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Medical Comorbidity (medical + comorbidity)

Distribution by Scientific Domains

Medical Sciences	93%
Psychology	6%

Selected Abstracts

Caring for the Whole Person: Integrated Health Care for Older Adults with Severe Mental Illness and Medical Comorbidity

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 2004
Stephen J. Bartels MD
First page of article [source]

Medical Comorbidity and Rehabilitation Efficiency in Geriatric Inpatients

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 11 2001
C Psych, Louise Patrick PhD
OBJECTIVES: To measure and describe medical comorbidity in geriatric rehabilitation patients and investigate its relationship to rehabilitation efficiency. DESIGN: Prospective, multivariate, within-subject design. SETTING: The Geriatric Rehabilitation inpatient unit of the SCO Health Service in Ottawa, Canada. MEASUREMENTS: The rehabilitation efficiency ratio, based on gains in functional status achieved with rehabilitation treatment, and the length of stay were computed for all patients. Values were regressed on the scores of the Cumulative Illness Rating Scale (CIRS), the Mini-Mental State Examination, and the Geriatric Depression Scale to establish predictive power. RESULTS: The findings suggest that geriatric rehabilitation patients experience considerable medical comorbidity. Sixty percent of patients had impairments across six of the 13 dimensions of the CIRS, whereas 36% of patients had impairments across 11 of the 13 dimensions. In addition, medical comorbidity was negatively related to rehabilitation efficiency. This relationship was significant even after controlling for age, cognitive status, depressive symptoms, and functional independence status at admission. CONCLUSION: Medical comorbidity was a significant predictor of rehabilitation efficiency in geriatric patients. Comorbidity scores> 5 were prognostic of poorer rehabilitation outcomes and can serve as an empirical guide in estimating a patient's suitability for rehabilitation. Medical comorbidity predicted both the overall functional change achieved with rehabilitation (Functional Independence Measure gains) and the rate at with which those gains were reached (rehabilitation efficiency ratio). [source]

Service delivery in older patients with bipolar disorder: a review and development of a medical care model

BIPOLAR DISORDERS, Issue 6 2008
Amy M Kilbourne
Objectives:, Medical comorbidities, especially cardiovascular disease (CVD), occur disproportionately in older patients with bipolar disorder. We describe the development, implementation, and feasibility/tolerability results of a manual-based medical care model (BCM) designed to improve medical outcomes in older patients with bipolar disorder. Methods:, The BCM consisted of (i) self-management sessions focused on bipolar disorder symptom control, healthy habits, and provider engagement, (ii) telephone care management to coordinate care and reinforce self-management goals, and (iii) guideline dissemination focused on medical issues in bipolar disorder. Older patients with bipolar disorder and a CVD-related risk factor (n = 58) were consented, enrolled, and randomized to receive BCM or usual care. Results:, Baseline assessment (mean age = 55, 9% female, 9% African American) revealed a vulnerable population: 21% were substance users, 31% relied on public transportation, and 22% reported problems accessing medical care. Evaluation of BCM feasibility revealed high overall patient satisfaction with the intervention, high fidelity (e.g., majority of self-management sessions and follow-up contacts completed), and good tolerability (dropout rate <5%). Use of telephone contacts may have mitigated barriers to medical care (e.g., transportation). Conclusions:, The BCM is a feasible model for older, medically ill patients with bipolar disorder, and could be an alternative to more costly treatment models that involve co-location and/or additional hiring of medical providers in mental health clinics. Future research directions pertinent to the development of the BCM and other medical care models for older patients with bipolar disorder include assessment of their long-term effects on physical health and their cost-effectiveness across different treatment settings. [source]

Complications of craniofacial resection for malignant tumors of the skull base: Report of an International Collaborative Study,

HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 6 2005
Ian Ganly MD
Abstract Background. Advances in imaging, surgical technique, and perioperative care have made craniofacial resection (CFR) an effective and safe option for treating malignant tumors involving the skull base. The procedure does, however, have complications. Because of the relative rarity of these tumors, most existing data on postoperative complications come from individual reports of relatively small series of patients. This international collaborative report examines a large cohort of patients accumulated from multiple institutions with the aim of identifying patient-related and tumor-related predictors of postoperative morbidity and mortality and set a benchmark for future studies. Methods. One thousand one hundred ninety-three patients from 17 institutions were analyzed for postoperative mortality and complications. Postoperative complications were classified into systemic, wound, central nervous system (CNS), and orbit. Statistical analyses were carried out in relation to patient characteristics, extent of disease, prior radiation treatment, and type of reconstruction to determine factors that predicted mortality or complications. Results. Postoperative mortality occurred in 56 patients (4.7%). The presence of medical comorbidity was the only independent predictor of mortality. Postoperative complications occurred in 433 patients (36.3%). Wound complications occurred in 237 (19.8%), CNS-related complications in 193 (16.2%), orbital complications in 20 (1.7%), and systemic complications in 57 (4.8%) patients. Medical comorbidity, prior radiation therapy, and the extent of intracranial tumour involvement were independent predictors of postoperative complications. Conclusions. CFR is a safe surgical treatment for malignant tumors of the skull base, with an overall mortality of 4.7% and complication rate of 36.3%. The impact of medical comorbidity and intracranial tumor extent should be carefully considered when planning therapy for patients whose tumors are amenable to CFR. © 2005 Wiley Periodicals, Inc. Head Neck27: XXX,XXX, 2005 [source]

Medical comorbidity in late-life depression

INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 10 2004
Warren D. Taylor
Abstract Objectives Medical comorbidity is common in elderly patients with depression, however the difference between depressed and non-depressed elderly populations is not well established. Additionally, differences between subgroups of depressed populations, including those with MRI-defined vascular depression and those with late-onset compared with early-onset depression are not well described. Methods We compared self-report of medical disorders between 370 depressed elders and 157 non-depressed control subjects. Subjects were additionally dichotomized based on presence or absence of subcortical MRI lesions and age of onset. Medical comorbidity was assessed by self report only, and depressed subjects were additionally assessed by the clinician-rated Cumulative Illness Rating Scale. Results When compared with the non-depressed group, depressed subjects were significantly more likely to report the presence of hypertension, heart disease, gastrointestinal ulcers, and ,hardening of the arteries'. Analyses of subjects with subcortical disease demonstrated they were significantly older, more likely to have depression, and more likely to report the presence of hypertension. Finally, the depressed cohort with late-onset depression (occurring after age 50 years) had more male subjects, exhibited greater CIRS scores, and greater prevalence of hypertension, but these did not reach a level of statistical significance after applying a Bonferroni correction. Conclusions Vascular comorbidities are common in depressed elders. The differences in the report of hypertension supports past work investigating a vascular contribution to late-life depression. Given the association between depression and poor medical outcomes of cardiac disease, this population deserves clinical scrutiny and further research. Copyright © 2004 John Wiley & Sons, Ltd. [source]

Medical Comorbidity and Rehabilitation Efficiency in Geriatric Inpatients

Older age predicts a decline in adjuvant chemotherapy recommendations for patients with breast carcinoma

CANCER, Issue 9 2003
Evidence from a tertiary care cohort of chemotherapy-eligible patients
Abstract BACKGROUND The appropriate use of adjuvant chemotherapy for elderly women with breast carcinoma remains controversial. Efficacy data in women age , 70 years are scarce, resulting in a lack of clear guidelines for patients in this age group. Although several studies have demonstrated decreasing use of chemotherapy with age, none specifically examined its use in an elderly cohort of patients who were deemed eligible for such therapy based on consensus guidelines, simultaneously examining the impact of comorbidity and previous history of malignant disease on these recommendations. METHODS The authors examined adjuvant chemotherapy use among chemotherapy-eligible patients age , 50 years who were evaluated in a tertiary care cancer center. Associations between patient age and 1) physician recommendation for adjuvant chemotherapy, 2) recommended treatment regimen, and 3) patient acceptance of the treatment plan recommended were examined, adjusting for the impact of aggressive tumor characteristics, medical comorbidity, previous history of malignant disease, and features of the treatment setting. RESULTS Of the 208 chemotherapy-eligible patients who were studied, 74% overall were recommended chemotherapy. Chemotherapy was recommended to 92% of women age 50,59 years compared with 77% of women age 60,69 years and 23% of women age , 70 years. Increasing age was associated strongly with a decreasing likelihood of receiving a recommendation in favor of chemotherapy. After adjusting for estrogen receptor status, previous history of malignant disease, comorbidity score, and prognostic group, the odds of receiving a recommendation in favor of chemotherapy fell by 22% per year or 91% per 10-year interval, and the rate of decline did not change significantly at age , 70 years. We found no age-related differences in either the drug regimens recommended or patient acceptance rates for adjuvant therapy. CONCLUSIONS Age was associated strongly and independently with physician recommendation for adjuvant chemotherapy among a group of older women who were eligible specifically for such therapy. Medical comorbidity and a history of previous malignant disease did not alter this correlation significantly, although the latter was a significant predictor of chemotherapy use. Further studies clearly are needed to determine the underlying reasons for this strong age effect and to explore strategies that will optimize the utilization of this potentially curative therapy in the elderly. Cancer 2003;97:2150,9. © 2003 American Cancer Society. DOI 10.1002/cncr.11338 [source]

Depression gets old fast: do stress and depression accelerate cell aging?,

DEPRESSION AND ANXIETY, Issue 4 2010
Owen M. Wolkowitz M.D.
Abstract Depression has been likened to a state of "accelerated aging," and depressed individuals have a higher incidence of various diseases of aging, such as cardiovascular and cerebrovascular diseases, metabolic syndrome, and dementia. Chronic exposure to certain interlinked biochemical pathways that mediate stress-related depression may contribute to "accelerated aging," cell damage, and certain comorbid medical illnesses. Biochemical mediators explored in this theoretical review include the hypothalamic,pituitary,adrenal axis (e.g., hyper- or hypoactivation of glucocorticoid receptors), neurosteroids, such as dehydroepiandrosterone and allopregnanolone, brain-derived neurotrophic factor, excitotoxicity, oxidative and inflammatory stress, and disturbances of the telomere/telomerase maintenance system. A better appreciation of the role of these mediators in depressive illness could lead to refined models of depression, to a re-conceptualization of depression as a whole body disease rather than just a "mental illness," and to the rational development of new classes of medications to treat depression and its related medical comorbidities. Depression and Anxiety, 2010. © 2010 Wiley-Liss, Inc. [source]

Population-Based U.S. Study of Severe Headaches in Adults: Psychological Distress and Comorbidities

HEADACHE, Issue 2 2006

Objective.,To examine the associations between severe headaches (SH), psychological distress, and comorbid conditions among U.S. adults. Background.,The lifetime prevalence of headaches is over 90% and headaches, particularly migraines, have been associated with disability, increased healthcare costs, and mood disorders. Methods.,We analyzed data obtained from adults aged 18 years or older (n = 29,828) who participated in the 2002 National Health Interview Survey, an ongoing, computer-assisted personal interview of a representative sample of the U.S. population. Results.,Approximately 15.1% of adults aged 18 years or older reported SH in the previous 3 months. Those reporting such headaches were significantly more likely, than those who did not, to report insomnia, excessive sleepiness, recurrent pain, and depressive or anxiety symptoms during the preceding 12 months. Approximately 88% of those who reported having had SH within the previous 3 months also indicated that they had at least one comorbid medical condition, relative to 67% of those without SH. Conclusion.,Despite their episodic nature, our results suggest that SH are associated with impairments in both physical and mental health. As the presence of SH may serve as an indicator of significant psychological distress and medical comorbidities, eliciting information about their occurrence during a standard medical examination appears to be warranted. [source]

The effects of antidepressant medication adherence as well as psychosocial and clinical factors on depression outcome among older adults

INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 2 2008
Hayden B. Bosworth
Abstract Objective To examine the contribution of medication adherence to 12-month depression scores in the context of other psychosocial and clinical predictors of depression in a sample of older adults treated for depression. Methods Secondary analysis of a prospective cohort study involving 241 older patients undergoing depression treatment using a standardized algorithm. Depression was measured at baseline and 12-months post-baseline. Baseline predictor variables included antidepressant adherence, barriers to antidepressant adherence, four domains of social support, basic and instrumental activities of daily living (BADLs and IADLs), and clinical factors including past history of depression and medical comorbidities. Results Nearly 28% of patients reported being nonadherent with their antidepressant medication. In bivariate analyses, greater antidepressant medication nonadherence, more medication barriers, poorer subjective social support, less non-family interaction, greater BADL and IADL limitations, poor self-rated health, higher baseline depression scores, and not having diabetes were related to higher 12-month depression scores. In multivariable analyses, greater medication nonadherence, not having diabetes, poorer subjective social support, greater BADL limitations, and higher baseline depression scores were related to higher 12-month depression scores. Conclusion Interventions should be directed toward improving antidepressant adherence and modifiable psychosocial variables. Copyright © 2007 John Wiley & Sons, Ltd. [source]

Hemorrhagic stroke associated with antidepressant use in patients with depression: does degree of serotonin reuptake inhibition matter?

PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 3 2009
Yan Chen MD
Abstract Objective This study aimed to determine whether the degree of serotonin (5-HT) reuptake inhibition affects risk of hemorrhagic stroke associated with antidepressant use in patients with depression. Method A population-based, nested case-control study was performed using a managed care medical claims database. Ninety two depressed patients with a diagnosis of hemorrhagic stroke were identified and matched with 552 controls by age, sex, and year of index date of depression (IDD). Diagnoses of depression, hemorrhagic stroke, and other medical comorbidities were identified using ICD-9 codes. Antidepressants were classified as high, medium, or low reuptake inhibition based on their affinities for the 5-HT reuptake transporter, determined using their respective equilibrium dissociation constants (KD; high: KD,<,1,nM; medium: 1,,,KD,<,10,nM; low: KD,,,10,nM). Conditional logistic regression analysis was performed to estimate the crude and adjusted odds ratios (ORs) with 95% confidence intervals (CIs) of the risk of hemorrhagic stroke. Results Compared to non-users of antidepressants, risk of hemorrhagic stroke did not significantly differ between patients who had ever used antidepressants with high (OR,=,0.82; 95% CI,=,0.44,1.55), medium (OR,=,0.93; 95% CI,=,0.37,2.31), or low (OR,=,0.38; 95% CI,=,0.11,1.41) 5-HTT inhibition. Conclusion Risk of hemorrhagic stroke associated with antidepressant use may not be related to an antidepressant's degree of 5-HT reuptake inhibition. Given the limitations of this study, additional studies are needed to confirm these findings. Copyright © 2009 John Wiley & Sons, Ltd. [source]

Substance Use Disorder Comorbidity in Major Depressive Disorder: A Confirmatory Analysis of the STAR*D Cohort

THE AMERICAN JOURNAL ON ADDICTIONS, Issue 4 2006
Lori L. Davis MD
The demographics and clinical features were compared between those with (29.4%) and without concurrent substance use disorder (SUD) in 2541 outpatients with major depression (MDD) enrolled in the Sequenced Treatment Alternatives to Relieve Depression study. Compared to those without SUD, MDD patients with concurrent SUD were more likely to be younger, male, divorced or never married, and at greater current suicide risk, and have an earlier age of onset of depression, greater depressive symptomatology, more previous suicide attempts, more frequent concurrent anxiety disorders, and greater functional impairment (p = 0.048 to < 0.0001). They were also less likely to be Hispanic and endorse general medical comorbidities (p = 0.006 and 0.002, respectively). [source]

Practitioner Review: Bridging the gap between research and clinical practice in pediatric obesity

THE JOURNAL OF CHILD PSYCHOLOGY AND PSYCHIATRY AND ALLIED DISCIPLINES, Issue 2 2007
Elissa Jelalian
Background:, Pediatric obesity is a significant public health concern, with rising prevalence rates in both developed and developing countries. This is of particular significance given that overweight children and adolescents are at increased risk for multiple medical comorbidities, as well as psychosocial and behavioral difficulties. The current review highlights findings from the empirical pediatric obesity treatment literature, with particular attention to diet, physical activity, and behavior interventions. Evaluation and treatment considerations relevant to working with overweight children and adolescents with psychiatric comorbidities are reviewed. Methods:, Review of the relevant treatment literature, with a focus on randomized clinical trials, was conducted. Recommendations regarding treatment of children and adolescents with psychiatric comorbidities are based on relevant prospective studies of the relationship between weight status and psychological variables and studies with adult populations. Results:, Well-established pediatric weight control interventions have been conducted in research settings. These studies provide a starting point, but are limited by homogeneous samples that may exclude participants with psychiatric comorbidities. Practitioners treating obese children and adolescents with psychiatric disorders are encouraged to assess individual, familial, and contextual variables specific to weight (e.g., motivation and existing support to change current eating and physical activity patterns, extent of weight-related conflict within family, impact of weight on current functioning) in order to prioritize treatment objectives. Conclusions:, The review concludes with a discussion of current empirical and practical challenges, including explicitly targeting obese children and adolescents with psychiatric concerns and determining appropriateness of pursuing weight control interventions in this population. [source]

Etiology of Late Free Flap Failures Occurring After Hospital Discharge,

THE LARYNGOSCOPE, Issue 11 2007
Mark K. Wax MD
Abstract Objectives: Vascular compromise of free flaps most commonly occurs in the immediate postoperative period in association with failure of the microvascular anastomosis. Rarely do flaps fail in the late postoperative period. It is not well understood why free flaps can fail after 7 postoperative days. We undertook a case review series to assess possible causes of late free flap failure. Study Design: Retrospective review at two tertiary referral centers: Oregon Health Sciences University and University of Alabama at Birmingham. Methods: A review of 1,530 flaps performed in 1,592 patients between 1998 and 2006 were evaluated to identify late flap failure. Late flap failure was defined as failure occurring after postoperative day 7 or on follow-up visits after hospital discharge. A prospective database with the following variables was examined: age, medical comorbidities, postreconstructive complications (fistula or infection), hematoma, seroma, previous surgery, radiation therapy, intraoperative findings at the time of debridement, nutrition, and, possibly, etiologies. Results: A total of 13 patients with late graft failure were identified in this study population of 1,530 (less than 1%) flaps; 6 radial forearm fasciocutaneous flaps, 2 rectus abdominis myocutaneous flaps, 4 fibular flaps, and 1 latissimus dorsi myocutaneous flap underwent late failure. The time to necrosis was a median of 21 (range, 7,90) days. Etiology was believed to possibly be pressure on the pedicle in the postoperative period in four patients (no sign of local wound issues at the pedicle), infection (abscess formation) in three patients, and regrowth of residual tumor in six patients. Loss occurring within 1 month was more common in radial forearm flaps and was presented in the context of a normal appearing wound at the anastomotic site, as opposed to loss occurring after 1 month, which happened more commonly in fibula flaps secondary to recurrence. Conclusion: Although late free flap failure is rare, local factors such as infection and possibly pressure on the pedicle can be contributing factors. Patients presenting with late flap failure should be evaluated for residual tumor growth. [source]

Surgical Excision of Acoustic Neuroma: Patient Outcome and Provider Caseload

THE LARYNGOSCOPE, Issue 8 2003
Fred G. Barker II
Abstract Objectives/Hypothesis For many complex surgical procedures, larger hospital or surgeon caseload is associated with better patient outcome. We examined the volume,outcome relationship for surgical excision of acoustic neuromas. Study Design Retrospective cohort study. Methods The Nationwide Inpatient Sample (1996 to 2000) was used. Multivariate regression analyses were adjusted for age, sex, race, payer, geographic region, procedure timing, admission type and source, medical comorbidities, and neurofibromatosis status. Results At 265 hospitals, 2643 operations were performed by 352 identified primary surgeons. Outcome was measured on a four-level scale at hospital discharge: death (0.5%) and discharge to long-term care (1.2%), to short-term rehabilitation (4.4%), and directly to home (94%). Outcomes were significantly better after surgery at higher-volume hospitals (OR 0.47 for fivefold-larger caseload, P <.001) or by higher-volume surgeons (OR 0.46, P <.001). Of patients who had surgery at lowest-volume-quartile hospitals, 12.3% were not discharged directly home, compared with 4.1% at highest-volume-quartile hospitals. There was a trend toward lower mortality for higher-volume hospitals (P = .1) and surgeons (P = .06). Of patients who had surgery at lowest-caseload-quartile hospitals, 1.1% died, compared with 0.6% at highest-volume-quartile hospitals. Postoperative complications (including neurological complications, mechanical ventilation, facial palsy, and transfusion) were less likely with high-volume hospitals and surgeons. Length of stay was significantly shorter with high-volume hospitals (P = .01) and surgeons (P = .009). Hospital charges were lower for high-volume hospitals (by 6% [P = .006]) and surgeons (by 6% [P = .09]). Conclusion For acoustic neuroma excision, higher-volume hospitals and surgeons provided superior short-term outcomes with shorter lengths of stay and lower charges. [source]

Outcomes of dental implants placed in a surgical training programme

AUSTRALIAN DENTAL JOURNAL, Issue 4 2009
LP Smith
Abstract Background:, This study evaluates surgical outcomes and survival rates of implants placed in a multidisciplinary implant teaching programme. Methods:, A retrospective review of all implant surgery performed over a 6-year period by accredited oral and maxillofacial surgery trainees at the Royal Dental Hospital of Melbourne was undertaken. Patients were reviewed for a minimum of 6 months post-implant placement. Implant survival was defined as those implants which were not removed, were clinically integrated as assessed by torque testing and in an appropriate position to receive a subsequent prosthesis. Kaplan-Meier analysis was used to assess overall survival and univariate factors affecting survival. Multivariate analysis used Cox proportional hazards models. Results:, Over 6 years, 127 patients were treated. Follow-up data were present for 105 patients with 236 implants placed. Survival of implants at 1 and 5 years was 94 per cent and 92.8 per cent, respectively. The only univariate and multivariate factor which affected implant survival was perioperative bone grafting. All failed implants were single stage. Other factors such as patient age, smoking status, implant site, anaesthetic type, immediate or delayed placement, implant length and diameter, and medical comorbidities did not significantly affect implant survival. Conclusions:, A satisfactory implant survival rate was found in a tertiary teaching centre. Perioperative bone grafting significantly increased the risk of implant failure. [source]

Kidneys from patients with small renal tumours: a novel source of kidneys for transplantation

BJU INTERNATIONAL, Issue 2 2008
David L. Nicol
OBJECTIVE To report the use of a novel donor source as a further option to increase the number of patients who might be able to receive a renal transplant. PATIENTS AND METHODS Between May 1996 and July 2007, 43 kidneys were transplanted using kidneys obtained from patients with small (<3 cm diameter) incidentally detected tumours. After bench surgery to excise the tumour, they were all successfully transplanted into patients who were elderly or had significant comorbidities. RESULTS Apart from four patients who died from unrelated illnesses, all grafts continued to function with a median and mean follow-up of 25 and 32 months. The follow-up, which included 3-monthly renal ultrasonography and chest X-rays, showed only one case of tumour recurrence, which occurred 9 years after transplantation; the patient remains stable under observation after 18 months. CONCLUSIONS From our experience we consider that where nephrectomy is used for small, localized, incidentally detected renal tumours, the kidney should be considered for transplantation into carefully selected patients. Such patients with numerous medical comorbidities might benefit from renal transplantation, but not survive the waiting period if they are dependent on a deceased donor graft. Paradoxically the use of these marginal kidneys has the potential to increase the quality and length of life of these patients, despite the apparent contradiction of an intuitive principle of organ transplantation and immunosuppression. [source]

Matched-cohort analysis of patients with prostate cancer followed with observation or treated with three-dimensional conformal radiation therapy,

BJU INTERNATIONAL, Issue 1 2004
Noel M. Kramer
OBJECTIVES To compare the outcome of similar patients with prostate cancer treated by either observation or three-dimensional conformal radiation therapy (3-DCRT). PATIENTS AND METHODS The study included 69 patients with nonmetastatic prostate cancer who were observed only; the indications included indolent disease, significant medical comorbidities and refusal of treatment. Of these, 62 patients had palpable T1,T2a and seven T2b,T3a disease, a median Gleason score of 6 and a median initial prostate-specific antigen (PSA) level of 5.3 ng/mL. A matched-cohort analysis of 69 patients, based on palpation T category, Gleason score and initial PSA, was used to compare the outcome between the observation and 3-DCRT groups. The median radiation dose for latter was 72 Gy. RESULTS The median follow-up for the observed patients was 49 months. The 5- and 8-year actuarial rates of freedom from distant metastases were 100% and 93%, respectively, and the actuarial overall survival rates 94% and 73%, respectively. Seven observed patients had local disease progression on physical examination. Four patients who initially were observed received radiation therapy later for a rising PSA and/or local disease progression. For the 69 matched 3-DCRT patients, the overall 5-year rate for no biochemically evident disease was 74%. The respective 5- and 8-year actuarial rates of freedom from distant metastases were 95% and 95%, and actuarial overall survival rates 95% and 75%. There were no significant differences in distant metastasis and overall survival rates between the groups, and no deaths from prostate cancer in either group. CONCLUSIONS Observation is a reasonable alternative to treatment in selected patients. During the 5-year follow-up the progression rates were relatively low, and there was no difference in distant metastasis or overall survival between the groups. As the follow-up was short a longer follow-up is needed to determine whether the outcome of those patients who chose observation will remain comparable to that in those undergoing immediate 3-DCRT. [source]

Predictors of injury-related and non-injury-related mortality among veterans with alcohol use disorders

ADDICTION, Issue 10 2010
Sylwia Fudalej
ABSTRACT Aims To describe the association between alcohol use disorders (AUDs) and mortality and to examine risk factors for and all-cause, injury-related and non-injury-related mortality among those diagnosed with an AUD. Setting Department of Veterans Affairs, Veterans Health Administration (VHA). Participants A cohort of individuals who received health care in VHA during the fiscal year (FY) 2001 (n = 3 944 778), followed from the beginning of FY02 through the end of FY06. Measurements Demographics and medical diagnoses were obtained from VHA records. Data on mortality were obtained from the National Death Index. Findings Controlling for age, gender and race and compared to those without AUDs, individuals with AUDs were more likely to die by all causes [hazard ratio (HR) = 2.30], by injury-related (HR = 3.29) and by non-injury-related causes (HR = 2.21). Patients with AUDs died 15 years earlier than individuals without AUDs on average. Among those with AUDs, Caucasian ethnicity and all mental illness diagnoses that were assessed were associated more strongly with injury-related than non-injury-related mortality. Also among those with AUDs, individuals with medical comorbidity and older age were at higher risk for non-injury related compared to injury-related mortality. Conclusions In users of a large health-care system, a diagnosis of an AUD is associated significantly with increased likelihood of dying by injury and non-injury causes. Patients with a diagnosis of an AUD who die from injury differ significantly from those who die from other medical conditions. Prevention and intervention programs could focus separately upon selected groups with increased risk for injury or non-injury-related death. [source]

Complications of craniofacial resection for malignant tumors of the skull base: Report of an International Collaborative Study,

The safety and tolerability of duloxetine in depressed elderly patients with and without medical comorbidity

INTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 8 2007
T. N. Wise
Summary Aim and methods:, The impact of medical comorbidity on the efficacy and tolerability of duloxetine in elderly patients with major depressive disorder (MDD) was investigated in this study. Data were obtained from a multicentre, randomised, double-blind, placebo-controlled study in 311 patients with MDD aged 65,89. The primary outcome measure was a prespecified composite cognitive score based on four cognitive tests: (i) Verbal Learning and Recall Test; (ii) Symbol Digit Substitution Test; (iii) 2-Digit Cancellation Test and (iv) Letter-Number Sequencing Test. Secondary measures included the Geriatric Depression Scale (GDS), 17-Item Hamilton Depression Scale (HAMD17), Clinical Global Impression-Severity (CGI-S) Scale, Visual Analogue Scale (VAS) for pain and 36-Item Short Form Health Survey (SF-36). Tolerability measures included adverse events reported as the reason for discontinuation and treatment-emergent adverse events (TEAEs). The consistency of the effect of duloxetine vs. placebo comparing patients with and without medical comorbidity (vascular disease, diabetes, arthritis or any of these) was investigated. Results:, Overall, duloxetine 60 mg/day demonstrated significantly greater improvement compared with placebo for the composite cognitive score, GDS and HAMD17 total scores, CGI-Severity, HAMD17 response and remission rates, and some of the SF-36 and VAS measures. There were few significant treatment-by-comorbidity subgroup interactions for these efficacy variables, or for adverse events reported as the reason for discontinuation and common TEAEs. Conclusions:, The present analyses suggested that the efficacy of duloxetine on cognition and depression in elderly patients, and its tolerability, were not largely affected by the comorbidity status. These results further support the use of duloxetine in elderly patients with MDD. [source]

Suicidal ideation among elderly homecare patients

INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 1 2007
Patrick J. Raue
Abstract Objectives To identify the prevalence, correlates, and one-year naturalistic course of suicidal ideation in a representative sample of elderly adults newly admitted to visiting nurse homecare. Method Five hundred and thirty-nine participants (aged ,65), newly initiating homecare for skilled nursing services, were interviewed with the Structured Clinical Interview for DSM-IV (SCID-IV) and measures of depression severity, medical comorbidity, functional status, and social support. Participants were classified as having no suicidal ideation in the past month, passive ideation, active ideation, or active ideation with poor impulse control or suicide plan. Results Fifty-seven participants (10.6%) reported passive and six (1.2%) reported active suicidal ideation. Higher depression severity, greater medical comorbidity, and lower subjective social support were independently associated with the presence of any level of suicidal ideation. At one year, suicidal ideation persisted for 36.7% of those with ideation at baseline, and the incidence of suicide ideation was 5.4% Conclusions The high prevalence, persistence, and incidence of suicidal ideation in medically ill home healthcare patients underscore the relevance of this population for suicide prevention efforts. The clinical and psychosocial factors associated with suicidal ideation in this underserved, high-risk population are potentially modifiable, and thus useful targets for suicide prevention interventions. Copyright © 2006 John Wiley & Sons, Ltd. [source]

Risk factors for neuropsychiatric symptoms in dementia: the Cache County Study

INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 9 2006
M. Steinberg
Abstract Objective To investigate the probability of individual neuropsychiatric symptoms in dementia patients as a function of eight risk factors. Methods In the Cache County Study, we administered the Neuropsychiatric Inventory (NPI) to 328 dementia patients at baseline. Approximately 18 months later, we re-administered the NPI to 184 participants available for follow-up. Generalized estimating equation methods were used to model the probability of individual neuropsychiatric symptoms as a function of: gender, age, education, dementia type and severity, APOE status, time of observation, and general medical health. Results Women showed increased tendency toward anxiety, [odds ratio (OR) 2.22, 95% confidence interval (CI) 1.31,3.76] and delusions (OR 2.15, CI 1.22,3.78), but older persons of both sexes showed less tendency toward anxiety. Dementia severity increased the tendency toward hallucinations and agitation (OR 2.42, CI 1.81,3.23) and decreased risk of depression. Positive APOE ,4 status increased the tendency toward aberrant motor behavior (OR 1.84, CI 1.05,3.22). Among dementia diagnoses, those with Alzheimer's disease showed decreased tendency toward agitation (OR 0.58, CI 0.35,0.95), depression (OR 0.56, CI 0.33,0.96) and disinhibition (OR 0.46, CI 0.24,0.88). Later time of observation increased risk of aberrant motor behavior and delusions, and more serious medical comorbidity increased risk of, agitation, irritability, disinhibition, and aberrant motor behavior. Conclusions Gender, age, dementia severity, APOE ,4, dementia diagnosis, time of observation, and general medical health appear to influence the occurrence of individual neuropsychiatric symptoms. Copyright © 2006 John Wiley & Sons, Ltd. [source]

The systematic assessment of depressed elderly primary care patients

INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 6 2001
Patrick J. Raue
Abstract Studies of the primary care treatment of depressed elderly patients are constrained by limited time and space and by subject burden. Research assessments must balance these constraints with the need for obtaining clinically meaningful information. Due to the wide-ranging impact of depression, assessments should also focus on suicidality, hopelessness, substance abuse, anxiety, cognitive functioning, medical comorbidity, functional disability, social support, personality, service use and satisfaction with services. This paper describes considerations concerning the assessment selection process for primary care studies, using the PROSPECT (Prevention of Suicide in Primary Care Elderly: Collaborative Trial) study as an example. Strategies are discussed for ensuring that data are complete, valid and reliable. Copyright © 2001 John Wiley & Sons, Ltd. [source]

Use of the Late-Life Function and Disability Instrument to Assess Disability in Major Depression

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 9 2009
Jordan F. Karp MD
OBJECTIVES: To determine whether there was greater disability in subjects with depression than in those without, the correlation between disability and depression severity and quality of life, and whether improvement in disability after antidepressant pharmacotherapy was greater in those who responded to antidepressant treatment. DESIGN: Disability in subjects with and without depression from two different studies was compared for 22 weeks. Correlations were performed for the subjects with depression between disability and depression, anxiety, health-related quality of life (HRQOL), and medical comorbidity. T -tests were used to compare disability between subjects who did and did not respond to antidepressant treatment and change in disability after pharmacotherapy. SETTING: Late-life depression research clinic. PARTICIPANTS: The 313 subjects were recruited from primary care and the community and were aged 60 and older; 244 subjects were participants in a depression treatment protocol, and 69 subjects without depression participated in a separate longitudinal observational study of the mental and cognitive health of depression-free older adults. MEASUREMENTS: The Late-Life Function and Disability Instrument (LL-FDI), a measure of instrumental activity of daily living, personal role, and social role functioning. RESULTS: Subjects with depression scored lower than controls for domains measuring limitation (can do) and frequency (does do) of activities. Both disability domains correlated with depression severity, anxiety, HRQOL, and cognition. Disability improved with antidepressant treatment; for partial responders who continued to receive higher-dose antidepressant treatment out to 22 weeks, there was continued improvement, although not to the level of comparison subjects without depression. CONCLUSION: The LL-FDI appears to discriminate subjects with depression from those without, correlates with depression severity, and demonstrates sensitivity to antidepressant treatment response. We recommend further investigation of the LL-FDI and similar disability instruments for assessing depression-related disability. [source]

Medical Comorbidity and Rehabilitation Efficiency in Geriatric Inpatients

Co-occurrence of posttraumatic stress disorder with positive psychotic symptoms in a nationally representative sample

JOURNAL OF TRAUMATIC STRESS, Issue 4 2005
Jitender Sareen
The association between posttraumatic stress disorder (PTSD) and positive psychotic symptoms was examined in the National Comorbidity Survey (N = 5877). The Composite International Diagnostic Interview (CIDI) was used to make DSM-III-R (Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised; American Psychiatric Association, 1987) diagnoses. Posttraumatic stress disorder was found to be associated with an increased likelihood of endorsing one or more psychotic symptoms after adjusting for sociodemographics, psychiatric and medical comorbidity (odds ratios (OR) = 1.83; 95% confidence interval (CI): 1.43,2.45; p < .001). The co-occurrence of PTSD with psychotic symptoms was marked by greater levels of severity (higher total number of PTSD symptoms, greater levels of comorbidity, and high distress) compared with PTSD alone. This is the first population-based study to investigate PTSD in relation to endorsement of positive psychotic symptoms, and a strong association was obtained. [source]

Disproportionately High Rate of Epileptic Seizure in Patients Abusing Dextropropoxyphene

THE AMERICAN JOURNAL ON ADDICTIONS, Issue 5 2009
Debasish Basu MD
Dextropropoxyphene (DPP), a weak opioid, is often abused as a psychoactive substance. In this retrospective chart review to document, characterize and put in perspective the often-obtained history of epileptic seizures in patients with DPP abuse, we analyzed the case files of all patients with DPP abuse registered in our center (a tertiary-care drug de-addiction clinic in north India) from May 1, 2001 until April 30, 2007 and those with use of other opioids during the same period. Non-drug-related seizures were excluded from analysis. Out of 312 patients with DPP abuse, 63 (20.2%) had epileptic seizures related to DPP use, in contrast to 0.4% ,4.2% of other opioid users. The seizures were mostly characterized as generalized tonic-clonic seizures (87.3%), occurring around two hours following a higher-than-usual dose of DPP. Those with seizures had significantly greater duration of DPP use and higher rates of medical comorbidity compared to patients without seizure. Age, duration of use and medical comorbidity were better predictors of seizure than dosage of drug or use of multiple drugs. Thus, DPP-induced epileptic seizures are common (one in five), and much more frequent than seizures in patients using other opioids. The awareness of this phenomenon has implications for diagnosis and management, as well as for drug regulation policy. [source]