bluuebunny/crossref_metadata_2025_split huggingface dataset:
How EverCare Nurse Practitioners Spend Their Time
Authors: Kane Robert L. , Flood Shannon , Keckhafer Gail , Rockwood Todd 
Published: March 2003

OBJECTIVES: To describe how nurse practitioners (NPs) employed by EverCare, a Medicare HMO serving exclusively nursing home residents, spend their working days.DESIGN:A descriptive study based on structured self‐reports.SETTING:Nursing homes.PARTICIPANTS:Seventeen NPs employed by EverCare in five sites.MEASUREMENTS:Self‐reports of time spent over a 2‐week period and specific reports of how time was spent on selected cases.RESULTS:NPs spend about 35% of their working day on direct patient care and another 26% in indirect care activities. Of the latter, 46% of the time was spent interacting with nursing home staff, 26% with family, and 15% with the physicians. The mean time spent on a given patient per day was 42 minutes (median 30); of this time 20 minutes was direct care (median 15).CONCLUSIONS:NPs' activities are varied. Much of their time is spent communicating with vital parties, an important function that supports the physicians' primary care role and should enhance families' satisfaction with care. J Am Geriatr Soc 49:1530–1534, 2001.
Recovery from Poststroke Urinary Incontinence: Associated Factors and Impact on Outcome
Authors: Patel Mehool , Coshall Catherine , Lawrence Enas , G Rudd Anthony , Wolfe Charles DA 
Published: March 2003

OBJECTIVES: To determine factors associated with recovery from poststroke urinary incontinence and to estimate the impact of this recovery on stroke outcome at 3 months.DESIGN: Prospective, observational study.SETTING: Population‐based stroke register.PARTICIPANTS: Three hundred twenty‐four incident cases of stroke with incontinence 1 week poststroke were identified from the register between January 1, 1995, and December 31, 1998.MEASUREMENTS: At 3 months, 105 patients were dead and 12 were lost to follow‐up. The remaining patients were classified by continence status; those who had regained continence (n = 127) were compared with those who remained incontinent (n = 80) in terms of demographic details, stroke risk factors, premorbid disability, neurological impairments, and Oxfordshire Community Stroke Project stroke subtypes. Data at 3 months included disability using the modified Barthel Index (BI) (without its urinary continence component) and the Frenchay Activity Index (FAI), and institutionalization.RESULTS: Multivariate analysis showed being age 75 and older (odds ratio (OR) = 0.38; 95% confidence interval (CI) = 0.17–0.83) was associated with poor recovery from incontinence. Compared with subjects with total anterior circulatory infarctions, those with lacunar infarctions were more likely to regain continence (OR = 3.66; 95% CI =1.10–12.2), and compared with subjects with a BI between 0 and 14, those with a BI between 15 and 18 were also more likely to regain continence (OR = 21.8; 95% CI = 5.95–79.7). At 3 months, the incontinent group had greater institutionalization rates (27 (34%) vs 9 (7%), P < .001) and worse disability, measured with BI and FAI (BI: P < .001, FAI: P = .002).CONCLUSIONS: Age 75 and older is independently associated with poor recovery from poststroke urinary incontinence. Further clinical trials are required to explore underlying mechanisms and efficacy of possible interventions for this group of stroke survivors. Recovery from poststroke urinary incontinence should be a major goal of stroke professionals because it is associated with lower institutionalization rates and less disability at 3 months.
Outbreak of Campylobacteriosis at a Senior Center
Authors: Winquist Andrea G. , Roome Aaron , Mshar Roger , Fiorentino Terry , Mshar Patricia , Hadler James 
Published: March 2003

OBJECTIVES: In August 1997, campylobacteriosis was diagnosed in four older persons in one Connecticut town. We investigated this outbreak to determine its cause and to identify appropriate preventive measures. We also analyzed surveillance data to assess the impact of campylobacteriosis among persons are 65 years and older in Connecticut. DESIGN: The outbreak was investigated through a case‐control study and an environmental investigation. Surveillance data were from population‐based, active foodborne disease surveillance. SETTING: The outbreak and environmental studies were conducted at a senior center identified as the one eating place common to all four patients. Active surveillance data were from three Connecticut counties during 1996/1997. PARTICIPANTS: We administered a questionnaire to senior center attendees. A case was defined as onset of diarrhea with fever or abdominal cramps during August 20–25 in a person who ate at the senior center during August 18–20. Respondents without illness meeting the case definition who ate at the senior center during August 18–20 were controls. MEASUREMENTS: Case‐control study participants were asked about symptoms of gastrointestinal illness and meals and foods eaten at the center. The environmental investigation gathered information about food preparation procedures and facilities. Active surveillance data were analyzed to determine age‐specific annual campylobacteriosis incidence rates and proportions of cases involving hospitalization. RESULTS: For the case‐control study, there were 66 respondents (16 case patients, 50 controls), representing approximately 52% of August 18–20 attendees. Case patients were more likely than controls to have eaten at a Hawaiian luau at the center. The most strongly implicated food was sweet potatoes. Review of food preparation procedures identified multiple opportunities for cross‐contamination from raw meats to other foods. In Connecticut's active surveillance area during 1996/1997, the annual campylobacteriosis incidence rate was highest among young adults, but the proportion of hospitalized cases was highest among persons age 70 years and older. CONCLUSION:
Campylobacter transmission occurred at the luau, likely because of cross‐contamination in the kitchen. This investigation emphasizes the importance of strict separation of raw meats from other foods during preparation. Careful attention to these measures is particularly important when an older population is served.
New Glaucoma Medications in the Geriatric Population: Efficacy and Safety
Authors: Novack Gary D. , O'Donnell Martin J. , Molloy D. William 
Published: March 2003

Glaucoma can be considered a disease of the aging eye. Most medications used to treat glaucoma are in topical eyedrop form and may cause numerous untoward systemic effects in older persons. In recent years, several new ocular hypotensive medications have become available. These medications are being used more commonly because there is a growing trend by ophthalmologists to aggressively lower intraocular pressure. Therefore, geriatricians require a comprehensive knowledge of medications used to treat glaucoma, in addition to an understanding of their mechanism of action profiles of untoward effects and possible interactions with other diseases or medications. Therefore, we performed a review of the medications recently introduced into clinical practice.We selected drugs approved by the U.S. Food and Drug Administration between 1996 and September 2001. The safety profiles of these agents and their untoward side effects were reviewed by class: topical carbonic anhydrase inhibitors (brinzolamide: ocular tolerance, taste perversion), β‐adrenoceptor antagonists (timolol: bradycardia and bronchospasm), α‐adrenergic agonists (brimonidine: oral dryness, headache, and fatigue), and prostaglandin analogs (latanoprost, bimatoprost, travoprost, and unoprostone isopropyl: ocular hyperemia, iris color changes).The function of this review is to make geriatricians more aware of the efficacy and untoward effects of medications recently introduced into clinical practice. We recommend that geriatricians perform a medication review on all medications their patients use, including eye drops.
Cognitive Impairment, Depressive Symptoms, and Functional Decline in Older People
Authors: Mehta Kala M. , Yaffe Kristine , Covinsky Kenneth E. 
Published: March 2003

OBJECTIVES: Although cognitive impairment and depressive symptoms are associated with functional decline, it is not understood how these risk factors act together to affect the risk of functional decline. The purpose of this study is to determine the relative contributions of cognitive impairment and depressive symptoms on decline in activity of daily living (ADL) function over 2 years in an older cohort.DESIGN: Prospective cohort study.SETTING: A U.S. national prospective cohort study of older people, Asset and Health Dynamics in the Oldest Old.PARTICIPANTS: Five thousand six hundred ninety‐seven participants (mean age 77, 64% women, 86% white) followed from 1993 to 1995MEASUREMENTS: Cognitive impairment and depressive symptoms were defined as the poorest scores: 1.5 standard deviations below the mean on a cognitive scale or 1.5 standard deviations above the mean on validated depression scales. Risk of functional decline in participants with depressive symptoms, cognitive impairment, and both, compared with neither risk factor, were calculated and stratified by baseline dependence. Analyses were adjusted for demographics and comorbidity.RESULTS: Eight percent (n = 450) of subjects declined in ADL function. In participants who were independent in all ADLs at baseline, the relative risk (RR) of 2‐year functional decline was 2.3 (95% confidence interval (CI) = 1.7–3.1) for participants with cognitive impairment, 1.9 (95% CI = 1.3–2.6) for participants with depressive symptoms, and 2.4 (95% CI = 1.4–3.7) for participants with cognitive impairment and depressive symptoms. In participants who were dependent in one or more ADLs at baseline, RR of 2‐year functional decline was 1.9 (95% CI = 1.2–2.8) for participants with cognitive impairment, 0.6 (95% CI = 0.3–1.3) for participants with depressive symptoms, and 1.5 (95% CI = 0.8–2.6) for participants with cognitive impairment and depressive symptoms.CONCLUSIONS: In participants with no ADL dependence at baseline, cognitive impairment and depressive symptoms are risk factors for decline, but that, in participants with dependence in ADL at baseline, cognitive impairment, but not depressive symptoms, is a risk factor for additional decline.
Prevalence of Dementia in Older Latinos: The Influence of Type 2 Diabetes Mellitus, Stroke and Genetic Factors
Authors: Haan Mary N. , Mungas Dan M. , Gonzalez Hector M. , Ortiz Teresa A. , Acharya Ananth , Jagust William J. 
Published: March 2003

OBJECTIVES: To estimate dementia prevalence in older Mexican Americans, determine the distribution of dementia by etiology, and evaluate the contribution of type 2 diabetes mellitus, stroke, and apolipoprotein E (ApoE) genotype to dementia.DESIGN: Analysis of baseline data from an epidemiological cohort study.SETTING: Sacramento Valley, California.PARTICIPANTS: One thousand seven hundred eighty‐nine Latinos aged 60 and older residing in targeted census tracts during 1998–99.MEASUREMENTS: Each subject was interviewed and screened for dementia and cardiovascular risk factors and diseases. Fasting blood samples were drawn for glucose, insulin, and lipids. Buccal cells were obtained for genetic analysis of ApoE. A three‐stage process of screening was used to diagnose dementia, including cognitive testing, a clinical examination, and imaging to determine etiology. Presence of dementia was established according to National Institute of Neurological Disorders and Stroke/Alzheimers and Related Disorders Association criteria and California Alzheimer's Disease Diagnostic and Treatment Criteria.RESULTS: Overall dementia prevalence was 4.8%. Prevalence in those aged 85 and older was 31%. Education and Anglo cultural orientation was negatively associated with dementia risk. Risk of dementia was nearly eight times higher in those with both type 2 diabetes mellitus and stroke. Forty‐three percent of dementia was attributable to type 2 diabetes mellitus, stroke, or a combination of the two. ApoE allele frequency was E2 5.9%, E3 90.1%, and E4 4%. Those with any E4 and 4–4 combinations had a higher risk for dementia than those with the E3–3 combination.CONCLUSIONS: Dementia prevalence in this ethnic group is similar to that reported in Canadian and European studies but lower than in Caribbean‐Hispanics residing in the United States. The etiological fraction of dementia attributable to type 2 diabetes mellitus and stroke is substantial and points toward the need for intervention research and treatment with the goal of reducing neurological sequelae in groups with high prevalence of type 2 diabetes mellitus. The allele frequency of ApoE was similar to that in other published studies on Mexican Americans. The low frequency of the E4 allele may contribute to the difference in etiology of dementia in older Mexican Americans and older people of European background. Dementia in this ethnic group may be related to preventable causes, with a smaller genetic component than in Europeans.
Cognitive Impairment and Mortality in Older Mexican Americans
Authors: Nguyen Ha T. , Black Sandra A. , Ray Laura A. , Espino David V. , Markides Kyriakos S. 
Published: March 2003

OBJECTIVES: To examine the extent to which cognitive status and decline in cognitive status predict mortality in older Mexican Americans.DESIGN: Longitudinal cohort.SETTING: Older Mexican Americans residing in five southwestern states in the United States.PARTICIPANTS: Two thousand six hundred twenty‐five persons aged 65 and older living in Texas, New Mexico, Colorado, Arizona, and California.MEASUREMENTS: The cognitive function of participants was assessed using the Mini‐Mental State Examination (MMSE) in 1993–94 and again in 1995–96. Cognitive decline was defined using two sets of criteria: a drop to 17 or less (moderate‐severe cognitive impairment) on the MMSE at 2‐year follow‐up and a decrease of at least four points, a threshold change in scores that was used to predict mortality in this sample. Cox proportional hazards models were conducted to examine the association between the MMSE and increased risk for mortality, after controlling for sociodemographic characteristics, medical conditions, and depressive symptoms.RESULTS: Five‐year mortality risk was significantly associated with persons in the moderately‐severely cognitively impaired category (hazard ratio (HR) = 2.35, P < .001). Moreover, mild cognitive impairment was also predictive of mortality in older Mexicans (HR = 1.45, P < .001). Two‐year declines in cognitive functioning, particularly in persons who had declined to the moderate‐severe impairment category (HR = 2.23, P < .001) and those who dropped at least four points on the MMSE (HR = 1.30, P < .001), were predictive of mortality 3 years later, after controlling for important variables.CONCLUSIONS: Baseline moderate‐severe and mild cognitive status and 2‐year decline in cognitive functioning independently predict mortality in older Mexican Americans. Although age and selected medical conditions have been reported as the more salient predictors of mortality, cognitive functioning should be considered part of identifying older persons at high risk for underlying medical conditions and mortality.
Topical lidocaine patch relieves a variety of neuropathic pain conditions: an open‐label study. (Department of Pain Medicine and Palliative Care, Beth Lsrael Medical Center, New York, NY) Clin J Pain 2000;16:205–208.
Authors: Devers Allison , Galer: Bradley S. 
Published: March 2003

Our goal was to perform a pilot, open‐label, prospective study to access the effectiveness and tolerability of a topical lidocaine patch (Lidoderm) for the treatment of peripheral neuropathic pain conditions other than postherpetic neuralgia. Sixteen patients with refractory peripheral neruopathic pain conditions who had reported intolerable side effects or inadequate pain relief with antidepressant, anticonvulsant, antiarrhythmic, and opioid medications participated in this study. Diagnoses included postthoracotomy pain, stump neuroma pain, intercostal neuralgia, diabetic polyneuropathy, meralgia paresthetica, complex regional pain syndrome, radiculopathy, and postmastectomy pain. A 6‐item Pain Relief Scale was used. Moderate or better pain relief was reported by 13 of the 16 participants (81%). One patient stopped treatment after 4 days due to lack of relief. The remaining 15 patients had a mean duration of patch use of 6.2 weeks with continued relief. Only 1 patient reported a side effect, a mild skin irritation. Conclude the Lidoderm patch provides clinically meaningful pain relief in most of these refractory neuropathic pain patients without side effects. Controlled trials need to be performed to confirm these preliminary findings.Comment by Tat‐Leang Lee, M.D. This is an interesting study that highlighted a simple, efficacious method for the treatment of resistant neuropathic pain. As this was a pilot study using an open‐label method, and treating a heterogenous group of neuropathic pain conditions, caution should be adopted in the interpretation of the results. What remains unanswered is the reason for the success of the lidocaine patch, particularly when previous studies have documented the failure of EMLA in the treatment of neuropathic pain. Indeed, several patients who participated in this study had used EMLA unsuccessfully before, although no details on its administration was reported. Both the lidocaine patch and EMLA contain 5% lidocaine, which presumably would result in greater penetration by the EMLA cream. Therefore, a placebo‐controlled randomized trial is needed to confirm the findings of this pilot study. Nevertheless, this is a promising treatment that is convenient, lacks systemic effect, easily added‐on to existing treatment, and with only minor side effects, that is worth considering for our patients.
Fentanyl improves analgesia but prolongs the onset of axillary brachial plexus block by peripheral mechanism. (Sapporo Medical University, School of Medicine, Sapporo, Japan) Anesth Analg 2000;91:384–387.
Authors: Nishikawa Kohki , Kanaya Noriaki , Nakayama Masayasu , Igarashi Motohiko , Tsunoda Kazumasa , Namiki: Akiyoshi 
Published: March 2003

This double‐blinded study evaluated the effects of fentanyl added to lidocaine for axillary brachial plexus block in 66 adult patients scheduled for elective hand and forearm surgery. All patients received 40 mL of 1.5% lidocaine with 1:200,000 epinephrine, injected into the brachial plexus sheath using the axillary perivascular technique, and they were randomized into 3 groups. Group 1 was given lidocaine containing 2 mL of normal saline plus 2 mL of normal saline IV. Patients in Group 2 received lidocaine containing 100 μg fentanyl plus 2 mL of normal saline IV. Group 3 patients received lidocaine containing 2 mL of normal saline plus 100 μg fentanyl IV. Sensory and motor blockade were evaluated by using a pinprick technique and by measuring the gripping force, respectively. The success rate of sensory blockade for radial and musculocutaneous nerves and the duration of the sensory blockade significantly increased in Group 2 (323 ± 96 min) as compared with Group 1 (250 ± 79 min). However, the onset time of analgesia was prolonged in every nerve distribution by adding fentanyl to the brachial plexus block. IV fentanyl had no effect on the success rate, onset, or duration of the blockade. Conclude that the addition of fentanyl to lidocaine causes an improved success rate of the sensory blockade, but a delayed onset of analgesia, although this may be accounted for by the decreased pH caused by the fentanyl.Comment by Alan Kaye, M.D. The addition of opioids to regional blocks is controversial. This is due in part to the potential uptake and distribution centrally of the opioid agent. In 66 patients undergoing axillary block, all had 40 mL of 1.5% lidocaine with epinephrine. One group had normal saline, another group has fentanyl plus saline, and a third had just fentanyl. The authors found that the addition of fentanyl caused an improved success rate with regard to sensory blockade. However, onset of the blockade was delayed with fentanyl and this was theorized by a decreased pH caused by the fentanyl. More studies are needed to better elucidate mechanistic effects of opioids and other agents in enhancing or modulating local anesthetics in regional blockade.
Continuous peripheral nerve block for ambulatory surgery. (Duke University, Durham, NC) Reg Anesth Pain Med 2001;26:209–214.
Authors: Grant Stuart A. , Nielsen Karen C. , Greengrass Roy A. , Steele Susan M. , Klein Stephen M. 
Published: March 2003

In this study data was prospectively gathered for 1 year from 228 patients in an ambulatory surgery center. All continuous peripheral nerve blocks (CPNB) were performed using the Contiplex system to provide anesthesia and postoperative analgesia. CPNB were performed using 5 upper and lower extremity techniques. Postsurgery local anesthetic was infused and at 24 hours, a rebolus of local anesthetic was performed. The CPNB catheter was removed and patients were examined for a loss of sensation. Patients were then discharged. The initial peripheral block was successful in 94% of the patients. Failed nerve block requiring general anesthesia occurred in 6%. The catheter was patent and functional in 90% of the patients at 24 hours, and 8% of the patients required more than 10 mg of intravenous morphine by 24 hours postsurgery. In the postanesthesia care unit, only 4 patients (1.7%) required treatment for nausea. At 24 hours and 7 days postsurgery, no patient reported a dysesthesia. Conclude that CPNB using the insulated Tuohy catheter system offered acceptable anesthesia and prolonged pain relief postsurgery. There were few side effects.Comment by Alan David Kaye, M.D., Ph.D., Erin Bayer, M.D. This study demonstrates the efficacy of the Contiplex system (CPNB) in providing surgical anesthesia and postoperative analgesia through CPNB. Despite the efficacy of CPNB, which could provide longer duration of postoperative analgesia than single injection block, it is not widely used due to lack of available equipment. Contiplex system utilizes a connector for a nerve stimulator attached to a 18‐gauge Tuohy needle. It allows for aspiration of blood, injection of local anesthesia and passage of a peripheral nerve catheter. This study demonstrated in an ambulatory surgery center with 228 patients, CPNB was used for 27 different types of surgical procedures which involved 5 different block sites. Success rates were 94% for initial peripheral block while 6% required general anesthesia. Patients required less postoperative analgesia. The incidence of postoperative side effects such as nausea and vomiting were minimal. Not a single patient reported dissatisfied with a 7‐day telephone follow‐up. A disadvantage of this technique is the use of an 18‐gauge needle and potential for vascular and/or nerve injuries, which did not occur in this study. Though previous studies have demonstrated the efficacy of the CPNB in inpatients, this is an important study focused on outpatients. A larger study group will be valuable in future studies.
A new test useful in identifying red cells with a (δ‐α) hybrid sialoglycoprotein
Authors: Vengelen‐Tyler V. , Mogck N. 
Published: March 2003

St(a+) and Dantu+ red cells (RBCs), treated with 0.1 percent ficin solutions, reacted strongly with Vicia graminea lectin (anti‐Nvg). No other RBC sample tested gave these results. This test (ficin‐pretreated RBCs tested with anti‐Nvg [FT‐Nvg]) was used to screen the RBCs of 300 Oriental and 100 black donors. Three percent of the Oriental donor samples tested were FT‐Nvg+, whereas no FT‐Nvg+ RBCs were found in the black donor samples tested.The FT‐Nvg test is easy to perform and gives selective reactions with antigens associated with (δ‐α) hybrid sialoglycoproteins, such as Sta and Dantu. This test can be used for mass screening of RBCs in a search for St(a+) or Dantu+ RBCs. Another application of the FT‐Nvg test would be to screen RBCs suspected of having a low‐incidence antigen before using scarce anti‐Sta and ‐Dantu reagents.