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Abstract
OBJECTIVE To examine the prevalence and correlates of non-opioid and opioid analgesic use and descriptively evaluate potential undertreatment in a sample of community-dwelling elders with symptomatic knee and/or hip osteoarthritis (OA). DESIGN Cross-sectional. SETTING Health, Aging, and Body Composition Study. PATIENTS Six hundred and fifty-two participants attending the year 6 visit (2002-03) with symptomatic knee and/or hip OA. OUTCOME MEASURES Analgesic use was defined as taking ≥1 non-opioid and/or ≥1 opioid receptor agonist. Non-opioid and opioid doses were standardized across all agents by dividing the daily dose used by the minimum effective analgesic daily dose. Inadequate pain control was defined as severe/extreme OA pain in the past 30 days from a modified Western Ontario and McMaster Universities Osteoarthritis Index. RESULTS Just over half (51.4%) reported taking at least one non-opioid analgesic and approximately 10% was taking an opioid, most (88.5%) of whom also took a non-opioid. One in five participants (19.3%) had inadequate pain control, 39% of whom were using <1 standardized daily dose of either a non-opioid or opioid analgesic. In adjusted analyses, severe/extreme OA pain was significantly associated with both non-opioid (adjusted odds ratio [AOR] = 2.44; 95% confidence interval [95% CI] = 1.49-3.99) and opioid (AOR = 2.64; 95% CI = 1.26-5.53) use. CONCLUSIONS Although older adults with severe/extreme knee and/or hip OA pain are more likely to take analgesics than those with less severe pain, a sizable proportion takes less than therapeutic doses and thus may be undertreated. Further research is needed to examine barriers to optimal analgesic use.
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P1-388 Transmission of pandemic influenza a (H1N1) on a passenger aircraft. JOURNAL OF EPIDEMIOLOGY & COMMUNITY HEALTH 2011. [DOI: 10.1136/jech.2011.142976f.79] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Age-related striatal dopaminergic denervation and severity of a slip perturbation. J Gerontol A Biol Sci Med Sci 2011; 66:980-5. [PMID: 21746736 DOI: 10.1093/gerona/glr060] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Striatal dopamine activity declines with normal aging. Age-related striatal dopaminergic denervation (SDD) has been implicated in standing balance and unperturbed gait. The goal of this study was to analyze the association between the degree of SDD and the magnitude of an unexpected slip perturbation induced during gait. METHODS Fifty healthy participants aged 20-86 years old underwent dopamine transporter positron emission tomography to classify SDD severity as mild, moderate, or severe. Participants also walked on a floor that was unexpectedly contaminated with a glycerol solution for gait testing. The magnitude of a slip was quantified using the peak slip velocity (PSV), measured at the slipping foot. Data were analyzed for both fast (greater than 1.2 m/s) and slow walkers as gait speed correlated with slip severity. All data analyses were age adjusted. RESULTS Greater severity of dopaminergic denervation in the caudate nucleus was correlated with higher PSV (p < .01) but only in the fast speed walking group. The relationship between SDD in the putamen and slip severity was not statistically significant in fast and slow walkers. CONCLUSIONS Age-related SDD may impact the ability to recover from large perturbations during walking in individuals who typically walk fast. This effect, prominent in the caudate nucleus, may implicate a role of cognitive frontostriatal pathways in the executive control of gait when balance is challenged by large perturbations. Finally, a cautious gait behavior present in slow walkers may explain the apparent lack of involvement of striatal dopaminergic pathways in postural responses to slips.
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Abstract
BACKGROUND UK national guidelines recommend the measurement of TSH receptor antibodies (TRAb) in certain clinical scenarios. A commercial third-generation TRAb autoantibody M22-biotin ELISA assay was introduced in May 2008 in our centre. OBJECTIVE To evaluate the diagnostic performance of a TRAb assay in a retrospective and subsequently a prospective cohort in a UK centre. DESIGN A retrospective review of patients with thyroid disease followed by a prospective observational study in consecutive patients with newly found suppressed serum thyrotrophin (TSH). PATIENTS AND MEASUREMENTS Medical records of 200 consecutive patients with thyroid disorders who had TRAb measured since the introduction of the assay. In a prospective study 44 patients with newly identified hyperthyroidism (TSH < 0·02 mIU/l) had sera assayed for TRAb prior to their clinic appointment at which a final diagnosis was sought. RESULTS In the retrospective cohort, the manufacturer's cut-off point of TRAb ≥0·4 U/l resulted in a positive predictive value (PPV) of 95%, sensitivity 85%, specificity 94% and negative predictive value (NVP) 79% to diagnose Graves' disease using defined criteria. Receiver operating characteristic (ROC) analysis determined an optimal cut-off point of TRAb ≥3·5 U/l with a 100% specificity to exclude patients without Graves' disease at the cost though of a lower sensitivity (43%). In the prospective study, the sensitivity, PPV, specificity and NPV were all 96% using the ≥0·4 U/l cut-off. When combining hyperthyroid patients from both cohorts the assay sensitivity and specificity at ≥0·4 U/l cut-off were 95% and 92% respectively. A positive TRAb result increased the probability of Graves' disease for a particular patient by 25-35% and only six (2·5%) patients had a diagnosis of hyperthyroidism of uncertain aetiology after TRAb testing. CONCLUSIONS The assay studied specifically identifies patients with Graves' disease. It is a reliable tool in the initial clinical assessment to determine the aetiology of hyperthyroidism and has the potential for cost-savings.
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Identification of novel genes involved in sarcopenia through RNAi screening in Caenorhabditis elegans. J Gerontol A Biol Sci Med Sci 2011; 67:56-65. [PMID: 21593014 DOI: 10.1093/gerona/glr072] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Aging in humans is characterized by a progressive loss of muscle mass and strength known as sarcopenia. Although considered to be a normal aspect of aging, the loss of strength can have significant effects on the health, functioning, and independence of elderly individuals. Although these aspects of sarcopenia have been well studied, the molecular mechanisms leading to its development are still unclear. The nematode Caenorhabditis elegans might be a novel animal model for sarcopenia as worms experience sarcopenia during aging and mutations affecting the daf-2/insulin-like signaling pathway are able to delay this process. METHODS Via the use of RNA interference, we screened a total of 43 genes, most of which have been shown to be required for the enhanced longevity of daf-2 mutants, to assess for the effects of these genes on muscle function and worm mobility during aging. RESULTS We identified 17 novel genes that are essential for the delay in the onset of sarcopenia in daf-2 mutants. The identified genes include splicing factors, vacuolar sorting proteins, transcription factors, and metabolic enzymes. Using a transgenic strain that only responds to RNA interference in the body wall muscle, we also found that most of the identified genes act in muscle to prevent the onset of sarcopenia. CONCLUSIONS Our results demonstrate that at least in worms, specific genetic pathways that modify the development of sarcopenia can be identified. Interestingly, almost all the identified genes also have a known human homolog, and hence, our findings may offer significant leads toward the identification of genes involved in sarcopenia in people.
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1006 MECHANISM OF BIOFEEDBACK THERAPY FOR URGENCY INCONTINENCE IN OLDER WOMEN. J Urol 2011. [DOI: 10.1016/j.juro.2011.02.1040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Is timed up and go better than gait speed in predicting health, function, and falls in older adults? J Am Geriatr Soc 2011; 59:887-92. [PMID: 21410448 DOI: 10.1111/j.1532-5415.2011.03336.x] [Citation(s) in RCA: 278] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVES To assess whether the Timed Up and Go (TUG) is superior to gait speed in predicting multiple geriatric outcomes. DESIGN Prospective cohort study. SETTING Medicare health maintenance organization and Veterans Affairs primary care clinics. PARTICIPANTS Adults aged 65 and older (N=457). MEASUREMENTS Baseline gait speed and TUG were used to predict health decline according to EuroQol and Medical Outcomes Study 36-item Short Form Survey (SF-36) global health; functional decline according to National Health Interview Survey (NHIS) activities of daily living (ADLs) score and SF-36 physical function index; hospitalization; and any falls and multiple falls over 1 year. RESULTS Mean age was 74, and 44% of participants were female. Odds ratios for all outcomes were equivalent for gait speed and TUG. Using area under the receiver operating characteristic curve of 0.7 or greater for acceptable predictive ability, gait speed and TUG each alone predicted decline in global health, new ADL difficulty, and falls, with no difference in predictive ability between performance measures. Neither performance measure predicted hospitalization, EuroQol decline, or physical function decline. As a continuous variable, TUG did not add predictive ability to gait speed for any outcome. CONCLUSION Gait speed predicts most geriatric outcomes, including falls, as does TUG. The time taken to complete TUG may not add to information provided by gait speed, although its qualitative elements may have other utility.
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Height loss, vertebral fractures, and the misclassification of osteoporosis. Bone 2011; 48:307-11. [PMID: 20870048 PMCID: PMC3021585 DOI: 10.1016/j.bone.2010.09.027] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2010] [Revised: 09/01/2010] [Accepted: 09/15/2010] [Indexed: 11/26/2022]
Abstract
BACKGROUND The presence of a vertebral fracture identifies a patient who has clinical osteoporosis. However, approximately 2/3 to 3/4 of VFs are asymptomatic. Vertebral Fracture Assessment is a method derived from dual-energy X-ray absorptiometry (DXA) to assess vertebral fractures. The objectives of this study were 1) to determine the association between the degree of height loss in older men and women and the risk of a vertebral fracture, and 2) to determine if the knowledge of vertebral fractures will alter the classification of osteoporosis based on bone mineral density alone. METHODS 231 men and women over the age of 65 underwent DXA scan of their spine and hip (including bone mineral density and Vertebral Fracture Assessment), measurement of their height, and a questionnaire. RESULTS We found that height loss was significantly associated with a vertebral fracture (p=0.0160). The magnitude of the association translates to a 19% increase in odds for 1/2 in. and 177% for 3 in. Although 45% had osteoporosis by either bone mineral density or fracture criteria, 30% would have been misclassified if bone mineral density criteria were used alone. CONCLUSIONS Height loss is an indicator for the presence of vertebral fractures. Bone mineral density criteria alone may misclassify older patients who have osteoporosis.
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Abstract
CONTEXT Survival estimates help individualize goals of care for geriatric patients, but life tables fail to account for the great variability in survival. Physical performance measures, such as gait speed, might help account for variability, allowing clinicians to make more individualized estimates. OBJECTIVE To evaluate the relationship between gait speed and survival. DESIGN, SETTING, AND PARTICIPANTS Pooled analysis of 9 cohort studies (collected between 1986 and 2000), using individual data from 34,485 community-dwelling older adults aged 65 years or older with baseline gait speed data, followed up for 6 to 21 years. Participants were a mean (SD) age of 73.5 (5.9) years; 59.6%, women; and 79.8%, white; and had a mean (SD) gait speed of 0.92 (0.27) m/s. MAIN OUTCOME MEASURES Survival rates and life expectancy. RESULTS There were 17,528 deaths; the overall 5-year survival rate was 84.8% (confidence interval [CI], 79.6%-88.8%) and 10-year survival rate was 59.7% (95% CI, 46.5%-70.6%). Gait speed was associated with survival in all studies (pooled hazard ratio per 0.1 m/s, 0.88; 95% CI, 0.87-0.90; P < .001). Survival increased across the full range of gait speeds, with significant increments per 0.1 m/s. At age 75, predicted 10-year survival across the range of gait speeds ranged from 19% to 87% in men and from 35% to 91% in women. Predicted survival based on age, sex, and gait speed was as accurate as predicted based on age, sex, use of mobility aids, and self-reported function or as age, sex, chronic conditions, smoking history, blood pressure, body mass index, and hospitalization. CONCLUSION In this pooled analysis of individual data from 9 selected cohorts, gait speed was associated with survival in older adults.
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Abstract
BACKGROUND Physical activity promotes health in older adults but participation rates are low. Interactive video dance games can increase activity in young persons but have not been designed for use with older adults. The purpose of this research was to evaluate healthy older adults' interest and participation in a dance game adapted for an older user. METHODS Healthy older adults were recruited from 3 senior living settings and offered three months of training and supervision using a video dance game designed for older people. Before and after the program, data was collected on vital signs, physical function and self reported quality of life. Feedback was obtained during and after training. RESULTS Of 36 persons who entered (mean age 80.1 + 5.4 years, 83 % female), 25 completed the study. Completers were healthier than noncompleters. Completers showed gains in narrow walk time, self-reported balance confidence and mental health. While there were no serious adverse events, 4 of 11 noncompleters withdrew due to musculoskeletal complaints. CONCLUSIONS Adapted Interactive video dance is feasible for some healthy older adults and may help achieve physical activity goals.
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The impact of an aromatase inhibitor on body composition and gonadal hormone levels in women with breast cancer. Breast Cancer Res Treat 2010; 125:441-6. [PMID: 21046232 DOI: 10.1007/s10549-010-1223-2] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2010] [Accepted: 10/09/2010] [Indexed: 11/29/2022]
Abstract
Aromatase inhibitors (AIs) have become the standard adjuvant therapy of postmenopausal breast cancer survivors. AIs induce a reduction of bioavailable estrogens by inhibiting aromatase, which would be expected to induce alterations in body composition, more extensive than induced by menopause. The objectives are to examine the impact of AIs on (1) DXA-scan derived body composition and (2) gonadal hormone levels. This is a sub-analysis of a 2-year double-blind, placebo-controlled, randomized trial of 82 women with nonmetastatic breast cancer, newly menopausal following chemotherapy, who were randomized to risedronate (35 mg once weekly) versus placebo, and stratified for their usage of AI versus no AI. Outcomes included DXA-scan derived body composition and gonadal hormone levels. As a group, total body mass increased in women over 24 months. Women on AIs gained a significant amount of lean body mass compared to baseline as well as to no-AI users (P < 0.05). Women not on an AI gained total body fat compared to baseline and AI users (P < 0.05). Free testosterone significantly increased and sex hormone binding globulin (SHBG) significantly decreased in women on AIs compared to no AIs at 24 months (P < 0.01) while total estradiol and testosterone levels remained stable. Independent of AI usage, chemotherapy-induced postmenopausal breast cancer patients demonstrated an increase of total body mass. AI users demonstrated maintenance of total body fat, an increase in lean body mass and free testosterone levels, and a decrease in SHBG levels compared to no-AI users. The mechanisms and implications of these changes need to be studied further.
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Abstract
BACKGROUND Altered biomechanics and/or neural control disrupt the timing of postures and muscle patterns necessary for smooth and regular stepping. Harmonic ratio of trunk accelerations has been proposed as a measure of smoothness of walking. We sought to validate this measure of smoothness by examining the measure in groups expected to differ in smoothness (ie, young and old) and across walking conditions expected to affect smoothness (ie, straight path, curved path, and dual task). METHODS Thirty young (mean age = 24.4 ± 4.3 years) and 30 older adults (mean age = 77.5 ± 5.1 years) who could ambulate independently participated. We measured linear acceleration of the body along vertical, anterior-posterior, and medial-lateral axes using a triaxial accelerometer firmly attached to the skin over the L3 segment of the lumbar spine during straight path, curved path, and dual task (reciting every other letter of the alphabet) walking. RESULTS Older adults had lower harmonic ratio anterior-posterior (HR(AP)), that is, were less smooth in the direction of motion and walked more slowly than young adults for all walking conditions. Once the analyses were adjusted for walking speed, only HR(AP) differed between young and old participants for all walking conditions. For the most part, both young and old participants were less smooth for slow pace walking, curved path walking, and dual task walking compared with usual pace straight path walking. CONCLUSIONS The harmonic ratio, calculated from trunk acceleration, is a valid measure of smoothness of walking, which may be thought of as a measure of the motor control of walking.
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Increasing influenza and pneumococcal immunization rates in a nursing home network. J Am Med Dir Assoc 2010; 12:678-84. [PMID: 21450182 DOI: 10.1016/j.jamda.2010.05.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2010] [Revised: 04/30/2010] [Accepted: 05/03/2010] [Indexed: 10/19/2022]
Abstract
INTRODUCTION AND RATIONALE Influenza and pneumonia remain serious health concerns for long-term care (LTC) residents. Vaccination of LTC residents and health care workers are reasonable preventive strategies, although most facilities fall short of Healthy People 2010 goals. Improving immunization rates across multiple LTC facilities remains an elusive challenge. This quality improvement study sought to improve immunization rates across 6 LTC facilities and identify persistent barriers to better performance. METHODS In 2002, 6 facilities associated with the University of Pittsburgh Institute on Aging established a quality improvement network addressing immunization rates. The facilities were provided with a written educational toolkit and shared information through an e-mail distribution list. To help determine optimal program structure in future years, 3 of the facilities participated in a single half-day collaborative training session. Change in immunization rates from baseline to year 2 were compared between those participating in the collaborative training and those not participating. Barriers to improved performance were sought from all groups through focus group analysis. RESULTS Facilities participating in the single collaborative training program improved immunization rates modestly, whereas facilities not participating in the collaborative training saw decreases in immunization rates. Staff turnover was cited as a significant barrier to improved performance. DISCUSSION It may be possible to improve immunization rates in LTC facilities, at least modestly, using a collaborative training process. Staff turnover may be an important barrier to improved LTC immunization rates.
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Abstract
Despite continuous improvement in long-term survival, there is no knowledge about risk of bone health impairment and management strategies before and after intestinal transplantation. Therefore, 147 adults were retrospectively studied via chart review; 70 long-term survivors, 53 candidates and 24 recipients with longitudinal follow-up. Evaluation process included measurement of bone mineral density (BMD) and allied biochemical markers. Both long-term survivors and candidates showed low bone mass with lower (p < 0.05) z-scores at hip, femoral neck and spine. Vitamin D deficiency and secondary hyperparathyroidism were observed in both groups. Prevalence of osteoporosis was 44% among long-term survivors and 36% in candidates with age, BMD, duration of parenteral nutrition, type of immunosuppression and rejection being significant risk factors. Fragility fractures occurred at a higher (p = 0.02) rate among long-term survivors (20%) compared to candidates (6%). The longitudinal study documented acceleration (p = 0.025) of bone loss after transplantation with a decline of 13.4% (femoral neck), 12.7% (hip) and 2.1% (spine). Alendronate reduced (p < 0.05) but did not prevent bone loss. In conclusion, intestinal transplant recipients are at risk of osteoporosis secondary to bone loss before and after transplantation. Accordingly, current management includes comprehensive preventive measures with prompt therapeutic intervention utilizing intravenous bisphosphonates or subcutaneous human PTH.
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A cross-sectional analysis of the prevalence of undertreatment of nonpain symptoms and factors associated with undertreatment in older nursing home hospice/palliative care patients. ACTA ACUST UNITED AC 2010; 8:225-32. [PMID: 20624612 DOI: 10.1016/j.amjopharm.2010.05.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2010] [Indexed: 11/28/2022]
Abstract
BACKGROUND Approximately 25% of all US deaths occur in the long-term care setting, and this figure is projected to rise to 40% by the year 2040. Currently, there is limited information on nonpain symptoms and their appropriate treatment in this setting at the end of life. OBJECTIVE This study evaluated the prevalence of undertreatment of nonpain symptoms and factors associated with undertreatment in older nursing home hospice/palliative care patients. METHODS This study used a cross-sectional sample of older (>or=65 years) hospice/palliative care patients to represent all patients from the 2004 National Nursing Home Survey (NNHS) funded by the Centers for Disease Control and Prevention. Nonpain symptoms were determined from facility staff, who used the medical records to answer questions about the residents. Data on medication use were derived from medication administration records. Undertreatment was defined as the omission of a necessary medication for a specific nonpain symptom and was evaluated as a dichotomous variable (yes = the nonpain symptom was not treated with a medication; no = the nonpain symptom was treated with a medication). Cross-sectional bivariate analyses were conducted using chi(2) and regression coefficient tests to determine factors potentially associated with undertreatment of nonpain symptoms. RESULTS The cross-sectional sample included 303 older nursing home hospice/palliative care patients from among the 33,413 (weighted) patients from the 2004 NNHS. Overall, most of the patients were white (91.4% [277/303]) and female (71.9% [218/303]), and nearly half were aged >or=85 years (47.9% [145/303]). One or more nonpain symptoms occurred in 82 patients (22.0% weighted). The most common nonpain symptoms (weighted percentages) were constipation/fecal impaction in 35 patients (8.8%), cough in 34 patients (9.2%), nausea/vomiting in 26 patients (7.2%), fever in 11 patients (3.1%), and diarrhea in 9 patients (1.9%). Medication undertreatment of any of the above symptoms was seen in 47 of 82 patients (60.0% weighted), ranging from a low of 26.4% for constipation/ fecal impaction to a high of 88.0% for nausea/vomiting. Undertreated patients had significantly more problems with bed mobility (n [weighted %], 43 [92.3%] vs 21 [67.2%]; P = 0.013), mood (21 [44.7%] vs 7 [19.7%]; P = 0.017), and pressure ulcers (12 [25.7%] vs 2 [6.1%]; P = 0.023) than did treated patients. The undertreated group also had a significantly greater number of secondary diagnoses (weighted mean [SD], 6.5 [0.7] vs 5.2 [0.5]; P = 0.004) but had a shorter length of stay in hospice/ palliative care (120.5 [20.1] vs 219.4 [51.8] days; P < 0.001) or in the nursing home (552.0 [96.5] vs 1285.4 [268.3] days; P = 0.001). CONCLUSIONS The prevalence of nonpain symptoms was low (22.0% weighted) in older nursing home hospice/palliative care patients. However, medication undertreatment of nonpain symptoms was seen in more than half of these patients. Future quality-improvement initiatives for nursing home hospice/palliative care patients are needed beyond the management of pain symptoms.
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Gait biomechanics, spatial and temporal characteristics, and the energy cost of walking in older adults with impaired mobility. Phys Ther 2010; 90:977-85. [PMID: 20488977 PMCID: PMC2897132 DOI: 10.2522/ptj.20090316] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2009] [Accepted: 04/01/2010] [Indexed: 11/17/2022]
Abstract
BACKGROUND Abnormalities of gait and changes in posture during walking are more common in older adults than in young adults and may contribute to an increase in the energy expended for walking. OBJECTIVE The objective of this study was to examine the contributions of abnormalities of gait biomechanics (hip extension, trunk flexion, and foot-floor angle at heel-strike) and gait characteristics (step width, stance time, and cadence) to the energy cost of walking in older adults with impaired mobility. DESIGN A cross-sectional design was used. METHODS Gait speed, step width, stance time, and cadence were derived during walking on an instrumented walkway. Trunk flexion, hip extension, and foot-floor angle at heel contact were assessed during overground walking. The energy cost of walking was determined from oxygen consumption data collected during treadmill walking. All measurements were collected at the participants' usual, self-selected walking speed. RESULTS Fifty community-dwelling older adults with slow and variable gait participated. Hip extension, trunk flexion, and step width were factors related to the energy cost of walking. Hip extension, step width, and cadence were the only gait measures beyond age and gait speed that provided additional contributions to the variance of the energy cost, with mean R(2) changes of .22, .12, and .07, respectively. Limitations Other factors not investigated in this study (interactions among variables, psychosocial factors, muscle strength [force-generating capacity], range of motion, body composition, and resting metabolic rate) may further explain the greater energy cost of walking in older adults with slow and variable gait. CONCLUSIONS Closer inspection of hip extension, step width, and cadence during physical therapy gait assessments may assist physical therapists in recognizing factors that contribute to the greater energy cost of walking in older adults.
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The Medicare drug benefit (Part D) and treatment of heart failure in older adults. Am Heart J 2010; 160:159-65. [PMID: 20598987 DOI: 10.1016/j.ahj.2010.04.023] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2009] [Accepted: 04/28/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Adherence to pharmacotherapy for heart failure is poor among older adults in part because of high prescription drug costs. We examined the impact of improvements in drug coverage under Medicare Part D on utilization of, and adherence to, medications for heart failure in older adults. METHODS We used a quasi-experimental approach to analyze pharmacy claims for 6,950 individuals aged >or=65 years with heart failure enrolled in a Medicare managed care organization 2 years before and after Part D's implementation. We compared prescription fill patterns among individuals who moved from limited (quarterly benefits caps of USD 150 or USD 350) or no drug coverage to Part D in 2006 with those who had generous employer-sponsored coverage throughout the study period. RESULTS Individuals who previously lacked drug coverage filled approximately 6 more heart failure prescriptions annually after Part D (adjusted ratio of prescription counts = 1.36, 95% CI 1.29-1.44, P < .0001 relative to the comparison group). Those previously lacking drug coverage were more likely to fill prescriptions for an angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker plus a beta-blocker after Part D (adjusted ratio of odds ratios = 1.73, 95% CI 1.42-2.10, P < .0001) and more likely to be adherent to such pharmacotherapy (adjusted ratio of odds ratios = 2.95, 95% CI 1.85-4.69, P < .0001) relative to the comparison group. CONCLUSIONS Medicare Part D was associated with improved access to medications and adherence to pharmacotherapy in older adults with heart failure.
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Differences in brain structure and function in older adults with self-reported disabling and nondisabling chronic low back pain. PAIN MEDICINE 2010; 11:1183-97. [PMID: 20609128 DOI: 10.1111/j.1526-4637.2010.00899.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE The primary aim of this pilot study was to identify structural and functional brain differences in older adults with self-reported disabling chronic low back pain (CLBP) compared with those who reported nondisabling CLBP. DESIGN Cross-sectional. PARTICIPANTS Sixteen cognitively intact older adults, eight with disabling CLBP and eight with nondisabling CLBP. Exclusions were psychiatric or neurological disorders, substance abuse, opioid use, or diabetes mellitus. METHODS Participants underwent: structural and functional brain MRI; neuropsychological assessment using the Repeatable Battery for the Assessment of Neuropsychological Status, Trail Making Tests A and B; and physical performance assessment using the Short Physical Performance Battery. RESULTS In the disabled group, there was significantly lower white matter (WM) integrity (P < 0.05) of the splenium of the corpus callosum. This group also demonstrated activation of the right medial prefrontal cortex at rest whereas the nondisabled demonstrated activation of the left lateral prefrontal cortex. Combined groups analysis revealed a strong positive correlation (r(s) = 0.80, P < 0.0002) between WM integrity of the left centrum semiovale with gait-speed. Secondary analysis revealed a strong negative correlation between total months of CLBP and WM integrity of the SCC (r(s) = -0.59, P < 0.02). CONCLUSIONS Brain structure and function is different in older adults with disabling CLBP compared with those with nondisabling CLBP. Deficits in brain morphology combining groups are associated with pain duration and poor physical function. Our findings suggest brain structure and function may play a key role in chronic pain related disability and may be important treatment targets.
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Abstract
OBJECTIVES To examine the overall responses of nursing home staff to a newly developed nursing home specific survey instrument to assess patient safety culture (PSC) and to examine whether nursing home staff (including administrator/manager, licensed nurse, nurse aide, direct care staff, and support staff) differ in their PSC ratings. METHODS Data were collected in late 2007 through early 2008 using a survey administered to staff in each of 40 nursing homes. In 4 of these nursing homes, the responses of different staff were identified. The Nursing Home Survey on Patient Safety Culture was used to assess the 12 domains of the PSC and identify differences in PSC perceptions between staff. RESULTS For the 40 nursing homes in the sample, the overall facility response rate was 72%. For the 4 nursing homes of interest, the overall facility response rate was 68.9%. The aggregate Nursing Home Survey on Patient Safety Culture scores, using all staff types for all survey items, show that most respondents report a poor PSC. However, administrators/managers had more positive scores than the other staff types (P < 0.05) across most domains. CONCLUSIONS Staff in nursing homes generally agree that PSC is poor. This may have a significant impact on quality of care and quality of life for residents.
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Longitudinal posturography and rotational testing in children three to nine years of age: normative data. Otolaryngol Head Neck Surg 2010; 142:708-14. [PMID: 20416461 DOI: 10.1016/j.otohns.2010.01.028] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2009] [Revised: 01/13/2010] [Accepted: 01/21/2010] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To obtain normative longitudinal vestibulo-ocular and balance test data in children from ages three to nine years with normal middle ear status. STUDY DESIGN Prospective, longitudinal cohort. SETTING Tertiary care pediatric hospital. SUBJECTS AND METHODS Three-year-old children were entered and tested yearly. Subjects underwent earth vertical axis rotation testing using sinusoidal and constant velocity stimuli and performed the Sensory Organization Test. RESULTS One hundred forty-eight children were entered, and usable data were collected on 127 children. A linear increase in the vestibulo-ocular reflex gain as children aged was found, without a change in the phase of the response. An age-related linear increase in equilibrium scores, indicating reduced postural sway, was also observed. CONCLUSION These normative data can be used in the evaluation of dizziness and balance disorders in children.
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Performance measures predict onset of activity of daily living difficulty in community-dwelling older adults. J Am Geriatr Soc 2010; 58:844-52. [PMID: 20406319 DOI: 10.1111/j.1532-5415.2010.02820.x] [Citation(s) in RCA: 202] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To assess the predictive value of five performance-based measures for the onset of difficulty in activities of daily living (ADLs). DESIGN A prospective cohort study; home visits every 6 months for 18 months. SETTING Community-based. PARTICIPANTS Community-dwelling older adults, n=110, (mean age 80.3+/-7.0; range 67-98) who reported no difficulty in basic ADLs. MEASUREMENTS The Short Physical Performance Battery (SPPB), gait speed, Berg Balance Scale (BBS), grip strength, and Timed Up and Go Test (TUG) were evaluated at baseline. Seven ADL items were assessed at baseline and 6, 12, and 18 months. The onset of ADL disability was self-report of difficulty in any of the seven ADL items. Logistic regression models were fitted for each of the physical performance measures to predict onset of ADL difficulty at 6, 12, and 18 months. RESULTS After controlling for age, comorbid conditions, and sex, the BBS was the most consistent and best predictor for the onset of ADL difficulty over an 18-month period (6 months, c-statistic=0.725, (95% confidence interval (CI)=0.60-0.85; 12 months, c-statistic=0.840 95% CI=0.75, 0.93; 18 months, c-statistic=0.821, 95% CI=0.71, 0.93). The SPPB showed excellent predictive value for the onset of difficulty at 12 months. Ninety-five, 89, and 75 older adults completed the 6, 12, and 18-month follow-up visits, respectively. CONCLUSION BBS, followed by SPPB, TUG, gait speed, and grip strength, were predictive of the onset of ADL difficulty over an 18-month period in community-dwelling older adults. Screening nondisabled older adults with simple performance tests could allow clinicians to identify those at risk for ADL difficulty and may help to detect early functional decline.
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Changes in trabecular microarchitecture in postmenopausal women on bisphosphonate therapy. Bone 2010; 46:1006-10. [PMID: 20051275 PMCID: PMC3889111 DOI: 10.1016/j.bone.2009.12.025] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2009] [Revised: 12/18/2009] [Accepted: 12/22/2009] [Indexed: 11/30/2022]
Abstract
PURPOSE In addition to bone mineral density (BMD), trabecular microstructure contributes to skeletal strength. Our goal was to examine changes in trabecular microstructure in women on therapy. MATERIALS AND METHODS We followed 10 postmenopausal women receiving a bisphosphonate, risedronate (35 mg once weekly), over 12 months and examined trabecular microarchitecture with high resolution wrist MR images (hr-MRI). MRI parameters included bone volume/total volume (BV/TV), surface density (representing plates), curve density (representing rods), surface-to-curve ratio and erosion index (depicting deterioration). We assessed BMD of the spine, hip and radius and markers of bone turnover. RESULTS Women had been receiving bisphosphonate therapy for 43+/-9 months (mean+/-SD) prior to the first MRI. Indices of hr-MRI demonstrated improvement in surface-to-curve ratio (13.0%) and a decrease in erosion index (12.1%) consistent with less deterioration (both p<0.05). BMD of the spine, hip and radius and markers of bone turnover remained stable. Parameters of hr-MRI were associated with 1/3 distal radius BMD (correlation coefficient 0.71 to 0.86, p<0.05). DISCUSSION We conclude that hr-MRI of the radius demonstrates improvements in trabecular microstructure not appreciated by conventional BMD and provides additional information on parameters that contribute to structural integrity in patients on antiresorptive therapy.
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The effect of risedronate on hip structural geometry in chemotherapy-induced postmenopausal women with or without use of aromatase inhibitors: a 2-year trial. Bone 2010; 46:655-9. [PMID: 19853678 PMCID: PMC2857766 DOI: 10.1016/j.bone.2009.10.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2009] [Revised: 09/29/2009] [Accepted: 10/16/2009] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Osteoporosis is a major health problem for postmenopausal women. Adjuvant hormonal therapy with aromatase inhibitors (AIs) in postmenopausal breast cancer patients further worsens bone loss. Bisphosphonates are able to prevent AI-induced bone loss, but limited data exists on their effect on bone structure. Our objectives were to (1) examine the impact of AIs and no-AIs on hip structural geometry (HSA) of chemotherapy-induced postmenopausal women, and (2) determine if oral bisphosphonates could affect these changes. METHODS This is a sub-analysis of a 2-year double-blind randomized trial of 67 women with nonmetastatic breast cancer, newly postmenopausal following chemotherapy (up to 8 years), who were randomized to risedronate, 35 mg once weekly (RIS) and placebo (PBO). Many women changed their cancer therapy from a no-AI to an AI during the trial. Outcomes were changes in Beck's HSA-derived BMD and structural parameters. RESULTS Eighteen women did not receive adjuvant hormone therapy, while 41 women received other therapy and 8 received AIs at baseline distributed similarly between RIS and PBO. Women on AIs and PBO were found to have the lowest BMD and indices. RIS improved BMD and several HSA indices at the intertrochanteric site in women regardless of their hormonal therapy, but most improvement was observed in women who were not on AIs (all p< or =0.05 except buckling ratio). Changes at the narrow neck and femoral shaft were similar. CONCLUSION The use of AIs appears to lead to lower HSA-derived BMD and hip structural indices as compared to women on no or non-AI therapy in chemotherapy-induced postmenopausal breast cancer patients. Preventive therapy with once weekly oral risedronate maintains structural, skeletal integrity independently of the use of or type of adjuvant therapy.
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Visual Stimulation: An Approach to Weight Loss in Long Term Care. J Am Med Dir Assoc 2010. [DOI: 10.1016/j.jamda.2009.12.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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120 BRAIN IMAGING AND CLINICAL MANIFESTATIONS OF SUBSYNDROMAL GAIT AND COGNITIVE PROBLEMS IN OLDER ADULTS. Parkinsonism Relat Disord 2010. [DOI: 10.1016/s1353-8020(10)70121-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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301 BRAIN BURDEN INFLUENCE ON OUTCOMES OF INTERVENTIONS TO IMPROVE GAIT IN OLDER ADULTS WITH MOBILITY DISABILITY: A RANDOMIZED CLINICAL TRIAL. Parkinsonism Relat Disord 2010. [DOI: 10.1016/s1353-8020(10)70302-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Meaningful change in measures of gait variability in older adults. Gait Posture 2010; 31:175-9. [PMID: 19889543 PMCID: PMC2818277 DOI: 10.1016/j.gaitpost.2009.10.002] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2009] [Revised: 09/29/2009] [Accepted: 10/03/2009] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Gait variability is an important indicator of impaired mobility in older adults; however, little is known about the meaning of change in gait variability over time. This study estimated clinically meaningful change in measures of gait variability using both distribution- and anchor-based approaches. DESIGN Community-based observational cohort study. SETTING Bronx County and the research center at Albert Einstein College of Medicine. PARTICIPANTS Of 1148 participants in the Einstein Aging Study, 241 had quantitative gait assessments in two consecutive years between 2001 and 2005. MEASUREMENTS Gait variables were collected using a 12-foot instrumented walkway as participants walked at their normal walking speed. Gait variability was defined as the within-person standard deviation (SD) across steps in two 12-foot walks. Distribution-based meaningful change estimates used Cohen's effect size (0.2 for small and 0.5 for moderate effects). Anchor-based estimates were obtained using dichotomous and ordinal self-reported walking ability ratings as anchors. RESULTS Distribution-based estimates for small and substantial changes of variability measures were: stance time 0.005 and 0.014 s; swing time 0.003 and 0.009 s; step length 0.24 and 0.61 cm; and step width 0.03 and 0.08 cm. Among those reporting no change in walking ability, measures of gait variability were stable over 1 year. Among those reporting a decline in walking, stance time and swing time variability increased. Among those reporting an improvement in walking, only step length variability improved. CONCLUSION Preliminary criteria for meaningful change are 0.01 s for stance time and swing time variability and 0.25 cm for step length variability. These estimates may identify important changes over time in both clinical settings and research studies.
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Natural History and Longer Term Outcomes of Hypertrophic Cardiomyopathy. Heart Lung Circ 2010. [DOI: 10.1016/j.hlc.2010.04.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Right Ventricular Septal Versus Right Ventricular Apical Pacing and Subsequent Development of Heart Failure—A Single Centre Experience. Heart Lung Circ 2010. [DOI: 10.1016/j.hlc.2010.04.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Long-Term Outcomes on Medically Managed Patients having Favourable Coronary Fractional Flow Reserve. Heart Lung Circ 2010. [DOI: 10.1016/j.hlc.2010.06.734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Left Ventricular Hypertrophy and Mortality in Patients with Asymptomatic Severe Aortic Stenosis. Heart Lung Circ 2010. [DOI: 10.1016/j.hlc.2010.04.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Long-Term Outcomes on Medically Managed Patients Having Favourable Coronary Fractional Flow Reserve. Heart Lung Circ 2010. [DOI: 10.1016/j.hlc.2010.04.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Natural History and Longer Term Outcomes of Hypertrophic Cardiomyopathy. Heart Lung Circ 2010. [DOI: 10.1016/j.hlc.2010.06.787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Left Ventricular Hypertrophy and Mortality in Patients with Asymptomatic Severe Aortic Stenosis. Heart Lung Circ 2010. [DOI: 10.1016/j.hlc.2010.06.697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Abstract
The purpose of this study was to compare the patient safety culture between nationally representative samples of hospitals and nursing homes.This research is important in expanding our understanding of safety culture, to better understand the differences and similarities between healthcare settings, and to promote shared learning of best practices between settings. Findings from the Nursing Home Survey on Patient Safety Culture (NHSPSC) were compared with findings from the Hospital Survey on Patient Safety Culture (HSOPSC). Of the 26 highly similar items in these questionnaires, 9 of the NHSPSC scores were lower than the HSOPSC scores (indicating poorer perceptions of safety culture), 1 score was identical, and 16 of the NHSPSC scores were higher than the HSOPSC scores (indicating better perceptions of safety culture). Some learning opportunity may present itself for both nursing homes and hospitals to improve safety culture. This may have a significant impact on quality of care and quality of life for residents.
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Attitudes of postmenopausal women toward interactive video dance for exercise. J Womens Health (Larchmt) 2009; 18:1239-43. [PMID: 19630550 DOI: 10.1089/jwh.2008.1176] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIMS Although physical activity (PA) is universally recommended, most adults are not regular exercisers. Interactive video dance is a novel form of PA in widespread use among young adults, but interest among adults is not known. Postmenopausal women are an appropriate target for interventions to promote PA because they have an increased risk of health problems related to sedentary behavior. We explored perceived advantages and disadvantages of video dance as a personal exercise option in postmenopausal women. METHODS Forty sedentary postmenopausal women (mean age +/- SD 57 +/- 5 years), were oriented in eight small groups to interactive video dance, which uses a force-sensing pad with directional panels: the player steps on the panels in response to arrows scrolling on a screen, synchronized to music. Perceived advantages and disadvantages were elicited through a nominal group technique (NGT) process. RESULTS Participants generated 113 advantages and 71 disadvantages. The most frequently cited advantages were "it's fun" and "improves coordination" (seven of eight groups), the fact that challenge encourages progress (five of eight groups), the potential for weight loss (four of eight groups), and the flexibility of exercise conditions (three of eight groups). Concerns were the potentially long and frustrating learning process, cost (six of eight groups), and possible technical issues (two of eight groups). CONCLUSIONS The recreational nature of interactive dance exercise was widely appealing to postmenopausal women and might help promote adherence to PA. Initial support to learn basic technical and movement skills may be needed.
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Assessing patient safety culture of internal medicine house staff in an academic teaching hospital. J Grad Med Educ 2009; 1:139-45. [PMID: 21975721 PMCID: PMC2931190 DOI: 10.4300/01.01.0023] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
PURPOSE Patient safety culture (PSC) examines how individuals perceive an organization's commitment and proficiency in health and safety management. The primary objective of this study was to assess hospital PSC from the perspective of internal medicine house staff, and to compare the results by postgraduate year (PGY) of training and to national hospital benchmark data. METHODS The authors modified and used a version of the Hospital Survey on Patient Safety Culture (HSOPSC), which has 12 PSC dimensions. Each dimension uses a 5-level Likert scale of agreement ("Strongly disagree" to "Strongly agree") or frequency ("Never" to "Always"). The survey was distributed to 68 PGY-2 and PGY-3 internal medicine house staff at an academic medical center between December 2006 and February 2007. Composite scores were created for each respondent by calculating the proportion of positive responses for each domain. Domain score means were compared between PGYs and to survey data from hospitals that administered the HSOPSC (ie, benchmark data). RESULTS The overall response rate was 85.3% (58/68). House staff scored lower on 6 and 4 of the 12 PSC dimensions, when compared with the overall national hospital and medicine unit benchmarks, respectively (P < .05). PGY-3 staff scored lower than PGY-2 staff in 2 dimensions (P < .05). CONCLUSIONS PGY-2 and PGY-3 internal medicine house staff at our institution were in agreement on most of the PSC dimensions. Overall, house staff PSC was significantly lower than national hospital benchmark data for half of the dimensions. The results of this study will be used to establish internal PSC benchmarks and to identify targets for interventions to further improve PSC.
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Development of New LC Chiral Stationary Phases Based on Ruthenium Tris(diimine) Complexes. J LIQ CHROMATOGR R T 2009. [DOI: 10.1080/10826070903126781] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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A randomized trial of two forms of therapeutic activity to improve walking: effect on the energy cost of walking. J Gerontol A Biol Sci Med Sci 2009; 64:1190-8. [PMID: 19643842 DOI: 10.1093/gerona/glp098] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Therapeutic activities to improve mobility often include walking practice and exercises to improve deficits in endurance, strength, and balance. Because walking may also be energy inefficient in people with decreased mobility, another approach is to reduce energy cost by improving timing and coordination (TC) of movement. METHODS This pilot randomized trial of older adults with slow and variable gait offered two types of therapeutic activity over 12 weeks. One addressed Walking, Endurance, Balance, and Strength (WEBS) and the other focused on TC. Outcomes were energy cost of walking and measures of mobility. RESULTS Of 50 participants (mean age, 77.2 +/- 5.5 years, 65% women), 47 completed the study. Baseline gait speed was 0.85 +/- 0.13 m/s and energy cost of walking was 0.30 +/- 0.10 mL/kg/m, nearly twice normal. Both interventions increased gait speed (TC by 0.21 m/s and WEBS by 0.14 m/s, p < .001). TC reduced the energy cost of walking 0.10 +/- 0.03 mL/kg/m more than WEBS (p < .001) and reduced the modified Gait Abnormalities Rating Scale 1.5 +/- 0.6 more points than WEBS (p < .05). TC had a 9.8 +/- 3.5 points greater gain than WEBS in self-reported confidence in walking (p < .01). CONCLUSIONS In older adults with slow and variable gait, activity focused on TC reduced the energy cost of walking and improved confidence in walking more than WEBS while generating at least equivalent gains in mobility. To optimize mobility, future larger studies should assess various combinations of TC and WEBS over longer periods of time.
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Trabecularversuscortical bone loss induced by GnRH agonists. J OBSTET GYNAECOL 2009. [DOI: 10.3109/01443619409004073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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What is a meaningful change in physical performance? Findings from a clinical trial in older adults (the LIFE-P study). J Nutr Health Aging 2009; 13:538-44. [PMID: 19536422 PMCID: PMC3100159 DOI: 10.1007/s12603-009-0104-z] [Citation(s) in RCA: 331] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Performance measures provide important information, but the meaning of change in these measures is not well known. The purpose of this research is to 1) examine the effect of treatment assignment on the relationship between self-report and performance; 2) to estimate the magnitude of meaningful change in 400-meter walk time (400MWT), 4-meter gait speed (4MGS), and Short Physical Performance Battery (SPPB) and 3) to evaluate the effect of direction of change on estimates of magnitude. DESIGN This is a secondary analysis of data from the LIFE-P study, a single blinded randomized clinical trial. Using change over one year, we applied distribution-based and anchor-based methods for self-reported mobility to estimate minimally important and substantial change in 400MWT, 4MGS and SPPB. SETTING Four university-based clinical research sites. PARTICIPANTS Sedentary adults aged 70-89 whose SPPB scores were less than 10 and who were able to complete a 400MW at baseline (n=424). INTERVENTIONS A structured exercise program versus health education. MEASUREMENTS 400MWT, 4MGS, SPPB. RESULTS Relationships between self-report and performance measures were consistent between treatment arms. Minimally significant change estimates were 400MWT: 20-30 seconds, 4MGS: 0.03-0.05m/s and SPPB: 0.3 - 0.8 points. Substantial changes were 400MWT: 50-60 seconds, 4MGS: 0.08m/s, SPPB: 0.4 - 1.5 points. Magnitudes of change for improvement and decline were not significantly different. CONCLUSIONS The magnitude of clinically important change in physical performance measures is reasonably consistent using several analytic techniques and appears to be achievable in clinical trials of exercise. Due to limited power, the effect of direction of change on estimates of magnitude remains uncertain.
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Changes in body composition in women with breast cancer on aromatase inhibitors: A two-year trial. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.9528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9528 Background: Aromatase inhibitors (AIs), the preferred adjuvant therapy of postmenopausal breast cancer patients, induce severe hypo-estrogenemia which differentiates them from the Estrogen-Receptor-Agonists-Antagonists (ERAAs). Little is known about the effect of AIs on body composition. We sought to examine the impact of AIs on body composition, and whether any changes correlate with gonadal hormone levels. Methods: We analyzed a two year double-blind trial (Risedronate's Effect on Bone loss in Breast CAncer, REBBeCA). 81 chemotherapy-induced newly postmenopausal nonmetastatic breast cancer patients had been randomized to risedronate 35 mg once weekly or placebo and followed, some of whom were on or started AI during the trial. Measures included body composition by whole body DXA-scan and serum sex hormone levels. Combining the two treatment arms, we estimated and compared body composition changes in those on (AI) and not on AIs (no-AI) using a linear mixed model, and examined correlations with serum hormone levels. Results: By 24 months, 41 women were on an AI. Over 2 years, lean mass increased by 1159g (p=0.0003) in women on an AI and did not change (85g; p=0.7684) in the no-AI group (adjusted difference, AD=1047g; p=0.0004). Percent fat did not change (0.0; p=0.9344) in those on an AI and increased (1.2; p=0.0097) in the no-AI group (AD=1.6; p=0.0433). The change in estradiol was associated with changes in lean mass (correlation r=0.42, p=0.0020) and percent fat (r=-0.48, p=0.0003). Conclusions: The use of AIs is associated with a decrease in fat mass and an increase in lean mass. The changes in estradiol are associated with alterations in body composition. The mechanisms and implications of these changes need to be studied further. [Table: see text]
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The reliability and validity of measures of gait variability in community-dwelling older adults. Arch Phys Med Rehabil 2009; 89:2293-6. [PMID: 19061741 DOI: 10.1016/j.apmr.2008.06.010] [Citation(s) in RCA: 131] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2008] [Revised: 06/12/2008] [Accepted: 06/17/2008] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To examine the test-retest reliability and concurrent validity of variability of gait characteristics. DESIGN Cross-sectional study. SETTING Research laboratory. PARTICIPANTS Older adults (N=558) from the Cardiovascular Health Study. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Gait characteristics were measured using a 4-m computerized walkway. SD determined from the steps recorded were used as the measures of variability. Intraclass correlation coefficients (ICC) were calculated to examine test-retest reliability of a 4-m walk and two 4-m walks. To establish concurrent validity, the measures of gait variability were compared across levels of health, functional status, and physical activity using independent t tests and analysis of variances. RESULTS Gait variability measures from the two 4-m walks demonstrated greater test-retest reliability than those from the single 4-m walk (ICC=.22-.48 and ICC=.40-.63, respectively). Greater step length and stance time variability were associated with poorer health, functional status and physical activity (P<.05). CONCLUSIONS Gait variability calculated from a limited number of steps has fair to good test-retest reliability and concurrent validity. Reliability of gait variability calculated from a greater number of steps should be assessed to determine if the consistency can be improved.
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Provider management of and satisfaction with laboratory testing in the nursing home setting: results of a national internet-based survey. J Am Med Dir Assoc 2009; 10:161-166.e3. [PMID: 19233055 DOI: 10.1016/j.jamda.2008.08.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2008] [Revised: 08/25/2008] [Accepted: 08/27/2008] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To describe the management of and satisfaction with laboratory testing, and desirability of laboratory health information technology in the nursing home setting. DESIGN Cross-sectional study using an Internet-based survey. PARTICIPANTS AND SETTING National sample of 426 nurse practitioners and 308 physicians who practice in the nursing home setting. MEASUREMENTS Systems and processes available for ordering and reviewing laboratory tests, laboratory test result management satisfaction, self-reported delays in laboratory test result review, and desirability of computerized laboratory test result management features in the nursing home setting. RESULTS A total of 96 participants (48 physicians and 48 nurse practitioners) completed the survey, for an overall response rate of 13.1% (96/734). Of the survey participants, 77.1% had worked in the nursing home setting for more than 5 years. Over half of clinicians (52.1%) reported 3 or more recent delays in receiving laboratory test results. Only 43.8% were satisfied with their laboratory test results management. Satisfaction was associated with keeping a list of laboratory orders and availability of computerized laboratory test order entry. In the nursing home, 35.4% of participants reported the ability to electronically review laboratory test results, 12.5% and 10.4% respectively had computerized ordering of chemistry/hematology and microbiology/pathology tests. The following 3 features were rated most desirable in a computerized laboratory test result management system: showing abnormal results first, warning if a test result was missed, and allowing electronic acknowledgment of test results. CONCLUSION Delays in receiving laboratory test results and dissatisfaction with the management of laboratory test result information are commonly reported among physicians and nurse practitioners working in nursing homes. Test result management satisfaction was associated with computerized order entry and keeping track of ordered laboratory tests, suggesting that implementation of certain health information technology could potentially improve quality of care.
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Fractional Flow Reserve and Long Term Outcomes in the Real World. Heart Lung Circ 2009. [DOI: 10.1016/j.hlc.2009.04.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Untreated severe aortic stenosis (AS) is associated with poor outcomes. Heart Lung Circ 2009. [DOI: 10.1016/j.hlc.2009.05.591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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248
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Untreated Severe Aortic Stenosis (AS) is Associated with Poor Outcomes. Heart Lung Circ 2009. [DOI: 10.1016/j.hlc.2009.04.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Assessing the performance characteristics of signals used by a clinical event monitor to detect adverse drug reactions in the nursing home. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2008; 2008:278-282. [PMID: 18998853 PMCID: PMC2656060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 03/13/2008] [Revised: 06/30/2008] [Indexed: 05/27/2023]
Abstract
Adverse drug reactions (ADRs) are a common cause of morbidity and mortality in the nursing home (NH) setting. Traditional non-automated mechanisms for ADR detection are time-consuming, costly, and fail to detect the majority of ADRs. We describe the implementation and pharmacist evaluation of a clinical event monitor using signals previously developed by our research team to detect potential ADRs in the NH. The overall positive predictive value (PPV) for all signals combined was 81% (54/67), with individual signal PPVs ranging from 0-100%. The PPVs were 53% (10/19) for the antidote signals category and 96% (44/46) for the laboratory/ medication combination signals category. The majority 75% (12/16) of the preventable ADRs were laboratory/medication combination signals. The results suggest that ADRs can be detected in the NH setting with a high degree of accuracy using a clinical event monitor that employs a set of signals derived by expert consensus.
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Efficacy of percutaneous electrical nerve stimulation and therapeutic exercise for older adults with chronic low back pain: a randomized controlled trial. Pain 2008; 140:344-357. [PMID: 18930352 DOI: 10.1016/j.pain.2008.09.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2008] [Revised: 08/09/2008] [Accepted: 09/04/2008] [Indexed: 11/30/2022]
Abstract
Chronic low back pain (CLBP) in older adults may be disabling and therapeutically challenging, largely because of the inefficacy and/or morbidity associated with traditional pain treatment. We conducted a randomized controlled trial in 200 men and women > or = age 65 with CLBP to evaluate the efficacy of percutaneous electrical nerve stimulation (PENS) with and without general conditioning and aerobic exercise (GCAE), for reducing pain and improving physical function. Participants were randomized to receive (1) PENS, (2) control-PENS (brief electrical stimulation to control for treatment expectancy), (3) PENS+GCAE, or (4) control-PENS+GCAE, twice a week for 6 weeks. All four groups experienced significantly reduced pain (range -2.3 to -4.1 on the McGill Pain Questionnaire short form), improved self-reported disability (range -2.1 to -3.0 on Roland scale) and improved gait velocity (0.04-0.07 m/s), sustained at 6 months. The GCAE groups experienced significantly fewer fear avoidance beliefs immediately post-intervention and at 6 months than non-GCAE groups. There were no significant side effects. Since brief electrical stimulation (i.e., control-PENS) facilitated comparably reduced pain and improved function at 6 months as compared with PENS, the exact dose of electrical stimulation required for analgesia cannot be determined. GCAE was more effective than PENS alone in reducing fear avoidance beliefs, but not in reducing pain or in improving physical function.
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