bluuebunny/crossref_metadata_2025_split huggingface dataset:
Support groups for caregivers of persons with Alzheimer's disease: Implications for practice and research
Authors: Raybuck Jacqueline A. 
Published: June 2007

An integrative review was conducted on the use of support groups for caregivers of and persons with dementia and Alzheimer's disease. The research review was limited to published experimental or quasi-experimental studies. The studies reviewed varied according to study design, group membership, type of intervention used, duration of support group, outcome measures employed, and results. Parallels drawn from the above-mentioned areas were variable among the studies. There were no replication of studies with favorable results. Strengths and limitations were discussed. Further research on the effect of support group interventions with caregivers and persons with progressive dementia is warranted. First, there is a need to evaluate the effect of the support group intervention on specific populations such as persons with all stages of the disease process and minority caregivers. Second, there is a need for longitudinal studies with measurement tools appropriate for the intervention. Caregivers and persons with Alzheimer's disease support groups are a rich area for future intervention and outcome studiesfor health care professionals.
To integrate or segregate the cognitively impaired and cognitively intact in nursing homes: Lessons to be learned from educational mainstreaming
Authors: Riter Robert N. 
Published: June 2007

This paper explores the parallels between the mainstreaming of disabled and non-disabled students in schools and the integration of cognitively impaired and cognitively intact residents in nursing homes. The research on educational mainstreaming at a more mature stage of development, can serve as a foundation for gerontologists by suggesting that: • The physical location of service is non-specific and relatively meaningless as an independent variable; • Integration may benefit some impaired individuals while proving detrimental to others; • Moral and political arguments often drive the discussion; and • The well-being of non-impaired individuals is often overlooked.
The effects of menu modification to increase dietary intake and maintain the weight of Alzheimer residents
Authors: Soltesz Kay S. , Dayton Judy H. 
Published: June 2007

Adaptive feeding techniques have been suggested as a method to promotefeeding independence in AD residents. The use of foods which patients can pick up with their fingers triggers resident 's attention producing increased involvement with the meal and increased resident consumption. The menu at an all-A lzheimer 's carefacility was modified to include more finger foods. Before the menu changes, the average number offingerfoods used at each meal was: breakfast 2.57, lunch 2. 19, and dinner 2.00. Menu changes increased finger foods to the following levels: breakfast 2.71, lunch 2.38, and dinner 3.80. The weight profiles and consumption patterns of 54 AD residents were determined through a chart review of two six month periods, before and after the menu change. During this period of time, the weights of the residents receiving finger foods did not significantly increase, but the usual weight loss seen in AD residents did not occur Food consumption patterns significantly increased (p=.05)for both male and female residents. Results indicate the inclusion of finger foods is an appropriate feeding method for AD residents.
The effects of hospice interventions on behaviors, discomfort, and physical complications of end stage dementia nursing home residents
Authors: Kovach Christine R. , Wilson Sarah A. , Noonan Patricia E. 
Published: June 2007

This project was guided by the question—what is the effect of hospice-oriented care on discomfort, physiological complications, and behaviors associated with dementia for residents of long term care facilities with an end stage dementing illness? Convenience sampling from three long term care facilities was used and 62 residents completed the project. The intervention was implemented through a four pronged approach: • Interdisciplinary development of the intervention strategies for the new hospice households; • Development of the households; • Use of a hospice nurse as a case manager; and • Education of staff A pretest-posttest experimental design with random assignment to groups was used. Two months after the interventions were implemented, there was a statistically significant difference in discomfort levels between the treatment and control groups (t = 3.88, p < .001). Even though the treatment group showed lower scores on the tool that assessed behavior problems, the differences were not large enough to be statistically significant (t = 1.44, p = .155). There was no difference in the number of physical iatrogenic problems between the treatment and control groups (t = .054, p = .957). Staff reaction to the project was positive with staff reporting greater job satisfaction and empathy, and describing a variety of improvements in residents.
Theoretical perspective concerning effects of environment on SDAT patients as a function of cognitive and behavioral functioning
Authors: Moyer Delores M. , Gilson Aaron 
Published: June 2007

The frequency of seven disruptive behaviors and the average intensity ratings of these behaviors were measuredfor 31 residents of Alzheimer group homes. A correlation design was used to investigate whether the behavior patterns of the subjects changed as a result of altering the residential environment through the introduction of Christmas holiday stimuli. A related goal was to assess whether such changes in behavior patterns were associated with the residents' levels of impairment. The study consisted of three, three-week phases. One group home served as the experimental condition in which Christmas stimuli were present for one week, while the comparison group consisted of two facilities which observed Christmas over a three-week period. Zero-order and partial correlations were computed comparing the three phases and controlled for the experimental condition. Results indicated that the introduction of holiday stimuli had a significant impact on the intensity of disruptive behaviors in both the experimental and comparison groups. This result was less consistent for the average frequency of the behaviors. When controlling for the influence of stage of Alzheimer's, a significant change in both the frequency and intensity of behaviors was obtained only when comparing phases one and two. Thus, regardless of stage, both the occurrence and the severity of behaviors were consistent before the introduction of the holiday stimuli. However, the means of the frequencies and average intensities of the behaviors reflected an increase in the disruptive behaviors upon introduction of the stimuli. In addition, higher stage levels were shown to be associated with greater increases in both the frequencies and intensities of the behaviors.
Impaired traffic sign recognition in drivers with dementia
Authors: Brashear Allison , Unverzagt Frederick W. , Kuhn Elizabeth R. , Glazier Bradley S. , Farlow Martin R. , Perkins Anthony J. , Hui Siu L. 
Published: June 2007

The determination of the safety of a patient with dementia who continues to drive is a difficult task for the physician who cares for geriatric patients. This study used the Traffic Sign Recognition Test (TSRT) discrimination between dementia patients who continue to drive and normal elderly volunteers. Thirty-seven subjects with dementia who continue to drive and 47 normal elderly volunteers were recruited to participate in the study. Each group was tested with the TSRT similar to that used for licensing in the state of Indiana. The difference in total number of signs correctly identified between the two groups was determined using the Wilcoxon Rank Sum Test. The difference between groups of each individual sign recognition was determined using a Chi Square test. The affected group was also tested with a neuropsychological battery (NB) designed to measure skills thought to be needed for driving. Drivers with dementia correctly identified 5.95 (± 2.17) of the 10 traffic signs used in licensing as compared to the normal elderly volunteers who correctly identified 8.77 (± 1.58) total signs (p < 0.0001). The “Slow Moving Vehicle” sign provided the largest difference between the two groups; demented drivers correctly identified the sign 39 percent of the time, compared with 89 percent in the normal volunteers (X2= 15.333, df= 1, p < 0.005). Only 76 percent of the demented drivers correctly identified a “Stop” sign compared with 98 percent of the normal elderly drivers. The percentage of correctly identified signs on the TSRT also correlated with several tests in the NB. Drivers with dementia who continue to drive perform worse on traffic sign recognition than normal elderly drivers. While our current screening tool did not assess the driving safety of either group, it suggests that demented patients who still drive may not recognize common traffic signs and may thus pose a risk to society.
The Use of Stents in the Treatment of Intimal Flaps: An Experimental Study
Authors: Wolosker Nelson , Rosoky Ruben Ayzin , Anacleto Alexandre Maieira , Puech-Leão Pedro 
Published: June 2007

The routine use of arteriography and duplex scan in arterial trauma has improved the diagnosis of asymptomatic arterial lesions. Specifically, in cases of blunt arterial lesions, intimal flap is the most frequent type of occult arterial trauma and usually follows an arterial contusion. Treatment of traumatic intimal lesions is controversial owing to its unknown natural history. Current therapeutic options include arterial reconstruction and clinical observation. The development of angioplasty catheters and stents has opened a new venue for the treatment of intimal flaps. The goal of this study was to evaluate the efficacy of endoprosthesis in the prevention of arterial thrombosis following traumatic intimal flap. The study was performed on 12 female mongrel dogs weighing more than 15 kg each. The common (CF) and superficial (SF) femoral arteries were exposed from the inguinal region to the midportion of the thigh in both posterior limbs. The SF was first crushed with a hemostatic forceps to induce a severe arterial contusion. A longitudinal arteriotomy of 2 cm was performed distal to the clamp site. A 5 mm deep intimal flap was than created along the 2 cm segment. The arterial wall was than sutured with prolene 7-0. The same procedure was performed on both SF. One of the arteries was randomized to receive a Palmaz Stent while the other was kept untreated for control. After 3 weeks, palpation, ultrasound Doppler and macroscopic studies were performed on both arteries to determine whether the arterial lumen was occluded or not. All arteries treated with stents were patent after 3 weeks, while five of the 12 untreated arteries were occluded (p < 0.05). Large intimal flaps are potentially thrombogenic. The use of stents is a good alternative in this situation, preventing arterial thrombosis, in the first 3 weeks after the trauma.
Long-Term Results After Percutaneous Low-Dose Streptokinase Treatment for Acute Arterial Thrombosis
Authors: Yilmaz E. N. , Vermeulen E. G. J. , van den Berg F. G. , Vahl A. C. , Rauwerda J. A. 
Published: June 2007

The objective of this study was to evaluate the immediate efficacy and long-term results of a standard protocol of percutaneous, low dose, intraarterial streptokinase treatment in acute arterial thrombosis. This involved analysis of 48 consecutive patients with acute peripheral arterial thrombosis, treated with thrombolysis between October 1988 and August 1997. There were 30 men and 18 women patients, with an average age of 66.5 years. There was thrombosis of the native artery in 32, thrombosis of an aneurysm in seven, and graft occlusion in nine. After the occlusion was defined by arteriography, the low-dose streptokinase (10,000 units per hour) was continuously infused into the thrombosed segment following a bolus injection of 10,000 units. The initial success rate (defined as partial or complete lysis) was 79.6%. Additional therapy after lysis consisted of percutaneous transluminal angioplasty in 18, bypass surgery in six, anticoagulant therapy in seven, and amputation in seven owing to irreversible ischemic damage. One patient died of myocardial infarction before additional therapy. Of the 20.4% failures to fibrinolysis, two patients received bypass surgery, two surgical thrombectomy, three sympathectomy, and three had amputations. Local bleeding complications were seen in five (10%) patients. Only one patient needed surgical exploration. Allergic reaction to streptokinase was seen in five patients (10%) and fibrinolytic therapy was continued with urokinase in three. In the follow-up (1-107 months) eight patients died and three amputations were performed after a mean time of 17 months after thrombolysis owing to progression of arteriosclerosis. This resulted in a limb salvage rate of 76% after 1 year and 65% after 5 years (Kaplan-Meier). Low-dose, local, intraarterial streptokinase therapy is an effective preliminary step in management of acute arterial thrombosis. Especially with adequate additional treatment, it is possible to achieve satisfactory long-term patency rates.
The Influence of Carotid Plaque Morphology on the Development of Cerebral Symptoms
Authors: Axisa B. , Naylor A. R. , London N. , Bell P. R. F. , Thompson M. M. 
Published: June 2007

Background: Large randomized trials such as the European Carotid Surgery Trial (ECST) and North American Symptomatic Carotid Endarterectomy Trial (NASCET) have defined a role for carotid endarterectomy in symptomatic patients with severe carotid artery stenosis. Data from the same trials also shows that a subgroup of patients with less severe stenosis with a higher risk of stroke might benefit form carotid endarterectomy. In recent years, it has become apparent that besides the degree of stenosis, the morphology of the plaque itself plays a significant role in its potential for development of symptoms, and noninvasive methods of assessing plaque morphology are currently being developed. This paper reviews the literature regarding the relationship between carotid plaque morphology and the potential for development of clinical symptoms. Methods: A Medline search and a meta-analysis of the literature was carried out. Intraplaque hemorrhage and plaque ulceration were both found to be associated with a higher risk of stroke development (p = 0.001 and 0.0001, respectively). Intraluminal thrombus was not found to be associated with an increased risk of symptom development in the data analyzed. A possible explanation for this incongruous finding is discussed. In addition, the paper also discusses the role of noninvasive plaque characterization as a method of identifying unstable plaques in the future. Conclusion: Certain characteristics of plaque morphology correlate with a higher risk of development of symptoms and better noninvasive identification of plaque characterization will lead to better patient selection and may be especially useful identifying patients with lower degrees of stenosis but with potentially unstable plaques who might benefit from carotid endarterectomy but do not qualify for surgery using currently accepted criteria.
Evaluation of Skeletal Muscle Metabolic Responses Following Exercise Training in Patients with Intermittent Claudication
Authors: Back Martin R. , Kluess Heidi A. , Huber Thomas S. , Stopka Christine B. , Scott Katherine N. , Ballinger J. Raymond , Welsch Michael A. , Bruner Angela P. , Lyles Teresa , Harward Timothy R. S. , Seeger James M. 
Published: June 2007

Objective: Factors responsible for the exercise intolerance occurring in patients with peripheral arterial occlusive disease (PAOD) manifesting intermittent claudication (IC) and contributing to the observed improvements in walking capacity after exercise training have not been elucidated. The authors characterized the resting and exercise responses of high-energy phosphate species in affected calf skeletal muscle as detected by phosphorus (P)-31 magnetic resonance spectroscopy (MRS) to determine whether metabolic derangements were present in patients with mild to moderate PAOD and IC and whether these abnormalities could be altered by training. Subjects: Thirteen patients evaluated for IC with resting ankle-brachial indices (ABIs) < 0.9 and positive exercise testing were enrolled in a supervised 10-week walking exercise program (IC training). Separate control groups were composed of (1) patients with PAOD and IC (IC control, n = 4) and (2) healthy, age-matched individuals (n = 4) without PAOD or IC who did not undergo exercise training. Outcome Measures: Resting ABIs and constant-load treadmill testing were performed prior to and following exercise training. ABIs, ankle pressure drop, and calf muscle bioenergetic response (P-31 MRS) of the most symptomatic limb were measured during inmagnet, lowand high-intensity calf exercise done before and after training. Results: Compared with healthy controls, patients with PAOD and IC before training had lower resting ABIs (0.66 ±0.11), larger ankle pressure drops (35 ±15%), shorter symptom-free walking distances during treadmill testing and significantly slower phosphocreatine recovery (Pcr t½) during in-magnet low-intensity (61 ±46 v. 36 ±40 sec, p=0.05) and high (119 ±93 v. 31 ±10 sec, p=0.003) exercise but had otherwise similar bioenergetic responses. Despite improved symptom-free walking distance (1,080 ±316 v. 498 ±367 ft, p < 0.001), patients with PAOD and IC exhibited no changes in resting ABI, ankle pressure drop or high-energy phosphate responses after training. Furthermore, no significant correlation was found between high-energy phosphate species and limb hemodynamics. Conclusions: The relatively subtle abnormalities in high-energy phosphate muscle metabolism present in patients with PAOD and IC may only partially account for their marked exercise intolerance and do not appear to contribute to the observed improvement in walking capacity after supervised training.
Local Application of Beta-Particle Radiation to Reduce Venous Anastomotic Intimal Hyperplasia in Polytetrafluoroethylene Arteriovenous Fistulas
Authors: Erzurum Victor Z. , Hafeli Urs O. , Hirko Mark K. , Schmidt Steven P. , Rubin Jeffrey R. 
Published: June 2007

The long-term patency of arteriovenous fistulas (AVF) created for hemodialysis is limited, especially when prosthetic implants such as polytetrafluoroethylene (PTFE) are used. Since intimal hyperplasia (IH) at the venous anastomosis is the most common cause of AVF demise, a therapeutic technique to safely diminish this hyperplastic response would be valuable to dialysis patients. Recently, pure beta-emitting stents were shown to be effective in decreasing IH in coronary arteries after angioplasty. This study was designed to assess the ability of a newly developed beta-emitting external foil to inhibit IH at the venous anastomosis in PTFE AVFs in a canine model. Bilateral PTFE bridge graft AVFs were placed from the femoral artery to vein in adult mongrel canines. A metallic stainless-steel foil coated with the beta-emitter rhenium 188 was placed around the venous anastomotic site of one AVF in each animal. Twelve weeks after AVF implantation each animal was sacrificed and samples of each anastomosis analyzed histologically. Eight venous anastomoses were analyzed (four test and four control). An analysis of neointimal hyperplasia was performed with image analysis software. Although not statistically significant, there was a trend toward diminished IH observed in the irradiated versus control anastomoses (132.36 ±36 μ vs 159 ±22 μ). However, a foreignbody response was noted external to the vein and anastomosis on the implant side, leading to decreased diameter in the irradiated versus control veins (1.52 ±0.21 mm vs 3.80 ±1.02 mm). Venous IH may be attenuated in canine PTFE AVFs with the use of an external betaemitting foil. Further larger studies to determine the ideal dosimetry and implant material to maximize vein contact yet minimize foreign body response are necessary. This technology could result in a safe and effective way to improve performance in AVFs.
Giant Renal Artery Aneurysms
Authors: Cikrit Dolores F. , Szwed James J. , Burkhart Harold M. , Dalsing Michael C. 
Published: June 2007

Renal artery aneurysms (RAAs) are rare, relatively small, and do not need to be treated in most instances. Giant RAAs (> 5.0 cm in diameter), however, may require a different approach. Two women, both 75 years old, were treated at the authors' institution for giant RAAs. One patient, with a single kidney, was diagnosed with acute renal failure as a result of ureteral obstruction by a 6.0-cm RAA. The other RAA was found incidentally on a plain abdominal radiograph performed for right flank pain; severe hypertension was present in this patient. Computerized tomography (CT) scan in this patient demonstrated a left RAA with a maximal diameter of 6.5 cm. Arteriography was obtained in both patients. Both aneurysms were located adjacent to the hilum of the kidney arising from a major branch of the main renal artery near the branch's origin. Both had evidence of partial calcification within the wall. The patients were treated surgically with partial excision and ligation. In the first patient, surgery was necessary to relieve ureteral obstruction, whereas hypertension control was the main goal in the other. The patients did well with maintenance of renal function postoperatively. Giant RAAs may cause pain, obstruction of the ureter, or renal vascular hypertension. Resolution of these symptoms can be expected with proper surgical intervention as well as elimination of the potential risk for rupture.
Primary Duodenocaval Fistula with Associated Venacaval Thrombus and Septic Pulmonary Emboli
Authors: DeTurris Stanley , Martin Harold , Bowers Susan , Simso Lee , Melin M. Mark 
Published: June 2007

Primary duodenocaval fistulae are exceedingly rare and associated with high morbidity and mortality rates. The authors report a 56-year-old man with a duodenal ulcer and sepsis associated with persistent Vancomycin-resistant enterococcal (VRE) bacteremia and respiratory distress caused by recurrent pulmonary emboli. Computerized tomography scanning and caval venography identified a suprarenal thrombus and duodenocaval fistula. At laparotomy, caval thrombectomy, internal jugular patch angioplasty, and primary duodenal closure were performed. Microscopic examination disclosed gram-positive bacteria and vegetable matter within the thrombus. Sepsis resolved postoperatively. Duodenocaval fistulae are a rare clinicopathologic entity with only 23 previously published cases, six from duodenal ulcers. Other inciting conditions include trauma, renal cell cancer with subsequent nephrectomy and irradiation, foreign body ingestion, and caval filter presentation. The clinical presentation is typically sepsis and gastrointestinal hemorrhage. Mortality rate is greater than 50%. The existence of caval thrombus associated with duodenal ulcer and subsequent thrombectomy has not been described previously. Successful treatment of duodenocaval fistulae requires a high index of suspicion and rapid assessment. Early surgical intervention is the only definitive management strategy.
Visceral Artery Pseudoaneurysms Secondary to Pancreatitis
Authors: Kudva Annappa , Mylarappa Prasad , Rao Ananda 
Published: June 2007

Upper gastrointestinal hemorrhage is an infrequent complication of acute and chronic forms of pancreatitis. Aneurysmal degeneration of contiguous splanchnic arteries due to pancreatic inflammation, with subsequent rupture into the intestinal lumen is a rare occurrence. These vascular lesions present major clinical problems, both in terms of timely diagnosis and appropriate surgical therapy.1 The authors report 3 cases of bleeding visceral artery pseudoaneurysms (2 cases of pancreaticoduodenal pseudoaneurysms and 1 case of gastroduodenal artery pseudoaneurysm) secondary to pancreatitis. Early diagnosis was possible because of angiographic evaluation, resulting in timely surgical intervention.