bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outcomes of Older People Admitted to Postacute Facilities with Delirium
Authors: Marcantonio Edward R. , Kiely Dan K. , Simon Samuel E. , John Orav E. , Jones Richard N. , Murphy Katharine M. , Bergmann Margaret A. 
Published: June 2005

Objectives: To compare outcomes of patients admitted to postacute skilled nursing facilities with delirium, subsyndromal delirium, and no delirium.Design: Observational cohort study.Setting: Seven skilled nursing facilities that specialize in postacute care within a single metropolitan region.Participants: Five hundred four subjects chosen from 1,248 consenting subjects aged 65 and older who underwent mental status testing within 5 days of admission to the participating facilities. Subjects who met full Confusion Assessment Method (CAM) criteria were classified as delirious, those with one or more CAM criteria were classified as having subsyndromal delirium, and those with no CAM features were classified as having no delirium. All subjects with delirium and with available medical records were included. A random subset of subjects with no delirium and subsyndromal delirium with available medical records was included.Measurements: The medical records of all subjects underwent a structured review by trained research nurses who were masked to the subjects' initial delirium status. Records were reviewed for the development of new complications within the postacute setting and to determine whether the subjects were discharged within 30 days and, if so, the discharge destination. The National Death Index was used to assess 6‐month mortality.Results: Subjects with delirium were more likely to experience one or more complications than subjects with no delirium (73% vs 41%, P < .01). Within 30 days of postacute admission, subjects with delirium were more than twice as likely to be rehospitalized (30% vs 13%), and less than half as likely to be discharged to the community (30% vs 73%) than subjects without delirium (differences P < .01). Subjects with subsyndromal delirium had outcomes intermediate between those with and without delirium. Finally, subjects admitted to the postacute setting with delirium experienced a 6‐month mortality rate of 25.0%, compared with 5.7% in subjects admitted without delirium. Subjects with subsyndromal delirium had a 6‐month mortality rate of 18.3%.Conclusion: Patients admitted to postacute skilled nursing facilities with delirium are more likely to experience complications, rehospitalization, and death than patients without delirium. These findings support the need for improved case finding and management of delirium in postacute care.
The Effects of Megestrol Acetate Suspension for Elderly Patients with Reduced Appetite After Hospitalization: A Phase II Randomized Clinical Trial
Authors: Reuben David B. , Hirsch Susan H. , Zhou Kefei , Greendale Gail A. 
Published: June 2005

Objectives: To provide preliminary evidence on the effectiveness and optimal dosage of megestrol acetate for older persons with impaired appetite after hospitalization.Design: Randomized clinical trial.Setting: Acute care hospital.Participants: Forty‐seven older persons (mean age 83) who were recently discharged from an acute care hospital and had fair or poor appetite.Intervention: Participants were randomized to placebo or megestrol acetate suspension 200 mg, 400 mg, or 800 mg daily for 9 weeks.Measurements: Appetite, health‐related quality of life, and adverse effects were measured at baseline and 20, 42, and 63 days. Serum nutritional markers were measured at baseline and 20 and 63 days.Results: During the course of the study, there were no significant differences between treatment groups on any of the appetite questions, although participants in the 400‐mg and 800‐mg groups demonstrated significant improvement from baseline on some questions. At 20 days, prealbumin increased in a dose‐response relationship across the four groups (by 0.4, 5.1, 7.5, and 9.0 mg/dL, respectively). Participants in the 400‐mg and 800‐mg groups demonstrated greater improvement in prealbumin levels at 20 days than those receiving placebo (P=.009 and P=.004, respectively) and those in the 400‐mg group also demonstrated improvement at 63 days (P=.02). At 20 days, no participant taking placebo had a morning serum cortisol level less than 8 ng/mL (the lower limit of normal). In contrast, 33%, 70%, and 78% of those taking 200 mg, 400 mg and 800 mg, respectively, had values below this level; by 63 days, these percentages were 11%, 30%, 56%, and 37%, respectively. No patient reported clinical symptoms of adrenal insufficiency. Diarrhea developed in three subjects, and thromboembolism occurred in two receiving active treatment.Conclusion: Megestrol acetate at doses of 400 mg and 800 mg increases prealbumin in recently hospitalized older persons. Cortisol suppression is common at higher doses and may be persistent. In this small study, the drug did not confer benefit on other nutritional or clinical outcomes.
Evaluation of Nationally Mandated Drug Use Reviews to Improve Patient Safety in Nursing Homes: A Natural Experiment
Authors: Briesacher Becky , Limcangco Rhona , Simoni‐Wastila Linda , Doshi Jalpa , Gurwitz Jerry 
Published: June 2005

Objectives: To test whether nationally required drug use reviews reduce exposure to inappropriate medications in nursing homes.Design: Quasi‐experimental, longitudinal study.Setting: Data source is the 1997–2000 Medicare Current Beneficiary Survey, a nationally representative survey of Medicare beneficiaries.Participants: Nationally representative population sample of 8 million nursing home (NH) residents (unweighted n=2,242) and a comparative group of 2 million assisted living facility (ALF) residents (unweighted n=664).Measurements: Prevalence and incident use of 38 potentially inappropriate medications compared before and after the policy: 32 restricted for all NH residents and six for residents with certain conditions. Inappropriate medications were stratified by potential for legitimate exceptions: always avoid, rarely appropriate, or some acceptable indications.Results: In July 1999, the Centers for Medicare and Medicaid Services (CMS) mandated expansions to the drug use review policy for nursing home certification. Using explicit criteria, surveyors and consultant pharmacists must evaluate resident records for potentially inappropriate medication exposures and related adverse drug reactions. Nursing homes in noncompliance may receive citations for deficient care. Before the CMS policy, 28.8% (95% confidence interval (CI)=27.3–30.3) of Medicare beneficiaries in NHs and 22.4% (95% CI=19.8–25.0) in ALFs received potentially inappropriate medications. Nearly all prepolicy use came from medications with some acceptable indications: 23.4% in NHs (95% CI=20.4–26.4) and 18.0% in ALFs (95% CI=15.6–20.4). After the policy, exposures in NHs declined to 25.6% (95% CI=24.1–27.1, P<.05), but similar declines occurred in ALFs (19.0%, 95% CI=16.7–21.3, nonsignificant). Postpolicy use of inappropriate medications with exempted indications remained high, and more than half was incident use: 20.6% of NH residents (95% CI=19.0–22.0) and 15.6% of ALF residents (95% CI=15.2–15.7). Use of drugs that are restricted with certain diseases increased 33% in NHs between 1997 and 2000 (from 9.3% to 13.2%; P<.05). Multivariate results detected no postpolicy differences in inappropriate drug use between long‐term care facilities with mandatory drug use reviews and those without.Conclusion: Some postpolicy declines were noted in NH use of potentially inappropriate medications, but the decrease was uneven and could not be attributed to the national drug use reviews. This study is the first evaluation of the CMS policy, and it highlights the unclear effectiveness of drug use reviews to improve patient safety in NHs even though state and federal agencies have widely adopted this strategy.
Evaluating Potentially Modifiable Risk Factors for Prevalent and Incident Nocturia in Older Adults
Authors: Johnson Theodore M. , Sattin Richard W. , Parmelee Patricia , Fultz Nancy H. , Ouslander Joseph G. 
Published: June 2005

Objectives: To examine associations between nocturia and potentially modifiable risk factors in older adults.Design: Secondary analysis of cross‐sectional and longitudinal data.Setting: Respondents were selected using population‐based sampling, drawing from a single Michigan county in 1983. They were followed through 1990.Participants: Community‐living adults aged 60 and older.Measurements: Episodes of nocturia, development of nocturia at 2 years after baseline survey, age, sex, hypertension, diabetes mellitus, drinking fluids before bedtime, amount of fluid intake before bedtime, diuretic use, and 24‐hour coffee intake. All measures were self‐reported.Results: Bivariate cross‐sectional analysis revealed significant associations with two or more episodes of nocturia for hypertension (odds ratio (OR)=1.7, 95% confidence interval (CI)=1.37–2.1), diabetes mellitus (OR=1.51, 95% CI=1.1–2.0), diuretic use (OR=1.7, 95% CI=1.3–2.1), age (OR=1.05 per additional year over 60, 95% 1.03–1.06), and number of cups of coffee (OR=0.93 for each cup of coffee, 95% CI=0.89–0.97). In multivariate analysis, hypertension (OR=1.52, 95% CI=1.2–1.9), diuretic use (OR=1.3, 95% 95% CI=1.0–1.7), and age (OR=1.04 per additional year over 60, 95% 1.03–1.06) were independently associated with two or more nocturia episodes per night. No baseline factors predicted future development of nocturia (save for age, in one model).Conclusion: Hypertension, older age, and diuretic use were independently associated with two or more episodes of nocturia in cross‐sectional analysis. No baseline factor was related to the development of nocturia over a 2‐year interval in this sample. Nighttime fluid intake and coffee intake, practices providers commonly target in patients with nocturia, were not associated with nocturia in this population‐based sample of community‐living older adults.
Depression in Older Patients Admitted for Postacute Nursing Home Rehabilitation
Authors: Webber Adam P. , Martin Jennifer L. , Harker Judith O. , Josephson Karen R. , Rubenstein Laurence Z. , Alessi Cathy A. 
Published: June 2005

Objectives: To describe the prevalence, recognition, and persistence of depression in older adults undergoing postacute rehabilitation in a nursing home (NH) setting and to explore the effect of depression on rehabilitation outcomes.Design: Prospective cohort study.Setting: One rehabilitative NH in the Los Angeles area.Participants: One hundred fifty‐eight patients (aged ≥65) admitted for postacute rehabilitation over a 9‐month recruitment period.Measurements: Depression was assessed using the 15‐item Geriatric Depression Scale (GDS‐15) or the Cornell Scale for Depression (in participants with dementia). Medical records were reviewed for documentation of depression and antidepressant use before and during the rehabilitative NH stay. Rehabilitation process was assessed using total amount of successfully completed therapy (minutes). Rehabilitation outcome was assessed using the motor component of the Functional Independence Measure (mFIM). Measures were performed at admission and 2 months later.Results: Of the 646 potentially eligible patients admitted during the study, 158 consented, and 151 were screened for depression. Forty‐two (27.8%) had depressive symptoms (GDS=6 or Cornell=5). Of these, only 15 had a documented diagnosis of depression, and 12 were receiving antidepressants. Depression was associated with longer NH stay but not with discharge mFIM score. Two months later, depression persisted in 24 participants and was associated with worse mFIM (55.5±22.7 vs 67.0±23.7, depressed vs nondepressed; P=.03).Conclusion: Depression was common, underrecognized, and undertreated in these postacute rehabilitation patients. Depression generally persisted and was associated with worse functional status at 2‐month follow‐up.
Prevalence of Appropriate and Problematic Antiepileptic Combination Therapy in Older People in the Nursing Home
Authors: Harms Susan L. , Eberly Lynn E. , Garrard Judith M. , Hardie Nancy A. , Bland Pat C. , Leppik Ilo E. 
Published: June 2005

Objectives: To determine the prevalence of mono‐ and poly‐antiepileptic drug (AED) therapy in a cohort of nursing home (NH) residents and to describe specific AED combinations used, as well as demographic, clinical, and functional factors associated with poly‐AED therapy and the most common AED combination.Design: Retrospective, point prevalence study.Setting: All NHs owned/managed by Beverly Enterprises.Participants: All residents aged 65 and older residing in one of the study NHs on July 1, 1999, and receiving an AED (N=3,881).Measurements: Data were gathered using two secondary source data sets: physicians' orders (AED use) and the Minimum Data Set (health status indicators).Results: Of residents taking AEDs, 370 (9.5%) were taking two or more; 268 of those (72%) were taking problematic AED combinations (those with the potential of undesirable pharmacokinetic or pharmacodynamic interactions). Phenytoin (PHT) with phenobarbital (PB) was the most common combination (27.0%). Logistic regression indicated that poly‐AED subjects were more likely to have a diagnosis of epilepsy/seizure (epi/sz) and less likely to have a diagnosis of cerebrovascular accident (CVA). Residents taking the PHT/PB combination were more likely to have an epi/sz diagnosis and longer NH stay. The association between CVA and PHT/PB polytherapy differed by presence or absence of aphasia.Conclusion: The overall prevalence of poly‐AED therapy is less than 10% in NH residents, but 72% of those residents were receiving problematic polytherapy combinations, thereby exposing them to potential risk of adverse reactions and toxicity.
Microbial contamination of hematopoietic progenitor cell grafts—incidence, clinical outcome, and cost‐effectiveness: an analysis of 735 grafts
Authors: Kamble Rammurti , Pant Shubham , Selby George B. , Kharfan‐Dabaja Mohamed A. , Sethi Sanjay , Kratochvil Kristen , Kohrt Nancy , Ozer Howard 
Published: June 2005

BACKGROUND: Screening of progenitor cell grafts (marrow, peripheral blood, and cord blood) for microbial contamination is required by the standards of AABB. Clinical sequelae from infusion of these contaminated grafts, however, is uncommon.STUDY DESIGN AND METHODS: A retrospective analysis of 735 consecutive marrow and peripheral blood progenitor cell harvests between 1998 and 2003 was performed. Analysis included incidence, clinical outcome, and cost outcomes of positive blood cultures and antibiotic therapy.RESULTS: Thirty‐three of 735 (4.5%) harvests were contaminated. The incidence of microbial contamination varied with the source of the graft (4 of 26 [15%] were cord blood, 8 of 177 [4.5%] were marrow, and 21 of 532 [3.9%] were peripheral blood). Coagulase‐negative Staphylococcus (n = 22) and Propionibacterium acnes (n = 8) were most frequently isolated. Potentially pathogenic organisms were isolated in 6 of 735 (0.81%) grafts (methicillin‐sensitive Staphylococcus aureus, 4; methicillin‐resistant S. aureus, 1; and Enterobacter cloacae, 1). The estimated total cost of surveillance was approximately $81,585. The cost of vancomycin therapy in 4 patients who received prophylactic antibiotic therapy was approximately $10,000. No adverse sequelae followed infusion of contaminated grafts.CONCLUSION: Clinical sequelae following infusion of microbially contaminated progenitor cells is extremely rare. Prophylactic empiric antibiotics may be unnecessary. Routine microbial surveillance of progenitor cell grafts is a low‐yield procedure.
Issues in the quality of umbilical cord blood stem cells for transplantation
Authors: McCullough Jeffrey , McKenna David , Kadidlo Diane , Schierman Therese , Wagner John 
Published: June 2005

BACKGROUND: Because the frequency of umbilical cord blood (UCB) stem cell transplantation has increased, the quality of UCB available in banks is an important part of the success of UCB stem cell transplants.STUDY DESIGN AND METHODS: A quality assurance monitoring system was used to evaluate 268 UCB units provided to us for transplant by UCB banks in the United States and Europe.RESULTS: Quality issues were found in 151 (56%) of 268 units, and there were a total of 246 specific issues in 151 units. The issues involved quality control (54%), medical history (40%), and labels and documentation (6%). Risks to patients from these issues were likely in 10 percent, potential in 35 percent, and unlikely in 55 percent.CONCLUSION: Because standards have evolved over time, cord blood banks contain units that have different levels of quality. Some units have been placed in the usable inventory with incomplete test results and/or documentation or that may not meet the bank's own current criteria. Information about any quality or operating procedure deviation should be provided in sufficient detail and at the initiation of the search process so that transplant physicians can consider these quality issues against the unique value of a particular UCB unit.
Results of a hepatitis C general transfusion lookback program for patients who received blood products before July 1992
Authors: Williams James L. , Cagle Henry H , Christensen Carol J. , Fox‐Leyva Leslie K. , McMahon Brian J. 
Published: June 2005

BACKGROUND: The Centers for Disease Control and Prevention recommend hepatitis C virus (HCV) antibody (anti‐HCV) screening for persons who received blood products before July 1992. A general transfusion lookback program was implemented to identify, counsel, and screen persons who received transfusions at the Alaska Native Medical Center between January 1980 and July 1992.STUDY DESIGN AND METHODS: Hard‐copy transfusion records data were entered, and available databases were queried to identify deceased patients and the mailing address of those living. Patients were notified by letter of their HCV risk and encouraged to seek counseling and testing. Serum samples were screened for anti‐HCV and HCV RNA, and program costs were estimated.RESULTS: Overall, 3169 transfusion recipients were identified, with 1356 (43%) living and targeted for notification. Of 764 patients notified and screened by this program, 41 (5%) were anti‐HCV–positive and 19 (2%) were HCV RNA–positive. There was a higher probability of detecting anti‐HCV with each subsequent increase of a transfusion event. Among 298 lookback patients, 33 percent were unaware of having received a blood transfusion. The estimated cost per person sent notification was US$57 and to detect an anti‐HCV–positive case it was US$3146.CONCLUSION: This general transfusion lookback program successfully notified and screened patients at a reasonable cost. Further investigation would be helpful in determining the role these programs or other measures could play in promoting HCV screening in persons receiving transfusions before July 1992, especially among those who are unaware of their transfusion history.
Onset of expression of the components of the Kell blood group complex
Authors: Pu Jeffrey J. , Redman Colvin M. , Visser Jan W.M. , Lee Soohee 
Published: June 2005

BACKGROUND:Kell and XK, two distinct red blood cell membrane proteins, are linked by a disulfide bond and form the Kell blood group complex. Kell surface antigens are expressed early during erythropoiesis but the onset of expression of XK which carries the Kx antigen is unknown.STUDY DESIGN AND METHODS:To determine whether Kell and XK are synchronously expressed, sorted human hematopoietic progenitor cells and mouse progenitor cells of defined lineage were studied. To determine the onset of expression, human marrow and cord blood cells were sorted into three subpopulations, representing stem, multipotent, and erythroid progenitor cells, and the expression of Kell and XK was determined by reverse transcription–polymerase chain reaction (RT‐PCR) and fluorescence‐activated cell sorting (FACS) analysis. Mouse Kell and XK transcripts were determined by cDNA blotting of progenitor cells of defined lineage.RESULTS:By RT‐PCR, human peripheral blood progenitor cells had weak expression of Kell and XK transcripts but FACS analysis did not detect surface antigens. Kell and XK transcripts are expressed in multipotent progenitor cells and these cells express Kell surface antigens. The expression of Kx antigen in progenitor cells was not determined owing to nonspecific reactions with the antibody. By cDNA blotting, mouse Kell expression was detected in bipotential megakaryocytes‐erythroid cells and in colony‐forming units–erythroid (CFU–E) and burst‐forming units–erythroid (BFU–E), whereas XK was only detected in CFU‐E and BFU‐E.CONCLUSION:Both Kell and XK transcripts occur early during erythropoiesis; however, expression may not be coincident because, in mice, Kell transcripts, but not XK, occur in bipotential megakaryocytes‐erythroid progenitor cells.
Placebo‐controlled study of intravenous magnesium supplementation during large‐volume leukapheresis in healthy allogeneic donors
Authors: Haddad Salim , Leitman Susan F. , Wesley Robert A. , Cecco Stacey , Yau Yu Ying , Starling Judith , Rehak Nadja N. , Bolan Charles D. 
Published: June 2005

BACKGROUND: Marked decreases in ionized magnesium (iMg) levels occur during large‐volume leukapheresis (LVL); however, the effect of intravenous (IV) magnesium supplementation in this setting has not been carefully studied.STUDY DESIGN AND METHODS: Thirty healthy allogeneic peripheral blood progenitor cell donors receiving citrate anticoagulant with IV calcium prophylaxis were randomized to receive either IV magnesium (0.2 mg Mg per mL acid citrate dextrose‐A) or placebo during LVL, with a double‐blind design.RESULTS: Thirty subjects underwent 75 LVL pro‐ cedures, 37 with magnesium and 38 with placebo. Group characteristics were similar for sex, weight, citrate infusion rate (1.36 mg/kg/min vs. 1.37 mg/kg/min), and volume processed (16 L vs. 17 L). Serum iMg levels remained within the reference range with magnesium supplementation, but decreased 39 ± 11 percent below baseline (p < 10−10) after placebo, with greater decreases after consecutive procedures. Subjects receiving magnesium had more vigorous parathyroid hormone responses and higher glucose levels and also tended to have higher serum potassium and ionized calcium levels. Mild paresthesias, coldness, and nausea occurred in 28, 20, and 7 percent of donors, respectively, with no significant differences between groups. Severe symptoms (chest tightness) occurred in only one subject receiving placebo.CONCLUSION: IV magnesium supplementation exerts a significant impact on serum magnesium levels, but does not reduce the frequency or severity of the relatively mild citrate‐related effects observed in LVL performed with continuous IV calcium prophylaxis.