Barbara Messinger-Rapport - Academia.edu (original) (raw)

Papers by Barbara Messinger-Rapport

Military Medicine, Jun 1, 1997

Two hundred one consecutive adult admissions to a 3-bed Special Care Unit in a 25-bed military ho... more Two hundred one consecutive adult admissions to a 3-bed Special Care Unit in a 25-bed military hospital were scored using APACHE IT (Acute Physiology and Chronic Health Evaluation). Outcome measures included APACHE IT scores and mortality predictions; active intensive care interventions; transfers for specialized care; and mortality. Although higher scores generally reflected the need for intensive care intervention, admissions with nondiagnostic chest pain had scores that did not accurately predict their course. This finding could be explained by bias in the original APACHE case mix and by the need for further subclassification of cardiovascular disease. APACHE II scoring can be applied in small intensive care settings. Scoring criteria and logistic regression equations may need to be customized accordingly.

Journal of Nutrition Health & Aging, Dec 5, 2014

Non-pharmacological interventions may improve cognition and quality of life, reduce disruptive be... more Non-pharmacological interventions may improve cognition and quality of life, reduce disruptive behaviors, slow progression from Mild Cognitive Impairment (MCI) to dementia, and delay institutionalization. It is important to look at their trial designs as well as outcomes to understand the state of the evidence supporting non-pharmacological interventions in Alzheimer's disease (AD). An analysis of trial design strengths and limitations may help researchers clarify treatment effect and design future studies of non-pharmacological interventions for MCI related to AD. A systematic review of the methodology of Randomized Controlled Trials (RCTs) targeting physical activity, cognitive interventions, and socialization among subjects with MCI in AD reported until March 2014 was undertaken. The primary outcome was CONSORT 2010 reporting quality. Secondary outcomes were qualitative assessments of specific methodology problems. 23 RCT studies met criteria for this review. Eight focused on physical activity, fourteen on cognitive interventions, and one on the effects of socialization. Most studies found a benefit with the intervention compared to control. CONSORT reporting quality of physical activity interventions was higher than that of cognitive interventions. Reporting quality of recent studies was higher than older studies, particularly with respect to sample size, control characteristics, and methodology of intervention training and delivery. However, the heterogeneity of subjects identified as having MCI and variability in interventions and outcomes continued to limit generalizability. The role for non-pharmacological interventions targeting MCI is promising. Future studies of RCTs for non-pharmacological interventions targeting MCI related to AD may benefit by addressing design limitations.

Cleveland Clinic Journal of Medicine, Aug 1, 2015

Readers comment on eruptive xanthoma (April 2015), risk of falls in older adults (May 2015), and ... more Readers comment on eruptive xanthoma (April 2015), risk of falls in older adults (May 2015), and sentinel lymph node biopsy after excision of melanoma (May 2015).

Infectious disease and therapy, Sep 1, 2006

PubMed, Jul 1, 2002

American women are more likely to die from cardiovascular disease than from any other cause. Alth... more American women are more likely to die from cardiovascular disease than from any other cause. Although hypertension is most prevalent, most deaths are attributed to coronary heart disease. Heart disease in women manifests approximately 12 to 15 years later than in men, up until menopause. Then the severity of coronary artery lesions in women accelerates until it equals or surpasses that of men by the late 70s or early 80s. Physicians can help older women reduce their risk for heart disease and stroke by managing hypertension and hypercholesterolemia and providing beta-blocker treatment when indicated after MI. Nonpharmacologic interventions may be effective as well. New guidelines for aspirin help identify women under age 80 who would benefit most from antiplatelet therapy.

PubMed, Jul 1, 2001

Life expectancy of women is greater than that of men at every age. Thus, an older woman is more l... more Life expectancy of women is greater than that of men at every age. Thus, an older woman is more likely than a man to be living without a spouse and living alone. It is important in caring for an older woman to establish how well she is functioning physically and cognitively and in what activities she may need assistance. Given the high prevalence of dementia with advanced age, screening for dementia should be considered in women over age 75. Although their risk of suicide is lower, older women are more likely to be depressed than older men, regardless of race, ethnic background, or economic status. Late-life depression is treatable, and screening should be considered in the presence of a major life change, recent stroke, or MI.

Clinics in Geriatric Medicine, Aug 1, 2006

The increasingly large proportion of elderly women in the United States population carries a disp... more The increasingly large proportion of elderly women in the United States population carries a disproportionate burden of breast cancer. The advent of minimally invasive surgical techniques applicable to breast disease has brought new opportunities to diagnose and treat breast cancer in the older population. This article reviews issues important to the evolving field of breast cancer management in older women: cancer risk and screening considerations, diagnosis and biopsy approaches, and surgical treatment options based on current studies and recommendations.

Cleveland Clinic Journal of Medicine, Sep 1, 2002

Yes, and there is some evidence that treating hypertension protects against cognitive decline lat... more Yes, and there is some evidence that treating hypertension protects against cognitive decline later in life.

PubMed, Jul 1, 2003

By anticipating issues of mobility, physicians can help older women lead more independent and sat... more By anticipating issues of mobility, physicians can help older women lead more independent and satisfying lives. Osteoarthritis is a major cause of physical disability in older women. Aerobic exercise, resistance training, and judicious analgesic use can be well-tolerated interventions that reduce pain and disability. Reducing the risk of injurious falls is paramount given the prevalence of osteoporosis. Interventions that may reduce fall risk include minimizing the use of sedative-hypnotic agents, providing training in transfer skills (balance and gait training), and adapting the home environment.

Cleveland Clinic Journal of Medicine, Apr 1, 2007

Nursing Clinics of North America, Jun 1, 2009

The goals of Healthy People 2010 (Fig. 1) recognize health disparities as a barrier to providing ... more The goals of Healthy People 2010 (Fig. 1) recognize health disparities as a barrier to providing quality of care to everyone regardless of gender, race or ethnicity, education or income, disability, geographic location, or sexual orientation. 1 Examples of health disparities affecting older adults include the much lower vaccination rate for influenza and pneumococcus in Hispanics and African Americans compared with that in whites; 2 lower rates of prescriptions for pain control in cancer-related pain for Hispanic and African Americans; 3 and lower rates of procedures for knee and hip replacements, carotid endarterectomies, and coronary-artery bypass grafting for African Americans. 4 Many aspects of the health care system may contribute to these disparities, including lack of or inadequacies in health coverage; lack of access to qualified physicians; lack of health literacy; geographic factors such as rural versus urban or region of the country. Health disparities in the subset of approximately 1.6 million older adults residing in nursing homes is not well studied but deserves more attention, given that approximately 1 in 4 Americans spend their last days in a nursing home. 5 Disparities in the nursing home reflect both the preexisting health care disparities in the general community as well as the influence of organizational and reimbursement factors imposed by the nursing home. This article provides a historical review of relevant demographic and financial aspects of minority usage of nursing homes and identifies health care disparities associated with long-term care. Because there is so few data on Hispanic and Asian minorities in the nursing home, most of the examples revolve around African Americans. The discussion and conclusion suggest future directions to consider to meet Healthy People 2010 goals for the frailest elders. BACKGROUND Before the 1960s, minorities were much less likely than their white counterparts to reside in a nursing facility. Nursing homes were typically racially segregated (by law

Journal of the American Medical Directors Association, Nov 1, 2016

This is the tenth clinical update. It covers chronic kidney disease, dementia, hypotension, polyp... more This is the tenth clinical update. It covers chronic kidney disease, dementia, hypotension, polypharmacy, rapid geriatric assessment, and transitional care.

PubMed, Apr 1, 2002

Osteoporosis causes approximately 1.5 million low-trauma fracture per year, and at all ages the i... more Osteoporosis causes approximately 1.5 million low-trauma fracture per year, and at all ages the incidence of fracture is higher in women than in men. Risk factors for osteoporotic fractures in postmenopausal women include family history of bone fracture, ethnicity, and weight < 127 pounds. Densitometry is used to diagnose osteoporosis and can be performed at intervals to monitor bone density during treatment. The older woman's diet should, in general, include 1,200 to 1,500 mg of calcium and 400 to 800 IU of vitamin D. Estrogens, bisphosphonates, selective estrogen receptor modulators, calcitonin, and exogenous parathyroid hormone are pharmacologic therapy options that can preserve and increase bone mass and reduce the risk of fracture.

PubMed, Dec 1, 2003

Despite the proliferation of motor vehicles and the increase in number of miles traveled in this ... more Despite the proliferation of motor vehicles and the increase in number of miles traveled in this country during the past century, motor vehicle safety has improved. The annual death rate has declined dramatically since it was first measured in 1925. However, motor vehicle accidents remain the leading cause of injury death in children and young and middle-aged adults and the third leading cause of years of potential life lost prior to age 65, behind cancer and heart disease. There are some regional and vehicular factors, with higher motor vehicle death rates in the southeast and in scattered western states. The highest rates of vehicular fatalities are in the youngest and oldest drivers, their passengers, and in all who drive under the influence of alcohol or as a passenger in a car driven by someone under the influence. Medical conditions may also compromise driving ability and/or increase fatality rate in adults of all ages. These conditions and situations, particularly as applied to older adults, are presented here.

Mathematical biosciences, May 1, 1988

~ydc, ~trie-sphe~s mode| was ~ to test me efficacy o,f different reg~ao l~r.a~don tee~q~e~ b~e~ o... more ~ydc, ~trie-sphe~s mode| was ~ to test me efficacy o,f different reg~ao l~r.a~don tee~q~e~ b~e~ on the TLLho~v f~y of r~qzer~. The model altho~g~h s~p~e, re|ai~ the ~2a~ve size ~ ~fio~ o~ ~ heart w~n the body and may im:ortm~te all the/~a~ogenddes of the h~ ~orso. The bo~ndary-e~ement m¢~ was |o eem~m~et a transfer maW~x relating *~he body surface po~entiMs to the epicardiM ~tenli~, for ~ ~o~og~'o~ fom~ of ~ ~L ~ffe~nt regu]m42ati~ techniques were ¢ompnred in ~ presence o~ s~face peten~M noise and in the presence o~ errors in e~l/ma~g the co~er6vities, ~ he~ s~e e~d the hea~ p(~idon. Results ir~icate ~ha~ Lh~ ~re|~liv, ¢~or L~ ~le i~v¢~-rccov**~d ¢p~Cm~M potent~M with rgg~darigai~on dt~s not fi~ pr~o~onaliy to ~¢ no~e level The relative error (RE) with a 5% Gaussian noise ]eve] ~ 0.17; with 20~ i~ is 0.29, ~±don~y~ the regul~ed inverse procedure is shown to restore smoo~hne~ ~ aee'~r~ to t~ inverse-recovered e#eardia~ potenti'ds in the p~es,~ ot e~r~ L~ esfimn~ing the he~ ~don and heart size, which, using an cn~eg~ari~ed i~e~ion, wo~d lead to ~rge~plitude o~cil]adons in the solution. *This wc~ was vTS.o~ed ff~ part by Na~o~ ~dtmes of Heaifn Gran~ HL°33343 a~d HLd793L by Nado~d Research Service Award GMO-7250, and by an A~e~iea~ AssocSa~en ef Umversity Wome~ Ed~c~do~ Founda6on Fellowship.

PubMed, Oct 1, 2002

As women live longer and anticipate good health during their later years, cancer screening become... more As women live longer and anticipate good health during their later years, cancer screening becomes increasingly complex. Physicians receive discordant recommendations from medical societies, task forces, Medicare, and special interest groups about which cancers merit screening, how screening should be performed, the frequency of screening, and when screening should be discontinued. Female patients may receive confusing recommendations from their friends, the lay press, the Internet, and their own doctors. Given the proliferation of opinions and the limited data regarding the efficacy of cancer screening in older women, physicians must help their patients understand the potential benefits, limitations, and consequences of various cancer screenings for each individual woman.

Cleveland Clinic Journal of Medicine, Jun 1, 2001

Journal of the American Medical Directors Association, Oct 1, 2015

Medical students report that they receive inadequate training in different levels of care, includ... more Medical students report that they receive inadequate training in different levels of care, including care transitions to and from post-acute (PA) and long-term care (LTC). The authors implemented the Medical Students as Teachers in Extended Care (MedTEC) program as an educational innovation at the Cleveland Clinic to address training in the care-continuum, as well as the new medical student and physician competencies in PA/LTC. MedTEC is a 7-hour interactive program that supplements standard geriatric didactics during the medical student primary care rotation. This study evaluated the performance of the program in improving medical student knowledge and attitudes on levels and transitions of care. The program occurs in a community facility that includes subacute/skilled nursing, assisted living, and nursing home care. Five to 8 students completing their primary care rotation at the Cleveland Clinic are required to participate in the MedTEC program each month. The program includes up to 3 hours of interactive discussion and opportunities to meet facility staff, residents, and patients. The highlight of the program is a student-led in-service for facility staff. With institutional review board approval as an exempt educational research project, pre- and postactivity surveys assessed self-efficacy and knowledge regarding levels of care for students who participated in the program and a student comparison group. The post-program knowledge test also was administered to hospital medicine staff, and test performance was compared with medical students who participated in the MedTEC program. Between October 2011 and December 2013, approximately 100 students participated in 20 sessions of MedTEC. All students reported improved self-efficacy and attitudes regarding care of older adults and care transition management. Mean percentage correct on the knowledge test increased significantly from 59.8% to 71.2% (P = .004) for the MedTEC participants but not for the comparison group students (63.1%-58.3%, P = .47). There was no significant difference in mean percentage correct on the post-program knowledge test between MedTEC medical students and hospitalists (71.0% versus 70.3%, P = .86). Students led 8 in-service sessions for facility staff on various topics relating to the care of older adults in PA/LTC. The MedTEC program appears to be a successful innovation in medical student education on levels of care. It could serve as a model for building competency of health professionals on managing care transitions and determining appropriate levels of care for older adults.

Journal of the American Medical Directors Association, Sep 1, 2012

This article is the sixth in the series of clinical updates on nursing home care. The topics cove... more This article is the sixth in the series of clinical updates on nursing home care. The topics covered are management of hypertension, antidepressant medications in people with dementia, peripheral arterial disease, probiotics in prevention, and treatment of Clostridium difficile-associated diarrhea, frailty, and falls.

Journal of the American Medical Directors Association, Sep 1, 2016

Objectives: To validate the HOSPITAL score for predicting 30-day all-cause readmission rates in a... more Objectives: To validate the HOSPITAL score for predicting 30-day all-cause readmission rates in a cohort of medical patients discharged to skilled nursing facilities (SNFs). Design: Retrospective cohort. Setting: Cleveland Clinic Main Campus. Participants: Cleveland Clinic Main Campus medicine services patients who were admitted between January 1, 2011, and December 31, 2012, and subsequently discharged to 110 SNFs within a 25-mile radius of the hospital. Measurements: Thirty-day all-cause readmissions to any hospital in the Cleveland Clinic Health System and the HOSPITAL score. Results: During the study period, 4208 medical patients were discharged to 110 SNFs; 30-day all-cause readmission rates were 40.9% for high-risk patients, 28.1% for intermediate-risk patients, and 15.4% for low-risk patients. Compared to intermediate-and low-risk patients, high-risk patients had more hospitalizations in the past year (3.6 vs 1.1 vs 0.8; P < .0001), longer hospital stays (12.0 days vs 9.9 days vs 4.9 days; P < .0001) and more comorbidities, including end-stage renal disease (18.5% vs 9.3% vs 2.5%; P < .0001), congestive heart failure (39.9% vs 33.1% vs 26.1%; P < .0001), chronic obstructive pulmonary disease (26.9% vs 21.5% vs 20.2%; P < .0001), and diabetes (46.5% vs 38.6% vs 35.3%; P < .0001). The c-statistic for the HOSPITAL score was 0.65. Conclusions: Among patients discharged to an SNF, the HOSPITAL score may be used to identify those at highest risk of readmission within 30 days.