Senior living. Sandhill Cove, Stuart, Florida.
Explore the source record for details and available documents.
Aged↗
Biomedical subjects
J Gorman
Publications and source records attributed to J Gorman.
Toward a 21st century quality-measurement system for managed-care organizations.
As the Nation's largest managed-care purchaser, the Health Care Financing Administration (HCFA) is working to develop a uniform data and performance-measurement system for all enrollees in managed-care plans. This effort will ultimately hold managed-care plans accountable for continuous improvement in the quality of care they provide and will provide information to consumers and purchasers to make responsible managed-care choices. The effort entails overhauling peer review organization (PRO) conduct of health maintenance organization (HMO) quality review, pilot testing a new HMO performance-measurement system, establishing criteria for Medicaid HMO quality-assurance (QA) programs, adapting employers' HMO performance reporting systems to the needs of Medicare and Medicaid, and participation in a new alliance between public and private sector managed-care purchasers to promote quality improvement and accountability for health plans.
Capitation Fee↗
Effect of recombinant human erythropoietin on hospitalization of hemodialysis patients.
The effect of recombinant human erythropoietin (EPO) on hospitalization of patients with end-stage renal disease (ESRD) was evaluated in a controlled clinical trial. A cohort of 67 new hemodialysis patients prescribed EPO shortly after the clinical availability of EPO were the treatment group. The control group was a cohort of 67 new hemodialysis patients matched for clinical center, age, cardiovascular disease and transfusion history. These patients had not been prescribed EPO as they had started hemodialysis prior to the clinical availability of EPO. There were 21 pairs without hospitalization and 46 pairs with at least 1 member of the pair experiencing hospitalization. Among the latter group, the median follow-up was 174 and 184 days for the EPO and control patients respectively. For all hospitalizations, those treated with EPO were hospitalized 15.3 days per year compared to 23.2 days for the control patients. The difference (EPO-control) was -7.9 days (95% CI: -21.0; 7.8) for all cause hospitalization. For hospitalizations due to cardiac, infectious disease and gastrointestinal disease, the differences were 1.6, 1.8 and 1.2 days favouring EPO treated patients. For hospitalizations related to vascular access complications, the difference was 0.9 days favoring the control group. All other causes favoured EPO treated patients by 4 days. There had been 58 hospitalizations in the EPO group compared to 97 in the control group. The mean duration of hospitalization was 8.0 days for the EPO and 9.6 for the control group. The direction and magnitude of the change in all cause hospitalization represents an improvement in morbidity and an important decrease in health resource utilization.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
A class switch control region at the 3' end of the immunoglobulin heavy chain locus.
We replaced the IgH 3' enhancer (3'EH) region with a neomycin resistance gene in ES cells and generated chimeric mice in which all mature lymphocytes were either heterozygous (3'EH+/-) or homozygous (3'EH-/-) for the mutation. In vitro activated 3'EH-/- B cells responded similarly to 3'EH+/- B cells with respect to proliferation and secretion of IgM and IgG1 but were specifically deficient in IgG2a, IgG2b, IgG3, and IgE secretion. These isotype deficiencies correlated with a deficiency in accumulation of transcripts from and class switching to affected CH genes. In vivo, chimeric mice containing only 3'EH-/- B cells were deficient in serum IgG2a and IgG3. We propose that the 3'EH-/- mutation disrupts the activity of a regulatory region that influences heavy chain class switching to several different CH genes that lie as far as 100 kb upstream of the mutation.
Animals↗
Probability of thrombosis of vascular access among hemodialysis patients treated with recombinant human erythropoietin.
The objective was to evaluate the effect of the treatment of anemia with recombinant human erythropoietin (EPO) on thrombosis of the vascular access used for hemodialysis. The research design was a prospective cohort study comparing EPO-treated hemodialysis patients with a comparison group matched for type of vascular access, clinical center, and age. All patients commencing hemodialysis in the study centers between March 1988 and July 1991 were eligible if either a graft or fistula had been used as a first permanent vascular access. There were 64 matched fistula pairs and 38 matched graft pairs. There were more patients with a history of cardiovascular disease in the EPO group than in the comparison group for both fistulae and grafts, 34 versus 14% for the former and 37 versus 5% for the latter. There was no difference between EPO and comparison groups with respect to time to first thrombosis of fistula, 11.3 versus 10.6%, respectively, by thrombosis of grafts among those treated with EPO--33.6 versus 11.2% (P = 0.02). EPO treatment does not increase the probability of fistula thrombosis, but there is an association with an increased probability of graft thrombosis.
Actuarial Analysis↗
The effect of methadone on immunological parameters among HIV-positive and HIV-negative drug users.
Our objective was to assess the effects of methadone use on immune parameters. A convenience sample of men and women drug injectors who knew their HIV serostatus were enrolled in a longitudinal observational study of HIV illness. During analysis of baseline data, differences were noted in immune parameters among Methadone users. Study participants were recruited in Manhattan, New York, from a methadone maintenance clinic, and infectious disease clinic of an inner city hospital, and a drug-free community center. The participants were 220 men and women, current or former drug injectors, approximately half of them HIV-antibody positive and the rest HIV-antibody negative. Candidates with opportunistic infections and secondary neoplasms were excluded. Methadone users were compared to nonmethadone users for absolute and percentage counts of CD4, CD8, and activated T lymphocytes; CD4/CD8 ratio; an HIV symptom check list; and medical staging. The results discussed in this paper were formulated after data collection was complete. Our data indicate that methadone treatment, while not significantly affecting absolute CD4 lymphocyte count, is associated with a lower CD4 percentage and CD4/CD8 cell ratio, and with a higher CD8 absolute count and percentage. These differences are present regardless of HIV serostatus. Our findings should be interpreted with caution since we did not set out to investigate the effects of methadone on the immune system. Nevertheless, if it is corroborated that methadone has a detrimental effect on the immune system, finding alternatives to methadone-maintenance treatment for drug injectors will be a necessity.
Adult↗
Sodium lactate infusion in late luteal phase dysphoric disorder.
The effects of sodium lactate infusion were compared in 13 women who sought treatment for marked premenstrual dysphoric changes that met criteria for late luteal phase dysphoric disorder and 7 control women. No subject had a lifetime history of panic disorder. The rate of blindly rated panic to sodium lactate was 7 (58%) in patients and 0% in controls. Nonpanicking patients also had higher Modified Acute Panic Inventory scores than control subjects. The differences cannot be fully explained on the basis of a history of panic attacks. Further study is warranted.
Adult↗
Effect of high-flux hemodialysis on cardiac structure and function among patients with end-stage renal failure.
The effect of high flux hemodialysis on left ventricular function in ESRD patients was evaluated in a double blind, single cross-over, study comparing conventional to high flux hemodialysis. The subjects were 21 stable chronic hemodialysis patients. Ten were randomly allocated to the conventional-high flux sequence and 11 to the reverse sequence. The conventional membrane was the CD 3,500 or 4,000; the high flux membrane was the Duoflux (Althin Medical Inc., Miami Lakes, Fla.). Both were cellulose acetate and both were sterilized with ethylene oxide. The dialysate bicarbonate and sodium were held constant for the study. The ultrafiltration rates were 3.5-5.0 ml/h/mm Hg transmembrane pressure for the conventional and 15 ml/h/mm for the high flux membrane. The beta-2-microglobulin sieving coefficient was 0 for conventional and 0.27 for the high-flux membrane. The modest improvements in estimates of systolic function suggest a cardiac advantage in high-flux dialysis, the clinical impact of which requires further study.
Adult↗
Comment on the London/Toronto Study of Alprazolam and Exposure in Panic Disorder with Agoraphobia.
Explore the source record for details and available documents.
Adolescent↗
A prospective controlled study of magnetic resonance imaging of the brain in gay men and parenteral drug users with human immunodeficiency virus infection.
To detect the earliest structural changes in the brain in human immunodeficiency virus (HIV) infection, 118 gay men and 115 parenteral drug users enrolled in a study of the natural history of HIV infection underwent magnetic resonance imaging evaluations. Routine T2-weighted and heavily T2-weighted scans for quantification of brain water were obtained, blinded to HIV serostatus. Atrophy and foci of increased signal did not correlate with any medical, immunologic, neurologic, or neuropsychologic parameters in the group as a whole, or in the gay men or parenteral drug user subgroups. Three subjects had progressive multifocal leukoencephalopathy and one had central nervous system lymphoma. In a subgroup in whom intracranial water percent was calculated, correlations were found with CD4 counts and CD4/CD8 ratios. We conclude that standard magnetic resonance imaging of the brain does not differentiate asymptomatic and mildly symptomatic HIV-positive individuals from HIV-negative individuals, regardless of risk group. However, intracranial water percent may distinguish HIV-positive from HIV-negative individuals because it correlates with raw CD4 counts and CD4/CD8 ratios.
Adolescent↗
Neurologic and neuropsychological manifestations of human immunodeficiency virus infection in intravenous drug users without acquired immunodeficiency syndrome. Relationship to head injury.
We examined 99 human immunodeficiency virus (HIV)-negative and 122 HIV-positive intravenous drug users (IVDUs) without acquired immunodeficiency syndrome (AIDS) to determine whether HIV-positive IVDUs had more neurologic and neuropsychological impairment than their HIV-negative counterparts. Controlling for age, education, drug use, history of head injury, and interactions between head injury and HIV status and drug use, HIV-positive subjects had more extrapyramidal signs and frontal release signs. These findings persisted when asymptomatic HIV-positive subjects without systemic signs of infection and HIV-negative subjects were compared. Neurologic findings were more severe in those with more systemic illness. Among those reporting a history of head injury with loss of consciousness, neuropsychological performance was significantly worse in the HIV-positive subjects, and this increased with severity of illness. This was not true in the group without head injury, suggesting an interaction between history of head injury and the seropositive state. No relationship was noted between head injury and either drug use or HIV state. Therefore, subtle neurologic and neuropsychological abnormalities may precede clinical evidence of AIDS in IVDUs and may be more evident in those with head injury.
Adult↗
Phenelzine vs atenolol in social phobia. A placebo-controlled comparison.
Seventy-four patients who met DSM-III criteria for social phobia completed 8 weeks of double-blind, randomly assigned treatment with the monoamine oxidase inhibitor phenelzine sulfate, the cardioselective beta-adrenergic blocker atenolol, or placebo. The overall response rates were 64% for phenelzine, 30% for atenolol, and 23% for placebo. Phenelzine was widely superior to both atenolol and placebo on independent rater analyses and, to a lesser extent, on self-report, with no significant differences between atenolol and placebo. At the end of 16 weeks, phenelzine was still significantly superior to placebo, while atenolol showed an intermediate response that did not differ significantly from either of the other treatments. Patients with generalized social phobia constituted 76% of the sample, and they were preferentially responsive to phenelzine. The small size of the discrete social phobic sample precluded separate outcome analyses for this subtype. Overall, the findings support the responsivity of social phobia to monoamine oxidase inhibitors.
Adolescent↗
Theoretical and therapeutic considerations for the anxiety disorders.
Everyone is familiar with that paralyzing state of dread known as anxiety. Although it is unpleasant, the experience of anxiety has adaptive aspects: it can serve as an impetus to effect beneficial life change and can facilitate psychological development. Anxiety becomes of clinical concern, however, when it interferes with intellectual function, or arrests normal social or vocational pursuits. Anxiety disorders are chronic illnesses. Treatment can eliminate many of the disease's debilitating features, but the underlying disorder is not usually cured. Discontinuation of treatment-pharmacological, behavioral, or both-often results in the recurrence of symptoms. The focus of treatment, therefore, generally centers on striking a balance between the goal of alleviating the patient's symptoms, and the need to avoid the deleterious effects which result from long-term treatment (1). The intention of this paper is to review theoretical and therapeutic considerations for four types of anxiety disorder: panic disorder, generalized anxiety disorder, social phobia, and obsessive-compulsive disorder. In doing this, emphasis will be placed on the physiological concomitants and, when possible, neuropsychological bases of these illnesses. Furthermore, pharmacological treatment will be related to the underlying substrata of the disorder whenever possible.
Anti-Anxiety Agents↗
VDJ recombination.
The ability of lymphocyte receptor V, D and J gene segments to rearrange generates much of the receptor diversity that is the hallmark of the immune system. Naturally, the mechanisms of immunoglobulin and T-cell receptor gene recombination are of enormous interest. Here, Fred Alt and colleagues review current understanding of the process and speculate on future findings.
Animals↗
Effect of high-flux hemodialysis on quality of life and neuropsychological function in chronic hemodialysis patients.
The objective was to evaluate the effect of high-flux hemodialysis on quality of life, intra- and interdialytic symptoms and neuropsychological function. The study was double-blind single cross-over with random allocation to order of treatment. The patients were stable adult hospital hemodialysis patients. Both the conventional and high-flux membranes were cellulose acetate, the dialysate was bicarbonate, and dialysate sodium was held constant. The high-flux membrane had an ultrafiltration rate of 15 ml/h/mm Hg transmembrane pressure, a B12 clearance of 88 ml/min and a beta 2-microglobulin clearance of 11.4 ml/min. The values of the conventional membrane were 3.5-5.0, 34-45 and negligible. Each treatment period was 4 months. Twenty-two patients completed both phases of the cross-over. The KT/V value was higher during high-flux than conventional treatment; 1.42 versus 1.27(p < 0.05). There were no differences between high-flux and conventional treatment with respect to quality of life. Symptoms during dialysis were less severe during high-flux than conventional treatment for 12/14 items. Only 3 items reached statistical significance (0.05 > p > 0.01) and none were clinically significant. Symptoms between dialyses were less severe during high-flux than conventional treatment for 18/20 items. No single item had a statistically significant improvement but 3 had clinically important improvement. Among the 23 neuropsychological variables, none demonstrated statistically significant changes.
Adolescent↗
Vulnerability to sodium lactate in panic disorder patients given cognitive-behavioral therapy.
Six patients with panic disorder who had panicked during sodium lactate infusion were given cognitive-behavioral treatment for 12-24 weeks. After treatment they underwent another lactate infusion, and four patients were rates as having no panic, suggesting that reduced vulnerability to lactate accompanies remission of panic. Controlled trials of cognitive-behavioral therapy and use of lactate infusion as a measure of remission are recommended.
Adolescent↗
A lighting evaluation of a facility for the elderly.
A residential facility for the aged was evaluated for their illumination needs. Only the shared facility and grounds immediately surrounding it were considered. The facility evaluated is one of the most modern and the lighting design is considered its best feature. The age of residents occupying the facility ranges from 60 to 85 years. The lighting evaluation included administering a lighting adequacy/inadequacy questionnaire and measurement of actual light levels in the various parts of the facility during the day and after dark hours. The results indicated that lighting in approximately half the areas surveyed was substandard. An attempt to develop recommendations for the lighting needs of the elderly was unsuccessful. It was concluded that realistic illumination level recommendations need to be developed for the elderly.
Aged↗