Search

AbstractObjectiveTo determine whether self-reports of disaster-related psychological distress predict older adults’ health care utilization during the year after Hurricane Sandy, which hit New Jersey on October 29, 2012.MethodsRespondents were from the ORANJ BOWL Study, a random-digit dialed sample from New Jersey recruited from 2006 to 2008. Medicare hospital, emergency department (ED) and outpatient claims data from 2012 and 2013 were matched to 1607 people age 65 and older in 2012 who responded to follow-up surveys conducted from July 2013 to July 2015 to determine their hurricane-related experiences.ResultsIn total, 7% (107) of respondents reported they experienced a lot versus 93% (1493) respondents reported they experienced little or no fear and distress from Hurricane Sandy. Those who experienced a lot versus little or no fear and distress had higher probability of all-cause hospital admissions and more ED visits through 3 months (hazard ratio [HR]: 2.19, 95% CI: 1.03-4.63; incidence ratio [IR]: 2.57, 95% CI: 1.21-5.35), and ED and outpatient visits (IR: 2.20, 95% CI: 1.44-3.37; IR: 1.37, 95% CI: 1.02-1.87) through the year after the hurricane.ConclusionsA self-reported assessment of disaster-related psychological distress is a strong predictor of older adults’ health care needs the year after the disaster. The results indicate that disaster preparedness should extend beyond acute health care needs to address longer-term health consequences of disasters. (Disaster Med Public Health Preparedness. 2018;12:578–581)

Whether postoperative subsyndromal delirium (SSD) is a separate syndrome from delirium and has clinical relevance is not well understood.

Background: Postoperative delirium and cognitive dysfunction are frequent phenomena in older patients; however, few studies have examined the temporal relationship between these two conditions in the early postoperative period. Therefore, this study aimed to determine if postoperative delirium and postoperative cognitive dysfunction (POCD) coexist after major noncardiac surgery. Methods: This was a prospective cohort study of patients who were ≥ 65 yr of age undergoing noncardiac surgery. Patients were evaluated preoperatively and for two days postoperatively for delirium and POCD. Delirium was determined using the Confusion Assessment Method, and POCD was measured by three cognitive tests addressing changes in executive function, memory, attention, and concentration. For each postoperative day, patients’ neurologic status was categorized into three mutually exclusive categories: delirium, POCD, or neither condition. Results: Four hundred sixty-one patients aged ≥ 65 yr of age were studied, and 421 patients with complete postoperative cognitive testing were reported. Eighty percent of patients experienced either delirium or POCD on the first day after surgery. Seventy percent of patients who had delirium on the first postoperative day also had delirium on the second postoperative day. Sixty-three percent of patients who had POCD on postoperative day one continued to have POCD on the next day. Sixteen percent of patients with delirium on day one were non-delirious on day two but met criteria for POCD on day two. Conversely, 15% of patients with POCD on day one became delirious on day two. Only 13% of patients did not experience delirium or POCD on either day after surgery. Conclusions: Eighty percent of surgical patients experienced some form of cognitive dysfunction the day after surgery, and few recovered by the second day after surgery.

To investigate whether preoperative risk for delirium moderates the effect of postoperative pain and opioids on the development of postoperative delirium.

Medication administration error (MAE) remains a patient safety concern. Few studies have investigated the impact of bar-coded technology on medication error reduction during the medication administration process at the bedside in acute care settings. The purpose and focus of this systematic review is to determine whether implementation of the Bar Code Medication Administration System (BCMA) is associated with declines in MAE rate. Findings from this systematic review reveal varied findings between studies and among the 5 rights of medication administration (right drug, right time, right patient, right dose, and right route) in general. Although BCMA did not consistently decrease the overall incidence of MAE, the technology did identify categories of medication errors not previously detected with the traditional 5 rights approach. The opportunity to analyze the additional categories of MAE identified by BCMA has implications for patient safety and is perhaps the most significant contribution of this review.

Background and aims:Many frail older adults experience multiple changes in activities of daily living (ADL) functioning over the course of a year. Accurate predictions of ADL status over quarterly intervals may improve the precision of care planning for older adults who seek long-term care in the community. The study sought to develop and validate a model that predicts older adults’ ADL status over quarterly intervals. Methods:The study included 3127 enrollees from 11 Program of All Inclusive Care for the Elderly (PACE) sites. Nurses assessed ADL status quarterly. Potential predictors included baseline assessment of age, sex, race, and living situation and quarterly assessments of prior functioning, co-morbidities, prior hospitalizations, and mental status. Results:Change in level of functioning occurred for 30% of quarterly observations. Predictors of functioning at the end of a quarter were prior ADL change, prior hospitalization, living with others, impaired mental status, cancer, dementia, coronary artery disease, congestive heart failure and chronic obstructive pulmonary disease. When the model was applied to the validation observations, 93% of predictions were within one level and 72% of the predictions were the same level of ADL functioning observed at the end of the quarter. Conclusions:In a sample of community-living ADL-disabled older adults, changes in functional status over a quarter were common and associated with functional and health status at the beginning of the quarter. Further validation of the model may result in an index that helps clinicians better predict future ADL needs of community-living older adults who need long-term care.

Medicaid waiver home and community-based long-term care services (HCBS) may provide a partial solution to the escalating costs of long-term care. Persons with dementia can have complex caregiving needs; it is unknown whether their expenditures and resource utilization differ between community-based versus institutional settings.

Although indwelling urinary catheterization is unpleasant and can cause complications, it is often performed without a specific medical indication. The objective of this study was to determine which patient characteristics were associated with indwelling urinary catheterization in hospitalized older patients without a specific medical indication.

Nonmelanoma skin cancer is the most common malignancy. Multiple therapies prevent recurrence but vary widely in cost. The most common therapies are local destruction, excision, and Mohs surgery (histologically guided tumor removal). Clinical variables that may affect treatment choices can be identified, but little is known about how clinicians choose among therapies.

This interpretive phenomenological study explores the commonalities and differences in how people with dementia understand the meaning of their symptoms, comparing those who are aware of their impairment, those who are unaware, and those who have mixed awareness. Participants included five women and four men with mild to moderate Alzheimer's disease. The Anosognosia QuestionnaireDementia AQD was used to measure symptom awareness, and indepth interviews and participant observations were conducted to gather qualitative data about the meaning of symptoms. AQD results identified a range of awareness across the nine participants. Three were aware of their symptoms, three were unaware, and three had mixed awareness. Interpretive analysis of the qualitative data revealed three meaning narratives that illustrate qualitative distinctions in symptom experience across the different levels of awareness a “Everything works more slowly” is a narrative of awareness b “It's just old age” is a narrative of unawareness c “It does not stick in the brain” is a narrative of mixed awareness. Such narratives offer important clues about the meaning and significance of symptoms for people with dementia. Nurses might use this information to tailor strategies for interacting with and offering support to people with dementia, depending on each individual's level of awareness.

Background: The overall health status and survival of HIV-infected patients has changed with the advent of highly active antiretroviral therapy (HAART). With this improved survival, there is a greater urgency to study quality-of-life issues.Objective: Our objectives were to measure skin-related quality of life in a cohort of HIV-infected patients and to determine whether the use of highly active antiretroviral therapy is associated with improved skin-related quality of life.Methods: We assembled a retrospective cohort of patients who were seen in our HIV-Dermatology Clinic at San Francisco General Hospital in June, July, or August of 1996. Eligible subjects were contacted by mail and asked (1) to complete a questionnaire (Skindex) and (2) to have a skin exam. Information on medication use and laboratory parameters was also collected.Results: Of 107 eligible patients, 76 (71%) responded to the questionnaire; 60 patients were examined. Many patients had multiple skin conditions. For most diagnoses (except warts and onychomycosis), there were no consistent differences in Skindex scores of HIV-infected patients compared with scores of patients not known to be infected with HIV. Patients on HAART for longer duration had significantly lower Skindex scores (improved skin-related quality of life) compared with those on HAART for a shorter duration.Conclusion: HAART is associated with improved quality of life with regard to HIV-associated skin diseases.Antécédents: L'état de santé général et le taux de survie des patients inféctés par le VIH ont changé grâce à l'avènement de traitements antirétroviraux hautement actifs (HAART). Cette amélioration du taux de survie implique un besoin urgent d'étudier les questions relatives à la qualité de vie.Objectifs: Mesurer la qualité de vie sur le plan dermatologique d'une cohorte de patients infectés par le VIH et déterminer si le recours à un traitement antirétroviral hautement actif est associé à une amélioration de la qualité de vie sur le plan dermatologique.Méthodes: Nous avons rassemblé une cohorte rétrospective de patients qui étaient suivis dans notre clinique de dérmatologie-VIH au San Francisco General Hospital, en juin, juillet ou aoôt de 1996. Nous avons contacté par courrier les sujets admissibles et leur avons demandé (1) de remplir un questionnaire (Skindex) et (2) de se soumettre à un examen dermatologique. Également, nous avons recueilli de l'information sur la consommation des médicaments et les paramètres de laboratoire.Résultats: Parmi les 107 patients admissibles, 76 (71%) ont retourné le questionnaire et 60 ont été examinés. Un grand nombre de patients présentaient multiples affections cutanées. Dans la plupart des diagnostics (sauf pour les verrues et les onychomycoses), les différences sont minimes entre les résultats du Skindex des patients infectés par le VIH et ceux des patients qui ne le seraient pas. Les patients qui ont suivi le traitement HAART pendant une plus longue durée accusent des résultats Skindex sensiblement inférieurs (meilleure qualité de vie sur le plan dermatologique) à ceux des patients ayant suivi un traitement HAART pendant une plus courte durée.Conclusion: Le traitement HAART est associé à une qualité de vie améliorée en ce qui concerne les maladies dermatologiques liées du VIH.

:

Background: An accurate, sensitive, but brief quality-of-life outcomes measure is needed for studies of dermatologic care.Objective: To construct a single-page version of Skindex (a dermatologic quality-of-life instrument) that would have two new features compared with the current 29-item version: (1) fewer items to which a majority of patients choose the same response, and (2) measurement of botherrather than frequency of patient experiences.Methods: Random samples of patients waiting for dermatology appointments in clinics of Veterans Affairs hospitals and in private dermatology practices completed questionnaires; 692 patients responded to the parent instrument and 541 additional patients responded to the brief version. Reproducibility, internal consistency reliability, validity, and responsiveness of the brief version of Skindex were determined.Results: For 16 items of the current 29-item version (55%), more than 50% of patients responded “Never.” After an explicit process of item analysis and elimination, a single-page 16-item version was composed that asks patients about bother from their experiences; responses are reported as three scales, Symptoms, Emotions, and Functioning. For 6 items of the 16-item version (38%), more than 50% of patients responded “Never.” Scale scores were reproducible after 72 hours (r= 0.88–0.90) and were internally reliable (Cronbach's a = 0.86–0.93). The instrument demonstrated both content and construct validity: Most patients' responses to an open-ended question about their skin disease was addressed by the items; patients with inflammatory dermatoses had higher scores than those with isolated lesions; and in an exploratory principal axes factor analysis with an oblique rotation, 74% of the common variance was explained by three factors that correlated with the a prioriscales. Mean scale scores stayed the same or changed in the expected direction in patients who reported that their skin was the same or had improved.Conclusion: This brief single-page version of Skindex accurately and sensitively measures how much patients are bothered by their skin conditions.

Background: An accurate, sensitive, but brief quality-of-life outcomes measure is needed for studies of dermatologic care. Objective: To construct a single-page version of Skindex (a dermatologic quality-of-life instrument) that would have two new features compared with the current 29-item version: (1) fewer items to which a majority of patients choose the same response, and (2) measurement ofbotherrather than frequency of patient experiences. Methods: Random samples of patients waiting for dermatology appointments in clinics of Veterans Affairs hospitals and in private dermatology practices completed questionnaires; 692 patients responded to the parent instrument and 541 additional patients responded to the brief version. Reproducibility, internal consistency reliability, validity, and responsiveness of the brief version of Skindex were determined. Results: For 16 items of the current 29-item version (55%), more than 50% of patients responded “Never.” After an explicit process of item analysis and elimination, a single-page 16-item version was composed that asks patients about bother from their experiences; responses are reported as three scales, Symptoms, Emotions, and Functioning. For 6 items of the 16-item version (38%), more than 50% of patients responded “Never.” Scale scores were reproducible after 72 hours (r= 0.88-0.90) and were internally reliable (Cronbach’s α = 0.86-0.93). The instrument demonstrated both content and construct validity: Most patients’ responses to an open-ended question about their skin disease was addressed by the items; patients with inflammatory dermatoses had higher scores than those with isolated lesions; and in an exploratory principal axes factor analysis with an oblique rotation, 74% of the common variance was explained by three factors that correlated with thea prioriscales. Mean scale scores stayed the same or changed in the expected direction in patients who reported that their skin was the same or had improved. Conclusion: This brief single-page version of Skindex accurately and sensitively measures how much patients are bothered by their skin conditions.

OBJECTIVE: To determine whether apolipoprotein E (Apo E) phenotype is associated with cognitive decline in community-dwelling nondemented elderly DESIGN: Prospective cohort study. SETTING: A university-affiliated clinic near Pittsburgh, Pa. PATIENTS: A total of 1750 nondemented community-dwelling women, aged 65 years and older, who were enrolled in the Study of Osteoporotic Fractures. MAIN OUTCOME MEASURES: The women completed a baseline interview and performed 3 cognitive tests: the modified Mini-Mental State Examination, Trails B, and Digit Symbol. Serum samples were obtained for Apo E typing. Baseline cognitive scores and repeated scores approximately 6 years after study enrollment were compared in women with and without Apo E ε4. Cognitive decline, defined as the worst 10th percentile change scores, was assessed for each test and by phenotype group. RESULTS: After adjustment for age, education, presence of severe tremor, and depression, baseline scores did not differ by Apo E ε4 status except for lower scores on Trails B in the homozygous ε4 group (mean score, 159.7 compared with 127.7 for the heterozygous ε4 group and 125.4 for the no ε4 group; P=.01). However, repeated test performance on follow-up examination was worse on all tests in those women with 1 or more ε4. Reduction on the modified Mini-Mental State Examination was 0% for no ε4 allele, 1.9% for 1 ε4 allele, and 3.7% for 2 ε4 alleles (P<.001); reduction on Digit Symbol was 6.2% for no ε4 allele, 9.0% for 1 ε4 allele, and 17.5% for 2 ε4 alleles (P=.04); and reduction on Trails B was 5.9% for no ε4 allele, 25.0% for 1 ε4 allele, and 10.9% for 2 ε4 alleles (P=.002). Women with at least 1 ε4 had an odds ratio of 1.6 (95% confidence interval, 1.1-2.3) of having cognitive decline during the study period. CONCLUSION: Apolipoprotein E ε4 is associated with cognitive decline in community-dwelling nondemented women.

The validity of an experimental 9-word version of the California Verbal Learning Test (CVLT) was investigated. The construct validity of the 9-word CVLT was assessed with a principal component analysis (PCA) on a sample of nondemented subjects. A three - factor solution, related to immediate free recall, delayed recall and recognition, and intrusion errors was produced. Construct validity was also assessed by comparing subjects with probable Alzheimer's disease (AD), probable ischemic vascular dementia (IVD), and a normal control (NC) group. AD subjects evidenced little learning on immediate free recall test conditions, made no improvement on cued recall or recognition test conditions, and produced copious amounts of intrusion errors. IVD subjects performed similarly to AD subjects on immediate free recall test conditions, but improved on all cued recall and recognition test conditions, and made significantly fewer intrusion errors. The NC group was vastly superior to both groups of demented subjects on all CVLT indices. These results indicate that the 9-word CVLT has good psychometric properties, and that it may be a reasonable alternative to the standard 16-word CVLT among subjects who are obviously impaired.

Current approaches to the diagnosis of delirium are based upon the recognition of symptoms that emerge in the pathological state. As an alternative, we propose an approach to case identification for research purposes based on the recognition of significant changes in the cognitive or cerebral state of the individual patient. Categorical change can be defined using prediction intervals calculated from repeated measures on a population of medically stable subjects. Data from subjects enrolled in a prospective study of delirium in a long-term care population were utilized to calculate prediction intervals for the Mini-Mental Status Examination and for measures of the electroencephalographic background frequency as obtained with a two-channel microprocessor-based EEG device. Preliminary findings support the validity of this quantitative approach for defining changes in brain state. Future research should evaluate both cognitive and electrophysiological techniques for monitoring vulnerable patients.

Repetition of single words and pronounceable nonwords (pseudowords) was assessed in Alzheimer's Disease (AD) patients to evaluate how lexical phonological processing might be accomplished when semantic and conceptual knowledge is impaired. AD patients performed significantly worse than healthy elderly controls on all repetition tasks. However, repetition abilities and dementia severity were not correlated, and AD patients produced the same distribution of error types as controls. Furthermore, despite their semantic problems, AD patients, like controls, showed a significant advantage for repeating real words compared to pseudowords, even when repeating low frequency phonologically complex words whose meaning is not likely to have been retained. The results support the postulated existence of a lexical phonological system that is used to repeat both known and novel words and that processes linguistic information independent of its meaning.

This study assessed the short-term psychological effects of an exercise training program for 267 healthy elderly volunteers randomly assigned to either a bicycle group that trained three times a week for 4 months or an attention control group that met once a week during the 4-month period. A second aim was to identify predictors of favorable change in either physiological performance in stress-test parameters or in behavioral attributes at the conclusion of training. Psychological assessment procedures included indicators of basic mental health, perceived quality of life, and activity level. One-way repeated-measure multivariate analysis of variance tests revealed only one significant univariate interaction effect: The exercising group showed significantly greater improvement in an index tapping report of feeling better from pretest to posttest as compared to controls. The directions of change for all other measures were uniformly in favor of exercisers but did not approach statistical significance. Behavioral and psychological variables were also found to be irrelevant in predicting improvement in physiological performance at Time 2. These data suggest that exercise program effects on psychological and behavioral indicators were very modest for older adults with very high levels of functioning.

Repetition and reading of various types of pronounceable nonwords (pseudowords) was examined in patients with probable Alzheimer's disease (AD) and healthy elderly controls. Overall accuracy of performance was lower in AD patients compared to controls, but the two groups showed qualitatively similar response patterns when reading different kinds of pseudowords aloud and when repeating pseudowords composed of familiar phonological forms, analogous to those in real English words. AD patients diverged in performance from controls, however, when repeating pseudowords composed of phonologically unusual forms. These results support two conclusions: (1) Aspects of phonological processing may become disrupted in AD patients in association with increasing dementia severity, while orthographic processing remains comparatively less impaired. (2) The results are consistent with the view that the processing of pseudowords is achieved through the same system as real words, and further show that the influence of prior language experience on the processing of novel linguistic forms occurs primarily at the level of phonological, rather than orthographic processing.

To examine the long‐term effects of aerobic exercise on the occurrence and time to onset of cardiovascular diagnoses, 184 initially healthy older subjects were randomized into either a long‐term exercise group (Group A, n = 80), a short‐term exercise group (Group B, n = 42), or a contact control group (Group C, n = 62). After completion of two years in the study, data on new cardiovascular diagnoses and time to onset of these diagnoses in each of the three groups were compared. The occurrence rates for new onset diagnoses were as follows: Group A, 2.5%; Group B, 2%; and Group C, 13%; the average time to onset was greatest for the long‐term exercisers and shortest for the contact control group (P ≤ .02). The results suggest that a regular program of exercise may have cardiovascular benefits for those over 60 years of age.

OBJECTIVES:To evaluate the cognitive effects of acute challenges with the antispasmodic agent oxybutynin hydrochloride in normal older volunteers and to compare these effects with those attributable to diphenhydramine, another commonly used medication with anticholinergic (muscarinicblocking) activity.

Although periventricular white matter alterations (PWMA) are commonly reported on magnetic resonance imaging (MRI) scans of elderly individuals, a consistent pattern of neuropsychological deficits has yet to be found. However, there are some findings suggesting that executive functions (Luria, 1980) are more impaired than other areas of neuropsychological functioning. We undertook a prospective study of two groups of elderly, demented patients with and without PWMA as measured by MRI. The results demonstrated that subjects with greater white matter alterations performed worse on some executive function tests (e.g., Trail Making Test-Part B and competing programs/go-no-go), whereas there were no differences in other areas of neuropsychological functioning. There were no between-group differences on the Modified Ischemic Scale (Rosen, Terry, Fuld, Katzman, & Peck, 1980) or on measures of depression. Other pertinent clinical and methodological issues related to the clinical presentation of PWMA, as well as Binswanger's disease, are discussed.

Abstract: Bowker's test for marginal equality in contingency tables provides a familiar chi-square test to determine whether the marginal distributions are the same across two or more factors or occasions. In this note it is shown how latent trait theory provides a theoretical framework for the development and application of this test.

Discusses the efforts of Nebraska and Kansas to attract dairy farmers from other states. Cost-consideration in the relocation; Strategies of the promoters; Importance of dairies for farmers in the region.

Discusses how certification and value-based marketing bring premium prices. Rigorous standards for Certified Angus Beef (CAB); Premium price for CAB label; Creation of more consumer demand; Setting production and genetic standards; Genetics and feeding practice factors.

Focuses on vision plan for greater Des Moines, Iowa's world-class quality of life. Creation of a dynamic community where people want to live, work and play; Development of downtown; Importance of public-private partnership to achieve the vision.

Focuses on the business performance and expertise of Certified Angus Beef LLC in making steaks in Nebraska. Consideration of quality specifications of oldest branded meat programs; Specialization in creating juicy and tender beefs; Establishment of Traditions Inn and Restaurant beef food chain.

Emphasizes disputes over trade inequities between farmers from the United States (U.S.) and Canada. Information on the investigation of the trade practices of the Canada wheat board; Lawsuit filed against the U.S. Environmental Protection Agency by North Dakota State officials; Considerations for an interim market registration for cheaper products in Canada.

Focuses on the effects of the United States farm policy strategy of cutting back wheat production through setasides and other paid cropland diversion programs. Impact of the policy on wheat producers; Benefits that policy may benefit producers; Relation of the policy with competitors on wheat production.

The article provides some insights into wheat production and trade in the United States. A one-year setside program has been suggested which is similar to the Conservation Reserve Program. Chuck Merja, the former National Association of Wheat Growers claimed dissatisfaction with prices and competition. Some suggest that even if existing prices are painful for farmers, it may actually benefit producers in the long term.

In a previous article we described a 10-point scoring system (i.e., scale 1) to grade clock drawings to command and copy with hands set for “ten after 11” among demented patients. Alzheimers subjects (AD) improved from the command to copy conditions, whereas subjects with ischaemic vascular dementia (IVD) did not. To investigate the underlying cognitive deficits responsible for this profile, an additional scale was developed (scale 2) that tallied errors in graphomotor functioning, hand/number placement, and executive control. On an independent sample of subjects, AD subjects, again, made significant improvement on scale 1 from the command to copy condition, whereas no such improvement occurred among the IVD subjects. On scale 2, IVD subjects made more graphomotor errors in the command condition, and more executive control and more total errors in the copy conditions than AD subjects. A number of positive correlations were noted between tests of language and memory on scale 1. By contrast, scores on tests of executive control declined as scale 2 errors increased. In addition, a principal component analysis indicated that scale 2 test performance loaded on a factor with other tests related to executive control. These results suggest that impairment in frontal systems functioning may explain why IVD subjects do not improve from the command to copy conditions on scale 1. Such a pattern of performance in clock drawing may also be helpful in making a differential diagnosis between AD and IVD.

Clock drawing has recently been shown to lie useful in differentiating Alzieimers disease patients from normal controls. Our procedure for clock drawing differed from other published reports in that a copy condition was employed and patients were asked to set clock hands to read “ten after eleven”. We found both clock drawing procedures to be correlated with tests related to executive and visuospatial functioning. In both conditions, nondemented controls performed significantly better than demented patients. In the command condition there was no difference between Alzheimer patients and patients with cerebrovascular dementia. In the copy condition, patients with cerebrovascular dementia performed significantly worse than Alzheimer patients. The inclusion of a copy condition appears to greatly expand the utility of this test. Although our scoring system did not differentiate between various dementing disorders in the command condition, if clock drawing is used as a screening instrument, lack of improvement in the copy condition in comparison to the command condition may be a sign of a vascular involvement.

Reports on the profitability of boosting the value of wheat crop through a processing cooperative in the United States. Creation of the United Spring Wheat Processors (USWP) cooperative; High market demand for preprocessed baking ingredients; Solution to cost cutting requirements of bakeries; Selection of core product to process; Formation of alliances between grain companies and producers.

Features Cheryl and Pat Murphy and the portable work station, one of the winners in the `I Built the Best' contest by the periodical `Farm Journal.' Background of the couple; Motivated by time; Description of the portable work station.