bluuebunny/crossref_metadata_2025_split huggingface dataset:
Delirium in the Intensive Care Unit: Occurrence and Clinical Course in Older Patients
Authors: McNicoll Lynn , Pisani Margaret A. , Zhang Ying , Ely E. Wesley , Siegel Mark D. , Inouye Sharon K. 
Published: December 2004

OBJECTIVES: To describe the occurrence of delirium in a cohort of older medical intensive care unit (ICU) patients and its short‐term duration in the hospital and to determine the association between preexisting dementia and the occurrence of delirium.DESIGN: Prospective cohort study.SETTING: Fourteen‐bed medical ICU of an 800‐bed university teaching hospital.PARTICIPANTS: One hundred eighteen consecutive patients aged 65 and older admitted to the ICU.MEASUREMENTS: Baseline characteristics were obtained through surrogate interviews and medical chart review. Dementia was determined using two validated surrogate‐rated instruments. Delirium was assessed daily in the ICU using the Confusion Assessment Method (CAM) for the ICU (CAM‐ICU). After discharge from the ICU, patients were followed for up to 7 days using the CAM.RESULTS: Delirium was present in 37 of 118 (31%) patients on admission. Only 45 patients had a normal mental status on admission, of whom 14 (31%) became delirious during their hospital stay. In the post‐ICU period, delirium occurred in 40% of patients. Almost half of patients with delirium in the ICU had persistent delirium in the post‐ICU period. Overall, 83 of 118 (70%) had delirium during hospitalization. Stupor or coma occurred in 44% of the patients overall, and 89% of survivors of stupor/coma progressed to delirium. Patients with dementia were 40% more likely to be delirious (relative risk = 1.4, 95% confidence interval = 1.1–1.7), even after controlling for comorbidity, baseline functional status, severity of illness, and invasive procedures.CONCLUSION: Delirium is a frequent complication in older ICU patients and often persists beyond their ICU stay. Delirium in older ICU persons is a dynamic and complex process. Dementia is an important predisposing risk factor for the development of delirium in this population during and after the ICU stay.
Unsteadiness Reported by Older Hospitalized Patients Predicts Functional Decline
Authors: Lindenberger Elizabeth C. , Landefeld C. Seth , Sands Laura P. , Counsell Steven R. , Fortinsky Richard H. , Palmer Robert M. , Kresevic Denise M. , Covinsky Kenneth E. 
Published: December 2004

OBJECTIVES: To determine whether a simple question about steadiness at admission predicts in‐hospital functional decline and whether unsteadiness at admission predicts failure of in‐hospital functional recovery of patients who have declined immediately before hospitalization.DESIGN: Prospective cohort study.SETTING: One university hospital and one community teaching hospital.PARTICIPANTS: One thousand five hundred fifty‐seven hospitalized medical patients aged 70 and older.MEASUREMENTS: On admission, patients reported their steadiness with walking and whether they could perform independently each of five basic activities of daily living (ADLs) at admission and 2 weeks before admission (baseline). For the primary analysis, the outcome was decline in ADL function between admission and discharge. For the secondary analysis, the outcome was in‐hospital recovery to baseline ADL function in patients who experienced ADL decline in the 2 weeks before admission.RESULTS: In the primary cohort (n = 1,557), 25% of patients were very unsteady at admission; 22% of very unsteady patients declined during hospitalization, compared with 17%, 18%, and 10% for slightly unsteady, slightly steady, and very steady patients, respectively (P for trend = .001). After adjusting for age; medical comorbidities; Acute Physiology, Age, and Chronic Health Evaluation II score; and admission ADL, unsteadiness remained significantly associated with ADL decline (odds for decline for very unsteady compared with very steady = 2.6, 95% confidence interval = 1.5–4.5). In the secondary analysis, predicting ADL recovery in patients who declined before hospitalization (n = 563), 46% of patients were very unsteady at admission. In this cohort, 44% of very unsteady patients failed to recover, compared with 35%, 36%, and 33% for each successively higher level of steadiness, respectively (P for trend = 0.06). After multivariate adjustment, greater unsteadiness independently predicted failure of recovery (P for trend = 0.02).CONCLUSION: A simple question about steadiness identified patients at increased risk for in‐hospital ADL decline and, in patients who lost ADL function immediately before admission, failure to recover.
Fall and Injury Prevention in Residential Care—Effects in Residents with Higher and Lower Levels of Cognition
Authors: Jensen Jane , Nyberg Lars , Gustafson Yngve , Lundin‐Olsson Lillemor 
Published: December 2004

OBJECTIVES: To evaluate the effectiveness of a multifactorial fall and injury prevention program in older people with higher and lower levels of cognition.DESIGN: A preplanned subgroup comparison of the effectiveness of a cluster‐randomized, nonblinded, usual‐care, controlled trial.SETTING: Nine residential facilities in Umeå, Sweden.PARTICIPANTS: All consenting residents living in the facilities, aged 65 and older, who could be assessed using the Mini‐Mental State Examination (MMSE; n = 378). An MMSE score of 19 was used to divide the sample into one group with lower and one with higher level of cognition. The lower MMSE group was older (mean ± standard deviation = 83.9 ± 5.8 vs 82.2 ± 7.5) and more functionally impaired (Barthel Index, median (interquartile range) 11 (6–15) vs 17 (13–18)) and had a higher risk of falling (64% vs 36%) than the higher MMSE group.INTERVENTION: A multifactorial fall prevention program comprising staff education, environmental adjustment, exercise, drug review, aids, hip protectors, and postfall problem‐solving conferences.MEASUREMENTS: The number of falls, time to first fall, and number of injuries were evaluated and compared by study group (intervention vs control) and by MMSE group.RESULTS: A significant intervention effect on falls appeared in the higher MMSE group but not in the lower MMSE group (adjusted incidence rates ratio of falls P = .016 and P = .121 and adjusted hazard ratio P < .001 and P = .420, respectively). In the lower MMSE group, 10 femoral fractures were found, all of which occurred in the control group (P = .006).CONCLUSION: The higher MMSE group experienced fewer falls after this multifactorial intervention program, whereas the lower MMSE group did not respond as well to the intervention, but femoral fractures were reduced in the lower MMSE group.
Meta‐Analysis of Psychosocial Interventions for Caregivers of People with Dementia
Authors: Brodaty Henry , Green Alisa , Koschera Annette 
Published: December 2004

OBJECTIVES: To review published reports of interventions for caregivers (CGs) of persons with dementia, excluding respite care, and provide recommendations to clinicians.DESIGN: Meta‐analytical review. Electronic databases and key articles were searched for controlled trials, preferably randomized, published in English from 1985 to 2001 inclusive. Thirty studies were located and scored according to set criteria, and the interventions' research quality and clinical significance were judged.SETTING: Home or noninstitutional environment.PARTICIPANTS: Informal CGs—persons providing unpaid care at home or in a noninstitutional setting.MEASUREMENTS: The primary measures were psychological morbidity and burden. Other varied outcome measures such as CG coping skills and social support were combined with measures of psychological distress and burden to form a main outcome measure.RESULTS: The quality of research increased over the 17 years. Results from 30 studies (34 interventions) indicated, at most‐current follow‐up, significant benefits in caregiver psychological distress (random effect size (ES) = 0.31; 95% confidence interval (CI) = 0.13–0.50), caregiver knowledge (ES = 0.51; CI = 0.05–0.98), any main caregiver outcome measure (ES = 0.32; CI = 0.15–0.48), and patient mood (ES = 0.68; CI = 0.30–1.06), but not caregiver burden (ES = 0.09; CI = −0.09–0.26). There was considerable variability in outcome, partly because of differences in methodology and intervention technique. Elements of successful interventions could be identified. Success was more likely if, in addition to CGs, patients were involved. Four of seven studies indicated delayed nursing home admission.CONCLUSION: Some CG interventions can reduce CG psychological morbidity and help people with dementia stay at home longer. Programs that involve the patients and their families and are more intensive and modified to CGs' needs may be more successful. Future research should try to improve clinicians' abilities to prescribe interventions.
Psychotropic Prescription Use by Community‐Dwelling Elderly in the United States
Authors: Aparasu Rajender R. , Mort Jane R. , Brandt Heather 
Published: December 2004

OBJECTIVES: To examine psychotropic prescription use in community‐dwelling elderly in the United States and its association with predisposing, enabling, and need factors.DESIGN: Retrospective analysis of the 1996 Medical Expenditure Survey (MEPS).SETTING: A national representative sample survey of the United States non‐institutionalized population.PARTICIPANTS: Community‐dwelling persons aged 65 and older participating in the MEPS.MEASUREMENTS: Psychotropic prescription use patterns and factors associated with the use of psychotropics in general as well as of individual classes, specifically antidepressants, antianxiety agents, and sedative/hypnotics.RESULTS: According to the MEPS, more than 6 million (19%) community‐dwelling elderly persons used psychotropic medications in 1996. Nearly 3 million (9.1%) elderly were taking antidepressants, almost 2.5 million (7.5%) antianxiety agents, and 1.5 million (4.8%) sedative/hypnotics. Several correlates of psychotropic prescription use were identified. Enabling (e.g., prescription insurance) and need (e.g., health status) factors were found to be consistently associated with the use of antidepressant, antianxiety, and sedative/hypnotic agents. Predisposing factors such as sex, race, region, and education varied with the type of psychotropic drug class examined.CONCLUSION: Nearly one in five community‐dwelling elderly persons used psychotropic medications, primarily antidepressants followed by antianxiety agents. Enabling and need factors were consistently associated with psychotropic classes examined, whereas most predisposing factors varied with the type of psychotropic drug class.
Prospective Evaluation of a Screen for Complex Discharge Planning in Hospitalized Adults
Authors: Holland Diane E. , Harris Marcelline R. , Pankratz V. Shane , Closson Diane C. , Matt‐Hensrud Natasha N. , Severson Mary A. 
Published: December 2004

OBJECTIVES: To test the predictive ability of the Probability of Repeated Admission (PRA) screen for nonroutine discharge planning (requiring new referrals for formal services).DESIGN: Prospective cohort.SETTING: Two hospitals within a large Midwestern, tertiary care, referral‐based system.PARTICIPANTS: Nine hundred ninety‐one hospitalized adults identified using a systematic sampling strategy.MEASUREMENTS: The PRA screen was administered, and use of nonroutine discharge planning resources and nonroutine discharge disposition were determined using observation and open record review. Prolonged length of stay was determined by comparing the actual length of stay with the combined average length of stay for diagnosis‐related groupings.RESULTS: Significant differences in PRA scores existed in two of three endpoints, but the differences were small, and the ranges of scores overlapped almost completely. Using, logistic regression, items predicting use of nonroutine discharge‐planning resources were self‐rated health, caregiver availability, age, and sex (chi‐square (χ2) = 105.7, df = 9, P < .001), accounting for 17.9% of the variability and area under receiver operating characteristic curve (AUC) of 0.74. Self‐rated health and sex predicted prolonged length of stay (χ2 = 15.3, df = 5, P = .009), but only explained 2.2% of the variability, with an AUC of 0.58. The predictors of nonroutine discharge disposition were self‐rated health, caregiver availability, age, sex, and diabetes mellitus (χ2 = 125.8, df = 11, P < .001), accounting for 23.0% of the variability, with an AUC of 0.79.CONCLUSION: The clinical utility of using the PRA as a screen for early identification of persons who use nonroutine discharge planning is limited, although certain individual items may be useful.
Screening for Preexisting Cognitive Impairment in Older Intensive Care Unit Patients: Use of Proxy Assessment
Authors: Pisani Margaret A. , Inouye Sharon K. , McNicoll Lynn , Redlich Carrie A. 
Published: December 2004

OBJECTIVES: To determine the prevalence of preexisting cognitive impairment (CI) in patients admitted to the medical intensive care unit (ICU) and compare two different proxy measures of preexisting CI in ICU patients.DESIGN: Cross‐sectional comparative study.SETTING: Urban university teaching hospital.PARTICIPANTS: One hundred thirty patients aged 65 and older admitted to the medical ICU.MEASUREMENTS: Two previously validated proxy measures of CI: the Modified Blessed Dementia Rating Scale (MBDRS) and the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE).RESULTS: The prevalence of preexisting CI in the ICU, determined using a combination of the measures, was 42%. Agreement between the two CI measures was 86%, with a kappa of 0.69, with discrepancies being related to the different domains measured by each instrument.CONCLUSION: There is a high prevalence of preexisting CI in patients admitted to the medical ICU. Both the MBDRS and IQCODE can be used to screen for preexisting CI in situations where direct patient assessment is not feasible. Future studies are needed to address physician recognition of CI and its effect on patient care decisions and outcomes.
Clinical aspects and outcomes of volunteer blood donors testing positive for hepatitis‐C virus infection in Taiwan: a prospective study
Authors: Liu Chun‐Jen , Chen Pei‐Jer , Shau Wen‐Yi , Kao Jia‐Horng , Lai Ming‐Yang , Chen Ding‐Shinn 
Published: December 2004

Abstract: Background/Aim: The natural history of hepatitis‐C virus (HCV) infection has been explored in volunteer blood donors, but not yet in hepatitis‐B endemic areas. Whether previous or concurrent hepatitis‐B virus (HBV) infection influences the natural history of HCV infection remains unknown. Thus, we followed the anti‐HCV‐positive blood donors who had past or concurrent HBV infection in Taiwan.Methods: From 1992 to 1993, 1588 anti‐HCV reactive volunteer blood donors were referred to us from the Taipei Blood Center and 879 (55%) repeatedly reactive for anti‐HCV were enrolled. Two hundred and forty‐three donors (HCV RNA seropositive rate 49% by polymerase chain reaction (PCR)) received regular follow‐ups (mean period: 4.9 years) with their liver disease status determined mainly by clinical and biochemical parameters, serum alpha‐fetoprotein level and imaging studies. Hepatitis‐C virus genotype and occult HBV infection were determined by PCR‐based assays.Results: Of the initial 879 subjects, 250 (28%) had chronic hepatitis, nine (1%) had liver cirrhosis (LC) and two (0.2%) had hepatocellular carcinoma (HCC) already. In the 243 regularly followed donors, 30% had repeatedly normal serum alanine aminotransferase (ALT) and 70% had more than once elevated ALT. Cirrhosis developed in four (1.6%; follow‐up period range: 2–6 years) and HCC in two (0.8%; follow‐up period: 3 and 4 years, respectively). Distribution of HCV genotype and hepatitis‐B surface antigen (HBsAg) did not differ between those with and those without elevation of ALT. Of the 15 donors with LC and/or HCC, only 1(7%) was positive for both HBsAg and HBV DNA and the other 14 were negative for both HBsAg and serum HBV DNA.Conclusions: Incidentally detected hepatitis‐C was progressive in a small proportion of anti‐HCV‐positive volunteer blood donors in Taiwan. Occult HBV infection played a minimal role in the development of LC in this donor population.
Multiple predator effects on size‐dependent behavior and mortality of two species of anuran larvae
Authors: Eklöv Peter , Werner Earl E. 
Published: December 2004

This study examined the effects of multiple predators on size‐specific behavior and mortality of two species of anuran larvae. Particularly, we focused on how trait changes in predators and prey may be transmitted to other species in the food web. In laboratory experiments, we examined the effects of bluegill sunfish, Lepomis macrochirus, and the odonate larva Anax junius on behavior and mortality of tadpoles of the bullfrog, Rana catesbeiana, and the green frog R. clamitans. Experiments were conducted with predators alone and together to assess effects on behavior and mortality of the tadpoles. The experiments were replicated on five size classes of the tadpoles to evaluate how responses varied with body size.

Predation rates by Anax were higher on bullfrogs than on green frogs, and both bullfrogs and green frogs suffered greater mortality from Anax than from bluegill. Bluegill only consumed green frogs. Predation rates by both predators decreased with increasing tadpole size and decreased in the non‐lethal (caged) presence of the other predator. Both anuran larvae decreased activity when exposed to predators. Bullfrogs, however, decreased activity more in the presence of Anax than in the presence of bluegill, whereas green frogs decreased activity similarly in the presence of both predators. The largest size class of green frogs, but not of bullfrogs, exhibited spatial avoidance of bluegill. These responses were directly related to the risk posed by the different predators to each anuran species. Anax activity (speed and move frequency) also was higher when alone than in the non‐lethal presence of bluegill. We observed decreased predation rate of each predator in the non‐lethal presence of the other, apparently caused by two different mechanisms. Bluegill decreased Anax mortality on tadpoles by restricting the Anax activity. In contrast, Anax decreased bluegill mortality on tadpoles by reducing tadpole activity. We discuss how the activity and spatial responses of the tadpoles interact with palatability and body size to create different mortality patterns in the prey species and the implications of these results to direct and indirect interactions in this system.
Regulation of the mutualism between yuccas and yucca moths: intrinsic and extrinsic factors affecting flower retention
Authors: Humphries Shelley A. , Addicott John F. 
Published: December 2004

Yuccas initiate far more flowers than they can mature as fruit, thereby providing opportunities for them to mature flowers of the highest quality. Flower quality in yuccas has both intrinsic and extrinsic components. Intrinsic components relate to flower morphology and inflorescence architecture. Yucca moths (Tegeticula spp.,
Incurvariidae), the sole pollinators and primary seed predators of most
yuccas (Yucca spp., Agavaceae), mediate extrinsic components of
flower quality through their ovipositions in flowers, and the quantity
and quality of pollen that they transfer. In addition, intrinsic and
extrinsic components interact as a function of flowering phenology and
moth activity within inflorescences.
We investigated selective abscission of flowers in Y. kanabensis
with respect to various combinations of intrinsic and extrinsic factors.
First, we considered the effect of high and low pollen loads delivered to
different subsets of flowers and in different presentation orders. In the
absence of moth ovipositions, Y. kanabensis is sensitive to the amount of pollen that moths deliver and tends to retain high pollen flowers, even when all flowers receive sufficient pollen for full fertilization. However, pollen delivery sequence and the position of flowers with an inflorescence modify this high pollen effect. We then considered the interplay between high and low pollen combined with moth ovipositions and found that the number of ovipositions dominated the pollen effect. Finally, we considered number of ovipositions in conjunction with different flowers in the blooming sequence while controlling pollen levels and found that the clear effect of ovipositions on flower fate can be tempered by where the flower is in the blooming sequence.  These results have implications for the regulation of the mutualism between yuccas and yucca moths, indicating that yuccas are capable of regulating costs, retaining flowers of relative high quality and selectively abscising the rest. Yucca sensitivity to several intrinsic and extrinsic factors allows the plant to respond flexibly to the pollination environment and several species of moths.
Genetic differentiation of life‐history traits within populations of the clonal plant Ranunculus reptans
Authors: Prati Daniel , Schmid Bernhard 
Published: December 2004

We tested the hypothesis that environmental heterogeneity can maintain genetic variation in life‐history traits within populations of the clonal plant Ranunculus reptans. This may be important for the further
evolution and potential adaptation to environmental change. Moreover, we
asked to what extent environmental heterogeneity can also reveal
trade‐offs among fitness components, in particular between sexual
reproduction and clonal growth. In the natural habitat of R.
reptans two distinct types of environment can often be found within
10 m distance: vegetation‐sparse zones close to the water
(“lake”) and zones of competition with grasses (mostly
Agrostis stolonifera) more inland (“land”). We grew
vegetative offspring of 16 land genotypes and 16 lake genotypes from four
populations in a plant room. Cuttings from each genotype were grown with
and without competition by the grass A. stolonifera and on two
different substrates, sand and gravel.
We found considerable environmental (E) and genetic (G) variation in
life‐history traits. Competition strongly reduced growth, branching,
flowering, and final biomass. Lake genotypes invested more into sexual
reproduction (measured as proportion of ramets that flowered), whereas
land genotypes invested more into vegetative reproduction (proportion of
rooted ramets). Significant G×E interactions were consistent with a
home‐away effect: land‐genotypes performed better if grown under
competition, lake‐genotypes without competition. These results indicate
that genetic variation and phenotypic plasticity in life‐history traits
of R. reptans are maintained in a heterogeneous environment,
thereby supporting the main hypothesis stated above. They further
demonstrate that genetic differentiation occurs even over very short
distances (10 m). We also found a significant genetic trade‐off between
sexual and vegetative reproduction (negative genetic correlation between
the proportion of flowering ramets and the proportion of rooted ramets).
In response to the supplementary question posed above, this suggests that
the environmental heterogeneity finds its correspondence in the
“genetic integration” of life‐history traits within the
phenotype of R. reptans.