A randomized trial of a consultation service to reduce falls in nursing homes.

Context: Falls are a major health problem in nursing homes, but no interventions have been shown to prevent falls in nursing home residents.

Objective: To evaluate an intervention program designed to prevent falls and associated injuries in high-risk nursing home residents.

Design: Randomized controlled trial.

MR diffusion imaging of human intracranial tumours.

We used MRI for in vivo measurement of brain water self-diffusion in patients with intracranial tumours. The study included 28 patients (12 with high-grade and 3 with low-grade gliomas, 7 with metastases, 5 with meningiomas and 1 with a cerebral abscess). Apparent diffusion coefficients (ADC) were calculated in a single axial slice through the tumours, the sequence was sensitive to diffusion along the cephalocaudal axis.

[Volumes of synovial membrane and joint effusion determined by MR imaging. Markers of severity and/or activity in rheumatoid arthritis?].

Volumes of synovial membrane and joint effusion were determined by MRI in 36 knees with gonarthritis and five healthy knees. In 18 knees MRI was performed before and immediately after arthrocentesis. The difference between MRI-determined and syringe-determined volumes of aspirated joint fluid was 0-7 ml, median 2 ml, corresponding to 0-18%, median 7%, of the pre-aspiration effusion volume.

Comparison of swallowing function in Parkinson's disease and progressive supranuclear palsy.

Dysphagia is common in both Parkinson's disease (PD) and progressive supranuclear palsy (PSP). Although it is believed to be more common in PSP, there are no controlled data and no comparison of swallowing function between these two disorders. Our aim was to assess dysphagia and swallow function in patients with PSP and PD.

Effective gastric acid suppression after oral administration of enteric-coated omeprazole granules.

Omeprazole is inactivated by exposure to gastric acid and is formulated as a gelatin capsule containing enteric-coated granules that release the drug in alkaline medium. In clinical situations where patients are unable to take the capsule orally, the optimum means of administration is uncertain. Eleven normal volunteers were given omeprazole 20 mg every day for one week before breakfast in random order as either a 20-mg capsule with water or free enteric-coated granules with either 8 oz of orange juice, 8 oz of water with 2 Alka-Seltzer antacid tablets (aspirin free), or 1 teaspoon of apple sauce.

Clinical and biomechanical measures of balance as fall predictors in ambulatory nursing home residents.

Background: We evaluated the capacity of biomechanical and clinical measures of balance to predict future risk of recurrent falls in a cohort of frail, elderly ambulatory residents of 12 Tennessee community nursing homes.

Methods: Baseline measurements of balance and other potential fall risk factors were obtained in 303 ambulatory nursing home residents. Balance measures included biomechanics force platform measurements of postural sway (area ellipse and mean velocity) and clinical measures, which included functional reach, Tinetti balance subscale (adapted from Tinetti's Performance Oriented Mobility Index), timed chair stands, and 10-foot walk.

Changes in synovial membrane and joint effusion volumes after intraarticular methylprednisolone. Quantitative assessment of inflammatory and destructive changes in arthritis by MRI.

Objective: To evaluate synovial membrane volumes, effusion volumes, and cartilage and bone erosion scores determined by magnetic resonance imaging (MRI) as markers of disease activity and severity in arthritis.

Methods: Gadolinium-DTPA enhanced MRI of 18 arthritic knees was performed before and 1, 7, 30 and 180 days after intraarticular methylprednisolone injection until clinical relapse. Intraobserver, interobserver, and inter-MRI variations were determined from 2 successive MRI of another 6 knees.

Excluding gastroesophageal reflux disease as the cause of chronic cough.

Gastroesophageal reflux disease (GERD) is recognized to be present in 10-20% of cases of chronic cough. Proving that it is the cause of the cough is more difficult. This problem is illustrated by way of a case report demonstrating that GERD can still be the cause, even when the patient is unresponsive to conventional use of proton pump inhibitors.

Sarcoidosis mortality in the United States 1979-1991: an analysis of multiple-cause mortality data.

Purpose: We sought to describe sarcoidosis mortality in the United States from 1979 through 1991.

Methods: We analyzed death certificate reports compiled by the National Center for Health Statistics for the period 1979 through 1991.

Results: Of the 26,866,600 people who died during the study period, 9,014 had a diagnosis of sarcoidosis listed on their death certificates.

Measurement of blood flow in the superior sagittal sinus in healthy volunteers, and in patients with normal pressure hydrocephalus and idiopathic intracranial hypertension with phase-contrast cine MR imaging.

Purpose: To measure blood flow and velocity in the superior sagittal ++sinus.

Material And Methods: MR velocity mapping was used to examine 14 healthy volunteers, 15 patients with normal pressure hydrocephalus (NPH), 3 patients with high pressure hydrocephalus (HPH), and 11 patients with idiopathic intracranial hypertension (IIH).

Results: Mean blood flow was 443 ml/min in healthy volunteers with a tendency towards reduced blood flow with increasing age.

Injurious falls in nonambulatory nursing home residents: a comparative study of circumstances, incidence, and risk factors.

Objective: To determine the circumstances of, incidence of, and risk factors for falls resulting in serious injuries in nonambulatory nursing home residents compared with those for ambulatory residents.

Design: Prospective cohort study with 1-year follow-up.

Setting: Twelve community nursing homes in Tennessee.

Uniform billing data in hospital planning, marketing and clinical guidelines.

Hospitals are major users of inpatient discharge data from the Pennsylvania Health Care Cost Containment Council (PHC4). A hospital planning and marketing executive and a hospital network consultant describe different uses for the data; including planning, competitor analysis, and development of clinical pathways. The PHC4 data are useful because they are reported in a uniform format for all facilities and they provide detailed clinical and financial information.

Psychotropic drugs and risk of recurrent falls in ambulatory nursing home residents.

Although psychotropic drug use has been associated with increased risk of falls in long-term care settings; this association may be confounded by the high prevalence of dementia and depression and other fall risk factors. This question was addressed in a prospective cohort study of recurrent falls among 282 ambulatory residents of 12 Tennessee nursing homes during 1991-1992. Eligible subjects were > or = 65 years of age, ambulatory, able to provide study data, and expected to remain in the nursing home for > or = 3 months.

Gastroesophageal reflux laryngitis resistant to omeprazole therapy.

Gastroesophageal reflux disease (GERD) is known to cause a variety of symptoms that lead a patient to seek otolaryngologic care. New advances in the treatment of GERD have enabled otolaryngologists to eliminate most of the signs and symptoms caused by acid reflux. Omeprazole, the most recent pharmacologic advancement, has been reported to be universally successful in controlling acid release from the stomach of patients with GERD.

Increased brain water self-diffusion in patients with idiopathic intracranial hypertension.

Purpose: To investigate changes in brain water diffusion in patients with idiopathic intracranial hypertension.

Methods: A motion-compensated MR pulse sequence was used to create diffusion maps of the apparent diffusion coefficient (ADC) in 12 patients fulfilling conventional diagnostic criteria for idiopathic intracranial hypertension and in 12 healthy volunteers.

Results: A significantly larger ADC was found within subcortical white matter in the patient group (mean, 1.

Short echo time proton spectroscopy of the brain in healthy volunteers using an insert gradient head coil.

An insert gradient head coil with built-in X, Y, and Z gradients was used for localized proton spectroscopy in the brain of healthy volunteers, using short echo time stimulated echo acquisition mode (STEAM) sequences. Volume of interest size was 3.4 ml, repetition time was 6.

Effect of intraarticular osmic acid on synovial membrane volume and inflammation, determined by magnetic resonance imaging.

The changes in MR-determined synovial membrane volume, early synovial enhancement, and cartilage and bone erosions after osmic acid knee synovectomy were studied. Gadolinium-DTPA enhanced magnetic resonance imaging (MRI) of 18 knees with persistent arthritis was performed before and 1 month after treatment. The synovial membrane volume was significantly reduced (median -52%) in all 9 patients brought into clinical remission (p < 0.

Ultrasonography in arthritis of the knee. A comparison with MR imaging.

Ultrasonography (US) of the knee in gonarthritis was evaluated with gadolinium-DTPA-enhanced MR imaging as a reference. The study included 13 patients with gonarthritis, 2 patients with osteoarthritis and 5 healthy controls. Compared to MR, US identified 100% (12/12) of joint effusions, 100% (5/5) of Baker's cysts, 57% (8/14) of the synovial membranes of the suprapatellar recess and 38% (3/8) of bone erosions.

Scoring of synovial membrane hypertrophy and bone erosions by MR imaging in clinically active and inactive rheumatoid arthritis of the wrist.

MRI-scores of synovial membrane hypertrophy and bone erosions of the RA-wrist are introduced. Gadolinium-DTPA enhanced magnetic resonance imaging (MRI) and conventional radiography (CR) of the wrist were performed in 16 patients with rheumatoid arthritis (RA) and 3 healthy controls. A MRI-score of synovial membrane hypertrophy was obtained by summation of gradings of synovial hypertrophy in 6 regions of the wrist.

The nocturnal increase in human cerebrospinal fluid production is inhibited by a beta 1-receptor antagonist.

A circadian variation in human cerebrospinal fluid (CSF) production has recently been demonstrated using magnetic resonance phase imaging. A nightly peak in CSF production was found at approximately 0200, when production is approximately twice the daytime values. In the present study, we have investigated the effect of a beta 1-receptor antagonist, atenolol, on the production of CSF, specifically the nocturnal production peak.

Increased self-diffusion of brain water in hydrocephalus measured by MR imaging.

We used MR imaging to measure the apparent brain water self-diffusion in 5 patients with normal pressure hydrocephalus (NPH), in 2 patients with high pressure hydrocephalus (HPH), and in 8 age-matched controls. In all patients with NPH significant elevations of the apparent diffusion coefficients (ADC) of brain water were found within periventricular white matter, in the corpus callosum, in the internal capsule, within cortical gray matter, and in cerebrospinal fluid, whereas normal ADCs were found within the basal ganglia. In 2 patients with HPH elevated ADCs were found most prominently within white matter, and in one patient reexamined one year after surgery, ADCs were unchanged in nearly all brain regions.

Assessment of CSF dynamics and venous flow in the superior sagittal sinus by MRI in idiopathic intracranial hypertension: a preliminary study.

A velocity-sensitive magnetic resonance imaging (MRI) phase-mapping method was used for non-invasive study of cerebrospinal fluid (CSF) flow in the cerebral aqueduct, for indirect calculation of supratentorial CSF production, and for measurement of blood flow in the superior sagittal sinus (SSS). We examined 12 patients with idiopathic intracranial hypertension (IIH; pseudotumour cerebri), and 10 healthy volunteers. The peak caudal and rostral CSF flow in the aqueduct during the cardiac cycle did not differ significantly between the patients and the volunteers.

Comparison of clinical and biomechanical measures of balance and mobility in elderly nursing home residents.

Objective: To compare biomechanics force platform measurements of postural sway with clinical measures of balance and mobility, in frail elderly residents of community nursing homes, in terms of feasibility, correlation with other known risk factors for falls, and intercorrelation with each other.

Design: Cross-sectional study.

Setting: Twelve Tennessee community nursing homes.

Long-term follow-up of cerebral infarction patients with proton magnetic resonance spectroscopy.

Background And Purpose: With proton magnetic resonance spectroscopy it is possible to measure the content of various brain metabolites in vivo, including N-acetylaspartate (which may be used as a neuronal marker), creatine, choline, and lactate. The content of these brain metabolites was measured serially from the acute stage to the chronic stage of infarction. Regional cerebral blood flow was also measured within the affected areas.