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Acute care for elders

Cedric Mabire, Andrew Dwyer, Antoine Garnier, Joanie Pellet
BACKGROUND: Inadequate discharge planning for the growing elderly population poses significant challenges for health services. Effective discharge planning interventions have been examined in several studies, but little information is available on nursing's role or the specific components of these interventions. Despite the research published on the importance of discharge planning, the impact on patient's health outcomes still needs to be proven in practice. OBJECTIVES: To determine the best available evidence on the effectiveness of discharge planning interventions involving at least one nurse on health-related outcomes for elderly inpatients discharged home and to assess the relative impact of individual components of discharge planning interventions...
September 2016: JBI Database of Systematic Reviews and Implementation Reports
Loretta McCormick, Christina M Godfrey, John Muscedere, Shawn Hendrikx
The objective of this review is to identify the evidence on the use of integrated knowledge translation (iKT) strategies in acute care. This information will assist in the identification of the strategies used to engage stakeholders, such as patients and decision makers, in the research process and how their involvement has influenced the implementation or integration of research into practice. The extent to which these iKT activities have occurred in the context of care of the elderly, intensively ill patient will be examined...
September 2016: JBI Database of Systematic Reviews and Implementation Reports
Juan Herrera-Tejedor
The preferences of the very elderly are not taken into account in healthcare planning. For this reason, a medical literature review was performed in order to fill the gap in appropriate information on this issue. The majority of them think that they receive good healthcare. They favour building a trusting relationship, with the physician handling their decision-making. They also maximise their quality of life at the expense of quantity, and give great importance to comfort and safety. Most of them express the wish to be cared for and die at home...
October 14, 2016: Revista Española de Geriatría y Gerontología
Sylvie Y Doerflinger, Julia Tabatabai, Paul Schnitzler, Carlo Farah, Steffen Rameil, Peter Sander, Anna Koromyslova, Grant S Hansman
Human noroviruses are the dominant cause of outbreaks of acute gastroenteritis. These viruses are usually detected by molecular methods, including reverse transcriptase PCR (RT-PCR) and enzyme-linked immunosorbent assay (ELISA). Human noroviruses are genetically and antigenically diverse, with two main genogroups that are further subdivided into over 40 different genotypes. During the past decade, genogroup 2 genotype 4 (GII.4) has dominated in most countries, but recently, viruses belonging to GII.17 have increased in prevalence in a number of countries...
September 2016: MSphere
Natalie Z Wong, Tony Rosen, Allen M Sanchez, Elizabeth M Bloemen, Kevin W Mennitt, Keith Hentel, Refky Nicola, Kieran Murphy, Veronica M LoFaso, Neal E Flomenbaum, Mark S Lachs
PURPOSE: Emergency department assessment represents a critical but often missed opportunity to identify elder abuse, which is common and has serious consequences. Among emergency care providers, diagnostic radiologists are optimally positioned to raise suspicion for mistreatment when reviewing imaging of geriatric injury victims. However, little literature exists describing relevant injury patterns, and most radiologists currently receive neither formal nor informal training in elder abuse identification...
October 13, 2016: Canadian Association of Radiologists Journal, Journal L'Association Canadienne des Radiologistes
Richard L Hodinka
Acute upper and lower respiratory infections are a major public health problem and a leading cause of morbidity and mortality worldwide. At greatest risk are young children, the elderly, the chronically ill, and those with suppressed or compromised immune systems. Viruses are the predominant cause of respiratory tract illnesses and include RNA viruses such as respiratory syncytial virus, influenza virus, parainfluenza virus, metapneumovirus, rhinovirus, and coronavirus. Laboratory testing is required for a reliable diagnosis of viral respiratory infections, as a clinical diagnosis can be difficult since signs and symptoms are often overlapping and not specific for any one virus...
August 2016: Microbiology Spectrum
Jean-Frédéric LeBlanc, Myriam Martel, Alan N Barkun
Introduction. Data are conflicting when assessing indications for colorectal self-expandable metallic stents (SEMS) in managing acute malignant large bowel obstruction (MLO). In November 2014, European and American Societies published guidelines to aid in understanding which patients might benefit from colorectal stenting. Yet, there remain marked disparities in clinical practice. Methods. A web-based survey was sent to Gastroenterologists and Surgical Specialists across Quebec to assess physicians' knowledge and adherence to the indications for colonic SEMS placement in the management of MLO using eight clinical scenarios...
2016: Canadian Journal of Gastroenterology & Hepatology
Thomas Volken, Andreas Buser, Damiano Castelli, Stefano Fontana, Beat M Frey, Ilka Rüsges-Wolter, Amira Sarraj, Jörg Sigle, Jutta Thierbach, Tina Weingand, Behrouz Mansouri Taleghani
BACKGROUND: Several studies have raised concerns that future demand for blood products may not be met. The ageing of the general population and the fact that a large proportion of blood products is transfused to elderly patients has been identified as an important driver of blood shortages. The aim of this study was to collect, for the first time, nationally representative data regarding blood donors and transfusion recipients in order to predict the future evolution of blood donations and red blood cell (RBC) use in Switzerland between 2014 and 2035...
September 30, 2016: Blood Transfusion, Trasfusione del Sangue
Tobin J Strom, Arash O Naghavi, Andy M Trotti, Jeffery Russell, Julie A Kish, Judith McCaffrey, Kristen J Otto, Louis B Harrison, Jimmy J Caudell
PURPOSE: Concurrent chemoradiotherapy (CRT) is the standard of care for many sites of locally advanced head and neck squamous cell carcinomas (LAHNC). However, on meta-analysis, the addition of chemotherapy did not improve survival for patients >70years. We hypothesized that elderly patients treated with CRT would have increased toxicity without similar improvements in survival. METHODS: A single-institution, IRB-approved retrospective study took place from 2005 to 2012 including 369 patients treated with CRT for LAHNC...
October 3, 2016: Journal of Geriatric Oncology
Francesco Orso, Gianna Fabbri, Aldo Pietro Maggioni
Heart failure (HF) is a major public health problem affecting more than 23 million patients worldwide. Incidence and prevalence rates vary significantly according to the source of data, but both increase with advancing age reaching, in the very elderly, prevalence rates that represent a challenge for the organization of medical care systems. Even if evidence-based treatments have improved prognosis in some patients with HF, patients with HF still need to be carefully characterized, described, and treated. Hospitalizations for acute HF are frequent and costly accounting for the vast majority of HF-related costs...
October 8, 2016: Handbook of Experimental Pharmacology
Chung-Lieh Hung, Ding-Kuo Chien, Shou-Chuan Shih, Wen-Han Chang
BACKGROUND: Accurate diagnosis of acute coronary syndrome (ACS) in a timely fashion is challenging in the elderly population, especially elderly women, who usually exhibit atypical clinical symptoms. A multiple cardiac biomarker (MCB) based approach has been shown to improve diagnostic efficacy of ACS. However, data in various age groups and sex differences remain largely unexplored. METHODS: Point-of-care testing (POCT) was performed on 290 patients (aged ≥18 years) who were admitted to the emergency department (ED) with symptoms of acute chest pain under suspicion of acute coronary syndrome (ACS)...
October 7, 2016: BMC Cardiovascular Disorders
Maël Heiblig, Mohamed Elhamri, Caroline Le Jeune, Marie-Charlotte Laude, Alexandre Deloire, Eric Wattel, Gilles Salles, Xavier Thomas
OBJECTIVE: Little data exist regarding long-term survival in elderly patients with acute myeloid leukemia (AML). METHODS: In view of the fact that most deaths occurred during the first 3 yr, this study examined long-term survival in this patient population, defined as overall survival for at least 3 yr with the aim to determine the number of long-term survivors and to identify factors that might impact on longer survival. RESULTS: The criterion for entry into this cohort was fulfilled by 57 patients among 302 seen over a 14-yr period (19%): 12 patients who never achieved complete remission (CR), 21 patients who relapsed after CR achievement, and 24 patients who achieved CR and did not relapse, including three patients who died while in CR and 21 patients still alive in first CR at the time of analysis...
September 26, 2016: European Journal of Haematology
Nefyn H Williams, Jessica L Roberts, Nafees Ud Din, Nicola Totton, Joanna M Charles, Claire A Hawkes, Val Morrison, Zoe Hoare, Michelle Williams, Aaron W Pritchard, Swapna Alexander, Andrew Lemmey, Robert T Woods, Catherine Sackley, Pip Logan, Rhiannon T Edwards, Clare Wilkinson
OBJECTIVE: To conduct a rigorous feasibility study for a future definitive parallel-group randomised controlled trial (RCT) and economic evaluation of an enhanced rehabilitation package for hip fracture. SETTING: Recruitment from 3 acute hospitals in North Wales. Intervention delivery in the community. PARTICIPANTS: Older adults (aged ≥65) who received surgical treatment for hip fracture, lived independently prior to fracture, had mental capacity (assessed by clinical team) and received rehabilitation in the North Wales area...
October 5, 2016: BMJ Open
Benjamin D Elder, Timothy F Witham
Low back pain is highly prevalent, affecting a vast majority of the adult population at some point in their lifetime. Thorough history and physical examination is critically important in evaluating these patients and screening for potentially serious conditions. Imaging should be guided by the history and physical examination, particularly when there is concern for serious conditions and/or a focal neurological deficit present. Adequate treatment of patients with low back pain often requires a multidisciplinary approach, involving several medical specialties...
October 2016: Seminars in Neurology
Nguyen Dang Thang, Björn Wilgot Karlson, Thomas Karlsson, Johan Herlitz
OBJECTIVES: This study analyzed age-adjusted sex differences among acute myocardial infarction (AMI) patients aged 75 years and above with regard to 7-year mortality (primary end point) and the frequency of angiograms and admission to the coronary care unit (CCU) as well as 1-year mortality (secondary end points). METHODS: A retrospective cohort study comprised 1,414 AMI patients (748 females and 666 males) aged at least 75 years, who were admitted to Sahlgrenska University Hospital in Gothenburg, Sweden, during two periods (2001/2002 and 2007)...
2016: Clinical Interventions in Aging
Chun-Fang Chiu, Miaw-I Lin, I Lee, Shiow-Rong Jeang, Yan-Choiu Ku
BACKGROUND: Unplanned readmissions increase healthcare utilization rates and healthcare costs. The Taiwan Healthcare Indicator Series regards the rate of hospital readmission as an important indicator of inpatient-care quality. The elderly face a higher risk of unplanned readmission due to elderly-specific health and disease characteristics such as deteriorating body functions and the relatively high incidence of complications after the treatment of acute diseases. PURPOSE: To explore the factors that relate to the unplanned readmission of elderly within 90 days of discharge at a geriatric medical center...
October 2016: Hu Li za Zhi the Journal of Nursing
Juan Antonio Llompart-Pou, Mario Chico-Fernández, Marcelino Sánchez-Casado, Fermín Alberdi-Odriozola, Francisco Guerrero-López, María Dolores Mayor-García, Javier González-Robledo, María Ángeles Ballesteros-Sanz, Rubén Herrán-Monge, Rafael León-López, Lucía López-Amor, Ana Bueno-González
BACKGROUND: Injury patterns may differ in trauma patients when age is considered. This information is relevant in the management of trauma patients and for planning preventive measures. METHODS: We included in the study all patients admitted for traumatic disease in the participating ICUs from November 23(rd), 2012 to July 31(st), 2015 with complete records. Data on epidemiology, injury patterns, severity scores, acute management, resources utilisation and outcome were recorded and compared in the following groups of age: ≤55years (young adults), 56-65 years (adults), 66-75 years (elderly), >75years (very elderly)...
September 2016: Injury
Esprit Ma, Vijayveer Bonthapally, Anita Chawla, Patrick Lefebvre, Ronan Swords, Marie-Hélène Lafeuille, Jonathan Fortier, Bruno Emond, Mei Sheng Duh, Bruce J Dezube
BACKGROUND: Many elderly patients with acute myeloid leukemia (AML) are considered ineligible for standard intensive induction therapy due to performance status and comorbidities. We analyzed treatment patterns and outcomes among elderly patients newly diagnosed with AML in the US community oncology setting. METHODS: A retrospective observational study was conducted using patient-level data from a network of US community oncology practices provided by Altos Solutions...
August 10, 2016: Clinical Lymphoma, Myeloma & Leukemia
Shuwang Ge, Sheng Nie, Zhangsuo Liu, Chunbo Chen, Yan Zha, Jing Qian, Bicheng Liu, Siyuan Teng, Anping Xu, Wei Bin, Xin Xu, Gang Xu
BACKGROUND: Information on acute kidney injury (AKI) in elderly hospitalized patients is limited. This study aims to assess the incidence, risk factors and outcomes of AKI in elderly Chinese patients. METHOD: The Epidemiology of AKI in Chinese Hospitalized adults (EACH) study is a multicenter, retrospective cohort study conducted in nine regional central hospitals across China. Patients aged more than 65 years were selected from the EACH study for this analysis...
September 29, 2016: BMC Nephrology
Hannelore Sprenger-Mähr, Emanuel Zitt, Karl Lhotta
INTRODUCTION: The number of patients suffering from acute kidney injury requiring dialysis (AKI-D) is increasing. Whereas causes and outcome of AKI-D in the intensive care unit (ICU) are described extensively, few data exist about AKI-D patients treated outside the ICU. Aim of this study was to identify the causes of AKI-D, determine in-depth the comorbid conditions and outcome of this particular patient group and identify possibilities for its prevention. METHODS: We retrospectively studied all AKI-D patients treated outside the ICU in a single nephrology referral center between January 2010 and June 2015...
2016: PloS One
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