bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pyrazolopyridine Derivative Acts as a Novel Cyclooxygenase Inhibitor: Antiplatelet Effect in Aged Patients with Ischemic Stroke
Authors: Satoh Kei , Yoshida Hidemi , Imaizumi Tada‐atsu , Koyama Masayuki , Hiramoto Makoto , Takamatsu Shigeru 
Published: April 2015

Objective: To examine the antiplatelet effect of a novel pyrazolopyridine derivative (KC‐764) in geriatric patients with ischemic stroke.Design: Randomized clinical trial of three graded dose levels.Setting: A geriatric clinic attached to a nursing home.Patients: Fifteen patients with a history of cerebral infarction with a mean age of 75±5 years (range, 65–83). Patients were divided into three groups and administered 10, 20, or 40 mg/day KC‐764 for 8 weeks.Measurements: Platelet aggregation induced by arachidonate, ADP, collagen and platelet‐activating factor. Plasma or serum levels of thromboxane B2 and 6‐ketoprostaglandin F1α.Main Results: Platelet aggregation was inhibited by KC‐764 administration and returned to the control level after discontinuation. Although plasma thromboxane B2 levels were markedly decreased, plasma 6‐ketoprostaglandin F1α was not affected. However, the dose of 10 mg/day was not sufficient to maintain an effective plasma level of KC‐764. There were no side effects or changes in laboratory findings.Conclusions: We confirmed that KC‐764 at a dose of 20 to 40 mg/day is an effective antiplatelet agent and a good candidate for a trial to see if it is feasible for long‐term use for the prevention of ischemic stroke in high‐risk patients.
The Pace Pilot Study: 12‐Month Results and Implications for Future Primary Prevention Trials in the Elderly
Authors: Silagy Christopher A , McNeil John J , Donnan Geoffrey A , Tonkin Andrew M , Worsam Bernard , Campion Katrina 
Published: April 2015

Objective: To document compliance with medication, dropout and drop‐in rates, and baseline cardiovascular event rates during the pilot phase of the PACE (Prevention with low‐dose Aspirin of Cardiovascular disease in the Elderly) study.Design: Randomized, double‐blind, placebo‐controlled trial of low‐dose aspirin therapy.Setting: Community‐based, in general practices and residential retirement villages, in Victoria, Australia.Subjects: Four hundred persons aged 70 years and older (53% females), ambulatory and living independently, who volunteered to participate. None had significant vascular disease, peptic ulceration, hemorrhagic symptoms, or were currently taking non‐steroidal anti‐inflammatory drugs.Main Outcome Measures: Compliance with medication (assessed by pill count and platelet function tests), self‐reported drop‐out and drop‐in rates, and incidence of cardiovascular events reported by participants and their general practitioners during a 12‐month period.Results: Two fatal cardiovascular events, three non‐fatal coronary events, and eight non‐fatal cerebrovascular events were observed during the 12‐month period. These incidence figures were approximately 15%, 15%, and 40%, respectively, of those in the general population of the same age and sex, based on morbidity data available from the Australian Bureau of Statistics. Compliance to medication was excellent (87%), and premature withdrawal (other than for a study end point) was limited to 14.5%. Secondary ‘softer’ endpoints, such as transient ischaemic attack and unstable angina, necessitated patient withdrawal from randomized therapy and possibly contributed to the small number of primary ‘hard’ end points observed. The projected power of the main study to detect a 20% treatment effect on overall cardiovascular mortality in 15,000 subjects over a 4‐year period may, therefore, be substantially reduced.Conclusions: These results suggest that any future primary prevention study of cardiovascular disease in the elderly examining the effect of low‐dose aspirin on overall cardiovascular mortality will likely need to use much larger numbers of patients or use a combined end point of fatal and non‐fatal ischemic events.
Long‐Term Care Facility Policies on Life‐Sustaining Treatments and Advance Directives in Canada
Authors: Choudhry Niteesh K. , Ma Joseph , Rasooly Iris , Singer Peter A. 
Published: April 2015

OBJECTIVE: To describe the prevalence and content of long‐term care facility policies regarding the use of life‐sustaining treatments (cardiopulmonary resuscitation (CPR), artificial hydration and nutrition, dialysis, antibiotics for life‐threatening infections, transfer to acute care hospital) and advance directives in Canada.DESIGN: Cross‐sectional mailed survey.SETTING: Canadian long‐term care facilities with 25 beds or more listed in the 1991–92 Directory of Long Term Care Centres in Canada. Institutions listed as, “general hospitals,” “psychiatric hospitals,” “children's treatment centres,” “group homes,” or as purely residential facilities were excluded.PARTICIPANTS: Chief Executive Officers or their designates.MAIN OUTCOME MEASURES: Respondents' self‐reports regarding the existence of life‐sustaining treatment or advance directive policies and content analysis of the policies themselves.RESULTS: Of 1472 long‐term care facilities, 1021 (69%) responded. Of these, 344 (34%) institutions had 397 policies regarding the use of life‐sustaining treatments or advance directives. Three hundred twenty facilities (31%) had 349 do‐not‐resuscitate (DNR) policies (40% on CPR alone and 60% on CPR plus other life‐sustaining treatments). Seventeen institutions (2%) each had one policy addressing life‐sustaining treatments other than CPR, and 31 institutions (3%) each had one policy addressing advance directives. Of the 397 policies, 171 (43%) required routine discussion with all patients, 156 (39%) mentioned futility, 331 (83%) indicated that the competent patient had the right to make a decision about life‐sustaining treatment, 265 (67%) indicated that the family of the incompetent patient had this right, 27 policies (7%) mentioned conflict resolution, 378 (95%) had an explicit requirement for recording the decision, 10 (3%) required explicit communication of the decision to the competent patient, 10 (3%) required such communication to the family of the incompetent patient, 260 (66%) required updating of the decision, and 213 (54%) mentioned rescinding or changing the decision.CONCLUSIONS: Only one‐third of Canadian long‐term care facilities have do‐not‐resuscitate policies, and even fewer have policies on advance directives or life‐sustaining treatments other than CPR. The policies themselves could be improved by encouraging routine advance discussions, scrutinizing the use of the futility standard, stipulating procedures for conflict resolution, and explicitly requiring communication of the decision to competent patients or substitute decision makers of incompetent patients.
A Nutritional Index Predicting Mortality in the Nursing Home
Authors: Frisoni Giovanni B. , Franzoni Simone , Rozzini Renzo , Ferrucci Luigi , Boffelli Stefano , Trablucchi Marco 
Published: April 2015

OBJECTIVE: To define a sensitive and specific index, based on nutritional indicators, predicting mortality in nursing home patients.DESIGN: A prospective cohort study.SETTING: A nursing home.MEASUREMENTS: Anthropometric and laboratory nutritional indicators were assessed in 104 nursing home elderly residents (20 males, 84 females). Patients were aged 60 years and older and had relatively good somatic health and nutritional status. Mortality data were collected over an 18‐month follow‐up period. Discriminant analysis was used to compute an adimensional measure (index) that could predict mortality with the highest sensitivity and specificity.RESULTS: Mortality was 0.20/year. A nonlinear, “U‐shaped” relationship of cholesterol levels with mortality was found. A prognostic index based on cholesterol, lymphocyte count, mid‐arm circumference, hemoglobin, age, and gender was obtained. Higher values of this index were associated with progressively higher risks at 12 months and 18 months. Sensitivity and specificity calculated on 18‐month mortality were 80% and 78.4%, respectively.CONCLUSIONS: This index, based on simple measures, can be a useful tool in the evaluation of health status of the elderly living in nursing homes.
Local Treatment of Pressure Sores in the Elderly: Amino Acid Copolymer Membrane Versus Hydrocolloid Dressing
Authors: Honde Chantal , Derks Christian , Tudor David 
Published: April 2015

OBJECTIVE: To compare the clinical effectiveness and wound management properties of a copolymer membrane, Inerpan (Synthelabo), and a hydrocolloid dressing, Corn‐feel (Coloplast), in the treatment of decubitus ulcers in the elderly.DESIGN: Open, randomized, multicentric French study, with two parallel groups of patients.PATIENTS: 168 in‐patients aged more 65 years (mean age: 82 years) suffering from grade II to grade IV (in the Shea classification) pressure sores.TRIAL PERIOD: Either 8 weeks or until the ulcer healed, whichever occurred first.MEASUREMENTS: In addition to a complete physical examination, patients were evaluated at baseline for nutritional status and risk factors. The wounds were described, their depth scored, and the areas traced at Weeks 0, 1,2, 4, 6, and 8. The number of dressings used was recorded.RESULTS: Thirty‐one Inerpan‐treated patients and 23 Comfeel‐treated patients achieved healing (P = 0.089), with respective median healing times of 32 and 38 days. Healing times were compared using survival curves (in the whole population) adjusted for ulcer depth effect and showed a significant difference in favor of Inerpan (P = 0.044 and 0.014). Progress of healing (percentage of ulcer healed) was calculated in the two groups. Clinically assessed the treatment performance scored at the completion of the study showed better results with Inerpan (F < 0.05). Both groups were similar in terms of granulation/exudation scores, surrounding skin, and ease of care.CONCLUSION: It is concluded that Inerpan is easy to use, safeguards the healing process, and is of particular value in the management of pressure sores.
Prognosis‐Based Futility Guidelines: Does Anyone Win?
Authors: Teno Joan M. , Murphy Donald , Lynn Joanne , Tosteson Anna , Desbiens Norman , Connors Alfred F. , Hatnel Mary Beth , Wu Albert , Phillips Russell , Wenger Neil , Harrell Frank , Knaus William A. ,   The SUPPORT Investigators
Published: April 2015

OBJECTIVE: Advocates for health care reform and others claim that significant savings could be achieved if “futile” care were eliminated. Our objective was to provide an initial estimate of the effects of a public policy that would preclude futile life‐sustaining treatments, defined as those employed despite ≤1% chance of surviving for 2 months.DESIGN: Simulation using data from an observational cohort study.SETTING: Five academic medical centers.PATIENTS: Seriously ill hospitalized adults enrolled in the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment (SUPPORT).METHODS: We examined the impact of prognosis‐based futility guidelines on survival and hospital length of stay on a cohort of seriously ill adults. We calculated the number of days of hospitalization that would not be used if, on the third study day, life‐sustaining treatment had been stopped or not initiated for subjects with estimated 2‐month survival probability of ≤1%.RESULTS: Of the 4301 patients, 115 (2.7%) had an estimated chance of 2‐month survival of ≤1%. All but one of these 115 subjects died within 6 months. Almost 86% died within 5 days of prognosis. At the time of death, 92 subjects (80.0%) had had no attempt at resuscitation; 35 (30.4%) had had a life‐sustaining mechanical ventilator withdrawn. A Do‐Not‐Resuscitate order was written either before (n = 61) or within 5 days (n = 18) of reaching this prognosis for 68.6% of the patients. These 115 subjects had total hospital charges of $8.8 million. By forgoing or withdrawing life sustaining treatment in accord with a strict 1% futility guideline, 199 of 1,688 hospital days (10.8%) would be forgone, with estimated savings of $1.2 million in hospital charges. Nearly 75% of the savings in hospital days would have resulted from stopping treatment for 12 patients, six of whom were under 51 years old, and one of whom lived 10 months.CONCLUSIONS: Patients at a high risk of dying can be identified prospectively. Implementation of a strict, prognosis‐based futility guideline on the third day of a serious illness would result in modest savings.
Nutrition and Function: Is There a Relationship Between Body Mass Index and the Functional Capabilities of Community‐Dwelling Elderly?
Authors: Galanos Anthony N. , Pieper Carl F. , Cornoni‐Huntley Joan C. , Bales Connie W. , Fillenbaum Gerda G. 
Published: April 2015

Objective: To determine if there is a relationship between body mass index and the ability to perform the usual activities of living in a sample of community‐dwelling elderly.Design: Secondary data analysis of The National Health and Nutrition Examination Survey‐I Epidemiologic Follow‐up Study (1982–1984). Follow‐up home interview of a population‐based sample originally interviewed between 1971 and 1975 in the National Health and Nutrition Examination Survey‐I (NHANES‐I).Participants: Survivors of the original NHANES‐I cohort who were 65 years of age or older and who were living at home at the time of the second interview (n = 3061). Excluded were those who could not be found, refused participation, or were institutionalized (n = 220), and those without complete height and weight data (n = 194).Main Outcome Measure: Functional status as measured by a 26‐item battery.Results: Bivariate analysis revealed a greater risk for functional impairment for subjects with a low body mass index or a high body mass index. The greater the extreme of body mass index (either higher or lower), the greater the risk for functional impairment. Logistic regression analysis indicated that both high and low body mass index continued to be significantly related to functional status when 22 other potential confounders were included in the model.Conclusion: The body mass index is related to the functional capabilities of community‐dwelling elderly. The inclusion of this simple measurement in the comprehensive assessment of community‐dwelling elderly is supported.
Arginine Vasopressin and Osmolality in the Elderly
Authors: Johnson Anthony G. , Crawford Georgina A. , Kelly Dianne , Nguyen Tuan V. , Gyory Akos Z. 
Published: April 2015

Objectives: To evaluate the influence of age on plasma arginine vasopressin (AVP) concentrations and the relationship between plasma AVP and serum osmolality in younger and older subjects, and in the elderly, to assess the effect of gender on plasma AVP concentration and to determine the impact of prostaglandin blockade on renal responsiveness to AVP.Design: Cross‐sectional study; randomized, double‐blind, crossover, placebo‐controlled study.Setting: The Renal Laboratory, Royal North Shore Hospital (younger adults) and Clinical Room, St Vincents Hospital (elderly subjects).Participants: 45 younger adults (35 ± 9 years) and 41 elderly subjects (29 males, 12 females; 78 ± 3 years). All subjects were healthy and non‐institutionalized. The elderly subjects were screened to exclude significant pathology (clinical assessment, multiple investigations).Intervention: Blood samples were drawn from all younger and elderly subjects. The elderly subjects were randomly allocated indomethacin or placebo for 1 month. Following a 1 to 2‐week washout, the alternative was administered for a further 1 month.Main Outcome Measures: Plasma AVP and serum osmolality and plasma AVP, serum, and urine osmolality at baseline were measured on indomethacin and placebo.Results: In the elderly subjects, baseline plasma AVP concentration was significantly higher than in the younger subjects studied (4.7 ± 0.7 vs 2.1 ± 0.2 pg/mL respectively; P = 0.0003). Plasma AVP was strongly correlated with serum osmolality in the younger subjects (r = 0.76, P = 0.0001) but not in the elderly cohort (r = –0.18, P = 0.26). No difference was found between the sexes in plasma AVP (P = 0.89), and indomethacin treatment did not alter the plasma AVP/urine osmolality ratio (P = 0.85) in the elderly subjects. In addition, changes in plasma AVP with indomethacin therapy did not correlate with changes in serum osmolality (r = 0.16, P = 0.09).Conclusions: Aging is accompanied by an increase in plasma AVP concentrations. In healthy, elderly subjects, plasma AVP is not dependent on serum osmolality and is not influenced by gender. Indomethacin has no effect on the renal responsiveness to plasma AVP.
Comparison of Static and Dynamic Posturography in Young and Older Normal People
Authors: Baloh Robert W. , Fife Terry D. , Zwerling Lisa , Socotch Tina , Jacobson Kathleen , Bell Theodore , Beykirch Karl 
Published: April 2015

Objective: To measure sway velocity during static and dynamic posturography in “normal’ older people and to determine which tests best distinguish young from older subjects.Subjects: A sample of 30 young (18–39 years) and 82 community‐dwelling older (>75 years) subjects who reported normal balance underwent a battery of balance tests.Measurements: Velocity and frequency of sway, Tinetti gait and balance score, self‐reported fear of falling and number of falls.Results: Mean sway velocity and the ratio of high to low frequency sway velocity were significantly increased in older subjects compared with younger subjects for static and dynamic tests with eyes open and with eyes closed. Measures of anterior‐posterior sway velocity during angular tilt of the platform with eyes closed best distinguished young from older subjects (almost three‐fourths of older subjects had values greater than 2 standard deviations from the young normal mean). Older subjects who reported falls in the past year did not have a significantly higher sway velocity on static or dynamic tests compared with those who did not report falls. However, subjects who reported a fear of falling had significantly higher sway velocity on dynamic tests with eyes closed compared to those who did not report a fear of falling.Conclusions: On average, velocity of sway is higher in older subjects compared with younger subjects, and the difference between young and old is greater with dynamic posturography than with static posturography.
The Effects of the Presence of a Third Person on the Physician‐Older Patient Medical Interview
Authors: Greene Michele G. , Majerovitz S. Deborah , Adelman Ronald D. , Rizzo Connie 
Published: April 2015

Objective: To compare communication in triadic (three‐person) and dyadic (two‐person) older patient medical interviews and to determine the influence of the presence of a third person on the physician‐older patient relationship.Design: Matched sample of dyadic and triadic audiotaped outpatient medical visits. Audiotapes were coded with the Multi‐dimensional Interaction Analysis (MDIA) system.Setting: Hospital‐based medical primary care group practice in a major urban teaching institution.Participants: Patients 60 years and older who were making their first visit to study physicians. In a sample of 96 audiotaped initial medical visits, 15 encounters involved three persons. These 15 cases were matched with 15 dyadic interviews for gender and race of the patient and for gender and race of the physician.Main Outcome Measures: Content, interactional processes, and specific language and communication behaviors of older patients, physicians, and third persons in the medical encounter, as measured by the MDIA system.Results: The specific content and the quality of interactional processes of physicians were not affected by the presence of a third person. However, older patients raised fewer topics in all content areas (medical, personal habits, psychosocial, and physician‐patient relationship) in triads than in dyads. Overall, patients were less responsive (ie, the quality of their questioning, informing, and supportiveness was poorer) on patient‐raised topics in triads than in dyads. Patients were rated as less assertive and expressive, and there was less joint decision‐making and shared laughter in triads than in dyads. Patients were frequently excluded from conversations in visits in which a third person was present.Conclusions: The presence of a third person in the medical encounter changes the interactional dynamics of older patient medical interviews and may influence the development of a trusting and effective physician‐older patient relationship.
Associations of Physical Activity with Performance‐Based and Self‐Reported Physical Functioning in Older Men: The Honolulu Heart Program
Authors: Young Deborah Rohm , Masaki Kamal H. , Curb J. David 
Published: April 2015

OBJECTIVE: To examine the association of self‐reported physical activity with performance‐based and self‐reported physical functioning measured 3 to 5 years later.DESIGN: A population‐based, longitudinal study.SETTING: The island of Oahu, Hawaii.PARTICIPANTS: Subjects were 3640 Japanese‐American men older than 70 years of age.MEASUREMENTS: Estimated daily energy expenditure evaluated from self‐reported engagement in a variety of activities determined from a mail survey in 1988; physical functioning status determined from both self‐report and performance‐based measures 3 to 5 years later. The effect of physical activity on physical functioning scores was determined through multiple logistic regression and analysis of covariance techniques for subjects who had chronic diseases as well as those in a healthy subsample.RESULTS: For the healthy subsample, those who were highly active in 1988 were more likely to have optimal function for the basic activities of daily living score (odds ratio 2.3; confidence interval (CI) 1.1 to 4.9), home management skills score (odds ratio 1.5; CI 1.1 to 2.1), and physical endurance‐type tasks score (odds ratio 1.7; CI 1.2 to 2.4) than subjects classified as low active. A significant linear trend was found additionally across physical activity level for time to walk 10 feet and grip strength (P values < .001). Similar results were found for subjects with chronic diseases; however, most of the benefit of physical activity for this subsample occurred for subjects who were at least physically active at a moderate level.CONCLUSION: Engaging in physical activity is predictive of a high level of physical functioning in older men with and without chronic diseases. Participation in at least moderate physical activity may be sufficient to maintain