bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Preliminary Report of Vitamin D and Calcium Metabolism in Older African Americans
Authors: Perry Horace M. , Miller Douglas K. , Morley John E. , Horowitz Michael , Kaiser Fran E. , Perry H. Mitchell , Jensen Judy , Boyd Sheila , Kraenzle Dale , Bentley Judy 
Published: April 2015

Objective: To determine normal serum bone‐related biochemical variables in older African‐Americans.Design: A convenience sample of older African‐Americans who had a health screening and blood testing for calciotropic hormones was compared with white Americans who were recruited at the end of the Systolic Hypertension in the Elderly Program (SHEP) study and were not on a thiazide diuretic.Setting: Community‐dwelling African‐Americans who participated in SHEP or who attended one of two mass health screenings.Participants: Thirty‐two African‐Americans aged 68–93 years and 43 white Americans aged 70–89 years.Measurements: Twenty‐five hydroxyvitamin D (250HD), parathyroid hormone, osteocalcin, and calcitonin.Results: Serum 250HD levels in 38% of the African‐American men and 38% of African‐American women were less than 8 ng/mL compared with 22% of Caucasian men and 40% of Caucasian women. Serum parathyroid hormone (PTH) was above the normal range in 25% of men and 33% of women of African‐American descent and 14% of Caucasian men and 30% of Caucasian women. Serum 25OHD was lower (P < 0.05) in individuals with a previous history of fracture. Serum albumin (P < 0.05), calcitonin (P < 0.05), and osteocalcin (P < 0.05), but not 25OHD, were lower in African‐Americans (men and women) when compared with Caucasians (P < 0.05). Serum calcium corrected for albumin was higher in the African‐Americans than in the Caucasians (P < 0.05). As previously reported in Caucasians, PTH was inversely related to log 25OHD in African‐Americans. Serum osteocalcin was positively correlated to PTH in African‐Americans, as previously reported in Caucasians. Log 25OHD correlated inversely with osteocalcin in African‐Americans, but this was not seen in Caucasians.Conclusions: In this limited sample, hypovitaminosis D (as assessed by 25OHD level) with secondary hyperparathyroidism occurred frequently in elderly African‐Americans. Osteocalcin, a measure of osteoblast activity, correlated with 25OHD and parathyroid hormone. Osteocalcin serum levels were lower in African‐Americans than Caucasians, but serum calcium corrected for albumin was higher in the former compared to the latter.
The Methodology of Studying Decline in Alzheimer's Disease
Authors: Brooks John O. , Kraemer Helena Chmura , Tanke Elizabeth Decker , Yesavage Jerome A. 
Published: April 2015

Objective: To present a new model for analyzing longitudinal data. The trilinear model is superior to the commonly used linear model that includes the flawed assumption that decline is uniform throughout the course of disease—an assumption that does not correspond to clinical observations.Design: A longitudinal cohort sample was used to compare the linear and trilinear models. Simulated longitudinal data were generated to assess classification errors with the trilinear model.Subjects and Setting: The subjects were 80 patients with Alzheimer's disease tested in a hospital out‐patient clinic.Methods: The trilinear model describes Alzheimer's disease as proceeding through three periods: An initial period of stability before detectable decline, a period of decline, and a final period of stability during which there is no further detectable decline. A program for the Apple Macintosh computer is available at no charge to apply the model to data.Findings: The analyses indicated that the trilinear model provides a better reflection of decline in Alzheimer's disease than does the linear model. This advantage is present whether the periods of stability reflect a “true” lack of decline or insensitivity of a measurement instrument.Conclusions: The trilinear model provides not only a more accurate estimate of the average rate of change, but also (when possible) estimates of the point at which decline begins and ends. Also, more detailed comparisons of tests could be made by using the trilinear parameters. The trilinear model would benefit researchers engaged in longitudinal research of progressive disorders.
Comparison of One‐Day and Three‐Day Calorie Counts in Hospitalized Patients: A Pilot Study
Authors: Breslow Rosalind A. , Sorkin John D. 
Published: April 2015

Objective: To determine whether a 1‐day calorie count can replace the labor‐intensive 3‐day calorie count commonly performed in hospitalized patients when estimates of caloric and protein intake are required.Design: Pilot study using prospective, non‐concurrent review of medical records.Setting: Hospital.Participants: Thirty patients (mean age 67 years).Results: Mean 3‐day intake (952 ± 91 calories, 41 ± 4 g protein) was about half of calculated requirements; first‐day intake was similar (918 ± 116 calories, 40 ± 5 g protein). The first day had high sensitivity (calories 96%; protein 93%) and positive predictive value (calories 100%; protein 96%). Malnutrition was evident; three‐fourths of patients had weights below recommended ranges, and 83% were hypoalbuminemic.Conclusions: Three‐day calorie counts are frequently performed in patients suspected of eating poorly. Results of this pilot study suggest that 1‐day calorie counts may be a valid alternative. However, readily available anthropometric and biochemical data may be as good an indicator of inadequate dietary intake.
Improving Neglected Influenza Vaccination Among Healthcare Workers in Long‐Term Care
Authors: Thomas David R. , Winsted Beverly , Koontz Carol 
Published: April 2015

Objective: To increase utilization of influenza vaccination among long‐term‐care health workers.Design: Before‐after intervention study.Setting: A 300‐bed life‐care community served by 195 staff employees.Intervention: An educational intervention followed by a Vaccination Fair.Measurements: Percent receiving vaccination. A post‐intervention survey was used to define staff attitudes towards vaccination.Results: Use of influenza vaccination among staff increased from 8% the previous year to 46% during a Vaccination Fair and to 54% during a similar Fair the next year.Conclusions: Organized institutional efforts to promote immunization among health‐care workers, such as a Vaccination Fair, improves compliance among health‐care workers.
Cross‐Cultural Cognitive Examination: Validation of a Dementia Screening Instrument for Neuroepidemiological Research
Authors: Glosser Guila , Wolfe Nicola , Albert Martin L. , Lavine Lawrence , Steele John C. , Calne Donald B. , Schoenberg Bruce S. 
Published: April 2015

Objective: Validation of a new instrument for screening dementia, the Cross Cultural Cognitive Examination (CCCE), is described.Design: Criterion and concurrent validation and cross‐cultural comparison of a new instrument.Participants: All individuals over the age of 40 in a village in southern Guam participated in a door‐to‐door survey. Alzheimer's and Parkinson's Disease patients and healthy controls aged 40–90 participated in the US mainland study.Measurements: The CCCE was administered to all subjects. Effects of age, language, education, and gender on test performances and social‐cultural differences were assessed. Concurrent validation of the test with respect to other well accepted screening instruments was determined.Results: High specificity (>94%) and sensitivity (>99%) for detecting dementia were found in Guam and US mainland samples, and these were not biased by differences in gender, linguistic preference, education, or cultural background. Sensitivity and specificity of the CCCE matched or exceeded that of already accepted dementia screening instruments.Conclusions: These validation studies support the usefulness of the CCCE for identifying patients with generalized dementia, rather than focal types of cognitive impairment, quickly and reliably in cross‐cultural neuroepidemiological research.
Clostridium difficile Colonization in Residents of Long‐Term Care Facilities: Prevalence and Risk Factors
Authors: Walker Karla J. , Gilliland Susan S. , Vance‐Bryan Kyle , Moody Julia A. , Larsson Alison J. , Rotschafer John C. , Guay David R. P. 
Published: April 2015

Objective: To determine the period prevalence of Clostridium difficile disease and asymptomatic carriage in the residents of long‐term care facilities (LTCF) and to characterize the risk factors for colonization or associated disease.Design: Period prevalence survey.Setting: Two long‐term care facilities in St. Paul, MN.Participants: Specimens were collected from 225 LTCF residents.Measurements: The dependent variable was the culture result for C. difficile, which was isolated and identified using selective culture media and a commercial anaerobe identification kit. Tissue culture assay was used to detect the ability of each C. difficile isolate to produce toxin. Independent variables (including gender, age, race, current medical diagnoses, severity of underlying disease, case mix, current clinical symptoms, current medications, antibiotic use within 4 weeks prior to specimen procurement, and other pertinent history) were obtained from the current medical record of each participant.Results: Of 225 stool cultures that were obtained, 16 (7.1%) were positive for C. difficile. None of the residents with a positive culture was symptomatic. History of nosocomial infection and the use of antibiotics in general, cephalosporins, trimethoprim/sulfamethoxazole (TMP/SMX), and histamine‐2 blockers were significantly associated with positive C. difficile culture (P ≤ 0.05) by univariate analyses. Trends towards significance (0.05 < P < 0.10) were noted for narcotic use, previous hospitalization, LTCF, and non‐insulin‐dependent diabetes mellitus. Logistic regression analysis revealed significant, independent predictors of positive culture: antibiotic use in general (P = 0.028; relative risk = 3.31), histamine‐2 antagonist use (P = 0.038; relative risk = 3.27), cephalosporin use (P = 0.038; relative risk = 4.66), and TMP/SMX use (P = 0.007; relative risk = 8.45).Conclusions: The use of antibiotics, particularly cephalosporins and TMP/SMX, is a significant risk factor for asymptomatic carriage of C. difficile in long‐term care facilities. The use of H‐2 blockers was also a significant risk factor for carriage; however, this finding has not been reported previously and should be confirmed by independent studies. These medications should be used judiciously in the LTCF population. When diarrheal diseases are encountered in LTCF residents, a high index of suspicion for C. difficile infection should be maintained and the appropriate diagnostic and therapeutic measures taken.
Oral Nutritional Supplement Use in Elderly Nursing Home Patients
Authors: Johnson Larry E. , Dooley Pamela A. , Gleick Jeffrey B. 
Published: April 2015

Objectives: To determine why elderly nursing home patients receive liquid oral protein supplements, what nutritional assessment is utilized, and whether there is evidence of effectiveness.Design: Retrospective, case control study comparing patients over 65 years of age, at two nursing homes, who were served oral supplements (OS) at least twice daily (n = 56), with a random sample of non‐supplemented, non‐tube fed patients (n = 53). Comparisons included medical diagnoses, medications, morbidity and mortality, weight changes, laboratory test results, and functional and behavioral status.Results: Nursing home patients were begun on OS (median time after admission = 2 months, range = 0–72 months) primarily because of weight loss (71%) and poor appetite (16%). Supplemented patients were below an age‐adjusted body weight on admission, unlike controls, and continued to lose weight until OS were started. On OS, weight was slowly regained over 9–10 months in a majority of patients to approximate admission weight. Some patients on OS showed improvement in albumin, total lymphocyte count, cholesterol, or hemoglobin, but too few patients had sufficient lab tests to verify any consistent effect. Mortality was higher in OS patients (8 vs 2, P = 0.057), who were also somewhat older (87.9 vs 84.5 years), but there was no statistical difference in infection or hospitalization rate.Measurements: Nutritional assessment in these nursing homes consisted almost exclusively of (1) serial measurement of weight, (2) comparison of weight to (a) “ideal body weight” and (b) previous weight, and (3) a subjective evaluation of food consumption. No other anthropometric evaluations or laboratory tests were conducted for nutritional assessment.Conclusions: The diagnosis of and intervention in undernutrition in nursing home patients is frequently disorganized. In addition, nutritional assessment, either for screening or for following intervention, is hampered by the lack of convenient and unambiguous assessment tools. OS use is associated with weight gain in many nursing home patients and also improves other nutritional parameters in selected individuals.
Medical Treatment Preferences of Nursing Home Residents: Relationship to Function and Concordance with Surrogate Decision‐Makers
Authors: Gerety Meghan B. , Chiodo Laura K. , Kanten Deanna N. , Tuley Michael R. , Cornell John E. 
Published: April 2015

Objective: To describe treatment preferences of nursing home residents, concordance with decisions by self‐selected proxies and to establish the relationship of sociodemographic and functional measures to decisions.Setting and Subjects: 52 patient‐proxy pairs at a Veterans Affairs nursing home.Methods: Treatment preferences were elicited from residents and proxies regarding cardiopulmonary resuscitation, mechanical ventilation, and intensive care unit care. Hospitalization, intravenous antibiotics, intravenous fluid administration, and tube feeding were presented in three separate health scenarios. Concordance was determined for the entire interview and separately for each scenario. Treatment‐seeking intensity and decision‐making consistency were scored and used to explore associations with sociodemographic variables and function.Results: Subjects were predominantly male (97%) and non‐Hispanic white (74%); average age was 70 ± 12 years, with 4 ± 2.9 diagnoses. Residents accepted 70% of all treatments. The proportion of subjects accepting interventions declined parallel to health status in each scenario. Only 7/52 (13%) subjects made inconsistent decisions. Resident treatment acceptance was inversely associated with GDS scores but not associated with any other sociodemographic or functional measure. Concordance with proxies was no greater than chance. Proxies' decisions were not systematically biased against resident preferences or influenced by patient characteristics.Conclusions: Veterans desired most treatments, but adjusted preferences according to health status and were not inconsistent. Depressive symptoms should be addressed prior to advance directive selection. The patient remains the best source of information, but proxies' decisions exhibit no bias and are not affected by patient status.
The Physics of Frailty
Authors: II Walter M. Bortz 
Published: April 2015

The contribution of frailty to human morbidity and mortality is immense. Yet it lacks a conceptual framework. By borrowing from the hypotheses provided by the thermophysicists, frailty can be understood in a way that both interrelates the relationship between form and function and provides medical science with an operational insight that yields clinical benefit.Frailty results where the organism is uncoupled from its environment yielding a break in the forward feedback cycle of stimulus to reaction to growth to increased functional competence to improved response to stimulus. Recognition of the centrality of this interrelatedness to health becomes a key theme for illness prevention and therapy.
Treatment of Vasculogenic Sexual Dysfunction with Pentoxifylline
Authors: Korenman Stanley G. , Viosca Sharon P. 
Published: April 2015

Objective: To evaluate the use of pentoxifylline to treat impotence in men with mild to moderate penile vascular insufficiency.Design: Double‐blind randomized clinical trial.Setting: Sexual Dysfunction Clinic at VA Medical Center, Sepulveda, CA.Participants: Convenience sample of couples.Intervention: Twelve weeks of treatment with placebo or 400 mg tid of pentoxifylline.Measurements: (1) Report of patient verified by partner as to number of coital episodes per month; (2) penile‐brachial pressure index determinations.Results: Pentoxifylline therapy regularly increased the PBPI in impotent men in comparison with the placebo, frequently into the normal range. Pentoxifylline therapy was particularly useful in restoring the PBPI in men with the pelvic steal syndrome; six of seven such subjects improved into the normal range. During the pentoxifylline treatment period, in contrast with the control period, nine men were able to reestablish coital function and three had no improvement. Six couples did not attempt intercourse despite a professed interest in sexual activity; however five out of the six men experienced erections during episodes of fantasy or attempts at masturbation during treatment. There were no complications of therapy.Conclusions: These promising preliminary results suggest a well tolerated alternative therapy for erectile dysfunction in patients with mild to moderate penile vascular disease.
The Dark Side of Incontinence: Nighttime Incontinence in Nursing Home Residents
Authors: Ouslander Joseph , Schnelle John , Simmons Sandra , Bates‐Jensen Barbara , Zeitlin Michael 
Published: April 2015

Objective: To describe the characteristics of nighttime urinary incontinence in a sample of nursing home (NH) residents.Design: Prospective descriptive study of a convenience sample of incontinent NH residents.Setting: Four NHs.Participants: 136 incontinent NH residents.Measurements: Frequency and volume of incontinent and continent voids for three 10‐hour daytime and three 10‐hour nighttime data collection periods.Results: The frequency of nighttime incontinence was the same as during the day, but the volume of nighttime incontinent voids and total nighttime volume were higher than during the day. There was substantial between‐ and within‐subject variability in volumes, but the distribution of ratios of night/total volumes approximated a normal curve. Diuretic use was associated with relatively low nighttime volumes.Conclusion: About one‐quarter of the NH residents we studied produced substantially more urine at night than during the day. Several medical, behavioral, and environmental approaches should be considered for reducing the frequency and volume of nighttime incontinence in this population.
Influence of Age on Measurement of Health Status in Patients Undergoing Elective Surgery
Authors: Mangione Carol M. , Marcantonio Edward R. , Goldman Lee , Cook E. Francis , Donaldson Magruder C. , Sugarbaker David J. , Poss Robert , Lee Thomas H. 
Published: April 2015

Purpose: To assess the influence of age on the relationships between global measures of health and specific health dimensions.Design: Cross‐sectional cohort study.Setting: University tertiary care hospital.Patients: Patients older than 50 years admitted for major elective non‐cardiac surgery.Measurements: Consenting patients underwent preoperative evaluations including a medical history, physical examination, and administration of health status assessment instruments. Global health status was measured with the Medical Outcomes Study Short Form (SF‐36) and with a 0 to 100 verbal measure of global health. Specific health dimensions (physical function, role function, social function, mental health, energy and fatigue, and pain) were measured using the SF‐36. Subjects also completed a second validated measure of physical functioning, the Specific Activity Scale (SAS).Results: Although patients aged >70 years (n = 276) had poorer role function, energy, and fatigue scores and poorer physical function on both the SF‐36 and SAS than younger patients (n = 469) (P < 0.05), they had similar overall health perception. In the entire population, global health status as measured with the SF‐36 health perception scale had the greatest correlation with the energy and fatigue scale (r = .45), correlated moderately with mental health (r = .35), social function (r = .32), and physical function (r = .33), and correlated less well with the surgically remediable dimension of pain (r = .23). However, correlations of global health perception with pain and global health perception with role functioning were significantly (P ≤ 0.05) lower in older patients when compared with subjects 70 years or younger (r = .13 vs .28 and r = .19 vs .33, respectively).Conclusion: Despite poorer role function, poorer energy and fatigue scores, and poorer physical function, elderly persons have similar global health perception when compared with younger individuals. These data indicate that global health perception may be determined by different factors in the elderly or that the elderly have fundamentally different expectations of what their global health status should be. Our findings emphasize the importance of multidimensional scales when evaluating quality of life because, particularly in the elderly, the use of global measures alone may not reflect critically important dimension‐specific impairments in health.
Utilization of Cardiopulmonary Resuscitation in Nursing Homes in One Community: Rates and Nursing Home Characteristics
Authors: Duthie E. , Mark D. , Tresch D. , Kartes S. , Neahring J. , Aufderheide T. 
Published: April 2015

Objective: To determine the rate of cardiopulmonary resuscitation use among all nursing homes in a large urban area, to examine CPR use over time, to discover whether CPR use varies among nursing homes, and to describe characteristics of patients undergoing CPR.Design: Retrospective survey.Setting: Nursing homes in a large urban area.Participants: One hundred ninety‐six nursing home residents of 68 nursing homes underwent cardiopulmonary resuscitation over a 4‐year period (1986–1989). Over this time there were 9,486 deaths in these homes, which comprised 10,252 beds.Measurements: The CPR:death ratio was determined for each facility. The ratio was analyzed over time and by type of facility (eg, proprietary, non‐profit, size of facility). The ratio was also examined among facilities with variable death rates. Patients undergoing CPR are described.Results: The ratio of CPR:death over the 4‐year period was 0.02. CPR:death ratio was higher (0.03) for the proprietary homes compared with the non‐profit homes (0.01) P < 0.0001. A significant downward trend of CPR:death was noted over the study period for the non‐profit homes; no such trend was noted in the proprietary homes. Size of nursing home did not influence the rate of CPR use. Homes with greater numbers of deaths per bed had a lower utilization of CPR. Patients undergoing CPR were old, frail, and had multiple medical problems. CPR attempts were frequent around the time of nursing home admission.Conclusion: The utilization of CPR in nursing homes is quite low. Non‐profit homes utilize CPR less than proprietary homes. Nursing homes with the highest numbers of deaths per bed utilize CPR less than homes with lower numbers of deaths per bed. Nursing home residents receiving CPR are quite old, have multiple illnesses, and are impaired.