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Biomedical subjects

L Morishita

Publications and source records attributed to L Morishita.

At least 19 recordsLinked to original sources
PubMed2001

A randomized clinical trial of outpatient geriatric evaluation and management.

OBJECTIVES: To measure the effects of outpatient geriatric evaluation and management (GEM) on high-risk older persons' functional ability and use of health services. DESIGN: Randomized clinical trial. SETTING: Ambulatory clinic in a community hospital. PARTICIPANTS: A population-based sample of community-dwelling Medicare beneficiaries age 70 and older who were at high risk for hospital admission in the future (N = 568). INTERVENTION: Comprehensive assessment followed by interdisciplinary primary care. MEASUREMENTS: Functional ability, restricted activity days, bed disability days, depressive symptoms, mortality, Medicare payments, and use of health services. Interviewers were blinded to participants' group status. RESULTS: Intention-to-treat analysis showed that the experimental participants were significantly less likely than the controls to lose functional ability (adjusted odds ratio (aOR) = 0.67, 95% confidence interval (CI) = 0.47-0.99), to experience increased health-related restrictions in their daily activities (aOR = 0.60, 95% CI = 0.37-0.96), to have possible depression (aOR = 0.44, 95% CI = 0.20-0.94), or to use home healthcare services (aOR = 0.60, 95% CI = 0.37-0.92) during the 12 to 18 months after randomization. Mortality, use of most health services, and total Medicare payments did not differ significantly between the two groups. The intervention cost $1,350 per person. CONCLUSION: Targeted outpatient GEM slows functional decline.

Aged↗
PubMed2000

The effects of outpatient geriatric evaluation and management on caregiver burden.

This study investigated the effects of outpatient geriatric evaluation and management (GEM) on informal caregivers' sense of burden. We randomized 568 high-risk, community-dwelling older adults to receive either GEM or usual care for 6 months. At baseline and one year later, we assessed the burden experienced by their informal caregivers (N = 88). Compared with caregivers of participants in the usual care group, caregivers of participants in the GEM group were less than half as likely to report increased burden during the one-year follow-up period (16.7% vs 38.5%, p = .034). The findings suggest that GEM helps protect the informal caregivers of high-risk older people from the increases in burden that often accompany advancing age.

Adult↗
PubMed1998

Soliciting defined populations to recruit samples of high-risk older adults.

BACKGROUND: Generalizable research on high-risk older persons requires samples that are both large enough for adequate statistical power and similar enough to community populations that its results can be generalized to them. We tested the effectiveness and efficiency of mixed-mode (mail-telephone) solicitation of a defined population as a method for recruiting a large, representative sample for a randomized trial of outpatient geriatric evaluation and management (GEM). METHODS: Fee-for-service, community-dwelling older Medicare beneficiaries were mailed a short self-administered screening questionnaire. Eligible respondents were called to assess eligibility and willingness to give consent; consenters were called again for baseline data. Information about nonrespondents, ineligibles, and refusers was obtained from the Health Care Financing Administration. RESULTS: The response rate to the screening questionnaire was 61.1%. Of the respondents, 13.2% were eligible for the study and, of those, 34.4% agreed to participate. Response rates appeared to be influenced by small financial incentives and by subjects' age, race, sex, location of residence, and use of hospitals in the previous year. Consent rates were influenced by age and sex. The final sample (N = 522) was representative of community high-risk respondents in racial composition, previous use of hospitals, and probability of repeated admission (Pre) in the future, but it was slightly younger and contained a higher percentage of men. Recruitment costs averaged $286.92 per consenting person. CONCLUSIONS: Mixed-mode solicitation of defined populations can produce, at reasonable cost, large samples whose representativeness of community high-risk populations can be determined. Procedures that may enhance the success of this approach include: advance communication with members of the target population and their families and physicians; provision of medical and small financial incentives; continuous monitoring of recruitment results; and attention to subjects' needs for convenience, time, transportation, and reassurance.

Aged↗
PubMed1998

Satisfaction with outpatient geriatric evaluation and management (GEM).

The purpose of this study was to evaluate high-risk older adults' satisfaction with outpatient geriatric evaluation and management (GEM). Community-dwelling Medicare beneficiaries (n = 522) age 70 years and older who had a high probability of repeated admission to hospitals (Pra > .40) were randomly assigned to receive either usual care or GEM for six months. Despite the stresses imposed by outpatient GEM (e.g., new relationships with providers, frequent office visits and changes in treatments), the mean satisfaction scores of the recipients of GEM were 9% higher than those of the recipients of usual care (4.31 vs 3.96, p < .001). The primary physicians of GEM recipients were also highly satisfied with GEM care.

Aged↗
PubMed1998

Outpatient geriatric evaluation and management.

OBJECTIVE: To describe the development and operation of a practical model of outpatient geriatric evaluation and management (GEM) for high-risk, community-dwelling older adults. PARTICIPANTS: Community-dwelling Medicare beneficiaries age 70 years and older who were medically stable but had a high probability of repeated admission to hospitals (P(ra) > .40) in the future (n = 248). INTERVENTION: Outpatient GEM. MEASUREMENTS: Demographic, clinical, and use-of-hospital characteristics of patients; nature and quantity of GEM services; satisfaction of patients and their established primary physicians. RESULTS: At enrollment, the average patient was 78.7 years old, took 5.0 long-term prescription medications and was unable to perform 0.5 (of six) activities of daily living (ADL) and 1.4 (of seven) instrumental ADL. Many patients (71.3%) reported hospital days during the previous year. Each of three interdisciplinary teams (geriatrician, gerontological nurse practitioner, nurse and social worker) performed comprehensive assessments and then provided primary care and case management to a case load of 45 to 52 patients. On average, GEM required 6 months, during which patients visited the GEM clinic 7.4 times, had 10.4 active problems addressed, spoke to GEM staff members weekly by telephone, and were referred to two other providers. Most patients (94.4%) completed the GEM program; 66.7% completed advance directives. Satisfaction with GEM was high among the patients and their established primary physicians. The cost of the GEM personnel averaged about $1540 per patient treated. CONCLUSIONS: This model of outpatient GEM provided 6 months of targeted intensive care at a reasonable cost. The satisfaction ratings of patients and their primary physicians were high.

Activities of Daily Living↗
PubMed1998

Milrinone inhibits contractility in skinned skeletal muscle fibers.

Direct action of the cardiotonic bipyridine milrinone on the cross bridges of single fibers of skinned rabbit skeletal muscle was investigated. At 10 degrees C and pH 7.0, milrinone reduced isometric tension in a logarithmically concentration-dependent manner, with a 55% reduction in force at 0.6 mM. Milrinone also reduced Ca2+ sensitivity of skinned fibers in terms of force production; the shift in the force-pCa curve indicated a change in the pCa value at 50% maximal force from 6.10 to 5.94. The unloaded velocity of shortening was reduced by 18% in the presence of 0.6 mM milrinone. Parts of the transient tension response to step change in length were altered by milrinone, so that the test and control transients could not be superimposed. The results indicate that milrinone interferes with the cross-bridge cycle and possibly detains cross bridges in low-force states. The results also suggest that the positive inotropic effect of milrinone on cardiac muscle is probably not due to the drug's direct action on the muscle cross bridges. The specific and reversible action of the bipyridine on muscle cross bridges makes it a potentially useful tool for probing the chemomechanical cross-bridge cycle.

Animals↗
PubMed1998

Image-analysis-based assessment of the effects of the "Ca2+-jump" technique on sarcomere uniformity.

A new image analysis-based technique was used to quantitatively examine the effects of the "Ca2+-jump" activation protocol on the maintenance of fiber quality in skinned rabbit psoas muscle fiber segments. Specifically, contractions in pCa 4.6 were preceded by short-duration "preactivation" soaks in a solution in which EGTA was replaced with the low-Ca2+ buffering capacity analog hexamethylenediamine-N, N, N', N'-tetraacetate, which facilitated rapid Ca2+ equilibration within the fiber segments. Fiber quality was assessed by examining the Fourier spectra of the muscle fiber images before, during, and after activation. Segment lengths were typically below 500 micrometer, thus allowing the majority of the sarcomeres to be visualized in the field of view (x200 and x400 magnification). The preactivation protocol resulted in less deterioration of fiber quality with repetitive activation. In addition, there was also a significant reduction in the time required to reach the 50% level of maximum tension, with no significant change in the maximum tension level.

Animals↗
PubMed1996

Spectral analysis of muscle fiber images as a means of assessing sarcomere heterogeneity.

A new image-analysis-based method is described for assessing sarcomere heterogeneity in skinned rabbit psoas muscle fiber segments. This method consists of off-line, two-dimensional Fourier spectral analysis of video-taped muscle images. Local sarcomere length is assessed by partitioning the muscle images into half and quarter images spanning the original image and analyzing the associated spectra. The spectra are analyzed in two different ways, yielding two measures of sarcomere length. The first measure is obtained by calculating and inverting the centroid frequency of the first-order peak associated with each two-dimensional Fourier spectrum. The second measure is obtained in a similar manner, the only difference being that the two-dimensional spectra are first collapsed into one-dimensional line spectra by summing the pixels perpendicular to the fiber axis. Comparison of the two measures provides a measure of striation skewness that cannot be obtained by other image analysis based methods that determine sarcomere length by analyzing selected line luminance profiles.

Animals↗
PubMed1994

Comprehensive geriatric assessment in a day hospital.

OBJECTIVE: To assess the effectiveness of comprehensive geriatric assessment conducted in day hospitals. DESIGN: Retrospective cohort comparison study with restricted inclusionary criteria and adjustment for baseline characteristics. SETTING: A hospital-based geriatric day hospital and geriatric clinic sites (both in the university and in the community). PATIENTS: Four hundred sixty-eight patients referred for comprehensive geriatric assessment during a 12-month period. INTERVENTION: Comprehensive geriatric assessment in a geriatric day hospital compared with assessment received in clinic sites without a day hospital. MAIN OUTCOME MEASURES: Services received in the first 2 weeks; hospitalization, emergency room visits, placement, death, and change in selected health status measures. Follow-up data was obtained from medical records, a telephone survey, and death certificates. RESULTS: Except in the case of rehabilitative services, day hospital patients were more likely to receive interdisciplinary services. The population seen in the day hospital was more functionally impaired and had significantly more dementia and depression. After adjusting for subjects' baseline characteristics and limiting the analyses to subjects meeting specific inclusionary criteria, the day hospital had no significant effect on mortality, use of emergency or hospital services, placement, or change on selected measures of health status. For example, compared with the clinic patients, receiving care in the day hospital was associated with an adjusted odds ratio of 1.01 (95% confidence interval: 0.53, 1.91) of being at a higher level of care at 6 months. The results were not sensitive to the choice of inclusionary criteria. CONCLUSION: Given their cost and uncertain effectiveness, day hospitals need additional evaluation before their further diffusion occurs.

Activities of Daily Living↗
PubMed1989

Comprehensive geriatric care in a day hospital: a demonstration of the British model in the United States.

A geriatric day hospital (GDH) was developed in a community hospital to meet the complex medical and social needs of the frail elderly. A review of medical records (n = 273) and interviews with referring physicians (n = 42 on 96 patients) revealed that the GDH provided intensive outpatient care, geriatric assessment, rehabilitation, and an alternative to hospitalization. In all, 21% of physician-referred patients would have been hospitalized without the GDH, 7% would have had longer hospital stays, and care would have been deferred for 18%.

Aged↗
PubMed1989

Prospective evaluation of an assessment strategy for geriatric urinary incontinence.

The objectives of this study were to design and prospectively evaluate a strategy to assess geriatric urinary incontinence in primary care settings. A management plan for urinary incontinence was determined for 264 elderly incontinent patients (205 females and 59 males) based on a clinical evaluation, simple tests of lower urinary tract function, and several criteria for referral for further evaluation derived from the literature on incontinence. Of the 264 patients, 168 (64%) also consented to undergo a urologic and formal urodynamic evaluation. Half of these 168 patients met at least one criterion for referral for further evaluation. At least one-quarter of the patients who met one or more of the criteria were found not to require surgical intervention, and probably did not benefit from the urologic and urodynamic evaluation. Among 84 patients who did not meet any of the criteria for referral, the urologic and urodynamic evaluation changed the initial treatment plan in only 10 (12%). The risks associated with the treatment plan based on the clinical assessment in these patients were, however, relatively small. While further refinement and testing in larger numbers of incontinent patients are needed, the data presented document that a substantial proportion of elderly patients with a treatable and often ignored problem can be appropriately managed based on a relatively simple and inexpensive assessment, which can easily be carried out in primary care settings.

Aged↗
PubMed1987

Clinical, functional, and psychosocial characteristics of an incontinent nursing home population.

Although urinary incontinence is recognized as a prevalent, disruptive, and costly problem among nursing home residents, the factors associated with this condition have not been carefully studied. We compared clinical, functional, and psychosocial characteristics of 50 incontinent and 50 continent nursing home residents. In spite of a selection bias due to the informed consent process that resulted in the exclusion of many of the most functionally impaired incontinent residents, the incontinent study participants had significantly greater impairments in functional abilities related to toileting and, on average, took longer to perform a timed series of toileting-related tasks than did the continent comparison group. With the exception of bacteriuria, we did not find incontinence to be associated with most of the major clinical conditions and medications we examined, nor did we find differences in morale and most measures of social activities between the incontinent and continent residents. The data highlight the strong association between functional disability and incontinence in the nursing home setting and suggest that a standard functional assessment of toileting skills could make an important contribution to the care of incontinent residents.

Activities of Daily Living↗
PubMed1986

GNP and LTC team.

Explore the source record for details and available documents.

Geriatric Nursing↗
PubMed1985

The influence of D2O, perchlorate, and variation in temperature on the potential-dependent contractile function of frog skeletal muscle.

D2O and perchlorate manifest opposing effects on the contractile function of skeletal muscle (amplitude of twitches and maximum K contractures, potential dependence of contraction activation and inactivation), and when combined the influence of one may effectively antagonize that of the other. The ratio of perchlorate concentrations required to produce effects of equal intensity (e.g., twitch enhancement and restoration of maximum K contractures in media lacking divalent cations or containing a depressant concentration of a cationic amphipath) in H2O and D2O solutions was generally rather constant. These findings are compatible with the view that both agents can influence contractile function by virtue of their effects on solvent structure. In the absence of divalent cations, the effects of reduced temperature resemble those of D2O whereas the effects of increased temperature resemble those of the chaotropic anion. However, in other media, variation in temperature was found to result in additional nonsolvent effects so that low temperature could oppose rather than enhance the effects of D2O. These observations are discussed in terms of a model postulates a role for solvent influences on the kinetics of two separate potential-dependent conformational transitions of membrane proteins which mediate the activation and inactivation of contraction in skeletal muscle.

Animals↗