bluuebunny/crossref_metadata_2025_split huggingface dataset:
HEALTH SCREENING: I
Authors: Mahmood Khalid , Rasgon Scott , Yeoh Hock H. 
Published: October 2007

L. G. is a 37‐year‐old black female, first seen in the Nephrology Clinic in May 1987 with a serum creatinine of 3.7 mg/dl. Ultrasound studies revealed bilaterally contracted kidneys. Over the next 18 months, the patient's renal function continued to deteriorate and she was started on hemodialysis. She stayed on hemodialysis for about one year but finally changed to continuous ambulatory peritoneal dialysis (CAPD) because of multiple vascular access problems. Over the next two and a half years the patient did well on CAPD. Then on a routine breast self‐examination, she discovered a firm, approximately 1.5 cm mass below the right nipple. A mammogram was done which revealed the lesion to be suspicious for malignancy. Biopsy of the lesion revealed a poorly differentiated mammary carcinoma. The patient subsequently underwent a right mastectomy without complication. Past medical history includes cholecystectomy which was done about seven years previously, and an abnormal Tiberoxime Stress Test, but a normal coronary angiogram done as part of her renal transplant evaluation. About four years ago, the patient complained of swelling in the right breast. She was seen by a surgeon and had a mammogram performed which was normal. She had a follow‐up mammogram in 1991 which was again normal.
INTRADIALYTIC CARDIAC ARRHYTHMIAS: I
Authors: Bailey Robert A. , Kaplan Andre A. 
Published: October 2007

An 87‐year‐old white male with adult onset diabetes mellitus and progressive renal insufficiency was admitted because of dyspnea. Admission workup revealed a blood urea nitrogen (SUN) of 133 mg/dl, a creatinine of 5.6 mg/dl, a potassium of 5.0 mEq/l, and echocardiographic evidence of a pericardial effusion. The pericardial effusion was not hemodynamically significant, with no pulsus paradoxus and no evidence of right atrial or right ventricular collapse on echocardiogram. Of significance was a past medical history of third degree heart block managed by the placement of a sequential atrial‐ventricular (DDD) cardiac pacemaker. On admission his pacemaker was A‐V sequential pacing at a rate of 80 bpm. Hemodialysis was initiated without heparin, and transmembrane pressure was minimized so as not to precipitate cardiac tamponade. No net ultrafiltration occurred during the dialysis. Two hours after the initiation of hemodialysis, hypotension and an irregular tachycardia occurred. The hypotension was not volume responsive. Echocardiogram and rhythm strip showed atrial fibrillation with irregularly irregular ventricular pacing. Cardiology consultation was requested to further evaluate the pacemaker status. The pacemaker was emergently converted to a VVI mode of 90 bpm. The patient subsequently became normotensive and hemodynamically stable. He was also given a loading dose of 1000 mg of procainamide and a continuous infusion of procainamide was initiated at 1 mg/min. Organized atrial activity was restored within 15 min. No further atrial arrhythmias were noted during subsequent hemodialyses.
INTRADIALMIC CARDlAC ARRHYTHMIAS: II
Authors: Kant K Shashi 
Published: October 2007

M.F., a 62‐year‐old black female, began hemodialysis on August 4, 1990. End‐stage renal disease (ESRD) was caused by diabetic glomerulosclerosis proved by renal biopsy. Past history was remarkable for insulin‐requiring Type II diabetes mellitus for more than 20 years and hypertension of approximately the same duration. The patient had documented coronary artery disease for at least five years, having culminated in two non‐Q wave myocardial infarcts, one year and three years prior to initiating dialysis. Cardiac systolic function was decreased with lefi ventricular ejection fraction being 45% when determined in fate 1989. Functional capacity gradually deteriorated to Class III on the New York Heart Association (NYHA) scale just prior to the initiation of dialysis. For the first two months after hemodialysis was begun, the patient gradually improved. Ultrafiltration decreased the patient's blood pressure and use of antihypertensive medication. On September 24, 1990, towards the end of a routine dialysis, the patient became hypotensive and had a cardiac arrest. The first rhythm strip showed ventricular tachycardia that quickly degenerated into fibrillation. She responded to defibrillation by electrical counter shock and was admitted to the coronary core unit (CCU). The subsequent hospital course ruled out a new ischemic event. Subsequent dialysis in the CCU with the patient being monitored showed the development of multifocal premature ventricular contractions (PVC) in the second hour of dialysis. These were subsequently quantitated at >300/hr. Medications at the time of arrest included Isordil 20 mg thrice daily, digoxin.125 mg thrice weekly, nifedipine XL 60 mg a day, multivitamins, ferrous sufate, and calcium citrate. At the conclusion of the aforementioned dialysis a renal profile and a set of blood gases were obtained. Serum K+ was 2.8 mEq/l, blood pH 7.48 with unremarkable paO2 and paCO2 values. A serum digoxin level at admission was 1.8 mg/ml. Serum calcium was normal. Digoxin was discontinued and the dialysate potassium level increased to 3.0 mEq/l. The patient was continuously monitored during the next several dialyses. The number of PVCs decreased but were still greater than 150/hr. They were most frequent immediately after dialysis and gradually decreased in number to 30/hr prior to the next dialysis. At this point, a serum magnesium was checked before and after dialyses and found to be 2.5 and 1.0 mg/dl respectively. Dialysate magnesium was increased from 0.75 to 1.25 mg/dl with almost complete resolution of the PVCs postdialysis. Since discharge from the hospital, the patient has done well and no further hemodynamic problems have been documented on dialysis.
Which anesthetic should be used in the treatment of refractory status epilepticus?
Authors: Rossetti Andrea O. 
Published: October 2007

Summary While the treatment of refractory status epilepticus (SE) relies on the use of anesthetic agents, mostly barbiturates, propofol, or midazolam, the study of the available literature discloses that the evidence level is low. Therapeutic coma induction appears straightforward for generalized convulsive or subtle SE, but this approach is debated for complex partial SE. Each anesthetic has its own advocates, and specific advantages and risks; furthermore, several different protocols have been reported regarding the duration and depth of sedation. However, it seems that the biological background of the patient (especially the etiology) remains the main prognostic determinant in SE. There is a clear need of controlled trials regarding this topic
Neuroprotection in epilepsy
Authors: Walker Matthew 
Published: October 2007

Summary Neuroprotection following status epilepticus should encompass not only the prevention of neuronal death, but also preservation of neuronal and network function. This is critical because these aims are not necessarily equivalent; prevention of neuronal loss, for example, does not inevitably prevent epileptogenesis. There are endogenous neuroprotective mechanisms that can serve dichotomous roles (e.g. ERK1/2 activation can result in either neuroprotection or promote neuronal death). The roles of potential endogenous mechanisms can depend upon the pattern and timing of their activation. The simplest exogenous neuroprotective mechanism is to halt seizure activity. Other approaches consist of early NMDA receptor antagonism or later inhibition of apoptotic pathways. The problem with the latter approach is that calcium accumulation results in the activation of a number of downstream pathways, the importance of which varies from region to region and in a cell‐type specific manner. Neuroprotection in epilepsy is not a straightforward concept, and we need to be clear about our eventual objectives (e.g. preventing cognitive decline). There are numerous possible approaches to neuroprotection, and the efficacy of these depends upon their timing, the specific aims and even the method of status epilepticus induction.
What is animal experimentation telling us about new drug treatments of status epilepticus?
Authors: Nehlig Astrid 
Published: October 2007

Summary Basic research is mostly focused on the consequences of status epilepticus (SE) in terms of neuronal loss, behavior, epileptogenesis or disease‐modifying effects such as preventing epilepsy or reducing seizure severity. Among the drugs tested, several were able to trigger neuroprotection but only a few had disease‐modifying effects. At this point, many data are still missing, namely which drugs could efficiently stop SE or which mechanisms of action should be searched for to prevent the harmful consequences of SE.
Cognitive outcome of status epilepticus in adults
Authors: Helmstaedter Christoph 
Published: October 2007

Summary There is no doubt that structural morphological brain lesions and malformations in epilepsy represent major etiological factors for the cognitive impairments seen in this disease. The role of epileptic activity and seizures for cognition and cognitive development, however, is less easily determined. Epileptic dysfunction ranges from interictal and periictal activity over self‐terminating seizures to non‐convulsive and convulsive status epilepticus, which appear the most severe conditions along this continuum. The decisive question in this regard is as to whether cognitive impairments observed in the acute epileptic condition are reversible or not. Impairments from interictal or postictal epileptic dysfunction are reversible and may interfere at most with brain maturation and cognitive development in the young patient. Seizures and ictal dysfunction in contrast, even when reversible, can leave a permanent trace which extends the phase of postictal recovery. As for status epilepticus and subsequent cognitive decline it often remains open whether the epileptic condition itself or the underlying clinical condition is causative for the aftermath. While there is evidence for both possibilities, group data from neuropsychological cross sectional and longitudinal studies indicate that more severe mental impairments, which in turn indicate more severe clinical conditions, appear to be a risk factor for sustaining status epilepticus, rather than that status epilepticus causes the cognitive decline. Reviewing the literature the cognitive condition in patients with status epilepticus varies with the type of epilepsy, the etiology of epilepsy, severity of the status, and the age of the patient.
Delivering Effective Primary Care to Older Adults: A Randomized, Controlled Trial of the Senior Resource Team at Group Health Cooperative
Authors: Phelan Elizabeth A. , Balderson Benjamin , Levine Martin , Erro Janet H. , Jordan Luesa , Grothaus Lou , Sandhu Nirmala , Perrault Patrick J. , LoGerfo James P. , Wagner Edward H. 
Published: October 2007

OBJECTIVES: To assess the effect of a team of geriatrics specialists on the practice style of primary care providers (PCPs) and the functioning of their patients aged 75 and older.DESIGN: Randomized, controlled trial.SETTING: Two primary care clinics in the Seattle, Washington, area.PARTICIPANTS: Thirty‐one PCPs and 874 patients aged 75 and older.INTERVENTION: An interdisciplinary team of geriatrics specialists worked with patients and providers to enhance the geriatric focus of care.MEASUREMENTS: Main outcomes were a practice style reflecting a geriatric orientation and patient scores on the physical and affect subscales of the Arthritis Impact Measurement Scale 2—Short Form. Secondary outcomes were hospitalizations, incident disability in activities of daily living (ADLs), and PCP perceptions of the intervention. Death rates were also assessed.RESULTS: Intervention providers screened significantly more for geriatric syndromes at 12 months, but this finding did not persist at 24 months. There were no significant differences in adequate hypertension control or high‐risk prescribing at 12 or 24 months of follow‐up. There were no significant differences in patient functioning or significant differences in hospitalization rates at either time point. Meaningful differences were observed in ADL disability at 12 but not 24 months. PCPs viewed the intervention favorably. Seventy‐eight participants died over the 24 months of follow‐up; the proportion dying was higher in the intervention group (11.4% in intervention group vs 7.1% of controls, P=.03).CONCLUSION: The addition of an interdisciplinary geriatric team was acceptable to PCPs and had some effect on care of geriatric conditions but little effect on patient function or the use of inpatient care and was associated with greater mortality.
Serum Calcium and Cognitive Function in Old Age
Authors: Schram Miranda T. , Trompet Stella , Kamper Adriaan M. , De Craen Anton J. M. , Hofman Albert , Euser Sjoerd M. , Breteler Monique M. B. , Westendorp Rudi G. J. 
Published: October 2007

OBJECTIVES: To determine whether serum calcium is associated with cognitive function in elderly individuals in the general population.DESIGN: Prospective follow‐up study of two independent, population‐based cohorts.SETTING: The Rotterdam Study (median follow‐up 11 years) and the Leiden 85‐plus Study (median follow‐up 5 years).PARTICIPANTS: Three thousand nine hundred ninety‐four individuals, mean age 71, from the Rotterdam Study and 560 individuals, all aged 85, from the Leiden 85‐plus Study.MEASUREMENTS: Global cognitive function was assessed in both cohorts using the Mini‐Mental State Examination; attention, psychomotor speed, and memory function were assessed in the Leiden 85‐plus Study only. Linear regression and linear mixed models were used for statistical analyses.RESULTS: In the Rotterdam Study, high serum calcium was associated with worse global cognitive function at baseline (P<.05) and a faster rate of decline in cognitive function during follow‐up (P=.005) in individuals aged 75 and older but not in younger individuals. In the Leiden 85‐plus Study, high serum calcium was associated with worse global cognitive function from age 85 through 90 (P<.001). This observation also held for the specific cognitive domains tested (all P<.01). These results did not change when individuals with serum calcium levels greater than normal (>2.55 mmol/L) were excluded from the analyses.CONCLUSION: In the general population, high serum calcium levels are associated with faster decline in cognitive function over the age of 75.
Increasing Influenza Immunization for Long‐Term Care Facility Staff Using Quality Improvement
Authors: Sand Kelly L. , Lynn Joanne , Bardenheier Barbara , Seow Hsien , Nace David A. 
Published: October 2007

OBJECTIVES: To improve staff immunization rates for influenza in long‐term care facilities (LTCFs).DESIGN: A quality improvement project.SETTING: LTCFs ranging in size from 50 to 2,000 beds.PARTICIPANTS: Staff members at facilities.MEASUREMENTS: Change in staff influenza immunization rate.RESULTS: Of the 13 nursing homes involved, 11 improved their staff influenza immunization rates; nine improved more than 10%, and six improved to a rate greater than 55%, a level that corresponds to substantial protection against outbreaks. Staff education was essential but insufficient. Direct encouragement and dramatic informative endeavors helped, as did financial incentives, competitions, and requiring unambiguously worded consents for refusals. Paying staff members $150 each achieved improvement rapidly.CONCLUSION: Quality improvement increased staff immunization rates at LTCFs, which reduces the risk of an influenza outbreak. Based on the insights learned about effective changes, the project developed a change package for use by other LTCFs.
Physical Activity in Middle‐Aged Adults Reduces Risks of Functional Impairment Independent of Its Effect on Weight
Authors: Lang Iain A. , Guralnik Jack M. , Melzer David 
Published: October 2007

OBJECTIVES: To assess the association between physical activity and subsequent physical functioning in middle‐aged adults across a range of body mass index (BMI) categories.DESIGN: Prospective nationally representative cohort studies.SETTING: The United States and England.PARTICIPANTS: Eight thousand seven hundred two individuals in the United States and 1,507 in England aged 50 to 69 and free of impairment at baseline, followed up for 6 years.MEASUREMENTS: Self‐reported and measured BMI and self‐reported level of physical activity. Outcome measures were score on a physical performance battery and self‐reported mobility impairment.RESULTS: In both studies, being overweight and being obese were associated with greater risk of impairment (than being of recommended weight). In all weight categories and both countries, higher levels of physical activity were associated with lower risks of mobility impairment. For example, U.S. respondents of recommended weight (BMI 20–25) who were active on 3 or more days per week had a relative risk (RR) of incident mobility difficulties, compared with those who were less active, of 0.56 (95% confidence interval (CI)=0.40–0.78); for those who were obese (BMI ≥30) the corresponding RR was 0.59 (95% CI=0.45–0.76).CONCLUSION: Excess bodyweight is a risk factor for impaired physical function in middle‐aged and older people. Physical activity is protective of impaired physical functioning in this age group in subjects with recommended weight, overweight, and obesity. Older adults should be encouraged to engage in appropriate levels of physical activity irrespective of their weight.
Pilot Test of an Attribution Retraining Intervention to Raise Walking Levels in Sedentary Older Adults
Authors: Sarkisian Catherine A. , Prohaska Thomas R. , Davis Connie , Weiner Bernard 
Published: October 2007

OBJECTIVES: To pilot test a new behavioral intervention to increase walking in sedentary older adults.DESIGN: Pre–post community‐based pilot study.SETTING: Three senior centers in greater Los Angeles.PARTICIPANTS: Forty‐six sedentary adults aged 65 and older.INTERVENTION: At four weekly 1‐hour group sessions held at the senior centers, a trained health educator applied a theoretically grounded, standardized “attribution retraining” curriculum developed by a multidisciplinary team of investigators. Participants were taught that becoming sedentary is not inevitable with aging and that older adults should attribute being sedentary to modifiable attributes rather than to old age. A 1‐hour exercise class including strength, endurance, and flexibility training followed each weekly attribution retraining session.MEASUREMENTS: Change from baseline in steps per week recorded using a digital pedometer was measured after 7 weeks. Age expectations (measured using the Expectations Regarding Aging‐38 survey, a previously tested instrument on which higher scores indicate that the participant expects high functioning with aging and lower scores indicate that the participant expects physical and mental decline) and health‐related quality of life were measured using in‐person interviews.RESULTS: Mean steps per week increased from 24,749 to 30,707, a 24% increase—equivalent to 2.5 miles (2‐sided t‐test P=.002). Age expectation scores increased 30% (P<.001), and the changes in age expectations and steps per week correlated (correlation coefficient=0.39, P=.01). Participants experienced improved mental health–related quality of life (P=.049) and reported less difficulty with activities of daily living (P=.04). More than 50% of participants reported improvements in pain, energy level, and sleep quality.CONCLUSION: In this small pre–post community‐based pilot study, a structured attribution retraining curriculum accompanied by a weekly exercise class was associated with increased walking levels and improved quality of life in sedentary older adults. Attribution retraining deserves further investigation as a potential means of increasing physical activity in sedentary older adults.
Functional Impact of Relative Versus Absolute Sarcopenia in Healthy Older Women
Authors: Estrada Marcos , Kleppinger Alison , Judge James O. , Walsh Stephen J. , Kuchel George A. 
Published: October 2007

OBJECTIVES: To determine whether adjustment of muscle mass for height2 or for body mass represents a more‐relevant predictor of physical performance.DESIGN: Cross‐sectional study, using baseline data from a trial comparing upper‐ and lower‐body training.SETTING: Women recruited from the community and gynecological practices in Connecticut.PARTICIPANTS: One hundred eighty‐nine healthy older (aged 67.5 ± 4.8), active women receiving estrogen for osteoporosis over 2 years.MEASUREMENTS: Total and appendicular skeletal muscle (ASM) and fat mass (AFM) were determined using dual x‐ray absorptiometry. Physical performance, muscle strength, and fitness measures were obtained at baseline.RESULTS: Adjusting ASM for height2 identifies lean women who are sarcopenic according to published standards yet fails to identify overweight and obese women whose ASM adjusted for body mass is low. ASM divided by body mass (ASM/body mass) is a stronger physical performance predictor, explaining 32.5%, 13.5%, 11.6%, 6.3%, and 6.8% of the variance in maximum time on treadmill, 6‐minute walk, gait speed, 8‐foot walk, and single leg stance, respectively, whereas ASM divided by height in m2 (ASM/height2) explained only 2.9%, 0.2%, 2.0%, 0.04%, and 0.1%. Multivariate modeling demonstrated considerable overlap in aspects of ASM/body mass and AFM/body mass associated with performance, with ASM/body mass dominant. In contrast, ASM/height2 is a much stronger predictor of leg press 1 repetition maximum and maximum power.CONCLUSION: The results suggest that relative sarcopenia with ASM adjusted for body mass is a better mobility predictor, with absolute sarcopenia a better indicator of isolated muscle group function in healthy postmenopausal women receiving estrogen replacement.
Hypodermoclysis to Treat Dehydration: A Review of the Evidence
Authors: Remington Ruth , Hultman Todd 
Published: October 2007

Dehydration is a serious acute condition in older adults associated with significant morbidity and mortality. Hypodermoclysis (HDC; the infusion of fluids into the subcutaneous tissue) can provide an alternative to intravenous (IV) rehydration of older adults.This article reviews the relevant literature on the use of HDC to treat mild to moderate dehydration in older adults. A comprehensive search of the literature was conducted to identify research reports on the use of HDC to treat dehydration in older adults. Articles published in English during the previous 10 years were reviewed to reflect current standards of practice. One systematic review; two randomized, controlled trials; and six cohort studies were identified and appraised. Only one study was conducted in the United States; the remainder were conducted in Europe, Asia, and Canada. The evidence indicated that HDC is as effective as IV rehydration of older adults with mild to moderate dehydration. The literature cites advantages of HDC over IV hydration, including the same number of or fewer complications, cost savings, greater patient comfort, and less nursing time to start and maintain the infusion. It remains unclear from the literature why HDC is used infrequently in the United States.