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  1. Article ; Online: An evaluation of geriatrics activities within internal medicine subspecialties.

    Sonu, Irene S / High, Kevin P / Clayton, Charles P / Woolard, Nancy F / Hazzard, William R

    The American journal of medicine

    2006  Volume 119, Issue 11, Page(s) 995–1000

    MeSH term(s) Certification ; Education, Medical, Continuing/organization & administration ; Geriatrics/organization & administration ; Geriatrics/standards ; Humans ; Internal Medicine/organization & administration ; Internal Medicine/standards ; Interviews as Topic ; Program Evaluation ; Research Design ; Societies, Medical/organization & administration ; United States
    Language English
    Publishing date 2006-11
    Publishing country United States
    Document type Evaluation Studies ; Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 80015-6
    ISSN 1555-7162 ; 1873-2178 ; 0002-9343 ; 1548-2766
    ISSN (online) 1555-7162 ; 1873-2178
    ISSN 0002-9343 ; 1548-2766
    DOI 10.1016/j.amjmed.2006.07.038
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  2. Article ; Online: Intensive vs Standard Blood Pressure Control and Cardiovascular Disease Outcomes in Adults Aged ≥75 Years: A Randomized Clinical Trial.

    Williamson, Jeff D / Supiano, Mark A / Applegate, William B / Berlowitz, Dan R / Campbell, Ruth C / Chertow, Glenn M / Fine, Larry J / Haley, William E / Hawfield, Amret T / Ix, Joachim H / Kitzman, Dalane W / Kostis, John B / Krousel-Wood, Marie A / Launer, Lenore J / Oparil, Suzanne / Rodriguez, Carlos J / Roumie, Christianne L / Shorr, Ronald I / Sink, Kaycee M /
    Wadley, Virginia G / Whelton, Paul K / Whittle, Jeffrey / Woolard, Nancy F / Wright, Jackson T / Pajewski, Nicholas M

    JAMA

    2016  Volume 315, Issue 24, Page(s) 2673–2682

    Abstract: Importance: The appropriate treatment target for systolic blood pressure (SBP) in older patients with hypertension remains uncertain.: Objective: To evaluate the effects of intensive (<120 mm Hg) compared with standard (<140 mm Hg) SBP targets in ... ...

    Abstract Importance: The appropriate treatment target for systolic blood pressure (SBP) in older patients with hypertension remains uncertain.
    Objective: To evaluate the effects of intensive (<120 mm Hg) compared with standard (<140 mm Hg) SBP targets in persons aged 75 years or older with hypertension but without diabetes.
    Design, setting, and participants: A multicenter, randomized clinical trial of patients aged 75 years or older who participated in the Systolic Blood Pressure Intervention Trial (SPRINT). Recruitment began on October 20, 2010, and follow-up ended on August 20, 2015.
    Interventions: Participants were randomized to an SBP target of less than 120 mm Hg (intensive treatment group, n = 1317) or an SBP target of less than 140 mm Hg (standard treatment group, n = 1319).
    Main outcomes and measures: The primary cardiovascular disease outcome was a composite of nonfatal myocardial infarction, acute coronary syndrome not resulting in a myocardial infarction, nonfatal stroke, nonfatal acute decompensated heart failure, and death from cardiovascular causes. All-cause mortality was a secondary outcome.
    Results: Among 2636 participants (mean age, 79.9 years; 37.9% women), 2510 (95.2%) provided complete follow-up data. At a median follow-up of 3.14 years, there was a significantly lower rate of the primary composite outcome (102 events in the intensive treatment group vs 148 events in the standard treatment group; hazard ratio [HR], 0.66 [95% CI, 0.51-0.85]) and all-cause mortality (73 deaths vs 107 deaths, respectively; HR, 0.67 [95% CI, 0.49-0.91]). The overall rate of serious adverse events was not different between treatment groups (48.4% in the intensive treatment group vs 48.3% in the standard treatment group; HR, 0.99 [95% CI, 0.89-1.11]). Absolute rates of hypotension were 2.4% in the intensive treatment group vs 1.4% in the standard treatment group (HR, 1.71 [95% CI, 0.97-3.09]), 3.0% vs 2.4%, respectively, for syncope (HR, 1.23 [95% CI, 0.76-2.00]), 4.0% vs 2.7% for electrolyte abnormalities (HR, 1.51 [95% CI, 0.99-2.33]), 5.5% vs 4.0% for acute kidney injury (HR, 1.41 [95% CI, 0.98-2.04]), and 4.9% vs 5.5% for injurious falls (HR, 0.91 [95% CI, 0.65-1.29]).
    Conclusions and relevance: Among ambulatory adults aged 75 years or older, treating to an SBP target of less than 120 mm Hg compared with an SBP target of less than 140 mm Hg resulted in significantly lower rates of fatal and nonfatal major cardiovascular events and death from any cause.
    Trial registration: clinicaltrials.gov Identifier: NCT01206062.
    MeSH term(s) Acute Coronary Syndrome/mortality ; Aged ; Aged, 80 and over ; Antihypertensive Agents/therapeutic use ; Blood Pressure/drug effects ; Blood Pressure Determination ; Cause of Death ; Female ; Heart Failure/mortality ; Humans ; Hypertension/complications ; Hypertension/drug therapy ; Male ; Myocardial Infarction/mortality
    Chemical Substances Antihypertensive Agents
    Language English
    Publishing date 2016-05-17
    Publishing country United States
    Document type Journal Article ; Multicenter Study ; Randomized Controlled Trial ; Research Support, N.I.H., Extramural
    ZDB-ID 2958-0
    ISSN 1538-3598 ; 0254-9077 ; 0002-9955 ; 0098-7484
    ISSN (online) 1538-3598
    ISSN 0254-9077 ; 0002-9955 ; 0098-7484
    DOI 10.1001/jama.2016.7050
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  3. Article ; Online: Prediction, progression, and outcomes of chronic kidney disease in older adults.

    Anderson, Sharon / Halter, Jeffrey B / Hazzard, William R / Himmelfarb, Jonathan / Horne, Frances McFarland / Kaysen, George A / Kusek, John W / Nayfield, Susan G / Schmader, Kenneth / Tian, Ying / Ashworth, John R / Clayton, Charles P / Parker, Ryan P / Tarver, Erika D / Woolard, Nancy F / High, Kevin P

    Journal of the American Society of Nephrology : JASN

    2009  Volume 20, Issue 6, Page(s) 1199–1209

    Abstract: Chronic kidney disease is a large and growing problem among aging populations. Although progression of chronic kidney disease to end-stage renal disease (ESRD) is a costly and important clinical event with substantial morbidity, it appears less ... ...

    Abstract Chronic kidney disease is a large and growing problem among aging populations. Although progression of chronic kidney disease to end-stage renal disease (ESRD) is a costly and important clinical event with substantial morbidity, it appears less frequently in aging people compared with cardiovascular mortality. The measurement of kidney function and management of kidney disease in older individuals remain challenging, partly because the pathophysiologic mechanisms underlying age-related decline in kidney function, the interactions between age and other risk factors in renal progression, and the associations of chronic kidney disease with other comorbidities in older people are understudied and poorly understood. The Association of Specialty Professors, the American Society of Nephrology, the American Geriatrics Society, the National Institute on Aging, and the National Institute of Diabetes and Digestive and Kidney Diseases held a workshop, summarized in this article, to review what is known about chronic kidney disease, identify research gaps and resources available to address them, and identify priority areas for future research. Answers to emerging research questions will support the integration of geriatrics and nephrology and thus improve care for older patients at risk for chronic kidney disease.
    MeSH term(s) Acute Kidney Injury/complications ; Aged ; Aging/physiology ; Biomedical Research ; Cardiovascular Diseases/complications ; Cardiovascular Diseases/mortality ; Comorbidity ; Disease Progression ; Humans ; Renal Insufficiency, Chronic/diagnosis ; Renal Insufficiency, Chronic/etiology ; Renal Insufficiency, Chronic/genetics ; Renal Insufficiency, Chronic/mortality ; Renal Insufficiency, Chronic/therapy
    Language English
    Publishing date 2009-05-21
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't ; Review
    ZDB-ID 1085942-1
    ISSN 1533-3450 ; 1046-6673
    ISSN (online) 1533-3450
    ISSN 1046-6673
    DOI 10.1681/ASN.2008080860
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  4. Article ; Online ; Conference proceedings: Workshop on immunizations in older adults: identifying future research agendas.

    High, Kevin P / D'Aquila, Richard T / Fuldner, Rebecca A / Gerding, Dale N / Halter, Jeffrey B / Haynes, Laura / Hazzard, William R / Jackson, Lisa A / Janoff, Edward / Levin, Myron J / Nayfield, Susan G / Nichol, Kristin L / Prabhudas, Mercy / Talbot, Helen K / Clayton, Charles P / Henderson, Randi / Scott, Catherine M / Tarver, Erika D / Woolard, Nancy F /
    Schmader, Kenneth E

    Journal of the American Geriatrics Society

    2010  Volume 58, Issue 4, Page(s) 765–776

    Abstract: Goals for immunization in older adults may differ from those in young adults and children, in whom complete prevention of disease is the objective. Often, reduced hospitalization and death but also averting exacerbation of underlying chronic illness, ... ...

    Abstract Goals for immunization in older adults may differ from those in young adults and children, in whom complete prevention of disease is the objective. Often, reduced hospitalization and death but also averting exacerbation of underlying chronic illness, functional decline, and frailty are important goals in the older age group. Because of the effect of age on dendritic cell function, T cell-mediated immune suppression, reduced proliferative capacity of T cells, and other immune responses, the efficacy of vaccines often wanes with advanced age. This article summarizes the discussion and proceedings of a workshop organized by the Association of Specialty Professors, the Infectious Diseases Society of America, the American Geriatrics Society, the National Institute on Aging, and the National Institute of Allergy and Infectious Diseases. Leading researchers and clinicians in the fields of immunology, epidemiology, infectious diseases, geriatrics, and gerontology reviewed the current status of vaccines in older adults, identified knowledge gaps, and suggest priority areas for future research. The goal of the workshop was to identify what is known about immunizations (efficacy, effect, and current schedule) in older adults and to recommend priorities for future research. Investigation in the areas identified has the potential to enhance understanding of the immune process in aging individuals, inform vaccine development, and lead to more-effective strategies to reduce the risk of vaccine-preventable illness in older adults.
    MeSH term(s) Adaptive Immunity/immunology ; Aged/physiology ; Aging/immunology ; Antigen-Presenting Cells/immunology ; B-Lymphocytes/immunology ; Centers for Disease Control and Prevention (U.S.) ; Evidence-Based Practice/organization & administration ; Forecasting ; Geriatrics/organization & administration ; Health Planning Guidelines ; Health Services Needs and Demand ; Humans ; Immunization Schedule ; Research/organization & administration ; T-Lymphocytes/immunology ; Telomere/immunology ; United States ; Vaccination/methods
    Language English
    Publishing date 2010-04
    Publishing country United States
    Document type Congresses ; Research Support, Non-U.S. Gov't
    ZDB-ID 80363-7
    ISSN 1532-5415 ; 0002-8614
    ISSN (online) 1532-5415
    ISSN 0002-8614
    DOI 10.1111/j.1532-5415.2010.02772.x
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  5. Article ; Online: Aging and infectious diseases: workshop on HIV infection and aging: what is known and future research directions.

    Effros, Rita B / Fletcher, Courtney V / Gebo, Kelly / Halter, Jeffrey B / Hazzard, William R / Horne, Frances McFarland / Huebner, Robin E / Janoff, Edward N / Justice, Amy C / Kuritzkes, Daniel / Nayfield, Susan G / Plaeger, Susan F / Schmader, Kenneth E / Ashworth, John R / Campanelli, Christine / Clayton, Charles P / Rada, Beth / Woolard, Nancy F / High, Kevin P

    Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

    2008  Volume 47, Issue 4, Page(s) 542–553

    Abstract: Highly active antiretroviral treatment has resulted in dramatically increased life expectancy among patients with HIV infection who are now aging while receiving treatment and are at risk of developing chronic diseases associated with advanced age. ... ...

    Abstract Highly active antiretroviral treatment has resulted in dramatically increased life expectancy among patients with HIV infection who are now aging while receiving treatment and are at risk of developing chronic diseases associated with advanced age. Similarities between aging and the courses of human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome suggest that HIV infection compresses the aging process, perhaps accelerating comorbidities and frailty. In a workshop organized by the Association of Specialty Professors, the Infectious Diseases Society of America, the HIV Medical Association, the National Institute on Aging, and the National Institute on Allergy and Infectious Diseases, researchers in infectious diseases, geriatrics, immunology, and gerontology met to review what is known about HIV infection and aging, to identify research gaps, and to suggest high priority topics for future research. Answers to the questions posed are likely to help prioritize and balance strategies to slow the progression of HIV infection, to address comorbidities and drug toxicity, and to enhance understanding about both HIV infection and aging.
    MeSH term(s) Adolescent ; Adult ; Age Distribution ; Aged ; Aging/immunology ; Antiretroviral Therapy, Highly Active ; Child ; HIV Infections/complications ; HIV Infections/drug therapy ; HIV Infections/immunology ; HIV Infections/virology ; HIV-1/drug effects ; Humans ; Immunity ; Kidney Diseases ; Liver Diseases ; Metabolic Diseases ; Middle Aged ; Research/trends
    Language English
    Publishing date 2008-07-31
    Publishing country United States
    Document type Congress ; Research Support, Non-U.S. Gov't
    ZDB-ID 1099781-7
    ISSN 1537-6591 ; 1058-4838
    ISSN (online) 1537-6591
    ISSN 1058-4838
    DOI 10.1086/590150
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  6. Article ; Online: Ginkgo biloba for prevention of dementia: a randomized controlled trial.

    DeKosky, Steven T / Williamson, Jeff D / Fitzpatrick, Annette L / Kronmal, Richard A / Ives, Diane G / Saxton, Judith A / Lopez, Oscar L / Burke, Gregory / Carlson, Michelle C / Fried, Linda P / Kuller, Lewis H / Robbins, John A / Tracy, Russell P / Woolard, Nancy F / Dunn, Leslie / Snitz, Beth E / Nahin, Richard L / Furberg, Curt D

    JAMA

    2008  Volume 300, Issue 19, Page(s) 2253–2262

    Abstract: Context: Ginkgo biloba is widely used for its potential effects on memory and cognition. To date, adequately powered clinical trials testing the effect of G. biloba on dementia incidence are lacking.: Objective: To determine effectiveness of G. ... ...

    Abstract Context: Ginkgo biloba is widely used for its potential effects on memory and cognition. To date, adequately powered clinical trials testing the effect of G. biloba on dementia incidence are lacking.
    Objective: To determine effectiveness of G. biloba vs placebo in reducing the incidence of all-cause dementia and Alzheimer disease (AD) in elderly individuals with normal cognition and those with mild cognitive impairment (MCI).
    Design, setting, and participants: Randomized, double-blind, placebo-controlled clinical trial conducted in 5 academic medical centers in the United States between 2000 and 2008 with a median follow-up of 6.1 years. Three thousand sixty-nine community volunteers aged 75 years or older with normal cognition (n = 2587) or MCI (n = 482) at study entry were assessed every 6 months for incident dementia.
    Intervention: Twice-daily dose of 120-mg extract of G. biloba (n = 1545) or placebo (n = 1524).
    Main outcome measures: Incident dementia and AD determined by expert panel consensus.
    Results: Five hundred twenty-three individuals developed dementia (246 receiving placebo and 277 receiving G. biloba) with 92% of the dementia cases classified as possible or probable AD, or AD with evidence of vascular disease of the brain. Rates of dropout and loss to follow-up were low (6.3%), and the adverse effect profiles were similar for both groups. The overall dementia rate was 3.3 per 100 person-years in participants assigned to G. biloba and 2.9 per 100 person-years in the placebo group. The hazard ratio (HR) for G. biloba compared with placebo for all-cause dementia was 1.12 (95% confidence interval [CI], 0.94-1.33; P = .21) and for AD, 1.16 (95% CI, 0.97-1.39; P = .11). G. biloba also had no effect on the rate of progression to dementia in participants with MCI (HR, 1.13; 95% CI, 0.85-1.50; P = .39).
    Conclusions: In this study, G. biloba at 120 mg twice a day was not effective in reducing either the overall incidence rate of dementia or AD incidence in elderly individuals with normal cognition or those with MCI. Trial Registration clinicaltrials.gov Identifier: NCT00010803.
    MeSH term(s) Aged ; Alzheimer Disease/epidemiology ; Alzheimer Disease/prevention & control ; Cognition ; Dementia/epidemiology ; Dementia/prevention & control ; Double-Blind Method ; Ginkgo biloba ; Humans ; Incidence ; Phytotherapy ; Plant Extracts/administration & dosage ; Plant Extracts/therapeutic use ; Proportional Hazards Models
    Chemical Substances Plant Extracts ; Ginkgo biloba extract (19FUJ2C58T)
    Language English
    Publishing date 2008-11-18
    Publishing country United States
    Document type Journal Article ; Multicenter Study ; Randomized Controlled Trial ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
    ZDB-ID 2958-0
    ISSN 1538-3598 ; 0254-9077 ; 0002-9955 ; 0098-7484
    ISSN (online) 1538-3598
    ISSN 0254-9077 ; 0002-9955 ; 0098-7484
    DOI 10.1001/jama.2008.683
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