摘要:

Monoclonal antibodies raised against cerebrospinal fluid (CSF) and human ventral forebrain from patients with Alzheimer's disease were tested against CSF pools derived from patients with Alzheimer's disease and normal controls. Antibodies that appeared to distinguish the two pools were subsequently tested against 58 CSF samples from individual Alzheimer patients, normal controls, and individuals with other neurologic diseases. The mean CSF content of two antigens was decreased in patients with Alzheimer's disease compared with controls; the mean CSF content of one of these antigens was also decreased in patients with other neurologic diseases. Although group differences could be detected, the degree of overlap did not follow for the separation of individual patients within these three groups.

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1987.tb04919.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

Despite a significant increase in the amount of research being conducted on the etiology, diagnosis, and treatment of Alzheimer's disease and other dementing disorders, there has been little assessment of the utilization of this new wealth of information by the primary care physician. It was hypothesized that there would be a wide variation in physicians' knowledge of dementing disorders and the procedures used to diagnose these disorders. To quantitate the present status of primary care physicians' knowledge of dementing disorders and to investigate possible relationships between this knowledge and different physician and practice characteristics, 50 general internists and family practitioners from Winnebago County, Illinois, were interviewed regarding their recall of causes of dementia, procedures used in diagnosing these diseases, treatment recommendations, and comfort in making a differential diagnosis.Results revealed a wide variation in both physicians' familiarity with the causes of dementia as well as the procedures used in making the diagnosis. Although a majority (80%) of the physicians reported some degree of confidence in making a differential diagnosis of dementing disorders, a significant trend was found between physician age and comfort in making the diagnosis, with age being directly correlated with comfort. This was in spite of a significant negative association between physician age and immediate recall of causes of dementia. These data imply that younger physicians are entering the work force with at least better immediate recall of information on dementing disorders, but they have had little opportunity to become comfortable with that knowledge due to a generally smaller geriatric population in their practice. Secondly, despite good recall of specific causes of dementia, younger physicians were no more likely to evaluate patients using mental status testing. In fact, only 42% of physicians mentioned mental status testing as a procedure with only 12% mentioning using any formal mental testing procedure. Although these data reflect favorably on the medical education system's incorporation of geriatric medicine classes in the curriculum, they also imply that dissemination of the information to the present physician population and subsequent use is still problematic.

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1987.tb04920.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

Growing public debate regarding no cardiopulmonary resuscitation (no‐CPR) policies in acute care hospitals, together with recent changes in the patient population of long‐term care facilities, has led nursing homes to examine their need for resuscitation policies. To determine current cardiopulmonary resuscitation policies and procedures in nursing homes, medical directors and directors of nursing service in long‐term care facilities in Portland, Oregon, were surveyed. Seventy‐five percent responded; of these, only 41% reported having a resuscitation policy. Of those with no policy, 70% thought one was needed. Most nursing homes reported that resuscitation was infrequently discussed with patients and families. When a no‐CPR determination was made, it was usually documented in the patient's chart. Training in basic life support was required for registered nurses in two thirds of the facilities. Few homes had equipment necessary for advanced life support. It is recommended that: a) nursing homes develop cardiopulmonary resuscitation policies; b) resuscitation orders be made part of the medical record; and c) nursing home personnel increase their ability to perform basic lif

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1987.tb04921.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

In order to examine the relative frequency of urinary tract infection (UTI) and bacteriuria among male nursing home patients managed with and without external catheters (EC), we prospectively followed four cohorts of patients (EC worn continuously, N = 30; EC worn at night only, N = 19; incontinent without catheter, N = 13; and continent, N = 30) for a total of 497 patient months at risk. The proportion of patients with EC worn continuously who had at least one episode of bacteriuria (87%) and at least one UTI (40%), and the incidence of UTI (0.08 episodes per patient‐month at risk) was significantly higher than among continent or incontinent patients without EC. Patients with EC at night only had an intermediate frequency of these findings. Differences in clinical and functional status characteristics among the four cohorts, in addition to the use of EC, could have contributed to the higher frequencies of bacteriuria and UTI. None of the clinical characteristics we examined were associated with the development of UTI among patients with EC. Further studies are necessary to identify factors associated with UTI among patients who are managed by EC so that effective preventive strategies can be developed and targeted to patients at high ris

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1987.tb04922.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

Although team‐oriented geriatric assessment clinics are growing throughout the country, little documentation exists regarding their clinical efficacy, cost‐effectiveness, or impact on patient functioning and well‐being. This report describes a randomized controlled clinical trial to evaluate the effectiveness of a team‐oriented geriatric assessment approach compared to traditional care. One hundred‐seventeen subjects 65 years of age and over, meeting eligibility criteria to target frail older persons with changing medical and social needs, were randomly assigned to receive a comprehensive geriatric assessment by a multidisciplinary team (treatment) or by one of a panel of community internists who were reimbursed according to their usual and customary fee (controls). Extensive analysis of baseline information failed to identify any significant differences between groups. Over the 1‐year follow‐up period, treatment participants experienced 26 hospital admissions and used 670 hospital days compared with 23 admissions and 1113 days for controls (a 39.8% difference). Annual hospital costs averaged $4297 for treatment subjects and $7018 for controls. Overall institutional costs including hospital and nursing home care revealed an average saving of $2189 per person for treatment subjects compared with controls, a 25% reduction. A small proportion of subjects accounted for this difference. No significant differences were noted in patient or caregiver satisfaction with the evaluation process, functional ability, or health status. These findings suggest that team‐oriented outpatient geriatric assessment provides a promising way to deliver high‐quality, satisfying care to older persons without increasing (and possibly decreasing)

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1987.tb04923.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

Seventy‐five patients, 75 years of age and over, experienced recurrent syncope, with the etiology remaining unclear but presumably cardiogenic, after cardiac and neurologic examinations and noninvasive laboratory testing (including an electrocardiogram and ambulatory electrocardiographic monitoring). The mean number of previous syncopal spells was 14 (range, 1 to 64) over a mean of 36 months (range, 1 to 480 months). These patients underwent invasive electrophysiologic testing and a potential cause for syncope was identified in 68%. Abnormal findings at electrophysiologic testing included: sinus node dysfunction (55%); abnormal His‐bundle conduction (39%); and ventricular tachycardia (14%), with some patients having more than one abnormality. No major complications were associated with the electrophysiologic testing. Patients were subsequently treated with permanent cardiac pacing or antiarrhythmic drugs or both, depending upon results of the electrophysiologic study. Follow‐up examinations (mean of 26 months; range, 1 to 70) were possible in 90% of patients. No further syncope occurred in 84% of patients with an abnormal electrophysiologic study who received subsequent therapy to prevent the identified abnormality. Thus, in this difficult group of patients with recurrent syncope of uncertain etiology, electrophysiologic testing was safe and indicated abnormalities of conduction or rhythm in 68% of patients; treatment to correct these abnormalities prevented recurrent syncope i

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1987.tb04924.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

This paper reviews studies published since 1970 on the quality of medical services received by older persons. Although many of the studies were flawed in design or limited in scope, they suggest that there are problems in the quality of care received by older persons in ambulatory, hospital, and nursing home settings. Changes in health care delivery and financing should attempt to improve, rather than merely maintain, the quality of medical and health services received by this vulnerable population.

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1987.tb04925.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1987.tb04926.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

The terminal stages of many neurological illnesses occurring in the elderly produce feeding and swallowing problems. These difficulties lead to ethical, religious, philosophical, and medico‐legal conflicts when decisions about starting or stopping tube feedings are considered. We present the case against all forms of tube feeding in a particular subset of elderly palliative patients. These are individuals who are in the end‐stage of a progressive neurological disease who are noncommunicative, and spend all or most of their time in a recumbent position. We discuss the physiological phenomena existing in these patients that make the probability of aspiration pneumonia as great or possibly greater than with careful spoon feeding. If tube feeding results in the outcome that it is thought to prevent (ie, aspiration pneumonia) then decisions regarding nutritional support in these patients become clinically clea

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1987.tb04927.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1987.tb04928.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY