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PubMed2003

State of the art in geriatric rehabilitation. Part I: review of frailty and comprehensive geriatric assessment.

OBJECTIVES: To increase recognition of geriatric rehabilitation and to provide recommendations for practice and future research. DATA SOURCES: A CINAHL and 2 MEDLINE searches were conducted for 1980 to 2001. A fourth search used the Cochrane database. STUDY SELECTION: One author reviewed the reference for relevance and another for quality. A total of 336 articles were selected. Excluded articles were unrelated to geriatric rehabilitation or were anecdotal or descriptive reports. DATA EXTRACTION: The following major geriatric rehabilitation subtopics were identified: frailty, comprehensive geriatric assessment, admission screening, assessment tools, interdisciplinary teams, hip fracture, stroke, nutrition, dementia, and depression. Part I describes the first 5 subtopics on concepts and processes in geriatric rehabilitation. Part II focuses on the latter 5 subtopics of common clinical problems in frail older persons. A level-of-evidence framework was used to review the literature. Level 1 evidence was a randomized controlled trial (RCT) or a meta-analysis or systematic review of RCTs. Level 2 evidence included controlled trials without randomization, cohort, or case-control studies. Level 3 evidence involved consensus statements from experts or descriptive studies. DATA SYNTHESIS: Of the 336 articles evaluated, 108 were level 1, 39 were level 2, and 189 were level 3. Recommendations were made for each subtopic. In cases in which several articles were written on the same topic and drew similar conclusions, the authors chose those articles with the strongest level of evidence, reducing the total number of references. CONCLUSIONS: Frail elderly patients should be screened for rehabilitation potential. Standardized tools are recommended to aid diagnosis, assessment, and outcome measurement. The team approach to geriatric rehabilitation should be interdisciplinary and use a comprehensive geriatric assessment. Medication reviews and self-medication programs may be beneficial. Future research should address cost effectiveness, consensus on outcome measures, which components of geriatric rehabilitation are most effective, screening, and what outcomes are sustainable.

Aged↗
PubMed1996

Short-stay comprehensive inpatient pulmonary rehabilitation for advanced chronic obstructive pulmonary disease.

OBJECTIVE: To evaluate the effectiveness of short-term, comprehensive inpatient pulmonary rehabilitation in severe chronic obstructive pulmonary disease (COPD). DESIGN: Retrospective analysis of several outcome measures. SETTING: Inpatient pulmonary rehabilitation unit. PARTICIPANTS: Thirty-eight consecutive adult patients with advanced COPD referred to our inpatient pulmonary rehabilitation program between January 1 and December 31, 1994. All but one were referred from acute care hospitals. The mean forced expiratory volume in 1 second (FEV1) was .69L; 79% required supplemental oxygen. MAIN OUTCOME MEASURES: (1) Discharge status; (2) timed walk, with measurements of distance and exertional dyspnea; and (3) functional status. RESULTS: All patients were able to be discharged home after a mean length of stay of 9.9 days. The 12-minute walk distance increased by 66%, from 416 +/- 282 feet to 690 +/- 337 feet (p < .001). Dyspnea during the walk testing also improved: the resting score decreased from 2.87 to .97, the 6-minute score from 7.84 to 3.05, and postwalk score from 8.53 to 3.51 (all p < .001). All patients showed improvement in the Pulmonary Function Status Scale (PFSS), with the functional activities subsection increasing by 39%, the dyspnea score by 65%, and psychosocial score by 35% (all p < .001). CONCLUSION: Short-term improvement in multiple areas can be accomplished with comprehensive pulmonary rehabilitation of short duration. This is particularly relevant to the current health care environment that dictates shorter in-hospital lengths of stay.

Activities of Daily Living↗
PubMed1997

Comprehensive assessment of activities of daily living in stroke. The Copenhagen Stroke Study.

OBJECTIVE: To assess activities of daily living (ADL) in stroke in a comprehensive way. The Barthel Index (BI) is widely used in stroke research, but is limited because it measures basic ADL functions only. This study sought to determine whether the Frenchay Activities Index (FAI) is a good choice for supplementary assessment of higher order ADL functions. DESIGN: Prospective and consecutive. SETTING: Follow-up investigation 6 months after stroke of patients who were admitted to, and completed rehabilitation at, a stroke unit. PATIENTS: 437 patients with strokes. MAIN OUTCOME MEASURES: Factor analysis of the BI, FAI, and the Scandinavian Neurological Stroke Scale (SSS); distribution characteristics of a comprehensive, combined ADL scale. RESULTS: Five factors were found. One factor comprised all items from the BI and all the motor items from the SSS, but no items from the FAI. The FAI loaded on three other factors. Finally, orientation and speech from the SSS loaded on a separate factor. A combined score consisting of the BI total score and a simple transformation of the FAI total score had a much improved distribution without strong ceiling or floor effects. CONCLUSIONS: The FAI supplements the BI with minimal overlap in content. A combined total score has a distribution that makes it very usable for research in stroke outcome and stroke rehabilitation effect.

Activities of Daily Living↗
PubMed2001

Comprehensive kinetic analysis of influenza hemagglutinin-mediated membrane fusion: role of sialate binding.

The data of Danieli et al. (J. Cell Biol. 133:559-569, 1996) and Blumenthal et al. (J. Cell Biol. 135:63-71, 1996) for fusion between hemagglutinin (HA)-expressing cells and fluorescently labeled erythrocytes has been analyzed using a recently published comprehensive mass action kinetic model for HA-mediated fusion. This model includes the measurable steps in the fusion process, i.e., first pore formation, lipid mixing, and content mixing of aqueous fluorescent markers. It contains two core parameters of the fusion site architecture. The first is the minimum number of aggregated HAs needed to sustain subsequent fusion intermediates. The second is the minimal number of those HAs within the fusogenic aggregate that must undergo a slow "essential" conformational change needed to initiate bilayer destabilization. Because the kinetic model has several parameters, each data set was exhaustively fitted to obtain all best fits. Although each of the data sets required particular parameter ranges for best fits, a consensus subset of these parameter ranges could fit all of the data. Thus, this comprehensive model subsumes the available mass action kinetic data for the fusion of HA-expressing cells with erythrocytes, despite the differences in assays and experimental design, which necessitated transforming fluorescence dequenching intensities to equivalent cumulative waiting time distributions. We find that HAs bound to sialates on glycophorin can participate in fusion as members of the fusogenic aggregate, but they cannot undergo the essential conformational change that initiates bilayer destabilization, thus solving a long-standing debate. Also, the similarity in rate constants for lipid mixing and content mixing found here for HA-mediated fusion and by Lee and Lentz (Proc. Natl. Acad. Sci. U.S.A. 95:9274-9279, 1998) for PEG-induced fusion of phosphatidylcholine liposomes supports the idea that subsequent to stable fusion pore formation, the evolution of fusion intermediates is determined more by the lipids than by the proteins.

Calibration↗
PubMed2000

The failure of language comprehension at sentence and phrasal levels in a patient who can speak normally.

An unexpected dissociation between intact propositional speech and impaired language comprehension was observed in a right handed patient following a right hemisphere stroke. Although CHO's comprehension was intact at the single word level, his ability to comprehend a wide range of sentence structures was profoundly impaired. This deficit was observed in the context of normal sentence production both with regard to semantic and syntactic content. This case provides further evidence for the independence of on-line language input and output systems.

Aphasia↗
PubMed1976

Error patterns in auditory comprehension of adult aphasics.

The error patterns of normal and aphasic adults on a sentence comprehension test were studied. For position of error, both normals and the three aphasic groups performed consistently with the expected error distribution. Neither sentence half was experienced as more difficult to process. All groups, both aphasic and normal, demonstrated error patterns for grammatical class and for surface structure linguistic constituent which were consistent with the expected error distributions. Exceptions were noted for the normals on the verb class and for the Wernicke's aphasics on the NP and VP linguistic constituents. Rank orderings of error proportions were similar across groups for both grammatical form class and linguistic constituent. The general findings lend support to the notion that, for auditory comprehension of sentences, aphasic patients differ quantitatively from normal adult speakers, but behave qualitatively similar to them.

Adult↗
PubMed1982

WAIS performance IQ in aphasia as a function of auditory comprehension and constructional apraxia.

This study investigated differences in nonverbal intelligence between diagnostic subgroups of aphasics using the Performance Tests of the Wechsler Adult Intelligence Scale (WAIS). Subjects were 98 right-handed hospitalized males with unilateral left-hemisphere damage who had unambiguous clinical diagnoses of Broca's, Anomic, Conduction, Mixed Non-Fluent, Wernicke's, or Global aphasia. Group differences were examined using the WAIS Performance IQ (PIQ), and subscores for spatial organization (Block Design and Object Assembly) and for verbalizability (Picture Completion and Picture Arrangement). There were significant group differences for each WAIS score, determined by the impaired performance of the Global aphasics. With covariance correction for level of auditory comprehension, group differences were eliminated on the verbalizable subtests, but not on the spatial organization subtests. Covarying for level of constructional apraxia (assessed with drawings, sticks, and blocks), however, eliminated group differences for both subscores. Using demographic, neurological, and linguistic variables, multiple regression analyses confirmed the covariate analysis findings; constructional apraxia was the most predictive variable for both spatial and verbalizability subscores, while auditory comprehension and education level predicted performance on the verbalizable subtests.

Anomia↗
PubMed1985

On comprehension across the adult lifespan.

To test whether healthy elderly subjects develop language comprehension strategies to compensate for decreases in pure-tone audition, we tested 128 healthy subjects aged 30-79 on two tasks: (1) Comprehension materials from the Boston Diagnostic Aphasia Examination (Goodglass and Kaplan, 1972) presented over babble noise with and without the speaker's face visible; and (2) the Kalikow et al. (1977) Speech Perception in Noise test, which assesses the effect of semantic predictability on sentence-final word intelligibility. Whereas, as predicted, overall performance decreased with advancing age, it appeared, unexpectedly, that older and younger adults were equally affected by the absence of visual input and the absence of semantic predictability.

Adult↗
PubMed2002

Theoretical study of incomplete sampling of the first dimension in comprehensive two-dimensional chromatography.

The process of regularly transferring material from the primary column to the secondary column is critical in producing comprehensive two-dimensional separations. A series of calculations have been performed to determine how sampling period, duty cycle, and sampling phase affect (1) the fraction of material transferred from the primary column to the secondary column, (2) the accuracy of primary retention time determination, and (3) the effective peak width along the primary retention axis. The results demonstrate that comprehensive two-dimensional separations can be produced without a substantial loss in quantitative precision and with only a moderate loss in primary column resolution if the sampling period is less than 1.5 times the primary peak standard deviation. The quantitative precision of total peak areas (for duty cycles less than 1.0) and primary retention time determination are rapidly reduced as the sampling period is increased above 1.5 times the primary peak standard deviation.

Chromatography, Liquid↗
PubMed2003

Retention time reproducibility in comprehensive two-dimensional gas chromatography using cryogenic modulation. II. An interlaboratory study.

An interlaboratory survey was conducted to determine the reproducibility of retention times in both the first (1D) and second dimension (2D) axes of the two-dimensional separation space, using the longitudinal cryogenic modulation comprehensive two-dimensional gas chromatographic approach. Intralaboratory reproducibility has been demonstrated in part 1 of this investigation [J. Chromatogr. A 968 (2002) 161]. Confidence in absolute retention times (hence component positions) in the two-dimensional separation space is critical to component identification. Comparing data from four independent laboratories, five independent gas chromatographs, five independent LMCS units, and numerous operators has determined that the LMCS cryogenic modulation approach provides reliable comprehensive two-dimensional GC results.

Chromatography, Gas↗
PubMed2000

New operational modes for multidimensional and comprehensive gas chromatography by using cryogenic modulation.

Historically, hardware and method-related concerns have limited the use of multidimensional gas chromatography in the routine laboratory. This paper presents a new approach that offers the potential to significantly alter the manner in which multidimensional gas chromatography is conducted, based on the use of a modulated cryogenic trap which can be moved longitudinally along the column. Two columns are directly coupled, and no switching valves are used. It is demonstrated that a heartcut section can be cryofocused and zone-compressed, and then rapidly remobilized at the prevailing column oven temperature without any supplementary heating. A short second dimension column is used, giving fast second dimension analysis. This allows a large number of heartcuts to be programmed for any one analysis. The 'ultimate' manifestation of multidimensional gas chromatography is the comprehensive GC technique (GC X GC). This is now simply effected by performing very rapid heartcuts at intervals on the order of 1/5th of the peak width of primary dimension peaks, and requires that the second dimension be able to complete the analysis of each collected zone on a similar timeframe. This paper uses a semi-volatile aromatic mixture to demonstrate these selected operational modes, that can be achieved with the longitudinal modulation method. The flexibility that arises from this approach is shown by the ability to swap between selected whole-peak enhancement and comprehensive modes during the one analytical run. The increased sensitivity that follows from peak compression is a further advantage, which would be beneficial for trace analysis.

Chromatography, Gas↗
PubMedDate not supplied

The validity of reading comprehension therapy materials.

This study examines the degree to which reading comprehension therapy materials measure reading comprehension. Thirty-six non-brain-damaged adults (18 females, 18 males) ranging in age from 55 to 75 years participated. They answered written multiple-choice questions from aphasia therapy workbooks before and after reading the paragraphs (n = 40) to which the questions related. Results showed that for each of four sets of workbook materials, subjects answered an average of 24% to 49% more of the questions after reading the paragraphs relative to the number they answered before reading the paragraphs. For questions that could not be answered using one's prior knowledge, subjects were more dependent on having to read the paragraph in order to answer the questions correctly. Based on binomial probabilities, at least half of the questions from 32/40 paragraphs were answered correctly at greater than chance levels without reading the related paragraph.

Aged↗
PubMedDate not supplied

Listening comprehension and recall abilities in adolescents with language-learning disabilities and without disabilities for social studies lectures.

Listening comprehension and recall abilities for social studies lectures were examined and compared in 20 adolescent males with language-learning disabilities (LLD) and 29 without disabilities (WD). Subjects viewed two social studies lectures with comparison and causation expository discourse structures and verbally responded to literal and inferential comprehension questions. Regardless of lecture type or question type, the group with LLD performed significantly more poorly than did the group WD. Both groups responded accurately to significantly more inferential questions for the causation lecture over the comparison lecture. Neither group demonstrated a significant difference with respect to their response accuracy for the literal questions across lecture types.

Adolescent↗
PubMed2002

Lexical processing of vocabulary class in patients with Broca's aphasia: an event-related brain potential study on agrammatic comprehension.

This paper presents electrophysiological evidence of an impairment in the on-line processing of word class information in patients with Broca's aphasia with agrammatic comprehension. Event-related brain potentials (ERPs) were recorded from the scalp while Broca patients and non-aphasic control subjects read open- and closed-class words that appeared one at a time on a PC screen. Separate waveforms were computed for open- and closed-class words. The non-aphasic control subjects showed a modulation of an early left anterior negativity in the 210-325ms as a function of vocabulary class (VC), and a late left anterior negative shift to closed-class words in the 400-700ms epoch. An N400 effect was present in both control subjects and Broca patients. We have taken the early electrophysiological differences to reflect the first availability of word-category information from the mental lexicon. The late differences can be related to post-lexical processing. In contrast to the control subjects, the Broca patients showed no early VC effect and no late anterior shift to closed-class words. The results support the view that an incomplete and/or delayed availability of word-class information might be an important factor in Broca's agrammatic comprehension.

Adult↗
PubMed2000

The effects of anterior lesions on performance on a story comprehension test: left anterior impairment on a theory of mind-type task.

Participants with unilateral anterior or posterior lesions were compared to a healthy group on a theory of mind-type task that involved explaining the words or actions of story characters in a series of brief vignettes. Participants also carried out a set of non-social neuropsychological tests. Those with left anterior brain lesions (n=6) showed impairment relative to those with right anterior (n=13), left (n=4) and right (n=8) posterior lesions and healthy participants (n=60) in story comprehension, and their errors commonly involved failure to make non-literal interpretations. The left anterior lesion participants also showed impairment on some measures of executive function. The implications of the findings for our understanding of impairments in story comprehension after brain injury are discussed in terms of models of executive function and theory of mind.

Adult↗
PubMed1997

Integrating comprehensive adolescent preventive services into routine medicine care. Rationale and approaches.

Relying on therapeutic interventions to address health problems after they occur has proven costly and does not address the need to reduce the number of youth who develop these health problems. Primary care physicians have an important role to play in promoting adolescent health through a strategy of providing health guidance to adolescents and parents, screening, and promoting immunizations. Reducing the health risk behaviors of adolescents is a challenge that is best accomplished with the support of other preventive initiatives. Clinical preventive services should complement and reinforce preventive efforts in schools (i.e., comprehensive school health programs) and communities (i.e., mass media campaigns and health regulations). GAPS recommendations developed by the AMA and recommendations from other groups provide a model for organizing the content and delivery of comprehensive preventive services for adolescents. Physicians and other primary care health providers may use these recommendations to expand the quantity and quality of preventive services they offer to adolescents. Additional information about preventive services and GAPS, including a complete list of the recommendations, dates for future GAPS training, a description of the materials developed to help implement preventive services, other national efforts in adolescent preventive services, and current articles in scientific literature, can be reviewed on the AMA web site (http:/(/)www.AMA-Assn.Org/Adolhlth/Adolhlth+ ++.htm).

Adolescent↗
PubMed2000

Development and validation of the expanded prostate cancer index composite (EPIC) for comprehensive assessment of health-related quality of life in men with prostate cancer.

OBJECTIVES: Health-related quality of life (HRQOL) is an increasingly important endpoint in prostate cancer care. However, pivotal issues that are not fully assessed in existing HRQOL instruments include irritative urinary symptoms, hormonal symptoms, and multi-item scores quantifying bother between urinary, sexual, bowel, and hormonal domains. We sought to develop a novel instrument to facilitate more comprehensive assessment of prostate cancer-related HRQOL. METHODS: Instrument development was based on advice from an expert panel and prostate cancer patients, which led to expanding the 20-item University of California-Los Angeles Prostate Cancer Index (UCLA-PCI) to the 50-item Expanded Prostate Index Composite (EPIC). Summary and subscale scores were derived by content and factor analyses. Reliability and validity were assessed by test-retest correlation, Cronbach's alpha coefficient, interscale correlation, and EPIC correlation with other validated instruments. RESULTS: Test-retest reliability and internal consistency were high for EPIC urinary, bowel, sexual, and hormonal domain summary scores (each r >/=0.80 and Cronbach's alpha >/=0.82) and for most domain-specific subscales. Correlations between function and bother subscales within domains were high (r >0.60). Correlations between different primary domains were consistently lower, indicating that these domains assess distinct HRQOL components. EPIC domains had weak to modest correlations with the Medical Outcomes Study 12-item Short-Form Health Survey (SF-12), indicating rationale for their concurrent use. Moderate agreement was observed between EPIC domains relevant to the Functional Assessment of Cancer Therapy Prostate module (FACT-P) and the American Urological Association Symptom Index (AUA-SI), providing criterion validity without excessive overlap. CONCLUSIONS: EPIC is a robust prostate cancer HRQOL instrument that complements prior instruments by measuring a broad spectrum of urinary, bowel, sexual, and hormonal symptoms, thereby providing a unique tool for comprehensive assessment of HRQOL issues important in contemporary prostate cancer management.

Aged↗