bluuebunny/crossref_metadata_2025_split huggingface dataset:
Criteria for enrolling dementia patients in hospice: A replication
Authors: Hanrahan Patricia , Raymond Michael , McGowan Elizabeth , Luchins Daniel J. 
Published: May 2006

Because survival time varies greatly in dementia, it is difficult for dementia patients to meet a key criterion for the Medicare Hospice Benefit, a six-month survival time. In a previous study, the authors examined guidelines for admitting dementia patients to hospice; the National Hospice Organization (NHO) guidelines were found to work well in identifying appropriate candidates for hospice among dementia patients. This was especially true for those patients whose deficits had progressed in an ordinal fashion consistent with Functional Assessment Staging (FAST) and who had reached stage 7C. The purpose of this study was to examine the utility of the NHO guidelines in identifying dementia patients who are appropriate for hospice; the limitations of these guidelines regarding non-ordinal patients; and the importance of the actual care plans used—as opposed to our previous study, which only examined initial treatment plans. Forty-five dementia patients enrolled in Hospice of the Great Lakes in Illinois were studied longitudinally over two years; this included a follow-up period of at least six months for all patients. Measures included: survival time; FAST; a medical complications checklist, which consisted of common complications of end-stage dementia; and co-morbid medical conditions and aggressive care, which consisted of feeding tubes, antibiotics, and Foley catheters used during the course of the study. Patients who had reached Stage 7C at intake had a mean survival time of 4.1 months; and the majority (71 percent) died within six months. Non-ordinal patients lived significantly longer at a mean of 10.9 months (p < .01), and and the minority (30 percent) died within six months. Foley catheters decreased survival time; and the use of antibiotics did not make a difference. This study echoed our previous findings regarding the usefulness of NHO guidelines in identifying dementia patients with a survival time of six months or less, specifically those at stage 7C or greater. The findings also suggest that the nature of the palliative care plan influences survival time.
Part three: Kidney cancer, leukemia, and liver cancer
Authors: Kemp Charles 
Published: May 2006

This is the third of a six-part series on metastatic spread and natural history of 18 common tumors. Part one summarized symptom/problem anticipation, cancer metastasis, and the 18 tumors that each cause more than 6,000 deaths per year in the United States. Bladder and brain cancers were discussed, with information given on tumor types, metastatic spread and invasion, and common symptoms. Part two charted the natural histories, problems, and assessment parameters of advanced breast, colon and rectum (colorectal), and esophageal cancers. Part three presents the natural histories, problems, and assessment parameters of advanced kidney cancer, leukemia, and liver cancer. Each of these cancers is presented separately, with information given on mortality rates, the most common tumor types, sites of metastases, common problems, and common oncologic emergencies. Sites of spread, resulting problems (including site-specific symptoms), and assessment parameters are presented as tables. Material is presented so that clinicians will be able to anticipate the spread of these cancers and can thus identify problems early in their development so that that they are more easily managed.
The Minimum Data Set 2.0: A functional assessment to predict mortality in nursing home residents
Authors: Abicht-Swensen Lisa M. , Debner Linda K. 
Published: May 2006

Measures of functional assessment, such as the Karnofsky Scale, the Modified ADL Scale, and the Descriptive Scale, have been used to predict appropriateness for hospice care. A tool is needed to assess functional status across all treatment settings, including acute care, long-term care, and hospice. The objective of this paper is to determine whether the Minimum Data Set, when utilized in conjunction with physical assessment tools to determine prognosis, is accurate in predicting short-term mortality in nursing home residents. The paper has been designed as a retrospective study of residents in 24 Minnesota nursing homes who were referred to a hospice program. The study included 199 patients from 30 to 107 years of age. Functional variables, as triggered by the Minimum Data Set, have a direct correlation to patient mortality within three months of the documented observation of the triggered variable, and are the main outcome measure. Of a total of 199 patients, 147 patients (74 percent) died within 15 days of a documented significant decline in the Minimum Data Set in areas of cognitive function, communication, activities of daily living, incontinence, and nutrition. Age, gender, diagnosis, and significant medical data received from the nursing home staff at the time of referral to hospice were applied to the Karnofsky Scale, the Modified ADL Scale, the Descriptive Scale, and the Minimum Data Set to determine if a resident assessment protocol (RAP) would be triggered by these data. The data were then analyzed to determine whether there existed a correlation between a significant change, as documented on the Minimum Data Set, and subsequent death of the patient. If there existed a correlation, the data were further studied to determine consistency in the categories of change that might demonstrate predictors of short-term mortality in nursing home residents. A decline in functional status, as documented on the Minimum Data Set 2.0 in the areas of cognitive functioning, communication, activities of daily living, incontinence, and nutrition, are strong predictors of short-term mortality in nursing home residents, independent of age, gender, and diagnosis.
Prison hospice: An unlikely success
Authors: Craig Elizabeth L. , Craig Robert E. 
Published: May 2006

Efforts to introduce hospice and palliative care into American prisons have become fairly widespread, in response to the sharp increase in inmate deaths. The primary impetus originally came from the alarming number of AIDS deaths among prisoners. The new combination therapies have proved very successful in treating AIDS, but are very costly, and many problems must be overcome to ensure their effectiveness in correctional settings. Although the AIDS epidemic seems to be in decline, prisons are experiencing a rise in the number of deaths due to “natural causes.” In this article we present a review of the prison hospice scene—the response to this crisis in correctional health care. First, we discuss the challenges facing the introduction of hospice into the correctional setting. Then, we present a brief overview of recent developments and a discussion of some ways hospice components have been adapted for life behind bars. Finally, we indicate some of the prospects for the future. Hospice professionals, armed with thorough professional training and years of experience, often fear that correctional health care providers will only parody superficial aspects of the hospice approach. Continual nudging and nurturing by local and state hospice professionals is required in order to bring about this change in the first place and to sustain it through time. Prison hospice workers need not only initial training, but also ongoing education and personal contact with experienced hospice professionals. While the interest of the big national organizations is necessary, the real action happens when local hospices work with nearby prisons to attend to the needs of dying inmates.
Special characteristics affecting the neuropsychologic assessment of the elderly in Greece
Authors: Fountoulakis Konstantinos N. , Kaprinis Stergios G. , Kaprinis George S. 
Published: May 2006

An important element in the diagnostic approach to psychogeriatric patients is the neuropsychologic assessment. Most instruments have been developed in the United States or the United Kingdom, but their appropriateness for culturally different populations is still an open question. Validation studies in Greece revealed certain difficulties both for the Mini-Mental State Examination and the Cambridge Cognitive Examination for the Elderly. These results were probably due to the functional illiteracy of elderly people in Greece, the coexistence of mood disorders, restricted access to news over past decades, and low levels of cooperation between the subject and the examiner. The need for a more suitable diagnostic instrument for this kind of population led to the development of the Epidemiological Dementia Index. Data from developing countries support the possibility that research results from Europe and the United States are not directly applicable to the whole world; thus, the need for data from non-English speaking countries is evergrowing. Our understanding of psychogeriatric disorders in the developing world is like an iceberg: The larger portion is hidden because of the lack of relevant data.
Depression and Alzheimer's disease: Symptom or comorbidity?
Authors: Moretti Rita , Torre Paola , Antonello Rodolfo M. , Cazzato Giuseppe , Bava Antonio 
Published: May 2006

Alzheimer's disease is the most frequent form of dementia, where behavioral and cognitive disruption symptoms coexist. Depression, apathy, anxiety, and other conduct disorders are the complaints most often reported by caregivers. Fifty subjects were referred to our Institute with a diagnosis of probable Alzheimer's disease. Cognitive impairment was equally distributed among the subjects. Patients, aged 68 to 76 years old, were randomized to receive inhibitors of cholinesterase (Donepezil, 5 mg/ day) alone, or inhibitors of cholinesterase plus selective seratonin reuptake inhibitors (SSRIs) (citalopram HBr, 20 mg/day). We followed up all the patients for one year, with particular concern for neuropsychological aspects associated with eventual behavioral changes. Results indicate that SSRI intake seems to be effective for depression, decreasing it and improving quality of life for both patients and caregivers. Side effects in both groups were few, and there were no study withdrawals. This paper discusses the relationship between dementia-and depression, and presents our finding that depressive symptoms, if specifically treated, tend to reduce caregiver stress and improve well-being in patients with Alzheimer's disease.
Age-or stage-appropriate? Recreation and the relevance of Piaget's theory in dementia care
Authors: Mahoney Alison E. J. 
Published: May 2006

In this study, the immediate effects (within 10 minutes) of age-and stage-appropriate activities and two control activities were observed in 56 dementia sufferers. Compared with the control activities, the two experimental treatment conditions elicited greater reductions in agitation and negative emotion and increases in positive emotion and duration of activity. Stage-appropriate activity was superior to age-appropriate activity in increasing positive emotion and had about the same effect in reducing negative emotion and agitation. The study also addressed the idea that people with Alzheimer's disease may regress through Piaget's stages of cognitive development and thus display the play interests associated with each stage. There was a significant relationship between cognitive level and type of Piagetian play observed; however, Piaget's descriptions of play were not entirely appropriate for persons with with Alzheimer's disease.
The relation between the perceived role of family and the behavior of the person wiht dementia
Authors: de Geest Gwendolyn 
Published: May 2006

The purpose of this study was to investigate the relation between the perceived role of family and the behavior of the person with dementia in a sample of older adults. Two instruments were used in data collection: The Family Perceptions of Caregiving Role (FPCR) and the Cohen-Mansfield Agitation Inventory (CMAI). A total of 40 persons with dementia were included in the study. Each had a family respondent and a nurse respondent. The data analyses produced three major findings. First, it was revealed that there was no significant difference between agitation levels of persons with dementia who received more frequent family visits and those who did not. Second, the study revealed that family caregivers did not perceive a partnering relationship with staff. Finally, correlational analysis provided little evidence of a link between the family's perceived role in partnering and the behavior of the person with dementia, specifically in relation to agitation levels. Although no significant relation was established between the family's perceived role in partnering and the behavior of the person with dementia, there was high family and caregiver satisfaction. The clearest element of the family's perspective was the desire that staff members care about the individual with dementia as a person.
Olanzapine as a possible treatment for anxiety due to vascular dementia: An open study
Authors: Moretti Rita , Torre Paola , Antonello Rodolfo M. , Cattaruzza Tatiana , Cazzato Giuseppe , Bava Antonio 
Published: May 2006

Disabilities caused by behavioral problems can be potentially devastating in cognitively impaired patients. These behavioral symptoms can be a major cause of stress, anxiety, and concern for caregivers. While psychotropic drugs are frequently used to control these symptoms, they can be accompanied by significant side effects, which include sedation, disinhibition, depression, falls, incontinence, parkinsonism, and akathisias. Agitation is a major problem in older patients with dementia. Agitation and aggression have always been difficult behaviors to manage, and when it is severe, agitation can be a behavioral emergency that requires urgent and immediate intervention. This six-month study included a group of 94 outpatients (48 men and 46 women) who had a diagnosis of subcortical vascular dementia (VaD). To be eligible for the study, patients needed a score of at least 3 for agitation/ aggression on the Neuropsychiatric Inventory (NPI), suggesting at least moderate frequency and/or severity, and 0 for delusions and hallucinations. Patients were divided into two homogenous groups. Group A received olanzapine (2.5-5 mg/day) and Group B received bromazepam (0.25 percent, 15 drops, three times per day). Patients in both groups were allowed to continue any previous therapy. Patients receiving olanzapine at an average dose of 3.21 ± 1.02 mg/day showed statistically significant improvement on the anxiety rating compared with those receiving bromazepam. Our patients had a host of medical conditions and received numerous concomitant medications. Given the potential complications associated with these therapeutic agents, these patients tolerated olanzapine quite well. It appeared that adverse events, particularly somnolence, postural instability, and postural hypotension, were mild and transient. Moreover, no anticholinerigic effect was registered. These findings suggest that olanzapine could be a safe and effective treatment for anxiety in cognitively impaired patients.
Stress in the caregivers of Alzheimer's patients: An experimental investigation in ltaly
Authors: Aguglia E. , Onor M. L. , Trevisiol M. , Negro C. , Saina M. , Maso E. 
Published: May 2006

In Italy, the family constitutes the major caregiving response to the needs of the elderly who are no longer self-sufficient. These caregivers are often wives or daughters who have chosen to keep the patient at home with them. On average, three-quarters of the caregiver's day is devoted to the patient, a proportion that tends to increase linearly as the disease progresses. The primary aim of our study was to describe a group of Italian caregivers of patients with a diagnosis of dementia to assess their levels of stress. We then correlated these caregivers with a number of sociodemographic variables and the patients' degree of cognitive impairment and independence in daily life activities. The study was conducted on a sample group of 236 caregivers of patients with a diagnosis of Alzheimer's disease (AD) according to the DSM-IV criteria. Each caregiver took part in a sociodemographic interview and filled in two questionnaires: the Caregiver Burden Inventory (CBI), to quantify the caregiving workload and the Brief Symptom Inventory (BSI), to assess the level of anxiety and depression. Patients were administered the Mini-Mental State Examination (MMSE) to evaluate their level of cognitive impairment and the Instrumental Activities of Daily Living (IADL) and Activities of Daily Living (ADL) tests to quantify their level of independence. The analysis of the results shows that the average Italian caregiver of an AD patient is a woman, approximately 60 years old. The majority of caregivers are spouses, followed by children. In general, these caregivers work at home, are housewives or retired, and are personally involved in caring for the patients. The greater the level of a patient's cognitive impairment and the less independent they are, the greater amount of care and supervision they require, leaving less free time for the caregiver; this leads to higher levels of anxiety related to caregiving. Toward the final stages of the disease, patient care tasks take up nearly all of the caregiver's free time, leaving them only about two hours per week for themselves or their friends. In conclusion, the management of dementia patients places a particular burden on the caregiver and involves several economic and social costs. The burden becomes heavier as the disease progresses, since the increase of cognitive disorders and the resulting reduction of independence in daily life, together with the onset of behavioral symptoms, heighten the caregiver's distress, anxiety, and depression. Establishing a network of community services able to alleviate the burden on families is therefore a priority. Parallels can be drawn between the stresses documented for American caregivers and their Italian counterparts.
Statin use and hippocampal volumes in elderly subjects at risk for Alzheimer's disease: A pilot observational study
Authors: Doraiswamy P. Murali , Steffens David C. , Mcquoid Douglas R. 
Published: May 2006

Statins are investigational therapies for preventing or treating Alzheimer's disease (AD) and mild cognitive impairment (MCI). Hippocampal atrophy is a characteristic feature of MCI and AD. This study analyzed cross-sectional data from 246 nondemented elderly subjects to test the effect of lipid lowering agent (LLA) therapy on cognition and brain magnetic resonance imaging (MRI) measures of white matter lesions and hippocampal volume. The study also compared rates of hippocampal volume change over two and four years in a smaller subset. At baseline, LLA users were younger, better educated, more likely to be male, and had higher cognitive scores. Cognitive performance also varied by age and gender, and MRI measures varied by age. After adjusting for these differences, the effect of LLA use on baseline cognition, baseline hippocampal volume, and baseline white matter lesion scores was not significant. The effect of LLA use on hippocampal volume loss at two-year and four-year follow-ups was also not significant. This study is the first to examine statin effects on brain atrophy measured by MRI. In this cohort, statin use was not associated with rate of change of hippocampal volume. While the study was limited by a relatively small number of statin users, the findings seem consistent with three prior randomized trials that found no cognitive benefits for statins in nondemented subjects. Prospective studies in both nondemented and AD subjects may provide more conclusive answers.
Focused supervision of high-risk fall dementai patients: A simple method to reduce fall incidence and severity
Authors: Detweiler Mark B. , Kim Kye Y. , Taylor Brenda Y. 
Published: May 2006

Dementia units in nursing homes have a disproportionately high number of demographic risk factors for falls. Many residents have a previous history of falls, the inability to call for assistance, and the inability to remember safety instructions. For interdisciplinary falls review committees, this population may be the most difficult to manage. The Virginia Veterans Care Center (VVCC) Dementia Unit Interdisciplinary Fall Team instituted a novel practice for reducing the number and severity of falls among the highest risk group of dementia patients. Certified nursing assistants (CNAs) were assigned to high-risk residents for focused supervision. The patients received consistent supervision by selected CNAs during the day and evening shifts. Eight residents identified as high risk who continued to have falls despite multiple interventions were selected for the study. A comparison of four months of intervention with the four months prior to the intervention revealed a significant (p = 0.024) fall reduction during the intervention months. Individually, seven of the eight participants had reduced falls during the intervention period. A 5-point scale for fall severity demonstrated an overall reduction in fall severity during that period. Individually, five of the eight patients had a decreased fall severity, and one had no change. Two patients experienced an increase in fall severity due to ongoing medical problems. While the small number of patients in the study limits the power of the results, this novel intervention of using designated CNAs to supervise high-risk fall residents with dementia may prove helpful for staff in other nursing facilities.
Undercoding of Alzheimer's disease and related dementias in hospitalized elderly patients in Italy
Authors: Greco Antonio , Cascavilla Leandro , Paris Francesco , Errico Massimo , Orsitto Giuseppe , D'Alessandro Vito , Placentino Giuliana , Franceschi Marilisa , Seripa Davide , Vendemiale Gian Luigi , Pilotto Alberto 
Published: May 2006

The prevalence of Alzheimer's disease (AD) and AD-related dementias (ADRD) in acute ward— hospitalized elderly patients is not well known, owing principally to misclassification and undercoding of AD and ADRD on hospital discharge abstract forms (DAFs). The aims of this study were to evaluate the prevalence of AD and ADRD, as evaluated by the DAF, in elderly patients hospitalized in acute wards, and to compare clinical severity, length of stay, comorbidity, and number of diagnostic procedures in patients with AD versus ADRD to explain the different reimbursement costs of DRG12 (AD) versus DRG429 (ADRD). From the inpatient DAF database of the Casa Sollievo della Sofferenza Hospital, the DAFs of patients aged 65 years or over discharged from January 1, 2001, to March 31, 2003, with principal or secondary diagnoses of AD (ICD9-CM code 331) or ADRD (ICD9-CM codes from 290.0 to 290.43) were extracted and grouped by APR-grouper version 12. Age, gender, length of stay, principal and secondary diagnoses and procedures, and APR-DRG severity index (SI) and mortality risk (MR) were evaluated in these patients. Senile dementia was reported in 294 patients (0.58 percent, N = 50,253). In 123 patients (41.8 percent) dementia was the principal diagnosis, whereas in 171 patients (58.2 percent) dementia was reported on the DAF as a secondary diagnosis. Of the 123 patients with a principal diagnosis of dementia, 35 patients were included in the DRG-12 (AD) and 88 patients were included in the DRG-429 (ADRD). No differences were found in mean age, length of stay, comorbidity, or number of diagnostic procedures, as well as in the APR-DRG SI and APR-DRG MR between AD and ADRD patients. Conversely, reimbursement amounts were established as 4,033 for DRG-12 (AD) and 2,952 for DRG-429 (ADRD). AD and ADRD are undercoded in elderly hospitalized patients. The limits of the ICD9-CM classification system and the influence of reimbursement amounts may influence the coding reports by physicians.