Improving measurement of functional status among older adults in primary care: A pilot study.

Despite its importance for clinical care and outcomes among older adults, functional status-the ability to perform basic activities of daily living (ADLs) and instrumental ADLs (IADLs)-is seldom routinely measured in primary care settings. The objective of this study was to pilot test a person-centered, interprofessional intervention to improve identification and management of functional impairment among older adults in Veterans Affairs (VA) primary care practices. The four-component intervention included (1) an interprofessional educational session; (2) routine, standardized functional status measurement among patients aged ≥75; (3) annual screening by nurses using a standardized instrument and follow-up assessment by primary care providers; and (4) electronic tools and templates to facilitate increased identification and improved management of functional impairment.

Relationship, marriage, and parenthood aspirations among sexual and gender minority youth assigned female at birth.

This study examined aspirations for future long-term committed relationships, marriage, and parenthood in a sample of 392 racially diverse sexual and gender minority (SGM) youth assigned female at birth (AFAB) aged 16-20. Differences by gender identity, sexual identity, and race/ethnicity were assessed, as were associations with contextual variables including minority stressors, SGM community involvement, perceived partner availability, and relationship experiences. Results showed that the majority of SGM-AFAB youth viewed long-term committed relationships as important and likely, whereas only about half of participants had high aspirations to get married and have children someday.

Factor analysis and matrix invariance of the HRNB-C category test.

This study examined the factorial invariance of the six individual Halstead-Reitan Neuropsychological Battery for Older Children (HRNB-C) Category subtests. The test scores for two large samples of learning disabled children were factor analyzed. A three-factor solution emerged for each group with a clear pattern of variable loadings.

Candida albicans purulent pericarditis treated successfully without surgical drainage.

Cures of Candida pericarditis reported in the literature uniformly involved surgical drainage of the pericardial space. We report a patient with purulent pericarditis caused by Candida albicans who was treated successfully with antifungal chemotherapy combined with a single pericardiocentesis that did not completely evacuate the pericardial space. This case indicates that thoracotomy with surgical drainage of the pericardium is not mandatory for successful therapy of Candida pericarditis.

Endogenous interferon-gamma, macrophage activation, and murine host defense against acute infection with Trypanosoma cruzi.

Parenteral interferon-gamma (IFN-gamma) activates murine macrophages to inhibit Trypanosoma cruzi multiplication and diminishes parasitemia and mortality in acute infection. To investigate the role of endogenous IFN-gamma in acute infection, monoclonal antibody to IFN-gamma was injected intraperitoneally into mice. The 6250 neutralizing units given 24 and 96 h after infection reproducibly increased mortality (P less than .

Alternative splicing of the HOX 2.2 homeobox gene in human hematopoietic cells and murine embryonic and adult tissues.

The HOX 2.2 homeobox gene is expressed in human hematopoietic cell lines with erythroid features (W.-F.

Cardiovascular evaluation after withdrawal from chronic alcohol or cocaine-alcohol abuse.

Alcohol ingestion commonly accompanies cocaine abuse, but the effects of chronic cocaine-alcohol abuse on the circulation are undefined. Therefore, to test for evidence of cocaine-alcohol cardiac dysfunction and interference with cardiovascular nervous system reflexes, 10 normal volunteers (group I), 8 asymptomatic alcoholic patients (group II), and 15 age matched, asymptomatic cocaine and alcohol abusers (group III) underwent screening two-dimensional echocardiography, electrocardiography, a series of autonomic nervous system tests, and upright bicycle exercises. Echocardiographic indices did not differ among groups.

"Spontaneous sump syndrome": Successful treatment by duodenoscopic sphincterotomy.

"Sump syndrome" is a rare complication of side-to-side choledochoenterostomy operations which develops in the distal, nonfunctioning limb of the common bile duct where lithogenic bile, gastrointestinal contents, and debris accumulate. We report here a patient who developed spontaneous sump syndrome as a result of the formation of choledochoduodenal fistula, and who presented with multiple pyogenic liver abscesses. The patient's symptoms and liver abscesses resolved completely after treatment by endoscopic sphincterotomy and antibiotics.

Current diagnosis and management of toxoplasmosis in cancer patients.

Toxoplasmosis should be considered as a potential pathogen in cancer patients who have clinical syndromes, especially lymphadenopathy, for which the cause is not clear. Patients with reticuloendothelial malignancies or solid cancers treated with systemic chemotherapy or with progressive disease appear to be at particular risk for life-threatening toxoplasmosis. There has also been an explosion in the number of cases of toxoplasmic encephalitis in patients infected with HIV.

Insulin resistance and hypertension.

The author has reviewed the development of the concept that insulin resistance is related not only to the hypertensive state but potentially to the initiation and maintenance of high blood pressure. Potential sequelae of insulin resistance and hyperinsulinemia, as they apply to atherogenesis, are also discussed. The impact of present antihypertensive pharmacologic therapy on insulin resistance is addressed, as are future directions in pharmacologic and nonpharmacologic management of hypertension.

Endobronchial radiation therapy (EBRT) in the management of lung cancer.

Between October 1987 and November 1988, 19 endobronchial Iridium-192 line source placements were attempted in 17 patients with advanced incurable lung cancer. Approximately 30 Gy was delivered to the endobronchus using a low dose rate (LDR) afterloading technique delivering a mean dose of 70 cGy/hr at 5 mm. Improvement in subjective symptoms was noted in 67% of evaluable patients whereas objective responses defined by chest X ray and bronchoscopy were noted in 26% and 60%, respectively.

Cerebellar structures and the programming of movement sequences.

Two patients with unilateral damage to the medial and lateral cerebellum were examined to determine whether local structures in the cerebellum are used to execute programmed movement sequences. Both patients performed a sequential tapping task which required the execution of either a single keystroke or of a sequence of three keystrokes. Movements executed with the contralateral hand showed increases in response onset times as the movement sequence increased from one to three response elements (sequence length effect).