bluuebunny/crossref_metadata_2025_split huggingface dataset:
Benchmarks for Antibiotic Use and Cost in Long‐Term Care
Authors: Mylotte Joseph M. , Keagle Jessica 
Published: August 2005

Objectives: To evaluate previously described antibiotic use and cost indicators in community nursing homes to determine whether they may be useful as benchmarks and to evaluate the association between functional status, infection occurrence, and antibiotic use.Design: Retrospective observational study.Setting: Eleven proprietary long‐term care facilities owned by one company.Participants: Only facility‐specific cumulative data were used.Measurements: Antibiotic use and cost indicators (incidence of antibiotic use, antibiotic utilization ratio, cost of antibiotics per resident care day (RCD), and cost per antibiotic day), infection rates, and functional status as measured using the case‐mix index (CMI) of the Resource Utilization Groups II system. Mean yearly values for each measure were calculated for each facility.Results: There was significant variation in all of the antibiotic indicators between the 11 nursing homes, but there was no correlation between mean facility CMI and infection rate. However, there was a trend toward a significant correlation between mean facility CMI and mean facility incidence of antibiotic use, antibiotic utilization rate, and cost per RCD. Variation in mean facility infection rate explained 66% of the variation in mean facility incidence of antibiotic use (P<.001). In a multivariate analysis, mean facility infection rate (P=.003) and mean facility CMI (P=.046) were predictors of mean incidence of antibiotic use and explained 83% of the variation in dependent variable.Conclusion: The significant variation in mean antibiotic use and cost indicators between the 11 study facilities suggests that these indicators may be useful as benchmarks for quality‐improvement efforts. For the first time, objective evidence is provided demonstrating the influence of functional status on antibiotic use in the nursing home setting.
Physicians' Experiences with Demented Patients with Advance Euthanasia Directives in the Netherlands
Authors: Rurup Mette L , Onwuteaka‐Philipsen Bregje D , Van Der Heide Agnes , Van Der Wal Gerrit , Van Der Maas Paul J 
Published: August 2005

Objectives: To estimate the incidence of (compliance with) advance euthanasia directives of patients suffering from dementia in the Netherlands and to gain knowledge about the experiences of physicians.Design: Retrospective interview study.Setting: Physicians in the Netherlands.Participants: Four hundred ten physicians.Measurements: Physicians were interviewed about their demented patients who had an advance euthanasia directive. Nursing home physicians were interviewed more extensively.Results: Approximately 2,200 demented patients with an advance euthanasia directive die annually after being treated by a physician who knows about this directive. In 76% of such cases, compliance with the directive was discussed, but euthanasia was seldom performed. In two‐thirds of the cases of demented nursing home patients with an advance euthanasia directive, the physician was able to identify during the course of the disease a situation for which the patient had intended the directive. One‐quarter of the nursing home physicians thought that their most recent patient suffered unbearably to a (very) high degree, and half of them thought that the patient suffered hopelessly to a (very) high degree. In three‐quarters of the cases, the relatives did not want the nursing home physician to comply with the directive, but they did want to respect the patient's wishes by forgoing life‐prolonging treatment, which occurred in approximately 90% of cases.Conclusion: Most nursing home physicians think that the suffering of patients with dementia can be unbearable and hopeless as a consequence of dementia, but most physicians do not consider dementia to be grounds for euthanasia, unless perhaps the patient has an additional illness.
Are Older People Dying of Depression? Findings from the Medical Research Council Trial of the Assessment and Management of Older People in the Community
Authors: Adamson Joy A. , Price Gill M. , Breeze Elizabeth , Bulpitt Christopher J. , Fletcher Astrid E. 
Published: August 2005

Objectives: To examine the relationship between symptoms of depression and mortality in older people.Design: Prospective longitudinal study.Setting: Fifty‐three general practices in the United Kingdom.Participants: Thirteen thousand ninety‐seven people aged 75 and older participating in the Medical Research Council Trial of the Assessment and Management of Older People in the Community.Measurements: Depression was measured using the 15‐item Geriatric Depression Scale (GDS‐15); the main outcome was all‐cause mortality.Results: Morbidity, disability, and lifestyle factors can explain most of the observed relationship between symptoms of depression and mortality (hazard ratio=1.75, 95% confidence interval (CI)=1.53–1.99), but after mutual adjustment for these factors, subjects who reported six or more symptoms of depression on the GDS‐15 were still 27% more likely to have died by the end of the follow‐up period than those below the threshold for depression (95% CI=1.11–1.45).Conclusion: The findings from this study suggest that depression confers a small risk for mortality in older people, not explained solely by poor health. The results support the encouragement of effective diagnosis, treatment, and support for individuals with depression as highlighted by the World Health Organization and the UK National Service Framework for older people.
Skilled Care Requirements for Elderly Patients After Coronary Artery Bypass Grafting
Authors: Nallamothu Brahmajee K. , Rogers Mary A. M. , Saint Sanjay , McMahon Laurence J. , Fries Brant E. , Kaufman Samuel R. , Langa Kenneth M. 
Published: August 2005

Objectives: To examine the extent to which elderly individuals use various skilled care facilities after coronary artery bypass grafting (CABG).Design: Retrospective cohort study.Setting: State of Michigan from 1997 to 1998.Participants: Residents aged 65 and older enrolled in Medicare who underwent CABG.Measurements: Cumulative incidence of admission within 100 days of hospital discharge, relative risk (RR) of admission, readmission or extended stay at a skilled care facility, and length of stay in a skilled care facility.Results: Fifty percent of patients aged 80 and older used a skilled care facility after CABG, with most requiring admission to a skilled nursing facility (SNF) or readmission to an acute‐care hospital within 100 days after discharge. Patients aged 80 and older had a significantly higher risk of admission to a SNF (adjusted RR=3.3, 95% confidence interval (CI)=2.8–4.0) than did those aged 65 to 69, as did patients aged 75 to 79 (adjusted RR=2.2, 95% CI=1.8–2.6) and those aged 70 to 74 (adjusted RR=1.5, 95% CI=1.3–1.8). The length of time spent in skilled care facilities significantly increased with age (mean days=13.3 for aged 65–69, 16.9 for 70–74, 19.6 for 75–79, and 22.9 for 80 and older; P<.001).Conclusion: Older patients are more likely to be admitted to a SNF, be readmitted to an acute‐care hospital, and have longer institutional stays after CABG. When balancing the risks and benefits of CABG, physicians, patients, families, and policy‐makers need to carefully consider the likelihood of follow‐up institutional care in elderly patients.
Associations Between Dementia/Mild Cognitive Impairment and Cognitive Performance and Activity Levels in Youth
Authors: Fritsch Thomas , Smyth Kathleen A. , McClendon McKee J. , Ogrocki Paula K. , Santillan Concepcion , Larsen Janet D. , Strauss Milton E. 
Published: August 2005

Objectives: To study the associations between dementia/mild cognitive impairment (MCI) and cognitive performance and activity levels in youth.Design: Retrospective cohort study.Setting: Research volunteers living throughout the United States.Participants: A total of 396 persons (mean age 75) who were graduates of the same high school in the mid‐1940s.Measurements: Adolescent intelligence quotient (IQ) scores were gathered from archived student records, and activity levels were determined from yearbooks. A two‐stage telephone screening procedure (Modified Telephone Interview for Cognitive Status or Informant Questionnaire on Cognitive Decline in the Elderly followed by Dementia Questionnaire) was used to determine adult cognitive status. Data were analyzed using logistic regression to model the risk of cognitive impairment (dementia/MCI) versus no cognitive impairment as a function of IQ and activity level, adjusting for sex and education.Results: High adolescent IQ and greater activity level were each independently associated with a lower risk for dementia/MCI (odds ratio (OR) for a 1‐standard deviation increase in IQ=0.51, 95% confidence interval (CI)=0.32–0.79; OR for a unit increase in activity=0.32, 95% CI=0.12–0.84). No association was found between sex or education and adult cognitive status in this model.Conclusion: High IQ and greater activity levels in youth reduce the risk for cognitive impairments in aging. The mechanism(s) underlying these associations are unknown, but intelligence may be a marker for cognitive/neurological “reserve,” and involvement in activities may contribute to “reserve.” Early neuropathology and ascertainment bias are also possible explanations for the observed associations.
Predictors of Combined Cognitive and Physical Decline
Authors: Atkinson Hal H. , Cesari Matteo , Kritchevsky Stephen B. , Penninx Brenda W. J. H. , Fried Linda P. , Guralnik Jack M. , Williamson Jeff D. 
Published: August 2005

Objectives: To determine the incidence and correlates of combined declines in cognitive and physical performance.Design: Cohort study of community‐dwelling older women with moderate to severe disability.Setting: The community surrounding Baltimore, Maryland.Participants: Participants in the Women's Health and Aging Study I with Mini‐Mental State Examination (MMSE) score or 24 or greater and walking speed greater than 0.4 m/s at baseline.Measurements: Cognitive decline was defined as an MMSE score less than 24 and physical decline as a walking speed of 0.4 m/s or less in at least one of the three annual follow‐up visits. Participants were stratified into groups based on cognitive or physical decline or both. Group characteristics were compared, and results were adjusted for age, race, education, and significant covariates.Results: Of 558 women that met the baseline MMSE and walking speed inclusion criteria, 21% developed physical decline, 12% developed cognitive decline, and 11% experienced combined cognitive and physical decline. After adjustment, physical decline was associated with age, nonwhite race, former smoking, baseline walking speed, and instrumental activities of daily living (IADL) impairment. Cognitive decline was associated with age and baseline MMSE score. Combined decline was associated with age, baseline walking speed, MMSE score, IADL impairment, as well as current smoking (odds ratio (OR)=5.66, 95% confidence interval (CI)=1.49–21.54) and hemoglobin level (OR=0.68, 95% CI=0.47–0.98).Conclusion: Potential predictors of cognitive and physical performance decline were identified. The association between smoking and lower hemoglobin levels and combined cognitive and physical decline may represent potentially modifiable risk factors and should be confirmed in future studies.
Effect of Blood Pressure and Diabetes Mellitus on Cognitive and Physical Functions in Older Adults: A Longitudinal Analysis of the Advanced Cognitive Training for Independent and Vital Elderly Cohort
Authors: Kuo Hsu‐Ko , Jones Richard N. , Milberg William P. , Tennstedt Sharon , Talbot Laura , Morris John N. , Lipsitz Lewis A. 
Published: August 2005

Objectives: To evaluate the effect of blood pressure (BP) and diabetes mellitus (DM) on cognitive and physical performance in older, independent‐living adults.Design: Longitudinal study with secondary data analysis from the Advanced Cognitive Training for Independent and Vital Elderly randomized intervention trial.Setting: Six field sites in the United States.Participants: Two thousand eight hundred two independent‐living subjects aged 65 to 94.Measurements: Cognitive functions in different domains and physical functions measured using activities of daily living, instrumental activities of daily living (IADLs), and the physical function subscale from the Medical Outcomes Study Short Form‐36 (SF‐36) Health Survey.Results: After the first annual examination, hypertension was associated with a faster decline in performance on logical reasoning tasks (ability to solve problems following a serial pattern), whereas DM was associated with accelerated decline on the Digit Symbol Substitution Test (speed of processing). The reasoning and Digit Symbol Substitution test are executive function tasks thought to be related to frontal‐lobe function. Hypertension and DM were associated with a significantly faster pace of decline on the SF‐36 physical function component score. Individuals with DM had a faster pace of decline in IADL functioning than nondiabetic subjects. There was no evidence for an interaction between BP and DM on cognitive or physical function decline.Conclusion: Hypertension and DM are associated with accelerated decline in executive measures and physical function in independent‐living elderly subjects. Further research is needed to determine whether cardiovascular risk modification ameliorates cognitive and functional decline in elderly people.
Hypoalbuminemia 3 Months After Hospital Discharge: Significance for Long‐Term Survival
Authors: Sullivan Dennis H. , Roberson Paula K. , Bopp Melinda M. 
Published: August 2005

Objectives: To determine change in albumin from hospital discharge to 3‐month follow‐up and the prognostic significance of persistent hypoalbuminemia in older veteran patients.Design: A prospective cohort study.Setting: A geriatric rehabilitation unit of a university‐affiliated Department of Veterans Affairs hospital.Participants: The study population consisted of 282 subjects (of 322 randomly selected discharges who were free of cancer and terminal conditions) that completed the 90‐day postdischarge assessment; most were older (75.4±8.6), white (76%), and male (99%).Measurements: Each subject completed a comprehensive discharge assessment, had a repeat albumin an average of 94 days later, and was then tracked for 5 years. The strongest predictors of survival were identified using Cox proportional hazards regression analysis.Results: Between hospital discharge and the 3‐month reassessment, albumins improved by more than 2 g/L in 122 subjects (43%), stayed the same in 112 subjects (40%), and deteriorated by more than 2 g/L in the rest. During follow‐up, 190 subjects (67%) died. Of the 38 nutritional, functional, demographic, and illness severity variables evaluated, the 3‐month postdischarge albumin was the strongest predictor of long‐term mortality. Those with albumins less than 35 g/L had a 2.6 times greater mortality than those with albumins of 40 g/L or greater (relative risk=2.6, 95% confidence interval=1.8–3.8). After controlling for 3‐month albumin, hospital‐discharge albumin was not significantly associated with long‐term mortality.Conclusion: In older people, a low serum albumin 3 months after hospital discharge is associated with a poor long‐term prognosis. It is not known whether this represents ongoing inflammation or inadequate nutrition.
Septic Arthritis in Patients Aged 80 and Older: A Comparison with Younger Adults
Authors: Gavet Florence , Tournadre Anne , Soubrier Martin , Ristori Jean Michel , Dubost Jean Jacques 
Published: August 2005

Objectives: To compare the frequency and characteristics of septic arthritis in patients younger than 80 and aged 80 and older.Design: Retrospective.Setting: Single hospital center.Participants: Patients admitted between 1979 and 2002 for septic arthritis.Measurements: Age, sex, time to diagnosis, predisposing factors, joint, temperature, white blood cell count, microorganism, and short‐term outcome.Results: Of 335 patients, 206 (61.4%) were aged 60 and older, and 42 (12.5%) were 80 and older. The latter had an average age of 84 (range 80–97) and were mainly women (72%). Eighteen of the 42 had at least one risk factor. The mean time to diagnosis was 21 days (range 1 day to 3 months). Twenty patients (47%) had knee involvement, six (14%) shoulder involvement, ten (23.8%) a prosthetic infection, and five (12%) polyarticular infection. Ten (23%) were afebrile. In half of the cases, there was no increase in white blood cell count. The microorganisms isolated were Staphylococcus aureus (n=16, 38%), coagulase negative staphylococci (n=8, 19%), streptococci (n=12, 28%), and gram‐negative bacilli (n=6, 14%). The mortality rate increased with age: 0.7% of patients younger than 60, 4.8% of those aged 60 to 79, and 9.5% of those aged 80 and older.Conclusion: Advanced age is a risk factor for septic arthritis and poor outcome.
Agreement Between Patient and Proxy Responses of Health‐Related Quality of Life After Hip Fracture
Authors: Jones C. Allyson , Feeny David H. 
Published: August 2005

Objectives: To examine agreement between patient and proxy respondents on health‐related quality of life (HRQL) over time during the 6‐month recovery after hip fracture.Design: Prospective longitudinal cohort study.Setting: A healthcare region serving Edmonton, Alberta, and the surrounding area.Participants: Two hundred forty‐five patients aged 65 and older, were treated for hip fracture, and had Mini‐Mental State Examination scores greater than 17; 245 family caregivers participated as proxy respondents.Measurements: Primary outcome was HRQL (Health Utilities Mark 2 and Mark 3). Interviews were completed within 5 days after surgery and at 1, 3, and 6 months. Agreement was evaluated using intraclass correlation coefficients (ICCs).Results: Agreement was considered moderate to excellent for HRQL. ICC values ranged from 0.50 to 0.85 (P<.001) for physically based observable dimensions of health status and from 0.32 to 0.66 (P<.01) for less‐observable dimensions. Agreement improved with time. Time and the number of days between patient and proxy interviews were significant factors in accounting for patient–proxy differences.Conclusion: Although proxy and patient responses are not interchangeable, proxy responses provide an option for assessing function and health status in patients who are unable to respond on their own behalf.
Impaired Vision and the Ability to Take Medications
Authors: Windham Beverly Gwen , Griswold Michael E. , Fried Linda P. , Rubin Gary S. , Xue Qian‐Li , Carlson Michelle C. 
Published: August 2005

Objectives: To assess relationships between vision (contrast sensitivity, stereopsis, visual acuity) and a performance‐based measure of ability to implement new medications.Design: Cross‐sectional analysis; prospective cohort study.Setting: Community‐based.Participants: Three hundred thirty‐five participants aged 73 to 82 in Year 3 of the Women's Health and Aging Study II, a representative sample of the two‐thirds least‐disabled community‐dwelling women.Measurements: Hopkins Medication Schedule Pillbox Ratio, a joint measure of accuracy and time, and a performance‐based measure of ability to implement a prescription. Participants received written and verbal instructions for taking two medications and were directed to place pills in a pillbox accordingly. Vision assessments: contrast sensitivity (Pelli‐Robson letter sensitivity chart), stereopsis (Randot Circles), and visual acuity (Early Treatment Diabetic Retinopathy Study eye chart).Results: Forty‐four percent (148/335) of women incorrectly placed one or both medications. Each vision measure was positively associated with Pillbox Ratio scores and varied with cognition and time to completion. Better visual acuity, contrast sensitivity, and stereopsis were each associated with better performance in women with poor cognition who filled the pillbox quickly. Additionally, better visual acuity was associated with better performance in participants with good cognition who filled the pillbox slowly; better stereopsis was associated with better performance in participants with poor cognition who filled the pillbox slowly and whose stereoacuity was below normal.Conclusion: Visual acuity, contrast sensitivity, and stereopsis should be considered potential risk factors for impaired ability to implement a medication regimen in older adults. Future research should investigate the role of vision, including contrast sensitivity and stereopsis, on performance of other instrumental activities of daily living.
Incidence of Complications in Patients with Implantable Cardioverter/Defibrillator Who Receive Additional Transvenous Pace/Sense Leads
Authors: WOLLMANN CHRISTIAN G. , BÖCKER DIRK , LÖHER ANDREAS , KÖBE JULIA , SCHELD HANS H. , BREITHARDT GÜNTER E. , GRADAUS RAINER 
Published: August 2005

Background: Implantation of an additional pace/sense (P/S) lead is commonly used in patients with implantable cardioverter/defibrillators (ICDs) to overcome P/S defects of integrated defibrillation leads (HV‐P/S leads). No information is available about the clinical outcome and the incidence of complications in these patients.
Methods: Retrospective analysis was performed in 151 patients (125 male, age 54.9 ± 13.6 years, LVEF 48.1 ± 17.8%, CAD in 86 [57%], DCM in 24 [16%], ARVCM in 11 [7%]) who received an additional P/S lead between 1990 and 2002 (54 patients with abdominal and 97 patients with pectoral ICD system). Statistical analysis was done using Kaplan‐Meier survival curves.
Results: The average follow‐up (FU) after implantation of the additional P/S lead was 43 ± 27 months. In total 117 patients [77.5%] remain implanted; 22 patients died due to cardiac‐related reasons. After a FU of 23 ± 23 months, 43 patients [28.5%] experienced lead‐related problems after implantation of the additional P/S lead: oversensing in 23 [53.5%], insulation defect in 3 [7.0%], fracture in 1 [2.3%], system infection in 4 [9.3%], and defect of the HV‐P/S lead in 6 [14.0%] patients. The event‐free cumulative survival of the additional P/S lead after 1, 2, and 5 years was 87.0%, 79.8%, and 59.4%, respectively (for pectoral leads: 89.6%, 82.0%, and 60.0%, respectively).
Conclusions: Implantation of an additional P/S lead in case of failure of an HV‐P/S lead is safe. However, it is associated with a substantial rate of complications during FU. Therefore, extraction of damaged defibrillation leads instead of implantation of P/S leads should be favored.