bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Impact of Metrifonate Therapy on Caregivers of Patients with Alzheimer's Disease: Results from the MALT Clinical Trial
Authors: Shikiar Richard , Shakespeare Annabelle , Sagnier Pierre‐Philippe , Wilkinson David , McKeith Ian , Dartigues Jean‐François , MD Bruno Dubois 
Published: April 2015

OBJECTIVE: To assess the impact on burden reported by caregivers of patients with mild to moderate Alzheimer's disease (AD) who were treated with metrifonate during a randomized double blind clinical trial.DESIGN: Randomized clinical trial, with a 2‐week screening period and a 26‐week double blind, placebo controlled, treatment phase. Caregivers were assessed at baseline, at 12 weeks, and at end of trial.SETTING: Caregivers were interviewed at clinics as part of the assessment of the patients.PARTICIPANTS: Six hundred and three caregivers of AD patients who were enrolled in the MALT trial; 591 (98%) provided data suitable for analysis at baseline, and 546 (91%) provided data allowing for inclusion in the analysis of change scores.MEASUREMENTS: The Caregiver Burden Assessment consisted of the Screen for Caregiver Burden, including both subjective (SCB‐subj) and objective (SCB‐obj) scores; the cognitive subscale of Poulshock and Deimling (PD); an abridged version of the Relatives Stress Scale (aRSS); assessments of time spent in providing care, including the Caregiver Activity Time Scale (CATS); and demographic and background variables on both the patient and caregiver.RESULTS: Treatment of mild to moderate AD patients with metrifonate for a duration of 26 weeks significantly reduced the psychological burden of care to the caregivers, as measured by the SCB‐subj, the PD, and the aRSS. There were no statistically significant differences on the measures assessing the time spent in caregiving, except for the caregiver's subjective impression of the change in time spent providing care during the trial. When comparing individual dose groups, most of the measures of burden showed the largest benefits in burden for the 60/80 mg group, followed by the 40/50 mg group, and then the placebo group. However, there was no statistically significant dose effect.CONCLUSIONS: This study provides the first evidence from a randomized clinical trial of any acetylcholinesterase inhibitor used in the treatment of AD demonstrating a positive impact on the patient's caregiver as well as benefits to the patient. These results were shown consistently across several measurement scales and were observed after six months of treatment. These findings reinforce the clinical significance of research that has shown that metrifonate has beneficial impacts on the cognitive, behavioral, and functional abilities of AD patients. Because caregiver burden is a leading factor in the decision for institutional care placement, the ability to favorably impact that burden through pharmacological treatment of the patient is important. J Am Geriatr Soc 48: 268–274, 2000.
Can the Control of Bodily Orientation Be Significantly Improved in a Group of Older Adults with a History of Falls?
Authors: Rose Debra J. , Clark Sean 
Published: April 2015

OBJECTIVE: To determine the short‐term effectiveness of a biofeedback‐based, computerized intervention that applied the principles of the ecological theory of perception and control of bodily orientation to the rehabilitation of older adults with a history of falling.PARTICIPANTS: Forty‐five older adults (X = 78.5 years) with a history of falls were assigned to either a control (n = 21) or intervention group (n = 24).DESIGN: A 2 × 2 (Group × Time) mixed factorial design with repeated measures on the second factor.MEASUREMENT: Impairments in multiple dimensions of balance (i.e., dynamic postural control and sensory organization) were measured before and after an 8‐week balance intervention using the 100% Limits of Stability Test® and Sensory Organization Test®. More functional limitations in balance and/or mobility were measured using two clinical tests: Berg Balance Scale and Timed Up and Go test.MAIN RESULTS: Repeated measures multivariate analyses and follow‐up testing indicated significant improvements in the dynamic balance and sensory integration capabilities in the case of the intervention group only (P < .03). Significant improvements were also observed in the two clinical measures of balance and mobility evaluated before and after the intervention for the intervention group only.CONCLUSIONS: Theory‐driven rehabilitation programs that focus on manipulating individual, task, and environmental constraints concurrently can significantly improve the control of bodily orientation of older adults with a previous history of falls in both static and dynamic action environments. Moreover, the significant improvements in functional performance observed for the intervention group suggest that interventions emphasizing task‐specific practice are not the only means by which an older adult's ability to perform daily activities requiring postural control can be improved. J Am Geriatr Soc 48: 275–282, 2000.
A Randomized Trial of Weighted Vest Use in Ambulatory Older Adults: Strength, Performance, and Quality of Life Outcomes
Authors: Greendale Gail A. , Salem George J. , Young Jean T. , Damesyn Mark , Marion Michael , Wang Man‐Ying , Reuben David B. 
Published: April 2015

BACKGROUND: Lower extremity weakness is a major risk factor for falls and hip fractures. Aging muscle is capable of responding to strengthening techniques. Strategies for providing accessible, inexpensive, safe, and effective strengthening programs for older adults are needed.OBJECTIVE: To evaluate whether use of a weighted vest improved strength, physical performance, markers of bone turnover, or health‐related quality of life.DESIGN: A 27‐week randomized, controlled, unmasked clinical trial. The primary outcome was peak isokinetic knee extensor strength at follow‐up, adjusted for baseline strength.SETTING: Home‐based program.PARTICIPANTS: A total of 62 women and men, mean age 74 years.INTERVENTIONS: Subjects were randomized to: no vest (n = 21), 3% body weight (BW) vest (n = 19), or 5% BW vest (n = 22). The vest is a nylon garment with pockets that are loaded with adjustable weights. The vest was prescribed for 2 hours daily, 4 days per week. No specific physical activities were mandated.MEASUREMENTS: All measures were made at baseline and 27 weeks. These included: knee strength and endurance by isokinetic dynamometer; timed physical performance tests; serum osteocalcin and urinary N‐telopeptides; and health‐related quality of life scales.RESULTS: Follow‐up values of muscular strength and endurance, physical performance, bone turnover markers, and health‐related quality of life did not differ by treatment assignment. The final study visit was attended by 19 (90%), 15 (80%), and 20 (91%) of the control, 3%, and 5% groups, respectively. Three permanent discontinuations of vest use occurred.CONCLUSIONS: Weighted vest use did not result in improvement in multiple domains of strength and function and did not affect bone turnover markers. We conclude that the training stimulus afforded by the vest (at the dosage tested) was below the required amount to produce strength gains or bone stimulation. J Am Geriatr Soc 48: 305–311, 2000.
Knowledge, Attitudes, and Practices of Geriatricians Regarding Patients with Dementia Who Are Potentially Dangerous Automobile Drivers: A National Survey
Authors: Cable Greg , Reisner Michelle , Gerges Salwa , Thirumavalavan Vallur 
Published: April 2015

OBJECTIVES: To determine geriatrician knowledge regarding how to prevent a patient with dementia who is a potentially dangerous driver from driving and to determine their willingness to recommend license revocation against the wishes of both the patient and the patient's family. Included is a comparison of responses from geriatricians in California, where related legislation has existed for a decade, with responses from geriatricians from all other US states combined.DESIGN: Survey sample.SETTING: Geriatric practices.PARTICIPANTS: Probability sample of 467 geriatricians.MAIN OUTCOME MEASURES: Survey responses.RESULTS: More than 28% of all geriatricians (95% CI, 24.3%–32.7%) do not know how to report patients with dementia who are potentially dangerous drivers. A 22% difference (95% CI, 13.9%–30.8%) exists between California geriatricians and those in all other US states. More than 75% (95% CI, 71.5%–79.5%) of all geriatricians agreed that physicians are responsible for reporting patients. More than 86% (95% CI, 83.2%–89.6%) of all geriatricians would contact state authorities despite the objections of the patient, and 72.9% (95% CI, 68.7%–77.1%) would contact authorities despite the objections of the patient's family.CONCLUSIONS: Although most geriatricians will act to protect the public from patients with dementia who are potentially dangerous drivers, many do not know how to report these drivers. Legislation can improve a physician's ability to report patients with dementia who are potentially dangerous drivers. J Am Geriatr Soc 48: 14–17, 2000.
Aging‐Related Decline of Gonadal Function in Healthy Men: Correlation with Body Composition and Lipoproteins
Authors: Denti Licia , Pasolini Giuseppe , Sanfelici Laura , Benedetti Raffaella , Cecchetti Alessandra , Ceda Gian Paolo , Ablondi Fabrizio , Valenti Giorgio 
Published: April 2015

OBJECTIVE: To assess if androgen decline in physiological aging contributes to the concomitant changes in body composition and lipoprotein levels.DESIGN: Cross‐sectional, observational study.SETTING: A university‐based outpatient center.SUBJECTS: The study comprised 206 healthy volunteers (aged 18–95 years).MEASUREMENTS: Blood samples were drawn after an overnight fast for the assay of hormones (free testosterone (FT), estradiol (E2), and sex hormone‐binding globulin (SHBG)) and lipids (total cholesterol, triglycerides, high‐density lipoprotein cholesterol, and lipoprotein Lp(a)). At the same time, body composition was assessed by both anthropometry (fat mass percentage (FM%) estimated from four measures of skinfold thickness using the Durnin and Womersley equation and the Siri equation) and by bioimpedance analysis (FM% estimated using the Segal or Deurenberg equations, respectively, for subjects younger or older than 62 years).RESULTS: A significant age‐related decline was found for FT and E2 concentrations, whereas SHBG levels were related positively with age. No significant association was apparent between hormonal changes and the concomitant modifications of body composition and lipoproteins. Only SHBG showed a significant inverse association between FM% and the waist‐to‐hip ratio, independent of age. The comparison between older hypogonadal (with FT levels below the lower limit of the normality range assessed in younger subjects) and eugonadal men did not show any significant differences in body composition or lipid profile.CONCLUSIONS: This study suggests that, in men, androgen decline caused by normal aging does not significantly affect some targets of testosterone action, such as body composition and lipid metabolism. Therefore, androgen supplementation in hypogonadal older men cannot be expected to influence nutritional status and body composition to the same extent that it does other main targets of testosterone action, such as sexual activity and muscle strength. However, we cannot exclude that selected subsets of older patients with low testosterone levels, especially if affected by catabolic disease, could benefit from the effects of androgen administration on nutritional status. J Am Geriatr Soc 48: 51–58, 2000.
Are We Improving the Quality of Nursing Home Care: The Case of Pressure Ulcers
Authors: Berlowitz Dan R. , Bezerra Herminio Q. , Brandeis Gary H. , Kader Boris , Anderson Jennifer J. 
Published: April 2015

BACKGROUND: There are widespread concerns regarding the quality of nursing home care and whether care is improving. We evaluated a large provider of nursing home care to determine whether risk‐adjusted rates of pressure ulcer development have changed.METHODS: We used the Minimum Data Set to study National HealthCare Corporation nursing homes from 1991 through 1995. Rates of pressure ulcer development were calculated for successive 6‐month periods by determining the proportion of residents initially ulcer‐free having a stage 2 or larger pressure ulcer on subsequent assessments. Rates were risk‐adjusted for patient characteristics. The proportion of new ulcers that were deep (stages 3 or 4) were also calculated.RESULTS: We examined risk‐adjusted rates of pressure ulcer development based on 144,379 observations of 30,510 residents at 107 nursing homes. The number of observations per 6‐month period ranged from 11,041 to 15,805. Between 1991 and 1995, there was a significant (P < .05) rate decline of more than 25%. Additionally, the proportion of new ulcers that were stages 3 or 4 declined from 30 to 22% (P < .01).CONCLUSIONS: Nursing homes showed significant improvement in the quality of pressure ulcer preventive care from 1991 to 1995. J Am Geriatr Soc 48: 59–62, 2000.
Elderly Persons' Last Six Months Of Life: Findings from the Hospitalized Elderly Longitudinal Project
Authors: Somogyi‐Zalud Emese , Zhong Zhenshao , Lynn Joanne , Hamel Mary Beth 
Published: April 2015

BACKGROUND: Few studies describe the end of life in very old people.OBJECTIVES: To characterize the last 6 months of life and dying in patients 80 years and older by describing demographic characteristics, functional state and quality of life, symptoms, preferences, use of life‐sustaining treatments, satisfaction with care, and family burden.DESIGN: A retrospective analysis for patients enrolled in a prospective cohort study.SETTING: Four teaching hospitals who participated in the Hospitalized Elderly Longitudinal Project (HELP).SUBJECTS: 417 patients who died within 1 year of their enrollment hospitalization.MEASUREMENTS: Chart reviews and interview data with patients and surrogates at several points in time. We constructed four observational time windows backward in time beginning with the patients' death.RESULTS: Before hospitalization, two out of three patients reported fair quality of life, and patients averaged 2.4 impairments in activities of daily living. Seventy percent preferred comfort care on the third day of hospitalization. During the last month of life, three of five patients interviewed in the hospital and four of five interviewed out of the hospital preferred not to be resuscitated. At the time of death, four of five patients had a do not resuscitate (DNR) order and two of five had an order to withhold a ventilator. During the last month of life, one out of four patients reported severe pain.CONCLUSIONS: Patients reported increasing functional impairments and limited quality of life. The majority preferred comfort care. The number of patients in severe pain was substantial. Before death, the majority had measures in place to limit aggressive care.
Ineffectiveness of the SUPPORT Intervention: Review of Explanations
Authors: Lynn Joanne , DeVries Kier Olsen , Arkes Hal R. , Stevens Marguerite , Cohn Felicia , Murphy Pat , Covinsky Kenneth E. , Hamel Mary Beth , Dawson Neal V. , Tsevat Joel 
Published: April 2015

BACKGROUND: The aim of the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments — SUPPORT — was to improve the care of seriously ill patients by improving decision‐making for patients with life‐threatening illnesses. Several theories have been proposed to explain why the SUPPORT intervention was unsuccessful at improving outcomes.OBJECTIVE: To review and discuss explanations offered by others regarding why the SUPPORT intervention failed to have a discernible impact on its prespecified outcome measures.DESIGN: A descriptive review of published articles and book chapters, with synthesis of data‐based and conceptual insights.METHODS: The Medline, Bioethicsline, and Ethx databases were searched for citations to SUPPORT articles between 1994 and the end of 1998. This search was supplemented by other published materials that had come to the authors' attention.RESULTS: The critiques and explanations regarding the reasons the SUPPORT intervention did not improve outcomes were catalogued and organized into 11 major categories, the first 10 of which are explored in the present study: (1) the inception cohort was biased against an effect of the intervention, (2) the intervention was not implemented as designed, (3) the intervention failed because nurses were too readily ignored, (4) the intervention was too polite, (5) the intervention presented information ineffectively, (6) the intervention did not focus on primary care physicians, (7) the intervention falsely dichotomized do not resuscitate (DNR) decisions, (8) the intervention needed more years on site or an earlier start with each patient, (9) the intervention required more appropriate outcome measures, (10) the intervention was irrelevant because usual care is not seriously flawed, (11) the conceptual model behind SUPPORT was fundamentally flawed in aiming to improve individual, patient‐level decision‐making as the way to improve seriously ill, hospitalized patients' experiences.CONCLUSIONS: Although some of the critiques were found to raise important concerns, we conclude in each case that the explanation offered is inadequate to explain the failure of the intervention. We urge further reflection on the fundamental assumptions that informed the design of that intervention and refer the reader to a more comprehensive treatment of that issue in the companion paper in this volume.
The Effect of Nutritional Supplementation on Survival in Seriously Ill Hospitalized Adults: An Evaluation of the SUPPORT Data
Authors: Borum Marie L. , Lynn Joanne , Zhong Zhenshao , Roth Katalin , Connors Alfred F. , Desbiens Norman A. , Phillips Russell S. , Dawson Neal V. 
Published: April 2015

BACKGROUND: Enteral tube and parenteral hyperalimentation are widely used nutritional support systems. Few studies examine the relation between nutritional support and patient outcomes in seriously ill hospitalized adults.OBJECTIVE: To explore the association between nutritional support and survival in seriously ill patients enrolled in the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT).DESIGN: A prospective study of preferences, decision‐making, and outcomes.SETTING: Five teaching hospitalsPARTICIPANTS: 6298 patients aged 18 or older meeting diagnostic and illness severity criteria.MEASUREMENT: Demographic characteristics, diagnoses, comorbid conditions, acute physiology score, nutritional support, and functional status before hospitalization.RESULTS: A total of 2149 patients received nutritional support. In patients who received artificial nutrition on hospital days 1 or 3 (Cohort 1), enteral feeding was associated with improved survival in coma (hazard: 0.53; 95%CI, 0.42‐0.66), and reduced survival in COPD (hazard: 1.57; 95%CI, 1.18‐2.08). In patients who were hospitalized on Day 7 and received artificial nutrition on days 1, 3, or 7 (Cohort 2), enteral tube feeding (hazard: 0.35; 95%CI, 0.27‐0.46) or hyperalimentation (hazard: 0.58; 95%CI, 0.38‐0.90) was associated with improved survival in coma. Tube feeding was associated with decreased survival in acute respiratory failure (ARF) or multiorgan system failure (MOSF) with sepsis (hazard: 1.21; 95%CI, 10.4‐1.41), cirrhosis (hazard: 2.15; 95%CI, 1.35‐3.42), and COPD (hazard: 1.37; 95%CI, 1.04‐1.80). Hyperalimentation was associated with decreased survival in ARF or MOSF with sepsis (hazard: 1.34; 95%CI, 1.12‐1.59).CONCLUSIONS: Nutritional support was associated with improved survival in coma. Enteral feeding and hyperalimentation was associated with decreased survival in ARF or MOSF with sepsis. Tube feeding was associated with decreased survival in cirrhosis and COPD. Except for patients in coma, artificial nutrition was not associated with a survival advantage.
Withholding Versus Withdrawing Life‐Sustaining Treatment: Patient Factors and Documentation Associated with Dialysis Decisions
Authors: Wenger Neil S. , Lynn Joanne , Oye Robert K. , Liu Honghu , Teno Joan M. , Phillips Russell S. , Desbiens Norman A. , Sehgal Ashwini , Kussin Peter , Taub Harry , Harrell Frank , Knaus William 
Published: April 2015

OBJECTIVE: We evaluated prospectively the use of acute hemodialysis among hospitalized patients to identify demographic and clinical predictors of and chart documentation concerning dialysis withheld and withdrawn.DESIGN: Prospective cohort studySETTING: Five teaching hospitalsPATIENTS: Five hundred sixty‐five seriously ill hospitalized patients who had not previously undergone dialysis who developed renal failure.MAIN OUTCOME MEASURES: Patient demographics, clinical characteristics, preferences, and prognostic estimates associated with having dialysis withheld rather than initiated and withdrawn rather than continued. Differences in chart documentation concerning decision‐making for dialysis withheld, withdrawn, and continued.RESULTS: Older patient age, cancer diagnosis, and male gender were associated with dialysis withheld rather than withdrawn. Age and gender differences persisted after adjustment for patients' aggressiveness of care preference. Worse 2‐month prognosis was associated with both withholding and withdrawing dialysis. Chart documentation of decision‐making was lacking more often for patients with dialysis withheld than for dialysis withdrawn.CONCLUSIONS: Measuring the equity of life‐sustaining treatment use will require evaluation of care withheld, not just care withdrawn. Older patients and men, after accounting for prognosis and function, are more likely to have dialysis withheld than withdrawn after a trial. Further exploration is needed into this disparity and the inadequate chart documentation for patients with dialysis withheld.
Fulminant Chemical Hepatitis Possibly Associated with Donepezil and Sertraline Therapy
Authors: Verrico Margaret M. , Nace David A. , Towers Adele L. 
Published: April 2015

OBJECTIVE: To describe a case of fulminant hepatitis possibly related to concomitant donepezil and seratriline therapy.PATIENT AND SETTING: An 83‐year‐old woman treated in a dementia care facility and later in a tertiary medical center.INTERVENTION AND MANAGEMENT: Discontinuation of donepezil and sertraline therapy with subsequent improvement evidenced by liver biopsy and liver function tests.RESULTS: An older woman with Alzheimer's disease was admitted to a dementia care facility because of aggressive behavior. Treatment with sertraline was initiated in February 1998. Sertraline doses were increased gradually to 200 mg daily by May 1998, and some improvement in behavior was seen. Concomitant therapy with donepezil 5 mg qhs was initiated June 26, 1998. Ten days later, confusion and jaundice were noted. Total bilirubin was 5.6 mg/dL, GGTP was 1208 IU/L, and alkaline phosphatase was 369 IU/L. Computed tomography revealed cholelithiasis without ductal dilation. Liver, spleen, and pancreas seemed normal. Donepezil and sertraline were discontinued. The patient was admitted to our institution and treated for dehydration. A liver biopsy revealed scattered portal eosinophils and prominent cholestasis consistent with acute chemical hepatitis. The GGTP and total bilirubin of this patient peaked at 2235 IU/L and 22.6 mg/dL, respectively. The patient improved, and her liver function tests normalized over the next 2 months.