[Application of scoring systems for quality assurance and cost estimation in intensive care medicine].
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Biomedical subjects
Publications and source records attributed to T Gregor.
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Recent studies of Alzheimer's disease patients have demonstrated (a) marked structural and biochemical alterations in brain regions associated with olfactory function (including the olfactory bulb and entorhinal cortex) and (b) decrements in the ability to identify odorants. In light of such findings, we administered the University of Pennsylvania Smell Identification Test (UPSIT) and a forced-choice phenyl ethyl alcohol odor detection threshold test to a relatively large number of patients diagnosed, on the basis of stringent criteria, as having mild to moderately severe Alzheimer's disease. Compared to age-, gender-, and race-matched normal controls, these individuals evidenced consistent and marked decrements on both types of olfactory tests (ps less than 0.001). Surprisingly few of the patients were aware of their disorder, despite its appearance early in the disease process. These findings indicate that both odor identification and odor detection problems are present in dementia of the Alzheimer's type, and raise the possibility that the odor identification problem may be secondary to the odor detection problem.
The University of Pennsylvania Smell Identification Test (UPSIT) was administered, on a volunteer basis, to workers frequenting the cafeteria of the corporate offices of a major chemical manufacturing company to (1) establish the level of acceptance of self-administered olfactory testing within such a setting, (2) determine the percentage of the sample that reported or evidenced marked olfactory impairment, and (3) develop guidelines for the use of the UPSIT as a corporate medical surveillance tool. The initial acceptance of the testing program was high. Thus, 640 of the cafeteria visitors agreed to take the test (total work force in building less than 1,000). However, only 52% of the tests handed out were completed by the employees and returned to the test examiners, possibly reflecting the informal atmosphere in which they were distributed. Of the group returning the tests, seven employees reported having smell problems due to allergies or sinus disease. However, all of these employees had normal UPSIT scores. Three subjects (1% of the sample) evidenced marked olfactory dysfunction. Of these three, only one was aware of the problem before testing. On average, the corporate subjects significantly outperformed matched control subjects obtained from previous administrations of the UPSIT at health fairs and other public events, although the difference was less than half a point (37.89 v 37.53; P less than .004). As in previous studies, the test scores of women were slightly, but significantly, higher than those of men (respective means = 37.98 v 37.80, P less than .04).
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OBJECTIVE: This study evaluates the efficacy of three perioperative warming protocols to improve control of body temperature in anesthetized dogs. STUDY DESIGN: A randomized controlled clinical trial. ANIMALS OR SAMPLE POPULATION: Thirty-two client-owned dogs. METHODS: We prospectively studied dogs entering the University of Pennsylvania Veterinary Teaching Hospital for orthopedic or dental procedures and assigned them to one of three perianesthetic warming protocols. Group 1 (n = 10) had a single circulating warm water mattress applied over the trunk (single-trunk warming). Group 2 (n = 12) had two circulating warm water mattresses, one placed over and one under the trunk (double-trunk warming). Group 3 (n = 10) had warm circulating mattresses applied only around the feet and legs of all available limbs (peripheral warming). The warm water mattresses were prewarmed and maintained at 40 degrees C (104 degrees F) and applied immediately after induction of general anesthesia. All dogs had a layer of thick terry cloth toweling beneath and above the trunk. Body temperature measurements were recorded every 15 minutes for the first 2.5 hours of anesthesia. RESULTS: The lowest mean temperature for dogs in group 3 was 37.4 +/- 0.2 degrees C (99.5 degrees F), compared with 36.4 +/- 0.2 degrees C (97.4 degrees F) and 36.7 +/- 0.2 degrees C (98.0 degrees F) in groups 1 and 2, respectively. CONCLUSIONS: Dogs in the peripheral warming group maintained significantly higher core body temperatures than dogs in either trunk warming groups throughout the 2.5-hour study period. CLINICAL RELEVANCE: To maintain body heat in dogs during anesthesia, it is more effective to warm the feet and legs than to warm the trunk.