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July 6, 2006


Intervention cuts delirium in hospitalized eldery

A study published in the current issue of the Journal of the American Geriatrics Society reports that a coordinated program focused on preventing delirium in elderly hospital patients leads to marked improvements in their health outcomes.

The study, led by Fred Rubin, professor of geriatric medicine at the School of Medicine and chief of medicine at UPMC Shadyside, tracked more than 700 elderly patients admitted to one nursing unit over a three-and-one-half-year period as part of an ongoing quality improvement initiative.

Delirious patients often experience agitation, hallucinations and a sharp decline in their attention and cognition. Conservative estimates suggest that 25 percent of patients age 70 and older are at risk for developing delirium, recognized as the single most common acute disorder affecting hospitalized adults. It adds both extra time and extra cost to hospital stays, increases stress to the patient, family members and nursing staff and is associated with a hospital mortality rate ranging from 10 to 65 percent — equal to that of acute heart attack.

Delirium is more likely to develop in older hospitalized patients who have had new medications added to their regimens, have been immobilized through the use of physical restraints, have lost weight or are using bladder catheters.

In 2001, the UPMC Shadyside implemented the delirium prevention program with the specific aim of improving the care of hospitalized older people. The program is based on the Hospital Elder Life Program (HELP) developed at Yale University, which demonstrated a reduction in the incidence of delirium at the Yale-New Haven Medical Center but had yet to be replicated in a community hospital setting prior to the UPMC Shadyside initiative.

Rubin’s team collected data on delirium rates and costs of care during a one-year baseline period. They later compared the data to a study intervention period during which a HELP team made up of a geriatrician, a nurse practitioner specializing in geriatrics and trained volunteers screened and evaluated for existing delirium or risk factors for delirium all patients over age 70 who were admitted to a general medical unit.

Those who had one or two risk factors (cognitive impairment, sleep deprivation, immobility, visual or hearing impairment and dehydration) but were not delirious received targeted daily interventions from the HELP team. The nurse practitioner advised staff nurses and treating physicians on matters that might precipitate delirium in these patients. HELP volunteers visited at-risk patients several times each day to socialize and orient them.

The HELP intervention led to a 14.4 percent reduction in delirium, translating into an estimated 101 delirium cases that were prevented and a savings of more than $626,000 in hospital expenses over six months. The study also found significant improvements in patient, family and nursing staff satisfaction. The program has been expanded to four inpatient units and the hospital plans to add it to more units.


Smokers of light cigarettes less likely to quit smoking

People who smoke low-tar and low-nicotine or “light” cigarettes as a way to reduce the health risks of smoking may be less likely to kick the habit, thus increasing their lifetime risk for smoking-related diseases, according to research by Pitt and Harvard University that was published on line by the American Journal of Public Health.

The analysis, conducted by Pitt assistant professor of medicine Hilary Tindle while she was based at Harvard Medical School, found that of 12,285 self-reported smokers, those who used light cigarettes were about 50 percent less likely to quit smoking than those who smoked non-light cigarettes.

Smoking light cigarettes was associated with reduced odds of quitting for all ages, but the effect increased with age, peaking in adults age 65 and older, who were 76 percent less likely to quit.

Additionally, Tindle and her collaborators, who included Saul Shiffman, professor of psychology, found that 37 percent of the self-reported smokers said they used light cigarettes to reduce their health risks. The majority of these light cigarette smokers were female, Caucasian and highly educated.

Tindle and her co-authors suggest that health care providers warn their patients about light cigarettes during routine smoking cessation counseling, because research shows that smokers are more likely to show interest in quitting if they know that lights do not reduce health risks. In addition, the authors suggest that there be disclosures on cigarette packs and warnings in advertisements whenever the term “light” or similarly misleading terms are used.


Anti-nerve agent inhaler developed, tested

The U.S. Army has awarded Augustine Choi, professor of medicine, a $3.8 million, three-year grant for the development of an inhaled dry powder delivery system for the administration of atropine.

The device development program and pilot clinical trial of self-administered, piezo-electric, dry-powder inhaler (DPI) seeks to show that the device, developed by MicroDose Technologies, is a viable replacement for the military’s Medical Aerosolized Nerve Agent Antidote (MANAA). Replacement of this metered dose inhaler is necessary since MANAA utilizes a chlorofluorocarbon (CFC) propellant to administer the atropine dose.

CFC propellants have been replaced for all but limited medical applications, causing a concern for continued availability of a reliable supply of medical-grade raw material. The project is structured to provide the fundamental in-vitro and in-vivo information to support the viability of the DPI as a replacement for MANAA. Therefore, deliverables from the project will provide the data necessary to rapidly advance replacement of MANAA. The new technology also should provide more dependable and consistent dose administration.


Causes of childhood depression sought

The National Institutes of Health has awarded $2.9 million to Maria Kovacs of Western Psychiatric Institute and Clinic over four years to continue the study of risk factors for childhood-onset depression (COD).

The hypothesis is that COD is genetically predisposed and that disrupted early development of emotion regulation in multiple domains (such as biological, social, cognitive or behavioral) is needed for the expression of the disorder.

Studies in the U.S. and Hungary will examine molecular genetic, psychophysiologic, psychosocial and behavioral indices of risk associated with COD. Two types of families are targeted: those containing a grown young adult with a documented history of childhood-onset depression and those containing a depressed child and his/her affected or unaffected sibling.

Testing specific hypotheses and integrating results across studies will provide a multifaceted characterization of risk for COD and related juvenile onset mood disorder.


NSF grant aims to make computer tutors more humanlike

Kurt Vanlehn of the Learning Research and Development Center has been granted a $1.15 million National Science Foundation continuation award for his project “Tutoring Scientific Explanations via Natural Language Dialogue.”

His research attempts to find ways to make natural language-based tutoring systems more effective. A major difference between human tutors and computer tutors is that only human tutors understand unconstrained natural language (NL) input. Recently, a few tutoring systems have been developed that carry on an NL dialogue with students.

Vanlehn’s approach is to derive new dialogue strategies for computer tutoring systems from studies of human tutorial dialogues to see whether they make the new systems more effective.


Tele-rehab grant continued

The U.S. Department of Education has continued its support of the School and Health and Rehabilitation Sciences’ rehabilitation engineering research center on tele-rehabilitation with a grant of $866,305.

The primary purpose of this project is to serve people with disabilities by researching and developing methods, systems and technologies that support remote delivery of rehabilitation and home health care services for individuals who have limited local access to comprehensive medical rehabilitation outpatient and community-based services.

The project focuses on remote assessment, monitoring, therapy and related issues including reimbursement, cost-effectiveness, consumer satisfaction and the International Classification of Functioning.


Culture, context matter in advertising

Would a company attempting to enter an East Asian market be wise to soften the edges of its very angular Western logo or its product design to fare better among Eastern consumers? Furthermore, could one expect an advertisement for a sharp-edge Hummer H2 to be more effective when embedded in a television program, such as “CSI: Miami,” that is permeated with turmoil and conflict?

According to new research conducted by marketing professor Larry Feick, the answer to both questions is yes. The results of a study conducted by Feick, who also is interim dean of the Katz Graduate School of Business, and colleagues from the University of Texas at San Antonio and the China Europe International Business School, hold practical implications for designers as well as advertisers.

The results suggest that designers should recognize the cultural background that people bring to any setting where their design will be viewed and used.

The research found that one might expect product designs that are more rounded to be less appealing to fans of the hit CBS law enforcement series than ones that are more angular because the nature of a show can influence, at least temporarily, a viewer’s shape preference. One lesson for advertisers is that they should match their product advertisements to the types of programs in which the ads will be embedded.

The research focuses on self-construal — the extent that an individual perceives him- or herself as being connected to or distinct from others — and how it, along with culture orientation and private/public consumption, affects people’s shape preference.

Based on previous findings, Feick and his colleagues hypothesized that individuals with independent self-construal (more prevalent in individualistic countries such as the United States and European nations), would perceive angular shapes as more attractive; those with interdependent self-construals (more prevalent in collectivist countries such as those of East Asia) would find rounded shapes more pleasing.

They also posited that the effect would be more pronounced when people expect that others would evaluate their preferences (public consumption).

These hypotheses largely were confirmed in a field study that classified logos from a variety of countries and two experiments in which self-construal was experimentally primed.

Feick and his colleagues recruited coders from a design school to rate 1,000 corporate logos from seven countries. The logos from individualist countries were seen as more angular than those from collectivist countries.

In the next two studies, researchers manipulated self-construal and examined subjects’ aesthetic preference for the shape of picture frames and trademark symbols, respectively.

The experiments showed that individuals with an independent self-construal are likely to perceive angular shapes as more attractive. The self-construal difference is moderated by whether consumption is private or public.

According to the researchers, “There is both universality and cultural specificity [to aesthetic rules], and which of these comes into play depends on whether diagnostic cultural knowledge is accessible for the phenomenon [being] investigated.”

The research suggests that it is the interplay between universality and cultural specificity that produces the total esthetic experience.


Pitt group tapped for HIV, AIDS research

The Magee-Womens Research Institute is one of six institutions selected to lead HIV/AIDS prevention and treatment efforts by the National Institute of Allergy and Infectious Diseases (NIAID). Estimated at $285 million in funding for the first year, these awards represent the first step in a two-part restructuring of the NIAID’s clinical trials networks.

Sharon L. Hillier, professor of obstetrics, gynecology and reproductive sciences and of molecular genetics and biochemistry at the School of Medicine, is principal investigator for the Pittsburgh consortium, which has been designated to lead the Microbicide Trials Network. MTN will focus on the identification and development of topically applied microbicides in a form that is acceptable both for the women who will use them and for their partners.

Several large clinical trials currently are testing the safety and efficacy of a number of microbicidal preparations. MTN will continue this international effort with support for these clinical trials in several areas including Africa and India.

In addition to Hillier, Pitt faculty members involved in the project are John W. Mellors, professor of medicine and chief of the division of infectious diseases and director of the HIV/AIDS program at the UPMC; Charlene Dezzutti, associate professor of obstetrics, gynecology and reproductive sciences and molecular genetics and biochemistry; Bernard J. Moncla, research associate professor, obstetrics, gynecology and reproductive sciences, and Lisa Cencia Rohan, assistant professor, pharmaceutical sciences and obstetrics, gynecology and reproductive sciences.

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