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emergency geriatric

Jui-Yuan Chung, Chien-Chin Hsu, Jiann-Hwa Chen, Wei-Lung Chen, Hung-Jung Lin, How-Ran Guo, Chien-Cheng Huang
Although influenza may cause death in the geriatric population, the best method for predicting mortality in this population is still unclear. We retrospectively recruited older people (≥65 yr) with influenza visiting the emergency department (ED) of a medical center between January 1, 2010, and December 31, 2015. We performed univariate and multivariate logistic regression to identify independent mortality predictors and then developed a prediction score. Four hundred nine older ED patients with a nearly equal sex ratio were recruited...
June 18, 2018: Scientific Reports
Carmen García-Peña, Mario Ulises Pérez-Zepeda, Leslie Viridiana Robles-Jiménez, Sergio Sánchez-García, Ricardo Ramírez-Aldana, Pamela Tella-Vega
BACKGROUND: Older emergency department patients are more vulnerable than younger patients, yet many risk factors that contribute to the mortality of older patients remain unclear and under investigation. This study endeavored to determine mortality and factors associated with mortality in patients over 60 years of age who were admitted to the emergency departments of two general hospitals in Mexico City. METHODS: This is a hospital cohort study involving adults over 60 years of age admitted to the emergency department and who are beneficiaries of the Mexican Institute of Social Security and residents of Mexico City...
June 18, 2018: BMC Geriatrics
Richard B Chow, Andre Lee, Bryan G Kane, Jeanne L Jacoby, Robert D Barraco, Stephen W Dusza, Matthew C Meyers, Marna Rayl Greenberg
OBJECTIVE: We sought to evaluate the effectiveness of the "Timed Up and Go" (TUG) and the Chair test as screening tools in the Emergency Department (ED), stratified by sex. METHODS: This prospective cohort study was conducted at a Level 1 Trauma center. After consent, subjects performed the TUG and the Chair test. Subjects were contacted for phone follow-up and asked to self-report interim falling. RESULTS: Data from 192 subjects were analyzed...
June 7, 2018: American Journal of Emergency Medicine
A Vilches-Moraga, J Fox, A Paracha, A Gomez-Quintanilla, J Epstein, L Pearce
Introduction A significant number of emergency general surgical admissions occur in older patients. Clinical decision making in this group is challenging and current risk prediction tools extrapolate data from cohorts of younger patients. This is the first UK study to examine risk factors predicting in-hospital mortality in older acute surgical patients undergoing comprehensive geriatric assessment. Methods This was a prospective study of consecutive patients aged ≥75 years admitted non-electively to general surgery wards between September 2014 and February 2017 who were reviewed by an elderly medicine in-reach service...
June 18, 2018: Annals of the Royal College of Surgeons of England
Sanjit R Konda, Ariana Lott, Hesham Saleh, Jordan Gales, Kenneth A Egol
OBJECTIVES: Determine if a novel inpatient mortality risk assessment tool designed to be calculated in the emergency department (ED) setting can risk stratify patient reported functional outcomes and mortality at one year. DESIGN: Prospective cohort SETTING:: Academic level one trauma center PATIENTS:: 685 patients >55 years old who were orthopaedic surgery consults or trauma surgery consults in the ED between 10/1/2014 and 9/30/2015. INTERVENTION: Calculation of validated trauma triage score (STTGMA) using each patient's demographics, injury severity, and functional status MAIN OUTCOME MEASUREMENTS:: mortality, EQ-5D questionnaire, and percent return to baseline function since their hospitalization at one-year post hospitalization...
June 4, 2018: Journal of Orthopaedic Trauma
Judy A Lowthian, Alyse Lennox, Andrea Curtis, Gillian Wilson, Cate Rosewarne, De Villiers Smit, Debra O'Brien, Colette Joy Browning, Lee Boyd, Cathie Smith, Peter Cameron, Jeremy Dale
OBJECTIVES: To ascertain the feasibility and acceptability of the HOW R U? programme, a novel volunteer-peer postdischarge support programme for older patients after discharge from the emergency department (ED). DESIGN: A multicentre prospective mixed-methods feasibility study. SETTING: Two tertiary hospital EDs in metropolitan Melbourne, Australia. PARTICIPANTS: A convenience sample of 39 discharged ED patients aged 70 years or over, with symptoms of social isolation, loneliness and/or depression...
June 14, 2018: BMJ Open
Olga Theou, Emma Squires, Kayla Mallery, Jacques S Lee, Sherri Fay, Judah Goldstein, Joshua J Armstrong, Kenneth Rockwood
BACKGROUND: The ability of acute care providers to cope with the influx of frail older patients is increasingly stressed, and changes need to be made to improve care provided to older adults. Our purpose was to conduct a scoping review to map and synthesize the literature addressing frailty in the acute care setting in order to understand how to tackle this challenge. We also aimed to highlight the current gaps in frailty research. METHODS: This scoping review included original research articles with acutely-ill Emergency Medical Services (EMS) or hospitalized older patients who were identified as frail by the authors...
June 11, 2018: BMC Geriatrics
Jarlath C Bolger, Akif Zaidi, Adrian Fuentes-Bonachera, Michael E Kelly, Aqeel Abbas, Ailin Rogers, Tom McCormack, Brian Waldron, Kevin P Murray
AIM: The Western world has an expanding older population, who are living longer with increasing numbers of comorbidities. In addition, expectations of patients and relatives are increasing. As a general hospital operating in a rural setting, our University Hospital Kerry, Tralee, Ireland, deals with a significant number of emergency presentations to the acute surgical service. The aim of the present study was to examine outcomes for patients in the extremes of age who present requiring emergency surgical procedures...
June 13, 2018: Geriatrics & Gerontology International
Angel F Farinas, Ravinder Bamba, Alonda C Pollins, Nancy L Cardwell, Lillian B Nanney, Wesley P Thayer
BACKGROUND: Individuals in the geriatric age range are more prone than younger individuals to convert their partial thickness thermal burns into full thickness injuries. We hypothesized that this often observed clinical phenomenon is strongly related to differential local injury responses mediated by the immune system. MATERIALS & METHODS: Skin samples from areas with partial thickness thermal burns were obtained during routine excision and grafting procedures between post burn days 2-6...
June 9, 2018: Burns: Journal of the International Society for Burn Injuries
P Koskas, C Pons-Peyneau, M Romdhani, N Houenou-Quenum, A Tigue-Wato, S Galleron, O Drunat
BACKGROUND: To avoid emergency hospitalisation of elderly people with dementia, which often has negative consequences, there are two main approaches: consultation and day care hospitalisation. However, it usually takes some time to arrange a consultation, and geriatric day hospital facilities are over-subscribed and costly. In 2014, we created a "consultation de crise" (CMC) programme in our sector of Paris, with several special features: a short wait for an appointment, a consultation involving an interdisciplinary team, a weekly multi-disciplinary meeting to reassess complex patients, and the possibility of a rapid referral to a social worker...
June 7, 2018: L'Encéphale
Hoai-An Truong, Michelle J Gorman, Meghan East, Dennis W Klima, Katherine A Hinderer, G Lawrence Hogue, Voncelia Brown, Robert L Joyner
Health care professionals working collaboratively on interprofessional teams are essential to optimize patient-centered care. Collaboration and teamwork can be best achieved if interprofessional education (IPE) starts early for health professions students. This commentary describes the formation, implementation, impact, and lessons learned from students' curricular and co-curricular activities and faculty collaboration over a five-year trajectory of the Eastern Shore Collaborative for Interprofessional Education (ESCIPE)...
May 2018: American Journal of Pharmaceutical Education
Jui-Yuan Chung, Chien-Chin Hsu, Jiann-Hwa Chen, Wei-Lung Chen, Hung-Jung Lin, How-Ran Guo, Chien-Cheng Huang
BACKGROUND: The shock index is a rapid and simple tool used to predict mortality in patients with acute illnesses including sepsis, multiple trauma, and postpartum hemorrhage. However, its ability to predict mortality in geriatric patients with influenza in the emergency department (ED) remains unclear. This study was conducted to clarify this issue. METHODS: We conducted a retrospective case-control study, recruiting geriatric patients (≥ 65 years) with influenza visiting the ED of a medical center between January 01, 2010 and December 31, 2015...
May 29, 2018: American Journal of Emergency Medicine
Celaleddin Soyalp, Nureddin Yuzkat, Mehmet Kilic, Mehmet Edip Akyol, Canser Yilmaz Demir, Nurcin Gulhas
AIM: To evaluate operative and prognostic parameters associated with elective versus emergency surgery in a retrospective cohort of elderly patients. METHODS: A total of 533 geriatric patients (aged ≥ 65 years, median age: 73.0 years, 50.7% were females) who underwent either elective surgery (n = 285) or emergency surgery (n = 248) were included in this study. Data on patient demographics, co-morbid disorders, type of surgery and anesthesia, American Society of Anesthesiologists (ASA) physical status (PS) classification, length of hospital stay, length of ICU stay, hospitalization outcome, prognosis (survivor, non-survivor) were obtained from medical records...
May 29, 2018: Aging Clinical and Experimental Research
C P Launay, A Kabeshova, A Lanoé, J Chabot, E J Levinoff, O Beauchet
BACKGROUND: With the rapid growth of elderly patients visiting the Emergency Department (ED), it is expected that there will be even more hospitalisations following ED visits in the future. The aim of this study was to examine the age effect on the performance criteria of the 10-item brief geriatric assessment (BGA) for the prolonged length of hospital stay (LHS) using artificial neural networks (ANNs) analysis. METHODS: Based on an observational prospective cohort study, 1117 older patients (i...
May 30, 2018: BMC Geriatrics
Sergey Motov, Stefan Mann, Jefferson Drapkin, Mahlaqa Butt, Antonios Likourezos, Elizabeth Yetter, Jason Brady, Nechama Rothberger, Ankit Gohel, Peter Flom, Mo Mai, Christian Fromm, John Marshall
STUDY OBJECTIVE: We compare the analgesic efficacy and safety of subdissociative intravenous-dose ketamine (SDK) versus morphine in geriatric Emergency Department (ED) patients. METHODS: This was a prospective, randomized, double-blind trial evaluating ED patients aged 65 and older experiencing moderate to severe acute abdominal, flank, musculoskeletal, or malignant pain. Patients were randomized to receive SDK at 0.3 mg/kg or morphine at 0.1 mg/kg by short intravenous infusion over 15 min...
May 16, 2018: American Journal of Emergency Medicine
Alyse Lennox, Sandra Braaf, De Villiers Smit, Peter Cameron, Judy A Lowthian
OBJECTIVE: To explore health professionals' perspectives about caring for community-dwelling older patients in the ED. METHODS: This exploratory qualitative study was undertaken with emergency nursing, medical and allied health staff from the ED of a large metropolitan public hospital in Melbourne. Nine focus groups (n = 54) and seven interviews were conducted between 2013 and 2014. Data were thematically analysed. RESULTS: Health professionals described tailoring their approach when caring for older patients, including adopting a specific communication approach (i...
May 24, 2018: Emergency Medicine Australasia: EMA
Hiroshi Yamamoto, Kenichi Ogawa, Henry Huaman Battifora, Kaori Yamamuro, Tatsuya Ishitake
BACKGROUND: Cognitive dysfunction due to delirium or dementia is a common finding in acutely ill geriatric patients, but often remains undetected. A brief and sensitive clinical identification method could prevent errors or complications while evaluating the mental status of elderly patients. AIMS: To evaluate the usefulness and clinical implications of the revised simplified short-term memory recall test (STMT-R) in geriatric patients admitted in the emergency department; with age, gender, dementia history, serum albumin, underlying diseases and clinical outcome used as comparative factors...
May 24, 2018: Aging Clinical and Experimental Research
Simone Gurlit, Henriette Möllmann
BACKGROUND: As more aged patients are surgically treated in hospitals without specialized geriatric care, patients at risk for perioperative complications must be identified and treatment must be adapted. The aim was the use of the Identification of Seniors at Risk (ISAR) as a screening tool for the identification of high-risk patients, who need specialized perioperative care. The study presented investigated the use of ISAR screening not only as recommended in the emergency room but also in validation tests as a new option in elective surgery...
May 23, 2018: Zeitschrift Für Gerontologie und Geriatrie
Paolo Ruscelli, Georgi Popivanov, Renata Tabola, Andrea Polistena, Alessandro Sanguinetti, Nicola Avenia, Claudio Renzi, Roberto Cirocchi, Pietro Ursi, Abe Fingerhut
BACKGROUND: Proximal or extended bowel resections are sometimes necessary during emergency surgery of the small bowel and call for creating a high small bowel stomy as a part of damage control surgery. Secondary restoration of intestinal continuity in the frail geriatric patient, further weakened by subsequent severe malabsorption may be prohibitive. METHODS: Six patients underwent emergency small bowel resection for proximal jejunal disease (83.3% highgrade adhesive SBO and 16...
May 24, 2018: Minerva Chirurgica
C Papailhau, S Gaujard, R Girard, L Bourguignon, C Mouchoux
INTRODUCTION: Fluoroquinolones (FQ) are widely used because of their broad spectrum and their ease of use, especially in the elderly. Nevertheless, their misuse is behind the development and the emergence of bacterial resistances. The objective of this study was to evaluate the compliance of FQ prescriptions in the elderly hospitalized, before and after pharmaceutical interventions (PI). METHODS: A prospective clinical audit was conducted for three months in three geriatric hospitals...
May 18, 2018: La Revue de Médecine Interne
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