Medicine and Health Sciences Commons^™

Development Of A Decision Support Tool To Facilitate Primary Care Management Of Patients With Abnormal Liver Function Tests Without Clinically Apparent Liver Disease [Hta03/38/02]. Abnormal Liver Function Investigations Evaluation (Alfie), Peter T. Donnan, David Mclernon, Douglas Steinke, Stephen Ryder, Paul Roderick, Frank M. Sullivan, William Rosenberg, John F. Dillon

Pharmacy Practice and Science Faculty Publications

BACKGROUND: Liver function tests (LFTs) are routinely performed in primary care, and are often the gateway to further invasive and/or expensive investigations. Little is known of the consequences in people with an initial abnormal liver function (ALF) test in primary care and with no obvious liver disease. Further investigations may be dangerous for the patient and expensive for Health Services. The aims of this study are to determine the natural history of abnormalities in LFTs before overt liver disease presents in the population and identify those who require minimal further investigations with the potential for reduction in NHS costs.

METHODS/DESIGN: …

Values Of Sleep/Wake, Activity/Rest, Circadian Rhythms, And Fatigue Prior To Adjuvant Breast Cancer Chemotherapy., Ann M. Berger, Lynne A. Farr, Brett R. Kuhn, Patricia Fischer, Sangeeta Agrawal

Journal Articles: College of Nursing

Fatigue is the most prevalent and distressing symptom experienced by patients receiving adjuvant chemotherapy for early stage breast cancer. Higher fatigue levels have been related to sleep maintenance problems and low daytime activity in patients who have received chemotherapy, but knowledge describing these relationships prior to chemotherapy is sparse. The Piper Integrated Fatigue Model guided this study, which describes sleep/wake, activity/rest, circadian rhythms, and fatigue and how they interrelate in women with Stage I, II, or IIIA breast cancer during the 48 hours prior to the first adjuvant chemotherapy treatment. The present report describes these variables in 130 females, mean …

Ambulatory Care Adverse Events And Preventable Adverse Events Leading To A Hospital Admission, Donna M Woods, Eric J Thomas, Jane L Holl, Kevin B Weiss, Troyen A Brennan

Faculty, Staff and Student Publications

BACKGROUND: Most healthcare in the US is delivered in the ambulatory care setting, but the epidemiology of errors and adverse events in ambulatory care is understudied.

METHODS: Using the population-based data from the Colorado and Utah Medical Practices Study, we identified adverse events that occurred in an ambulatory care setting and led to hospital admission. Proportions with 95% CIs are reported.

RESULTS: We reviewed 14,700-hospital discharge records and found 587 adverse events of which 70 were ambulatory care adverse events (AAEs) and 31 were ambulatory care preventable adverse events (APAEs). When weighted to the general population, there were 2608 AAEs …

Sociodemographic Characteristics And Diabetes Predict Invalid Self-Reported Non-Smoking In A Population-Based Study Of U.S. Adults, Monica A. Fisher, George W. Taylor, Brent J. Shelton, Sara M. Debanne

Markey Cancer Center Faculty Publications

BACKGROUND: Nearly all studies reporting smoking status collect self-reported data. The objective of this study was to assess sociodemographic characteristics and selected, common smoking-related diseases as predictors of invalid reporting of non-smoking. Valid self-reported smoking may be related to the degree to which smoking is a behavior that is not tolerated by the smoker's social group.

METHODS: True smoking was defined as having serum cotinine of 15+ng/ml. 1483 "true" smokers 45+ years of age with self-reported smoking and serum cotinine data from the Mobile Examination Center were identified in the third National Health and Nutrition Examination Survey. Invalid non-smoking was …

An Occupational Therapy Intervention Program Addressing The Needs Of Older Adults As They Transition To New Living Situations, Judith M. Sokol

Occupational Therapy Capstones

As individuals age and approach retirement, face life changes (loss of spouse or significant others), or health changes, they often make the decision to relocate. Responses may vary; but frequently stress, depression, and anxiety are experienced to the level that they impede a healthy adjustment. This can lead to diminished self-care, difficulty engaging in meaningful occupation, and isolation. Older adults may experience a poor sense of personal mastery within their new environment, contributing to feelings of low self esteem, sadness, grief secondary to loss, anger, and loneliness.

The purpose of this scholarly project was to address the pre-relocation needs and …

Patient Education In Glaucoma: What Do Patients Know About Glaucoma?, Vital Paulino Costa, George L Spaeth, Maura Smith, Cordelia Uddoh, José Paulo Cabral Vasconcellos, Newton Kara-José

Wills Eye Hospital Papers

PURPOSE: To evaluate the knowledge glaucoma patients have about their disease and its treatment.

METHODS: One hundred and eighty-three patients were interviewed at the Glaucoma Service of Wills Eye Hospital (Philadelphia, USA, Group 1) and 100 at the Glaucoma Service of University of Campinas (Campinas, Brazil, Group 2). An informal, relaxed atmosphere was created by the interviewer before asking a list of 18 open-ended questions.

RESULTS: In Group 1, 44% of the 183 patients did not have an acceptable idea about what glaucoma is, 30% did not know the purpose of the medications they were taking, 47% were not aware …

New Award: Carah And Germantown's Center In The Park Awarded $2.2 Million To Study Mental Health Of Older African-American Adults

CenterPieces

Why do older African-Americans tend to report less depression than Whites although they have poorer health and higher rates of chronic illness?

Research from the past 15 years consistently shows health disparities between Whites and minorities in the United States. African-Americans, in particular, are at higher risk than Caucasians for serious health conditions such as stroke, diabetes, cancer, cardiovascular disease and mild cognitive impairment. These chronic conditions typically contribute to depression in elders as a whole. However, the rates of depression for African-Americans are unclear with many studies reporting lower depression than in Whites and others reporting the reverse.

This …

Project Able Featured By Reuters Health Service

CenterPieces

CARAH's randomized trial, Project ABLE (Advancing Better Living for Elders), funded by the National Institute on Aging, and published in the May, 2006 issue of the Journal of the American Geriatric Society, was recently featured by Reuters Health service, the world's leading provider of medical and healthcare news.

This study tested a six-month intervention in which people received four 90-minute visits with an occupational therapist, as well as one 20-minute telephone contact, and one 90-minute physical therapy visit and home modifications provided by the Philadelphia Corporation for Aging. Of 319 men and women 70 years of age and older, half …

Mild Cognitive Impairment, Activity Participation, Functional Difficulty, & Adaptations , Laraine Winter, Laura N. Gitlin

Center for Applied Research on Aging and Health Research Papers

No abstract provided.

Mild Cognitive Impairment, Activity Participation, Functional Difficulty, And Adaptations In Functionally Vulnerable Elderly People: A Closer Look, Laraine Winter, Laura N. Gitlin

Center for Applied Research on Aging and Health Research Papers

No abstract provided.

Oncolog Volume 51, Number 07/08, July/August 2006, Diane Witter, Sunni Hosemann, Elihu Estey Md

OncoLog MD Anderson's Report to Physicians (All issues) Archives

• Gaining Momentum in MDS
• When Bone Marrow Goes Awry
• Pancreatic Cancer: It Takes a Village
• House Call: Tired of Being Tired
• DiaLog: Anemia in the Elderly, by Elihu Estey, MD, Professor, Department of Leukemia

Molecular Diagnosis Of Burkitt's Lymphoma., Sandeep S. Dave, Kai Fu, George W. Wright, Lloyd T. Lam, Philip Kluin, Evert-Jan Boerma, Timothy Greiner, Dennis D. Weisenburger, Andreas Rosenwald, German Ott, Hans-Konrad Müller-Hermelink, Randy D. Gascoyne, Jan Delabie, Lisa M. Rimsza, Rita M. Braziel, Thomas M. Grogan, Elias Campo, Elaine S. Jaffe, Bhavana J. Dave, Warren Sanger, M Bast, Julie M. Vose, James O. Armitage, Joseph M. Connors, Erlend B. Smeland, Stein Kvaloy, Harald Holte, Richard I. Fisher, Thomas P. Miller, Emilio Montserrat, Wyndham H. Wilson, Manisha Bahl, Hong Zhao, Liming Yang, John Powell, Richard Simon, Wing C. Chan, Louis M. Staudt

Journal Articles: Pathology and Microbiology

BACKGROUND: The distinction between Burkitt's lymphoma and diffuse large-B-cell lymphoma is crucial because these two types of lymphoma require different treatments. We examined whether gene-expression profiling could reliably distinguish Burkitt's lymphoma from diffuse large-B-cell lymphoma.

METHODS: Tumor-biopsy specimens from 303 patients with aggressive lymphomas were profiled for gene expression and were also classified according to morphology, immunohistochemistry, and detection of the t(8;14) c-myc translocation.

RESULTS: A classifier based on gene expression correctly identified all 25 pathologically verified cases of classic Burkitt's lymphoma. Burkitt's lymphoma was readily distinguished from diffuse large-B-cell lymphoma by the high level of expression of c-myc target …

Imaging Breast Adipose And Fibroglandular Tissue Molecular Signatures By Using Hybrid Mri-Guided Near-Infrared Spectral Tomography, Ben Brooksby, Brian W. Pogue, Shudong Jiang, Hamid Dehghani, Subhadra Srinivasan, Christine Kogel, Tor D. Tosteson, John Weaver, Steven P. Poplack, Keith D. Paulsen

Dartmouth Scholarship

Magnetic resonance (MR)-guided near-infrared spectral tomography was developed and used to image adipose and fibroglandular breast tissue of 11 normal female subjects, recruited under an institutional review board-approved protocol. Images of hemoglobin, oxygen saturation, water fraction, and subcellular scattering were reconstructed and show that fibroglandular fractions of both blood and water are higher than in adipose tissue. Variation in adipose and fibroglandular tissue composition between individuals was not significantly different across the scattered and dense breast categories. Combined MR and near-infrared tomography provides fundamental molecular information about these tissue types with resolution governed by MR T1 images.

A Randomized Trial Of A Multicomponent Home Intervention To Reduce Functional Difficulties In Older Adults, Laura N. Gitlin, Laraine Winter, Marie P. Dennis, Mary Corcoran, Walter W. Hauck

Center for Applied Research on Aging and Health Research Papers

OBJECTIVES: To test the efficacy of a multicomponent intervention to reduce functional difficulties, fear of falling, and home hazards and enhance self-efficacy and adaptive coping in older adults with chronic conditions.

DESIGN: A prospective, two-group, randomized trial. Participants were randomized to a treatment group or no-treatment group.

SETTING: Urban community-living older people.

PARTICIPANTS: Three hundred nineteen community-living adults aged 70 and older who reported difficulty with one or more activities of daily living.

INTERVENTION: Occupational and physical therapy sessions involving home modifications and training in their use; instruction in strategies of problem-solving, energy conservation, safe performance, and fall recovery techniques; …

Pharmacological Studies Of Nicotine And Galantamine Effects On Age Associated Memory Impairment And The Neurotrophic System In Aged Female Rats, Kristen L. French

MUSC Theses and Dissertations

Nicotine and Galantamine were studied for their pharmacological effects on age associated memory impairment (AAMI) and the neurotrophin system in the aged female F344 rat. Nicotine was found to have dose dependent effects on cognition in the 24 month old rat. A low dose of nicotine improved both working and reference memory (WM, RM) performance on the water radial arm maze and also improved the ability of aged rats to handle an increasing WM load. A high dose did not improve WM and caused deficits in RM, and high cotinine levels in these subjects correlated with worse performance. Nicotine treatment …

Oncolog, Volume 50, Number 12, December 2005, Sunni Hosemann, Diane Witter

OncoLog MD Anderson's Report to Physicians (All issues) Archives

• Moving New Drugs from "Bench to Bedside and Back"
• House Call: When the End Is Near: Ways to Cope When a Loved One Is Terminally Ill
• After Katrina: Caring for Cancer Patients in the Wake of the Storm

Harvest Health: Chronic Disease Self-Management Program For Older African-Americans, Nancy L. Chernett, Laura N. Gitlin

Population Health Matters (Formerly Health Policy Newsletter)

No abstract available.

The Role Of Spiritual Well-Being In Moderating Frail Elders' Affective Response To Functional Difficulty, Marie P. Dennis, Laura N. Gitlin, Laraine Winter, Yeon K. Chee

Center for Applied Research on Aging and Health Research Papers

Anxiety and depression have been well documented as affective consequences of functional impairment. Little research, however, has examined factors that moderate these associations. The present cross-sectional study examined the role of spiritual well-being in buffering the impact of functional difficulty on the anxiety and depressive symptoms of 319 functionally vulnerable community-dwelling elders, aged 70 or older, participating in a 6-month randomized controlled trial designed to enhance function. As demonstrated in recent research on spirituality and health, we expected that spiritual well-being would moderate the association between functional difficulty and anxiety as well as the relationship between functional difficulty and depression. …

What Is Valuation Of Life For Frail Community-Dwelling Older Adults: Factor Structure And Criterion Validity Of The Vol, Marie P. Dennis, Laraine Winter, Helen K. Black, Laura N. Gitlin

Center for Applied Research on Aging and Health Research Papers

Lawton et al. (1999) defined valuation of life (VOL) as a cognitive-affective schema consisting of complex judgments, emotions and projections influenced by demographic and QOL factors. However, little is known about what constitutes VOL for frail elders. The present study evaluated the psychometric properties of a 13-item version of Lawton et al's. (2001) VOL Scale and examined correlational evidence in support of its construct validity with 319 elders enrolled in the Project ABLE study. Responses of half the sample (N=159) were submitted to principal axis factoring, yielding two factors (spiritual well-being, a = .88 and goal-related self-efficacy, a = .84), …

The Tension Of Loss In Old Age, Christa Caruso, Helen K. Black

Center for Applied Research on Aging and Health Research Papers

Our poster is based on a larger qualitative study that explores the personal meaning of suffering to 122 community-dwelling elders. Because loss in old age emerges as a significant aspect of suffering in elders' narratives, we focus on suffering as loss. We are recruiting community dwelling elders aged 80 and above, stratified by ethnicity, gender and self-reported health for extended qualitative interviews. Respondents tell their life story and story of suffering along with personal definitions of suffering. Through narrative analysis we examine responses to the many losses experienced during a long life and the suffering that results from loss. By …

Near-Infrared Characterization Of Breast Tumors In Vivo Using Spectrally-Constrained Reconstruction, Subhadra Srinivasan, Brian W. Pogue, Ben Brooksby, Shudong Jiang, Hamid Dehghani, Christine Kogel, Wendy A. Wells, Steven P. Poplack, Keith D. Paulsen

Dartmouth Scholarship

Multi-wavelength Near-Infrared (NIR) Tomography was utilized in this study to non-invasively quantify physiological parameters of breast tumors using direct spectral reconstruction. Frequency domain NIR measurements were incorporated with a new spectrally constrained direct chromophore and scattering image reconstruction algorithm, which was validated in simulations and experimental phantoms. Images of total hemoglobin, oxygen saturation, water, and scatter parameters were obtained with higher accuracy than previously reported. Using this spectral approach, in vivo NIR images are presented and interpreted through a series of case studies (n=6 subjects) having differing abnormalities. The corresponding mammograms and ultrasound images are also evaluated. Three of six …

Experts Recommend Strategies For Strengthening The Use Of Advanced Practice Nurses In Nursing Homes., Mathy Mezey, Sarah Greene Burger, Harrison G Bloom, Alice Bonner, Mary Bourbonniere, Barbara Bowers, Jeffrey B Burl, Elizabeth Capezuti, Diane Carter, Jacob Dimant, Sarah A Jerro, Susan C Reinhard, Marilyn Ter Maat

College of Nursing Faculty Papers & Presentations

In 2003, The John A. Hartford Foundation Institute for Geriatric Nursing, New York University Division of Nursing, convened an expert panel to explore the potential for developing recommendations for the caseloads of advanced practice nurses (APNs) in nursing homes and to provide substantive and detailed strategies to strengthen the use of APNs in nursing homes. The panel, consisting of nationally recognized experts in geriatric practice, education, research, public policy, and long-term care, developed six recommendations related to caseloads for APNs in nursing homes. The recommendations address educational preparation of APNs; average reimbursable APN visits per day; factors affecting APNs caseload …

The Personal Care Partnership Program, Christopher Minnick, Jennifer Campbell, Pearl Beth Graub, Ed Ratajczak, Carol A. Irvine

Population Health Matters (Formerly Health Policy Newsletter)

No abstract available.

Assuring Individualized Pharmacotherapy For The Elderly, Richard G. Stefanacci

Population Health Matters (Formerly Health Policy Newsletter)

No abstract available.

Pharmaceutical Care For An Aging America, Jennifer B. Koenig

Population Health Matters (Formerly Health Policy Newsletter)

No abstract available.

The Medication Safety Program: Medication-Food Risks And Behaviors Among The Pace Elderly, William E. Staas Jr.

Population Health Matters (Formerly Health Policy Newsletter)

No abstract available.

Surgical Images: Soft Tissue. Incarcerated Gallbladder In A Parastomal Hernia., Shawn D. St Peter, Jacques Heppell

Manuscripts, Articles, Book Chapters and Other Papers

No abstract provided.

A Pilot Randomized, Controlled Trial Of An In-Home Drinking Water Intervention Among Hiv + Persons, John M. Colford, Sona R. Saha, Timothy J. Wade, Catherine C. Wright, Mai Vu, Sandra Charles, Peter Jensen, Alan Hubbard, Deborah A. Levy, Joseph N. S. Eisenberg

Journal Articles: Epidemiology

Although immunocompromised persons may be at increased risk for gastrointestinal illnesses, no trials investigating drinking water treatment and gastrointestinal illness in such patients have been published. Earlier results from San Francisco suggested an association (OR 6.76) between tap water and cryptosporidiosis among HIV + persons. The authors conducted a randomized, triple-blinded intervention trial of home water treatment in San Francisco, California, from April 2000 to May 2001. Fifty HIV-positive patients were randomized to externally identical active (N = 24) or sham (N = 26) treatment devices. The active device contained a filter and UV light; the sham provided no treatment. …

A Randomized, Controlled Trial Of In-Home Drinking Water Intervention To Reduce Gastrointestinal Illness, John M. Colford, Timothy J. Wade, Sukhminder K. Sandhu, Catherine C. Wright, Sherline Lee, Susan Shaw, Kim Fox, Susan Burns, Anne Benker, M. Alan Brookhart, Mark Van Der Laan, Deborah A. Levy

Journal Articles: Epidemiology

Trials have provided conflicting estimates of the risk of gastrointestinal illness attributable to tap water. To estimate this risk in an Iowa community with a well-run water utility with microbiologically challenged source water, the authors of this 2000-2002 study randomly assigned blinded volunteers to use externally identical devices (active device: 227 households with 646 persons; sham device: 229 households with 650 persons) for 6 months (cycle A). Each group then switched to the opposite device for 6 months (cycle B). The active device contained a 1-microm absolute ceramic filter and used ultraviolet light. Episodes of "highly credible gastrointestinal illness," a …

Occupational Therapy Driving Protocol For The Elderly Population, Terra Nelson, Courtney Marrs

Occupational Therapy Capstones

No abstract provided.