bluuebunny/crossref_metadata_2025_split huggingface dataset:
Standardized Quality‐Assessment System to Evaluate Pressure Ulcer Care in the Nursing Home
Authors: Bates‐Jensen Barbara M. , Cadogan Mary , Jorge Jennifer , Schnelle John F. 
Published: August 2003

Objectives: To demonstrate reliability and feasibility of a standardized protocol to assess and score quality indicators relevant to pressure ulcer (PU) care processes in nursing homes (NHs).Design: Descriptive.Setting: Eight NHs.Participants: One hundred ninety‐one NH residents for whom the PU Resident Assessment Protocol of the Minimum Data Set was initiated.Measurements: Nine quality indicators (two related to screening and prevention of PU, two focused on assessment, and five addressing management) were scored using medical record data, direct human observation, and wireless thigh monitor observation data. Feasibility and reliability of medical record, observation, and thigh monitor protocols were determined.Results: The percentage of participants who passed each of the indicators, indicating care consistent with practice guidelines, ranged from 0% to 98% across all indicators. In general, participants in NHs passed fewer indicators and had more problems with medical record accuracy before a PU was detected (screening/prevention indicators) than they did once an ulcer was documented (assessment and management indicators). Reliability of the medical record protocol showed kappa statistics ranging from 0.689 to 1.00 and percentage agreement from 80% to 100%. Direct observation protocols yielded kappa statistics of 0.979 and 0.928. Thigh monitor protocols showed kappa statistics ranging from 0.609 to 0.842. Training was variable, with the observation protocol requiring 1 to 2 hours, medical records requiring joint review of 20 charts with average time to complete the review of 20 minutes, and the thigh monitor data requiring 1 week for training in data preparation and interpretation.Conclusion: The standardized quality assessment system generated scores for nine PU quality indicators with good reliability and provided explicit scoring rules that permit reproducible conclusions about PU care. The focus of the indicators on care processes that are under the control of NH staff made the protocol useful for external survey and internal quality improvement purposes, and the thigh monitor observational technology provided a method for monitoring repositioning care processes that were otherwise difficult to monitor and manage.
The Minimum Data Set Pressure Ulcer Indicator: Does It Reflect Differences in Care Processes Related to Pressure Ulcer Prevention and Treatment in Nursing Homes?
Authors: Bates‐Jensen Barbara M. , Cadogan Mary , Osterweil Dan , Levy‐Storms Lené , Jorge Jennifer , Al‐Samarrai Nahla , Grbic Valena , Schnelle John F. 
Published: August 2003

Objectives: To determine whether nursing homes (NHs) that score in the extreme quartiles of pressure ulcer (PU) prevalence as reported on the Minimum Data Set (MDS) PU quality indicator provide different PU care.Design: Descriptive, cohort.Setting: Sixteen NHs.Participants: Three hundred twenty‐nine NH residents at risk for PU development as determined by the PU Resident Assessment Protocol of the MDS.Measurements: Sixteen care process quality indicators (10 specific to PU care processes, five related to nutrition, and one related to incontinence management) were scored using medical record data, direct human observation, interviews, and data from wireless thigh movement monitors.Results: There were no differences between homes with low‐ and high‐PU prevalence rates reported on the MDS PU quality indicator on most care processes. NHs with high PU prevalence rates used pressure‐reduction surfaces more frequently and were better at documentation of four wound characteristics when PUs were present. No measure of PU care processes was better in low‐PU NHs. Neither low‐ nor high‐PU prevalence NHs routinely repositioned residents every 2 hours, even though 2‐hour repositioning was documented in the medical record for nearly all residents.Conclusion: The assumption that homes with fewer PUs and thus low PU prevalence according to the MDS PU quality indicator are providing better PU care was not supported in this sample. NHs that scored low on the MDS PU quality indicator did not provide significantly better care than NHs that scored high. All NHs could improve PU prevention, as evidenced by the poor performance on prevention care processes by low‐ and high‐PU NHs. The MDS PU quality indicator is not a useful measure of the quality of PU care in NHs and can be misleading if not presented with an explanation of the meaning of the indicator.
Dementia as a Risk Factor for Falls and Fall Injuries Among Nursing Home Residents
Authors: Van Doorn Carol , Gruber‐Baldini Ann L. , Zimmerman Sheryl , Richard Hebel J. , Port Cynthia L. , Baumgarten Mona , Quinn Charlene C. , Taler George , May Conrad , Magaziner Jay ,   for the Epidemiology of Dementia in Nursing Homes Research Group
Published: August 2003

Objectives: To compare rates of falling between nursing home residents with and without dementia and to examine dementia as an independent risk factor for falls and fall injuries.Design: Prospective cohort study with 2 years of follow‐up.Setting: Fifty‐nine randomly selected nursing homes in Maryland, stratified by geographic region and facility size.Participants: Two thousand fifteen newly admitted residents aged 65 and older.Measurements: During 2 years after nursing home admission, fall data were collected from nursing home charts and hospital discharge summaries.Results: The unadjusted fall rate for residents in the nursing home with dementia was 4.05 per year, compared with 2.33 falls per year for residents without dementia (P<.0001). The effect of dementia on the rate of falling persisted when known risk factors were taken into account. Among fall events, those occurring to residents with dementia were no more likely to result in injury than falls of residents without dementia, but, given the markedly higher rates of falling by residents with dementia, their rate of injurious falls was higher than for residents without dementia.Conclusion: Dementia is an independent risk factor for falling. Although most falls do not result in injury, the fact that residents with dementia fall more often than their counterparts without dementia leaves them with a higher overall risk of sustaining injurious falls over time. Nursing home residents with dementia should be considered important candidates for fall‐prevention and fall‐injury‐prevention strategies.
Effects of Vitamin D Supplementation on Strength, Physical Performance, and Falls in Older Persons: A Systematic Review
Authors: Latham Nancy K. , Anderson Craig S. , Reid Ian R. 
Published: August 2003

Objectives: To identify, appraise, and synthesize data from randomized, controlled trials of vitamin D supplementation in older people.Design: A systematic review of trials identified from searches of databases, reference lists, review articles, and recent conference proceedings.Setting: Most studies performed in ambulatory setting.Participants: Older people (mean age=60).Interventions: Vitamin D or vitamin D metabolites.Measurements: Strength, physical performance, or falls.Results: Thirteen trials involving 2,496 patients met this study's inclusion criteria. Most of the trials were small and had methodological problems. In 10 trials, there was no evidence that vitamin D or vitamin D metabolites had an effect on falls or physical function, but three trials showed a positive effect of vitamin D in combination with calcium. When available data from the four highest quality trials were pooled (n=1,317), there continued to be no evidence that vitamin D reduced the risk of falling (relative risk= 0.99, 95% confidence interval=0.89–1.11), although a single trial of vitamin D and calcium showed a positive effect.Conclusion: Although there is insufficient evidence that vitamin D supplementation alone improves physical performance in older people, some data suggest a benefit from vitamin D combined with calcium supplementation, but this requires confirmation in large, well‐designed trials.
Cognitive Impairment in Hip Fracture Patients: Timing of Detection and Longitudinal Follow‐Up
Authors: Gruber‐Baldini Ann L. , Zimmerman Sheryl , Morrison R. Sean , Grattan Lynn M. , Hebel J. Richard , Dolan Melissa M. , Hawkes William , Magaziner Jay 
Published: August 2003

Objectives: To examine the prevalence, incidence, persistence, predictors, and outcomes of cognitive impairment after hip fracture.Design: Longitudinal cohort study.Setting: Eight hospitals in Baltimore, Maryland.Participants: Six hundred seventy‐four hip fracture patients aged 65 and older living in the community before fracture.Measurement: Delirium at admission and postsurgery, Mini‐Mental State Examination (MMSE) scores postsurgery, and prefracture proxy ratings of MMSE and dementia. Follow‐up measures at 2 and 12 months postfracture included mortality, MMSE, physical activities of daily living (PADLs), instrumental activities of daily living (IADLs), social functioning, and the Center for Epidemiologic Studies—Depression Scale.Results: Overall, 28% had prefracture dementia or MMSE impairment, 8% had cognitive impairment first detected presurgery, 14% had impairment first detected postsurgery, and 50% were not impaired before or during hospitalization. Incident cognitive impairment was more likely in patients who were older, male, and less educated and had more prefracture PADL impairment, intertrochanteric fractures, and higher anesthesia risk ratings. Presurgery incident cases did not differ significantly from those detected postsurgery in functional outcomes or in persistence of cognitive impairment. Cognitive impairment first noted in the hospital persisted through 2 and 12 months in more than 40% of patients. Those with cognitive impairment persisting through 2 months had poorer 12‐month PADLs and social functioning.Conclusion: Prefracture cognitive impairment and incident cognitive impairment during hospitalization are risk factors for poor functional outcomes. Many incident cognitive problems persisted over 2 to 12 months, and per‐sistence predicted later functional and social impairment.
Insulin‐Like Growth Factor‐1 and Interleukin 6 Predict Sarcopenia in Very Old Community‐Living Men and Women: The Framingham Heart Study
Authors: Payette Hélène , Roubenoff Ronenn , Jacques Paul F. , Dinarello Charles A. , Wilson Peter W. F. , Abad Leslie W. , Harris Tamara 
Published: August 2003

Objectives: To assess the prognostic role of the inflammatory cytokine, interleukin 6 (IL‐6), and insulin‐like growth factor‐1 (IGF‐1) in predicting 2‐year changes in fat‐free mass (FFM) while controlling for potential confounders.Design: Population‐based cohort, the Framingham Heart Study, examined in 1992–93 and 1994–95.Setting: General community.Participants: Two hundred thirty‐two men and 326 women aged 72 to 92.Measurements: IGF‐1 was measured using radio‐immunoassay and cellular IL‐6 production using non‐cross‐reacting radioimmunoassays. FFM was estimated using population‐specific equations for predicting FFM from bioelectrical impedance analysis developed separately for men and women.Results: Higher IGF‐1 predicted smaller loss of FFM in men than lower IGF‐1 did (P=.002), after adjusting for age, baseline FFM, fat mass, and 2‐year weight changes, whereas cellular IL‐6 was a significant predictor of sarcopenia in women (P=.02). Weight change was a strong determinant of change in FFM in both sexes (P<.0001).Conclusion: Predictors of sarcopenia include body composition characteristics that are common to men and women and sex‐specific metabolic predictors. Sarcopenia appears to reflect a withdrawal of anabolic stimuli, such as growth hormone, in men but an increase in catabolic stimuli, such as cellular IL‐6, in women.
Activity Restriction Among Wheelchair Users
Authors: Hoenig Helen , Landerman Lawrence R. , Shipp Kathy M. , George Linda 
Published: August 2003

Objectives: To identify factors associated with activity restriction.Design: Cohort study.Setting: Patients prescribed a new wheelchair at one of two teaching hospitals (one Veterans Affairs and one private hospital).Participants: One hundred fifty‐three consecutive, community‐dwelling wheelchair users, who had a Short Portable Mental Status Score greater than 6 out of 10 and could be interviewed within 7 to 21 days of receiving the wheelchair.Measurements: Dependent variables were selfreported nonmedical visits and medical visits in the preceding week (any vs no visits and the number of visits). Independent variables were self‐reported sociodemographic and health characteristics, mobility limitations, and environmental barriers.Results: Study subjects reported, on average, 1.79 mobility limitations, 11.17 hours out of bed, and 5.56 hours of personal assistance per day. Multivariate analyses show that higher income was the only significant sociodemographic factor; it was associated with more medical visits (β=0.44, P<.01). Of health status characteristics, more comorbid conditions predicted fewer nonmedical visits (β=−0.14, P<.10) and amputation was associated with fewer medical visits (β−0.82, P<.05). Regarding mobility limitations, more mobility limitations was associated with lower odds of any nonmedical visit (odds ratio (OR)=0.71, P<.5) and fewer nonmedical visits (β=−0.28, P<.05); more hours out of bed predicted more nonmedical visits (β=0.05, P<.5) and lower odds any medical visit (OR=0.92, P<.05). More environmental barriers predicted fewer nonmedical (β=−0.32, P<.01) or medical visits (β=−0.21, P<.05).Conclusion: Mobility limitations and environmental barriers were associated with restricted participation in diverse activities outside the home.
Effect of Nurse Case Management on the Treatment of Older Women with Breast Cancer
Authors: Goodwin James S. , Satish Shiva , Anderson Elizabeth T. , Nattinger Ann B. , Freeman Jean L. 
Published: August 2003

Objectives: To evaluate the effect of nurse case management on the treatment of older women with breast cancer.Design: Randomized prospective trial.Setting: Sixty surgeons practicing at 13 community and two public hospitals in southeast Texas.Participants: Three hundred thirty‐five women (166 control and 169 intervention) aged 65 and older newly diagnosed with breast cancer.Intervention: Women seeing surgeons randomized to the intervention group received the services of a nurse case manager for 12 months after the diagnosis of breast cancer.Measurements: The primary outcome was the type and use of cancer‐specific therapies received in the first 6 months after diagnosis. Secondary outcomes were patient satisfaction and arm function on the affected side 2 months after diagnosis.Results: More women in the intervention group received breast‐conserving surgery (28.6% vs 18.7%; P=.031) and radiation therapy (36.0% vs 19.0%; P=.003). Of women undergoing breast‐conserving surgery, greater percentages in the case management group received adjuvant radiation (78.3% vs 44.8%; P=.001) and axillary dissection (71.4% vs 44.8%; P=.057). Women in the case management group were also more likely to receive more breast reconstruction surgery (9.3% vs 2.6%, P=.054), and women in the case management group with advanced cancer were more likely to receive chemotherapy (72.7% vs 30.0%, P=.057). Two months after surgery, higher percentages of women in the case manager group had normal arm function (93% vs 84%; P=.037) and were more likely to state that they had a real choice in their treatment (82.2% vs 69.9%, P=.020). Women with indicators of poor social support were more likely to benefit from nurse case management.Conclusion: Nurse case management results in more appropriate management of older women with breast cancer.
Sex Differences in the Effect of Heart Rate on Mortality in the Elderly
Authors: Perk Gila , Stessman Jochanan , Ginsberg Gary , Bursztyn Michael 
Published: August 2003

Objectives:  To examine the association between heart rate and mortality risk in the elderly.Design:  Longitudinal cohort.Setting:  Outpatient.Participants: Four hundred twenty‐two people, aged 70 upon entry, were surveyed and followed for 6 years.Measurements: Pulse rate was measured manually, while sitting and standing, and heart rate was measured from electrocardiogram recordings. The population was divided into quartiles of heart rate, with the top quartile comprising those with heart rate greater than 77 beats per minute (bpm) and the bottom quartile those with heart rate less than 60 bpm.Results: After controlling for possible confounders, there was a clear correlation (r) between heart rate and all‐cause mortality in elderly women (r=0.25, P=.0003). The correlation in women was observed using the three different methods for measuring heart rate. Heart rate was associated with all‐cause and cardiovascular mortality. There was no relationship between heart rate and level of exercise or smoking status. In multiple regression analysis, the increased risk of death in the women was independent of previous cardiovascular or cerebrovascular disease, hypertension, anemia, congestive heart failure, smoking, and level of exercise or activities of daily living (relative odds ratio (ROR)=3.37, 95% confidence interval (CI)=0.96–11.8). When women using beta‐blockers were excluded, this relationship became even stronger (ROR=8.5, 95% CI=1.19–60.1).Conclusion: Elevated heart rate is related to increased mortality in elderly women, thus representing a simple index of general health status in this population. Elevated heart rate did not predict mortality in elderly men.
Associations Between Polymorphisms of the High‐Affinity Immunoglobulin E Receptor and Late‐Onset Airflow Obstruction in Older Populations
Authors: Ruse Charlotte E. , Hill Maureen C. , Burton Paul R. , Connolly Martin J. , Wardlaw Andrew J. , Parker Stuart G. 
Published: August 2003

Objectives: To test the hypothesis that genetic polymorphisms in the β subunit of the high‐affinity immunoglobulin E (IgE) receptor are associated with late‐onset airflow obstruction.Design: Case‐control candidate gene association study.Setting: Department of Medicine for the Elderly and Respiratory Medicine in three teaching hospitals in Leicester and Manchester, United Kingdom.Participants: Cases with late‐onset airflow obstruction with age‐, sex‐, and geographically matched controls.Measurements: Subjects were genotyped for two polymorphisms of the β subunit of the high‐affinity IgE receptor (RsaI intron 2 and RsaI exon 7). The association between the polymorphisms and phenotypes was examined using contingency tables and linear regression models.Results: Two hundred eighty‐three cases and 144 controls were genotyped. RsaI exon 7 AA was associated with eczema (odds ratio (OR)=2.27, 95% confidence interval (CI)=1.17–4.38, P=.015). No other associations were found. Total serum IgE levels were significantly higher in cases than controls (adjusted OR for high/low IgE=2.56, 95% CI=1.53–4.28, P<.001).Conclusion: Serum IgE levels, but not the high‐affinity IgE receptor polymorphisms, were associated with late‐onset airflow obstruction, suggesting that interaction between environmental and genetic factors controlling serum IgE levels and disease pathogenesis may differ between early‐ and late‐onset airflow obstruction phenotypes.
Assessment and Treatment of Nursing Home Residents with Depression or Behavioral Symptoms Associated with Dementia: A Review of the Literature
Authors: Snowden Mark , Sato Kersten , Roy‐Byrne Peter 
Published: August 2003

Depression and the behavioral symptoms associated with dementia remain two of the most significant mental health issues for nursing home residents. The extensive literature on these conditions in nursing homes was reviewed to provide an expert panel with an evidence base for making recommendations on the assessment and treatment of these problems.Numerous assessment instruments have been validated for depression and for behavioral symptoms. The Minimum Data Set, as routinely collected, appears to be of limited utility as a screening instrument for depression but is useful for assessing some behavioral symptoms. Laboratory evaluations are often recommended, but no systematic study of the outcomes of these evaluations could be found. Studies of nonpharmacological interventions out‐number those of pharmacological interventions, and randomized, controlled trials document the efficacy of many interventions. Antidepressants are effective for major depression, but data for minor depressive syndromes are limited. Recreational activities are effective for major and minor depression categories. Neither pharmacological nor nonpharmacological interventions totally eliminate behavioral symptoms, but both types of interventions decrease the severity of symptoms. In the absence of comparison studies, it is unclear whether one approach is more effective than another. Despite federal regulations limiting their use, antipsychotics are effective and remain the most studied medications for treating behavioral symptoms, whereas benzodiazepines and antidepressants have less support. Structured activities are effective, but training interventions for behavioral symptoms had limited results. There are sufficient data to formulate an evidenced‐based approach to treatment of depression and behavioral symptoms, but more research is needed to prioritize treatments.
Modulation of liver fibrosis and pathophysiological changes in mice infected with Mesocestoides corti (M. vogae) after administration of glucan and liposomized glucan in combination with vitamin C
Authors: Ditteová G. , Velebný S. , Hrčkova G. 
Published: August 2003

AbstractThe effects of glucan and liposomized glucan, alone or co-administered with vitamin C, and empty liposomes on hepatic fibrosis in mice infected with Mesocestoides corti (M. vogae) tetrathyridia were studied. Preparations were administered every third day from day 7 to day 31 post-infection (p.i.), nine doses in total. Activities of alanine aminotransferase (ALT), aspartate aminotransferase (AST) and cholesterol levels were measured in sera collected on days 11, 15, 21, 28, 32, 42, 50 and 65 p.i. Liver fibrosis was studied on the same days by measuring hydroxyproline concentration, which is considered a marker for collagen content. Larvicidal effects of the glucan and liposome preparations were estimated on day 65 p.i. in the liver and peritoneal cavity. Glucan formulations significantly enhanced collagen content, most prominently after administration of liposomized glucan in combination with vitamin C. Activities of both enzymes and cholesterol levels were slightly modified after administration of glucan alone. Liposomized glucan with vitamin C significantly increased ALT and AST activity and cholesterol levels up to days 28–32 p.i., after which they plateaued or declined. The most pronounced decrease was after administration of liposomized glucan and vitamin C. The same pattern of biochemical parameters in serum was observed after administration of empty liposomes, however, collagen content was not modified significantly. Larval counts in the liver and the peritoneal cavity were significantly reduced after treatment with either glucan formulation, but were unaffected following treatment with empty liposomes. In summary, intense fibrosis in the liver of mice treated with liposomized glucan and vitamin C did not result in the most extensive parenchymal cell injury but, rather in the highest efficacy of treatment. Liposomal lipids were probably utilized in the reparation of the damaged parenchymal cells, while glucan stimulated phagocytic cells.