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Acute care for elders

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https://www.readbyqxmd.com/read/29339097/safety-and-preliminary-efficacy-of-venetoclax-with-decitabine-or-azacitidine-in-elderly-patients-with-previously-untreated-acute-myeloid-leukaemia-a-non-randomised-open-label-phase-1b-study
#1
Courtney D DiNardo, Keith W Pratz, Anthony Letai, Brian A Jonas, Andrew H Wei, Michael Thirman, Martha Arellano, Mark G Frattini, Hagop Kantarjian, Relja Popovic, Brenda Chyla, Tu Xu, Martin Dunbar, Suresh K Agarwal, Rod Humerickhouse, Mack Mabry, Jalaja Potluri, Marina Konopleva, Daniel A Pollyea
BACKGROUND: Elderly patients (aged ≥65 years) with acute myeloid leukaemia have poor outcomes and no effective standard-of-care therapy exists. Treatment with hypomethylating agents such as azacitidine and decitabine is common, but responses are modest and typically short-lived. The oral anti-apoptotic B-cell lymphoma 2 protein inhibitor, venetoclax, has shown promising single-agent activity in patients with relapsed or refractory acute myeloid leukaemia and preclinical data suggested synergy between hypomethylating agents and venetoclax, which led to this combination phase 1b study...
January 12, 2018: Lancet Oncology
https://www.readbyqxmd.com/read/29336918/current-prevention-and-control-of-health-care-associated-infections-in-long-term-care-facilities-for-the-elderly-in-japan
#2
Naoko Kariya, Naomi Sakon, Jun Komano, Kazunori Tomono, Hiroyasu Iso
Residents of long-term care facilities for the elderly are vulnerable to health care-associated infections. However, compared to medical institutions, long-term care facilities for the elderly lag behind in health care-associated infection control and prevention. We conducted a epidemiologic study to clarify the current status of infection control in long-term care facilities for the elderly in Japan. A questionnaire survey on the aspects of infection prevention and control was developed according to SHEA/APIC guidelines and was distributed to 617 long-term care facilities for the elderly in the province of Osaka during November 2016 and January 2017...
January 11, 2018: Journal of Infection and Chemotherapy: Official Journal of the Japan Society of Chemotherapy
https://www.readbyqxmd.com/read/29336301/-acute-promyelocytic-leukaemia
#3
Michael Tøstesen, Lene S G Østergård, Eigil Kjeldsen, Jesper Stentoft, Jan M Nørgaard
Acute promyelocytic leukaemia has changed from being a highly fatal to a highly curable disease. Over time, key discoveries have identified the genetic and molecular abnormalities, which cause the disease. First choice of treatment has now changed from all-trans retinoic acid (ATRA) and chemotherapy to a chemo-free combination of arsenic trixoide and ATRA. This new regimen has shown equal responses and overall cure rates compared with the previous standard of care containing conventional chemotherapy, but with much lower toxicity...
January 15, 2018: Ugeskrift for Laeger
https://www.readbyqxmd.com/read/29321797/prediction-model-of-in-hospital-mortality-in-elderly-patients-with-acute-heart-failure-based-on-retrospective-study
#4
Qian Jia, Yu-Rong Wang, Ping He, Xue-Liang Huang, Wei Yan, Yang Mu, Kun-Lun He, Ya-Ping Tian
Objectives: The aim of this study was to develop a clinical risk model that is predictive of in-hospital mortality in elderly patients hospitalized with acute heart failure (AHF). Methods: 2486 patients who were 60 years and older from intensive care units of Cardiology Department in the hospital were analyzed. Independent risk factors for in-hospital mortality were obtained by binary logistic regression and then used to establish the risk prediction score system (RPSS)...
November 2017: Journal of Geriatric Cardiology: JGC
https://www.readbyqxmd.com/read/29317806/profile-of-sugammadex-for-reversal-of-neuromuscular-blockade-in-the-elderly-current-perspectives
#5
REVIEW
Michele Carron, Francesco Bertoncello, Giovanna Ieppariello
The number of elderly patients is increasing worldwide. This will have a significant impact on the practice of anesthesia in future decades. Anesthesiologists must provide care for an increasing number of elderly patients, who have an elevated risk of perioperative morbidity and mortality. Complications related to postoperative residual neuromuscular blockade, such as muscle weakness, airway obstruction, hypoxemia, atelectasis, pneumonia, and acute respiratory failure, are more frequent in older than in younger patients...
2018: Clinical Interventions in Aging
https://www.readbyqxmd.com/read/29317223/cluster-analysis-of-vulnerable-groups-in-acute-tbi-rehabilitation
#6
Erkut N Kucukboyaci, Coralynn Long, Michelle Smith, Joseph F Rath, Tamara Bushnik
OBJECTIVE: To analyze the complex relationship between various social indicators that contribute to socioeconomic status and healthcare barriers. DESIGN: Cluster analysis of historical patient data obtained from inpatient visits. SETTING: Setting: Inpatient rehabilitation unit in a large, urban university hospital PARTICIPANTS: Adult patients receiving acute inpatient care, predominantly for closed head injury. INTERVENTIONS: Not applicable MAIN OUTCOME MEASURES: We examined the membership of TBI patients in various "vulnerable group" (VG) clusters (e...
January 6, 2018: Archives of Physical Medicine and Rehabilitation
https://www.readbyqxmd.com/read/29305431/case-of-nasogastric-tube-dysfunction
#7
Florian Rainer, Guenther Prenner, Lukas Peter Binder, Peter Fickert, Johannes Plank
CLINICAL PRESENTATION: An elderly female patient was admitted to intensive care for prolonged vasopressor therapy and mechanical ventilation after cardiac arrest and acute percutaneous coronary intervention. Antiplatelet, thyroid hormone replacement and statin therapies were administered through a 14-French nasogastric tube (Nestlé Health Science) and enteral feeding was initiated. Correct position of the nasogastric tube was confirmed radiologically. On the seventh day in the intensive care, our patient was seen to regurgitate soft crumbs into her mouth...
January 5, 2018: Gut
https://www.readbyqxmd.com/read/29301226/impact-of-pharmacist-conducted-comprehensive-medication-reviews-for-older-adult-patients-to-reduce-medication-related-problems
#8
Whitney J Kiel, Shaun W Phillips
Older adults are demanding increased healthcare attention with regards to prescription use due in large part to highly complex medication regimens. As patients age, medications often have a more pronounced effect on older adults, negatively impacting patient safety and increasing healthcare costs. Comprehensive medication reviews (CMRs) optimize medications for elderly patients and help to avoid inappropriate medication use. Previous literature has shown that such CMRs can successfully identify and reduce the number of medication-related problems and improve acute healthcare utilization...
December 31, 2017: Pharmacy (Basel, Switzerland)
https://www.readbyqxmd.com/read/29291023/combined-venetoclax-and-alvocidib-in-acute-myeloid-leukemia
#9
James Bogenberger, Clifford Whatcott, Nanna Hansen, Devora Delman, Chang-Xin Shi, Wontak Kim, Hillary Haws, Katherine Soh, Ye Sol Lee, Peter Peterson, Adam Siddiqui-Jain, Steven Weitman, Keith Stewart, David Bearss, Ruben Mesa, Steven Warner, Raoul Tibes
More effective treatment options for elderly acute myeloid leukemia (AML) patients are needed as only 25-50% of patients respond to standard-of-care therapies, response duration is typically short, and disease progression is inevitable even with some novel therapies and ongoing clinical trials. Anti-apoptotic BCL-2 family inhibitors, such as venetoclax, are promising therapies for AML. Nonetheless, resistance is emerging. We demonstrate that venetoclax combined with cyclin-dependent kinase (CDK) inhibitor alvocidib is potently synergistic in venetoclax-sensitive and -resistant AML models in vitro, ex vivo and in vivo...
December 5, 2017: Oncotarget
https://www.readbyqxmd.com/read/29289386/mortality-risk-factors-in-elderly-patients-in-intensive-care-without-limitation-of-therapeutic-effort
#10
S E Giannasi, M S Venuti, A D Midley, N Roux, C Kecskes, E San Román
OUTCOME: To determine mortality prognostic factors in elderly patients who are admitted to intensive care units (ICUs) due to acute critical illness. DESIGN: A prospective cohort study was carried out. SETTING: A polyvalent Intensive Care Unit at a University Hospital in Argentina. PATIENTS OR PARTICIPANTS: We included 249 patients over 65years of age who were consecutively admitted to the ICU and required mechanical ventilation for more than 48hours, between January 2011 and December 2012...
December 27, 2017: Medicina Intensiva
https://www.readbyqxmd.com/read/29288428/outcomes-of-previously-untreated-elderly-patients-with-aml-a-propensity-score-matched-comparison-of-clofarabine-vs-flag
#11
Gianni B Scappaticci, Bernard L Marini, Victoria R Nachar, James R Uebel, Vera Vulaj, Ashley Crouch, Dale L Bixby, Moshe Talpaz, Anthony J Perissinotti
The 5-year overall survival (OS) in patients ≥ 60 years old with acute myeloid leukemia (AML) remains < 10%. Clofarabine-based induction (CLO) provides an alternative to low-intensity therapy (LIT) and palliative care for this population, but supporting data are conflicted. Recently, our institution adopted the FLAG regimen (fludarabine, cytarabine, and granulocyte colony-stimulating factor) based on data reporting similar outcomes to CLO in elderly patients with AML unable to tolerate anthracycline-based induction...
December 29, 2017: Annals of Hematology
https://www.readbyqxmd.com/read/29278266/regional-nerve-blockade-for-early-analgesic-management-of-elderly-patients-with-hip-fracture-a-narrative-review
#12
REVIEW
A Scurrah, C T Shiner, J A Stevens, S G Faux
Elderly patients with hip fracture experience high morbidity and mortality, and are often undertreated for pain. Acute pain management in the elderly is challenging, with physiological frailty, medical comorbidities and cognitive impairment commonly compounding pain assessment and treatment. Guidelines outlining current best practice for acute pain management in the elderly now exist, but evidence suggests that practice remains variable and there continues to be scope for improvement. We conducted a narrative review of the literature to examine the challenges of acute pain management in the elderly, and to evaluate evidence for the role of regional nerve blocks for acute pain associated with hip fracture in the elderly...
December 26, 2017: Anaesthesia
https://www.readbyqxmd.com/read/29251766/handing-off-the-older-patient-improved-documentation-of-geriatric-assessment-in-transitions-of-care
#13
Ben A Blomberg, Rebekah C Mulligan, Stephen J Staub, Laura C Hanson, Margaret A Drickamer, Maureen C Dale
OBJECTIVES: To improve assessment and documentation of function, cognition, and advance care planning (ACP) in admission and discharge notes on an Acute Care of the Elderly (ACE) unit. DESIGN: Continuous quality improvement intervention with episodic data review. SETTING: ACE unit of an 866-bed academic tertiary hospital. PARTICIPANTS: Housestaff physicians rotating on the ACE unit (N = 31). INTERVENTION: Introduction of templated notes, housestaff education, leadership outreach, and posted reminders...
December 18, 2017: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/29240661/physical-restraint-use-with-elderly-patients-perceptions-of-nurses-and-nursing-assistants-in-spanish-acute-care-hospitals
#14
Emilio Fariña-López, Gabriel J Estévez-Guerra, M Luz Polo-Luque, Alica Hanzeliková Pogrányivá, Eva Penelo
BACKGROUND: Physical restraint is often used during the hospitalization of elderly people. However, this procedure is associated with adverse outcomes; therefore, it is necessary to be aware of the circumstances that promote restraint use, such as the perceptions of professionals who use it. OBJECTIVES: The purpose of the research was to determine the situations in which nursing staff considered the use of physical restraint as most important and to evaluate the possible associations with the sociodemographic and professional variables...
January 2018: Nursing Research
https://www.readbyqxmd.com/read/29238363/bleeding-outcomes-after-non-emergency-percutaneous-coronary-intervention-in-the-very-elderly
#15
Vimalraj Bogana Shanmugam, Dennis T Wong, Hashrul Rashid, James D Cameron, Yuvaraj Malaiapan, Peter J Psaltis
Background: Octogenarians constitute an increasing proportion of patients presenting for non-emergency percutaneous coronary intervention (PCI). Methods: This study evaluated the in-hospital procedural characteristics and outcomes, including the bleeding events of 293 octogenarians presenting between January 2010 and December 2012 for non-emergency PCI to a single large volume tertiary care Australian center. Comparisons were made with 293 consecutive patients aged less than or equal to 60 years, whose lesions were matched with the octogenarians...
October 2017: Journal of Geriatric Cardiology: JGC
https://www.readbyqxmd.com/read/29232970/primary-coronary-intervention-in-octogenarians-and-nonagenarians-with-st-segment-elevation-myocardial-infarction-a-canadian-single-center-perspective
#16
Rajat Sharma, Brett Hiebert, David Cheung, Davinder S Jassal, Kunal Minhas
The proportion of individuals >80 years of age constitute an increasing proportion of patients who present with ST-segment elevation myocardial infarction (STEMI). The objective of this study is to evaluate in-hospital outcomes and 1-year survival of very elderly patients who present with an STEMI and undergo primary percutaneous coronary intervention (pPCI). Between 2009 and 2015, individuals >80 years of age (very elderly patients) with an STEMI presenting at a single tertiary Canadian care center were included in the study...
January 1, 2017: Angiology
https://www.readbyqxmd.com/read/29230961/health-and-social-factors-associated-with-a-delayed-discharge-amongst-inpatients-in-acute-geriatric-wards-a-retrospective-observational-study
#17
George Moore, Peter Hartley, Roman Romero-Ortuno
AIM: In the English National Health Service there is an increasing interest in understanding the factors associated with delayed discharges in older hospitalized adults. The present study sought to analyze whether clinical frailty was a significant and independent risk factor for having a delayed discharge when the data were controlled for potential health and social confounders. METHODS: This was a retrospective observational study in an English National Health Service teaching hospital...
December 12, 2017: Geriatrics & Gerontology International
https://www.readbyqxmd.com/read/29210172/experience-of-dental-care-knowledge-and-attitudes-of-older-immigrants-in-sweden-a-qualitative-study
#18
E Olerud, M-L Hagman-Gustavsson, P Gabre
OBJECTIVES: Knowledge about the oral health and dental care habits of older immigrants is limited. The aim of this study was to explore dental service utilization, oral care habits, and attitudes to and knowledge about oral diseases and their prevention among older immigrants in Sweden. METHODS: A qualitative research method was used, and data were collected in individual interviews to gain a deeper understanding of the immigrants' views. Thirteen immigrants, seven women and six men, recruited from meeting places for older immigrants, participated, all aged between 59 and 88 (median 72 years)...
December 6, 2017: International Journal of Dental Hygiene
https://www.readbyqxmd.com/read/29201813/risk-factors-and-functional-impact-of-medical-complications-in-stroke
#19
Bo-Ram Kim, Jongmin Lee, Min Kyun Sohn, Deog Young Kim, Sam-Gyu Lee, Yong-Il Shin, Gyung-Jae Oh, Yang-Soo Lee, Min Cheol Joo, Eun Young Han, Yun-Hee Kim
Objective: To determine the incidence and risk factors for medical complications in Korean patients suffering from stroke and the impact of such complications on post-stroke functional outcomes. Methods: We assessed patients enrolled in a prospective cohort study. All recruited patients had suffered a first acute stroke episode and been admitted to nine university hospitals in Korea between August 2012 and June 2015. We analyzed patient and stroke characteristics, comorbidities, prevalence of post-stroke medical complications, and functional outcomes at time of discharge and 3, 6, and 12 months after stroke onset...
October 2017: Annals of Rehabilitation Medicine
https://www.readbyqxmd.com/read/29193557/a-three-goal-model-for-patients-with-multimorbidity-a-qualitative-approach
#20
Neeltje P Vermunt, Mirjam Harmsen, Glyn Elwyn, Gert P Westert, Jako S Burgers, Marcel G Olde Rikkert, Marjan J Faber
BACKGROUND: To meet the challenge of multimorbidity in decision making, a switch from a disease-oriented to a goal-oriented approach could be beneficial for patients and clinicians. More insight about the concept and the implementation of this approach in clinical practice is needed. OBJECTIVE: This study aimed to develop conceptual descriptions of goal-oriented care by examining the perspectives of general practitioners (GPs) and clinical geriatricians (CGs), and how the concept relates to collaborative communication and shared decision making with elderly patients with multimorbidity...
November 28, 2017: Health Expectations: An International Journal of Public Participation in Health Care and Health Policy
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