics to relieve their patients’ pain

Some 57·1% of nurses stated that they would have investigated whether the patients had really been experiencing pain, prior to administering the prescribed analgesics to patients

Some 85·7% of the sample indicated that the patients themselves would make the most accurate evaluation of their pain. The data suggested that 39·6% of nurses did not know how to evaluate pain symptoms in critical care patients suffering from complicated problems, and that 37·4% evaluated pain by monitoring the patients’ behaviours

The study demonstrated that most of the critical care nurses did not know how to evaluate pain in patients having communication problems. The paper concludes by suggesting that there is a clear need to address nursing education and training with regard to evaluation and management of patients’ pain whilst in critical care environment
Nurse‐led discharge from high dependency unit
Authors: Knight Gillian
Published: December 2004

High dependency care is a rapidly evolving area of critical care, with high patient turnover, which ultimately leads to high levels of pressure for beds

There is a growing trend emerging, recognizing the importance and value of nurse‐led initiatives in delivering effective nursing care in acute care settings

One specific nurse‐led initiative this author has developed is that of nurse‐led discharge (NLD) from the high dependency unit (HDU), in order to optimize the utilization of critical care beds within the HDU

An audit of the current practice was undertaken, which ultimately led to the implementation of NLD

Early experiences indicate that HDU beds are now being used more effectively
Exercise Adherence and 10‐Year Mortality in Chronically Ill Older Adults
Authors: Morey Miriam C. , Pieper Carl F. , Crowley Gail M. , Rnc‐Bsn  , Sullivan Robert J. , Puglisi Carmel M.
Published: December 2004

OBJECTIVES: To compare mortality of adherents and nonadherents of an exercise program.

DESIGN: Prospective intervention study.

SETTING: Supervised geriatric fitness program called Gerofit.

PARTICIPANTS: One hundred thirty‐five adults aged 65 and older who enrolled in Gerofit between January 1, 1990, and November 30, 1999. All participants had a baseline medical screen and exercise test. They were classified as adherent (n = 70) if they participated in Gerofit for more than 47 sessions or nonadherent (n = 65) if they did not complete 47 sessions within the first 6‐month period.

INTERVENTION: Program participation was voluntary and consisted of aerobic, strength, flexibility, and balance exercises. The program met three times week for 90 minutes.

MEASUREMENTS: All‐cause mortality.

RESULTS: Twenty‐six deaths occurred within the 10‐year follow‐up period. Using proportional hazards, time to death was not related to adherence group. However, in multivariate analyses controlling for age, sex, race, baseline risk/health status, history of heart disease, cancer, diabetes mellitus, and baseline smoking status, there was significant group‐by‐time interaction (P = .004), indicating a crossover in mortality risk. The initial survival benefit observed in nonadherers changed over time, resulting in a long‐term protective survival effect on mortality for the adherent group (hazard rate = 0.75, 95% confidence interval = 0.61–0.91 for the interaction term).

CONCLUSIONS: Older adults with chronic diseases experience a long‐term beneficial mortality effect from participation in exercise programs. Physicians should strongly encourage their patients, including those with comorbidities, to maintain a regular exercise program.
Effect of Exercise on Ease in Performing Activities of Daily Living and Instrumental Activities of Daily Living From Age 70 to 77: The Jerusalem Longitudinal Study
Authors: Stessman Jochanan , Hammerman‐Rozenberg Robert , Maaravi Yoram , Cohen Aaron
Published: December 2004

OBJECTIVES: To determine the prevalence of independence and ease of performance in activities of daily living (ADLs) and instrumental activities of daily living (IADLs) at ages 70 and 77 in a well‐characterized cohort and to measure the effect of regular exercise at age 70 on independence and ease of performance 7 years later.

DESIGN: Two stages of a longitudinal study of an age‐homogeneous cohort employing extensive interview data, physical examination, and clinical laboratory investigation.

SETTING: Home‐based interviews and examinations in Jerusalem.

PARTICIPANTS: Two hundred eighty‐seven west Jerusalem residents, born between June 1920 and May 1921, who participated fully in two phases of an ongoing longitudinal cohort study. Subjects were culled from a larger study population of 605 in the first phase and 1,021 in the second phase.

MEASUREMENTS: Two‐stage comprehensive demographic, social, and economic profile; medical history and examination; cognitive and affective assessment; and clinical laboratory studies performed in 1990–91 and 1997–98. The investigation questionnaire included details of ADL and IADLs and voluntary exercise.

RESULTS: Most aspects of personal and social life did not change from age 70 to 77. Independence in ADLs remained high, as did self‐reliance in IADLs for women. A more‐sensitive marker of diminished function was reported ease in performance, which declined for use of the toilet, dressing, and all spheres of IADLs. For nearly every task, subjects who reported exercising 4 days a week at age 70 were more likely to report ease in performance at age 77. In a logistic regression accounting for the presence of diabetes mellitus, hypertension, obesity, chronic back pain, loneliness, and performance with ease at age 70 and deterioration in self‐assessed health from age 70 to 77, ease of performance in at least three of four ADL tasks was independently related to exercise at age 70 for women (odds ratio (OR) = 8.5, 95% confidence interval (CI) = 2.0–36.2) and for men (OR = 4.3, 95% CI = 1.1–17.1). Ease of independent function in at least four of five IADL tasks also correlated to exercise for men in this regression (OR = 3.7, 95% CI = 1.1–12.2) but not for women (OR = 2.0, 95% CI = 0.6–6.3). Ease in shopping, alternatively, correlated with physical activity for men (OR = 4.3, 95% CI = 1.5–12.0) and women (OR = 2.6, 95% CI = 1.1–6.1).

CONCLUSIONS: Subjects remained active and independent at age 77. Reported ease of performance declined and revealed changes in function. Exercise at least four times a week at age 70 preserved ease of performance at age 77 independent of the influence of specific disease or general self‐assessed health.
Effect of Cilostazol on Treadmill Walking, Community‐Based Walking Ability, and Health‐Related Quality of Life in Patients with Intermittent Claudication Due to Peripheral Arterial Disease: Meta‐Analysis of Six Randomized Controlled Trials
Authors: Regensteiner Judith G. , Ware John E. , McCarthy Walter J. , Zhang Peter , Forbes William P. , Heckman Jeffrey , Hiatt William R.
Published: December 2004

OBJECTIVES: To assess whether cilostazol, a phosphodiesterase III inhibitor, improves treadmill and community‐based walking ability and health‐related quality of life (HQL) in patients with intermittent claudication resulting from peripheral arterial disease (PAD).

DESIGN: Retrospective meta‐analysis of data pooled from six Phase 3, multicenter, double‐blind, placebo‐controlled, parallel‐group, randomized studies.

SETTING: Patients were recruited from outpatient ambulatory medical care facilities.

PARTICIPANTS: Patients' (n = 1,751) mean age ± standard deviation was 65 ± 9, and they had a history of PAD for 6 months or longer and an ankle brachial index (ABI) of 0.90 or less.

INTERVENTION: Cilostazol 50 mg bid or 100 mg bid for 12, 16, or 24 weeks.

MEASUREMENTS: ABI; maximal walking distance (MWD); pain‐free walking distance on a graded and constant‐load treadmill; and HQL, measured using the Walking Impairment Questionnaire (WIQ) and the Medical Outcomes Study Short Form‐36 (SF‐36).

RESULTS: Maximal treadmill walking distance improved more in both cilostazol groups than in the placebo group (both P < .0001). WIQ and SF‐36 physical summary scores improved significantly more with cilostazol than with placebo (for instance, WIQ distance score, P < .0001 and SF‐36 physical summary score, P < .0001, comparing persons taking cilostazol with controls). Improved MWD correlated with improvements in WIQ (correlation with distance score, r = 0.34, P < .0001) and SF‐36 physical summary scores (r = 0.29, P < .0001).

CONCLUSIONS: Treatment with cilostazol was associated with greater improvements in community‐based walking ability and HQL in patients with intermittent claudication than treatment with placebo. These improvements correlated with increased MWD. This analysis of effects of cilostazol on improving walking ability in persons with claudication is the first cilostazol study focused on community‐based measures of functional status and HQL. Questionnaires assessing walking ability and HQL provide important patient‐based information about clinical outcomes of claudication therapy.
Adverse Drug Reactions as Cause of Hospital Admissions: Results from the Italian Group of Pharmacoepidemiology in the Elderly (GIFA)
Authors: Onder Graziano , Pedone Claudio , Landi Francesco , Cesari Matteo , Della Vedova Cecilia , Bernabei Roberto , Gambassi Giovanni
Published: December 2004

OBJECTIVES: To determine the prevalence of adverse drug reaction (ADR)‐related hospital admissions in an older population, to describe the most common clinical manifestations and drugs most frequently responsible for ADR‐related hospital admissions, and to identify independent factors predictive of these ADRs.

DESIGN: Multicenter pharmacoepidemiology survey conducted between 1988 and 1997.

SETTING: Eighty‐one academic hospitals throughout Italy.

PARTICIPANTS: Twenty‐eight thousand four hundred eleven patients consecutively admitted to participating centers during the survey periods.

MEASUREMENTS: For each suspected ADR at admission, a physician, who coded description, severity, and potentially responsible drugs, completed a questionnaire.

RESULTS: Mean age ± standard deviation of the patients was 70 ± 16. One thousand seven hundred four ADRs were identified upon hospital admission. In 964 cases (3.4% of all admissions), ADRs were considered to be the cause of these hospital admissions. Of these, 187 ADRs were coded as severe. Gastrointestinal complaints (19%) represented the most common events, followed by metabolic and hemorrhagic complications (9%). The drugs most frequently responsible for these ADRs were diuretics, calcium channel blockers, nonsteroidal antiinflammatory drugs, and digoxin. Female sex (odds ratio (OR) = 1.30, 95% confidence interval (CI) = 1.10–1.54), alcohol use (OR = 1.39, 95% CI = 1.20–1.60), and number of drugs (OR = 1.24, 95% CI = 1.20–1.27 for each drug increase) were independent predictors of ADR‐related hospital admissions. For severe ADRs, age (OR = 1.50, 95% CI = 1.01–2.23 for age 65–79 and OR = 1.53, 95% CI = 1.00–2.33 for age ≥80, respectively), comorbidity (OR = 1.12, 95% CI = 1.05–1.20 for each point in the Charlson Comorbidity Index), and number of drugs (OR = 1.18, 95% CI = 1.11–1.25 for each drug increase) were the only predisposing factors.

CONCLUSIONS: The most important determinant of risk for ADR‐related hospital admissions in older patients is number of drugs being taken. When considering only severe ADRs, risk is also related to age and frailty.
Nutritional Status Using Mini Nutritional Assessment and Subjective Global Assessment Predict Mortality in Geriatric Patients
Authors: Persson Margareta D. , Brismar Kerstin E. , Katzarski Krassimir S. , Nordenström Jörgen , Cederholm Tommy E.
Published: December 2004

OBJECTIVES: To evaluate the clinical assessment of nutritional status and mortality in geriatric patients.

DESIGN: Prospective follow‐up study.

SETTING: Acute geriatric inpatient ward.

PARTICIPANTS: Eighty‐three consecutive acute geriatric patients (mean age ± standard deviation = 83 ± 7; 68% women).

MEASUREMENTS: Patients were classified as (1) having protein‐energy malnutrition (PEM), (2) having moderate PEM or being at risk for PEM, or (3) being well nourished according to Subjective Global Assessment (SGA) and Mini Nutritional Assessment (MNA). Body mass index ((BMI) kg/m2), arm anthropometry, and handgrip strength were determined. In a subgroup of patients (n = 39), body composition was analyzed using dual energy x‐ray absorption and bioelectrical impedance. Three‐year mortality data were obtained from the Swedish population records.

RESULTS: Twenty percent and 26% of the patients were classified as having PEM based on SGA and MNA, respectively, whereas 43% and 56%, respectively, were classified as having moderate PEM or being at risk for PEM. Objective measures, such as BMI, arm anthropometry, handgrip, and body fat were 20% to 50% lower in the malnourished group than in the well‐nourished subjects (P < .05). Moreover, mortality was higher in those classified as being malnourished, ranging from 40% after 1 year to 80% after 3 years, compared with 20% after 1 year (P = .03–0.17) and 50% after 3 years (P < .01) in patients classified as being well nourished.

CONCLUSION: Fewer than one‐third of newly admitted geriatric patients had a normal nutritional status according to SGA and MNA. BMI, arm anthropometry, body fat mass, and handgrip strength were reduced, and 1‐, 2‐, and 3‐year mortality was higher in patients classified as malnourished. The present data justify the use of SGA and MNA for the assessment of nutritional status in geriatric patients.
Effects of Aerobic Exercise Training in Community‐Based Subjects Aged 80 and Older: A Pilot Study
Authors: Vaitkevicius Peter V. , Ebersold Caroline , Shah Muhammad S. , Gill Nikita S. , Katz Robert L. , Narrett Matthew J. , Applebaum Gary E. , Parrish Sheryl M. , O'Connor Frances C. , Fleg Jerome L.
Published: December 2004

OBJECTIVES: To assess the ability of sedentary, frail subjects aged 80 and older to train in a community‐based exercise program and to evaluate clinical factors that predict improvements in peak oxygen consumption (VO2peak).

DESIGN: Pretest, posttest.

SETTING: Charlestown Retirement Community, Catonsville, Maryland

PARTICIPANTS: Twenty‐two (11 male, 11 female; mean age ± standard deviation = 84 ± 4.0, range 80–92) self‐referred.

INTERVENTION: Six months of moderate‐intensity aerobic exercise training, two to three sessions/week, 20 to 30 minutes per session. Training modes included treadmill walking and/or stationary cycling.

MEASUREMENTS: Baseline and follow‐up maximal exercise treadmill tests (ETTs) with electrocardiogram monitoring and respiratory gas analysis.

RESULTS: Six months of aerobic exercise training resulted in significant increases (mean ± standard deviation) in ETT duration (11.9 ± 3.3 vs 15.9 ± 4.3 minutes; P = .01), VO2peak (1.23 ± 0.37 vs 1.31 ± 0.36 L/min; P = .04), and oxygen pulse (9.3 ± 2.8 vs 10.1 ± 3.2; P = .03). Mean heart rate was significantly lower during submaximal ETT stages 1 through 4 (P < .05), and resting systolic blood pressure decreased (146 ± 18 vs 133 ± 14 mmHg; P = .01) after training. Multiple regression analysis indicated that baseline VO2peak (r = 0.75, P = .002) and the total amount of time spent in exercise training (r = 0.55, P = .008) were independent predictors of the training‐related improvements in VO2peak.

CONCLUSION: Subjects aged 80 and older can increase aerobic capacity and reduce systolic blood pressure in a community‐based exercise program of moderate intensity. The most important predictors of change in VO2peak were baseline VO2peak and the time spent in exercise training. Subjects with a lower baseline VO2peak had the greatest improvements in VO2peak after training.
Alzheimer's Disease Patients' and Caregivers' Capacity, Competency, and Reasons to Enroll in an Early‐Phase Alzheimer's Disease Clinical Trial
Authors: Karlawish Jason H. T. , Casarett David J. , James Bryan D.
Published: December 2004

OBJECTIVES: To examine the capacity, competency, and reasons for enrolling of patients with Alzheimer's disease (AD) and of their caregivers in an early phase AD clinical trial.

DESIGN: Interviews were conducted with patients with AD, nondemented older persons, and caregivers.

SETTING: Participants' homes.

PARTICIPANTS: Fifteen patients with mild to moderate AD, 15 age‐ and education‐matched nondemented older persons, and 15 patient caregivers.

MEASUREMENTS: Capacity was measured using the MacArthur Competency Assessment Tool for Clinical Research (MacCAT‐CR); a study coordinator who reviewed audiotapes of the capacity interviews judged competency, and the reasons for a decision were determined by coding the capacity interviews.

RESULTS: On all measures except the ability to make a choice, patients performed worse than controls (understanding: z = 3.2, P = .001; appreciation: z = 2.8, P = .005; reasoning: z = 3.5, P = .0005), and caregivers (understanding: z = 3.8, P = .0002; appreciation: z = 3.0, P = .003; reasoning: z = 3.6, P = .0003). Using the controls' performance to set psychometric criteria to define capacity, the proportions of patients with adequate understanding, appreciation, and reasoning were six of 15 (40%), three of 15 (20%), and five of 15 (33%). All caregivers and nine of the 15 (60%) patients were competent. Reasons for enrolling typically featured the potential benefit to the patients' health or well‐being and altruism that was expressed as a desire to help other patients and their families or a desire to contribute to scientific knowledge.

CONCLUSIONS: The MacCAT‐CR, in particular its understanding scale, is a reliable and valid way to assess patient capacity and competency to enroll in an early‐phase clinical trial. Although many patients have significant impairments in their capacity, some mild‐stage patients are competent. Reasons for enrolling in an early‐phase trial blend an expectation of therapeutic benefit and a desire to help others.
Angiotensin‐Converting Enzyme Gene Polymorphism May Influence Blood Loss in a Geriatric Population Undergoing Total Hip Arthroplasty
Authors: Pola Enrico , Gaetani Eleonora , Pola Roberto , Papaleo Pierangelo , Flex Andrea , Aloi Francesco , De Santis Vincenzo , Santoliquido Angelo , Pola Paolo
Published: December 2004

OBJECTIVES: To evaluate how angiotensin‐converting enzyme (ACE) gene polymorphism is associated with perioperative blood loss in hip arthroplasty in a geriatric population.

DESIGN: A case‐control study of subjects consecutively undergoing total hip arthroplasty.

SETTING: A department of orthopedic surgery in Italy.

PARTICIPANTS: One hundred five patients, mean age ± standard deviation 68.6 ± 10.4, undergoing total hip arthroplasty.

MEASUREMENTS: ACE gene polymorphism was analyzed using polymerase chain reaction. Decrement of hemoglobin (Hb) and hematocrit (Ht) was calculated as the difference between the preoperative and the lowest postoperative value, measured 1, 2, and 3 days after surgery. Total blood loss was calculated as the sum of intra‐ and postoperative blood loss.

RESULTS: Patients carrying the deletion homozygous and insertion/deletion heterozygous genotypes of the ACE gene show a higher decrement of Hb (P < .01) and Ht (P < .01) and higher total blood loss (P < .007) after hip surgery than subjects carrying the insertion (II) homozygous. The role of ACE gene polymorphism seems hypertension independent. Logistic regression analysis showed that II genotype reduces total blood loss.

CONCLUSIONS: This is the largest study evaluating the distribution of ACE gene genotypes in patients undergoing hip arthroplasty and the first investigating the association between bleeding and ACE gene polymorphism. Our data suggest that II genotype is associated with lower total blood loss.
Is Satisfaction With Pain Management a Valid and Reliable Quality Indicator for Use in Nursing Homes?
Authors: Casarett David J. , Hirschman Karen B. , Miller Elizabeth R. , Farrar John T.
Published: December 2004

OBJECTIVES: To determine whether satisfaction with pain management can be measured reliably in nursing homes and to gather preliminary data about the validity of satisfaction assessments in this population.

DESIGN: Cross‐sectional interview study.

SETTING: Two urban nursing homes.

PARTICIPANTS: Sixty‐six nursing home residents with pain.

MEASUREMENTS: Overall satisfaction with pain management, satisfaction with pain medication, experiences related to pain management, cognitive function, depressive symptoms, and retest reliability of overall satisfaction rating.

RESULTS: Most residents (60/66; 91%) could rate their overall satisfaction with pain management. Overall satisfaction was weakly correlated with pain severity at the time of the interview (Spearman correlation coefficient = –0.28; P = .033) and over the past week (–0.27; P = .038). Overall satisfaction was also negatively associated with the Geriatric Depression Scale score (–0.50; P < .001). Satisfaction with pain medication was associated with several ratings of the medication's beneficial effects, including improved activity, sleep, and speed of relief, but not with the frequency with which it caused side effects. Ratings of overall satisfaction showed good reliability overall (kappa = 0.62; P < .001) and for those with Mini‐Mental State Examination scores greater than 21 (kappa = 0.70; P < .001) and 21 or less (kappa = 0.54; P = .004).

CONCLUSION: These results suggest that satisfaction with pain management can be measured reliably when residents are able to report their pain, but further research is needed before satisfaction with pain management can be incorporated into routine assessments in nursing homes.
Physical Performance Measures in the Clinical Setting
Authors: Studenski Stephanie , Perera Subashan , Wallace Dennis , Chandler Julie M. , Duncan Pamela W. , Rooney Earl , Fox Michael , Guralnik Jack M.
Published: December 2004

OBJECTIVES:  To assess the ability of gait speed alone and a three‐item lower extremity performance battery to predict 12‐month rates of hospitalization, decline in health, and decline in function in primary care settings serving older adults.

DESIGN:   Prospective cohort study.

SETTING:   Primary care programs of a Medicare health maintenance organization (HMO) and Veterans Affairs (VA) system.

PARTICIPANTS:   Four hundred eighty‐seven persons aged 65 and older.

MEASUREMENTS:   Lower extremity performance Established Population for Epidemiologic Studies of the Elderly (EPESE) battery including gait speed, chair stands, and tandem balance tests; demographics; health care use; health status; functional status; probability of repeated admission scale (Pra); and primary physician's hospitalization risk estimate.

RESULTS:   Veterans had poorer health and higher use than HMO members. Gait speed alone and the EPESE battery predicted hospitalization; 41% (21/51) of slow walkers (gait speed <0.6 m/s) were hospitalized at least once, compared with 26% (70/266) of intermediate walkers (0.6–1.0 m/s) and 11% (15/136) of fast walkers (>1.0 m/s) (P < .0001). The relationship was stronger in the HMO than in the VA. Both performance measures remained independent predictors after accounting for Pra. The EPESE battery was superior to gait speed when both Pra and primary physician's risk estimate were included. Both performance measures predicted decline in function and health status in both health systems. Performance measures, alone or in combination with self‐report measures, were more able to predict outcomes than self‐report alone.

CONCLUSION:   Gait speed and a physical performance battery are brief, quantitative estimates of future risk for hospitalization and decline in health and function in clinical populations of older adults. Physical performance measures might serve as easily accessible “vital signs” to screen older adults in clinical settings.
Strength and Muscle Quality in a Well‐Functioning Cohort of Older Adults: The Health, Aging and Body Composition Study
Authors: Newman Anne B. , Haggerty Catherine L. , Goodpaster Bret , Harris Tamara , Kritchevsky Steve , Nevitt Michael , Miles Toni P. , Visser Marjolein , The Health, Aging, and Body Composition Research Group
Published: December 2004

OBJECTIVES:  To determine whether lower lean mass and higher fat mass have independent effects on the loss of strength and muscle quality in older adults and might explain part of the effect of age.

DESIGN:   Single‐episode, cross‐sectional analyses of a cohort of subjects in the Health, Aging and Body Composition (Health ABC) Study.

SETTING:   Ambulatory clinic and research laboratory.

PARTICIPANTS:   Two thousand six hundred twenty‐three men and women aged 70 to 79 from the Health ABC Study.

MEASUREMENTS:   Upper and lower extremity strength was measured using isokinetic (knee extension) and isometric (grip strength) dynamometers. Body composition (lean mass and fat mass) was determined by measuring lean mass of upper and lower extremities and the total body by dual‐energy x‐ray absorptiometry. Muscle quality was ascertained by taking the ratio of strength to muscle mass for both upper and lower extremities.

RESULTS:   Upper and lower extremity strength and muscle quality decreased as age increased. Most of the explained variance in strength was due to differences in muscle mass, but, in those at the extremes of body fat and lower leg muscle quality, the association with body fat was independent of the effect of age. Although blacks had greater muscle strength and mass than whites, leg muscle quality tended to be lower in blacks than in whites. Upper extremity strength adjusted for lean mass and muscle quality were also associated inversely and independently with age, body fat, and black race.

CONCLUSION:   In this older cohort, lower strength with older age was predominantly due to a lower muscle mass. Age and body fat also had significant inverse associations with strength and muscle quality. Both preservation of lean mass and prevention of gain in fat may be important in maintaining strength and muscle quality in old age.
A Home‐Based Pedometer‐Driven Walking Program to Increase Physical Activity in Older Adults with Osteoarthritis of the Knee: A Preliminary Study
Authors: Talbot Laura A. , Gaines Jean M. , Huynh Tu N. , Metter E. Jeffrey
Published: December 2004

OBJECTIVES:  To determine whether a home‐based pedometer‐driven walking program with arthritis self‐management education (Walk +) would increase physical activity, muscle strength, and functional performance in older adults with osteoarthritis (OA) of the knee as opposed to arthritis self‐management education alone (EDU).

DESIGN:   A randomized two‐by‐three (group‐by‐time) design with participants assigned to Walk + (n = 17, mean age ± standard deviation = 69.6 ± 6.7) or EDU (n = 17, age = 70.8 ± 4.7).

SETTING:   Community located in the Baltimore‐Washington area.

PARTICIPANTS:   Thirty‐four community‐dwelling adults, aged 60 and older with symptomatic knee OA and self‐reported functional impairment.

INTERVENTIONS:   Both groups received 12 hours of the Arthritis Self‐Management program over 12 weeks and were followed for an additional 12 weeks. In addition, the Walk + group received individualized instruction in the use of a pedometer, with the goal of increasing their step count by 30% of their baseline step count.

MEASUREMENTS:   The outcome measures were physical activity (daily step counts and total activity vector magnitude as measured by a pedometer and Tritrac‐R3D accelerometer), quadriceps femoris strength (isometric peak torque), and functional performance tasks (100‐foot walk‐turn‐walk, timed stair climb, timed chair rise, and pain status).

RESULTS:   Daily steps walked showed a significant group‐by‐time interaction (P = .04) after controlling for age. From baseline to completion of training, a 23% increase in daily steps occurred in the Walk + group and a 15% decrease in the EDU group. Although steps increased in the Walk + group, total activity vector magnitude was maintained, suggesting a more efficient gait. The Walk + group became quicker than the EDU group in the normal‐pace walk‐turn‐walk (P = .04). An isometric strength gain of 21% postintervention was seen in the Walk + group, compared with a loss of 3.5% in the EDU group.

CONCLUSION:   In older adults with symptomatic knee OA, Walk + appears to increase walking, with improvements in muscle strength and walking performance. The use of a home‐based pedometer‐driven program to increase physical activity, strength, and function in this population warrants further research.
Environmental Components of Mobility Disability in Community‐Living Older Persons
Authors: Shumway‐Cook Anne , Patla Aftab , Stewart Anita , Ferrucci Luigi , Ciol Marcia A. , Guralnik Jack M.
Published: December 2004

OBJECTIVES:  To examine the relationship between characteristics of the physical environment and mobility disability in community‐living older persons.

DESIGN:   Cross‐sectional study conducted on three groups of community‐dwelling older adults.

SETTING:   Community‐dwelling older people in Seattle, Washington, and Waterloo, Ontario, Canada.

PARTICIPANTS:   Fifty‐four older adults (≥70) were recruited from two geographic sites and grouped according to level of physical function (elite, physically able, physically disabled).

MEASUREMENT:   Subjects reported on frequency of encounter versus avoidance of 24 features of the physical environment, grouped into eight dimensions, using a five‐point ordinal scale (never, rarely, sometimes, often, always). Never and rarely responses were combined and coded as not encountered or not avoided, whereas the sometimes, often or always responses were combined and coded as encountered or avoided.

RESULTS:   Disabled older adults reported fewer encounters with and concomitantly greater avoidance of physical challenges to mobility than nondisabled older adults. However, both encounter and avoidance varied by environmental dimension.

CONCLUSION:   Results support the hypothesis that mobility disability results from an interaction of individual and environmental factors. Mobility disability is associated with avoidance of some, but not all, physically challenging features within the environment, suggesting that some environmental features may disable community mobility more than others.
Loss of Independence in Activities of Daily Living in Older Adults Hospitalized with Medical Illnesses: Increased Vulnerability with Age
Authors: Covinsky Kenneth E. , Palmer Robert M. , Fortinsky Richard H. , Counsell Steven R. , Stewart Anita L. , Kresevic Denise , Burant Christopher J. , Landefeld C. Seth
Published: December 2004

OBJECTIVES: To describe the changes in activities of daily living (ADL) function occurring before and after hospital admission in older people hospitalized with medical illness and to assess the effect of age on loss of ADL function.

DESIGN: Prospective observational study.

SETTING: The general medical service of two hospitals.

PARTICIPANTS: Two thousand two hundred ninety‐three patients aged 70 and older (mean age 80, 64% women, 24% nonwhite).

MEASUREMENTS: At the time of hospital admission, patients or their surrogates were interviewed about their independence in five ADLs (bathing, dressing, eating, transferring, and toileting) 2 weeks before admission (baseline) and at admission. Subjects were interviewed about ADL function at discharge. Outcome measures included functional decline between baseline and discharge and functional changes between baseline and admission and between admission and discharge.

RESULTS: Thirty‐five percent of patients declined in ADL function between baseline and discharge. This included the 23% of patients who declined between baseline and admission and failed to recover to baseline function between admission and discharge and the 12% of patients who did not decline between baseline and admission but declined between hospital admission and discharge. Twenty percent of patients declined between baseline and admission but recovered to baseline function between admission and discharge. The frequency of ADL decline between baseline and discharge varied markedly with age (23%, 28%, 38%, 50%, and 63% in patients aged 70–74, 75–79, 80–84, 85–89, and ≥90, respectively, P < .001). After adjustment for potential confounders, age was not associated with ADL decline before hospitalization (odds ratio (OR) for patients aged ≥90 compared with patients aged 70–74 = 1.26, 95% confidence interval (CI) = 0.88–1.82). In contrast, age was associated with the failure to recover ADL function during hospitalization in patients who declined before admission (OR for patients aged ≥90 compared with patients aged 70–74 = 2.09, 95% CI = 1.20–3.65) and with new losses of ADL function during hospitalization in patients who did not decline before admission (OR for patients aged ≥90 compared with patients aged 70–74 = 3.43, 95% CI = 1.92–6.12).

CONCLUSION: Many hospitalized older people are discharged with ADL function that is worse than their baseline function. The oldest patients are at particularly high risk of poor functional outcomes because they are less likely to recover ADL function lost before admission and more likely to develop new functional deficits during hospitalization