Biomedical subjects
Publications and source records attributed to M F Weiner.
This questionnaire study of a nurse support group on a pediatric intensive care unit confirms previous subjective reports of increased morale and better communication. The authors were also able to demonstrate reduced turnover rate of ICU nurses at the same that the turnover rate for the rest of the hospital increased, and found that the group had a positive influence on nurses' lives away from the hospital.
A questionnaire study of 197 insulin-dependent diabetics which was supplemented by individual interviews with fourteen of the respondents suggests that few diabetics maintain tight control. Most maintain the level of control at which they are most physically or psychologically comfortable. However, tight control is feasible for the average diabetic. The main factors which impede tight control are difficulty coping with stresses of daily living, eating to satisfy emotional needs, discomfort at euglycemic levels, and fear of hypoglycemia. Re-regulation must therefore employ temporary reduction of life stress, some impediment to snacking, support through the discomfort of altering blood sugar level, and careful monitoring to avoid severe hypoglycemia. A specific type of hospital experience and/or involvement in an outpatient educational and treatment milieu are possible avenues to provide these necessary factors.
This review describes and evaluates developments in the early diagnosis and the treatment of Alzheimer's disease. It is hoped that early diagnosis of the disorder will enable treatment that will reduce or arrest the associated cognitive loss so that affected individuals can retain significant function and institutionalization can be delayed or averted. Diagnostic techniques, including use of neuropsychological measures, functional imaging measures, and biological markers, are reviewed; such techniques are useful for confirming diagnosis but do not replace a comprehensive clinical evaluation. Potential treatment modalities, such as techniques to enhance neurotransmission, replace estrogen effects, reduce the effects of free radicals, and combat inflammation, are explored. Cholinesterase inhibitors are the only modality thus far shown in large-scale studies to be effective, but their effect is small.
OBJECTIVE: The Texas Functional Living Scale (TFLS) is a new performance-based measure of functional abilities with an emphasis on instrumental activities of daily living skills that is brief and weighted toward cognitive tasks. The purpose of this study was to examine its psychometric properties and clinical utility in patients with Alzheimer disease (AD) and normal elderly individuals. BACKGROUND: Measures of daily functional capacities used in patients with dementia often rely upon informant-based behavioral ratings or lengthy assessments of instrumental activities of daily living. Few existing quantitative tools emphasize performance-based cognitively-oriented tasks designed for patients with AD, although there is a need for such measures. METHOD: Twenty-two AD patients and 21 healthy controls were administered the TFLS and a measure of global cognitive status (Mini-Mental State Examination). Additionally, informant-based ratings of daily living skills (Blessed Dementia Rating Scale) and emotional and behavioral status (Consortium to Establish a Registry for Alzheimer's Disease Behavior Rating Scale for Dementia) were obtained from caregivers of the AD patients. All subjects were re-evaluated approximately 1 month later using the same instruments. RESULTS: The TFLS showed a strong correlation with the Mini-Mental State Examination (r = 0.92). At 1 month, test-retest reliability was high, and TFLS subscale scores were highly correlated (r > 0.90 for most) with the total score. The TFLS was moderately correlated with informant ratings of functional skills as assessed with the Blessed Dementia Rating Scale but was unrelated to emotional and behavioral symptoms as assessed with the Consortium to Establish a Registry for Alzheimer's Disease Behavior Rating Scale for Dementia. CONCLUSIONS: The TFLS showed evidence of good reliability, internal consistency, and convergent and discriminant validity with several popular measures of global cognitive status and behavioral functioning. It is a brief and easily administered performance-based measure of daily functional capabilities that is sensitive to level of cognitive impairment and seems applicable in patients with varying degrees of dementia.
OBJECTIVES: To develop a valid and reliable instrument for rating quality of life in persons with late-stage Alzheimer's disease and other dementing illnesses. DESIGN: A group of clinicians with extensive experience in dealing with dementia patients developed by consensus the Quality of Life in Dementia Scale (QUALID), an 11-item scale. The window of observation for each subject was 7 days. A 5-point scale captured the frequency of each item (total score ranging from 11 to 55). Lower scores reflected a higher quality of life (QOL). Validity was assessed by comparison with other measures. SETTING: Dementia special care unit. PARTICIPANTS: Professional caregivers of 42 patients. MEASUREMENTS: QUALID, Mini-Mental State Exam (MMSE), Physical Self-Maintenance Scale (PSMS), Neuropsychiatric Inventory (NPI), and Geriatric Depression Scale (GDS). RESULTS: QUALID scores ranged from 12 to 45 points and were skewed toward higher QOL (lower scores). Internal consistency of items was high, as were test-retest reliability and consistency across recorders. As expected, there was no relationship between QUALID and MMSE or PSMS scores, but there was a statistically significant, although moderate, relationship between QUALID and NPI, and GDS scores. CONCLUSION: The QUALID is a reliable and valid scale, administered to caregivers, for rating QOL in persons with late-stage dementing illness.
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BACKGROUND: Adult polyglucosan body disease (APBD) is a rare disorder, presenting with varying combinations and severity of upper and lower motor neuron dysfunction, sensory deficits, dementia, and urinary incontinence. Onset is in the 40s or 50s. The diagnosis is made by finding polyglucosan bodies (PB) in histologic sections of brain or spinal cord, peripheral nerve, or dermal sweat glands. Although 2 pairs of the 22 previously reported cases were siblings, the familial nature of the disease has not been emphasized. METHODS: We report 2 adult siblings, a male and a female, each of whom had the clinical diagnosis of vascular dementia. Both were confirmed at autopsy to have APBD. We characterized the lesions in autopsy tissues using a battery of histological stains, lectin histochemistry, and electron microscopy. RESULTS: Innumerable PB were distributed throughout brain, heart, skeletal muscle, liver, and dermal sweat glands. PB were highlighted by periodic acid Schiff stain and concanavalin A lectin. Ultrastructurally, PB were composed of aggregates of filaments within axons and astrocytic processes, and lying free in the neuropil, but not within neuronal perikarya. CONCLUSIONS: It is important to consider APBD in cases of familial dementia of unknown etiology. Ante-mortem biopsy of axillary skin may be diagnostic.