Elderly drugs wound care

BACKGROUND: Ten years after the first proposal, a consensus definition of healthcare-associated infection (HCAI) has not been reached, preventing the development of specific treatment recommendations. A systematic review of all definitions of HCAI used in clinical studies is made. METHODS: The search strategy focused on an HCAI definition. MEDLINE, SCOPUS and ISI Web of Knowledge were searched for articles published from earliest achievable data until November 2012...

BACKGROUND: The use of skeletal muscle relaxants (SMRs) among older adults is associated with sedation and confusion, which may lead to an increased risk of falls and injuries. SMRs continue to be used among older adults, although they are on the Beers list as drugs to avoid in the elderly. OBJECTIVE: To investigate the relationship between SMR use and subsequent risk of injury. METHODS: This was a retrospective case-control study of members aged 65 years or older enrolled in an integrated health care system...

SUMMARY: Antihypertensive drugs are associated with an immediate increased falls risk in elderly patients which was significant during the first 14 days after receiving a thiazide diuretic, angiotensin-converting enzyme inhibitor, angiotensin II receptor blocker, calcium channel blocker, or beta-adrenergic blocker. Fall prevention strategies during this period may prevent fall-related injuries. INTRODUCTION: The purpose of this study is to evaluate if initiation of the common antihypertensive drugs is associated with the occurrence of falls...

Population estimates projects a significant increase in the geriatric population making elderly trauma patients more common. The geriatric trauma patients experience higher incidence of pre-existing medical conditions, impaired age-dependent physiologic reserve, use potent drugs and suffer from trauma system related shortcomings that influence outcomes. To improve adjustments for older age in pre-hospital assessment and care, several initiatives should be implemented. Decision-makers should make system revisions and introduce advanced point-of-care initiatives to improve outcome after trauma for the elderly...

BACKGROUND CONTEXT: Postoperative back pain is common after decompression surgery for lumbar stenosis and often delays discharge from hospital. Achieving regional analgesia by intraoperative delivery of epidural opiates after lumbar canal decompression is a promising approach to reduce postoperative pain and enhance early mobilization. However, there have been concerns about opiate-related complications, such as respiratory depression and urinary retention in what is generally an elderly population of patients...

Pre-tibial lacerations are complex wounds affecting a primarily aged population, with poor healing and a potentially significant impact on social well-being. Management of these wounds has changed little in 20 years, despite significant advances in wound care. A retrospective observational study was undertaken to observe current wound care practice and to assess the effect of various medical factors on wound healing time on 24 elderly patients throughout their wound journey. Wound length was found to be substantively and significantly associated with wound healing time, with a reduction in instantaneous healing rate of about 30% for every increase of 1 cm in wound length...

BACKGROUND: Skin and soft tissue infections (SSTIs) have become the second most common type of infection among persons residing in long-term care facilities. OBJECTIVE: The purpose of this article was to review the latest information on SSTIs among the elderly, including age-related changes, challenges, and treatment strategies in the era of emerging bacterial resistance. METHODS: Relevant information was identified through a search of MEDLINE (1970-April 2010), International Pharmaceutical Abstracts (1970-April 2010), and Google Scholar using the terms skin and soft tissue infection, skin and skin structure infection, cellulitis, treatment guidelines, and elderly...

BACKGROUND: Delivery of effective primary, secondary, and tertiary injury prevention in homeless populations is complex and could be greatly aided by an improved understanding of contributing factors. METHODS: Injury and health conditions were examined for hospitalized New York City homeless persons (n = 326,073) and low socioeconomic status (SES) housed residents (n = 1,202,622) using 2000 to 2002 New York statewide hospital discharge data (Statewide Program and Research Cooperative System)...

OBJECTIVE: To examine whether preoperative statin use is associated with a reduced risk of surgical site infections. DESIGN, SETTING, AND PATIENTS: Population-based retrospective cohort study of all elderly patients undergoing elective surgery in Ontario from April 1, 1992, through March 31, 2006. Preoperative statin use was identified using provincewide pharmacy records. Procedure and patient characteristics were derived from hospital and physician claims databases within Canada's single-payer universal health care system...

PURPOSE: To identify the associated factors and study the clinical and microbiological characteristics of corneal ulcers resulting in evisceration and enucleation in elderly patients in a tertiary care hospital. METHODS: A review of all patients who required evisceration or enucleation due to microbial keratitis at the Royal Victorian Eye and Ear Hospital, Melbourne, Australia between July 1998 and November 2007 was performed. Of these, patients more than 60 years of age were included in the study for analysis...

OBJECTIVE: To outline the characteristics of deep dissecting hematoma (DDH). DESIGN: Retrospective medical record review. SETTING: Department of Dermatology, University Hospital of Geneva, Geneva, Switzerland. PATIENTS: Thirty-four patients with DDH. INTERVENTIONS: Deep incision or surgical debridement was performed in all the patients. Direct closure of the incision was possible in 6 patients, and split-thickness skin grafting was applied to 17 patients...

Community and rural hospitals rely to a greater extent on transferring acute patients to other settings which can provide the required definitive care. Using data on all hospital discharges of patients from the 11 acute care hospitals of the Frosinone Local Health Unit (7 of which were publicly run, and 4 were run by privates) over the period 1997-2005, a study was carried out to assess the frequency, time-trend and determinants of transfers. Between 1997 and 2005, 8,009 patients (1.3%) were transferred to acute care hospitals, while 2,499 (0...

BACKGROUND: Perioperative antibacterial prophylaxis (PAP) is an important component of surgical site infection prevention but may be associated with adverse effects, such as Clostridium difficile infection (CDI). Since the emergence of a hypervirulent strain of C. difficile, the risk of development of CDI after PAP has not been evaluated. The purpose of this study was to determine the risk of PAP-induced CDI after selected surgical procedures and to compare such risk before with such risk after the emergence of the hypervirulent strain of C...

OBJECTIVES: The aim of this study was to describe the rates of antimicrobial susceptibility of Staphylococcus aureus from skin and wound infections reported from nine regions of the USA during 2005-07 and to identify the regional variation in patterns of resistance. METHODS: The Surveillance Network (TSN) comprises 296 laboratories across the nine census regions of the USA. TSN laboratories reported the susceptibility data for six antimicrobials by isolate with source and other relevant data...

Aging has become a major health care problem and socio-economic burden worldwide. Myocardial infarction (MI) is the major killer worldwide and coronary reperfusion is the major form of acute post-MI therapy. The aging population is increasing, and with it, morbidity and mortality due to impaired healing after ST-segment elevation MI (STEMI) and its consequences. Optimal healing of the wounded heart is critical for preservation of structural and functional integrity of the pumping chambers, survival, and a favorable outcome irrespective of age...

BACKGROUND: The surveillance of surgical site infections (SSI) has been undertaken in many centres worldwide to ascertain the extent of the problem and where possible, to improve the incidence rates, thereby decreasing the undesirable outcomes. The study investigates the processes and outcomes of total hip replacement SSI surveillance carried out in Dunedin Public Hospital in 2004. METHODS: Two hundred and six patients were enlisted in the study and 189 primary replacements and 22 revision replacements were carried out...

OBJECTIVE: To estimate the cost-utility of bio-electric stimulation therapy (Posifect) compared to standard care in elderly patients with chronic, non-healing wounds of > 6 months duration, from the perspective of the National Health Service (NHS) in the UK. METHODS: Clinical and resource use data from a 16 week clinical evaluation of bio-electric stimulation therapy among patients who had recalcitrant wounds were combined with utility data obtained from a standard gamble analysis to construct a 16 week Markov model...

This review discusses the molecular and genetic evidence for silver resistance in bacteria isolated from skin wounds and medical devices with reference to a case study of resistant Enterobacter cloacae from the leg ulcers of an elderly woman.

The aim of this study was to describe and quantify systemic antibiotic prescribing for patients with chronic skin wounds presenting at the primary care, nonspecialist setting. Data for 1 year were extracted from a general practice morbidity database comprising approximately 185,000 patients attending family medical practitioners in Wales. Patients with chronic wounds (PCW) were identified using Read Codes and compared with nonwound patients who were randomly selected after matching for age-band, sex, and general practice...

OBJECTIVE: To review the standardized subcutaneous insulin protocols for diabetic patients on general medical and surgical floors at the University of Vermont. METHOD: Insulin protocols were developed for inpatients eating regular meals, and those receiving continuous tube feedings or total parental nutrition. RESULTS: The recommended starting subcutaneous insulin protocol for patients receiving meals is a basal-bolus approach using 0.5 U/kg basal insulin (glargine once daily, or neutral protamine Hagedorn [NPH] twice daily) and 0...