bluuebunny/crossref_metadata_2025_split huggingface dataset:
Elder Financial Abuse: An Evaluation Framework and Supporting Evidence
Authors: Kemp Bryan J. , Mosqueda Laura A. 
Published: August 2005

Objectives: To develop a valid and reliable framework for evaluating cases of alleged elder financial abuse.Design: Experienced experts in elder financial abuse rated a framework with eight elements.Setting: Professionals attending an advanced training course on elder abuse.Participants: Deputy district attorneys (n=44), senior law enforcement detectives (n=59), Adult Protective Service workers, and public guardians and victim advocates (n=56) who had a combined total of 1,985 years of experience and who had investigated a total of 3,225 cases (mean of 13.1 years and 21.2 cases) were included.Measurements: These experienced professionals were asked to rate how well an evaluative framework matched their experience with elder financial abuse using a 5‐point rating scale ranging from very little to almost entirely.Results: The mean rating for the model was 4.4 out of 5. About 90% of the sample rated it as almost entirely or very much matching their experience. There were no differences between professions. The reliability measure was 0.85.Conclusion: These results suggest a reliable and valid framework for evaluating cases of possible elder financial abuse.
End‐of‐Life Care in Black and White: Race Matters for Medical Care of Dying Patients and their Families
Authors: Welch Lisa C. , Teno Joan M. , Mor Vincent 
Published: August 2005

Objectives: To compare the end‐of‐life medical care experienced by African‐American and white decedents and their families.Design: Cross‐sectional, retrospective survey with weighted results based on a two‐stage probability sampling design.Setting: Hospitals, nursing homes, and home‐based medical services across the United States.Participants: Surrogates (N=1,447; primarily family members) for decedents from 22 states.Measurements: Validated end‐of‐life care outcomes concerning symptom management, decision‐making, informing and supporting families, individualized care, coordination, service utilization, and financial impact.Results: Family members of African‐American decedents were less likely than those of white decedents to rate the care received as excellent or very good (odds ratio (OR)=0.4). They were more likely to report absent (OR=2.4) or problematic (OR=1.9) physician communication, concerns with being informed (OR=2.5), and concerns with family support (OR=2.6). Family members of African Americans were less likely than those of whites to report that the decedent had treatment wishes (OR=0.3) or written advance care planning documents (OR=0.4). These differences persist when limiting the sample to respondents whose expectations for life‐sustaining treatments matched treatments received. Family members of African‐American decedents also were more likely to report financial hardship due to savings depletion (OR=2.1) or difficulty paying for care (OR=2.0) and that family/friends (OR=2.0) or home health workers (OR=1.9) provided home care.Conclusion: This national study brings evidence that racial disparities persist into end‐of‐life care, particularly regarding communication and family needs. Results also suggest different home care patterns and levels of financial impact.
Functional Incidental Training: A Randomized, Controlled, Crossover Trial in Veterans Affairs Nursing Homes
Authors: Ouslander Joseph G. , Griffiths Patricia C. , McConnell Eleanor , Riolo Lisa , Kutner Michael , Schnelle John 
Published: August 2005

Objectives: To test the effects of a rehabilitative intervention directed at continence, mobility, endurance, and strength (Functional Incidental Training (FIT)) in older patients in Department of Veterans Affairs (VA) nursing homes.Design: Randomized, controlled, crossover trial.Setting: Four VA nursing homes.Participants: All 528 patients in the nursing homes were screened; 178 were eligible, and 107 were randomized to an immediate intervention group (Group 1; n=52) and a delayed intervention group (Group 2; n=55).Intervention: Trained research staff provided the FIT intervention, which included prompted voiding combined with individualized, functionally oriented endurance and strength‐training exercises offered four times per day, 5 days per week, for 8 weeks. Group 1 received the intervention while Group 2 served as a control group; then Group 2 received the intervention while Group 1 crossed over to no intervention. A total of 64 subjects completed the intervention phase of the trial.Measurements: Timed measures of walking or wheeling a wheelchair (mobility), sit‐to‐stand exercises, independence in locomotion and toileting as assessed using the Functional Independence Measure (FIM), one‐repetition maximum weight for several measures of upper and lower body strength, frequency of urine and stool incontinence, and appropriate toileting ratios.Results: There was a significant effect of the FIT intervention on virtually all measures of endurance, strength, and urinary incontinence but not on the FIM for locomotion or toileting. The effects of FIT were observed when Group 1 received the intervention and was compared with the control group and when Group 2 crossed over to the intervention. Group 1 deteriorated in all measures during the 8‐week crossover period. Within‐person comparisons also demonstrated significant effects on all measures in the 64 participants who completed the intervention; 43 (67%) of these participants were “responders” based on maintenance or improvement in at least one measure of endurance, strength, and urinary incontinence. No adverse events related to FIT occurred during the study period.Conclusion: FIT improves endurance, strength, and urinary incontinence in older patients residing in VA nursing homes. Translating these positive benefits achieved under research conditions into practice will be challenging because of the implications of the intervention for staff workload and thereby the costs of care.
Do Age and Comorbidity Affect Intensity of Pharmacological Therapy for Poorly Controlled Diabetes Mellitus?
Authors: Chaudhry Sarwat I. , Berlowitz Dan R. , Concato John 
Published: August 2005

Objectives: To examine the influence of age and comorbidity on intensification of medical therapy for patients with poorly controlled diabetes mellitus (DM).Design: Observational cohort study using data from Department of Veterans Affairs (VA) national databases.Setting: Thirteen VA medical centers in New England, Florida, and Puerto Rico.Participants: Veterans (N=5,317) with poorly controlled DM receiving regular medical careMeasurements: An increase in hypoglycemic medications, or intensification of therapy, was considered present at the visit if a new hypoglycemic medication was started or the dosage of an existing medication was increased.Results: The overall rate of intensification of therapy was 20.8% (1,106/5,317). The rate of intensification was highest in the youngest patients without comorbidity (24.5%) and lowest in the oldest patients with comorbidity (15.7%) (P<.001).Conclusion: Rates of intensification at a single clinic visit were quite low in all groups and were lowest in older patients with comorbidity.
Community‐Acquired Thoracic Empyema in Older People
Authors: Tsai Tzu‐Hsiu , Jerng Jih‐Shuin , Chen Kuan‐Yu , Yu Chong‐Jen , Yang Pan‐Chyr 
Published: August 2005

Objectives: To compare the clinical characteristics of community‐acquired thoracic empyema in older and younger patients and to analyze the effect of various factors on outcome.Design: A retrospective, comparative observational study.Setting: A university‐affiliated tertiary medical center.Participants: Forty‐six patients aged 65 and older (older group) and 86 patients aged 18 to 64 (younger group).Measurements: Demographic, clinical, and microbiological data were reviewed.Results: Older patients were more likely to have dyspnea but less likely to have chest pain or fever (P<.05 for all). The causative organisms were similar between the two groups, with anaerobes and facultative streptococci the most common pathogens. Older patients had increased morbidity and longer hospital stay (median 29.5 vs 20 days, P<.001), but the in‐hospital mortality was not significantly different between the two groups (13% vs 8%, P=.37). Multivariate analysis showed that coexisting malignancy (odds ratio (OR)=10.33, P=.01), lack of fever higher than 38°C (OR=17.97, P=.03), and isolation of fungi from pleural fluid (OR=32.66, P=.01) were independently and significantly associated with in‐hospital deaths.Conclusion: The microbiology and mortality of community‐acquired thoracic empyema were similar between the two age groups. Difference in chronological age did not explain in‐hospital death. This finding highlights the importance of effective treatment to obtain better outcomes for older patients.
Reduction in Fear of Falling Through Intense Tai Chi Exercise Training in Older, Transitionally Frail Adults
Authors: Sattin Richard W. , Easley Kirk A. , Wolf Steven L. , Chen Ying , Kutner Michael H. 
Published: August 2005

Objectives: To determine whether an intense tai chi exercise program could reduce fear of falling better than a wellness education (WE) program in older adults who had fallen previously and meet criteria for transitioning to frailty.Design: Cluster‐randomized, controlled trial of 48 weeks' duration.Setting: Ten matched pairs of congregate living facilities in the greater Atlanta area.Participants: Sample of 291 women and 20 men, aged 70 to 97.Measurements: Activity‐related fear of falling using the Activities‐Specific Balance Confidence Scale (ABC) and the Fall Efficacy Scale at baseline and every 4 months for 1 year. Demographics, time to first fall and all subsequent falls, functional measures, Centers for Epidemiologic Studies Depression Scale, medication use, level of physical activity, comorbidities, and adherence to interventions.Results: Mean ABC was similar in both cohort groups at the time of randomization but became significantly higher (decreased fear) in the tai chi cohort at 8 months (57.9 vs 49.0, P<.001) and at study end (59.2 vs 47.9, P<.001). After adjusting for covariates, the mean ABC after 12 months of intervention was significantly greater in the tai chi group than in the WE group, with the differences increasing with time (mean difference at 12 months=9.5 points, 95% confidence interval=4.8–14.2, P<.001).Conclusion: Tai chi led to a significantly greater reduction in fear of falling than a WE program in transitionally frail older adults. The mean percentage change in ABC scores widened between tai chi and WE participants over the trial period. Tai chi should be considered in any program designed to reduce falling and fear of falling in transitionally frail older adults.
Multichannel Data Acquisition System for Mapping the Electrical Activity of the Heart
Authors: CIACCIO EDWARD J. , SALTMAN ADAM E. , HERNANDEZ OSCAR M. , BORNHOLDT REIDAR J. , COROMILAS JAMES 
Published: August 2005

Background: Details of the electrical conduction pattern of the heart are revealed to the electrophysiologist when multichannel data are used for activation mapping. Commercial electronic systems are available for simultaneous acquisition of many surface electrograms; however, the cost of these systems may be prohibitive and they can be mostly inflexible for adaptation to other research projects. Furthermore, the hardware and software design is often proprietary. In this article we describe the in‐house design and implementation of a 320‐multichannel acquisition system for animal electrophysiologic research.
Method and Results: Several modules comprise this system. The multichannel data are first preprocessed by amplification, filtering, and analog multiplexing. An algorithm for automatic adjustment of signal gains is implemented to maximize the voltage resolution and minimize noise pickup. Signals are then digitized, and sequenced to order the multichannel data and to add markers required for analysis. The digital data are streamed to archival storage media. Additionally, the electrocardiogram (ECG), blood pressure, and stimulus channel signals are stored simultaneously. Selected signals are then displayed in real‐time for measurement and analysis and as a check of the system integrity. Examples of multielectrode arrays and surface recordings are provided. Costs for building such a system are estimated.
Conclusions: Multichannel data acquisition systems that are designed and constructed in‐house have several advantages over turnkey commercial systems, including the potential for considerable cost savings, flexibility in acquiring data, and the ability to subsequently add additional components.
Understanding Atrial Symptom Reports: Objective versus Subjective Predictors
Authors: SEARS SAMUEL F. , SERBER EVA R. , ALVAREZ LUIS G. , SCHWARTZMAN DAVID S. , HOYT ROBERT H. , UJHELYI MICHAEL R. 
Published: August 2005

Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with a variety of symptoms such as dizziness, palpitations, shortness of breath, and other signs of heart failure, which in turn impact quality of life (QOL). Implantable cardioverter defibrillators with atrial therapies (ICDs‐ATs) have been shown to reduce AF symptoms and improve QOL in select AF samples.
Method: This study examined the strength of relationships between objective (device‐detected AF events) versus subjective (emotional symptoms) data and AF symptoms (number) reported as part of the Patient Atrial Shock Survey of Acceptance and Tolerance Study (N = 96, 72% men, M age = 65, SD = 12). Depression and anxiety were assessed via the Center for Epidemiological Studies—Depression Scale and the‐State Trait Anxiety Inventory. AF disease burden was measured via a number of device‐detected AF episodes and the Atrial Tachyarrhythmia Symptom Severity Scale.
Results: Hierarchical multiple regression analysis indicated that negative emotions accounted for a significant 13.2% of unique variance in AF symptom score (F change (1, 54) = 9.625, P = 0.003). On the other hand, the number of device‐detected AF episodes accounted for non‐significant 8.2% of unique variance in the AF symptom score (P = 0.167). The full model explained 25.7% of the variance in AF symptom score (F(6, 54) = 3.110, P = 0.011). Specifically, greater number of treated AF episodes (β= 0.251, P = 0.043) and higher levels of negative emotions (β= 0.369, P = 0.003) predicted greater number of reported AF symptoms.
Conclusion: Therefore, psychological distress may be a significant confounding factor affecting patient's report of AF symptoms rather than the actual experience of recurrent AF episodes.
Implant Experience with an Implantable Hemodynamic Monitor for the Management of Symptomatic Heart Failure
Authors: STEINHAUS DAVID , REYNOLDS DWIGHT W. , GADLER FREDRIK , KAY G. NEAL , HESS MIKE F. , BENNETT TOM ,   For The Chronicle Investigators
Published: August 2005

Introduction: Management of congestive heart failure is a serious public health problem. The use of implantable hemodynamic monitors (IHMs) may assist in this management by providing continuous ambulatory filling pressure status for optimal volume management.
Methods and Results: The Chronicle® system includes an implanted monitor, a pressure sensor lead with passive fixation, an external pressure reference (EPR), and data retrieval and viewing components. The tip of the lead is placed near the right ventricular outflow tract to minimize risk of sensor tissue encapsulation. Implant technique and lead placement is similar to that of a permanent pacemaker. After the system had been successfully implanted in 148 patients, the type and frequency of implant‐related adverse events were similar to a single‐chamber pacemaker implant. R‐wave amplitude was 15.2 ± 6.7 mV and the pressure waveform signal was acceptable in all but two patients in whom presence of artifacts required lead repositioning. Implant procedure time was not influenced by experience, remaining constant throughout the study.
Conclusion: Based on this evaluation, permanent placement of an IHM in symptomatic heart failure patients is technically feasible. Further investigation is warranted to evaluate the use of the continuous hemodynamic data in management of heart failure patients.
Atypical Proarrhythmia with Dofetilide: Monomorphic VT and Exercise‐Induced Torsade de Pointes
Authors: REIFFEL JAMES A. 
Published: August 2005

Proarrhythmia with dofetilide has most typically taken the form of torsade de pointes (TdP) and generally occurs early with therapy, such that in‐hospital initiation of dofetilide with 3 days of continuous electrocardiogram monitoring is recommended. This article reports two unusual variants of ventricular proarrhythmia with dofetilide: (1) nonsustained runs of monomorphic ventricular tachycardia shortly after taking the first dose of dofetilide, confirmed by rechallenge; and (2) TdP that followed the development of isolated ventricular premature beats during an exercise test in a patient with neither excessive QT prolongation on dofetilide nor any ectopy whatsoever during in‐hospital telemetric monitoring but with significant QT interval prolongation after the postectopic pause. These cases demonstrate that clinicians must be alert to the appearance of proarrhythmia with dofetilide at times other than early during drug initiation if the electrophysiological milieu is altered during nonhospital activity and/or of a pattern other than TdP.
Invasive Optimization of Cardiac Resynchronization Therapy: Role of Sequential Biventricular and Left Ventricular Pacing
Authors: KURZIDIM KLAUS , REINKE HEINRICH , SPERZEL JOHANNES , SCHNEIDER HANS JÜRGEN , DANILOVIC DEJAN , SIEMON GREGOR , NEUMANN THOMAS , HAMM CHRISTIAN W. , PITSCHNER HEINZ‐FRIEDRICH 
Published: August 2005

Background: Aim of this invasive study was to characterize and quantify changes in left ventricular (LV) systolic function due to sequential biventricular pacing (BV) as compared to right atrial triggered simultaneous BV (BV0), LV, and right ventricular (RV) pacing in patients with congestive heart failure (CHF).
Methods: In 22 CHF patients, all in sinus rhythm, temporary multisite pacing was performed prior to implantation of a permanent system. LV systolic function was evaluated invasively by the maximum rate of LV pressure increase (dP/dtmax). Sequential BV pacing was performed with preactivation of either ventricle at 20–80 ms.
Results: In comparison to RV pacing, LV and BV0 pacing increased dP/dtmax by 33.9 ± 19.3% and 34.0 ± 22.6%, respectively (P < 0.001). In 9 patients, optimized sequential BV pacing further improved dP/dtmax by 8.5 ± 4.8% compared to BV0 (range 3.3–17.1, P < 0.05). In 10 patients exhibiting a PR interval ≤200 ms, LV pacing was either superior (n = 6) or equal to BV0 pacing (n = 4). In these 10 patients, LV pacing yielded a 7.4 ± 8.0% higher dP/dtmax than BV0 pacing (P < 0.05).
Conclusions: Using sequential BV pacing, generally with LV preactivation, moderate improvements in LV systolic function can be achieved in selected patients. Baseline PR interval may aid in the selection of the optimum cardiac resynchronization therapy (CRT) mode, favoring LV pacing in patients with a PR interval ≤200 ms.
Continuous Positive Airway Pressure Treatment Improves the QT Rate Dependence Adaptation of Obstructive Sleep Apnea Patients
Authors: ROCHE FRÉDÉRIC , BARTHÉLÉMY JEAN‐CLAUDE , GARET MARTIN , DUVERNEY DAVID , PICHOT VINCENT , SFORZA EMILIA 
Published: August 2005

Background: QT rate dependence is one of the major properties of ventricular repolarization, with its circadian and autonomic modulations. The alteration of cardiac autonomic tone occurring in obstructive sleep apnea syndrome (OSAS) patients could explain the altered rate‐dependent adaptation of the myocardial repolarization. Thus, we postulated that dynamic alterations in QT interval adaptation could be ameliorated in OSAS patients under continuous positive airway pressure (CPAP) treatment. To assess ventricular repolarization features in patients with OSAS, we compared QT parameters and their dynamicities along RR intervals from 24‐hour ECG.
Methods: The study groups consisted of 38 consecutive OSAS patients and 38 healthy age‐matched subjects. The syndrome was confirmed for OSAS patients according to standard polysomnographic criteria (apnea plus hypopnea index: 56.9 ± 28.4/h). A second polysomnography synchronized with 24‐hour ECG Holter and realized under efficient CPAP therapy confirmed the control of sleep‐related breathing disorder.
Results: QT length related to heart rate was found significantly altered in patients with OSAS compared with controls (QTend/RR slope: −0.126 ± 0.031 vs −0.173 ± 0.038; P < 0.01). This flattened relationship was significantly improved with the treatment of the OSAS (−0.151 ± 0.051; P < 0.01 vs pretreatment status). There was no significant impact of CPAP therapy on ventricular ectopic activity as well as on static repolarization parameters (QT, RT, QTc, RTc) measured separately over daytime and nighttime.
Conclusions: The prognostic implications of such findings and the protective role of CPAP treatment to prevent sudden cardiac death in OSAS need to be evaluated.
Preoperative insertion of transanal ileus tubes for treatment of acute obstruction in cancer of the colon and rectum
Authors: OKI Eiji , OKUYAMA Toshiro , HIGASHI Hidefumi , YOSHIDA Michio , BABA Hideo , MAEHARA Yoshihiko 
Published: August 2005

AbstractBackground/Aims:  To evaluate the usefulness of treatment with a transanal ileus tube for acute obstruction in patients with cancer of colon and rectum.Materials and methods:  In 12 patients with colorectal obstruction due to cancer treated between 1999 and 2001, lesions were located in the transverse colon, descending colon, sigmoid colon and rectum. Transanal ileus tube insertion was attempted for initial treatment and diagnosis.Results:  Insertion of a transanal ileus tube was successful in eight (67%) of 12 patients. Symptoms of obstruction were resolved and one‐stage operations were performed in‐all eight cases. In two cases, insertion failed and temporary colostomy was used before a two‐stage operation. Perforation of the rectum and sigmoid colon occurred during the insertion procedure in another two cases. These two cases underwent emergency tumor resection and colostomy.Conclusion:  Insertion of transanal ileus tube effectively relieved acute colonic obstruction. Furthermore, tube insertion allowed patients to undergo a one‐stage operation. However, tube insertion is not appropriate in all obstructive cases and the risk of severe complication must always be considered.