bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development of chronic lung disease in preterm infants treated with surfactant
Authors: Hammoud Majeda S , Thalib Lukman 
Published: October 2002

Abstract
Background
: Chronic lung disease (CLD) is generally known to develop among preterm infants who have severe respiratory distress syndrome (RDS) at birth. Many clinical trials have established the efficacy of surfactant replacement therapy to treat RDS at birth with differing doses. In this study, the preterm infants diagnosed to have RDS at birth and treated with one or two doses of surfactant, depending on the severity of the RDS, were studied to evaluate the effect of surfactant on the later development of CLD.
Methods
: A retrospective examination of case records of preterm infants who were born at ≤28 weeks gestation period were studied. The subjects received a natural surfactant product (survanta) between September 1994 and April 1996 at the Monash Medical Center, Australia.
Results
: Despite less severe initial lung disease, the subsequent respiratory outcome of infants who received one dose of surfactant, showed a trend towards being poorer compared to those who were diagnosed as having severe RDS at birth and received two doses of surfactant. At the corrected gestational age of 36 weeks, 54% of those infants began with mild RDS required oxygen, while only 44% of those who started with a severe RDS required supplemental O2.
Conclusion
: This study reports the infants with severe RDS at birth had responded slightly better or equally, compared to those with mild RDS, in terms of later development of CLD under surfactant treatment proportional to the severity.
Follow‐up study of auditory brainstem responses in infants with high unbound bilirubin levels treated with albumin infusion therapy
Authors: Hosono Shigeharu , Ohno Tsutomu , Kimoto Hirofumi , Nagoshi Ren , Shimizu Masaki , Nozawa Masayo , Harada Kensuke 
Published: October 2002

Abstract
Background
: Several authors reported that there was a close relationship between unbound bilirubin concentrations and abnormal results of auditory brainstem responses. Full‐term infants with high‐unbound bilirubin concentrations who were treated with human albumin were followed to evaluate their hearing abilities by using auditory brainstem responses.
Methods
: Fifty‐eight infants (gestational age, 39.4 ± 1.4 weeks; birthweight, 3245 ± 435 g) with high unbound bilirubin concentrations (≥0.9 µg/dL) were treated with intensive phototherapy. Twenty infants (control group) received only phototherapy, while 38 others (albumin‐treated group) were also given i.v. human albumin administration (1 g/kg bodyweight) during the first 2 h of phototherapy. The follow‐up study of auditory brainstem responses was carried out at 6 and 12 months of age. Development quotient tests were carried out at 18 months of age.
Results
: Abnormalities of auditory brainstem response were detected in three infants in the albumin‐treated group and six infants in the control group at 6 months. Two infants in the albumin‐treated group and four infants in the control group had improved at 12 months. The results of the follow‐up study at 18 months of age in the both groups were normal with development quotient >85. No patients with hearing disability and cerebral palsy were clinically detected at the age of 2 years.
Conclusion
: The results suggest that albumin priming might be effective for decreasing the rate of auditory brainstem response abnormalities at 6 months.
Current respiratory syncytial virus prevention strategies in high‐risk infants
Authors: Weisman Leonard E 
Published: October 2002

AbstractRespiratory syncytial virus (RSV) was initially isolated in 1956. Since then it has become recognized as a major pathogen worldwide. It is a ubiquitous pathogen that produces seasonal epidemics. Primary infection occurs in children before 2 years of age. In older children and adults, RSV usually manifests itself as an upper respiratory tract infection. In immunecompromised patients, those with underlying cardiopulmonary disorders, premature infants, and other vulnerable individuals, RSV infection can produce severe bronchiolitis or pneumonia. In recent years we have observed exciting new information about the prevention of serious RSV infection in high‐risk infants including infection control practices, active immunity and passive immunity. Two immunoprophylaxis products (RSV i.v. immune globulin and palivzumab) have been developed for clinical use in the prevention of serious RSV infection. Many other agents including vaccines, super monoclonal antibodies, and antivirals are under development. Although clinicians now have the ability to provide their most vulnerable patients with meaningful prevention strategies, much more needs to be done before we can regard RSV as a preventable disease.
Financial Effect of a Hospital Outpatient Senior Clinic on an Academic Medical Center
Authors: Dang Stuti , Baker Glen , Lipschitz David A. 
Published: October 2002

OBJECTIVES: To estimate the billed charges generated for the university hospital (UH) by patients seen in a UH outpatient senior clinic over a 6‐month period. To estimate the average billed charges per geriatric patient generated for the UH over the same 6‐month period.DESIGN: Retrospective analysis.SETTING: Hospital‐based outpatient senior clinic at a university medical center.PARTICIPANTS: Outpatients aged 65 and older.MEASUREMENTS: The total inpatient, outpatient, and professional fee charges generated for the UH by the senior health center (SHC) patients were estimated for a 6‐month period, with the use of billing data from the professional and hospital billing systems. To estimate the multiplier effect and average charges per SHC patient per year, our analysis focused on professional charges generated directly in the SHC and professional fees and hospital charges generated by secondary referral (inpatient and outpatient).RESULTS: One thousand nine hundred ninety‐eight patients were seen in the SHC during the 6‐month period. For every $1 billed in professional charges in the SHC, $17 was billed elsewhere in the hospital system. Geriatric medicine professional charges generated by the 1,998 SHC patients over the 6‐month period totaled $546,691. The 6‐month charges by the rest of the hospital system for the same 1,998 patients included hospital inpatient charges of $4,684,195 for all departments; hospital outpatient charges (ancillary plus technical, including facility fees for the SHC) of $3,027,212; and professional fees of $1,606,287 for other departments, thereby producing a multiplier factor of 17. The average overall charges per geriatric patient per 6 months totaled $4,937, which included hospital inpatient, hospital outpatient, and professional fees. The UH generated an average of $3,860 in hospital charges per SHC patient per 6 months. The average hospital charges generated per established SHC patient per 6 months were $2,936. The average hospital charges for a new SHC patient were $7,187 per 6 months. The average professional charges were $1,078 per patient per 6 months.CONCLUSIONS: This study provides a reasonable estimate of the substantial multiplier, or “flow‐through,” effect of a senior clinic on its parent medical center. Although senior clinics may be a cost center when viewed in isolation, these clinics are actually revenue generators when viewed from the perspective of the entire health system.
Central Nervous System–Active Medications and Risk for Falls in Older Women
Authors: Ensrud Kristine E. , Blackwell Terri L. , Mangione Carol M. , Bowman Paula J. , Whooley Mary A. , Bauer Douglas C. , Schwartz Ann V. , Hanlon Joseph T. , Nevitt Michael C. , For The Study of Osteoporotic Fractures Research Group  
Published: October 2002

OBJECTIVES: To determine whether current use of central nervous system (CNS)‐active medications, including benzodiazepines, antidepressants, anticonvulsants, and narcotics, increases the risk for subsequent falls.DESIGN: Prospective cohort study.SETTING: Four clinical centers in Baltimore, Maryland; Portland, Oregon; Minneapolis, Minnesota; and the Monongahela Valley, Pennsylvania.PARTICIPANTS: Eight thousand one hundred twenty‐seven women aged 65 and older participating in the fourth examination of the Study of Osteoporotic Fractures between 1992 and 1994.MEASUREMENTS: Current use of CNS‐active medications was assessed with an interviewer‐administered questionnaire with verification of use from medication containers. A computerized dictionary was used to categorize type of medication from product brand and generic names. Incident falls were reported every 4 months for 1 year after the fourth examination.RESULTS: During an average follow‐up of 12 months, 2,241 women (28%) reported falling at least once, including 917 women (11%) who experienced two or more (frequent) falls. Compared with nonusers, women using benzodiazepines (multivariate odds ratio (MOR) = 1.51, 95% confidence interval (CI) = 1.14–2.01), those taking antidepressants (MOR = 1.54, 95% CI = 1.14–2.07), and those using anticonvulsants (MOR = 2.56, 95% CI = 1.49–4.41) were at increased risk of experiencing frequent falls during the subsequent year. We found no evidence of an independent association between narcotic use and falls (MOR = 0.99 for frequent falling, 95% CI = 0.68–1.43). Among benzodiazepine users, both women using short‐acting benzodiazepines (MOR = 1.42, 95% CI = 0.98–2.04) and those using long‐acting benzodiazepines (MOR = 1.56, 95% CI = 1.00–2.43) appeared to be at greater risk of frequent falls than nonusers, although the CIs overlapped 1.0. We found no evidence to suggest that women using selective serotonin‐reuptake inhibitors (MOR = 3.45, 95% CI = 1.89–6.30) had a lower risk of frequent falls than those using tricyclic antidepressants (MOR 1.28, 95% CI = 0.90–1.84).CONCLUSIONS: Community‐dwelling older women taking CNS‐active medications, including those taking benzodiazepines, antidepressants, and anticonvulsants, are at increased risk of frequent falls. Minimizing use of these CNS‐active medications may decrease risk of future falls. Our results suggest that fall risk in women taking benzodiazepines is at best marginally decreased by use of short‐acting preparations. Similarly, our findings indicate that preferential use of selective serotonin‐reuptake inhibitors is unlikely to reduce fall risk in older women taking antidepressants.
Hip Fracture Incidence in Nursing Home Residents and Community‐Dwelling Older People, Washington State, 1993–1995
Authors: Sugarman Jonathan R. , Connell Frederick A. , Hansen Amy , Helgerson Steven D. , Jessup Michael C. , Lee Helan 
Published: October 2002

OBJECTIVES: To establish and validate a method of linking data from the Minimum Data Set (MDS) and Medicare hospital claims, to estimate hip fracture incidence rates for Medicare beneficiaries aged 65 and older in Washington State, and to compare the incidence rates of hip fractures in nursing home and non‐nursing home residents.DESIGN: Retrospective analysis of Medicare population‐based enrollment, hospital claims, and nursing home administrative data sets.SETTING: Nursing home and non‐nursing home setting.PARTICIPANTS: Medicare beneficiaries in Washington State residing in the community or in skilled nursing facilities.MEASUREMENTS: Crude age‐ and sex‐specific and standardized age‐ and sex‐adjusted hip fracture incidence for persons residing and not residing in nursing homes.RESULTS: From October 1, 1993, through September 30, 1995, 7,812 Medicare beneficiaries aged 65 or older were hospitalized for hip fractures (6,566 fractures for 1,155,234 person‐years of exposure in non‐nursing home residents and 1,246 fractures for 42,986 person‐years of exposure in nursing home residents). The standardized age‐ and sex‐adjusted hip fracture rate of nursing home residents (23.0 per 1,000 person‐years) substantially exceeded that of non‐nursing home residents (5.7 per 1,000 person‐years) (incidence rate ratio = 4.0, 95% confidence interval = 3.7–4.5).CONCLUSION: The incidence of hip fracture in nursing home residents far exceeds that in noninstitutionalized older people. Linkage of MDS and Medicare hospital claims data is a useful tool for epidemiological surveillance regarding events in nursing homes that are likely to result in hospitalization.
Mortality, Disability, and Nursing Home Use for Persons with and without Hip Fracture: A Population‐Based Study
Authors: Leibson Cynthia L. , Tosteson Anna N. A. , Gabriel Sherine E. , Ransom Jeanine E. , Melton L. Joseph 
Published: October 2002

OBJECTIVES: To compare persons with and without hip fracture for subsequent mortality and change in disability and nursing home (NH) use.DESIGN: Population‐based historical cohort study.SETTING: Olmsted County, Minnesota.PARTICIPANTS: All residents who experienced a first hip fracture between January 1, 1989, and December 31, 1993, and, for each case, a resident of the same sex and similar age who had not experienced a hip fracture and was seen by a local care provider.MEASUREMENTS: Data on disability (Rankin score), comorbidity (Charlson Index), and NH residency before baseline (fracture date for cases and registration date for controls) were obtained by review of complete community‐based medical records. The records were then reviewed from baseline through December 31, 1994, for Rankin disability at 1 month and 1 year, all NH admissions and discharges, and date of death for those who died.RESULTS: There were 312 cases and 312 controls (81% female, mean age ± standard deviation = 81 ± 12 years). Before baseline, cases had higher comorbidity (45% vs 30% had Charlson Index ≥ 1, P < .001) and disability (mean Rankin score = 2.5 ± 1.1 vs 2.2 ± 1.1, P < .001) and were more likely to be in a NH (28% vs 18%, P < .001) than controls. One year after baseline, estimated mortality was 20% (95% confidence interval (CI) = 16–24) for cases vs 11% (95% CI = 8–15) for controls, 51% of cases versus 16% of controls had a level of disability one or more units worse than before baseline (P < .001), and the cumulative incidence of first NH admission was 64% (95% CI = 58–71) for cases versus 7% (95% CI = 4–11) for controls. The risk of NH admission for cases relative to controls diminished over time, but remained elevated 5 years after the event (risk ratio = 20.0 at 3 months and 2.1 at 5 years), but, in persons admitted to a nursing home, cases were two times more likely than controls to be discharged alive within a year (P < .001).CONCLUSIONS: Hip fracture is an important contributor to disability and NH use, but the potential savings from hip fracture prophylaxis may be overestimated by studies that fail to consider differential risk, mortality, and long‐term follow‐up.
The Effect of Comorbid Illness on Receipt of Cancer Screening by Older People
Authors: Heflin Mitchell T. , Oddone Eugene Z. , Pieper Carl F. , Burchett Bruce M. , Cohen Harvey Jay 
Published: October 2002

OBJECTIVES: To identify associations between the type and number of diagnoses and receipt of screening for breast, cervical, and colorectal cancer by older people.DESIGN: Sixth annual follow‐up of a community‐based survey with 4,162 participants aged 65 and older at baseline in 1986.SETTING: Piedmont area of North CarolinaPARTICIPANTS: Two thousand two hundred twenty‐five subjects with a mean age of 79 who responded in 1992.MEASUREMENTS: Self‐reported receipt of clinical breast examination, mammography, Papanicolaou (Pap) smear, and fecal occult blood testing (FOBT) within the 2 years before the survey.RESULTS: Hip fracture was associated with lower rates of mammography (odds ratio (OR) = 0.53, 95% confidence interval (CI) = 0.32–0.87) and cognitive impairment with lower rates of FOBT (OR = 0.71, 95% CI = 0.54–0.94). Hypertension was associated with higher rates of breast examination (OR = 1.56, 95% CI = 1.18–2.07), Pap smear (OR = 1.41, 95% CI = 1.09–1.83), and FOBT (OR = 1.37, 95% CI = 1.12–1.66) and a trend toward increasing rates of mammography (OR = 1.28, 95% CI = 0.98–1.69). The presence of three or more comorbid conditions was associated with an increased rate of mammography (OR = 1.35, 95% CI = 1.06–1.71), breast examination (OR = 1.46, 95% CI = 1.12–1.89), and Pap smear (OR = 1.31, 95% CI = 1.04–1.65).CONCLUSIONS: With few exceptions, the presence of comorbid conditions is not associated with a decreased rate of receipt of screening. In fact, hypertension and the presence of a higher number of comorbid conditions are associated with a higher rate of receipt of cancer screening. This finding may be due to an increase in the frequency of office visits increasing the opportunity for cancer screening.
Survival Benefits of Angiotensin‐Converting Enzyme Inhibitors in Older Heart Failure Patients with Perceived Contraindications
Authors: Ahmed Ali , Kiefe Catarina I. , Allman Richard M. , Sims Richard V. , DeLong James F. 
Published: October 2002

OBJECTIVES: To determine the association between angiotensin‐converting enzyme (ACE) inhibitor therapy and survival of older heart failure patients with conditions perceived by physicians as contraindications to ACE inhibitors.SETTING: Hospital.DESIGN: Retrospective follow‐up study.PARTICIPANTS: Hospitalized older heart failure patients with systolic blood pressure of 90 mmHg or less, serum creatinine of 2.5 mg/dL or more, serum potassium of 5.5 mmol/L or more, or severe aortic stenosis.MEASUREMENTS: One‐year postdischarge mortality (with and without adjustment for various patient and care characteristics). Logistic regression analyses were used to estimate the effect of the perceived contraindications on subsequent use of ACE inhibitors. Using Cox proportional hazards models, crude and adjusted hazard ratios (HRs) of 1‐year mortality with 95% confidence intervals (CIs) were estimated for patients discharged on ACE inhibitors and compared with those without. HRs were estimated for all patients and were repeated after stratifying patients based on the presence of perceived contraindications to ACE inhibitor use.RESULTS: Of the 295 subjects, 52 (18%) had conditions perceived as contraindications, 186 (63%) received ACE inhibitors, and 107 (40%) died within 1 year of discharge. Presence of a perceived contraindication was independently associated with underutilization of ACE inhibitors on discharge (adjusted OR = 0.35, 95% CI = 0.17–0.71). ACE inhibitor prescription at discharge was associated with lower 1‐year mortality overall (HR = 0.58, 95% CI = 0.40–0.85) and for the groups of patients with (HR = 0.34, 95% CI = 0.14–0.81) and without (HR = 0.66, 95% CI = 0.42–1.02) perceived contraindications.CONCLUSIONS: ACE inhibitor use was associated with a significant survival benefit in this cohort of hospitalized older heart failure patients with perceived contraindications.
Bloodstream Infection: Differences Between Young‐Old, Old, and Old‐Old Patients
Authors: Gavazzi Gaetan , Mallaret Marie‐Reine , Couturier Pascal , Iffenecker Anne , Franco Alain 
Published: October 2002

OBJECTIVES: To compare the epidemiological and microbiological characteristics of bloodstream infection (BSI) between the young old (65–75), old (76–85), and old old (>85).DESIGN: Retrospective study.SETTING: Forty‐six hospitals in southeast France.PARTICIPANTS: One thousand seven hundred forty patients aged 65 and older with BSI, seen between January 1 and December 31, 1998.MEASUREMENTS: Epidemiological and microbiological data and outcome.RESULTS: Community‐acquired BSIs (CABSIs) were significantly more frequent in the old old, but microbiological data were similar to those in the young‐old group. Conversely, microbiological data were significantly different for nosocomial BSIs (NSBIs). Escherichia coli was the main pathogen in the old old and Staphylococcus aureus in the young old. Mortality was independently associated with the presence of methicillin‐resistant S. aureus in NSBI and CABSI.CONCLUSIONS: The differences in NBSI are important in serious infectious diseases and often require empirical antibiotic therapy. Age is also a risk factor but only for CABSI and suggests that the old‐old patients represent a frail population in the community. Further prospective studies are needed to confirm these findings and analyze predisposing factors.
Detecting Helicobacter Pylori Infection in Hospitalized Frail Older Patients: The Challenge
Authors: Salles‐Montaudon Nathalie , Dertheil Sylvia , Broutet Nathalie , Gras Nathalie , Monteiro Lurdes , De Mascarel Antoine , Megraud Francis , Emeriau Jean‐Paul 
Published: October 2002

OBJECTIVES: Helicobacter pylori infection has not been well studied in older people, especially in hospitalized, frail patients. The aim of our study was to evaluate the prevalence of the infection in this population using five H. pylori diagnostic tests.DESIGN: Prospective observational study.SETTING: Geriatric acute care unit of the Department of Geriatrics (Hôpital Xavier Arnozan, Pessac, France).PARTICIPANTS: One hundred seven consecutively hospitalized patients with a diagnostic indication for upper gastrointestinal endoscopy.MEASUREMENTS: Geriatric assessment, information on drug intake, indication/results of gastric endoscopy, and results of H. pylori infection diagnostic tests (culture and histological analysis on biopsy specimens, serology, 13carbon‐urea breath test (13C‐UBT), detection of H. pylori stool antigens (HpSA)) were assessed for each included patient.RESULTS: Fifty‐one patients (47.7%) were H. pylori positive with at least one test. 13C‐UBT was more frequently positive than the other four tests, with a significant difference from culture, histological analysis, and HpSA (P < .05). Positive 13C‐UBT results were significantly associated with H. pylori presence using histological analysis and neutrophil activity of the antrum and corpus. Antibiotic treatments significantly decreased the positivity rate of all of the tests performed, and severe corpus atrophy decreased the positivity rate of culture, histological analysis, and HpSA.CONCLUSIONS: Almost one‐third of the H. pylori–positive patients would have remained undetected without performing the 13C‐UBT. The low prevalence of H. pylori detection in these hospitalized, frail patients may be explained by the high frequency of current and previous antibiotic treatments.