摘要:

We examined the relationship between age and extent of disease at initial diagnosis as part of a population‐based, prospective study documenting the patterns of care received by over 1500 newly diagnosed lung, breast, and colorectal cancer patients identified in nine Rhode Island hospitals. For each cancer site examined, no age by extent of disease relationship was observed; however, analysis by sex among lung cancer patients indicated an inverse age relationship for men. The absence of an age effect for breast cancer patients is in contrast to earlier research findings that identify a positive association between extent of disease and age at diagnosis. Past results may reflect age‐related differences in patient and physician screening behavior characteristic of earlier time peri

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1988.tb05778.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

This study investigates three questions related to the problem of medication nonadherence among elders. First, does recall failure play a significant role in nonadherence? Recent research suggests that it may not. Second, can the new portable bar code scanner technology be used to study nonadherence? Other forms of monitoring are obtrusive or inaccurate. Finally, can inexpensive computer assisted instructions (CAI) be used to teach mnemonic techniques specifically designed to improve medication schedule recall? Current research on memory training teaches nonspecific mnemonics and uses the expensive classroom approach. Results of the present study suggest that physically active and cognitively alert elders do have significant nonadherence (control group — 32.0%) problems related to forgetting and that CAI courseware can significantly reduce (medication recall training group = 10.0%) this form of nonadherence. Portable bar code technology proved easy to use by elderly patients and provided detailed information about the type of forgetting underlying nonadherence. Most significant recall failure was in the complete forgetting to take medication rather than delays in medicating or overmedicatin

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1988.tb05779.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

The reformulated learned helplessness model of depression was tested in a study of families caring for relatives with Alzheimer's disease who did not participate in family support groups or have access to respite care. Family members who identified themselves as major caregivers, ie, those providing daily assistance to the patient, received a clinical psychiatric interview, the Beck Self‐Report Depression Scale, and a modified Hammen and deMayo Attributional Style Questionnaire. The results showed that 55% of major caregivers, primarily spouses, living with an older relative with dementia experienced clinical depression. Depressed caregivers were more likely to perceive a lack of control over their situation than those who were not depressed. Contrary to the reformulated learned helplessness hypothesis, they did not perceive their situation to be the result of internal, stable, and global attributions. The results suggest the need to study depression in ecologically stressful natural settings and to develop effective clinical intervention strategie

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1988.tb05780.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

An association between depression and physical dependency arising from a recent illness has been generally accepted. To clarify this relationship over time, 30 medical rehabilitation patients aged 54 to 94 years were assessed 1 week after admission and at discharge to quantify symptoms of depression, physical dependency, and cognitive functioning using the Hamilton Depression Scale (HAM‐D), the Geriatric Depression Scale (GDS), the Barthel Index for physical function, and the Mini‐Mental State Examination (MMSE). Significant depressive symptomatology was found by HAM‐D in 25 patients on admission and 14 on discharge. No significant associations were present between either admission or discharge depression scores and all other variables. The HAM‐D change score was significantly correlated with the Barthel change score (r — 0.57, P<0.001) and with the MMSE change score (r = 0.48, P = 0.01). All patients whose mood improved also improved in physical functioning, whereas 75% of those whose mood did not improve failed to make headway in physical functioning. This implies that it is not the degree of physcial incapacity but rather the failure to regain prior abilities which is strongly associated with persisting depression following a catastrophic illness. Furthermore, characteristics found commonly in the group whose mood did not improve included physicians' failure to diagnose and treat depression or a setback from a significant medical or surgical com

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1988.tb05781.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

This study compared three interventions designed to increase acceptance of influenza and pneumococcal vaccines among elderly hospitalized patients. All individuals 65 and older able to give informed consent (73 patients) who were admitted to one medical floor of an acute care hospital were randomized to one of three groups. All groups received informational pamphlets explaining influenza and pneumococcal disease, their respective vaccines, and indications for their use. The first group received pamphlets only, the second received nursing follow‐up, and the third received trained volunteer follow‐up. Patients on another medical floor served as controls. The results showed a significant improvement in vaccine acceptance in all three study groups compared to controls for both influenza (78% vs 0%) and pneumococcal (75% vs 0%) vaccines. The differences among the three groups were not significant. No significant differences were found among patients accepting or refusing vaccination with regard to diagnosis, age, length of stay, sex, or having a private physician. We conclude that a simple educational program followed by offering vaccination before hospital discharge can be easily implemented, and dramatically increase immunization rates in this high risk gr

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1988.tb05782.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

All elderly patients with established urinary incontinence residing in an intermediate care facility during one year were evaluated for medical and urological conditions contributing to the incontinence; treatment was initiated for all diagnosed problems if possible. Unstable detrusor function (65%), sphincter weakness (13%), and overflow incontinence (10%) were all frequent urological causes, although several patients required extensive testing in addition to cystometrics to establish a complete diagnosis. Frequent nonurological causes of incontinence included behavioral problems (53%), immobility (45%), medication problems (24%), diabetes (18%), and local pathology (47%). Thirty‐seven percent had three or more conditions identified. Treatment aimed at nonurological causes was more successful in ameliorating incontinence than urological medication; side effects were significant limitations to urological treatment success. Of the 22 patients who completed evaluation, treatment, and follow‐up, five patients (23%) were cured, three (14%) showed at least a 65% decrease in incontinence, four (18%) showed at least a 30% decrease in incontinence, and 10 (45%) showed no change or worsened. We conclude that nonurological problems frequently contribute to urinary incontinence in long term care facilities; incontinence in some of these patients can be improved without urological therapy. Nonurological problems need careful definition and treatment; patients whose incontinence persists require comprehensive urological evaluation and therapy. A complete solution to incontinence in this setting may require safer drugs and better understanding of urinary pathophysiol

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1988.tb05783.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

Iodinated glycerol is used as a mucolytic expectorant in the treatment of respiratory disorders. Iodine can inhibit the biosynthesis of thyroid hormone and induce hypothyroidism, particularly in patients with a history of thyroid disease. Such effects have not been reported in individuals without known thyroid disease who are being treated with organically bound iodine in the form of iodinated glycerol. In the course of a thyroid screening program for nursing home residents, eight subjects were identified who were being treated with iodinated glycerol.Five of these were found to have thyrotropin elevations; one showed a low serum thyroxine level and a decreased free thyroxine index. None of these residents had a history of thyroid disease. Abnormalities of thyroid function improved or resolved after discontinuation of therapy. Elderly nursing home residents without known thyroid disease are at risk of thyroid suppression when given iodinated glycerol.

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1988.tb05784.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

Emphasis is placed on the importance of early detection of colorectal cancer by the primary care physician using the 60 cm flexible sigmoidoscope. A training format for this procedure is proposed. The author, trained according to this format, found 49 polyps and three carcinomas among his first 365 randomly chosen patients. Of these 317 (87%) were asymptomatic, having no risk factors. The average distance of insertion was 53 cm and the average examination time was 20 minutes. The calculated cost for these 365 patients was approximately $60,000, and the estimated average cost for a potentially curable colorectal cancer detection was approximately $20,000. Although a relatively long examination time may be necessary for the beginner, the author concludes that the primary care physician can be readily trained to handle the 60 cm flexible sigmoidoscope safely and cost effectively.

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1988.tb05785.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1988.tb05786.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1988.tb05787.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY