bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Effect of a Multifaceted Physician Office‐Based Intervention on Older Women's Mammography Use
Authors: Preston Jeanette A. , Scinto Jeanne D. , Grady Jacqueline N. , Schulz Allyson F. , Petrillo Marcia K. 
Published: April 2015

BACKGROUND: In response to identified low mammography use among older women in three geographic areas in Connecticut, a physician office‐based mammography intervention was initiated under the Health Care Financing Administration's Health Care Quality Improvement Program.OBJECTIVE: To evaluate the intervention's impact on older women's mammography use.DESIGN: A quasi‐experimental design comparing mammography rates for women in the intervention program with a randomly selected control sample.SETTING: Community‐based physician offices.PATIENTS: Female Medicare beneficiaries aged 65 to 74 years seen by participating and control physicians for at least one primary care visit in 1995 (baseline) and 1996 (follow‐up). In the baseline period, 1720 women in the intervention sample and 2761 women in the control sample were included in the study.INTERVENTION: The recruitment strategies included the use of physician opinion leaders and modified academic detailing. The multifaceted intervention incorporated patient education, physician reminders, and audit‐with‐feedbackMEASUREMENTS: Biennial mammography rates. Patient adherence to physician mammography referral was evaluated in a restricted cohort of women selected from the intervention sample.RESULTS: The mammography rate for the intervention sample increased from 62.7% (baseline) to 73.1% (follow‐up), (P < .001), whereas the control sample's rate remained essentially unchanged (68.3 to 69.5%), (P = .34). The intervention patients were 48% more likely than controls to experience an increase in biennial mammography use (OR = 1.48; 95% CI, 1.22–1.79) after adjustment for patient race and income and physician gender, specialty, and age. The proportion of women who adhered to their physicians' mammography referral was 70.6%.CONCLUSIONS: These data demonstrate the effectiveness of a multifaceted intervention program administered in the setting of community physician practices. The relatively low rate of patients' acceptance of their physicians' mammography recommendations has identified the need to address more effectively older women's concerns about mammography screening. J Am Geriatr Soc 48: 1–7, 2000.
Characteristics of Motor Vehicle Crashes of Drivers with Dementia of the Alzheimer Type
Authors: Carr David. B. , Duchek J. , Morris J. C. 
Published: April 2015

OBJECTIVE: To determine whether there is a difference in crash rates and characteristics between drivers with dementia of the Alzheimer type (DAT) and nondemented older persons who were controls.DESIGN: A pilot study using a 5‐year retrospective analysis of state‐recorded crash data and crash characteristics followed by patient enrollment into a study on road test skills.SETTING: Alzheimer's Disease Research Center at Washington University in St. Louis, Missouri. Subjects were enrolled as volunteers in a longitudinal study of aging and DAT.PARTICIPANTS: One hundred twenty‐one subjects (58 nondemented, older drivers and 63 drivers with DAT) with a mean age of 11 years met the inclusion criteria for this study. DAT was diagnosed using validated clinical diagnostic criteria and was staged by the Clinical Dementia Rating (CDR) Scale. All subjects with DAT were in the very mild (CDR = 0.5) or mild (CDR = 1) stages.MAIN OUTCOME MEASURE: State‐recorded traffic crashes. Also, a daily driving diary was completed by each subject and used to estimate miles traveled per year.RESULTS: Subjects diagnosed with mild DAT (CDR = 1) reported less roadway exposure (average number of miles driven per year) than did drivers with very mild DAT (CDR = 0.5) or controls. Crashes in both groups were infrequent, with 0.07 state‐recorded crashes per driver per year in the nondemented group (CDR = 0), 0.06 in the very mild DAT group (CDR = 0.5), and 0.04 in the mild DAT group (CDR = 1). There was no statistical difference in the crash frequency between groups, even when adjusting for exposure. Drivers with DAT had trends toward more at‐fault crashes, crashes with injuries, and crashes in which the officer on the scene cited failure to yield.CONCLUSIONS: In our sample, individuals with very mild or mild DAT who continued to drive seemed to have crash rates similar to those of the controls. There may be significant differences between the causes and the consequences of crashes involving drivers with DAT when compared with cognitively intact age‐matched controls, but none were found in this pilot study. Further research on crash characteristics is needed in larger samples of community‐based drivers with DAT across wider ranges of dementia severity to address issues such as driving competency and public safety. J Am Geriatr Soc 48: 18–22, 2000.
Completed Suicide Among Older Patients in Primary Care Practices: A Controlled Study
Authors: Conwell Yeates , Lyness Jeffrey M. , Duberstein Paul , Cox Christopher , Seidlitz Larry , DiGiorgio Andrea , Caine Eric D. 
Published: April 2015

OBJECTIVE: To determine whether physical and psychiatric illness, functional status, and treatment history distinguish older primary care patients who committed suicide from those who did not.DESIGN: A case‐control study using data collected by psychological autopsies of suicides and prospective patient interviews for controls.SETTING: Primary care practices in Monroe County, NY.PARTICIPANTS: Forty‐two suicides aged 60 years and older who visited a primary care provider within 30 days of death and 196 patients aged 60 years and older from a group practice of general internal medicine (n = 115) or family medicine (n = 81).MEASUREMENTS: Psychiatric diagnosis; depressive symptom severity; physical health and function; psychiatric treatment history.RESULTS: Completed suicides had more depressive illness (P = .001), physical illness burden (P = .0002), and functional limitations (P = .0001) than controls and were more likely to be prescribed antidepressants (P = .004), anxiolytic agents (P = .0001), and narcotic analgesics (P = .022). Among depressed subjects, affective symptom severity (P < .0001) and emotional dysfunction (P < .0001) distinguished suicide completers. However, physical health, overall function, and treatments received did not differ between groups.CONCLUSIONS: The primary care setting is an important venue for late life suicide prevention. Primary care providers should be well prepared to diagnose and treat depression in their older patients. Additional research is needed concerning the interactions of physical health, functional status, and depressive symptoms in determining suicide risk. J Am Geriatr Soc 48: 23–29, 2000.
Acute Stroke in Very Old People: Clinical Features and Predictors of In‐Hospital Mortality
Authors: Arboix Adrià. , García‐Eroles L. , Massons J. , Oliveres M. , Targa C. 
Published: April 2015

OBJECTIVES: To examine demographic characteristics, clinical features, neuroimaging data, and outcome of all acute stroke events occurring in individuals aged 85 years or older.DESIGN: Collection of data from a prospective hospital‐based stroke registry.SETTING: Between January 1986 and December 1995, the data was collected of 2,000 stroke patients admitted consecutively to the department of neurology (having 25 beds and an acute stroke unit) of Sagrat Cor‐L'Alianza Hospital of Barcelona (an acute care, 350‐bed teaching hospital serving a population of approximately 250,000).PARTICIPANTS AND MEASUREMENTS: For the purpose of this study, very old patients (aged 85 years or older) were selected (n = 262). The data of very old stroke patients were compared with the data of patients younger than 85 years of age (n = 1738). Predictors of in‐hospital mortality based on clinical and neuroimaging variables were recorded within 48 hours of stroke onset, and outcome variables (medical complications that developed during hospitalization) were assessed by multiple regression analysis.RESULTS: The very old patients showed a significantly greater frequency of atherothrombotic (27.5% vs 21.9%, P < .05) and cardioembolic infarctions (24.4% vs 26.3%, P < .001) and a lesser frequency of stroke of unusual cause. Acute stroke in the very old patients was more severe than in patients younger than 85 years of age, with greater rates of in‐hospital mortality (27% vs 13.5%, P < .001), longer duration of hospital stay (22.03 ± 29.6 vs 17.5 ± 21.5 days, P < .001), and lesser frequency of absence of neurologic deficit at the time of hospital discharge (21.4% vs 33.1%, P < .001). Altered consciousness, limb weakness, sensory symptoms, involvement of the parietal lobe and temporal lobe, involvement of the internal capsule (with a protective effect), intraventricular hemorrhage, cardiac events, and respiratory events were selected as independent predictors of in‐hospital mortality in the multivariate analysis.CONCLUSIONS: Very old patients with acute stroke showed a differential clinical profile, different frequency of stroke subtypes, and a poorer outcome compared with stroke patients who were younger than 85 years of age. Clinical and neuroimaging factors that are indicative of the severity of stroke and that were available at the time of the initial diagnosis and at the time of the development of cardiac and respiratory complications showed a predominant influence on in‐hospital mortality and may help clinicians to establish prognosis more accurately. J Am Geriatr Soc 48: 36–41, 2000.
Comparison of Rectal and Infrared Ear Temperatures in Older Hospital Inpatients
Authors: Smitz Simon , Giagoultsis Theodora , Dewé Walthère , Albert Adelin 
Published: April 2015

OBJECTIVES: To assess the agreement between infrared emission detection (IRED) ear and rectal temperatures and to determine the validity of IRED ear thermometry in detecting rectal fever.DESIGN: Prospective, convenience sample, unblinded study.SETTING: An acute geriatric unit (teaching hospital) and a multidisciplinary intensive care unit.PARTICIPANTS: The study included 45 inpatients (26 women and 19 men), aged 78.3 ± 6.9 years, admitted over a 4‐month period. Twelve of the patients were definitely infected.MEASUREMENTS: Sequential rectal (RT) and ear temperature (ET) measurements were performed using mercury‐in‐glass and IRED ear thermometers, respectively. IRED ear temperatures were measured at both ears (unadjusted mode), with the highest of six ear temperatures considered the true value.RESULTS: Mean RT (37.39°C ± 0.52°C) was significantly (P < .001) higher than mean ET (36.89°C ± 0.59°C). A highly significant positive correlation was found between RT and ET (slope = 0.69; 95% CI, 0.52–0.86; P < .001; r = 0.78). The mean bias (mean of the differences) between RT and ET was 0.50°C ± 0.37°C (95% CI, 0.41°C‐0.59°C), and the 95% limits of agreement −0.22°C and 1.23°C (95% CI, −0.38°C to 1.39°C). According to the standard criterion (RT ≥ 37.6°C), 14 patients were febrile. Using an optimum IRED ear fever threshold (37.2°C), the sensitivity and specificity of IRED ear thermometry for predicting rectal fever were 86% and 89%, respectively (positive predictive value, 80%; negative predictive value, 93%).CONCLUSIONS: The degree of agreement between rectal temperature and the highest of six IRED ear temperatures was acceptable. Using an optimal IRED ear fever threshold of 37.2°C (99°F), IRED ear thermometry had acceptable sensitivity and specificity for predicting rectal fever. J Am Geriatr Soc 48: 63–66, 2000.
Dying with End Stage Liver Disease with Cirrhosis: Insights from SUPPORT
Authors: JD Katalin Roth , MD Joanne Lynn , PhD Zhenshao Zhong , MD Marie Borum , Dawson Neal V. 
Published: April 2015

OBJECTIVES: To understand patterns of care and end‐of‐life preferences for patients dying with end stage liver disease with cirrhosis (ESLDC).METHODS: Data were collected during the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment (SUPPORT), a prospective cohort study of seriously ill hospitalized adults at five teaching hospitals in the United States, and included all patients enrolled in SUPPORT with ESLDC.RESULTS: Of 575 patients with ESLDC, 166 died during index hospitalization, and 168 died in the following year. The majority were male (65%) and white (80%); the median age was 52 years. Most rated their quality of life as poor or fair, and multiple comorbidities were common. Most spent their last few days completely disabled. Families often reported loss of most income and the need to leave work or other activities in order to care for patients. Pain was at least moderately severe most of the time in one‐third of patients. End‐of‐life preferences were not associated with survival. Most patients (66.8%) preferred CPR, but DNR orders and orders against ventilator use increased near death.CONCLUSIONS: Patients with liver disease were young, likely to be male, and often had low incomes. The high burden of pain was comparable to that reported for patients with lung and colon cancer. Persons dying with liver disease may benefit from increased attention to relief of symptoms, improved home care, and advanced care planning.
Dying with Lung Cancer or Chronic Obstructive Pulmonary Disease: Insights from SUPPORT
Authors: Claessens Michael T. , Lynn Joanne , Zhong Zhenshao , Desbiens Norman A. , Phillips Russell S. , Wu Albert W. , Harrell Frank E. , Conno Alfred F.rs 
Published: April 2015

CONTEXT: Many are calling for patients with advanced chronic obstructive pulmonary disease (COPD) to receive hospice care, but the traditional hospice model may be insufficient.OBJECTIVE: To compare the course of illness and patterns of care for patients with non‐small cell lung cancer and severe COPD.DESIGN: Prospective cohort study of seriously ill, hospitalized adults.SETTING: Five teaching hospitals in the United States.PATIENTS: Patients with Stage III or IV non‐small cell lung cancer (n = 939) or acute exacerbation of severe COPD (n = 1008).MAIN OUTCOME MEASURES: Patients' preferences for pattern of care and for ventilator use; symptoms; life‐sustaining interventions; and survival prognoses.RESULTS: Sixty percent in each group wanted comfort‐focused care; 81% with lung cancer and 78% with COPD were extremely unwilling to have mechanical ventilation indefinitely. Severe dyspnea occurred in 32% of patients with lung cancer and 56% of patients with COPD and severe pain in 28% of patients with lung cancer and 21% of patients with COPD. Patients with COPD who died during index hospitalization were more likely than patients with lung cancer to receive mechanical ventilation (70.4% vs 19.8%), tube feeding (38.7% vs 18.5%), and cardiopulmonary resuscitation (25.2% vs 7.8%). Mechanical ventilation had greater short term effectiveness in patients with COPD, based on survival to hospital discharge (76% vs 38%). Patients with COPD maintained higher median 2‐month and 6‐month survival prognoses, even days before death.CONCLUSIONS: Hospitalized patients with lung cancer or COPD preferred comfort‐focused care, yet dyspnea and pain were problematic in both groups. Patients with COPD were more often treated with life‐sustaining interventions, and short‐term effectiveness was comparatively better than in patients with lung cancer. In caring for patients with severe COPD, consideration should be given to implementing palliative treatments more aggressively, even while remaining open to provision of life‐sustaining interventions.
Description of the SUPPORT Intervention
Authors: Murphy Patricia , Kreling Barbara , Kathryn Erica , Stevens Marguerite , Lynn Joanne , Dulac Jennie 
Published: April 2015

BACKGROUND: The purpose of Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT) was to improve outcomes for seriously ill hospitalized adults by improving information and decisionmaking. The SUPPORT intervention has been characterized only briefly in previous publications.OBJECTIVE: To characterize the intervention in SUPPORT and its implementation.DESIGN: Reports derived from training and administrative materials, quantitative descriptions of implementation activities, and qualitative analysis of narrative reports and focus group participation by the intervention nurses.SETTING AND PATIENTS: SUPPORT enrolled 2652 patients in the intervention arm and 2152 in the control arm of a block‐randomized trial of enhanced information, counseling, and support. The patients were hospitalized with one of nine serious illnesses in one of five US teaching hospitals between 1992 and 1994.MEASUREMENTS: (1) Reports on training and supervisory materials; (2) Rates of intervention component completion from contact logs and reports completed by the intervention nurses; and (3) grounded theory analysis of patient narratives, overview questionnaires, and focus group transcripts from the intervention nurses.RESULTS: Prognostic reports were delivered on time to the caregiving team in 83% of cases on Day 3. Reports of surrogate interviews of patient preferences and understanding were delivered on time to the caregiving team in 72% of first week cases. Patients' own reports of preferences were unavailable for 56% of cases in the first week. Overall, 39% of the rest of the patients had their interview information delivered on time to the caregiving team. The SUPPORT intervention nurses averaged 8.5 contacts with patients, 7.6 with surrogates, 3.5 with physicians, and 11.7 with other staff. The intervention nurses felt that they were fully involved in 81% of cases and had a limited role in another 14%. The major issues for patients were: understanding their situation, communication and decision‐making, advance planning, do not resuscitate orders, and general support, including support for loss and grieving. The narrative sources showed that the nurses were enthusiastic, dedicated, and strong in their support of the study objectives. They identified various barriers to effectiveness and voiced doubt that the analytic targets would show an effect from the intervention.CONCLUSIONS: The SUPPORT intervention was implemented vigorously and completely.
Prediction of Survival for Older Hospitalized Patients: The HELP Survival Model
Authors: Teno Joan M , Harrell Frank E. , Knaus William , Phillips Russell S. , Wu Albert W. , Connors Alfred , Wenger Neil S. , Wagner Douglas , Galanos Anthony , Desbiens Norman A. , Lynn Joanne 
Published: April 2015

OBJECTIVE:To develop and validate a model estimating the survival time of hospitalized persons aged 80 years and older.DESIGN:A prospective cohort study with mortality follow‐up using the National Death Index.SETTING:Four teaching hospitals in the US.PARTICIPANTS:Hospitalized patients enrolled between January 1993 and November 1994 in the Hospitalized Elderly Longitudinal Project (HELP). Patients were excluded if their length of hospital stay was 48 hours or less or if admitted electively for planned surgery.MEASUREMENTS:A log‐normal model of survival time up to 711 days was developed with the following variables: patient demographics, disease category, nursing home residence, severity of physiologic imbalance, chart documentation of weight loss, current quality of life, exercise capacity, and functional status. We assessed whether model accuracy could be improved by including symptoms of depression or history of recent fall, serum albumin, physician's subjective estimate of prognosis, and physician and patient preferences for general approach to care.RESULTS:A total of 1266 patients were enrolled over a 10‐month period, (median age 84.9, 61% female, 68% with one or more dependency), and 505 (40%) died during an average follow‐up of more than 2 years. Important prognostic factors included the Acute Physiology Score of APACHE III collected on the third hospital day, modified Glasgow coma score, major diagnosis (ICU categories together, congestive heart failure, cancer, orthopedic, and all other), age, activities of daily living, exercise capacity, chart documentation of weight loss, and global quality of life. The Somers' Dxy for a model including these factors was 0.48 (equivalent to a receiver‐operator curve (ROC) area of 0.74, suggesting good discrimination). Bootstrap estimation indicated good model validation (corrected Dxy of 0.46, ROC of 0.73). A nomogram based on this log‐normal model is presented to facilitate calculation of median survival time and 10th and 90th percentile of survival time.A count of geriatric syndromes or comorbidities did not add explanatory power to the model, nor did the hospital of patient recruitment, depression, or the patient preferences for general approach to care. The physician's perception of the patient's preferences and the physician's subjective estimate of the patient's prognosis improved the estimate of survival time significantly.CONCLUSIONS:Accurate estimation of length of life for older hospitalized persons may be calculated using a limited amount of clinical information available from the medical chart plus a brief interview with the patient or surrogate. The accuracy of this model can be improved by including measures of the physician's perception of the patient's preferences for care and the physician's subjective estimate of prognosis.
Length of Stay and Therapeutic Intervention Allow Estimation of In‐Hospital Resource Use Independent of Site and Inflation
Authors: Alzola Carlos , Lynn Joanne , Wagner Douglas , Wu Albert W. 
Published: April 2015

OBJECTIVES:To develop and evaluate a model to estimate inpatient resource utilization for seriously ill patients using periodic medical record abstraction and hospital length of stay.DESIGN:A prospective cohort study of prognoses and preferences and outcomes of seriously ill hospitalized adults. The predictive model was based on the Therapeutic Intervention Scoring System (TISS), length of stay (LOS), and hospital site, and was developed on Phase I data and validated on Phase II data.SETTING:Five teaching hospitals in the United StatesPARTICIPANTS:The derivation sample included 4301 patients enrolled in the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment (SUPPORT). The validation sample included 4804 patients.MEASUREMENTS:Hospital charges were correlated with the product of hospital length of stay and average score from the TISS. Model fit assessment usedR2for total hospital charges.RESULTS:The correlation between hospital charges and the final model, after adjusting for site differences, was 0.86. The correlation was similar when validating the model in an independent data set.CONCLUSIONS:We present a method to estimate hospital resource utilization that is independent of site and inflation and can estimate actual costs in multiyear, multisite research endeavors.