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Acute care for elders

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https://www.readbyqxmd.com/read/29163354/diabetes-and-sepsis-risk-recurrence-and-ruination
#1
REVIEW
Lynn M Frydrych, Fatemeh Fattahi, Katherine He, Peter A Ward, Matthew J Delano
Sepsis develops when an infection surpasses local tissue containment. A series of dysregulated physiological responses are generated, leading to organ dysfunction and a 10% mortality risk. When patients with sepsis demonstrate elevated serum lactates and require vasopressor therapy to maintain adequate blood pressure in the absence of hypovolemia, they are in septic shock with an in-hospital mortality rate >40%. With improvements in intensive care treatment strategies, overall sepsis mortality has diminished to ~20% at 30 days; however, mortality continues to steadily climb after recovery from the acute event...
2017: Frontiers in Endocrinology
https://www.readbyqxmd.com/read/29152005/humeral-head-replacement-and-reverse-shoulder-arthroplasty-for-the-treatment-of-proximal-humerus-fracturesm
#2
REVIEW
Aaron Andrew Frombach, Kendra Brett, Peter Lapner
Acute proximal humeral fractures in the elderly are generally treated non-operatively if alignment is acceptable and in stable fracture patterns. When operative treatment is indicated, surgical fixation is often difficult or impossible to obtain. Hemiarthroplasty has long been the standard of care. However, with its reliance on tuberosity healing, functional outcomes and patient satisfaction are often poor. Reverse shoulder arthroplasty has emerged as a new technology for treating proximal humeral fractures but the indications for its use remain uncertain...
2017: Open Orthopaedics Journal
https://www.readbyqxmd.com/read/29147805/can-clinical-practice-indicator-relating-to-long-acting-benzodiazepine-use-in-the-elderly-be-easily-generated-in-a-hospital-setting
#3
Badria Kadri, Antonio Teixeira, Christelle Duteil, Annabelle Tan, Hélène Barreteau, Christophe Segouin, Pénélope Troude
BACKGROUND: To improve the appropriate use of long-acting benzodiazepine (la.bzd) prescriptions in the elderly, the Haute Autorité de Santé (HAS) has developed clinical practice indicators (CPI). The alert indicator (AI) evaluates the prevalence of la.bzd prescription among older people. The mastering indicator (MI) corresponds to the prevalence of elderly with a justified, i.e., appropriate, la.bzd prescription among all the elderly with la.bzd prescriptions. OBJECTIVE: The objective of this study was to test the feasibility of routine generation of CPI regarding la...
November 16, 2017: European Journal of Clinical Pharmacology
https://www.readbyqxmd.com/read/29147496/markov-chain-based-acute-effect-estimation-of-air-pollution-on-elder-asthma-hospitalization
#4
Li Luo, Fengyi Zhang, Wei Zhang, Lin Sun, Chunyang Li, Debin Huang, Gao Han, Bin Wang
Background: Asthma caused substantial economic and health care burden and is susceptible to air pollution. Particularly, when it comes to elder asthma patient (older than 65), the phenomenon is more significant. The aim of this study is to investigate the Markov-based acute effects of air pollution on elder asthma hospitalizations, in forms of transition probabilities. Methods: A retrospective, population-based study design was used to assess temporal patterns in hospitalizations for asthma in a region of Sichuan province, China...
2017: Journal of Healthcare Engineering
https://www.readbyqxmd.com/read/29142496/precipitous-resolution-of-type-a-intramural-hematoma-with-medical-management-in-a-patient-with-metastatic-stage-4-renal-cell-carcinoma
#5
Camilo A Velasquez, Syed Usman Bin Mahmood, Mohammad A Zafar, Adam J Brownstein, Ayman Saeyeldin, Bulat A Ziganshin, John A Elefteriades
Intramural hematoma (IMH) is a variant form of aortic dissection characterized by involvement of the aortic media without the presence of an overt intimal flap. Surgical extirpation is the standard of care for type-A IMH in the Western world. However, a conservative approach with anti-impulse therapy has been advocated especially in Japan as a viable alternative. Here, we report a case of an elderly male patient with a history of metastatic stage 4 renal cell carcinoma who was treated with anti-impulse therapy for an acute type-A IMH...
December 2017: International Journal of Angiology: Official Publication of the International College of Angiology, Inc
https://www.readbyqxmd.com/read/29137820/does-acute-care-for-the-elderly-ace-unit-decrease-the-incidence-of-falls
#6
Ahmed Abdalla, Mehul Adhaduk, Raad A Haddad, Yanal Alnimer, Carlos F Ríos-Bedoya, Ghassan Bachuwa
To determine whether acute care for the elderly (ACE) units decrease the incidence of patient falls compared to general medical and surgical (GMS) units, a non-concurrent prospective study included individuals aged 65 and older admitted to ACE or GMS units over a 2-year span was done. There were 7069 admissions corresponded to 28,401 patient-days. A total of 149 falls were reported for an overall incidence rate (IR) of 5.2 falls per 1000 patient-days, 95% CI, 4.4/1000-6.1/1000 patient-days. The falls IR ratio for patients in ACE unit compared to those in non-ACE units after adjusting for age, sex, prescribed psychotropics and hypnotics, and Morse Fall Score was 0...
November 11, 2017: Geriatric Nursing
https://www.readbyqxmd.com/read/29132658/-elderly-hospitalised-people-and-walking-capacities
#7
Camille Castel, Pascale Lescure, Gilles Loggia, Rémi Morello, Rémi De Mil, Guillaume Saint-Lorant
Falls in the elderly are frequent. A study carried out over 6 months in a university hospital's acute geriatric unit highlighted the real walking capacities of hospitalised elderly people. It also changed the perception of caregivers, doctors and nurses with regard to the real physical aptitudes of these patients enabling the risk of falls to be reduced in preparation for their return home or to a residential care home.
November 2017: Soins. Gérontologie
https://www.readbyqxmd.com/read/29129447/amplified-hearing-device-use-in-acute-care-settings-for-patients-with-hearing-loss-a-feasibility-study
#8
Amber R Kimball, Cecelia I Roscigno, Coretta M Jenerette, Kimberly M Hughart, Wendy W Jenkins, Wesley Hsu
The objective of this study was to assess the feasibility of using amplified hearing devices (AHD) in acute care settings for patients with hearing loss. Secondary objectives include patient and nurse satisfaction, and nursing perceived productivity. Twenty-five adult hard of hearing patients and 15 nurses were evaluated. Patients with a perceived hearing handicap were identified through the Hearing Handicap for the Elderly Screening Version. Patient and staff nurse surveys were used to assess for satisfaction with using the AHD...
November 9, 2017: Geriatric Nursing
https://www.readbyqxmd.com/read/29122806/diagnostic-utility-of-appetite-loss-in-addition-to-existing-prediction-models-for-community-acquired-pneumonia-in-the-elderly-a-prospective-diagnostic-study-in-acute-care-hospitals-in-japan
#9
Toshihiko Takada, Yosuke Yamamoto, Kazuhiko Terada, Mitsuyasu Ohta, Wakako Mikami, Hajime Yokota, Michio Hayashi, Jun Miyashita, Teruhisa Azuma, Shingo Fukuma, Shunichi Fukuhara
OBJECTIVE: Diagnosis of community-acquired pneumonia (CAP) in the elderly is often delayed because of atypical presentation and non-specific symptoms, such as appetite loss, falls and disturbance in consciousness. The aim of this study was to investigate the external validity of existing prediction models and the added value of the non-specific symptoms for the diagnosis of CAP in elderly patients. DESIGN: Prospective cohort study. SETTING: General medicine departments of three teaching hospitals in Japan...
November 8, 2017: BMJ Open
https://www.readbyqxmd.com/read/29109625/postoperative-delirium-in-elderly-citizens-and-current-practice
#10
REVIEW
Siddareddygari Velayudha Reddy, Jawaharlal Narayanasa Irkal, Ananthapuram Srinivasamurthy
Postoperative delirium (POD) represents an acute brain dysfunction in the postsurgical period. Perioperative physicians caring for the older adults are familiar with the care of dysfunction of organs such as lungs, heart, liver, or kidney in the perioperative setting, but they are less familiar with management of brain dysfunction. As early detection and prompt treatment of inciting factors are utmost important to prevent or minimize the deleterious outcomes of delirium. The purpose of this review is to prepare perioperative physicians with a set of current clinical practice recommendations to provide optimal perioperative care of older adults, with a special focus on specific perioperative interventions that have been shown to prevent POD...
July 2017: Journal of Anaesthesiology, Clinical Pharmacology
https://www.readbyqxmd.com/read/29102999/prospective-cohort-study-to-investigate-the-burden-and-transmission-of-acute-gastroenteritis-in-care-homes-a-study-protocol
#11
Thomas Inns, Anna Pulawska-Czub, John P Harris, Roberto Vivancos, Jonathan M Read, Nicholas J Beeching, David J Allen, Miren Iturriza-Gomara, Sarah J O'Brien
INTRODUCTION: Noroviruses are the leading cause of acute gastroenteritis in all age groups, but illness is more severe and causes excess mortality in the elderly, particularly those in long-term care. The total burden of norovirus disease in the elderly in the UK is poorly defined; no current surveillance programmes systematically or accurately quantify norovirus infection in those living in care homes. The aim of this study is to evaluate an enhanced surveillance system for acute gastroenteritis among the elderly in care homes...
November 3, 2017: BMJ Open
https://www.readbyqxmd.com/read/29096710/putting-research-in-place-an-innovative-approach-to-providing-contextualized-evidence-synthesis-for-decision-makers
#12
Stephen Bornstein, Rochelle Baker, Pablo Navarro, Sarah Mackey, David Speed, Melissa Sullivan
BACKGROUND: The Contextualized Health Research Synthesis Program (CHRSP), developed in 2007 by the Newfoundland and Labrador Centre for Applied Health Research, produces contextualized knowledge syntheses for health-system decision makers. The program provides timely, relevant, and easy-to-understand scientific evidence; optimizes evidence uptake; and, most importantly, attunes research questions and evidence to the specific context in which knowledge users must apply the findings. METHODS: As an integrated knowledge translation (KT) method, CHRSP: Involves intensive partnerships with senior healthcare decision makers who propose priority research topics and participate on research teams; Considers local context both in framing the research question and in reporting the findings; Makes economical use of resources by utilizing a limited number of staff; Uses a combination of external and local experts; and Works quickly by synthesizing high-level systematic review evidence rather than primary studies...
November 2, 2017: Systematic Reviews
https://www.readbyqxmd.com/read/29096539/the-role-of-participatory-music-making-in-supporting-people-with-dementia-in-hospital-environments
#13
Norma Daykin, Barbara Parry, Kerry Ball, David Walters, Ann Henry, Bronwyn Platten, Rachel Hayden
Background Improving the quality of care for people with dementia in general hospitals is a key priority. Creative activities including music have been examined for their potential role in enhancing quality of life for people with dementia, although relatively few studies have evaluated their use in acute hospital settings. Methods A mixed methods study examined the effects of a ten week period of weekly music sessions on the wellbeing of patients with dementia and on the ward environment in an acute elderly care service in a UK hospital...
January 1, 2017: Dementia
https://www.readbyqxmd.com/read/29089456/no-racial-difference-in-rehabilitation-therapy-across-all-post-acute-care-settings-in-the-year-following-a-stroke
#14
Lesli E Skolarus, Chunyang Feng, James F Burke
BACKGROUND AND PURPOSE: Black stroke survivors experience greater poststroke disability than whites. Differences in post-acute rehabilitation may contribute to this disparity. Therefore, we estimated racial differences in rehabilitation therapy utilization, intensity, and the number of post-acute care settings in the first year after a stroke. METHODS: We used national Medicare data to study 186 168 elderly black and white patients hospitalized with a primary diagnosis of stroke in 2011...
October 31, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/29088951/update-on-critical-care-for-acute-spinal-cord-injury-in-the-setting-of-polytrauma
#15
John K Yue, Ethan A Winkler, Jonathan W Rick, Hansen Deng, Carlene P Partow, Pavan S Upadhyayula, Harjus S Birk, Andrew K Chan, Sanjay S Dhall
Traumatic spinal cord injury (SCI) often occurs in patients with concurrent traumatic injuries in other body systems. These patients with polytrauma pose unique challenges to clinicians. The current review evaluates existing guidelines and updates the evidence for prehospital transport, immobilization, initial resuscitation, critical care, hemodynamic stability, diagnostic imaging, surgical techniques, and timing appropriate for the patient with SCI who has multisystem trauma. Initial management should be systematic, with focus on spinal immobilization, timely transport, and optimizing perfusion to the spinal cord...
November 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/29066661/exercise-induced-anaphylaxis-in-an-elderly-patient
#16
Hirofumi Namiki
A 75-year-old Japanese woman presented with acute flushing pruritus and a feeling of diffuse warmth followed by collapse while dancing. After resting for 30 min and receiving a rapid infusion of 0.9% sodium chloride, her condition stabilised. She admitted that she had a similar experience 2 years earlier while dancing. Based on her history, her symptoms were attributed to exercise-induced anaphylaxis. None of the episodes was associated with any other suspicious cotriggers of anaphylaxis. She was successfully discharged from the clinic without any complications after receiving careful guidance on how to prevent this condition...
October 24, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/29065395/life-threatening-atypical-case-of-acute-generalized-exanthematous-pustulosis
#17
Azadeh Tajmir-Riahi, Petra Wörl, Thomas Harrer, Stefan Schliep, Gerold Schuler, Miklos Simon
Antibiotics are known to cause severe cutaneous adverse reactions, such as the rare acute generalized exanthematous pustulosis (AGEP). Unlike Stevens-Johnson syndrome or toxic epidermal necrolysis, AGEP is rarely life-threatening. Systemic involvement is not typical, and if present usually coincides with a mild elevation of the hepatic enzymes and a decrease in renal function. Hence, AGEP is known to have a good prognosis and to be life-threatening only in elderly patients or patients with chronic diseases...
2017: International Archives of Allergy and Immunology
https://www.readbyqxmd.com/read/29064263/long-term-prognostic-value-of-delirium-in-elderly-patients-with-acute-cardiac-diseases-admitted-to-two-cardiac-intensive-care-units-a-prospective-study-delirium-cordis
#18
Giovanni Falsini, Simone Grotti, Italo Porto, Giulio Toccafondi, Aureliano Fraticelli, Paolo Angioli, Kenneth Ducci, Francesco Liistro, Maurizio Pieroni, Tamara Taddei, Serena Romanelli, Roberto Rossi, Leonardo Bolognese
BACKGROUND: Delirium is a frequent in-hospital complication in elderly patients, and is associated with poor clinical outcome. Its clinical impact, however, has not yet been fully addressed in the setting of the cardiac intensive care unit (CICU). The present study is a prospective, two-centre registry aimed at assessing the incidence, prevalence and significance of delirium in elderly patients with acute cardiac diseases. METHODS: Between January 2014 and March 2015, all consecutive patients aged 65 years or older admitted to the CICU of our institutions were enrolled and followed for 6 months...
January 1, 2017: European Heart Journal. Acute Cardiovascular Care
https://www.readbyqxmd.com/read/29061633/factors-associated-with-quality-of-life-in-elderly-hospitalised-patients-undergoing-post-acute-rehabilitation-a-cross-sectional-analytical-study-in-switzerland
#19
Marc-Antoine Bornet, Eve Rubli Truchard, Etienne Rochat, Jérôme Pasquier, Stéfanie Monod
OBJECTIVES: We investigated whether biopsychosocial and spiritual factors and satisfaction with care were associated with patients' perceived quality of life. DESIGN: This was a cross-sectional analytical study. SETTING: Data were collected from inpatients at a postacute geriatric rehabilitation centre in a university hospital in Switzerland. PARTICIPANTS: Participants aged 65 years and over were consecutively recruited from October 2014 to January 2016...
October 22, 2017: BMJ Open
https://www.readbyqxmd.com/read/29059475/incidence-of-and-risk-factors-for-severe-adverse-events-in-elderly-patients-taking-angiotensin-converting-enzyme-inhibitors-or-angiotensin-ii-receptor-blockers-after-an-acute-myocardial-infarction
#20
Gang Fang, Izabela E Annis, Joel F Farley, Nirosha Mahendraratnam, Ryan P Hickson, Til Stürmer, Jennifer G Robinson
STUDY OBJECTIVE: To assess the incidence of and risk factors associated with severe adverse events in elderly patients who used angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) after an acute myocardial infarction (AMI). DESIGN: Retrospective cohort study. DATA SOURCES: Centers for Medicare & Medicaid Services Chronic Conditions Data Warehouse (Medicare service claims database), American Community Survey of the U...
October 23, 2017: Pharmacotherapy
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