bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessment of delays in presentation of patients with retinal detachment to a tertiary referral centre
Authors: Quinn Shauna M. , Qureshi Farhan , Charles Stephen J. 
Published: December 2004

AbstractThe referral pathway of patients with retinal detachment from primary care providers to a tertiary care ophthalmic unit was examined, in order to determine the length and source of any delays between the onset of symptoms and arrival at the hospital. A prospective survey of all symptomatic patients (n = 60) admitted for primary rhegmatogenous retinal detachment surgery was carried out over an 8 week period. Twenty‐one patients were referred by their optometrists and 18 by their general practitioners. The remainder were referred by local accident and emergency and ophthalmic departments or presented directly to the tertiary referral centre. Patients who presented to their optometrists were symptomatic for an average of four times longer. More than half the patients thought that the time to initial presentation was the most significant delay. Referral from optometrists via general practitioners and local ophthalmic clinics was considerably longer. Increased awareness of symptoms, necessity of urgent referral and knowledge of available services locally may reduce delay for those who require emergency sight‐saving surgery.
How do intensive care nurses assess patients’ pain?
Authors: Aslan Fatma Eti , Badir Aysel , Selimen Deniz 
Published: December 2004

Summary

Identification and evaluation of pain in critical care patients may be difficult because of communication problems. Moreover, at present there are very few nursing studies that examine the attitudes of critical care nurses towards the assessment of patients’ pain
This study was designed to determine the approach of critical care nurses towards assessing patients’ pain levels, and to evaluate the problems in nursing diagnosis of those having difficulty in articulating their pain symptoms
We used a questionnaire to assess nurses attitudes to patients’ pain. The study sample consisted of 91 critical care nurses who were recruited between January and February 2002. The results suggest that patient pain was considered undesirable by 44% of nurses. About 70·3% of the nurses reported resorting to administering analgesics to relieve their patients’ pain
Some 57·1% of nurses stated that they would have investigated whether the patients had really been experiencing pain, prior to administering the prescribed analgesics to patients
Some 85·7% of the sample indicated that the patients themselves would make the most accurate evaluation of their pain. The data suggested that 39·6% of nurses did not know how to evaluate pain symptoms in critical care patients suffering from complicated problems, and that 37·4% evaluated pain by monitoring the patients’ behaviours
The study demonstrated that most of the critical care nurses did not know how to evaluate pain in patients having communication problems. The paper concludes by suggesting that there is a clear need to address nursing education and training with regard to evaluation and management of patients’ pain whilst in critical care environment
Nurse‐led discharge from high dependency unit
Authors: Knight Gillian 
Published: December 2004

Summary

High dependency care is a rapidly evolving area of critical care, with high patient turnover, which ultimately leads to high levels of pressure for beds
There is a growing trend emerging, recognizing the importance and value of nurse‐led initiatives in delivering effective nursing care in acute care settings
One specific nurse‐led initiative this author has developed is that of nurse‐led discharge (NLD) from the high dependency unit (HDU), in order to optimize the utilization of critical care beds within the HDU
An audit of the current practice was undertaken, which ultimately led to the implementation of NLD
Early experiences indicate that HDU beds are now being used more effectively
Exercise Adherence and 10‐Year Mortality in Chronically Ill Older Adults
Authors: Morey Miriam C. , Pieper Carl F. , Crowley Gail M. , Rnc‐Bsn  , Sullivan Robert J. , Puglisi Carmel M. 
Published: December 2004

OBJECTIVES: To compare mortality of adherents and nonadherents of an exercise program.DESIGN: Prospective intervention study.SETTING: Supervised geriatric fitness program called Gerofit.PARTICIPANTS: One hundred thirty‐five adults aged 65 and older who enrolled in Gerofit between January 1, 1990, and November 30, 1999. All participants had a baseline medical screen and exercise test. They were classified as adherent (n = 70) if they participated in Gerofit for more than 47 sessions or nonadherent (n = 65) if they did not complete 47 sessions within the first 6‐month period.INTERVENTION: Program participation was voluntary and consisted of aerobic, strength, flexibility, and balance exercises. The program met three times week for 90 minutes.MEASUREMENTS: All‐cause mortality.RESULTS: Twenty‐six deaths occurred within the 10‐year follow‐up period. Using proportional hazards, time to death was not related to adherence group. However, in multivariate analyses controlling for age, sex, race, baseline risk/health status, history of heart disease, cancer, diabetes mellitus, and baseline smoking status, there was significant group‐by‐time interaction (P = .004), indicating a crossover in mortality risk. The initial survival benefit observed in nonadherers changed over time, resulting in a long‐term protective survival effect on mortality for the adherent group (hazard rate = 0.75, 95% confidence interval = 0.61–0.91 for the interaction term).CONCLUSIONS: Older adults with chronic diseases experience a long‐term beneficial mortality effect from participation in exercise programs. Physicians should strongly encourage their patients, including those with comorbidities, to maintain a regular exercise program.
Effect of Exercise on Ease in Performing Activities of Daily Living and Instrumental Activities of Daily Living From Age 70 to 77: The Jerusalem Longitudinal Study
Authors: Stessman Jochanan , Hammerman‐Rozenberg Robert , Maaravi Yoram , Cohen Aaron 
Published: December 2004

OBJECTIVES: To determine the prevalence of independence and ease of performance in activities of daily living (ADLs) and instrumental activities of daily living (IADLs) at ages 70 and 77 in a well‐characterized cohort and to measure the effect of regular exercise at age 70 on independence and ease of performance 7 years later.DESIGN: Two stages of a longitudinal study of an age‐homogeneous cohort employing extensive interview data, physical examination, and clinical laboratory investigation.SETTING: Home‐based interviews and examinations in Jerusalem.PARTICIPANTS: Two hundred eighty‐seven west Jerusalem residents, born between June 1920 and May 1921, who participated fully in two phases of an ongoing longitudinal cohort study. Subjects were culled from a larger study population of 605 in the first phase and 1,021 in the second phase.MEASUREMENTS: Two‐stage comprehensive demographic, social, and economic profile; medical history and examination; cognitive and affective assessment; and clinical laboratory studies performed in 1990–91 and 1997–98. The investigation questionnaire included details of ADL and IADLs and voluntary exercise.RESULTS: Most aspects of personal and social life did not change from age 70 to 77. Independence in ADLs remained high, as did self‐reliance in IADLs for women. A more‐sensitive marker of diminished function was reported ease in performance, which declined for use of the toilet, dressing, and all spheres of IADLs. For nearly every task, subjects who reported exercising 4 days a week at age 70 were more likely to report ease in performance at age 77. In a logistic regression accounting for the presence of diabetes mellitus, hypertension, obesity, chronic back pain, loneliness, and performance with ease at age 70 and deterioration in self‐assessed health from age 70 to 77, ease of performance in at least three of four ADL tasks was independently related to exercise at age 70 for women (odds ratio (OR) = 8.5, 95% confidence interval (CI) = 2.0–36.2) and for men (OR = 4.3, 95% CI = 1.1–17.1). Ease of independent function in at least four of five IADL tasks also correlated to exercise for men in this regression (OR = 3.7, 95% CI = 1.1–12.2) but not for women (OR = 2.0, 95% CI = 0.6–6.3). Ease in shopping, alternatively, correlated with physical activity for men (OR = 4.3, 95% CI = 1.5–12.0) and women (OR = 2.6, 95% CI = 1.1–6.1).CONCLUSIONS: Subjects remained active and independent at age 77. Reported ease of performance declined and revealed changes in function. Exercise at least four times a week at age 70 preserved ease of performance at age 77 independent of the influence of specific disease or general self‐assessed health.
Effect of Cilostazol on Treadmill Walking, Community‐Based Walking Ability, and Health‐Related Quality of Life in Patients with Intermittent Claudication Due to Peripheral Arterial Disease: Meta‐Analysis of Six Randomized Controlled Trials
Authors: Regensteiner Judith G. , Ware John E. , McCarthy Walter J. , Zhang Peter , Forbes William P. , Heckman Jeffrey , Hiatt William R. 
Published: December 2004

OBJECTIVES: To assess whether cilostazol, a phosphodiesterase III inhibitor, improves treadmill and community‐based walking ability and health‐related quality of life (HQL) in patients with intermittent claudication resulting from peripheral arterial disease (PAD).DESIGN: Retrospective meta‐analysis of data pooled from six Phase 3, multicenter, double‐blind, placebo‐controlled, parallel‐group, randomized studies.SETTING: Patients were recruited from outpatient ambulatory medical care facilities.PARTICIPANTS: Patients' (n = 1,751) mean age ± standard deviation was 65 ± 9, and they had a history of PAD for 6 months or longer and an ankle brachial index (ABI) of 0.90 or less.INTERVENTION: Cilostazol 50 mg bid or 100 mg bid for 12, 16, or 24 weeks.MEASUREMENTS: ABI; maximal walking distance (MWD); pain‐free walking distance on a graded and constant‐load treadmill; and HQL, measured using the Walking Impairment Questionnaire (WIQ) and the Medical Outcomes Study Short Form‐36 (SF‐36).RESULTS: Maximal treadmill walking distance improved more in both cilostazol groups than in the placebo group (both P < .0001). WIQ and SF‐36 physical summary scores improved significantly more with cilostazol than with placebo (for instance, WIQ distance score, P < .0001 and SF‐36 physical summary score, P < .0001, comparing persons taking cilostazol with controls). Improved MWD correlated with improvements in WIQ (correlation with distance score, r = 0.34, P < .0001) and SF‐36 physical summary scores (r = 0.29, P < .0001).CONCLUSIONS: Treatment with cilostazol was associated with greater improvements in community‐based walking ability and HQL in patients with intermittent claudication than treatment with placebo. These improvements correlated with increased MWD. This analysis of effects of cilostazol on improving walking ability in persons with claudication is the first cilostazol study focused on community‐based measures of functional status and HQL. Questionnaires assessing walking ability and HQL provide important patient‐based information about clinical outcomes of claudication therapy.
Adverse Drug Reactions as Cause of Hospital Admissions: Results from the Italian Group of Pharmacoepidemiology in the Elderly (GIFA)
Authors: Onder Graziano , Pedone Claudio , Landi Francesco , Cesari Matteo , Della Vedova Cecilia , Bernabei Roberto , Gambassi Giovanni 
Published: December 2004

OBJECTIVES: To determine the prevalence of adverse drug reaction (ADR)‐related hospital admissions in an older population, to describe the most common clinical manifestations and drugs most frequently responsible for ADR‐related hospital admissions, and to identify independent factors predictive of these ADRs.DESIGN: Multicenter pharmacoepidemiology survey conducted between 1988 and 1997.SETTING: Eighty‐one academic hospitals throughout Italy.PARTICIPANTS: Twenty‐eight thousand four hundred eleven patients consecutively admitted to participating centers during the survey periods.MEASUREMENTS: For each suspected ADR at admission, a physician, who coded description, severity, and potentially responsible drugs, completed a questionnaire.RESULTS: Mean age ± standard deviation of the patients was 70 ± 16. One thousand seven hundred four ADRs were identified upon hospital admission. In 964 cases (3.4% of all admissions), ADRs were considered to be the cause of these hospital admissions. Of these, 187 ADRs were coded as severe. Gastrointestinal complaints (19%) represented the most common events, followed by metabolic and hemorrhagic complications (9%). The drugs most frequently responsible for these ADRs were diuretics, calcium channel blockers, nonsteroidal antiinflammatory drugs, and digoxin. Female sex (odds ratio (OR) = 1.30, 95% confidence interval (CI) = 1.10–1.54), alcohol use (OR = 1.39, 95% CI = 1.20–1.60), and number of drugs (OR = 1.24, 95% CI = 1.20–1.27 for each drug increase) were independent predictors of ADR‐related hospital admissions. For severe ADRs, age (OR = 1.50, 95% CI = 1.01–2.23 for age 65–79 and OR = 1.53, 95% CI = 1.00–2.33 for age ≥80, respectively), comorbidity (OR = 1.12, 95% CI = 1.05–1.20 for each point in the Charlson Comorbidity Index), and number of drugs (OR = 1.18, 95% CI = 1.11–1.25 for each drug increase) were the only predisposing factors.CONCLUSIONS: The most important determinant of risk for ADR‐related hospital admissions in older patients is number of drugs being taken. When considering only severe ADRs, risk is also related to age and frailty.
Nutritional Status Using Mini Nutritional Assessment and Subjective Global Assessment Predict Mortality in Geriatric Patients
Authors: Persson Margareta D. , Brismar Kerstin E. , Katzarski Krassimir S. , Nordenström Jörgen , Cederholm Tommy E. 
Published: December 2004

OBJECTIVES: To evaluate the clinical assessment of nutritional status and mortality in geriatric patients.DESIGN: Prospective follow‐up study.SETTING: Acute geriatric inpatient ward.PARTICIPANTS: Eighty‐three consecutive acute geriatric patients (mean age ± standard deviation = 83 ± 7; 68% women).MEASUREMENTS: Patients were classified as (1) having protein‐energy malnutrition (PEM), (2) having moderate PEM or being at risk for PEM, or (3) being well nourished according to Subjective Global Assessment (SGA) and Mini Nutritional Assessment (MNA). Body mass index ((BMI) kg/m2), arm anthropometry, and handgrip strength were determined. In a subgroup of patients (n = 39), body composition was analyzed using dual energy x‐ray absorption and bioelectrical impedance. Three‐year mortality data were obtained from the Swedish population records.RESULTS: Twenty percent and 26% of the patients were classified as having PEM based on SGA and MNA, respectively, whereas 43% and 56%, respectively, were classified as having moderate PEM or being at risk for PEM. Objective measures, such as BMI, arm anthropometry, handgrip, and body fat were 20% to 50% lower in the malnourished group than in the well‐nourished subjects (P < .05). Moreover, mortality was higher in those classified as being malnourished, ranging from 40% after 1 year to 80% after 3 years, compared with 20% after 1 year (P = .03–0.17) and 50% after 3 years (P < .01) in patients classified as being well nourished.CONCLUSION: Fewer than one‐third of newly admitted geriatric patients had a normal nutritional status according to SGA and MNA. BMI, arm anthropometry, body fat mass, and handgrip strength were reduced, and 1‐, 2‐, and 3‐year mortality was higher in patients classified as malnourished. The present data justify the use of SGA and MNA for the assessment of nutritional status in geriatric patients.
Effects of Aerobic Exercise Training in Community‐Based Subjects Aged 80 and Older: A Pilot Study
Authors: Vaitkevicius Peter V. , Ebersold Caroline , Shah Muhammad S. , Gill Nikita S. , Katz Robert L. , Narrett Matthew J. , Applebaum Gary E. , Parrish Sheryl M. , O'Connor Frances C. , Fleg Jerome L. 
Published: December 2004

OBJECTIVES: To assess the ability of sedentary, frail subjects aged 80 and older to train in a community‐based exercise program and to evaluate clinical factors that predict improvements in peak oxygen consumption (VO2peak).DESIGN: Pretest, posttest.SETTING: Charlestown Retirement Community, Catonsville, MarylandPARTICIPANTS: Twenty‐two (11 male, 11 female; mean age ± standard deviation = 84 ± 4.0, range 80–92) self‐referred.INTERVENTION: Six months of moderate‐intensity aerobic exercise training, two to three sessions/week, 20 to 30 minutes per session. Training modes included treadmill walking and/or stationary cycling.MEASUREMENTS: Baseline and follow‐up maximal exercise treadmill tests (ETTs) with electrocardiogram monitoring and respiratory gas analysis.RESULTS: Six months of aerobic exercise training resulted in significant increases (mean ± standard deviation) in ETT duration (11.9 ± 3.3 vs 15.9 ± 4.3 minutes; P = .01), VO2peak (1.23 ± 0.37 vs 1.31 ± 0.36 L/min; P = .04), and oxygen pulse (9.3 ± 2.8 vs 10.1 ± 3.2; P = .03). Mean heart rate was significantly lower during submaximal ETT stages 1 through 4 (P < .05), and resting systolic blood pressure decreased (146 ± 18 vs 133 ± 14 mmHg; P = .01) after training. Multiple regression analysis indicated that baseline VO2peak (r = 0.75, P = .002) and the total amount of time spent in exercise training (r = 0.55, P = .008) were independent predictors of the training‐related improvements in VO2peak.CONCLUSION: Subjects aged 80 and older can increase aerobic capacity and reduce systolic blood pressure in a community‐based exercise program of moderate intensity. The most important predictors of change in VO2peak were baseline VO2peak and the time spent in exercise training. Subjects with a lower baseline VO2peak had the greatest improvements in VO2peak after training.
Alzheimer's Disease Patients' and Caregivers' Capacity, Competency, and Reasons to Enroll in an Early‐Phase Alzheimer's Disease Clinical Trial
Authors: Karlawish Jason H. T. , Casarett David J. , James Bryan D. 
Published: December 2004

OBJECTIVES: To examine the capacity, competency, and reasons for enrolling of patients with Alzheimer's disease (AD) and of their caregivers in an early phase AD clinical trial.DESIGN: Interviews were conducted with patients with AD, nondemented older persons, and caregivers.SETTING: Participants' homes.PARTICIPANTS: Fifteen patients with mild to moderate AD, 15 age‐ and education‐matched nondemented older persons, and 15 patient caregivers.MEASUREMENTS: Capacity was measured using the MacArthur Competency Assessment Tool for Clinical Research (MacCAT‐CR); a study coordinator who reviewed audiotapes of the capacity interviews judged competency, and the reasons for a decision were determined by coding the capacity interviews.RESULTS: On all measures except the ability to make a choice, patients performed worse than controls (understanding: z = 3.2, P = .001; appreciation: z = 2.8, P = .005; reasoning: z = 3.5, P = .0005), and caregivers (understanding: z = 3.8, P = .0002; appreciation: z = 3.0, P = .003; reasoning: z = 3.6, P = .0003). Using the controls' performance to set psychometric criteria to define capacity, the proportions of patients with adequate understanding, appreciation, and reasoning were six of 15 (40%), three of 15 (20%), and five of 15 (33%). All caregivers and nine of the 15 (60%) patients were competent. Reasons for enrolling typically featured the potential benefit to the patients' health or well‐being and altruism that was expressed as a desire to help other patients and their families or a desire to contribute to scientific knowledge.CONCLUSIONS: The MacCAT‐CR, in particular its understanding scale, is a reliable and valid way to assess patient capacity and competency to enroll in an early‐phase clinical trial. Although many patients have significant impairments in their capacity, some mild‐stage patients are competent. Reasons for enrolling in an early‐phase trial blend an expectation of therapeutic benefit and a desire to help others.
Angiotensin‐Converting Enzyme Gene Polymorphism May Influence Blood Loss in a Geriatric Population Undergoing Total Hip Arthroplasty
Authors: Pola Enrico , Gaetani Eleonora , Pola Roberto , Papaleo Pierangelo , Flex Andrea , Aloi Francesco , De Santis Vincenzo , Santoliquido Angelo , Pola Paolo 
Published: December 2004

OBJECTIVES: To evaluate how angiotensin‐converting enzyme (ACE) gene polymorphism is associated with perioperative blood loss in hip arthroplasty in a geriatric population.DESIGN: A case‐control study of subjects consecutively undergoing total hip arthroplasty.SETTING: A department of orthopedic surgery in Italy.PARTICIPANTS: One hundred five patients, mean age ± standard deviation 68.6 ± 10.4, undergoing total hip arthroplasty.MEASUREMENTS: ACE gene polymorphism was analyzed using polymerase chain reaction. Decrement of hemoglobin (Hb) and hematocrit (Ht) was calculated as the difference between the preoperative and the lowest postoperative value, measured 1, 2, and 3 days after surgery. Total blood loss was calculated as the sum of intra‐ and postoperative blood loss.RESULTS: Patients carrying the deletion homozygous and insertion/deletion heterozygous genotypes of the ACE gene show a higher decrement of Hb (P < .01) and Ht (P < .01) and higher total blood loss (P < .007) after hip surgery than subjects carrying the insertion (II) homozygous. The role of ACE gene polymorphism seems hypertension independent. Logistic regression analysis showed that II genotype reduces total blood loss.CONCLUSIONS: This is the largest study evaluating the distribution of ACE gene genotypes in patients undergoing hip arthroplasty and the first investigating the association between bleeding and ACE gene polymorphism. Our data suggest that II genotype is associated with lower total blood loss.
Is Satisfaction With Pain Management a Valid and Reliable Quality Indicator for Use in Nursing Homes?
Authors: Casarett David J. , Hirschman Karen B. , Miller Elizabeth R. , Farrar John T. 
Published: December 2004

OBJECTIVES: To determine whether satisfaction with pain management can be measured reliably in nursing homes and to gather preliminary data about the validity of satisfaction assessments in this population.DESIGN: Cross‐sectional interview study.SETTING: Two urban nursing homes.PARTICIPANTS: Sixty‐six nursing home residents with pain.MEASUREMENTS: Overall satisfaction with pain management, satisfaction with pain medication, experiences related to pain management, cognitive function, depressive symptoms, and retest reliability of overall satisfaction rating.RESULTS: Most residents (60/66; 91%) could rate their overall satisfaction with pain management. Overall satisfaction was weakly correlated with pain severity at the time of the interview (Spearman correlation coefficient = –0.28; P = .033) and over the past week (–0.27; P = .038). Overall satisfaction was also negatively associated with the Geriatric Depression Scale score (–0.50; P < .001). Satisfaction with pain medication was associated with several ratings of the medication's beneficial effects, including improved activity, sleep, and speed of relief, but not with the frequency with which it caused side effects. Ratings of overall satisfaction showed good reliability overall (kappa = 0.62; P < .001) and for those with Mini‐Mental State Examination scores greater than 21 (kappa = 0.70; P < .001) and 21 or less (kappa = 0.54; P = .004).CONCLUSION: These results suggest that satisfaction with pain management can be measured reliably when residents are able to report their pain, but further research is needed before satisfaction with pain management can be incorporated into routine assessments in nursing homes.