bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prediction of Intracerebral Haemorrhage Expansion with Clinical, Laboratory, Pharmacologic, and Noncontrast Radiographic Variables
Authors: Chan Sheila , Conell Carol , Veerina Kaivalya T. , Rao Vivek A. , Flint Alexander C. 
Published: April 2015

Background Hematoma expansion confers excess mortality in intracerebral haemorrhage, and is potentially preventable if at-risk patients can be identified. Contrast extravasation on initial computed tomographic angiography strongly predicts hematoma expansion but is not very sensitive, and most centers have not yet integrated computed tomographic angiography into acute intracerebral haemorrhage management. We therefore asked whether other presentation variables can predict hematoma expansion. Methods We searched the electronic medical records of a large integrated healthcare delivery system to identify patients with a hospitalization discharge diagnosis of intracerebral haemorrhage between the years 2008 and 2010. Hematoma expansion was defined as radiographic increase by 1/3 or by 12·5 ml within 48 h of presentation. Pre-specified patient demographic and clinical presentation variables were extracted. Stepwise multivariable logistic regression was performed to model hematoma expansion. Because some patients may have died from hematoma expansion without a second head computed tomography, we constructed a separate model including patients that died without a second head computed tomography in 48 h, hematoma expansion or death. Results Ninety-one of 257 patients (35%) had hematoma expansion. Antithrombotic use (odds ratio = 1·9, P = 0·04) and initial mNIHSS (modified National Institutes of Health Stroke Scale; odds ratio = 1·06, P = 0·001) were significant predictors in the hematoma expansion model (area under the Receiver–Operator Characteristics curve, AUROC = 0·6712, pseudo- r2 = 0·0641). 163 of 343 patients (48%) had hematoma expansion or death. Age (odds ratio = 1·02, P = 0·02), initial mNIHSS (odds ratio = 1·07, P < 0·001), and initial hematoma volume (odds ratio = 1·01, P = 0·03) were significant predictors of hematoma expansion or death (AUROC = 0·7579, pseudo- r2 = 0·1722). Conclusion Clinical and noncontrast radiographic variables only weakly predict hematoma expansion. Examination of other indicators, such as computed tomographic angiography contrast extravasation (the ‘spot sign’), may prove more valuable in acute intracerebral haemorrhage care.
The Ratio of Mesial to Neocortical Temporal Lobe Blood Flow as a Predictor of Dementia
Authors: Cohen Robert M. , Andreason Paul J. , Sunderland Trey 
Published: April 2015

OBJECTIVE: The hypothesis tested was that an increased ratio of cerebral blood flow (rCBF) in the mesocortical temporal lobe to that of the neocortical temporal lobe (MES/ NEO ratio) would be related to clinical measures of dementia severity and would help distinguish Alzheimer's patients from normal controls.DESIGN: The rCBF of nine Alzheimer's patients (5 males and 4 females; age = 65.9 ± 6.0 years, range 55–71; Folstein Mini‐Mental Status Examination = 18.6 ± 7.4, range 9–28) and 10 age‐matched normal controls (7 males, 3 females; age = 66.0 ± 5.7 years, range 58–75) was determined by positron emission tomography (PET) using H2150 and the method of Alpert et al.25RESULTS: Alzheimer's disease patients had a significantly higher MES/NEO ratio (1.19 ± .17) than the age‐matched normal controls (.854 ± .14; t = .‐4.74, df= 17, P = .0002). Using a MES/NEO ratio of 1 as the cutoff point for discrimination between Alzheimer's patients and normal controls, the ratio demonstrated 100% sensitivity (no. of correctly identified Alzheimer's patients/no. of Alzheimer's patients) and 90% specificity (no. of correctly identified unaffected subjects/no. of unaffected subjects). Further, those patients with the highest MES/NEO ratios had the lowest overall measures of cognitive function (Folstein Mini‐Mental Status Examination: r = ‐.75, P < .02, 1‐tail; Mattis Dementia Rating Scale: r = −0.655, P = .028, 1‐tail) scores.CONCLUSIONS: The findings are consistent with other in vivo and postmortem studies, suggesting that functional and structural changes of the lateral temporal lobe in Alzheimer's disease occur relatively early in the disease process and appear to be distinguishable from those changes accompanying normal aging. In contrast, the memory loss and pathology of the mesial temporal lobe that is characteristic of the early stages of Alzheimer's patients do not appear to be associated with a reduction in cerebral blood flow in the resting Alzheimer's patient. Nevertheless, the clinical significance of the results must await findings of longitudinal studies of larger numbers of Alzheimer's patients and controls.
Preventive Medicine and Screening in Older Adults
Authors: Goldberg Todd H. , Chavin Stephen I. 
Published: April 2015

PURPOSE: To review important current issues, studies, recommendations and controversies relating to preventive medicine and screening in older people.STUDY SELECTION/DATA ABSTRACTION: MEDLINE searches for literature on prevention and screening with regard to older adults as well as each individual condition reviewed; bibliographical reviews of textbooks, journal articles, government and advocacy organization task force reports, and recommendations. Important information synthesized and discussed qualitatively.DATA SYNTHESIS: Data and recommendations are presented for most common preventive services, including primary prevention and screening for cardiovascular diseases and risk factors, common malignancies, endocrine and infectious diseases, osteoporosis, sensory deficits, and dementia.CONCLUSIONS: The goal of preventive medicine in older people should be not only reduction of premature morbidity and mortality but preservation of function and quality of life. Attempts to prevent diseases of old age should start in youth; the older the patient, the less likely the possibility or value of primary and secondary prevention, and the greater the stress must be on tertiary prevention. Age 85 is proposed as a general cutoff range beyond which conventional screening tests are unlikely to be of continued benefit; however, care must always be individualized. Emphasis should be on offering the best proven and most effective interventions to the individuals at highest risk of important problems such as cardiovascular diseases, malignancies, infectious and endocrine diseases, and other important threats to function in older people. Breast cancer screening, smoking cessation, hypertension treatment, and vaccination for infectious diseases are thus far among the most firmly proven and well accepted specific preventive measures, with physical exercise also being particularly promising. Although more research is needed, a current working approach is necessary and possible. A summary table of recommendations and information tools such as reminders or flowsheets may be valuable in helping the physician carry out prevention and screening programs.
Transitions in Health Care Use and Expenditures Among Frail Older Adults by Payor/Provider Type
Authors: Pearlman Deborah N. , Branch Laurence G. , Ozminkowski Ronald J. , Experton Bettina , Li Zili 
Published: April 2015

OBJECTIVES: To assess whether transitions in health care expenditures differed over time by payor/provider type: Medicare fee‐for‐service (FFS), Medicaid‐Medicare, and Medicare HMO.DESIGN: Longitudinal study.SETTING: A large, nonprofit healthcare system in San Diego, California.PARTICIPANTS: A total of 450 frail older people who responded to the baseline and follow‐up surveys and who survived the 18‐month study period.MEASUREMENTS: Measures included three total expenditure categories for each 6‐month period: low users (<$4000); medium users ($4000–$19,999); or high users ($20,000+). Seven conceptually meaningful expenditure trajectories over time were identified: (1) consistently low expenditures, (2) consistently medium expenditures, (3) consistently high expenditures, (4) decreasing expenditures, (5) increasing expenditures, (6) U‐shaped expenditures, and (7) inverted U‐shaped expenditures.MAIN RESULTS: Logistic regression analyses showed that HMO enrollees were about twice as likely as Medicaid‐Medicare beneficiaries to have consistently low expenditures, but no differences were found between the FFS and HMO groups on this trajectory. Other expenditure patterns showed no significant differences by payor/provider group. Significant interactions among payor/provider type, low/medium/high expenditure status, and time were observed for inpatient hospital care, skilled nursing/rehabilitation care, and home health care.CONCLUSION: This study illustrates the complexity of frail older people with respect to their health care expenditures and service use. Expanded efforts to control health care expenditures for frail older people should focus first on those who are dually‐enrolled. In addition, because mean medical expenditures for high users enrolled in different payor/provider groups were surprisingly similar, the data suggest that containing expenditures for individuals in the highest usage group ($20,000+) presents challenges for physicians practicing in an era of healthcare reform, regardless of payor/provider setting.
Frontotemporal Dementia Versus Vascular Dementia: Differential Features on Mental Status Examination
Authors: Cherrier Monique M. , Mendez Mario F. , Ferryman Kent M. , Pachana Nancy A. , Miller Bruce L. , Cummings Jeffrey L. 
Published: April 2015

OBJECTIVE: After Alzheimer's disease, vascular dementia (VaD) and frontotemporal dementia (FTD) are among the most common dementing illnesses. FTD may have a neuropsychological profile similar to that of VaD, and patients with these dementias may be difficult to distinguish on clinical examination. The purpose of this study was to elucidate distinct cognitive profiles of a large group of FTD and VaD patients on a brief, clinical mental status examination.DESIGN: A comparison of 39 FTD patients and 39 VaD patients on a brief, clinical mental status examination.SETTING: A Dementia Research Center and affiliated, university hospitals.METHODS: The FTD patients were diagnosed by noncognitive clinical and neuroimaging criteria, and the VaD patients met NINDS‐AIREN criteria for vascular dementia. The two dementia groups were comparable on three dementia assessment scales.MEASUREMENTS: The mental status measures included the neuropsychological battery from the Consortium to Establish a Registry for Alzheimer's Disease (CERAD), plus supplementation from the Neurobehavioral Cognitive Status Examination (NCSE) for cognitive areas not assessed by the CERAD.RESULTS: The FTD and VaD groups differed significantly on the mental status examination measures. FTD patients performed significantly better than the VaD patients on digit span and constructions, despite comparable performance by both groups on calculations. Although not statistically significant, the FTD group performed worse than the VaD group on verbal fluency and abstractions. These differences were not explained by group differences in age and education.CONCLUSION: These results suggest that cognitive differences between FTD and VaD groups reflect greater frontal pathology in contrast to relative sparing of posterior cortex and subcortical white matter in FTD. These cognitive differences as measured by a mental status examination may help distinguish between these two dementia syndromes.
Oral Staphylococcus in Older Subjects with Rheumatoid Arthritis
Authors: Jacobson Jed J. , Patel Bonnie , Asher Gillian , Woolliscroft James O. , Schaberg Dennis 
Published: April 2015

OBJECTIVE: To determine if Staphylococcus aureus and Staphylococcus epidermidis, etiologic bacterial agents to late prosthetic joint infections (LPJI), are more prevalent in the oral flora of older individuals with rheumatoid arthritis (RA) than in an age and gender‐matched nonarthritic control population (NA).DESIGN: Cultures were obtained from the nares, oropharynx, saliva, tongue, and gingival crevice, and the results were compared between older patients with RA and controls.SETTING: University of Michigan Medical Center, Ann Arbor, VA Medical Center, and University of Michigan School of Dentistry.PARTICIPANTS: A total of 111 community‐dwelling subjects with a diagnosis of RA and 83 gender‐matched control subjects.MEASUREMENTS: Colistin nalidixic acid agar plates with 5% sheep's blood were inoculated and incubated. Isolates were speciated using the API Staph Trac® micro method and catalase and coagulase tests.MAIN RESULTS: Individuals with RA had a higher prevalence of S. aureus isolated from the oral cavity. However, only the oropharynx and tongue revealed higher rates; all other sites were insignificant. The presence of oral S. aureus was associated with xerostomia. Staphylococcus epidermidis was not detected from any of the oral sites sampled. Sixty‐two percent (10/16) of the S. aureus isolates from the RA subjects were resistant to penicillin and ampicillin, whereas none were resistant to a cephalosporin.CONCLUSIONS: These findings suggest that rheumatoid arthritis may be a risk factor for LPJI in older prosthetic joint patients undergoing invasive dental procedures in the posterior oral cavity. This increased risk is caused, in part, by a higher prevalence of S. aureus in the posterior oral cavity. The prevalence and the antibiotic resistance of S. aureus must be considered when determining the need for chemoprophy‐laxis.
Cerebral White Matter Changes (Leukoaraiosis), Stroke, and Gait Disturbance
Authors: Briley Dennis P. , Wasay Mohammad , Sergent Susan , Thomas Stuart 
Published: April 2015

OBJECTIVES: Leukoaraiosis, a radiological change of cerebral white matter thought to be caused by ischemia, is associated with gait disturbance. However, because of concomitant stroke and cerebral atrophy, the clinical relevance of leukoaraiosis is uncertain. We, therefore, sought to determine if leukoaraiosis is a predictor of gait disturbance after accounting for cerebral atrophy and stroke in patients with a high prevalence of cerebrovascular disease.DESIGN: Cross‐sectional observational study.SETTING: Neurology service (inpatient and outpatient) of a Department of Veterans Affairs Hospital.PARTICIPANTS: Consecutive sample of 130 patients, 127 men and three women.MEASUREMENTS: The findings of a gait scale were correlated to vascular risk factors, neurological examination as quantified by the NIH stroke scale and supplemental motor scale, and to brain CT findings. Brain CT scans were rated for leukoaraiosis, cerebral infarction, and cerebral atrophy.RESULTS: Gait disturbance was more frequent and more severe in subjects with leukoaraiosis, of whom 31% had mild and 49% moderate/severe gait disturbance compared with 27% with mild and 12% with moderate/severe gait disturbance in subjects without leukoaraiosis (P < .001). Leukoaraiosis, cerebral atrophy, a history of multiple strokes, and weakness and ataxia of the legs were independent predictors of gait disturbance. The proportion and severity of leukoaraiosis increased with increasing gait disturbance in subgroups without leg deficit (P < .001) and without multiple strokes (P < .001), but no association with leukoaraiosis was shown in patients with leg deficit or a history of multiple strokes (P = .037 and P = .186, respectively). Gait disturbance was more severe when both leukoaraiosis and cerebral atrophy were present (P = .019).CONCLUSION: In our Veteran population, leukoaraiosis is an independent predictor of gait disturbance after accounting for stroke and cerebral atrophy. Although leukoaraiosis is a form of cerebrovascular disease, it appears to be most closely associated to gait disturbance in the absence of symptomatic stroke or leg deficit. J Am Geriatr Soc 45:1434–1438, 1997.
The Synergy of Low Lung Function and Low Body Mass Index Predicting All‐Cause Mortality Among Older Japanese‐American Men
Authors: Sharp Dan S. , Burchfiel Cecil M. , Curb J. David , Rodriguez Beatriz L. , Enright Paul L. 
Published: April 2015

OBJECTIVE: To assess the joint characteristics of low standardized weight and compromised pulmonary function in predicting all‐cause mortality.DESIGN: A population‐based, prospective cohort study.SETTING: Oahu Island, Hawaii.PARTICIPANTS: Surviving Japanese‐American men of the Honolulu Heart Program cohort, 71 to 93 years of age (N = 3059).MEASUREMENTS: Body mass index (BMI ‐ weight in kilograms/square of height in meters) and 1‐second forced expiratory volume (FEV1) as a percentage of age‐and height‐predicted FEV1 from the 1991 to 1993 examination of the cohort. Mortality data derived from the ongoing tracking of deaths of the cohort. Relations of selected risk factors among joint levels of BMI (≤ 21, >21 to <25, ≥ 25 kg/m2) and percent predicted FEV1 (≤ 70%, >70%) were determined. The impact of these covariates on relations between joint BMI/percent predicted FEV1 levels and subsequent all‐cause mortality was assessed.RESULTS: The highest age‐adjusted mortality rate (91.9 deaths per 1000 person‐years) was noted among men characterized by the joint conditions of percent predicted FEV1 ≤ 70% and BMI ≤ 21 kg/m.2 This rate was 4.0 times the mortality rate of a “healthy” reference group characterized by percent predicted FEV1 > 70% and 21 < BMI < 25 kg/m2. This rate ratio is attenuated to 3.2 upon statistical control for measures of current and past smoking behavior. Among the three strata of BMI, statistical interaction is reflected in a heterogeneity of mortality rate differences (49.7, 21.8, − 9.6 deaths/person‐year, respectively) and rate ratios (2.18, 1.98, .66, respectively) comparing men with percent predicted FEV1 ≤ 70% to > 70%.CONCLUSION: Joint loss of pulmonary function and relative weight is predictive of subsequent all‐cause mortality in excess of additive or multiplicative effects of each condition separately. Smoking behavior may contribute to this observation. J Am Geriatr Soc 45:1464–1471, 1997.
Older Women and Hormone Replacement Therapy: Factors Influencing Late Life Initiation
Authors: Leveille Suzanne G. , LaCroix Andrea Z. , Newton Katherine M. , Keenan Nora L. 
Published: April 2015

OBJECTIVE: To describe factors associated with initiation of hormone replacement therapy (HRT) by older women.DESIGN: A cross‐sectional study of 671 randomly selected women aged 65 to 80 who participated in a larger telephone survey on preventive health behaviors.SETTING: A large health maintenance organization (HMO) in Seattle, Washington.PARTICIPANTS: Of the 521 women who responded (78%), 51 had begun taking HRT at age 60 or older and were identified as initiators. Women who had never used HRT or past users who had begun HRT before age 60 were classified as noninitiators (n = 362). Current users who started HRT before age 60 (n = 108) were excluded.MEASUREMENTS: Sources included the telephone survey, automated HMO pharmacy data, and HMO utilization and provider databases.RESULTS: Initiators were similar to noninitiators with respect to age, marital status, education, and health status. Initiators were more likely to have had a hysterectomy at age 60 or later than noninitiators. Sixty‐two percent of the non‐initiators said they had received no information about the benefits of HRT from their providers compared with 18% of initiators. HRT initiation was associated with belief in prevention benefits of HRT for fractures and cardiovascular disease and with reported encouragement from the physician to use HRT.CONCLUSIONS: Other than hysterectomy status, there were few sociodemographic or health characteristics that markedly distinguished older initiators from noninitiators. Our findings show the importance of physician counseling in an older woman's decision to initiate HRT. J Am Geriatr Soc 45:1496–1500, 1997.
Skin Disorders and Moisture in Incontinent Nursing Home Residents: Intervention Implications
Authors: Schnelle John F. , Adamson Greg M. , Cruise Patrice A. , Al‐Samarrai Nahla , Sarbaugh Frank C. , Uman Gwen , Ouslander Joseph G. 
Published: April 2015

OBJECTIVE: To provide data needed to design an intervention trial to prevent or treat skin disorders in a high risk, incontinent nursing home population.DESIGN: The incidence and prevalence of nine common skin disorders were measured prospectively over a 60‐day period using trained observers. Urinary and fecal incontinence frequency were measured over 24 hours, and mobility was measured with subjects both in and out of bed. Direct measures of skin moisture were taken with an impedance device in the presence and absence of urinary incontinence. Multiple regression analyses were used to relate the incontinence and mobility variables to the presence and development of skin disorders.SETTING: Four nursing homes.PARTICIPANTS: One hundred incontinent nursing home residents.MAIN OUTCOME MEASURES: Prospective measures of nine common skin disorders and skin moisture in four perineal regions under continent and incontinent conditions.RESULTS: All subjects had at least one skin condition identified during the 60‐day data collection period. The most commonly observed skin condition was blanchable erythema, which occurred in 94% of the subjects, predominantly in the front and back regions that were closest to the urethra and rectum. Twenty‐one percent of residents developed either a Stage 1 (nonblanchable erythema) or 2 pressure ulcer. All skin conditions were transient when measured every 3 weeks with the exception of blanchable erythema, which showed stability. Stage 3 or greater pressure ulcers and edema were not observed, and interrater reliability for the measure of papules was poor. Measures of urinary and fecal incontinence severity were correlated with blanchable erythema severity, and blanchable erythema and low bed mobility were predictive of pressure ulcer severity. Blanchable erythema severity was also predictive of Stage 1 and 2 pressure ulcers. Skin moisture levels in the back perineal farthest from the rectum (peripheral) were affected most by urinary incontinence.CONCLUSION: A trial to detect a 50% preventive effect on Stage 1 and 2 pressure ulcers would require that 167 subjects be monitored for 60 days. The transient nature of the skin effects require that skin be monitored at least once a week. Because blanchable erythema is so prevalent and appears to be associated with more severe skin conditions, it would make an excellent marker for beginning to assess the potential preventive effects of various interventions on the incidence of pressure ulcers and other related skin disorders in incontinent patients. It is likely that the back area peripheral to the urethra and rectum would experience the greatest benefit from an intervention trial to reduce moisture caused by incontinence.
Accuracy of Patient Care Staff in Estimating and Documenting Meal Intake of Nursing Home Residents
Authors: Pokrywka Helene S. , Koffler Karen H. , Remsburg Robin , Bennett Richard G. , Roth Jesse , Tayback Matthew , Wright Jonelle E. 
Published: April 2015

OBJECTIVES: To determine the accuracy of patient care staff estimates and documentation of food intake of residents in nursing homes.DESIGN: Prospective, observed, unblinded cohort study.SETTING: Three urban nursing home facilities.SUBJECTS: Staff estimation and documentation of 27 nursing home residents' meal intake.MEASUREMENTS: Actual amount consumed by 27 nursing home residents was ascertained by weighing food and caloric fluids on resident trays before and after one lunch time meal. Staff estimates and documentation of percent of meal consumed was compared with actual intake. RESULTS: Patient care staff estimates differed from actual intake by approximately 20%, and in most instances intake was overestimated. Almost one‐third of the residents at risk for nutritional problems were not identified correctly by staff. Chart documentation of meal intake frequently did not reflect either actual amount of meal consumed or the staff's estimation of what was eaten.CONCLUSION: Study findings indicate that the present system used to document nursing home residents' intake is inadequate and that a more accurate mechanism or an entirely different process for identifying residents at risk for nutritional problems should be developed and implemented.