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Biomedical subjects

R Cogen

Publications and source records attributed to R Cogen.

13 recordsLinked to original sources
PubMed1992

Surrogate decision-maker preferences for medical care of severely demented nursing home patients.

BACKGROUND: In the absence of advanced directives, physicians treating demented patients rely on surrogates to help make medical care decisions. METHOD: We surveyed family members of severely demented nursing home residents to determine preferences for medical intervention in five hypothetical situations involving tube feeding, hospitalization, intensive care unit admission, mechanical ventilation, and cardiopulmonary resuscitation. RESULTS: Only 11.8% of surrogates rejected all interventions. Cardiopulmonary resuscitation and tube feeding were accepted least frequently (31.6% and 36.4%, respectively). Mechanical ventilation, hospitalization, and intensive care unit admission were accepted by 43.6%, 63.4%, and 75.2%, respectively. There was no correlation between previous surrogate experience with an intervention and its acceptance. Nearly 70% of surrogates indicated that decisions were independent of any previously expressed resident views. CONCLUSIONS: In this study, surrogates of even the most demented nursing home patients prefer hospital level services including intensive care unit care for the treatment of acute illness. Efforts to control access to services on ethical or economic grounds may meet with resistance.

Aged↗
PubMed1991

Effect of Medicare prospective payment system on a home health agency: changes in patient population and services provided.

Data from a large home health agency was retrospectively reviewed to determine the effect of Medicare's Diagnosis Related Group (DRG) payment system on posthospital care. Variables included demographics, diagnoses, functional ability, frequency and type of services provided, and discharge status. An increase in the provision of rehabilitation and nursing services provided in the post-DRG population was found. No negative effects on patient outcomes, such as increases in emergency room visits, rehospitalization, or death, were found.

Diagnosis-Related Groups↗
PubMed1991

Use of digital radiography to demonstrate the potential of naproxen as an adjunct in the treatment of rapidly progressive periodontitis.

The effect of the non-steroidal anti-inflammatory drug, naproxen, in reducing periodontal disease activity was assessed in 15 patients with rapidly progressive periodontitis. All patients in this double-blind study were treated with scaling and root planing. Thereafter, 7 patients receiving 500 mg naproxen b.i.d. for 3 months, and 8 patients received placebo. Disease activity was assessed in three ways. First, alveolar bone height was determined using standardized radiography. Second, alterations in alveolar bone metabolism were assessed using 99m-Tc-methylene diphosphonate uptake prior to dosing and 3 months later. Finally, bone loss or gain was detected using digital subtraction radiography. In this study, conventional subtraction images were processed to isolate the area of change and superimpose the change on the original radiograph. This allowed determination of both the direction and location of osseous changes. There was significantly less bone loss as determined by analysis of bone height during the 3-month study in the naproxen-treated patients when compared to the placebo-treated patients (p less than 0.001). Radiopharmaceutical uptake was significantly reduced in the alveolar bone in patients receiving naproxen (p less than 0.03), whereas no significant change was observed in the placebo-treated patients. Furthermore, the subtraction radiographs showed a significant increase in the proportion of teeth demonstrating bone gain in the naproxen-treated group. These findings indicate that naproxen may be a useful adjunct to scaling and root planing in patients with rapidly progressive periodontitis.

Adolescent↗
PubMed1991

Complications of jejunostomy tube feeding in nursing facility patients.

Maintaining nutrition in patients who are unable to eat is difficult. Jenunostomy feeding has been recommended, especially for patients known to aspirate, but few data are available regarding its efficacy in the nursing home setting. We performed a retrospective review of 44 consecutive jejunostomy fed patients in a skilled nursing facility (SNF) to determine the incidence of complications, particularly aspiration pneumonia. Among them, 81.8% experienced at least one complication, most frequently tube dislodgement or obstruction. In 52.2%, intervention by the physician was required before feeding could be resumed. The incidence of aspiration pneumonia was 15.9%: 31.6% in patients who had previously aspirated and 4% in those without previous aspiration (p less than 0.05). We conclude that jejunostomy feeding does not protect against aspiration pneumonia in patients known to aspirate, and that the high overall complication rate makes its use problematic in the SNF setting.

Aged↗
PubMed1990

Sexual function and practice in elderly men of lower socioeconomic status.

Normal aging plus certain prevalent diseases are believed to render many elderly men impotent. Recent studies have suggested that educated middle-class and upper-class elderly men continue sexual activity, despite erectile dysfunction, by employing alternative practices such as mutual masturbation and oral sex. Few elderly men of lower socioeconomic background have been included in these studies, however. Using physician-administered interviews, 87 men attending an urban Veterans Administration geriatric clinic were studied to determine (1) the prevalence of erectile dysfunction, and (2) the sexual practices and attitudes of this group. Of the 87 men, 28% reported complete loss of erectile function, while 31% had frequent difficulties achieving vaginal intromission. Unlike economically advantaged groups, only 29% used mutual masturbation and 16% used oral sex. Attitudes toward these practices were negative. With one exception, men unable to perform coitus ceased all heterosexual activities.

Aged↗
PubMed1989

Tube feeding. Providing the most nutrition with the least discomfort.

In patients who cannot or will not eat, nutrition can be provided by enteral feeding through a gastrostomy or jejunostomy tube (or a nasogastric tube if use is to be brief). Endoscopic placement of tubes is increasing in popularity. Numerous enteral formulas have been devised to provide complete nutrition in a variety of circumstances, and special formulas are available for patients with malabsorption or hepatic, renal, or lung disease. Mechanical, metabolic, and gastrointestinal complications of enteral feeding are possible, but taking precautions by ordering specific techniques can reduce the risk.

Dietary Carbohydrates↗
PubMed1989

Aspiration pneumonia in nursing home patients fed via gastrostomy tubes.

Aspiration pneumonia is among the most serious complication of gastrostomy tube feedings. However, few data are available from the nursing home setting where tube feedings are used for extended periods. We reviewed 109 nursing facility charts in order to determine the incidence of, and risk factors for, aspiration pneumonia: 22.9% of gastrostomy tube-fed patients aspirated. A history of recent previous pneumonia was found in 40.7% of those who subsequently developed aspiration pneumonia. This was the only risk factor related (p less than 0.05) to subsequent aspiration pneumonia. No association was found with age, mental status, or the method of enteral formula administration (continuous vs. intermittent infusion). We conclude that patients with a previous history of pneumonia are a high risk group in which alternative forms of enteral alimentation (i.e., jejunostomy feedings) should be explored.

Age Factors↗
PubMed1977

Cytopathologic effects of chlorhexidine on human cells.

Exposure of human cells in culture to chlorhexidine at concentrations equal to or greater than 0.004% resulted in impaired cellular function and/or cell death. Release of membrane bound 51Cr, inhibition of protein synthesis as measured by incorporation of 3H-leucine into protein-like material, and staining by trypan blue were seen as sequellae to exposure to 0.006% chlorhexidine for 3 hours. Lower doses were capable of inhibiting protein synthesis and releasing 51Cr, but did not result in staining of cells by trypan blue. Exposure of cells to 0.2% chlorhexidine for 30 seconds produced maximal suppression of protein synthesis and release of 51Cr.

Amino Acids↗