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Biomedical subjects

Charles E Gessert

Publications and source records attributed to Charles E Gessert.

17 recordsLinked to original sources
PubMed2006

Childhood stye and adult rosacea.

BACKGROUND: Little is known about how individuals with a predisposition for rosacea appear in childhood. This retrospective, matched control, longitudinal study examined the relationship between childhood stye and adult rosacea. METHODS: The records of the Rochester Epidemiology Project were examined to identify patients who received care for stye or blepharitis between ages 2 and 17 years, and received care for any cause at age 40 years or older. Patients were matched by group to control subjects (1:2). RESULTS: Patients with stye during childhood (N = 201) had a higher prevalence of adult rosacea than did control subjects (5.5% vs 1.5%, P = .01). Patients who had other childhood eye conditions without stye (N = 504) were not at higher risk. LIMITATIONS: The study population included few minority patients. CONCLUSIONS: The association between childhood stye and adult rosacea appears to be significant and should be examined further. Rosacea prevalence in adults may be lower (2.1%) than previously reported.

Adolescent↗
PubMed2006

Rural-urban differences in medical care for nursing home residents with severe dementia at the end of life.

OBJECTIVES: To identify factors associated with the use of selected medical services near the end of life in cognitively impaired residents of rural and urban nursing homes. DESIGN: Retrospective cohort study using Centers for Medicare and Medicaid Services administrative data for 1998 through 2002. SETTING: Minnesota and Texas nursing homes. PARTICIPANTS: Nursing home residents aged 65 and older with severe cognitive impairment who subsequently died during 2000/01. MEASUREMENTS: Minimum Data Set and Medicare Provider Analysis and Review, Hospice, and Denominator files were used to identify subjects and to assess medical service use. U.S. Department of Agriculture metro-nonmetro continuum county codes defined rural (codes 6-9) and urban (codes 0-2) nursing homes. Nursing home residents with hospice or health maintenance organization benefits were excluded. Use of hospital services at the end of life was adjusted for use of corresponding services before the last year of life. Outcome variables were feeding tube use, any hospitalization, more than 10 days of hospitalization, and intensive care unit (ICU) admission. RESULTS: The population included 3,710 subjects (1,886 rural, 1,824 urban). In multivariable logistic regression analyses (all P<.05), feeding tube use was more common in urban nursing home residents, whereas rural nursing home residents were at greater risk for hospitalization. CONCLUSION: Rural residence was also associated with lower risk of more than 10 days of hospitalization and ICU admission. Nonwhite race and stroke were associated with higher use of all services. Rural nursing home residence is associated with lower likelihood of use of the most-intensive medical services at the end of life.

Aged↗
PubMed2006

Family decision-making for nursing home residents with dementia: rural-urban differences.

CONTEXT: Research has demonstrated substantial differences between end-of-life care in rural and urban settings. As the end of life approaches, rural elders are less likely to be hospitalized, to be placed in an intensive care unit, or to have a feeding tube, compared to their urban counterparts. These differences cannot be fully explained by rural-urban differences in access to medical services. PURPOSE: To describe and understand rural-urban differences in attitudes toward death and in end-of-life decision making. METHODS: Eight focus groups were convened in rural and urban Minnesota nursing homes. The 38 focus group participants were family members of nursing home residents with severe cognitive impairment. FINDINGS: Most rural focus group participants voiced unqualified acceptance of death and placed few conditions on death, beyond their hope that it would be quick and peaceful. Urban respondents presented a wider range of attitudes toward death, from unambiguous acceptance of immediate death to evident discomfort with welcoming death under any circumstances. These rural-urban differences had practical implications. Rural respondents were much less likely to endorse interventions that would impede death, compared to their urban counterparts. CONCLUSIONS: Rural respondents tended to express confidence in natural forces; death was seen as neutral or beneficent. Resistance to the approach of death was more characteristic of urban respondents, some of whom insisted upon aggressive medical care in advanced dementia.

Aged↗
PubMed2005

End of life in nursing homes: connections between structure, process, and outcomes.

PURPOSE: This study was a prospective, in-depth exploration of the experience of dying in two nursing homes from the perspective of residents, staff, and family members. DESIGN AND METHODS: A qualitative, case study design was used. Formal and informal interviews, participant observation, and document review were the primary data collection methods. A total of 56 declining residents were followed until death or for 6 months, whichever occurred first. RESULTS: The intimate linkages between structure, process, and outcome were evident in both nursing homes. The two homes had contrasting institutional philosophies, reflected in staffing and environment (structure) and processes of care. Processes included different patterns of planning, communication, and decision making. Most importantly, outcomes (residents' satisfaction with care and quality of life while approaching death) were substantively different. IMPLICATIONS: Institutional philosophy and leadership permeate all aspects of care. A compliance- centered, deficiency-free approach to assessing quality of care is not sufficient to address the needs of declining residents. A client-centered philosophy that embraces "caring for dying people," combined with integrated care planning, contributes to improved resident outcomes.

Adult↗
PubMed2004

Measurement of the severity of rosacea.

BACKGROUND: There are no standardized measures for the severity of rosacea. OBJECTIVES: To determine what clinical signs correlate best with global severity of rosacea, and to examine inter-rater reliability. Methods Four clinicians each made 82 assessments of rosacea patients. Each assessment used 60 0-to-10 Likert-like scales for the signs of rosacea. Subjects also assessed the severity of their rosacea. RESULTS: The clinicians' assessment of global severity correlated strongly with erythema, especially on the cheeks. Subjects' assessment of global severity correlated more strongly with papules/pustules. Different methods of assessing severity--estimation of area involved, intensity, or lesion counts--did not produce significantly different results. Inter-rater reliability was low on 11-point (0-10) scales, but improved when scales were collapsed to 5 or 4 points. CONCLUSIONS: Clinicians and patients assess severity of rosacea differently, with clinicians focusing on erythema and patients focusing on papules/pustules. New instruments for assessing severity must address inter-rater reliability.

Adult↗
PubMed2004

Ethical wills and suffering in patients with cancer: a pilot study.

INTRODUCTION: Suffering at the end of life may be caused by many factors, including pain and other symptoms, concern about family and friends, and loss of control of one's life. Several authors have suggested that loss of meaning is pivotal in suffering. An ethical will (EW) is a statement, usually written, capturing one's values, wisdom, hopes, and advice. EWs have been suggested as a vehicle for finding meaning as the end of life approaches. This pilot study of EWs examined methods for exploring the role of EWs in reducing suffering at the end of life. METHODS: Oncology clinic patients 65+ years of age in active therapy for cancer were randomly assigned to one of two arms: EW or control. Subjects in both arms had writing assignments, three home visits, and exit interviews. Suffering was measured at baseline and at the time of the exit interview, using a series of Likert-like scales. RESULTS: Twenty-four subjects (10 EW and 14 control) completed the study. Among EW subjects, trends toward reduced suffering were noted in "concern for loved ones," "unfinished business," and "fear of the future." Several methodological issues were identified by this pilot study, including selection of population for studying suffering, placebo effect, and randomization. CONCLUSIONS: EW may be valuable in alleviating suffering; a larger study will be needed to examine efficacy. The study of interventions designed to reduce suffering at the end of life requires careful attention to the definition and measurement of suffering, study design, and subject selection.

Adaptation, Psychological↗
PubMed2004

"Getting everyone on the same page": nursing home physicians' perspectives on end-of-life care.

PURPOSE: To improve understanding of nursing home physicians' perspectives regarding end-of-life care, and to suggest directions for further research. METHODS: An exploratory qualitative design based on interviews of 12 nursing home physicians, 10 of whom were medical directors. Medical students served as interviewers. SAMPLE: A purposeful sampling strategy yielded interviews with 12 physicians. The sample was selected based on "intensity sampling," which seeks information-rich but not extreme cases. Ten of the 12 physicians were nursing home medical directors; all respondents practiced at least 4 years part-time or full-time in a nursing home setting. Respondents varied by age, gender, urban/rural location, and fellowship training (half the sample had completed a geriatrics fellowship). Seven physicians were affiliated with an academic medical center. RESULTS: Four themes were identified in the analysis of the 12 interview transcripts: extensive familiarity with dying; consensus is integral to good end-of-life care; obstacles can interfere with consensus; and advance directives set the stage for conversations about end-of-life care. The importance of consensus, both in terms of prognosis and in developing a palliative care plan, emerged as the major finding. CONCLUSIONS: For the 12 physicians in this study consensus about the resident's status and an appropriate care plan are important features of good end-of-life care. Further research is needed to determine if other members of the health care team (i.e., residents, family members, nursing staff, social worker, etc.) also value consensus highly. It will be important to determine what barriers to consensus other team members identify. Based on the understanding generated from this study, a refinement of the general Education for Physicians on End-of-Life Care (EPEC) model describing the relationship between curative and palliative care is proposed for nursing homes. The refinement underscores the points at which the team might consider revisiting consensus about the resident's status and care plan.

Adult↗
PubMed2003

Recurrent Clostridium difficile colitis: case series involving 18 patients treated with donor stool administered via a nasogastric tube.

Clostridium difficile-associated diarrhea and colitis have emerged as major complications associated with use of systemic antimicrobials. In this study, the medical records for 18 subjects who received donor stool by nasogastric tube for recurrent C. difficile infection during a 9-year period at a single institution were retrospectively reviewed. During the period between the initial diagnosis of C. difficile colitis and the stool treatments, the 18 subjects received a total of 64 courses of antimicrobials (range, 2-7 courses; median, 3 courses). During the 90 days after receipt of treatment with stool, 2 patients died of unrelated illnesses. One of the 16 survivors experienced a single recurrence of C. difficile colitis during 90-day follow-up. No adverse effects associated with stool treatment were observed. Patients with recurrent C. difficile colitis may benefit from the introduction of stool from healthy donors via a nasogastric tube.

Aged↗
PubMed2003

Measuring the severity of rosacea: a review.

BACKGROUND: Assessment of severity is essential in the clinical care of rosacea patients and in the research on rosacea. OBJECTIVE: To determine the range of methods used to assess rosacea severity in clinical trials. METHODS: The medical literature from 1965 through 2001 was searched for rosacea clinical trials using MEDLINE and published citations. Forty-seven articles were reviewed. RESULTS: The most frequently assessed signs of rosacea were papules/pustules (43 studies), erythema (35), and telangiectasia (24). Other signs and symptoms of rosacea and adverse reactions to therapies were assessed in 27 studies. Counts of papules/pustules were conducted in 34 studies. Four-point scales were the most frequently used assessment tools for erythema (17) and telangiectasia (11). Other frequently used techniques included global assessment by clinicians (29) and by patients (21), and photography (13). CONCLUSIONS: At present, there are no standard validated tools for assessing the severity of rosacea or its signs or symptoms.

Humans↗
PubMed2002

Dying of old age: an examination of death certificates of Minnesota centenarians.

OBJECTIVES: To compare how causes of death are recorded on the death certificates of centenarians with those who die in their 70s, 80s, and 90s. We also examined direct and indirect acknowledgment of age as a cause of death. DESIGN: Retrospective review of death certificates. SETTING: State of Minnesota. PARTICIPANTS: The death certificates of 26,415 individuals aged 70 and over who died in Minnesota in 1998 were examined for underlying causes of death. Of these, 449 were for individuals who were aged 100 and older at the time of their death. MEASUREMENTS: Causes of death. RESULTS: Diabetes mellitus, chronic obstructive pulmonary disease, cirrhosis, myocardial infarction, and most cancers decreased in frequency as reported causes of death with advancing age. Conversely, congestive heart failure, atherosclerosis, and neurological/mental and poorly defined conditions increased in frequency with age. CONCLUSIONS: Centenarians appear to "outlive" the risks for many of the conditions that are common causes of death for those who die in their 70s, 80s, and 90s, such as cancer and myocardial infarction. Conditions associated with aging, such as congestive heart failure and degenerative neurological conditions become more prominent as reported causes of death in the oldest individuals. The guidelines for the completion of death certificates should be modified to facilitate direct acknowledgment of age-related frailty as a contributing cause of death.

Aged↗
PubMedDate not supplied

Cognitive impairment and quality-of-life: views of providers of long-term care services.

Quality-of-life (QoL) is now recognized as a principal outcome marker for long-term care. However, QoL is difficult to define and measure, especially in residents with dementia. Providers of long-term care services (n = 182) were asked to rate the importance of 19 psychosocial quality-of-life elements for hypothetical residents with physical impairment and for residents with cognitive impairment. Respondents also were asked to rate their ability to influence these elements for each type of resident. Respondents rated the importance of 18 of the 19 elements and their ability to influence 17 of 19 elements lower for residents with cognitive impairment. Of the five types of respondents, certified nursing assistants (CNAs) rated their ability to influence these QoL elements the highest for both types of residents; physicians' ratings were the lowest. Pain management was given high ratings for both importance and ability to influence for both resident types; the lowest ratings were given for elements that pertained to residents' understanding. A strong correlation between ratings for importance and ability to influence was observed. Additional research is needed on the psychosocial aspects of long-term care residents' QoL, especially those with cognitive impairment.

Adult↗