Apathy: Why Care?

(Reprinted with permission from 2005; 17:7-19).

Apathy: why care?

This review presents data showing that apathy is common across a number of disorders. Apathy is not only common, but is also associated with significant problems: reduced functional level, decreased response to treatment, poor illness outcome, caregiver distress, and chronicity. Preliminary evidence of treatment efficacy exists for dopaminergic drugs and for amphetamines.

A randomized, placebo-controlled trial of the discontinuation of long-term antipsychotics in dementia.

The objectives of this randomized clinical trial were to investigate the impact of the discontinuation of long-term antipsychotics in residents with dementia in chronic care institutions and to identify clinical predictors of safe discontinuation. Subjects included 34 residents with dementia who were on antipsychotics for more than 6 months and whose behavior was currently stable. Subjects were randomized to either continue receiving their regular dosage of antipsychotics or to receive placebo for 6 months.

Repeat neurobehavioral study of borderline personality disorder.

Previous research has tentatively identified a large subgroup of patients with borderline personality disorder (BPD) with histories of developmental or acquired brain insults. Similarly, these studies have demonstrated a possible biological correlation between the severity of BPD and the number of previous brain insults. The possibility of frontal system cognitive dysfunction in BPD has been raised.

A retrospective analysis of laparoscopic and open cholecystectomies.

A total of 686 consecutive cases were reviewed for comparison between open cholecystectomy (OC) and laparoscopic cholecystectomy (LC). The procedures were performed by the teaching surgical service of a community hospital. Between March 1989 and December 1992, 381 patients had LC, 262 had OC, and 43 patients had attempted LC that was converted to open cholecystectomy (CONV).

Distal thigh/arm index as a predictor of success for lumbar sympathectomy.

Data from 90 lumbar sympathectomies were reviewed to assess the role of a distal thigh/arm Doppler systolic index (DTAI) and of external magnetic flowmeter (MCBF) measurements for predicting patient outcome following lumbar sympathectomy. The presenting symptoms included impending gangrene, gangrene, rest pain, nonhealing ulcers, and disabling claudication. Of the 90 cases, clinical improvement occurred in 57% of the limbs.

The relationship of surface reflectance measurements to optical properties of layered biological media.

Reflectance from a turbid biological tissue is discussed for a diffusive light source illuminating the surface of the medium, and is related to the optical property distribution within the medium and to photon propagation through the medium. A three-dimensional photon diffusion model with closed form is developed to describe the photon diffuse intensity in a homogeneous medium. The solution is extended by numerical methods to the medium with layered structure.

A compartment model for fluorometric indication of tissue perfusion.

Sodium fluorescein is an in vivo blood perfusion indicator for soft tissue. When fluorescein dye is introduced into the blood, it distributes throughout the vasculature and the extravascular space. Incident light from an external source causes the dye to fluoresce, the level of which is monitored by a photodetector placed over the tissue.

Monitoring skin fluorescein delivery independent of skin pigmentation.

This study evaluated two changes in fluorometric assessment of fluorescein dye delivery: (1) monitoring the proportional, rather than the absolute, increase above the preinjection background reading at each site to obviate the effect of skin color and (2) employing gradual means of dye administration to facilitate monitoring uptake kinetics and to lessen the likelihood and severity of histamine-mediated reactions. In 15 beagles, background and postdye readings were obtained with the fiberoptic fluorometer at 27 pairs of matched light- and dark-skin sites of intact perfusion. After dye administration, the absolute increase in fluorescence at light sites averaged more than twice (approximately 225%) that at dark sites.

In vivo reflectance of blood and tissue as a function of light wavelength.

Light reflectance from soft tissue has been utilized in noninvasive clinical measurement devices such as the photoplethysmograph and the reflectance pulse oximeter. Incident light on the skin travels into the underlying layers and is in part reflected back to the surface. This paper describes the reflectance of light from in vivo tissue for wavelengths in the range from 420 to 940 nm, based on photon diffusion theory and on experimental results from studies of 17 subjects.

Constant infusion fluorometry to predict flap survival.

Prediction of surgical flap survival in a dog model was evaluated by using the technique of fluorometry. The model provides a graded variation of flap ischemia with tissue necrosis occurring at the distal end. The indicator sodium fluorescein was administered via the saphenous vein at a constant infusion rate for 20 minutes.

Effect of lumbar sympathectomy on muscle blood flow: distribution of perfusion measured by hydrogen clearance in skeletal muscle.

Measurements of local tissue blood flow using a technique of hydrogen clearance were used to examine the effect of lumbar sympathectomy on skeletal muscle blood flow. Polarographic recordings on 25 hydrogen desaturations were obtained with platinized platinum electrodes. Lumbar sympathectomies were done on five canines leaving the contralateral limb as a control.

Clinical engineering as an academic discipline.

This paper includes sections written by the current or former Clinical Engineering coordinators of five universities on common problems faced by Clinical Engineering (CE) educational programs and the different solutions adopted on various campuses. The problems discussed include student recruitment, financial support, containment of student credit hours and faculty time, retention of CE graduates in the profession, and differentiation between Clinical Engineering and Biomedical Engineering Technology.

Mortality from coronary heart disease in the Tecumseh study. Long-term effect of diabetes mellitus, glucose tolerance and other risk factors.

The coronary heart disease mortality of participants in the Tecumseh study was examined with particular emphasis on the roles of diabetes and glucose tolerance as risk factors. The cohort consisted of 921 men and 937 women aged 40 years and older who did not have evident coronary heart disease at entry to the study during the period 1959-1965 and whose outcome was determined in the period 1977-1979. Previously diagnosed diabetes was a statistically significant risk factor for coronary heart disease mortality in both sexes even after controlling for systolic blood pressure, serum cholesterol, relative weight, and cigarette smoking.

Diabetes mellitus in Tecumseh, Michigan. Prevalence, incidence, and associated conditions.

A high proportion of the population of Tecumseh, Michigan, participated in comprehensive assessments of health, personal habits, and socioeconomic status during the periods 1959-1960 and 1962-1965. A total of 5735 persons older than 20 years of age, comprising 2749 men and 2986 women, form the subject of this report. Diabetics were identified at entry and contrasted to nondiabetics with respect to personal characteristics.

Blood glucose and risk of coronary heart disease.

Health status of 1877 Tecumseh Study subjects aged 35-64 years was ascertained in 1977. They represented 77% of the persons in this age range who were apparently healthy and had participated in comprehensive examinations of nearly the entire population of the community in 1959-1960 and 1962-1965. Subjects who developed coronary heart disease had a significantly higher mean blood glucose concentration than other members of the cohort, even after exclusion of diabetics.

Physiological variables and diabetic status. Findings in Tecumseh, Mich.

A random sample of 568 participants in the Tecumseh, Mich, study, aged 30 to 59 years, was stratified according to blood glucose concentration to select a high proportion of diabetics. Subjects were categorized as overt diabetics, chemical or probable diabetics, or nondiabetics. Diabetic groups and nondiabetics were compared for levels of blood glucose, plasma insulin, serum cholesterol, serum triglyceride, blood pressure, and contours of glucose and insulin curves.

Oral contraceptives and physiological variables.

Physiological variables were compared among women who had never used oral contraceptives, past users, and current users. Randomly selected subjects were aged 30 to 59 years. Blood was sampled for determination of blood glucose, serum cholesterol and triglyceride, and plasma insulin concentration.

Studies of blood pressure in Tecumseh, Michigan. I. Blood pressure in young people and its relationship to personal and familial characteristics and complications of pregnancy in mothers.

Relationships between blood pressures (BPs) of young people and a number of personal, parental and familial characteristics have been assessed in the population of Tecumseh, Michigan. Systolic and fifth phase diastolic BPs were measured in 4500 persons under 20 years of age at the time of their first examination. Body size, fatness and heart rates of the subjects themselves were significantly related to their age- and sex-adjusted BP scores.