Original Research: Implementation of an Early Mobility Program in an ICU.

Objective: Research is needed to determine the feasibility of implementing a dedicated ICU mobility team in community hospital settings. The purpose of this study was to assess, in one such hospital, four nurse-sensitive quality-of-care outcomes (falls, ventilator-associated events, pressure ulcers, and catheter-associated urinary tract infections [CAUTIs]), as well as hospital costs, sedation and delirium measures, and functional outcomes by comparing ICU patients who received physical therapy from a dedicated mobility team with ICU patients who received routine care.

Methods: We conducted a retrospective longitudinal study at a community acute care hospital; patients were randomly assigned to intervention or routine care groups.

Turbulent heating in galaxy clusters brightest in X-rays.

The hot (10(7) to 10(8) kelvin), X-ray-emitting intracluster medium (ICM) is the dominant baryonic constituent of clusters of galaxies. In the cores of many clusters, radiative energy losses from the ICM occur on timescales much shorter than the age of the system. Unchecked, this cooling would lead to massive accumulations of cold gas and vigorous star formation, in contradiction to observations.

A massive, cooling-flow-induced starburst in the core of a luminous cluster of galaxies.

In the cores of some clusters of galaxies the hot intracluster plasma is dense enough that it should cool radiatively in the cluster's lifetime, leading to continuous 'cooling flows' of gas sinking towards the cluster centre, yet no such cooling flow has been observed. The low observed star-formation rates and cool gas masses for these 'cool-core' clusters suggest that much of the cooling must be offset by feedback to prevent the formation of a runaway cooling flow. Here we report X-ray, optical and infrared observations of the galaxy cluster SPT-CLJ2344-4243 (ref.

Transient global amnesia: a case report and literature review.

In this case report and review of the literature, transient global amnesia (TGA) is discussed. A 72-year-old physician presented to the emergency department with sudden loss of memory. In particular, he was unable to recall recent events.

Discrete sources as the origin of the Galactic X-ray ridge emission.

An unresolved X-ray glow (at energies above a few kiloelectronvolts) was discovered about 25 years ago and found to be coincident with the Galactic disk-the Galactic ridge X-ray emission. This emission has a spectrum characteristic of a approximately 10(8) K optically thin thermal plasma, with a prominent iron emission line at 6.7 keV.

End-of-life care in Hancock County, Maine: a community snapshot.

This study presents a model for identifying end-of-life concerns in 1 rural community: Hancock County, Maine. Focus groups and structured interviews were held with primary care physicians, hospice staffs, clergy, hospice board members, long-term care facility staffs, and families of patients who had died either with or without hospice services. A list of suggestions for action within the community was generated from the interviews.

Hospice and palliative care: an educational intervention for healthcare professionals in a rural community.

The purpose of the study was to increase the awareness and availability of hospice care in rural communities. In Taos, New Mexico, a community of about 30,000 people, we developed an educational intervention that introduced the topic of end-of-life care and hospice to their healthcare professionals. We targeted nurses, physicians, and other related healthcare professionals.

The ABCs of New Zealand Sign Language: Aerial Spelling.

Aerial spelling is the term given here for the way many deaf people in New Zealand, especially the elderly, manually represent letters of the alphabet. It is simply a system using the index finger to write letter(s) "in the air" and is an integral part of New Zealand Sign Language (NZSL). Unfortunately, recent research into NZSL is either dismissive of it or fails to acknowledge it.

Comprehension of written health care information in an affluent geriatric retirement community: use of the Test of Functional Health Literacy.

Background: The comprehension of written health care information, e.g. prescription bottle labels or an informed consent form, impacts on communication with patients and their ability to understand medical procedures, as well as goals of therapy.

Chandra X-Ray Observations of the Hydra A Cluster: An Interaction between the Radio Source and the X-Ray-emitting Gas.

We present Chandra X-ray observations of the Hydra A cluster of galaxies, and we report the discovery of structure in the central 80 kpc of the cluster's X-ray-emitting gas. The most remarkable structures are depressions in the X-ray surface brightness, approximately 25-35 kpc in diameter, that are coincident with Hydra A's radio lobes. The depressions are nearly devoid of X-ray-emitting gas, and there is no evidence for shock-heated gas surrounding the radio lobes.

A Chandra High-Resolution X-ray Image of Centaurus A.

We present first results from a Chandra X-Ray Observatory observation of the radio galaxy Centaurus A with the High-Resolution Camera. All previously reported major sources of X-ray emission including the bright nucleus, the jet, individual point sources, and diffuse emission are resolved or detected. The spatial resolution of this observation is better than 1&arcsec; in the center of the field of view and allows us to resolve X-ray features of this galaxy not previously seen.

Chandra X-Ray Detection of the Radio Hot Spots of 3C 295.

An observation of the radio galaxy 3C 295 during the calibration phase of the Chandra X-Ray Observatory reveals X-ray emission from the core of the galaxy, from each of the two prominent radio hot spots, and from the previously known cluster gas. We discuss the possible emission processes for the hot spots and argue that a synchrotron self-Compton (SSC) model is preferred for most or all of the observed X-ray emission. SSC models with near-equipartition fields thus explain the X-ray emission from the hot spots in the two highest surface brightness FR II radio galaxies, Cygnus A and 3C 295.

Incorporating education on palliative care into the long-term care setting. National Consensus Conference on Medical Education for Care Near the End of Life.

Approximately one-third of all Americans will pass through a long-term care facility before they die, and many who require palliative care will reside there during the final weeks and months of their lives. In order to address this need, the unique characteristics of long-term care facilities are outlined, and the incentives for all levels of academic institutions to offer education in that setting are presented.

Formal geriatric assessment, An imperative for the older person with cancer.

Purpose: The authors evaluate the role of cognitive, functional, and affective geriatric assessment measures in elderly cancer patients, and analyze the associations between these factors, stage of malignancy, and cancer treatment choices.

Description: Fifty consecutive patients older than 65 years of age who were referred to the Geriatric Oncology Clinic at the University of New Mexico Health Sciences Center in Albuquerque were evaluated using standard geriatric assessment tools. Each person underwent a complete history and physical examination.

Symptomatic management of the older person with cancer.

The older person with cancer is often unable to participate in treatment regimens that a younger person might tolerate. We review the complex reasons why this may be so as well as provide to the reader a brief review of the major symptoms that can cause suffering and treatment regimens that can improve the patient's sense of well being. Palliative care provides the older person with advanced cancer the opportunity to live his or her life to the fullest during that period of life called dying.

Life expectancy, comorbidity, and quality of life. A framework of reference for medical decisions.

The treatment of cancer in the elderly can benefit from increasingly sophisticated methods that measure a patient's quality of life. These measures are both general and cancer specific and herald a new and enlightened approach to patient care. The care of the older patient must be seen in light of what is known about life expectancy, the outcome of treatment, an awareness of comorbidity, and the importance of informed consent and respect for the values and preferences of the individual patient.

Opioid analgesic drugs in the elderly.

Much is known about opioid metabolism, which is critical in administering these agents to the elderly. Fear of addiction and tolerance are the major barriers to their use among patients as well as health-care professionals. Addressing these issues early in the initiation opioid therapy will help to alleviate these concerns.

Abscess formation in desmoid tumors of Gardner's syndrome and percutaneous drainage: a report of three cases.

Purpose: To describe abscess formation complications in desmoid tumors of patients with Gardner's syndrome and percutaneous drainage.

Methods: Three patients with Gardner's syndrome and intramesenteric desmoid tumors were diagnosed as having intratumor abscess formation. Percutaneous drainage was the initial method of treatment in each case.

A community survey of ptosis of the eyelid and pupil size of elderly people.

A randomly selected, age-stratified sample of subjects 50 years of age and older, living in the Salford Health District area of Greater Manchester was drawn from the age-sex register of a four-doctor group practice and invited by post to enter a study of ptosis. Of 851 subjects approached, 499 (59%) replied. Of these, 99 refused to participate.

The role of chemotherapy and adjuvant therapy in the management of colorectal cancer.

This review of the current literature related to the use of chemo- and adjuvant chemotherapy in colorectal carcinoma emphasizes the present dilemma in caring for people affected with this disorder. Adjuvant chemotherapy using combinations of 5-fluorouracil and levamisole clearly prolong survival, albeit, for only a small group of individuals. However, for the older person, this regimen may be associated with unacceptable toxicity and a physician's inability to deliver a dose-intensive course, as the authors currently understand it.