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Biomedical subjects

D Rudman

Publications and source records attributed to D Rudman.

At least 19 recordsLinked to original sources
PubMed2000

Exploration of a group model in fieldwork education.

OBJECTIVE: Organizational changes, such as program management and managed care, and fluctuations in resources present challenges to the effective provision of fieldwork placements. This study compared an innovative group model with a traditional 1:1 supervision model to determine their effect on students and supervisors. METHOD: The two models were implemented at an urban clinical facility in several areas of practice over a 2 year period. Questionnaires were used to assess student skill development, student and supervising therapist satisfaction, and impact on supervising therapists' use of time. Focus groups were used to explore the advantages and disadvantages of each model. RESULTS: There were few statistically significant differences in students' (n = 26) and supervising therapists' (n = 28) ratings when the two models were compared. The qualitative findings suggest that the advantages of one model often relate to the disadvantages of the other model. In addition, supervising therapists and students offered several suggestions for how to improve implementation of the group model. CONCLUSION: When the results of the study are compared to the objectives established for the group model, it appears that many of the objectives outlined for the model were partially achieved. Several issues, such as the student-supervisor relationship and the evaluation process, need to be addressed with participants to ensure successful implementation of the group model.

Data Collection↗
PubMed1999

Description and validation of a measure of received support specific to HIV.

Validation data are described for the Social Support Inventory for People who are HIV Positive or Have AIDS. This inventory was developed specifically for use with individuals who are HIV-positive to assess three types of received support (instrumental, informational, emotional) for each of four dimensions: whether support is received or wanted, satisfaction with support, and source of the support. It was validated in the context of a larger cross-sectional study of 120 adults with HIV who completed a set of questionnaires. Descriptive statistics, internal consistency coefficients, and evidence of construct validity for the original inventory are presented. An improved, revised version based on the validation data for the original one is also briefly described, but not tested.

Adult↗
PubMed1996

Serum insulin-like growth factor-I and serum testosterone status of elderly men in an inpatient rehabilitation unit.

This study was designed to estimate the prevalence of hyposomatomedinemia and hypogonadism in an inpatient rehabilitation unit. The authors studied healthy young men (HOM) ages 20-29 years (n=33); healthy old men (HOM) ages 59-98 years (n=27), and elderly men in an inpatient rehabilitation unit (ERM) ages 58-95 years (n=42). Serum concentrations of insulin-like growth factor (IGF-I), total testosterone (TT), and free testosterone (FT) were measured. A low IGF-I level (below the lower 2.5 percentile of HYM) occurred in 85% of the HOM and in 62.5% of the ERM. When a low IGF-I was defined as a value below the 2.5 percentile of the HOM, the prevalence in ERM was 6.2%. A low TT level (below the lower 2.5 percentile of the HOM) occurred in 78% of the HOM and in 90% of the ERM. Low TT, defined as a value below the lower 2.5 percentile of the HOM, occurred in 22% of the ERM. The results with FT were similar. In neither HOM nor ERM was IGF-I significantly correlated to TT and FT. A large percentage of HOM and ERM have severe hypogonadism (TT<193 ng/mL) as compared with HOM. The ERM had a higher prevalence of severe hypogonadism as compared with the HOM.

Adult↗
PubMed1995

Studies of growth hormone/insulin-like growth factor-I in polio survivors.

In the later years of life, many polio survivors develop post-polio syndrome manifested by progressive muscular weakness. Previous work by the authors showed low IGF-I level in polio survivors compared to age-matched controls. IGF-I concentration tended to be lower in polio survivors who were older, male, obese, and also in persons experiencing difficulty in the activities of daily living which were independent of other factors. IGF-I levels did not correlate with the subjective report of recent decline in functional status. Further studies of nocturnal GH secretion indicated that low IGF-I level was secondary to impaired growth hormone secretion. Low IGF-I levels in subjects with post-polio syndrome were corrected by physiologic doses of hGH and the response was dose dependent. Lesser dosage was required to normalize IGF-I level compared to standard dosages previously used in younger persons. Inasmuch as low IGF-I level resulting from GH deficiency is known to be associated with weakness, muscle atrophy, and decrease in aerobic work capacity, it is postulated that low IGF-I levels that occur in aging polio survivors may have an adverse effect on their neuromuscular function, and that hGH replacement may improve their functional status. Moreover, the new dose-response data may decrease the frequency of side effects in future hGH treatment of older adults.

Adult↗
PubMed1995

Observations on the nutrient intakes of eating-dependent nursing home residents: underutilization of micronutrient supplements.

OBJECTIVE: To estimate the intakes of essential nutrients by eating-dependent nursing home residents (EDR). METHODS: This study was done in a 190 bed VA nursing home. Thirty-four EDR were selected for the study. Clinical data base which included age, sex, primary diagnosis, body mass index, albumin, hematocrit, activities of daily living status, decubitus ulcer medications and use of multivitamin/trace mineral supplement were recorded from the medical records. Caloric and essential nutrient intakes were determined over a 3-day period by a registered dietitian. RESULTS: Seventy percent (24/34) residents in the study group were underweight (body mass index < 23 kg/m2), 26% were hypoalbuminemic (serum level < 3.5 g/dl), 50% were anemic (hematocrit < 37%); and 38% had pressure ulcers. In 88% EDR, the dietary intakes of three or more essential nutrients were below 50% of the RDA. Most frequent and severely deficient were zinc, copper, and vitamin B6. Despite the inadequate essential micronutrient intakes in the majority of EDR, only 35% received a multivitamin supplement and only 3% received a trace mineral supplement. A survey of 30 other VA nursing homes indicated generally similar findings to those in the Milwaukee facility with regard to the high frequency for eating-dependence, and the low frequency for administration of multivitamin and trace mineral supplements. CONCLUSIONS: Despite eating supervision and assistance, the majority of EDR have inadequate intakes of numerous essential macro- and micronutrients. The deficient micronutrient intakes could be normalized by administration of a multivitamin/trace mineral supplement daily. Nevertheless, only a minority of EDR in VA nursing homes currently receive such a supplement.

Aged↗
PubMed1995

Observations on nursing home residents with a history of hip fracture.

The authors evaluated nursing home residents with a prior history of hip fracture for osteopenia and its risk factors, and attempted to learn to what extent the residents' bone status had been considered by their primary care physicians. Thirty-one hip fracture residents in the Milwaukee VA nursing home were studied to determine their status with regard to bone mineral density of the proximal femur, and the following risk factors or predictors of osteopenia: history of smoking; history of fractures; calcium and vitamin D intake; underweight; immobility; hypogonadism; and administration of drugs that may accelerate bone demineralization. Data were also collected on the evaluation and management of the post hip fracture residents in three other nursing homes. In the Milwaukee nursing home, out of 31 hip fracture survivors, 74% had sustained a hip fracture before admission to the nursing home; 29% had a history of second fracture. In 84% of patients, there was no mention of osteopenia in the active medical problem list and, therefore, there was no intervention plan in place to improve or prevent further bone loss. Thirty-two percent were underweight, 36% were currently smoking, 55% were immobile, 64% were consuming at least one medication that might increase bone loss, calcium intake was less than 1,000 mg daily in 52%, and 66% were hypogonadal (serum testosterone level less than 300 ng/dL). Chart reviews of the hip fracture survivors at three other nursing homes revealed similar findings. Approximately 5-15% of nursing home residents are hip fracture survivors. They usually have severe osteopenia and multiple risk factors for further bone loss and future fractures.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1994

Clinical indicators derived from the patient assessment instrument in the long-stay residents of 69 VA nursing homes.

OBJECTIVES: Previous work has shown that clinical indicators reflecting occurrence of bedsores, behavioral disturbances, and deterioration of activities of daily living (ADLs) can be calculated for the long-stay residents of Veterans Affairs (VA) nursing homes from the standard biannual Patient Assessment Instrument (PAI). The present study aimed to construct national curves for these indicators, against which each facility could in the future compare its own values; and to determine the correlations between the indicator values and selected nursing home characteristics. METHODS: Eight indicators were calculated for the long-stay (more than six months) residents of the 69 VA nursing homes housing 50 or more such patients from the 1992 PAI data. The indicators were: prevalence of bedsores; incidence of bedsores; prevalence of physically aggressive behavior; incidence of aggressive behavior; and frequencies of six-month losses of eating, mobility, transfer, and toileting functions by the initially independent residents. RESULTS: There was a two- to sixfold difference between the most favorable quartile and the least favorable quartile for the eight indicators. Significant correlations across institutions were found between the prevalence and incidence of bedsores, the prevalence and incidence of aggressive behavior, and the frequencies of declines in the four ADLs by the initially independent residents. One or several of the indicators were significantly superior in nursing homes with these characteristics: a smaller size, a slower resident turnover rate, a smaller proportion of residents with nonorganic psychoses, a lower ratio of short-stay to long-stay residents, and a lower ratio of independent to dependent long-stay residents. CONCLUSIONS: These data provide national standards against which each VA nursing home can compare its PAI-derived clinical indicator values. The outcomes measured by these indicators appear to be influenced both by casemix and by environmental factors.

Activities of Daily Living↗
PubMed1994

Human growth hormone effect on serum IGF-I and muscle function in poliomyelitis survivors.

Previous work showed low insulin-like growth factor I (IGF-I) in polio survivors compared with age-matched controls and it was hypothesized that the low IGF-I was caused by the lack of growth hormone (GH) secretion. The present study asked: Is the nocturnal release of GH subnormal in polio survivors? Can the low IGF-I level be raised to the range of healthy young men (240 to 460 ng/mL) by human growth hormone (hGH) treatment? If so, what dose of hGH is required? Does the hormone treatment affect muscle function? Eleven polio survivors with evidence of postpoliomyelitis syndrome, aged 50 to 65 years, and low IGF-I levels (average IGF-I value of 170 ng/mL) were studied. The serum level of GH was measured in the first 4 hours of sleep. The serum IGF-I level was determined before and during hGH treatment at 0.0075, 0.015 or 0.03 mg/kg of ideal body weight (IBW), three times a week for successive periods of 1 month. Before and after hGH treatment, strength was determined in knee extensor and flexor muscles and the elbow flexor and elbow extensor muscles. Nocturnal GH was low in the polio survivors compared with healthy young men. Serum IGF-I was raised into the target range by either 0.0075 or 0.015 mg hGH/kg three times a week. After 3 months of hGH treatment, no consistent changes in muscle strength were observed in the study group.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Relations of endogenous anabolic hormones and physical activity to bone mineral density and lean body mass in elderly men.

OBJECTIVE: It has been proposed that declining activities of the somatotrophic or gonadotrophic axes, or sedentary life style, are partial causes for geriatric losses of bone mineral density (BMD) and of lean body mass (LBM). The present study tested these hypotheses by determining, in both free-living and institutionalized elderly men, the correlations of bone mineral density (BMD), total body bone mineral content (TBBMC) and lean body mass (LBM) with the following predictor variables: age, body mass index, body weight, serum insulin-like growth factor I (IGF-I), serum testosterone, habitual physical activity and mobility. SUBJECTS: Forty-nine independent, community-dwelling older men, and 49 men of similar age residing in two Veterans Administration extended care facilities. The age range was 58-95 years. MEASUREMENTS: Serum IGF-I and testosterone were measured by radioimmunoassay. Habitual physical activity in the independent men and mobility in the institutionalized men were estimated by standard instruments. LBM and bone status at nine skeletal sites were determined by dual X-ray absorptiometry. RESULTS: The BMD and TBBMC values of the free living men were 4-20% higher than those of the institutionalized men. In the independent old men, serum testosterone was the strongest predictor of BMD and TBBMC, while age was the only predictor of LBM. In the chronically institutionalized men, age, body weight and immobility were the strongest predictors of body composition, and testosterone was correlated only with femoral neck BMD. CONCLUSIONS: In aging independent men, low levels of testosterone are associated with demineralization of the skeleton. Immobility and under-weight are associated with the osteopenia of old men residing in nursing homes. In this cross-sectional study of elderly men, there was no evidence of a relation of the somatotrophic axis to bone status or LBM, or of the gonadotrophic axis to LBM.

Activities of Daily Living↗
PubMed1994

Serum insulin-like growth factor I in healthy older men in relation to physical activity.

OBJECTIVE: The serum level of insulin-like growth factor-I (IGF-I) is lower in old men than in young men. It has been theorized that this change may result in part from the lower level of physical activity in the elderly. The objective of the present study was to test this theory. DESIGN: Cross-sectional study. SETTING: Community-dwelling healthy men. PARTICIPANTS: Twenty-nine young men aged 21-29 and 120 older men aged 58-98. A wide range of habitual physical activity was assured in the older men by recruiting them both in senior centers and in fitness centers. MEASUREMENTS: Serum IGF-I level was measured by radioimmunoassay. Physical activity was estimated as the sum of moderate, hard, and very hard activities in leisure and occupation during the previous week as determined by the interviewer-administered Seven Day Physical Activity Recall questionnaire. RESULTS: IGF-I was significantly higher (363.7 +/- 16 ng/mL, avg +/- SEM) in the young men than in the senior center older men (219.6 +/- 5 ng/mL) or in the fitness center older men (168.3 +/- 11 ng/mL) (P < 0.01). The level of IGF-I in the senior center older men was higher than that in the fitness center older men (P = 0.05). The physical activity of the fitness center older men (128.5 +/- 15 Kcal/kg/wk, avg +/- SE) was statistically similar to that of the young men (101.3 +/- 19 Kcal/kg/wk). The physical activity levels of both of these groups were significantly higher than that of the senior center older men (33.6 +/- 3 Kcal/kg/wk) (P < 0.010). Within none of the three groups was there a significant correlation between IGF-I and physical activity. When the two groups of older men were combined, there was, in fact, an inverse correlation of IGF-I and physical activity (P = 0.001). CONCLUSION: The data do not support the hypothesis that lack of physical activity is responsible for the decline in serum IGF-I with advancing age.

Adult↗
PubMed1994

Undernutrition in the nursing home: prevalence, consequences, causes and prevention.

Approximately 5% of Americans over age 65, or 1.5 million individuals, currently reside in the nation's 20,000 nursing homes. The authors present material that lead to three conclusions about this population. First, nutritional deficiencies are common underlying causes of adverse clinical outcomes. Second, nutritional deficiencies are frequently not recognized. Third, opportunities for preventing or correcting undernutrition exist, provided that the significant and reversible nature of the nutrient deficiencies are identified.

Aged↗
PubMed1994

Hyposomatomedinemia and hypogonadism in hemiplegic men who live in nursing homes.

The purpose of this study was to determine the prevalence of low serum insulin-like growth factor-I (IGF-I) and testosterone in men with poststroke hemiplegia. Serum concentrations of IGF-I, total testosterone, and free testosterone were compared in healthy young men, healthy old men, and old men with poststroke hemiplegia. A low IGF-I level, below the lower 2.5 percentile of the healthy young men, occurred in 85% of the healthy old men, and in 88% of the poststroke hemiplegic patients. When a low IGF-I was defined as a value below the lower 2.5 percentile of the healthy old men, the prevalence in the hemiplegic men was 5%. For total testosterone, a value below the lower 2.5 percentile in the healthy young men occurred in 78% of the healthy old men and in 79% of the stroke survivors. Low total testosterone, defined as a value below the lower 2.5 percentile of the healthy old men, occurred in 17% of the hemiplegic men. The results with free testosterone were similar. Compared with healthy young men, most healthy old men have low serum IGF-I and testosterone levels. Old hemiplegic men resemble healthy old men in their IGF-I levels, but they have more cases of severe hypogonadism (total tostosterone < 193ng/dL). Because correction of IGF-I and testosterone deficiencies in younger adults improves muscle strength, work capacity, and quality of life, treatment with human growth hormone and testosterone may be a useful adjunct to physical measures in the rehabilitation of selected hemiplegic stroke survivors.

Adult↗
PubMed1993

The occurrence of pressure ulcers in three nursing homes.

BACKGROUND: In the 27 nursing homes located within the Veterans Affairs (VA) Central Region, the proportion of residents with pressure ulcers in 1986 varied from 2% to 16%. Three of these nursing homes were selected for study: nursing home A from the highest prevalence quintile, B from close to the median, and C from the lowest quintile. METHODS: Two indicators of pressure ulcer occurrence were calculated: the point-in-time prevalence of bedsores and the percentage of residents who were free of pressure ulcers at the beginning of a six-month study period but who had bedsores six months later. Data were also collected in each nursing home to determine the bedsore status at the time of admission and the resident's location if and when a bedsore began. RESULTS: The three institutions were generally similar in available measures of casemix and severity of illness. The ratio of nursing and medical personnel to residents was 29%-76% lower in nursing home A than in B or C. In nursing home A, the turnover of nursing personnel was about twice as rapid as that in B or C. In each institution the pressure ulcer statistics showed little variation from one six-month period to another. The average rates in nursing home A were 15.3% for prevalence and 10.3% for the six-month conversion from bedsore-negative to bedsore-positive status. The average rates in facilities B and C were, respectively, 6.9% and 3.5% for prevalence and 4.7% and 4.2% for the six-month conversion from negative to positive status. Furthermore, the number of new bedsores that developed during uninterrupted nursing home residence, per 100,000 resident days, was 36.5 in A, 10.8 in B, and 2.1 in C. CONCLUSIONS: The pressure ulcer statistics in nursing homes B and C were consistently superior to those in A. the interinstitutional differences could not be explained by the comparisons of scoring methodologies and of casemixes that were made. It is hypothesized that more favorable staffing patterns in B and C than in A contributed to more effective prevention of bedsores in the former two institutions.

Activities of Daily Living↗
PubMed1993

Hyposomatomedinemia in quadriplegic men.

Many studies have shown that vigorous exercise acutely stimulates growth hormone (GH) release but the relative contribution of daily physical activity to maintaining the GH/somatomedin C (SmC) axis is not known. It has been reported that basal and post-exercise plasma SmC values are higher in physically conditioned young men than in sedentary men of similar age. To assess the effect of severe inactivity on the plasma SmC level, basal concentrations of this hormone were measured in patients with quadriplegia (QP) resulting from spinal cord injury (SCI). Venous blood samples were obtained after overnight fast in 41 QP men, ages 24-66, and compared with 119 healthy men of similar ages. Nonparametric analysis of variance showed SmC to be significantly lower in QP than in healthy men (p < .007). Plasma SmC below 0.35 U/ml in adults usually indicates little or no GH secretion by the pituitary gland. In QP, 46% of plasma SmC values were < 0.35 U/ml compared to 24% in the healthy group (p < .02). In both groups, an inverse relationship of SmC and increasing age was observed (p < .01). The data suggest that severe inactivity or SCI tend to cause hyposomatomedinemia. The latter endocrine alteration may contribute to the decrease in lean body mass and muscle atrophy of QP patients, and add further functional impairment to the original neurologic deficit. In addition, hyposomatomedinemia could increase the tendency for pressure sore formation and osteoporosis in SCI patients.

Adult↗
PubMed1993

A simple method to quantify the changes in activities of daily living of long-stay nursing home populations.

This report describes a simple method to quantify changes in the activities of daily living (ADLs) over a 6-month time period in long-stay VA nursing home populations. In these institutions, each resident receives a score of one to five every 6 months describing the degree of dependence in eating, mobility, transfer and toileting ("patient assessment instrument" or PAI). From these data, quantitative indicators can be calculated for the studied population: the average score for each ADL at the beginning and end of the period, and the average 6-month change in this score; the proportions of all residents whose ADL score improved, remained unchanged or worsened; the proportion of initially independent residents whose ADL score worsened, and the proportion of initially dependent residents whose score improved. The method was applied in two VA nursing homes (A and B). The profiles of ADL outcomes in the two nursing homes differed in several respects. For example, in nursing home A, 80% or more of the population either remained unchanged or improved in ADLs and only 2 to 18% deteriorated. In nursing home B, on the other hand, only 50 to 60% of the population remained unchanged or improved and 36 to 50% deteriorated. For the initially independent residents, the frequency of deterioration of ADLs in nursing home B was several times greater than that in nursing home A. The described method of quantifying ADL outcomes could readily be applied to the PAI data that are available in all VA nursing homes.(ABSTRACT TRUNCATED AT 250 WORDS)

Activities of Daily Living↗