A patient-completed screening instrument for functional disability in the elderly
Article Abstract:
Geriatric assessment, or evaluation of elderly patients, has been useful in detecting their diseases and disabilities and in identifying elderly patients who may need to be placed in a health care institution. This process has helped to decrease the rates of death and disability among the elderly. There is no standard procedure for geriatric assessment, which consists of evaluation of the medical, functional, mental and emotional status, as well as the economic and social well-being, of patients by physicians, nurses, and other health care professionals. Geriatric evaluation is time-consuming and requires the participation of many health care personnel. This medical examination may not be covered by health insurance, and is often performed in private, office-based medical practices that are not equipped for evaluations of functional disabilities. A suitable screening instrument, or method of testing, for disability is required to identify elderly persons at risk for health service use, institutionalization, and adverse outcomes. A screening instrument called the Functional Assessment Screen was developed and compared to the standard geriatric evaluation. The ability of the screening instrument to predict the future use of home care services in 58 elderly patients was also assessed. The patients were an average age of 76 years, frail, and functionally disabled. At the 18-month follow-up, of the 58 elderly patients nine had required placement in an institution, five had died, and 31 had required new home care services. The screening instrument was as sensitive as but less specific than clinical evaluation in detecting social, economic, and health problems. The need for home care services was higher among patients with poor health status and dependency in housework, shopping, meals, dressing, and bathing. These findings show that the screening instrument can identify patients who need home services, and would be beneficial in office practice. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1991
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Chromogranin A in familial pheochromocytoma: diagnostic screening value, prediction of tumor mass, and post-resection kinetics indicating two-compartment distribution
Article Abstract:
The protein chromogranin A is stored and released with catecholamine hormones from chromaffin cells, which are located in the adrenal gland and sympathetic nerves. Studies show that chromogranin A levels are increased in patients with pheochromocytoma, a chromaffin cell tumor that releases excessive amounts of catecholamines. (The sympathetic nervous system controls involuntary body functions under conditions of stress, such as anger, fear and increased physical activity. Catecholamine hormones mediate the effects of the sympathetic nervous system.) Pheochromocytoma is characterized by pounding headaches, sweating, palpitations, apprehension, facial flushing, nausea and vomiting, and tingling of the extremities. The relationship of chromogranin A levels to the diagnosis and type of pheochromocytoma and to tumor size was assessed. A high incidence of pheochromocytoma among members of a family is the familial form of the disease, whereas the sporadic form occurs in scattered instances. Chromogranin A levels of greater than 52 nanograms per milliliter were 83 percent sensitive (identifies people with the disease) and 100 percent specific (identifies people who do not have the disease) in detecting familial pheochromocytoma. Measurement of chromogranin A levels were comparable to other methods used to diagnose pheochromocytoma. Among 13 patients with either familial or sporadic pheochromocytoma, blood levels of chromogranin A could effectively predict the tumor size before surgical removal of the tumor. A model was developed to predict the change and distribution of chromogranin A levels after pheochromocytoma removal. The model suggested that, after removal of the tumor, stored chromogranin A may still be detected outside of blood vessels. These findings demonstrate that chromogranin A levels may be used to diagnose familial or sporadic pheochromocytoma and to predict tumor size. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1990
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Screening for hereditary non-polyposis colorectal cancer: a study of 22 kindreds in the Netherlands
Article Abstract:
The natural history of hereditary cancer of the colon and rectum which does not form polyps (non-polyposis colorectal carcinoma or HNPCC) is studied to determine the usefulness of screening family members of known HNPCC patients. HNPCC patients and family members who were found to have the disease by screening were evaluated for the stage of the disease. Tissue samples were taken of lesions (sores) and evaluated by microscopic (biopsy) examination. Tumors were classified and their location noted and described in the results of the study. The authors believe that careful examination of the colon in members of HNPCC families who do not have symptoms of the disease is justified. Screening should be initiated at the age of 20 and continued for the rest of the individual's life. The authors suggest that once a patient has been diagnosed, the removal of part of the colon is proper because of the risk of more primary tumors.
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1989
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