Faculty Bibliography

BACKGROUND AND OBJECTIVES: Frail older adults are especially vulnerable in a health system that is fragmented and fails to focus on preservation or restoration of function. The School of Nursing at the University of Pennsylvania, together with the School of Medicine and the Hospital of the University of Pennsylvania, established the Collaborative Assessment and Rehabilitation for Elders (CARE) Program to meet the needs of this population. We used the British Day Hospital as a model because it provides a comprehensive approach to care and a bridge between acute, home-based, and institutional long-term care. We have designed our program to provide innovative, interdisciplinary care as well as to be reimbursable under current and future payment structures. This nurse-managed, collaborative practice seeks to maximize independent functioning, promote health, and enhance quality of life for chronically ill, frail older adults living in the community whose needs are left unmet by existing services. The program was certified as a Comprehensive Outpatient Rehabilitation Facility (CORF) in December 1993 to maximize reimbursement of services through Medicare and other third party payers. With a Gerontological Nurse Practitioner as care manager, clients receive an intensive, individualized, time-limited program of nursing, rehabilitation, mental health, social, and medical services in one setting several days each week. Additional geriatric services, such as primary care, are available in the same location when needed. SETTING: The program is housed in renovated space devoted to the care of older people. The academic and clinical offices of the University of Pennsylvania's nursing and medical gerontologic and geriatric faculty are in the same building. PARTICIPANTS: We have targeted those persons older than age 65 who have complex health problems and are living at home. Individuals must need multiple services, including at least one rehabilitation therapy, and they must be unsuitable-for inpatient rehabilitation. DESCRIPTION OF THE POPULATION: In its first 8 months of operation, the program received 97 referrals and admitted 53 clients. Clients were, on average, 78 years of age. Over three-fourths (77%) were women and 58% were black. The average stay in the program was 6 weeks. FIM scores, which improved a mean of 2.4 points, were found to lack sensitivity to the functional improvements achieved by clients. CONCLUSION: Under existing Medicare and third party reimbursement policies, it is feasible to establish a nurse-managed comprehensive outpatient rehabilitation program designed to meet the needs of frail older persons. Preliminary data support the beneficial effects of the program as well as the economic feasibility of this approach.

A small study being published today in The Journal of the American Medical Association strongly links chronic fatigue syndrome to a common abnormality in the way the body regulates blood pressure. Many patients with the syndrome respond to treatment with increased salt and fluid intake in combination with standard drugs to regulate blood pressure, the researchers who carried out the study at Johns Hopkins Hospital in Baltimore said yesterday. But he cautioned that the treatment findings were preliminary and needed to be verified in a larger study conducted under more scientifically rigid criteria before they are widely applied among the estimated 1 million Americans who have chronic fatigue syndrome

Presumably, those with the abnormality of blood pressure regulation have had it all their lives. So the findings would not fully explain why some people with it suddenly develop chronic fatigue syndrome and others never do. A strong possibility, Dr. Calkins said, is that a virus infection or some other unidentified event sets off chronic fatigue syndrome, since so many people date an abrupt onset of the syndrome to a viral infection. 'To some degree, it is diet-related,' Dr. Calkins said. 'If you look at the differences in chronic fatigue syndrome between different countries, you don't see it in South America and Asia, where the diet is high in salt.' The 23 patients in the study were recruited from chronic fatigue syndrome support groups and met the criteria set by the Centers for Disease Control and Prevention for a diagnosis of chronic fatigue syndrome. They were compared with 14 people who responded to an advertisement placed by the researchers and who did not have the syndrome

Consider Dr. Barry J. Marshall, who was among the winners of this year's Albert Lasker Awards, which were announced yesterday. Dr. Marshall was honored for finding that a bacterium, not stress, causes inflammation of the stomach and ulcers. The research was partly based on experiments he did on himself in the early 1980's. Dr. Rosalyn S. Yalow won a Lasker Award in 1976 and a Nobel Prize in 1977, many years after she and Dr. Solomon A. Berson at the Bronx Veterans Administration Hospital developed the radioimmunoassay technique to detect tiny amounts of hormones and other substances. By 1976, Dr. Berson had died, an illustration that prize-worthy scientists need the good fortune to survive until their work is recognized. Posthumous Nobel Prizes and Lasker awards are not given. The Nobel awards were created by the will of Alfred Nobel, the Swedish chemist and inventor of dynamite. Yet the prizes almost did not come into being. The King of Sweden and the Prime Minister went to court to fight Nobel's will in part because they believed that his wealth would be scattered around the world, to Sweden's loss

Federal health officials on Sep 21, 1995 recommended coronary bypass surgery over angioplasty for diabetics with coronary artery disease because of surprising long-term findings from the world's largest study of the two heart procedures

Federal health officials Thursday recommended coronary bypass surgery over angioplasty for diabetics with coronary artery disease because of surprising long-term findings from the world's largest study of the two heart procedures. The recommendation applies only to diabetics treated with insulin or pills called oral hypoglycemics to lower blood sugar who have two or more blocked coronary arteries, the officials said at a news conference at the National Institutes of Health

BETHESDA, Md. - Federal health officials Thursday recommended coronary bypass surgery over angioplasty for diabetics with coronary artery disease because of surprising long-term findings from the world's largest study of the two heart procedures. The recommendation applies only to diabetics treated with insulin or pills called oral hypoglycemics to lower blood sugar who have two or more blocked coronary arteries, the officials said at a news conference. The officials said they were alerting doctors about the recommendation. On average, about 50 diabetic patients fitting the criteria undergo bypass surgery or angioplasty each day in this country

Fifty years after tuberculosis became curable, a worldwide surge in drug-resistant strains of the disease is occurring not just because of the limits of medical science but because of the profit motives of pharmaceutical companies, experts at an international meeting said. Many participants in last week's conference, in all 250 experts from 40 countries, also criticized the World Health Organization, a United Nations agency in Geneva, for spending minuscule amounts on tuberculosis after declaring it a ``global health emergency.'' While it was the first time the agency had so designated any disease, it spent only $800,000 of its $1 billion annual budget on tuberculosis. It also spent $4.6 million from other sources on tuberculosis last year. An overwhelming majority of cases occur in developing countries; fewer than 10 percent occur in developed countries. In the United States, for example, there were about 26,000 new cases of active tuberculosis reported last year. Participants at the conference said drug company officials told them the low number of cases in this country represented too small a market to warrant large investments

A new skin test developed by a team of federal scientists at the CDC in Atlanta promises to improve the surveillance for the deadly Ebola infection that occurs in remote areas of Africa