Many patients with end-stage renal disease come to rely on catheters as their only means of hemodialysis when other options are no longer viable. These patients have a very poor quality of life due to their chronic illness as well as many long-term complications related to the use of tunneled catheters. Many prior attempts have been made to understand these catheter-related problems. Yet, they continue to be a major cause of morbidity and mortality in chronic catheter-reliant patients. We hope to examine the rate as well as long term time course of these complications such that in future, we may decrease their occurrence. We predict that over time, chronic catheter use decreases the mean indwell time for each catheterization and increases the incidence of complications. To study this, we conducted a retrospective study looking at all patients who had three or more tunneled catheter exchanges between July 2003 and July 2008. We collected information from Yale IDX database on the patients age and gender, the type of catheter used, the indwell time of the catheter, the vessel used as access, the indication for catheter removal, whether the procedure was performed by a medical doctor (M.D.) or physicians assistant (P.A.) and whether it was a de novo insertion or over-the-wire exchange. We collected a total of 764 data points on 191 patients (89 males and 102 females). They ranged from 8 to 87 years old with a median age of 56 years. Infection was the number one indication for catheter removal at 37%. The rate of infection was 3.34 per 1,000 catheter days. There was no difference in the rate of complications by the side of vessel accessed nor by type of catheter. However, right-sided catheters had a longer indwell time of 117 + 159 days compared to left-sided catheters, 87 + 124 days (p =0.008). There was no significant difference in the indwell duration of first catheter in comparison to all subsequent placements. There was also no difference in complications whether the catheter was exchanged over the wire or placed de novo. Nor were complication rates different among M.D. versus P.A. conducted procedures. We conclude that our rates of infection are similar to other institutions and the vessels located on the right-side of the neck are preferable to left-sided vessels to increase catheter longevity. Future research is needed to better assess how rates and incidences of complications change with long standing catheter-reliance.

This study explores the relationship between living arrangement and psychological wellbeing in retired elderly individuals living in Yancheng, Jiangsu (PR China). Data on mode of residence, socio-economic background, daily activities, and intergenerational dynamics were collected from 200 subjects, and their potential correlations with depression (assessed via the Geriatric Depression Scale Short Version) were analyzed. Univariate as well as logistic regression confirmed mode of residence as a significant predictor of depression in this group. The following depression odds ratios associated with each mode of residence were derived via logistic regression: 1) nuclear household, i.e. living with a spouse only ¨C 1 [reference category], 2) multigenerational households in which a spouse is not present ¨C 4.341, 3) multigenerational households in which a spouse is present ¨C 0.781, and 4) living alone ¨C 3.018. Based on these ratios, we conclude that the traditional model of intergenerational coresidence is not, in itself, associated with less depression. Rather, it is the presence of a sharing spousal in a household (whether single or multigenerational) that protects against elderly depression. Other predictors of depression identified in backward logistic regression included presence of a chronic illness and self assessed wealth status. Additionally, a number of psychosocial variables were identified as independently correlated with depression, but were subsequently selected out by multivariate analysis. These included: educational background, religious affiliation, membership in an organization, attitude toward aging, and family status. Based on this study, we believe that efforts to promote mental wellbeing among today¡¯s Chinese elders should be directed toward psychosocial factors that are modifiable (education, building supportive social networks etc.) rather than insisting on the traditional ideal of multigenerational living and dependence on filial piety.

Clinical trials investigating autologous stem cell transplantation (ASCT) have historically excluded elderly patients due to the risk of treatment-related morbidity related to the administration of high dose chemotherapy. While the availability of this procedure continues to expand, the elderly still represent a population for which the role of ASCT needs to be fully defined. 201 patients who underwent autologous stem cell transplantation (ASCT) for Non Hodgkins lymphoma (NHL) at a single institution following BEAM conditioning between January 1, 2000 and December 31, 2007 were retrospectively identified from the Yale University School of Medicine Bone Marrow Transplant Database. 67 patients were older than 60 years at the time of transplantation (median age 65, range 60 75) and were compared to a matched group of 134 patients transplanted during the same time period. These groups were extremely well-matched for all demographics such as gender, NHL histology, performance status, and comorbidities. Most patients had advanced stage disease at diagnosis and were transplanted at first or second remission. Diffuse large B-cell and mantle cell lymphoma were the most common subtypes but other subtypes were represented. The elderly group experienced significantly more serious toxicities within the first 100 days (63%) when compared to the control group (42%). However, there were no statistical differences (p<0.0001) between the groups regarding specific organ system toxicities. The 1-year non-relapse mortality (3%) was not significantly different when compared to the younger cohort (1%). At a median follow-up of 31 months the median overall survival is 85 months in the elderly group and at a median follow up of 33 months in the younger group the median overall survival has not yet been reached. The overall survival at 3 years is 74% and 75% respectively (p=0.91). The disease-free survival at 3 years is 48% in the elderly group compared to 58% in the control group (p=0.66). By univariate analysis, age >60 years (RR 3.1, 95% CI 1.7 5.7, p=0.004) was the only factor predictive of developing a serious toxicity from ASCT within the first 100 days. HCT-CI score (RR 2, 95% CI 1 4, p=0.043) was the only factor associated with significantly worse overall survival. Autologous stem cell transplantation can be safely performed in selected patients older than 60 years with chemosensitive NHL. Although elderly patients appear more likely to develop acute toxicities, the outcomes are similar to that of younger patients with respect to non-relapse mortality, disease-free survival, and overall survival.

Thesis (Ph. D.)--University of Missouri--Columbia, 2003. / "December 2003." Typescript. Vita. Includes bibliographical references (leaves 162-175). Also available on the Internet.

Thesis (Ph. D.)--University of Missouri--Columbia, 2003. / Typescript. Vita. Includes bibliographical references (leaves 146-165). Also available on the Internet.

Thesis (Ph. D.)--University of Missouri--Columbia, 2003. / Typescript. Vita. Includes bibliographical references.

Thesis (Ph. D.)--University of Missouri-Columbia, 2000. / Typescript. Vita. Includes bibliographical references (leaves 101-109). Also available on the Internet.

Thesis (Ph. D.)--University of Missouri-Columbia, 2000. / Typescript. Vita. Includes bibliographical references (leaves 101-109). Also available on the Internet.

Thesis (M.A.)--West Virginia University, 2001. / Title from document title page. Document formatted into pages; contains v, 47 p. Vita. Includes abstract. Includes bibliographical references (p. 26-28).

Thesis (M. Soc. Sc.)--University of Hong Kong, 1985.