Nutrition and Health for Older Persons in Rural America: A Managed Care Model

Health care services and resources for older persons living in rural areas may be highly variable, and integrated service-delivery models are often lacking. This article presents a managed-care model of nutrition risk screening and intervention for older persons in rural areas. Nutrition risk screening was implemented by the Geisinger Health Care System, Danville, Pa, to target all eligible enrollees in a regional Medicare risk program. A single remote clinic site participating in the managed health care system was chosen for further study of a linked screening and case-management effort for undernourished persons. Screening and intervention at the clinic site selected for this study were guided by centralized expertise and resources. Individualized evaluation and intervention plans were developed with the aid of a dietitian and implemented by the clinic case manager. Of the 417 subjects who completed screening at the remote site, 68 met the risk criteria for undernutrition and were selected for case management. Many of the targeted persons received interventions that included evaluations by a physician or physician extender (eg, physician assistant, nurse practitioner) at the clinic and consultations with nutrition, mental health, or social services professionals. Twenty-six of the subjects who took part in the intervention completed a follow-up screening 6 months later. Ten of those persons no longer exhibited risk criteria. This demonstrates the feasibility of a linked screening and case management program for nutrition risk in the managed-care setting. J Am Diet Assoc. 1997; 97: 885-888.     

Effects of Spascupreel versus hyoscine butylbromide for gastrointestinal cramps in children

BACKGROUND: Gastrointestinal spasms and cramps are common in children as well as in adults. Alternative medical practices such as chiropractice and homeopathy are becoming increasingly popular in Europe and the USA. The effectiveness and tolerability of the homeopathic preparation Spascupreel was compared with that of hyoscine butylbromide treatment in children <12 years of age. METHODS: An observational cohort study in 204 children <12 years was conducted over a 1 week treatment period. The efficacy of the respective therapies were evaluated on the effect on severity of spasms and clinical symptoms (pain/cramps, sleep disturbances, distress, eating or drinking difficulties and frequent crying). Compliance was evaluated on a four-point scale from 'very good' to 'low'. Evaluation was done by the practitioner based on information given by the patient or minder. RESULTS: The analysis showed comparative improvements with the homeopathic preparation and hyoscine butylbromide therapy on severity of spasms, pain/cramps, sleep disturbances, eating or drinking difficulties, and frequent crying, all as evaluated by the practitioner. Both treatments were very well tolerated. CONCLUSIONS: For patients opting for a homeopathic therapy, Spascupreel seems to be an effective and well tolerated alternative to conventional therapies in children suffering from gastrointestinal spasms.     

Use of the Implantable Loop Recorder in Evaluation of Patients with Unexplained Syncope

Syncope is a complex symptom with multiple potential etiologies that can be difficult to establish. The major obstacles to diagnosis are the periodic and unpredictable nature of events and the high spontaneous remission rate. Short-term ECG monitoring often is unproductive when initial noninvasive testing is negative due to the low probability of recurrence during the brief monitoring period. Implantable loop recorders extend the ability to monitor cardiac patients, enhancing the diagnostic yield to as high as 85% in difficult to diagnose syncope. Several recent studies suggest that prolonged monitoring with an implantable loop recorder has a role in patients with syncope and conduction disturbances, negative tilt testing, and unexplained seizures, and may be superior to conventional testing with tilt and electrophysiologic studies. (J Cardiovasc Electrophysiol, Vol. 14, pp. S70-S73, September 2003, Suppl.)     

Comparison of acute haemodynamic effects of dopexamine hydrochloride, dobutamine and sodium nitroprusside in chronic heart failure

Dopexamine hydrochloride (Dopacard®) is a new syntheticcatecholamine compound, which possesses potent ß2-adrenergicand D A 1-dopaminergic agonistic properties. It is free of a-adrenergicactivity, has no ß1-adrenergic activity and is lesspotent at D A2-dopaminergic receptors than dopamine. In thepresent study the acute haemodynamic effects of dopexamine hydrochloridewere compared to those of dobutamine and nitroprusside in 12patients with idiopathic congestive cardiomyopathy in an opencrossover study. With dopexamine hydrochloride, there were dose-dependentincreases from control in cardiac output and stroke volume,decreases in blood pressure, right and left atrial pressure,systemic vascular resistance and pulmonary vascular resistanceand little change in heart rate. Similar effects were seen withnitroprusside, apart from a marked increase in heart rate, andwith dobutamine, except that systolic aortic blood pressureincreased and there was no change in diastolic or mean pressureor pulmonary artery systolic pressure. In general, dopexamine hydrochloride produced effects betweenthose produced by the other two treatments. This suggests thatdopexamine with its combined vasodilator and inotropic actionhas a desirable cardiovascular profile with advantages overthe ß1-receptor aganist dobutamine and the pure vasodilatorsodium nitroprusside.