Although a great number of psychometric tests and rating scales for the assessment of psychogeriatric patients is available, there is still an urgent need, in research and practice, for a clinical rating instrument that meets the following main requirements: (1) applicable to institutionalized and community patients and covering a wide range of behavioral pathology; (2) acceptable and easy to use for professionals and lay persons alike; (3) covering a wide range of behavior relevant to daily functioning but independent of sex or social status of the individual assessed. The NOSGER contains 30 items of behavior, each rated on a 5-point scale according to frequency of occurrence. Item scores are summarized into 6 Dimension scores (memory, instrumental activities of daily life, self-care, mood, social behavior, and disturbing behavior) which are clinically relevant in dementia, depression, and other psychiatric disorders of old age. Validation studies with a preliminary version of the NOSGER indicated good acceptance of the scale, high inter-rater and test-retest reliability, and high correlations of all NOSGER Dimension scores with results of a variety of established assessment instruments. The NOSGER is currently being used in a number of European and North American centers and should turn out to be a useful instrument for longitudinal studies in psychogeriatrics.
SUMMARY. Whole blood and washed erythrocytes from nutritionally normal and abnormal elderly patients were stored at room temperature, 4 c e and -20 c e for up to 14 days. In both groups, and under all storage conditions, the erythrocyte transketolase (ETK) activity and the thiamine pyrophosphate (TPP) effect decreased with time of storage. The ETK activity for specimens stored at -20 c e decreased significantly by day 14 (P<0·05). The TPP effect in specimens stored at -2OCe decreased significantly in the nutritionally abnormal group at 4 days (P<0·05) and in the nutritionally normal group by day 14 (P<0·05). These significant changes in ETK activity and TPP effect with storage can lead to misleading interpretation of thiamine nutritional status.Erythrocyte transketolase (ETK) assays are widely used to assay thiamine status indirectly. There is, however, no clear consensus on the stability of the enzyme under different storage conditions. Brin' reported that haemolysed specimens are stable for only a matter of hours at room temperature, 2-3 days at 4 believed, this could perhaps contribute to these variations.We investigated, therefore, possible changes in the saturated and unsaturated ETK activities and the TPP effect after storage at different temperatures. Method SUB1ECTSThe nutritional status of 22 elderly in-patients was assessed on the basis of their dietary history, weight and anthropometric measurements. Eleven were considered to be nutritionally normal, with a mean age of 74 (67-90) years whereas 11 were regarded to be nutritionally abnormal, with a mean age of 76 (6&-84) years. None of the subjects had any evidence of infection. SAMPLE PREPARATION AND STORAGETwenty millilitres of heparinised blood was centrifuged at 3000g for 5 min, following which the plasma and buffy coat were discarded. An equal volume of cold sodium chloride solution (140 mmoUL) was added to the erythrocytes and then centrifuged at 3000 g for 5 min; the supernatant was discarded and the washing procedure repeated twice.
Simultaneous oral, rectal and axillary temperatures were measured in 73 elderly patients on a geriatric unit. Axillary and oral temperatures were significantly lower than rectal readings. If oral or axillary temperatures alone had been measured, pyrexia would have been missed in two thirds of patients with a rectal temperature of 37.5 degrees C or more, and about three quarters of those with a rectal temperature of 38 degrees C or more. These findings suggest that oral or axillary temperature measurements are inadequate screening tests for pyrexia in the elderly.
Nail changes similar to those reported by Terry and Lindsay were defined in an elderly inpatient population. Two hundred fifty-eight patients were studied, and an overall incidence of 19 per cent was found. There was no significant difference between men and women. The only significant correlations in this study were with osteoporosis and thin skin. Eight men with nail changes were compared with seven men without such changes by calculating the metacarpal index of cortical bone mass. The index was much lower in patients with nail changes (t = 2.64; P less than 0.01). All patients with nail changes had thin skin. No correlations were found with serum albumin, liver function, or kidney function. These nail changes are less frequent in the "less frail" elderly living in the community. Changes of the Terry type are common in children but disappear by early adult life. It is suggested that the nail changes are age-related phenomena and that they may reflect an underlying disturbance of collagen being manifested as changes in the nail bed, skin, and bone.
Benign giant lymphoid hyperplasia of the mediastinum with associated abnormalities of the immune system.
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