bluuebunny/crossref_metadata_2025_split huggingface dataset:
Issues and problems in Alzheimer's disease registry development
Authors: Sayetta Rona Beth 
Published: June 2007

The case registry is a system for recording, storing, and updating standardized information about all individuals who acquire a particular disease or class of disorders from a specified date onwards. It may contain personal, familial, social, clinical, and genetic information. To be most informative, cases should be culled from a precisely defined geographical or administrative area. Registries produce cumulative, chronologically oriented records about people for epidemiologic and other research as well as statistics for health services planning. The historical development of case registers for cancer, congenital defects, psychiatric conditions, and other disorders has illustrated the diverse, often multipurpose functions that they may serve. Registries are, or can be, populationbased sampling frames for both retrospective and longitudinal studies, and statistical databases. Creating a registry involves addressing six common problems and issues: 1) defining objectives; 2) determining scope of coverage of populations and conditions; 3) ascertaining cases reliably and validating diagnoses; 4) choosing accurate, efficient data collection methods; 5) maintaining confidentiality of patient records and family privacy; 6) bearing the (growing) financial burden. Sites are unique, so solutions must be individualized. Registry operations are complex, expensive, and long-term. The key to their success does not lie in technical and statistical details alone, but in an essential spirit of cooperation and commitment among all participants.
A new approach for physical therapists in the long term care of Alzheimer patients
Authors: Ebel Susan 
Published: June 2007

Throughout the progressive stages of dementia, there is a need for an interdisciplinary team approach in the long term care of Alzheimer patients. This article describes the need for a shift in our therapeutic strategies and will address ways in which the physical therapist can positively impact Alzheimer patient care and reduce caregiver burden, whether the patient is at home or in an institution. This can be accomplished in part by: • Designing a daily exercise program; • Making modifications to the environment to decrease sensory stress andfacilitate autonomy; • Designing appropriate cues to help the patient with activities of daily living; • Evaluating home safety, equipment needs and falls prevention; and finally • Teaching safe transfers and bed-bound care.
Effects of a three-year exercise therapy program on cognitive functioning of elderly personal care home residents
Authors: Lindenmuth G. Frank , Lindenmuth Elise B. 
Published: June 2007

The purpose of this study was to examine the effects of the Intense Exercise Therapy (IET) on the cognitive levels offunctioning of elderly persons monitored for three years. The study was based on the premise that daily group exercise enhances physiological as well as psychological processes and consequently may improve cognitive abilities for elderly persons. The study hypothesized that the cognitive functioning level of elderly persons participating in the IET would be significantly higher than the level of those persons in the no treatment control group. A previous study by Lindenmuth and Moose' indicated a positive effect of exercise therapy on cognitive functioning for Alzheimer patients. The sample consisted of 82 elderly (64-98 years old) residents of eight separate personal care facilities in Pennsylvania. Residents who volunteered attended by choice either group exercise therapy or a no treatment control group. A pretest, posttest experimental design was utilized in an attempt to control extraneous variables. Pretreatment, during treatment, and posttreatment measures were collected on the Cognitive Abilities Screening Test (CAST). After participating in the IET, elderly persons were found to have significantly higher (2 < .001) cognitivefunctioning levels. Thesefindings lead to the conclusion that effects of the IETincluded an improvement in cognitive levels offunctioningfor the elderly participants in the treatment group. In addition, elderly persons in the control group showed Alzheimer-like symptoms and demonstrated CAST scores indicative of moderate impairment and organic brain disease. The implication is that a strategy such as the IET used by personal care homes and other institutions caring for the elderly would be of benefit in assisting elderly residents to maintain and improve cognitive levels. The IET is especially practical due to ease of use, low cost, and brevity of actual exercise sessions.
The concepts and benefits of dementia specific programming within an assisted living setting
Authors: Forbes Celeste S. 
Published: June 2007

This paper focuses on the concepts, specifics and effects of dementia programming within an assisted living setting. The target population consists of 20 people, 60 years of age and older, who reside at Kensington Cottages, Rochester, Minnesota, a residential assisted living facility for people with Alzheimer's disease and other forms of dementia. The residents at Kensington Cottages are unable to live independently and require assistance with their daily cares in varying degrees. They also need to be provided with homemaker services and recreational stimulation. This 24-hour assistance is provided by staff caregivers; these residents do not require the degree of skilled nursing supplied in a nursing home. The paper begins with an analysis of the concept of dementia programming. This concept is then applied to the specifics of the program which is presently being used at Kensington Cottages Rochester The effects of dementia specific programming are shown through case studies of two Kensington Cottages residents diagnosed with Alzheimer's disease. These case studies demonstrate the positive effects of dementia programming on individuals through program involvement, the results of which are analyzed through the eyes of family members. Further information is derived from a January 1996, Kensington Cottages Corporation survey of Kensington Cottages Rochester family members which elicits information concerning the general well being of their relatives with dementia.
Neuropsychological correlates of wandering in persons with Alzheimer's disease
Authors: Edgerly Elizabeth S. , Donovick Peter J. 
Published: June 2007

Dementia is a common disorder affecting an estimated 20 to 47 percent of persons over the age of 85.1 In addition No the pervasive cognitive deficits found in dementia, various behavioral disturbances are common.2 Wandering is one of the most troubling behaviors associate with dementia and has been found to lead to institutionalization and increased risk for injury. It continues to Tee common practice for wanderers to be physically or chemically restrained in order to prevent them from leavings home. This practice leads to extreme limitations on nobility and freedom for the client as well as extra demands on caregivers. To develop less restrictive and efficient interventions it is essential to understand how to assess, predict, and alter wandering patterns.4 We examined the relationship between cognitive impairments and wandering. Neuropsychological tests were administered to 29 residents of two special care units. Exiting attempts, the level of activity, and staff ratings of wandering were correlated with measures of global impairments (as measured by the Mini Mental State Examination) as well as focal deficits (assessed by the Token Test, the Benton Visual Retention Test-revised, the nine item dementia form of the California Test of Verbal Learning, and the Information Subtest of the WAIS-R). The Mini Mental State Examination was the best predictor of staff ratings of wandering. Poor performance on the CVLT-AD best predicted the level of activity. Exiting did not significantly correlate to staff ratings of wandering or cognitive deficits. Data were analyzed also by means of a principal components analysis and entered into a multiple regression equation. Neuropsychological tests loaded heavily on one factor relating to global deterioration which was predictive of staff ratings of wandering as well as behavioral observations of activity. Exit-seeking behavior was not associated with this index of the severity of dementia.
What decisions are made by family caregivers?
Authors: Wackerbarth Sarah 
Published: June 2007

Before decision support can be offered, we need to understand what decisions family caregivers face, which are considered challenging, and what causes the challenge. To address these issues, 100 caregivers were asked to: • Indicate decisions faced; • Describe challenging decisions; and • Describe specific decision making questions. Eighty surveys (80 percent) were returned and used in the analysis. The most prevalent decisions involved nursing home placement, communicating the diagnosis, and driving. The most challenging decisions involved providing care and relocation. The most prevalent question involved the timing of actions. These results will guide the design of decision aids for family caregivers.
Transcutaneous Oximetry, Laser Doppler Fluxmetry, and Capillary Microscopy: Variability in Patients with Advanced Atherosclerotic Disease of the Lower Extremity
Authors: Klomp Houke M. , Wittens Cees H. A. , van Urk Hero 
Published: June 2007

Purpose. Noninvasive methods of studying the microcirculation have been advocated in patients with advanced peripheral vascular disease to assess skin viability. Good reliability is a prerequisite for such parameters. This study was carried out to evaluate the variability of three methods: transcutaneous oxygen tension measurement (tc.pO9, diode laser Doppler fluxmetry (dLDF), and capillary microscopy (CM). Methods. Repeated measurements were performed in 20 patients with restpain or severe disabling intermittent claudication (ankle/brachial pressure index <0.5). Tc.pO2 was performed on the dorsum of the foot and measured under baseline conditions, during 4 minutes of O2-inhalation, and during reperfusion after 3 minutes of tourniquet occlusion. dLDF was performed on the palmar skin of the hallux, at rest, and during reperfusion after 3 minutes of tourniquet occlusion. CM was performed at the nailfold of the hallux; capillary density, morphologic changes of the capillaries, and perfusion with fluorescein were studied. Results. Increased tc.pO2 rates during the oxygen inhalation and reperfusion tests are well-reproducible and show discriminative power. Resting tc.pO2 seems less valuable. Some dLDF parameters are highly reproducible, but only resting flux and the flux increase rate during reperfusion demonstrate discriminative power. CM is highly reproducible as performed by one observer. The capillary morphology score allows for severity grading. Conclusion. Controversies on interpretation and cutoff values of microcirculatory parameters could well be associated with the variability of some of the parameters. Only parameters with adequate reproducibility and discriminatory power can be used to evaluate intervention procedures or to determine amputation levels.
Distal Aortic Perfusion and Theophylline in the Augmentation of Postischemic Renal Blood Flow
Authors: Wilcox Gwen M. , Harlin Stuart A. , Miller Michael L. , Newton William D. , Peyton Brian D. , Lane Alexis G. 
Published: June 2007

This study was designed to determine the efficacy of pulsatile versus nonpulsatile perfusion in augmenting renal blood flow following renal ischemia. Theophylline was added to assess the additive effect on postischemic renal blood flow. A porcine model was divided into six experimental groups encompassing a total of 48 pigs. Each group underwent cross clamping of the suprarenal aorta for 60 minutes. The control group underwent cross clamping of the suprarenal aorta without femoral cannulation and half of this group received theophylline. The remaining four groups underwent cross clamping of the suprarenal aorta and were placed on pulsatile or nonpulsatile distal perfusion with or without theophylline. Theophylline (2 mg/kg) was administered 30 minutes before the cross clamping of the suprarenal aorta. Renal blood flow was measured by utilizing a flow probe placed on the renal artery and data were recorded for 20 minutes. Baseline recordings were taken as well as recordings during cross clamp and immediately postclamp. Renal ischemia was measured by using serum urea nitrogen, serum creatinine, and urine alpha glutathione-S-transferase (alpha-GST). Postclamp renal blood flow measurements were standardized as a percentage of preclamp renal blood flow. Treatment with either distal perfusion or distal perfusion with theophylline demonstrated increased renal blood flow in comparison to the controls (p < 0.001). Pulsatile perfusion with theophylline was superior to pulsatile perfusion alone (p < 0.023). Pulsatile perfusion with theophylline was superior to nonpulsatile perfusion with theophylline (p < 0.030). Creatinine 6 hours postoperative showed a significant decrease with both forms of distal aortic perfusion when compared to the control groups (p = 0.002). Creatinine values at 18 hours postoperative were not significant (p = 0.237). Serum urea nitrogen values at 6 (p = 0.239) and 18 (p = 0.460) hours postoperative were not significant. Alpha-GST values at 6 (p = 0.034) and 18 (p = 0.035) hours postoperative showed a significant difference between the control and treatment groups. Pulsatile distal aortic perfusion with theophylline is superior to nonpulsatile distal aortic perfusion with theophylline in augmenting renal blood flow following renal ischemia in the porcine model.
Conservative Management of Popliteal Aneurysm: Is There a Role for Selective Observation?
Authors: Ginzburg Enrique , Cheanvechai Vasana , Parra-Davila Eduardo 
Published: June 2007

Popliteal artery aneurysm (PAA) is the most common peripheral aneurysm, comprising 70% of these lesions. More than two thirds of these patients have bilateral aneurysms and the most common etiology is atherosclerosis. Elderly men in their sixth and seventh decade of life constitute over 90% of these patients, and up to 55% will have an aneurysm in other portions of the vascular tree. Only 3% to 5% of these aneurysms are found in women. The abdominal aorta will be involved in 30% to 75% of cases and, therefore, dictate a full work-up when a PAA is found. The authors report a case of an 80-year-old man with a chief complaint of intermittent calf pain that occurred without any pattern of distance. This atypical pattern of claudication had been recurring for more than three months. The patient underwent a duplex ultrasound that showed a dilation of his arteries measuring 1.7 cm and 2.3 cm on the right and left sides, respectively. Further work-up with a magnetic resonance image demonstrated a 4 cm x 3 cm left PAA with thrombus and a smaller aneurysm on the right side. An angiogram demonstrated single peritoneal artery runoff on the left side and posterior tibial artery runoff on the right side. The patient was cleared for surgery with an ejection fraction of 40%; however, he refused to undergo reconstruction. The patient ehas been followed up for the past four years without change in his symptomatology and repeated ultrasounds have not shown any significant size change.
Internal Thoracic Artery Flow in Diabetic Patients
Authors: Aranki Sary F. , Rizzo Robert J. , Adams David H. , Couper Gregory S. , Kinchla Nancy M. , Collins John J. , Cohn Lawrence H. 
Published: June 2007

Patients with diabetes mellitus have an increased frequency of atherosclerotic coronary artery disease, plus abnormalities of vascular tone that could be contributed to autonomic, platelet, and endothelial dysfunction. The purpose of this prospective study was to compare the internal thoracic artery (ITA) flow of diabetic and nondiabetic patients, to determine whether any pathophysiologic changes occur that have any bearing on vascular tone and the adequacy of flow of the ITA. In a consecutive group of patients undergoing coronary artery bypass graft (CABG) surgery, 117 patients (group I) were nondiabetic (ND), 18 patients (group II) were noninsulin dependent (NIDDM), and 20 patients (group III) were insulin dependent (IDDM) diabetics. The ITA was mobilized, and following systemic heparinization it was divided and trimmed for the subsequent anastomoses. The first ITA flow measurement was recorded (flow 1). This was followed by an intraluminal injection of 2 mL of dilute papaverine solution (30 mg in 20 mL N/saline), which was enclosed in the artery for fifteen minutes by applying a soft clamp to the distal end. At the end of this period, a second flow measurement was taken (flow 2). Percent increase in flow and flow reserve (flow 2/flow 1) were recorded for each patient. The median values for flow 1 were 48, 46, and 58 mL/minute for groups I, II, and III respectively. For flow 2 the values were 132, 118, and 126 for groups I, II, and III, respectively, with a median percent increase in flow being 138% (47-380%), 179% (100-380%), and 115% (35-470%) for groups I, II, and III respectively (P < 0.0001). ITA flow reserve was similar among the three groups and was 2.4, 2.8, and 2.2 for groups I, II, and III respectively. The ITA exhibits the same degree of initial spasm, similar relaxation to intraluminal papaverine, and similar flow reserve. No physiologic abnormalities of ITA flow and reactivity are specific to diabetes. The ITA should be used with the same indications or contraindications as in nondiabetic patients.
Peripheral Atherosclerotic Disease: Aging and Risk Factors
Authors: Fabris Fabrizio , Zanocchi Mauro , Bo Mario , Poli Leone , Fonte Gianfranco 
Published: June 2007

The aim of this study was to assess the prevalence of peripheral atherosclerotic disease (PAD) and its relation to principal cardiovascular risk factors, at different ages, in a sample of the general population. Ultrasonographic methods (continuous wave Doppler and high-resolution B-mode Doppler) were used to evaluate the ankle-to-arm ratio and to investigate the femoral district in 457 free-living subjects (231 men and 226 women, mean age 55.4 ±18.7 years) resident in the metropolitan area of Turin. PAD, detected by ankle-to-arm ratio, was observed in 148 subjects (32.4%). Femoral plaques were found in 180 subjects (39.4%). The overall prevalence of atherosclerosis, number of plaques, and percentage of stenosis were observed to increase with age (P < 0.0001). In the multiple logistic regression model, analysis of subjects under sixty-five years of age showed independent associations between femoral atherosclerosis and age (P < 0.0001), LDL cholesterol (P < 0.01), cigarette smoking (P < 0.05), and years of exposure to smoking (P < 0.05); analysis of subjects over sixty-five years of age showed positive and independent associations only with age (P < 0.001), male gender (P < 0.01), and cigarette smoking (P < 0.05). The authors conclude that there is a high prevalence of asymptomatic lower limb atherosclerosis in the general population, particularly among the very old. The association between risk factors and femoral atherosclerosis is less pronounced in the elderly than in younger subjects.
Magnetic Resonance Angiography and Duplex Scanning Concordance in Detecting Severe Carotid Stenosis
Authors: Reed James F. , McCullough Sean , Wasser Thomas 
Published: June 2007

In this meta-analysis, the authors examine published studies on the consistency (homogeneity) of study outcomes of magnetic resonance angiography (MRA), conventional angiography (XRA), and duplex ultrasound (DU) scanning in assessment of the degree of carotid artery disease. The sensitivity, specificity, and accuracy of the MRA as a noninvasive diagnostic test are exceptional. Given an adequate two-dimensional time-of-flight (2D-TOF) study, it provides a robust test for the evaluation of carotid stenosis. The authors conclude from this meta-analysis that MRA is at least as accurate as DU in a selected group of patients. The question of superiority for all patients with suspected carotid artery disease is not, however, answered by this meta-analysis. Another question not answered is the question of DU/MRA-XRA concordance/discordance. If DU and MRA were concordant across all, rather than a selected group of patients, would the clinical decision tree be in favor of elimination of XRA? The cost for a DU scan is approximately one third of the cost of an MRA and, from an economic point of view, one could not argue the use of MRA over DU. However, as MRA technology and accuracy improve and when the cost of MRA approaches that of DU, MRA may replace DU as a screening method. Clearly, a consecutive series of all patients suspected of having carotid artery disease needs to be evaluated by use of the best available diagnostic technologies. A comprehensive protocol would include an evaluation of the sources of difficulties in conducting these tests.
Continuous Intra-arterial Blood Gas Monitoring in Patients Undergoing Suprarenal Aortic Surgery
Authors: Gordon George , Flaherty Paul , Strafford Maureen , Belkin Michael , O'Donnell Thomas F. , Bojar Robert 
Published: June 2007

The authors used an on-line, real-time, continuous blood gas monitor in 5 patients undergoing elective suprarenal aortic reconstruction. They retrospectively analyzed data to evaluate its utility in acid-base management and in detection of dynamic changes in oxygenation. Seven sets of data were analyzed since 1 patient underwent two additional periods of aortic crossclamping. A similar group of 7 patients undergoing elective suprarenal aortic surgery without continuous blood gas monitoring was analyzed and served as a control group. There was a highly significant mean decrease in partial pressure of oxygen (P02) of 158 mm Hg (P = 0.0060) with unclamping. In 1 patient the P02 dropped from 218 to 63 mm Hg within sixty seconds of unclamping, and this required immediate reinstitution of two-lung ventilation. Continuous availability of pH permitted accurate therapy with bicarbonate infusion during clamping. As a result there was no significant change in pH between preclamp and immediately after unclamping (P = 0.97). In the control group the pH decreased from a mean of 7.38 to a mean of 7.24 (P = 0.0005) between preclamp and after unclamping. In summary, dynamic changes in oxygenation and pH are observed during suprarenal aortic surgery. Continuous blood gas monitoring provided data resulting in improved management of acid-base status and early detection of significant decreases in oxygenation.
Treatment of Unreconstructible Upper Extremity Arterial Occlusive Disease by Spinal Cord Stimulation
Authors: Bartels Claus , Claeys Luc , Ktenidis Kiriakos , Bechtel Matthias , Horsch Svante 
Published: June 2007

Spinal cord stimulation (SCS) of peripheral arterial disease (PAD) of the lower limbs has been shown to be effective for pain reduction, limb salvage, and improvement of blood supply; however, treatment of PAD of the upper extremity by SCS has never been performed. Ten patients with unreconstructible severe PAD of the upper extremity were treated by SCS at the authors' institution. Transcutaneous oxygen tension index (chest TcPo2/hand TcPo2), Doppler wrist pressure index (WPI), capillary microscopy (red blood cell velocity, capillary density), and a patient's pain score graded from 1 to 10 (1 =no pain) were used as follow-up parameters. Pain reduction after SCS was excellent in all patients. TcPo2 index decreased from 1.95 ± 0.87 prior to implantation to 1.5 ± 1.1 at eighteen months. No significant improvement of capillary microscopy parameters or Doppler WPI could be observed. SCS effectively reduced pain and provided limb salvage in patients with severe unreconstructible PAD of the upper extremity; however, reduction of pain was not paralleled by improvement of the studied microcirculatory parameters.