bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevalence of Analgesic and Psychotropic Medication Use by Older People with Chronic Pain
Authors: Kung Francis , Gibson Stephen J. , Helme Robert D. 
Published: December 2008

Objective: The aim of the study was to examine the profile of analgesic and psychotropic medication use in community dwelling older people with chronic pain of non‐malignant origin. Method: Two groups of older people with chronic pain were compared. The first group comprised 193 from a random sample of 1,000 community dwelling older people. The second group comprised 150 consecutive patients from a pain management centre for older people. Results: The overall use prevalence of analgesic and psychotropic medications was similar in the two study groups. However, significant differences in use prevalence of sub categories of analgesic and psychotropic medications were found between the two study groups. The referred patients with neurological and non‐musculoskeletal conditions as the main causes of pain were more likely to use narcotics and anti‐depressants, while the community sample with the majority having musculoskeletal pain was more likely to use non‐steroidal anti‐inflammatory drugs. Conclusion: The differences regarding the use of analgesic and psychotropic medications between the two study groups appear to be associated with different causes of pain.
Pet Ownership is Not Associated with Future Health: a Nine Year Prospective Study in Older Australians
Authors: Simons Leon A. , Simons Judith , McCallum John , Friedlander Yechiel 
Published: December 2008

Objective: To examine the relationship between pet ownership and future health in older Australians. Method: A longitudinal study was conducted over 110 months in Dubbo, New South Wales, in a community‐based sample of subjects 60 years and over (1,235 men and 1,570 women). There was a baseline survey of demographic, psychosocial and cardiovascular risk factors in 1988–89, with follow‐up of all‐causes mortality and hospitalisation. Results were modeled using multiple logistic regression. Results: At baseline, 52% of men and 42% of women owned a pet. In comparison with non‐owners, older people who owned pets were younger and more likely to be married, yet they were less likely to live alone or use blood pressure medication. Among women only, pet owners had a greater peak expiratory flow volume than non‐owners and were less likely to have physical disability. After controlling for the confounding effects of age and other factors likely to influence mortality, there was no significant relationship between pet ownership and all‐causes mortality in either sex (odds ratio [95% confidence interval] in men 1.02 [0.75–137], in women 1.27 [0.93–1.75]). Pet ownership was associated with reduced risk of a hospitalisation in women (odds ratio 0.72 [0.54–0.96]). Conclusions: Pet ownership in older subjects is not associated with all‐causes mortality. Female owners have a slightly reduced risk of hospitalisation.
A Longitudinal Study of Alcohol Consumption and Functional Disability in a Community Sample of Older People
Authors: Dent Owen F. , Grayson David A. , Waite Louise M. , Cullen John S. , Creasey Helen , Bennett Hayley P. , Casey Barney J. , Broe G. Anthony 
Published: December 2008

Objective: To examine the association between alcohol consumption and incident functional disability in community‐living older people after adjustment for other risk factors. Method: Randomly sampled community‐living people aged 75 years and older from the inner western suburbs of Sydney underwent a clinical interview and medical examination by a physician experienced in geriatric medicine. This was repeated three years later. The examination included an assessment of functional disability and chronic systemic and neurodegenerative illnesses and impairments. Self‐reported alcohol consumption was recorded. The relationship between alcohol consumption and incident disability was examined by logistic regression analysis. Results: Cross‐sectional analysis at the first wave showed that those who did not drink were more likely to be disabled than drinkers (39.3% and 30.4% respectively, p = 0.032). Although 11.3% were drinking at hazardous or harmful levels there was no concurrent association between disability and hazardous/harmful drinking. Incident disability between waves did not differ between non‐drinkers at the first wave and those who drank at non‐hazardous/harmful levels (35.3% and 29.3% disabled respectively, p=0.306). However 80% of those who drank at hazardous/harmful levels experienced incident disability as compared with 32.5% among non‐drinkers and non‐hazardous/harmful drinkers combined (p<0.001). Logistic regression showed that, among the risk factors examined, hazardous/harmful consumption had by far the strongest effect with an adjusted odds ratio of 12.9 (95% CI 3.1–53.9). Conclusion: Alcohol consumption at defined hazardous/harmful levels is a major independent risk factor for incident functional disability in older people.
Knowledge, stereotyping and attitudes towards self ageing
Authors: Getting Lindsay , Fethney Judith , McKee Kevin , Churchward Margaret , Goff Marilyn , Matthews Siade 
Published: December 2008

Objectives: The Reactions to Ageing Questionnaire (RAQ) was developed in Australia in order to measure attitudes to personal or self ageing. A two‐country project assessed the relationships between attitudes to self ageing and measures of misconceptions and stereotyping of older people. Method: Researchers in Australia and the United Kingdom administered to nursing samples the Reactions to Ageing Questionnaire, Facts about Aging Quiz and Aging Semantic Differential, along with a page of demographic questions.Results: Results indicated patterns of stereotyping and misconception about older people that were similar across two countries. In the main, views were negative and devalued older people in their personal attributes and capabilities. Significant correlations extended across two countries, indicating that attitudes to self ageing as measured by the RAQ were significantly associated with measures of misconception and stereotyping of older people.Conclusion: It was concluded that urgent attention is required to address negative attitudes and to develop strategies for addressing ageism among nurses.
The involvement of adult children in their parent's decision to move to a retirement village
Authors: Knight Steve C. , Buys Laurie R. 
Published: December 2008

Objective: For a variety of reasons, some older people seek alternative accommodation, with retirement villages being one option. However, deciding to move is a significant decision, and one that often involves family members. The purpose of this research was to investigate the involvement of adult children in the decision to relocate to a retirement village by independent older adults.Method: Thirty older adults, aged 65 years of age and over, living in retirement villages in South East Queensland, were interviewed, as were thirty nominated adult children.Results: The results suggest that whilst adult children play a significant role in the relocation to a retirement village, the decision to move is most likely made independently by the parent.Discussion: The decision to move seems to have been made quite independently by the older parents. However, the results indicate that adult children do have some level of involvement probably in providing support to the older adult.
‘Stops walking to talk’: a simple measure of predicting falls in the frail elderly
Authors: Nitz Jennifer C. , Thompson Karen J. 
Published: December 2008

Objective: To discover if the measure ‘stops walking to talk’ is a useful indicator of falls risk in the frail elderly in residential care.Method: Twelve frail elderly residents of care facilities were assessed for falls likelihood with the Timed Up‐and‐Go (TUG) and the Berg Balance Scale (BBS) tests, and then observed in walking to determine if they needed to stop walking to talk. These results were compared with the number of falls subjects had experienced in the previous six months.Results: Eight subjects were deemed at risk of falling by the TUG and seven by the BBS. Four of these subjects had fallen in the previous six months. Three subjects needed to stop walking to talk on at least one occasion and were deemed at risk of falling by the TUG and BBS. One of these had fallen in the previous six months.Conclusion: This study demonstrated in this group of frail older people that falling in the previous six months was associated with high TUG and low scores on the BBS. Only three observations of ‘stops walking to talk’ were made; this limited the comparisons as only one of these subjects had fallen but all were predicted as falters by the TUG and BBS. A future study with a larger sample size and incorporating memory recall in the conversation should confirm these results.
Vision screening for older people: the barriers and the solutions
Authors: Camicelli Anthony , Keeffe Jill , Martin Kern , Carbone Joe , Balding Cathy , Taylor Hugh 
Published: December 2008

The need for detection of vision impairment in older people has been well established To help achieve such a goal, vision screening should be integrated into the provision of aged care services, health and Community organisations.This study aimed to facilitate access to vision screening for people aged 65 and over in the City of Whitehorse (Melbourne) through aged care, health and community services. In total 147 people within these organisations were trained to use a vision screening kit. However, it was estimated that only 20% of participants used the kit, citing a number of barriers: the major ones being time restraints, conflict with other duties, and wanting an outside organisation to perform resting. Overall out of 510 people, 442 (87%) could be tested and 169 (38%) wre detected with vision impairment. Of these, 40 (24%) were under care and 129 (76%) were referred for further examination.As a result of this study we recommended that vision screening be integrated into a services provision of care to older people and patients as part of a holistic approach to heath.
Women of the baby boom generation and unpaid work ‐What are the indications for the future?
Authors: Merkes Monika , Wells Yvonne 
Published: December 2008

Objectives:Most unpaid work is performed by women. Will Australian women of the baby boom generation continue to provide such work for the benefit of their families and communities? This article examines the indications for changes in the provision of unpaid work in the future, in particular, the potential future contribution of unpaid work performed by women of the baby boom generation.Method:Data from the Healthy Retirement Project were used to assess the views of a large group of women from the baby boom generation (n= 1359) regarding voluntary work in retirement. Focus groups explored in more depth the views of women of the baby boom generation regarding paid and unpaid work after the age of 65.Results:A large proportion of female baby boomers intend to provide unpaid caring and community work after their retirement. Women in the baby boom generation were equally as likely as their predecessors to be volunteers and to be looking forward to having more time for voluntary work in retirement. Women were more likely to anticipate having more time for voluntary work in retirement if they were already involved in voluntary work and in good health.Conclusions:The provision of unpaid work in Australia is likely to increase, as the proportion of older people in the population increases.
The experiences of staff concerning the introduction and impact of a fall prevention intervention in aged care facilities: a qualitative study
Authors: Butler Meg , Kerse Ngaire , Coggan Carolyn 
Published: December 2008

Objective: Falls in aged care facilities are a major public health concern. A pilot study tested the acceptability of a falls risk management intervention.Method: Focus group discussions with care giving staff and falls coordinators and individual interviews with principal nurse managers were taped and transcribed and thematic analysis identified main issues for staff in utilising the intervention.Results: Acceptance of the intervention was high for principal nurse managers and falls coordinators, although the paper work was found to be time consuming. While most caregivers found undertaking fall prevention strategies worthwhile, others found such strategies were irrelevant to them as they “knew” their residents.Conclusions: Among all levels of staff, falls among residents were regarded as stressful events. While the general acceptunce of the intervention programme was high, resistance to changing practices of care by some staff could limit the wider implementation of such a programme. Further research is needed to examine appropriate delivery of educational messages for caregivers, which include multiple cultural understandings.
Challenging patient populations in breast cancer: Taxane resistance and triple‐negative receptor subtype
Authors: OHNO Shinji , FORNIER Monica N 
Published: December 2008

AbstractOver the last decade the introduction of the taxanes and several targeted therapies have led to an improvement in breast cancer morbidity and mortality. However, several groups of patients, including patients with taxane‐resistant, multidrug resistant, and estrogen‐negative, progesterone‐negative, and HER2/neu receptor‐negative tumors, have now emerged that present challenges to clinicians as they strive to improve the outcomes for patients with breast cancer. This review examines the state of knowledge at the time of writing regarding the mechanisms of taxane resistance and the natural history of triple‐negative disease. Strategies for overcoming taxane resistance and the improving clinical outcomes for these groups of patient are discussed.
Pioglitazone and Heart Failure: Results From a Controlled Study in Patients With Type 2 Diabetes Mellitus and Systolic Dysfunction
Authors: Harris Scott , Tepper David , Ip Randy 
Published: December 2008

Abstract.  Background.  Thiazolidinediones are associated with fluid retention, often interpreted as worsening cardiac function, limiting their use in patients with heart failure (HF). We compared the effects of pioglitazone and glyburide on cardiac function in patients with type 2 diabetes, systolic dysfunction, and New York Heart Association functional class II or III HF.Methods and Results.  Participants received pioglitazone or glyburide (±insulin) for 6 months in this double‐blind, randomized, multicenter study. The primary end point was time to HF, a composite of cardiovascular mortality, and hospitalization or emergency department visit for HF. Secondary end points included echocardiographic and functional classification assessments. An earlier time to onset and higher incidence of the primary end point was noted with pioglitazone (13%) vs glyburide (8%) (P=.024). Hospitalization or emergency department visit occurred in 30 pioglitazone and 15 glyburide participants, 19 and 12 of whom, respectively, continued treatment. Cardiac mortality (5 vs 6 participants, respectively) and cardiac function, as measured by change in ventricular mass index (P=.959), ejection fraction (P=.413), or fractional shortening (P=.280), were similar between treatments.Conclusions.  Pioglitazone was associated with a higher incidence of hospitalization for HF without an increase in cardiovascular mortality or worsening cardiac function (by echocardiography).—Giles TD, Miller AB, Elkayam U, et al. Pioglitazone and heart failure: results from a controlled study in patients with type 2 diabetes mellitus and systolic dysfunction. J Card Fail. 2008;14(6):445–452.
Influence of β‐Blocker Continuation or Withdrawal on Outcomes in Patients Hospitalized With Heart Failure: Findings From the OPTIMIZE‐HF Program
Authors: Harris Scott , Tepper David , Ip Randy 
Published: December 2008

Abstract.  Objectives.  This study ascertains the relationship between continuation or withdrawal of β‐blocker therapy and clinical outcomes in patients hospitalized with systolic heart failure (HF).Background.  Whether β‐blocker therapy should be continued or withdrawn during hospitalization for decompensated HF has not been well studied in a broad cohort of patients.Methods.  The Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure (OPTIMIZE‐HF) enrolled 5791 patients admitted with HF in a registry with prespecified 60‐ to 90‐day follow‐up at 91 academic and community hospitals throughout the United States. Outcomes data were prospectively collected and analyzed according to whether β‐blocker therapy was continued, withdrawn, or not started.Results.  Among 2373 patients eligible for β‐blockers at discharge, there were 1350 (56.9%) who were receiving β‐blockers before admission and continued on therapy, 632 (26.6%) were newly started, 79 (3.3%) in whom therapy was withdrawn, and 303 (12.8%) were eligible but not treated. Continuation of β‐blockers was associated with a significantly lower risk and propensity‐adjusted postdischarge death (hazard ratio [HR], 0.60; 95% confidence interval [CI], 0.37–0.99; P=.044) and death/rehospitalization (odds ratio, 0.69; 95% CI, 0.52–0.92; P=.012) compared with no β‐blocker. In contrast, withdrawal of β‐blocker use in patients was associated with a substantially higher adjusted risk for mortality compared with those continued on β‐blockers (HR, 2.3; 95% CI, 1.2–4.6; P=.013) but with similar risk as HF patients eligible but not treated with β‐blockers.Conclusions.  The continuation of β‐blocker therapy in patients hospitalized with decompensated HF is associated with lower postdischarge mortality risk and improved treatment rates. In contrast, withdrawal of β‐blocker therapy is associated with worse risk and propensity‐adjusted mortality.—Fonarow GC, Abraham WT, Albert NM, et al; for the OPTIMIZE‐HF investigators. Influence of beta‐blocker continuation or withdrawal on outcomes in patients hospitalized with heart failure: findings from the OPTIMIZE‐HF program. J Am Coll Cardiol. 2008;52(3):190–199.
Personal responsibility for health as a rationing criterion: why we don’t like it and why maybe we should
Authors: Buyx A M 
Published: November 2008

Whether it is fair to use personal responsibility of patients for their own health as a rationing criterion in healthcare is a controversial matter. A host of difficulties are associated with the concept of personal responsibility in the field of medicine. These include, in particular, theoretical considerations of justice and such practical issues as multiple causal factors in medicine and freedom of health behaviour. In the article, personal responsibility is evaluated from the perspective of several theories of justice. It is argued that in a healthcare system based on both equality of opportunity and solidarity, responsible health behaviour can—in principle—be justifiably expected. While the practical problems associated with personal responsibility are important, they do not warrant the common knee-jerk refusal to think more deeply about responsibility for health as a means of allocating healthcare resources. In conclusion, the possibility of introducing personal responsibility as a fair rationing criterion is briefly sketched.
A report on small team clinical ethics consultation programmes in Japan: Table 1
Authors: Fukuyama M , Asai A , Itai K , Bito S 
Published: November 2008

Clinical ethics support, including ethics consultation, has become established in the field of medical practice throughout the world. This practice has been regarded as useful, most notably in the UK and the USA, in solving ethical problems encountered by both medical practitioners and those who receive medical treatment. In Japan, however, few services are available to respond to everyday clinical ethical issues, although a variety of difficult ethical problems arise daily in the medical field: termination of life support, euthanasia and questions about patient autonomy.In light of these conditions, a group of 17 volunteer educators and researchers from the area of biomedical ethics, including the authors, have formed the Clinical Ethics Support and Education Project, and began providing Japan’s first small team clinical ethics consultation service in October, 2006. Members include scholars of biomedical ethics, scholars of philosophy and ethics, legal professionals and legal scholars, nurses and doctors, consisting of five women and 12 men. Consultation teams, made up of a small number of members, were organised each time a request for consultation was received.Over approximately 15 months (October 2006–December 2007), the programme received 22 consultation requests from medical practitioners and medical institutions, and three from the families of patients. In this paper, we will discuss the status of our consultation service and examples of consultation cases we have handled. In addition, we will examine the process of evaluating small team clinical ethics consultation services, as well as the strengths and weakness of such programmes.
Determining the need for ethical review: a three-stage Delphi study
Authors: Reynolds J , Crichton N , Fisher W , Sacks S 
Published: November 2008

Aims:The aims of the study were to explore expert opinion on the distinction between “research” and “audit”, and to determine the need for review by a National Health Service (NHS) Research Ethics Committee (REC).Background:Under current guidelines only “research” projects within the NHS require REC approval. Concerns have been expressed over difficulties in distinguishing between research and other types of project, and no existing guidelines appear to have been validated. The implications of this confusion include unnecessary REC applications, and crucially, the potential for ethically unsound projects to escape review.Methods:A three-stage Delphi method was chosen to explore expert opinion and develop consensus. Stage 1 comprised ten semi-structured interviews gathering opinion on distinguishing between types of project and how to determine need for ethical review. Stages 2 and 3 were questionnaires, asking 24 “experts” to rate levels of ethical concern and types of project for a series of questions. Anonymised responses from stage 2 were fed back in stage 3. The final responses were analysed for consensus.Results:Of 46 questions, consensus was achieved for 14 (30.4%) for level of ethical concern and for 15 (32.6%) for type of project.Conclusions:Several ideas proved discriminatory for classifying the type of project and assessing level of ethical concern, and they can be used to develop an algorithm to determine need for ethical review. There was little relationship between assessment of the level of ethical concern and classification of the project. There was inconsistency in defining and classifying studies as something other than “research” or “audit”.