bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prospective versus Retrospective Methods of Identifying Patients with Delirium
Authors: Johnson J. C. , Kerse N. M. , Gottlieb G. , Wanich C. , Sullivan E. , Chen K. 
Published: April 2015

ObjectiveTo determine if DSM‐III criteria or clinical or discharge diagnoses, reviewed retrospectively, are as accurate an indicator of the presence of delirium as prospective evaluation by a psychiatrist.DesignSelection of delirious patients prospectively by a psychiatrist, followed by retrospective record review of the same patients.SettingA referral‐basesd university hospital.PatientsFrom a sample of 235 consecutive medical patients over age 70, 47 delirious patients were identified prospectively by a research psychiatrist using DSM‐III criteria. The medical record of these delirious patients was reviewed after discharge for evidence of delirium.ResultsFour patients were assigned ICD‐9 codes suggestive of delirium (sensitivity 0.09). Review of physicians' diagnoses correctly identified 8 of 47 (sensitivity 0.17) patients as being delirious or acutely confused. The specific diagnostic criteria necessary to meet a DSM‐III diagnosis of delirium could be ascertained from 10 of 47 records (sensitivity 0.21).ConclusionThe retrospective medical record review is very imprecise in establishing the diagnosis of delirium. As research in this field moves from descriptive epidemiology to studies of pathogenesis and treatment, prospective designs will be needed.
Cognitive Function in Non‐Demented Older Adults with Hypothyroidism
Authors: Osterweil Dan , Syndulko Karl , Cohen Stanley N. , Pettier‐Jennings Penny D. , Hershman Jerome M. , Cummings Jeffrey L. , Tourtellotte Wallace W. , Solomon David H. 
Published: April 2015

Purpose(1) to evaluate objectively changes in cognitive function and electrophysiologic characteristics associated with hypothyroidism of varying severity and duration in primarily older persons; (2) to determine whether these changes are reversible when a euthyroid state has been attained after treatment with thyroid hormone.Subjects and MethodsWe enrolled 54 non‐demented hypothyroid patients (31–99, mean 68.6 ± 16.4 years) with biochemical evidence of hypothyroidism (38 had overt and 14 had minimal hypothyroidism) and 30 euthyroid controls (31–96, mean 63.7 ± 18.4 years) screened for good general health. We evaluated attention, orientation, memory, learning, visual‐spatial abilities, calculation, language, visual scanning, and motor speed using standardized neuropsychological tests. Electrophysiological measures of neurocognitive function included the P300 latency component of the auditory Event‐Related Potentials (ERP) and conduction speed from eye to cortex, the P100 latency component of the Patterned Visual‐Evoked Potential (PVEP). All patients were studied when hypothyroid. A subset of patients with minimal initial test abnormalities were available to be retested when euthyroid, 5 and 9 months after onset of thyroid replacement therapy.ResultsHypothyroid patients showed significantly lower scores on the Mini‐Mental Status Test (MMS) and on five of 14 neuropsychological tests as compared to controls. The neuropsychological tests affected were copying a cube (visual‐spatial function), the Inglis Paired Associates Learning Test‐Low and Medium association items (memory and learning), Animal Naming (word fluency/production), and the Trail Making A test (attention, visual scanning and psychomotor function. Hypothyroidism also was associated with longer P100 latencies of PVEPs to 20‘ checks, but showed no significant differences in PVEP P100 latency to 50‘ checks, nor in the latency of the auditory ERP component P300. There was a statistically significant correlation between a laboratory index of the severity of hypothyroidism (serum T4) and the Inglis Medium Association items and Animal Naming. There was a statistically significant improvement after 5 months of treatment on three of the timed performance tests that previous studies have shown to be most sensitive to brain dysfunction.ConclusionHypothyroidism in non‐demented older adults is associated with impairments in learning, word fluency, visual‐spatial abilities, and some aspect of attention, visual scanning, and motor speed. The MMS by itself was sensitive in differentiating hypothyroid patients with cognitive deficits from controls, while electrophysiological measures did not generally differentiate the hypothyroid patients from normal controls. The MMS was not sensitive to treatment effects, but treatment was associated with significant improvements in three of the most sensitive measures of cognitive dysfunction.
Hypertension: Cardiovascular Implications in a Cohort of Old Old
Authors: Guzik Howard J. , Ooi Wee Lock , Frishman William H. , Greenberg Steven , Aronson Miriam K. 
Published: April 2015

ObjectiveTo examine the prevalence and cardiovascular implications of hypertension in advanced age.DesignProspective non‐interventional study of a fixed cohort of very elderly subjects.Participants and SettingThe subjects were 488 community‐dwelling volunteers. Mean age at entry was 79 years (range 75–85). All subjects were ambulatory, non‐demented, and free of terminal illness at baseline. Participants were evaluated at the gerontology department of an urban medical school.Main Outcome MeasuresCardiovascular morbid and mortal events that were followed included fatal and non‐fatal myocardial infarction, fatal and non‐fatal stroke, and death. Prevalence of unrecognized myocardial infarction defined by electrocardiographic changes was also assessed.ResultsWhen hypertension was defined by history, current use of medications, or measured elevations in blood pressure, 78% of the subjects could be considered hypertensive. Univariate analysis showed an increased incidence of strokes in subjects with measured hypertension (P = 0.04). Subjects with elevated blood pressure (untreated) were more likely to develop clinically unrecognized myocardial infarction (P = 0.017). Multivariate survival analysis showed hypertension to be a modest predictor of overall cardiovascular disease (P = 0.067) but not of all‐cause mortality. Left ventricular hypertrophy was a predictor of cardiovascular disease (P = 0.013) and all‐cause mortality (P = 0.008). Age remained a significant risk factor for these endpoints, even in the very old. Isolated systolic hypertension was analyzed separately and in univariate analysis was a risk factor for stroke but not other cardiovascular morbidity.ConclusionsHypertension at advanced age remains a modestly important risk factor in the development of cardiovascular disease.
An Interdisciplinary Approach to the Assessment and Behavioral Treatment of Urinary Incontinence in Geriatric Outpatients
Authors: McDowell B. Joan , Burgio Kathryn L. , Dombrowski Marianne , Locher Julie L. , Rodriguez Eric 
Published: April 2015

ObjectiveTo test the effectiveness of an interdisciplinary assessment and behavioral treatment of persistent urinary incontinence in geriatric outpatients.DesignProspective case series in which frequency of incontinence was measured before and after intervention.SettingWe established an interdisciplinary continence program within an existing academic center, the Benedum Geriatric Center.PatientsConvenience sample of 70 non‐demented outpatients aged 56 to 90 years. Behavioral treatment was provided to 29 patients including many with multiple medical problems (Mean = 6.0 problems).InterventionBehavioral treatment consisted of biofeedback, pelvic floor muscle exercise, scheduled voiding, and other strategies for preventing accidental urine loss.Outcome measureOutcome of treatment was measured by comparing bladder diaries completed in the 2 weeks immediately following treatment to those completed in the pre‐treatment phase.ResultsFollowing an average 5.6 treatment sessions, the mean weekly frequency of accidents was reduced from 16.9 to 2.5 (P < 0.01). Individual reductions ranged from 30.8% to 100% with an average of 81.6% improvement. Ten patients achieved continence. Patients with mixed incontinence had greater improvement than those with urge incontinence alone (P < 0.05), and patients who reported previous evaluation or treatment had a poorer outcome than those coming for their first evaluation (P = 0.05). Degree of improvement was not significantly related to age, duration of symptoms, baseline frequency of accidents, number of treatment sessions, number of other medical diagnoses, or urodynamic findings.ConclusionWe conclude that older adults who are able and willing to participate in behavioral treatment can benefit significantly despite other health problems or disabilities.
Bedside Assessment of Executive Cognitive Impairment: The Executive Interview
Authors: Royall Donald R. , Mahurin Roderick K. , Gray Kevin F. 
Published: April 2015

Objective: This study is a pilot validation of the Executive Interview (EXIT), a novel instrument designed to assess executive cognitive function (ECF) at the bedside.Objective: Inter‐rater reliability testing and validation using inter‐group comparisons across levels of care and measures of cognition and behavior.Participants: Forty elderly subjects randomly selected across four levels of care.Setting: Settings ranged from independent living apartments to designated Alzheimer's Special Care units in a single 537‐bed retirement community.Measurements: The EXIT: a 10‐minute, 25‐item interview scored from 0–50 (higher scores = greater executive dyscontrol) was administered by a physician. Subjects were also administered the Mini‐Mental State Exam (MMSE) and traditional tests of “frontal” executive function by a neuropsychologist, and the Nursing Home Behavior Problem Scale (NHBPS) by Licensed Vocational Nurses.Results: Interrater reliability was high (r= .90). EXIT scores correlated well with other measures of ECF. The interview discriminated among residents at each level of care. In contrast, the MMSE did not discriminate apartment‐dwelling from residential care residents, or residential care from nursing home residents. The EXIT was highly correlated with disruptive behaviors as measured by the NHBPS (r= .79).Conclusions: These preliminary findings suggest that the EXIT is a valid and reliable instrument for the assessment of executive impairment at the bedside. It correlates well with level of care and problem behavior. It discriminates residents at earlier stages of cognitive impairment than the MMSE.J Am Geriatr Soc 40:1221–1226, 1992
The Relationship between Electromyographically Documented Peripheral Neuropatny and Falls
Authors: Richardson James K. , Ching Christopher , Hurvitz Edward A. 
Published: April 2015

Objective: To determine if the presence of an electromyographically demonstrated peripheral polyneuropathy involving the lower extremities is associated with falls.Design: Case control study.Setting: A University‐based referral center.Patients: Twenty‐five patients with an axonal peripheral polyneuropathy affecting the lower extremities, demonstrated by electromyography more than 8 and less than 16 months before, and 25 age‐ and sex‐matched controls who had normal electromyographic studies of the lower extremities during the same time period, were identified from a computer record of all electromyography results during the year prior to the study, using diagnostic codes and demographic data. Twenty‐eight pairs were identified, 25 of whom completed the study.Main Outcome Measures: Number of falls and resultant injuries during the year before the interview, and number of previously identified risk factors for falling, based on interview.Results: Peripheral neuropathy was found to be significantly associated with falling (14/25, 56% vs 2/25, 8% ‐ odds ratio 23.0, 95% confidence interval 2.5, > 100) and repetitive falling (10/25, 40% vs 1/25, 4% ‐ odds ratio, 95% confidence interval 1.4, > 100). There was a trend toward increased injury requiring medical attention (5/25, 20% vs 0/25, 0%), but it did not reach statistical significance. Previously identified risk factors were not significantly more common in the peripheral neuropathy group.Conclusion: An electromyographically identified peripheral neuropathy is strongly associated with and may be a risk factor for falls. J Am Geriatr Soc 40:1008–1012, 1992
Quinine Sulfate for Leg Cramps: Does It Work?
Authors: Sidorov Jaan 
Published: April 2015

ObjectiveTo study the efficacy of quinine in the prevention of nocturnal leg muscle cramps.DesignDouble‐blind, randomized, crossover trial with four periods of observation, each lasting 2 weeks.SettingGeneral internal medicine outpatient clinic.ParticipantsAmbulatory outpatients who experienced an estimated two or more typical nocturnal leg cramps per week.Intervention200 mg of quinine taken at bedtime.Main Outcome MeasuresSelf‐reported ratings of leg cramp frequency, duration, and intensity.ResultsSixteen patients completed the trial. During the 2 weeks patients used quinine, there was no statistically significant reduction in mean leg cramp number (quinine 3.5 vs placebo 4.2, P = 0.48), mean leg cramp duration (quinine 152 seconds vs placebo 163 seconds, P = 0.89), or patient ratings of severity using a 1 (low) to 10 (high) scale (quinine = 4.2 vs placebo = 4.0, P = 0.83).ConclusionNo significant reduction in nocturnal leg cramp frequency, intensity, or duration could be found using nightly quinine in this study. Since quinine is not without the potential for side effects and drug interactions, clinicians need to carefully consider the likelihood of modest benefit associated with quinine against the potential for side effects and drug‐drug interactions.
The Relationship between Ankle‐Arm Index and Mortality in Older Men and Women
Authors: Vogt Molly T. , McKenna Matthew , Anderson Stewart J. , Wolfson Sidney K. , Kuller Lewis H. 
Published: April 2015

ObjectiveTo determine whether the ankle‐arm blood pressure index is a useful predictor of mortality in a large group of patients aged 50 or older.DesignCohort study over a 13‐year period.SettingPeripheral vascular laboratory in a hospital affiliated with an academic health center.Participants1,027 male and 903 female patients referred for arterial evaluation.Outcome MeasuresAll‐cause and cause‐specific mortality.ResultsA decrease in ankle‐arm index was a strong independent predictor of all‐cause mortality [relative risk (RR) for men = 1.8(95% CI 1.5, 1.9); for women = 1.5, (1.2, 2.0)] and atherosclerotic heart disease mortality [RR for men = 2.0 (1.4, 2.9); for women = 2.1 (1.4, 3.1)]. The risk of mortality was inversely proportional to the ankle‐arm index. No relationship was found between the index and mortality due to stroke or cancer.ConclusionsThese results suggest that a decreased ankle‐arm index has important prognostic significance for mortality due to atherosclerotic heart disease in older men and women. Measurement of this index may be useful in identifying those at high risk who may benefit from aggressive therapeutic intervention.
Acute Exercise Facilitates Semantically Cued Memory in Nursing Home Residents
Authors: Stones M. J. , Dawe Doreen 
Published: April 2015

ObjectiveTo study the acute effects of non‐strenuous physical exercise on memory retrieval and visuo‐motor performance in old‐old nursing home residents.DesignA randomized control trial.SettingA nursing home.ParticipantsAmbulatory volunteers from the nursing home, with all 20 shown to be normal on mental status. Three were male and 17 female, with a means of 84.5 years for age and 9.3 years for education. They were divided at random into an exercise and a control group.InterventionA single 15‐minute standardized bout of non‐strenuous exercise administered independently to each participant in the exercise group. Control group participants watched a video of similar exercises for 15 minutes.MeasurementsTwo measures requiring the retrieval of category instances with semantic or initial consonant cues. Retrieval time was 60 seconds for each of four categories per measure. Visuo‐motor performance was measured by Symbol Digit coding. Testing sessions were held before exercise, immediately post‐exercise and 30 minutes post‐exercise.ResultsThe group‐by‐time interaction was significant only for semantically cued memory (P < 0.01), with higher retrieval at post‐testing only in the exercised group. The higher retrieval was mainly attributable to more new items retrieved by the exercise group at the immediate post‐test (P < 0.05).ConclusionsThis study provides preliminary support for the hypothesis that non‐strenuous physical exercise has positive acute effects on meaningfully cued memory.
Nursing Home Medical Directors: Ideals and Realities
Authors: Zimmer James G. , Watson Nancy M. , Levenson Steven A. 
Published: April 2015

ObjectiveTo evaluate what nursing home medical directors actually do, what they and other nursing home personnel believe would be desirable to do, and what problems and deficiencies are perceived.DesignMail survey with follow‐up telephone interview when necessary.SettingForty‐five nursing facilities in upstate New York.ParticipantsThe medical directors, administrators, and directors of nursing of the 45 facilities.MeasurementsInventory of what medical directors reported as to their actual activities and time spent, and of what they, the administrators, and the directors of nursing felt should be their responsibilities and activities under ideal circumstances.ResultsFor part‐time medical directors, self‐reported time spent on medical directorship activities averaged 12 hours per month; of all directors, 45% spent 8 hours or less per month. Proportion of time spent on various specific activities varied widely. There was general agreement that substantially more time should be spent, in particular, on evaluating and addressing problems of adequacy and quality of care, communicating with attending physicians about problems, and assisting with inservice training programs.ConclusionsTo fill the role adequately, more time should be spent by many part‐time medical directors, which will require greater financial commitment by facilities and reimbursement systems. Efforts need to made to better coordinate the expectations of medical directors and facility staff.
Effects of Cognitive Impairment on the Reliability of Geriatric Assessments in Nursing Homes
Authors: Phillips Charles D. , Chu Catharine W. , Morris John N. , Hawes Catherine 
Published: April 2015

ObjectiveTo explore the relationship between an elderly subject's cognitive status and the reliability of multidimensional assessment data.DesignSurvey, with cognitive status as the independent variable and interrater reliability as dependent variable.SettingMedicare/Medicaid‐certified nursing homes.Participants147 residents age 65 or older.MeasurementsDual assessments of elderly nursing home residents were performed by nurse assessors using the Health Care Financing Administration's new Minimum Data Set for Nursing Home Resident Assessment and Care Screening (MDS). Assessments were classified on the basis of residents' cognitive status, and levels of disagreement between assessors were analyzed.Main ResultsOverall assessment reliability, agreement concerning a resident's activities of daily living status, and the reliability of estimates of his or her communication skills and sensory abilities were significantly affected by a resident's cognitive status. The presence of cognitive impairment made these measurements less reliable—especially those related to communication skills, vision, and hearing.ConclusionsAssessments of residents suffering from cognitive impairment were significantly less reliable than assessments of cognitively intact residents. However, these differences in reliability were not uniform across all assessment domains. When treating the cognitively impaired elderly, clinicians must exercise caution in their reliance on standardized measurements that may be less reliable for this population.
Effects of Testosterone Replacement Therapy in Old Hypogonadal Males: A Preliminary Study
Authors: Morley John E. , Perry H. Michael , Kaiser Fran E. , Kraenzle Dale , Jensen Judy , Houston Kathy , Mattammal Michael , Perry H. Mitchell 
Published: April 2015

ObjectiveTo examine the effects of testosterone administration to older hypogonadal males (bioavailable testosterone less than 70 ng/dL).DesignAlternate‐case controlled trial.SettingSt. Louis University.PatientsEight males (mean age 77.6 ± 2.3 years) who received testosterone and six males (mean age 76 ± 2.3 years) who served as controls. Selected from alumni of the SHEP trial and attendees at the St. Louis University Impotence Clinic.InterventionsTestosterone enanthate (200 mg/mL) was administered intramuscularly to the treatment group every 2 weeks for 3 months.MeasurementsSerum testosterone, bioavailable testerone and estradiol, weight, % body fat, right hand muscle strength, balance, cholesterol, HDL‐cholesterol, hematocrit, BUN, creatinine, albumin, calcium, PTH, 25(OH) vitamin D, 1,25 (OH)2 vitamin D, osteocalcin, prostate‐specific antigen, and fructosamine.ResultsMales who received testosterone had a significant increase in testosterone and bioavailable testosterone concentration, hematocrit, right hand muscle strength and osteocalcin concentration. They had a decrease in cholesterol (without a change in HDL‐cholesterol) levels and decreased BUN/Creatinine ratios.ConclusionThese preliminary findings support the need for long term studies of testosterone therapy in older hypogonadal males.
Percutaneous Transhepatic Cholecystostomy for Acute Complicated Calculous Cholecystitis in Elderly Patients
Authors: Steenbergen Werner Van , Rigauts Hans , Ponette Eric , Peetermans Willy , Pelemans Walter , Fevery Johan 
Published: April 2015

ObjectiveTo assess the immediate and long‐term outcomes of elderly patients with acute complicated cholecystitis treated by percutaneous cholecystostomy. To assess the results of bile cultures obtained in this group of patients.DesignCase series.SettingTertiary care center.PatientsThirty‐two patients, with a mean (±S.D.) age of 78 ± 8 years (range, 58–92 years), and who presented with acute cholecystitis complicated by empyema formation. Sixty‐six percent had associated disorders, which rendered them at high risk for surgical intervention.InterventionPercutaneous transhepatic catheter drainage of the gallbladder, with a mean drainage time of 20 days (range 0–84 days). In addition, endoscopic sphincterotomy with removal of common bile duct stones was performed in six patients and percutaneous aspiration of an associated liver abscess in four cases.ResultsPercutaneous cholecystostomy was followed by rapid regression of clinical symptoms and of radiologic abnormalities in all patients. Sixteen cases (50%) underwent elective cholecystectomy 1–12 weeks after cholecystostomy. One of them died of aspiration pneumonia, whereas 15 had no post‐operative problems and were discharged 9 days (mean) after surgery. Forty‐four percent (14/32) were considered inoperable: they remained completely free of biliary symptoms and died of unrelated illness (22%) after a mean follow‐up of 6 months (range, 1–22 months) or are still alive (22%) with a mean follow‐up of 15 months (range, 5–36 months). Bile cultures were positive in 75% of the patients. Escherichia coli, other aerobic Gram‐negative micro‐organisms, and anaerobic bacterial species accounted for 35% (16/46), 28% (13/46), and 20% (9/46) of the isolated bacteria, respectively. All aerobic Gram‐negative species tested in vitro were susceptible to gentamicin and to temocillin.ConclusionsPercutaneous transhepatic cholecystostomy is a safe and effective procedure in the treatment of elderly high‐risk patients with acute cholecystitis complicated by empyema formation. It can be followed by elective cholecystectomy, if possible, or by expectant conservative management in patients who are inoperable because of systemic disease.