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Biomedical subjects

S Lipson

Publications and source records attributed to S Lipson.

At least 19 recordsLinked to original sources
PubMed2001

The measurement of health: a comparison of indices of disease severity.

This study compared the utility of different health indicators in frail older people, as a component of a larger study of medical evaluations of 183 adult day care participants in five Maryland centers. Indices examined included: number of disease categories, number of active categories, number of severe categories, number of categories with worsening trajectory, and average severity score. In predicting survival, none of the medical indicators without dementia was a strong predictor of survival. When dementia was included, number of categories with worsening trajectory seemed to be the best indicator of survival, with average severity score being a close second. Among the diagnoses, dementia and its severity were the strongest predictors of survival. Prediction of continuous stay in the community (in contrast to death or entry into a nursing home) was significant for most indices and is easier to predict from medical indices than death. Different indicators provided best utility depending on the criterion applied.

Aged↗
PubMed2001

Health status of participants of adult day care centers.

This study compared the medical conditions found in 183 participants of 5 suburban adult day care programs to the medical and mental health status of community-dwelling elderly persons. Analysis revealed that adult day care center participants are very similar to the community-dwelling elderly population in most health indicators, but suffer from much higher rates of dementia and associated functional disabilities. Moreover, those day care participants who do not suffer from dementia tend to suffer from a psychiatric disorder (e.g., major depression, adjustment disorder). These results show that adult day care has become a facility with a primary mental health function.

Activities of Daily Living↗
PubMed2000

Melatonin for treatment of sundowning in elderly persons with dementia - a preliminary study.

This pilot study investigated the impact of melatonin administration as a clinical intervention for improving sleep and alleviating sundowning in 11 elderly nursing home residents who suffer from dementia. Melatonin is a hormone produced and secreted by the pineal gland in response to darkness, which plays a major role in the induction and regulation of sleep. Melatonin production decreases with age. Age-related sleep disorders are frequently associated with disruption of circadian cycle rhythms, and sometimes with 'sundowning'. Sundowning refers to the manifestation of agitation and/or confusion in the evening hours. Agitation has been linked to sleep disorders. Analysis revealed a significant decrease in agitated behaviors in all three shifts, and a significant decrease in daytime sleepiness. There was a nonsignificant decrease in latency (time to fall asleep) during the evening shift and no significant changes were reported in night-time sleep ratings. The results of this study are important, because finding ways of decreasing sundowning in elderly persons may improve their well being, alleviate the burden of the caregivers, and even enable caregiving in a less restrictive environment.

Journal Article↗
PubMed2000

Impact of relational coordination on quality of care, postoperative pain and functioning, and length of stay: a nine-hospital study of surgical patients.

BACKGROUND: Health care organizations face pressures from patients to improve the quality of care and clinical outcomes, as well as pressures from managed care to do so more efficiently. Coordination, the management of task interdependencies, is one way that health care organizations have attempted to meet these conflicting demands. OBJECTIVES: The objectives of this study were to introduce the concept of relational coordination and to determine its impact on the quality of care, postoperative pain and functioning, and the length of stay for patients undergoing an elective surgical procedure. Relational coordination comprises frequent, timely, accurate communication, as well as problem-solving, shared goals, shared knowledge, and mutual respect among health care providers. RESEARCH DESIGN: Relational coordination was measured by a cross-sectional questionnaire of health care providers. Quality of care was measured by a cross-sectional postoperative questionnaire of total hip and knee arthroplasty patients. On the same questionnaire, postoperative pain and functioning were measured by the WOMAC osteoarthritis instrument. Length of stay was measured from individual patient hospital records. SUBJECTS: The subjects for this study were 338 care providers and 878 patients who completed questionnaires from 9 hospitals in Boston, MA, New York, NY, and Dallas, TX, between July and December 1997. MEASURES: Quality of care, postoperative pain and functioning, and length of acute hospital stay. RESULTS: Relational coordination varied significantly between sites, ranging from 3.86 to 4.22 (P <0.001). Quality of care was significantly improved by relational coordination (P <0.001) and each of its dimensions. Postoperative pain was significantly reduced by relational coordination (P = 0.041), whereas postoperative functioning was significantly improved by several dimensions of relational coordination, including the frequency of communication (P = 0.044), the strength of shared goals (P = 0.035), and the degree of mutual respect (P = 0.030) among care providers. Length of stay was significantly shortened (53.77%, P <0.001) by relational coordination and each of its dimensions. CONCLUSIONS: Relational coordination across health care providers is associated with improved quality of care, reduced postoperative pain, and decreased lengths of hospital stay for patients undergoing total joint arthroplasty. These findings support the design of formal practices to strengthen communication and relationships among key caregivers on surgical units.

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PubMed2000

Relationships between psychotropic drug dosage, plasma drug concentration, and prolactin levels in nursing home residents.

This study aimed to characterize the relationships between administered dosages of psychotropic drugs, plasma drug concentration, and prolactin levels in a group of elderly nursing home residents. In a randomized, placebo-controlled, double-blind crossover design study, blood samples were drawn from 47 nursing home residents at least 6 hours after taking either haloperidol, thioridazine, or lorazepam. Correlations between drug dosage and plasma drug levels were significant for haloperidol and thioridazine, but not for lorazepam. Plasma drug levels were below the levels of detection for most of those taking haloperidol. Lorazepam was detected in the blood of 4 of the participants even after 3 weeks of downward titration to placebo and 6 weeks of placebo. Prolactin level was related to administered dosage only in those who were taking haloperidol. For those taking haloperidol or thioridazine, prolactin levels decreased when participants were on placebo. When an older person is taken off lorazepam, the possibility of residual drug in their bodies even 6 weeks after termination of drug use should be considered. Haloperidol may be clinically active in the brain despite no currently detectable plasma drug concentration.

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PubMed1999

Predictors of mortality in nursing home residents.

A prospective cohort study was conducted to examine predictors of mortality in the nursing home. Participants were 399 long-term nursing home residents, who were followed up for 11 years at the end of which 380 had died, 16 were still alive, 2 were discharged with unknown status, and 1 was alive when discharged. The median duration from baseline to death was 2.75 years. For cognitively intact residents, male gender, larger number of medical diagnoses, and manifestations of physically nonaggressive agitated behaviors (e.g., restlessness, pacing) were significant predictors. For cognitively impaired residents, the significant predictors were older age, impaired activities of daily living, and screaming behavior at a high frequency. Cognitive impairment is important both in predicting death in this population and in understanding the impact of other predictors. The impact of agitated behaviors, quality of social relations, and appetite on mortality highlights issues of quality of life at the end of life.

Activities of Daily Living↗
PubMed1994

Upper-airway obstruction and perioperative management of the airway in patients managed with posterior operations on the cervical spine for rheumatoid arthritis.

We reviewed the records of 128 patients who had a total of 128 consecutive posterior operations on the cervical spine for problems related to rheumatoid arthritis. Our purpose was to examine perioperative complications related to the airway. The patients were divided into two groups for analysis on the basis of the technique of intubation that had been used. An upper-airway obstruction developed after extubation in eight (14 per cent) of the fifty-eight patients who had been intubated without fiberoptic assistance compared with one (1 per cent) of the seventy patients who had been intubated fiberoptically (p = 0.02). The two groups had similar characteristics with regard to age, sex, severity of the myelopathy, American Rheumatology Association classification, American Society of Anesthesiologists physical status classification, cigarette use, duration of the arthritis, use of preoperative traction, use of steroids (both preoperatively and intraoperatively), size of the endotracheal tube, duration of the operation, total duration of the anesthesia, intraoperative fluid balance, and type of immediate immobilization of the neck. The only significant difference between the groups was the time to extubation, which averaged 17.9 hours in the fiberoptic group and 10.6 hours in the non-fiberoptic group (p = 0.02). Logistic regression analysis showed that non-fiberoptic intubation was the significant risk factor, even when allowance was made for the difference in the lengths of time to extubation. We concluded that this life-threatening complication can be minimized with fiberoptic management of the airway.

Adult↗
PubMed1994

The restraint-free approach to behavior problems in the nursing home.

The Omnibus Budget Reconciliation Act of 1987 states that nursing home residents have the right to be free of physical and chemical restraints that are not required to treat the residents' medical symptoms. The article outlines a "restraint proper" approach to treating behavior problems: assess the problem, establish a presumptive diagnosis, consider the risks and benefits of treatment alternatives, select the best treatment for the individual patient, evaluate the effectiveness of treatment and side effects, change treatment as necessary, discontinue treatments when they are no longer needed, and provide documentation.

Aged↗
PubMed1993

Clinical classification as a predictor of therapeutic outcome after cervical epidural steroid injection.

A retrospective analysis was done on 100 patients who had received cervical epidural steroid injections for neck pain and cervical radiculopathy to identify the predictors of outcome after such treatment. Potential predictors of outcome were assessed individually and then simultaneously with a multiple-regression model. Patients with radicular symptoms and signs had the best pain relief in contradistinction to those with axial (neck) pain. A clinical classification model predicting the outcome and an algorithm for the use of such injections in the treatment of cervical radiculopathy were developed.

Adult↗
PubMed1991

Pharmacological treatment of agitation in a nursing home.

Agitation is a significant problem in the management of residents in long-term care settings. This study assessed the pharmacological treatment of agitation in a 550-bed nursing home and correlated nurses' ratings of agitation with pharmacological treatment. It further examined the differential use of various psychotropic agents in the management of several sub-types of agitated behavior. Significant results included: (1) subjects designated as demented and agitated were most likely to receive neuroleptics, while non-demented agitated residents were most likely to be treated with a benzodiazepine; (2) agitated individuals received significantly less antidepressant treatment than non-agitated patients. The sub-typing of agitation may allow for the possibility of more selective treatment of various agitation syndromes.

Aged↗
PubMed1991

The decision to execute a durable power of attorney for health care and preferences regarding the utilization of life-sustaining treatments in nursing home residents.

One hundred three nursing home residents were interviewed regarding their preferences for the choice of an agent for health-care decision making while being offered the opportunity to execute a Durable Power of Attorney for health care. They also completed a questionnaire that tapped their preferences regarding the use of four types of life-support treatment under three hypothetical levels of future cognitive functioning. Factors that might influence these preferences, such as previous experiences with life-sustaining treatments, religious beliefs, and personal values, were also examined. Participants tended to choose their son or daughter as their agent for future health-care decision making. They had clear and consistent patterns of preferences regarding the utilization of life-sustaining treatment. Generally, participants opted not to be treated, although there was variability among participants. They were even less inclined to opt for treatment as their perceived level of future cognitive functioning declined, or when the life-sustaining treatment involved permanent rather than temporary procedures.

Aged↗
PubMed1990

Medical correlates of agitation in nursing home residents.

This paper examines the relationship between agitation and medical and psychiatric diagnoses. Agitation marked by aggressive behaviors (e.g., hit, kick) was related to dementia and impairments in activities of daily living. Physically nonaggressive behaviors (e.g., pacing, disrobing inappropriately) correlated with cognitive impairment, fewer medical diagnoses, and absence of a hearing loss. Verbally agitated behaviors (e.g., constant complaints) were manifested by residents with more physical diagnoses, mental disease (other than schizophrenia and affective disorders), more reported pain, and higher cognitive functioning than the population as a whole.

Activities of Daily Living↗
PubMed1989

Clinical evaluation of a new herpes simplex virus ELISA: a rapid diagnostic test for herpes simplex virus.

A new sensitive and rapid enzyme-linked immunosorbent assay (ELISA) test (Du Pont HERPCHEK) for the detection of herpes simplex virus (HSV) antigen was evaluated. A total of 563 clinical samples collected from patients attending obstetrics and gynecology and sexually transmitted disease clinics in two geographic locations were tested by ELISA, and the results were compared with virus isolation in cell culture. The sensitivity and specificity of the ELISA were 97.5 and 98.6%, respectively. When a confirmatory blocking ELISA was used to demonstrate the presence of HSV antigen in culture-negative but ELISA-positive samples, the specificity of the assay increased to 100%. The assay is easy to perform and may be used to diagnose HSV infection rapidly without the need for culture confirmation.

Adult↗