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Biomedical subjects

B J Volicer

Publications and source records attributed to B J Volicer.

At least 19 recordsLinked to original sources
PubMed1997

Effects of dronabinol on anorexia and disturbed behavior in patients with Alzheimer's disease.

A placebo-controlled crossover design, with each treatment period lasting 6 weeks, was used to investigate effects of dronabinol in 15 patients with a diagnosis of probable Alzhemer's disease who were refusing food. Eleven patients completed both study periods; one patient who died of a heart attack 2 weeks before the end of the study was also included in the analysis. The study was terminated in 3 patients: one developed a grand mal seizure and 2 developed serious intercurrent infections. Body weight of study subjects increased more during the dronabinol treatment than during the placebo periods. Dronabinol treatment decreased severity of disturbed behavior and this effect persisted during the placebo period in patients who received dronabinol first. Adverse reactions observed more commonly during the dronabinol treatment than during placebo periods included euphoria, somnolence and tiredness, but did not require discontinuation of therapy. These results indicate that dronabinol is a promising novel therapeutic agent which may be useful not only for treatment of anorexia but also to improve disturbed behavior in patients with Alzheimer's disease.

Aged↗
PubMed1996

Effect of fever-management strategy on the progression of dementia of the Alzheimer type.

This study was undertaken to determine if the progression of dementia of the Alzheimer type (DAT) is accelerated by an intercurrent infection and if management strategy (aggressive or palliative care) would modify this effect. A prospective cohort study compared the progression of DAT in patients in three 25-bed dementia special care units that provide a hospice option for care. There were three groups of patients, as follows: (a) developed a fever and received aggressive care (FAC, n = 30), (b) developed a fever and received palliative care (FPC, n = 19), and (c) did not develop a fever (NF, n = 46). The presence of a fever episode did not have an effect of its own on DAT progression. Over a 3-month period, DAT severity increased in most patients, but more so in FAC patients. Thus aggressive medical treatment of infections did not affect the underlying disease process and was associated with an acceleration of the progression of severity of DAT. Providing palliative care is recommended because it prevents patients from undergoing invasive diagnostic workups and treatments, does not accelerate the progression of DAT, and conserves scarce health care resources.

Activities of Daily Living↗
PubMed1993

Predicting short-term survival for patients with advanced Alzheimer's disease.

OBJECTIVE: The purpose of this study was to develop a statistical model for predicting short term survival in patients with dementia of the Alzheimer type (DAT). DESIGN: A prospective cohort study. SETTING: Three 25-bed intermediate medical care units using a structured approach to patient care management including palliative care options and patients from a second, traditional long-term care setting. PARTICIPANTS: Of 104 patients with advanced DAT monitored for 34 months, 68 patients (97% white male) who had at least one fever episode were included in the model development phase. Data from 71 additional DAT patients with at least one fever episode were used to test the statistical model. MAIN OUTCOME MEASURES: Six-month survival following a fever episode. RESULTS: Older age and higher severity of DAT at the time of the fever episode, palliative care, and hospital admission for long-term care within 6 months prior to the fever were found to be positively associated with likelihood of mortality within 6 months of the fever onset. Adjusted odds ratios for each of these variables were statistically significant. The model performed well in subsequent testing on an independent sample of patients. CONCLUSION: Results provide a formula which can be used to predict likelihood of dying within 6 months following onset of a fever in DAT patients. This statistical prediction is recommended for use in combination with clinical judgment to certify DAT patients for Medicare hospice coverage.

Age Factors↗
PubMed1993

Is hospice care appropriate for Alzheimer patients?

Hospice care can benefit late-stage Alzheimer's patients, but caregivers and families must first be aware of the complications and treatment difficulties that often accompany Alzheimer's disease. From this awareness they can determine whether and when hospice care is appropriate for their patients or loved ones.

Aged↗
PubMed1992

Assessment of discomfort in advanced Alzheimer patients.

An objective scale for measuring discomfort in noncommunicative patients with advanced Alzheimer's disease was empirically generated from the perspectives of nursing staff practicing on special care Alzheimer units and was judged to have content validity. On the basis of a pilot test, the discomfort scale was reduced to nine items. Quantifiable scoring procedures and a rater training program were developed. The scale (DS-DAT) was tested longitudinally for 6 months with 82 subjects at two sites. Psychometric properties, measurement issues, and recommendations for use in practice and research are discussed.

Alzheimer Disease↗
PubMed1988

Predicting cost for new HMO subscribers.

The purpose of the project was to develop a model for predicting costs for potential new HMO subscribers, using available cost data from fiscal year 1985 for current enrollees of a large HMO. Regression analysis of aggregated clinic, referral, and hospital cost data using a log transformation of cost indicated that 20 percent of the variation in cost could be explained by sex and coverage type of the subscriber, compared with 7 percent explainable by a simple comparison of costs for single versus family subscribers. Subscriber age, while by itself a significant and nonlinear predictor of cost, was not significant when controlled for coverage type. Application of the model to 28 large companies yielded predicted costs well correlated with observed costs (r = .75, p less than .01). Prediction was significantly better for companies with low observed mean costs than for companies with high observed mean costs.

Adult↗
PubMed1985

Assessment of genetic predisposition to alcoholism in male alcoholics.

Association between the history of alcoholism in different relatives with the development of alcoholism in male probands was analysed using the rate of development of alcoholism as a marker of genetic predisposition. It was found that a history of alcoholism in parents, grandparents and siblings of parents was associated with an accelerated rate in the development of alcoholism while a history of alcoholism in siblings and children of probands was not. The rate of development of alcoholism was positively associated with the number of generations of the proband's family in which alcoholism occurred.

Adult↗
PubMed1984

Relationship of family history of alcoholism to patterns of drinking and physical dependence in male alcoholics.

The occurrence of physical dependence, morning drinking and binge drinking was assessed in alcoholic men in relation to family history of problem drinking. The incidence of physical dependence, binge drinking and morning drinking was higher in men with a family history of problem drinking than in men without such a history. Physical dependence also developed earlier in family history positive subjects than in family history negative ones. The incidence of physical dependence was higher in subjects who reported binge drinking or morning drinking than in others. These results indicate that family history of problem drinking is associated with severe alcohol abuse resulting in early development of physical dependence.

Alcohol Drinking↗
PubMed1983

Variation in length of time to development of alcoholism by family history of problem drinking.

Patients hospitalized for treatment of alcoholism were asked to provide information on family history of drinking problems, age at onset of drinking, and timing of the occurrence of problems due to use of alcohol in their lives, using a time scale. Analysis of data from 256 male patients indicated a strong association between a family history of problem drinking and development of alcoholism at a young age. Mean age at the time the patients could be defined as alcoholic, based on the chronological history of the time of occurrence of symptoms, ranged from 27.2 years for bilineal family history positive patients to 38.5 years for those with negative family history, and the difference could not be explained by differences in age at onset of drinking. The results indicate that the increased risk of alcoholism among individuals with family history of problem drinking, which has been postulated on the basis of many cross-sectional studies, is likely to be overestimated.

Adolescent↗
PubMed1983

Randomized response estimates of problem use of alcohol among employed females.

As part of the evaluation of an alcoholism orientation program conducted in 12 federal agencies, 378 female employees were asked to provide personal information about problems associated with their use of alcohol. The optimized form of the unrelated question randomized response technique (RRT) was used to provide for a comparison of estimates of frequency of problem drinking obtained with guaranteed confidentiality of response versus estimates obtained using a conventional anonymous questionnaire. The estimated proportion of alcoholics or possible alcoholics among participants in the orientation program was 34.3% (+/- 4.9) by the RRT and 21.9% (+/- 3.6) by direct response. Significant underreporting of alcoholism was found among older respondents (greater than or equal to 36 years), lower GS level respondents (less than grade 6), those with low seniority (less than 8 years), and those never married. Further, significant underreporting was found among those who claimed they were told they had to attend the program versus others, and among those who claimed they were not curious about the topic of alcoholism versus others. The RRT is recommended for use in experimental situations where answers to sensitive questions are needed to evaluate program success. The necessity for caution in interpretation of apparent differences in respondent characteristics with respect to problems with alcohol use is discussed. Finally, the findings indicate the importance of providing avenues by which confidential treatment for alcoholism can be obtained.

Adult↗
PubMed1982

Randomized response technique for estimating alcohol use and noncompliance in hypertensives.

Hypertensives reported a greater incidence of daily use of alcohol and higher noncompliance in taking prescribed medicines by a randomized response technique with a dichotomous response as compared with direct response, and more mean drinks per week, but similar compliance in taking prescribed medicines, by a randomized response technique with a quantitative response as compared with direct response.

Alcohol Drinking↗
PubMed1982

Self reports on alcohol use and compliance with antihypertensive medication.

Adverse effects of alcohol drinking were investigated in 240 hypertensive patients. Perceived interaction between alcohol and antihypertensive medication was reported by 9.9% of patients but the symptoms were rather mild. Except for the fact that the patients who perceived drug-alcohol interaction had higher diastolic blood pressure than the rest of the patients there was no evidence that alcohol use decreased compliance with antihypertensive treatment. Most heavy alcohol users believed that they should take their antihypertensive medication while drinking and reported doing so. Indiscriminate emphasis on avoidance of drug-alcohol combination might decrease blood pressure control of these patients.

Alcohol Drinking↗
PubMed1981

Sex differences in correlates of problem drinking among employed males and females.

Drinking patterns and problems were analyzed in relation to demographic and occupational characteristics, using data from a survey of a random sample of 3000 employed men and women. Results indicated an association between problem drinking and youth, low education, low job seniority, single or divorced or separated marital status, and low income, for males only. Among females, problem use of alcohol was found to be positively associated with the number of children and the number of children at home, and this relationship persisted when age, education, marital status, and income were statistically controlled.

Adult↗
PubMed1981

Male and female differences in severity of problems with alcohol at the workplace.

A study was undertaken in order to estimate the frequency of occurrence of alcohol problems among female and male employees in selected large work settings with ongoing occupational alcoholism/employee assistance programs. Randomly selected employees provided information through a survey about their alcohol related behavior as well as demographic and occupational characteristics. Results indicated a range of alcohol problems from 9.2% to 17.5% for females and 20.0% to 29.9% for males. These figures, combined with client monitoring data, indicated that none of the programs was having a significant impact on either males or females. The most striking correlate of problem drinking for both sexes was family drinking problems.

Adult↗
PubMed1978

Hospital stress and patient reports of pain and physical status.

The Hospital Stress Rating Scale was used to measure stress due to the experience of hospitalization for 535 medical and surgical patients in a community hospital. Patients were also asked to rate the pain they experienced on a pain thermometer, and a recovery inventory was used to score patient self-reports of their physical status, both during hospitalization and subsequent to discharge. With statistical control for patient characteristics correlated with self-reports of pain and physical status, associations between hospital stress and these variables were observed. Patients scoring high in hospital stress tended to report more pain, lower physical status during hospitalization, and less improvement after discharge than patients scoring low in hospital stress.

Adult↗
PubMed1977

Medical-surgical differences in hospital stress factors.

Psychosocial stress due to the experience of hospitalization was ascertained for 535 medical and surgical patients in a community hospital, using a Hospital Stress Rating Scale, Medical-surgical differences along nine dimensions of stress as measured by this scale were examined, using analysis of covariance to control for the effects of patient characteristics known to be associated with scores on the Hospital Stress Rating Scale. The controlled variables were age, education, number of previous hospitalizations, number of years since last hospitalization, and seriousness of illness (Seriousness of Illness Rating Scale). The analysis of covariance results indicated higher perceived stress for surgical patients on the dimensions of unfamiliarity of surroundings, loss of independence, and threat of severe illness. Medical patients scored higher on the dimensions of stress due to financial problems and lack of information. The authors discuss how these findings might be incorporated in experimental studies designed to reduce stress among hospital patients.

Awareness↗