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Acute care of the elderly

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https://www.readbyqxmd.com/read/28297624/genomics-of-acute-myeloid-leukemia-diagnosis-and-pathways
#1
Lars Bullinger, Konstanze Döhner, Hartmut Döhner
In recent years, our understanding of the molecular pathogenesis of myeloid neoplasms, including acute myeloid leukemia (AML), has been greatly advanced by genomics discovery studies that use novel high-throughput sequencing techniques. AML, similar to most other cancers, is characterized by multiple somatically acquired mutations that affect genes of different functional categories, a complex clonal architecture, and disease evolution over time. Patterns of mutations seem to follow specific and temporally ordered trajectories...
March 20, 2017: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28289681/thanatophobia-death-anxiety-in-the-elderly-the-problem-of-the-child-s-inability-to-assess-their-own-parent-s-death-anxiety-state
#2
Gary Sinoff
Thanatophobia is omnipresent in our lives. Research has shown separate but connected constructs: fear of death or fear of the dying process. The influences on death anxiety are varied including religiosity, gender, psychological state, and age. It is often assumed by the children of the elderly that the fear of death is prevalent in their parents. Daily the medical staff encounters the presence of death anxiety: from family members or the staff itself. In order to understand this phenomenon, a three-tier study was conducted on non-terminal elderly inpatients in an acute geriatric care ward...
2017: Frontiers in Medicine
https://www.readbyqxmd.com/read/28277048/the-use-of-a-swedish-telephone-medical-advice-service-by-the-elderly-a-population-based-study
#3
K Dahlgren, M J Holzmann, A C Carlsson, P Wändell, J Hasselström, T Ruge
OBJECTIVE: The present study aimed to describe contact made by the elderly to Sweden's nationwide medical helpline, Healthcare Guide 1177 by Phone (HGP). Other objectives were to study potential gender differences and the association between different HGP referral levels and acute visits to hospital-based emergency departments and acute visits to primary care centres. DESIGN: De-identified data from recorded calls to HGP was extracted for analysis (n = 7477 for the oldest age group)...
March 3, 2017: Scandinavian Journal of Primary Health Care
https://www.readbyqxmd.com/read/28272915/national-trends-in-admission-for-aspiration-pneumonia-in-the-united-states-in-2002-2012
#4
Chao-Ping Wu, Yu-Wei Chen, Min-Jung Wang, Evgeny Pinelis
RATIONALE: Aspiration pneumonia is a subset of pneumonias prevalent in elderly patients and patients with neurologic disorders. Previous studies mostly reported incidence and/or mortality rates from regional data or in specific subgroups of patients. There is paucity of nationwide data in contemporary United States population. OBJECTIVES: To describe United States national trends in acute care hospital admission for aspiration pneumonia from 2002 to 2012. METHODS: We used the US Nationwide Inpatient Sample (NIS) database to identify patients admitted with a primary diagnosis of aspiration pneumonia between 2002 and 2012...
March 8, 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/28272239/cutaneous-presentation-preceding-acute-monocytic-leukemia-a-care-compliant-article
#5
Xianhua Jin, Fuqiu Li, Xue Li, Wenjing Zhu, Yan Mou, Yang Huang, Huanyu Zhao, Wei Gao, Jianxin Xia
RATIONALE: Cutaneous presentation preceding acute myeloid leukemia (AML) is rare, and the prognosis is poor. PATIENT CONCERNS: We report 4 cases of AML cutis, where skin infiltration precedes any blood or bone marrow evidence of leukemia. We also reviewed 13 cases reported in English and Chinese literature. The 4 cases all presented typical cutaneous lesions without any systemic evidence of leukemia. Histopathological examination found that dense monomorphous cell infiltration involved the dermis...
March 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28267949/buprenorphine-related-complications-in-elderly-hospitalised-patients-a-case-series
#6
S Richards, L Torre, B Lawther
We report a case series of buprenorphine-related respiratory and neurological depression in opioid-naïve elderly hospitalised patients who received buprenorphine for acute pain management at our institution over a 24-month period. All six patients had risk factors for respiratory depression such as advanced age, concurrent comorbidities, or the ingestion of other potential central nervous system depressants. All patients required escalation of management with additional monitoring, with some transferred to a high dependency or intensive care unit...
March 2017: Anaesthesia and Intensive Care
https://www.readbyqxmd.com/read/28265980/outcomes-in-elderly-patients-admitted-to-the-intensive-care-unit-with-solid-tumors
#7
Edouard Auclin, Anaïs Charles-Nelson, Baptiste Abbar, Emmanuel Guérot, Stéphane Oudard, Caroline Hauw-Berlemont, Constance Thibault, Alexandra Monnier, Jean-Luc Diehl, Sandrine Katsahian, Jean-Yves Fagon, Julien Taieb, Nadia Aissaoui
BACKGROUND: As the population ages and cancer therapies improve, there is an increased call for elderly cancer patients to be admitted to the intensive care unit (ICU). This study aimed to assess short-term survival and prognostic factors in critically ill patients with solid tumors aged ≥65 years. METHODS: We conducted a retrospective study. The primary endpoint was ICU mortality. Resumption of anticancer therapy in patients who survived the ICU stay and 90-day mortality were secondary endpoints...
December 2017: Annals of Intensive Care
https://www.readbyqxmd.com/read/28260868/the-diagnosis-of-delirium-in-an-acute-care-hospital-in-moscow-what-does-the-pandora-s-box-contain
#8
Olga N Tkacheva, Nadezda K Runikhina, Arkadiy L Vertkin, Irina V Voronina, Natalia V Sharashkina, Elen A Mkhitaryan, Valentina S Ostapenko, Elena A Prokhorovich, Tamar Freud, Yan Press
BACKGROUND: Delirium, a common problem among hospitalized elderly patients, is not usually diagnosed by doctors for various reasons. The primary aim of this study was to evaluate the effect of a short training course on the identification of delirium and the diagnostic rate of delirium among hospitalized patients aged ≥65 years. The secondary aim was to identify the risk factors for delirium. METHODS: A prospective study was conducted in an acute-care hospital in Moscow, Russia...
2017: Clinical Interventions in Aging
https://www.readbyqxmd.com/read/28257284/pharmacogenomics-and-tailored-polypharmacy-an-80-year-old-lady-with-rosuvastatin-associated-rhabdomyolysis-and-maprotiline-related-ogilvie-s-syndrome%C3%A2
#9
Katherina B Sreter, Blazenka Barisic, Sanja Popovic-Grle
What is known and objectives: Multiple adverse drug reactions (ADRs) are expected, and thus should be prevented in the elderly comorbid patient on polypharmacy. Rosuvastatin is commonly prescribed for the treatment and prevention of atherosclerotic diseases, and in rare cases, is associated with rhabdomyolysis. Maprotiline is a tetracyclic antidepressant, infrequently used in the United States, but seemingly more broadly in European countries. Acute colonic pseudo-obstruction (Ogilvie's syndrome) caused by maprotiline has thus far, to our knowledge, not yet been described in the literature...
March 3, 2017: International Journal of Clinical Pharmacology and Therapeutics
https://www.readbyqxmd.com/read/28251606/a-randomised-trial-of-peri-operative-positive-airway-pressure-for-postoperative-delirium-in-patients-at-risk-for-obstructive-sleep-apnoea-after-regional-anaesthesia-with-sedation-or-general-anaesthesia-for-joint-arthroplasty
#10
J W Nadler, J L Evans, E Fang, X A Preud'Homme, R L Daughtry, J B Chapman, M P Bolognesi, D E Attarian, S S Wellman, A D Krystal
Previous pilot work has established an association between obstructive sleep apnoea and the development of acute postoperative delirium , but it remains unclear to what extent this risk factor is modifiable in the 'real world' peri-operative setting. In a single-blind randomised controlled trial, 135 elderly surgical patients at risk for obstructive sleep apnoea were randomly assigned to receive peri-operative continuous positive airway pressure (CPAP) or routine care. Of the 114 patients who completed the study, 21 (18...
March 2, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28246688/-patient-oriented-medicine-in-the-elderly
#11
C C Sieber
A higher age is usually associated with multimorbidity due to chronic illnesses intermittently aggravated by acute disease and exarcerbation of pre-existing chronic illnesses. Physical and psychological diseases often coexist. Cure in the classical sense should not be the priority of diagnostic and therapeutic decision making, but more a prioritization of patient-oriented care. This includes polypharmacy which most often accompanies multimorbidity. Therapeutic actions and designated endpoints are therefore different from those in younger persons because preservation of functionality and independence is priority, not survival...
February 28, 2017: Der Internist
https://www.readbyqxmd.com/read/28246074/delirium-after-mechanical-ventilation-in-intensive-care-units-the-cognitive-and-psychosocial-assessment-capa-study-protocol
#12
Daniella Bulic, Michael Bennett, Helen Rodgers, Mary Nourse, Patrick Rubie, Jeffrey Cl Looi, Frank Van Haren
BACKGROUND: In the intensive care unit (ICU), critical illness delirium occurs in the context of multiple comorbidities, multi-organ failure, and invasive management techniques, such as mechanical ventilation, sedation, and lack of sleep. Delirium is characterized by an acute confusional state defined by fluctuating mental status, inattention, and either disorganized thinking or an altered level of consciousness. The long-term cognitive and psychosocial function of patients that experience delirium in the ICU is of crucial interest because preliminary data suggest a strong association between ICU-related delirium and long-term cognitive impairment...
February 28, 2017: JMIR Research Protocols
https://www.readbyqxmd.com/read/28243502/ceeg-electrode-related-pressure-ulcers-in-acutely-hospitalized-patients
#13
Lidia M V R Moura, Thiago S Carneiro, David Kwasnik, Valdery F Moura, Christine S Blodgett, Joseph Cohen, Mary McKenna Guanci, Daniel B Hoch, John Hsu, Andrew J Cole, M Brandon Westover
BACKGROUND: Pressure ulcers resulting from continuous EEG (cEEG) monitoring in hospitalized patients have gained attention as a preventable medical complication. We measured their incidence and risk factors. METHODS: We performed an observational investigation of cEEG-electrode-related pressure ulcers (EERPU) among acutely ill patients over a 22-month period. Variables analyzed included age, sex, monitoring duration, hospital location, application methods, vasopressor usage, nutritional status, skin allergies, fever, and presence/severity of EERPU...
February 2017: Neurology. Clinical Practice
https://www.readbyqxmd.com/read/28243434/spontaneous-thyroid-hemorrhage-on-chronic-anticoagulation-therapy
#14
Kulothungan Gunasekaran, Kelly M Rudd, Swetha Murthi, Scott Kaatz, Nazir Lone
Even though highly vascularized, the thyroid gland rarely has spontaneous bleeding. Bleeding into the thyroid gland can result in potentially lethal acute airway compromise. This case report describes an elderly patient on warfarin for atrial fibrillation, who presented with swelling on the right side of her neck causing acute airway obstruction. An urgent computed tomography of the neck showed an enlarging hemorrhage into the right lobe of the thyroid gland. She was initially intubated for airway protection and her anticoagulation was reversed to stop the bleeding...
January 11, 2017: Clinics and Practice
https://www.readbyqxmd.com/read/28237047/percutaneous-cholecystostomy-in-the-management-of-high-risk-patients-presenting-with-acute-cholecystitis-timing-and-outcome-at-a-single-institution
#15
S Zarour, A Imam, G Kouniavsky, G Lin, A Zbar, E Mavor
BACKGROUND: Cholecystectomy is the standard of care in acute cholecystitis (AC). Percutaneous cholecystostomy (PC) is an effective alternative for high-risk surgical cases. METHODS: A retrospective analysis is presented of AC patients treated with PC drainage at a single tertiary institution over a 21 month period, assessing outcome and complications. RESULTS: Of 119 patients, 103 had clinical improvement after PC insertion. There were 7 peri-procedural deaths (5...
February 14, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28228902/mri-diagnosis-of-herpes-simplex-encephalitis-in-an-elderly-man-with-nonspecific-symptoms
#16
Benjamin J Croll, Zachary M Dillon, Kevin R Weaver, Marna Rayl Greenberg
A 78-year-old male presented to the Emergency Department complaining of a 1-week onset of increasing fatigue and anorexia. The patient was previously well but had a history of depression, chronic diarrhea, and hypertension. His examination was remarkable for mild fever (100.1°F). He had no acute neurologic deficits. The patient felt better after intravenous fluids and was discharged to follow-up with the primary care provider. With no resolution of symptoms and new memory loss, the patient's primary care doctor ordered an MRI which revealed abnormal signal/patchy enhancement of the left temporal lobe indicative (pathognomonic) of herpes simplex encephalitis...
March 2017: Radiology case reports
https://www.readbyqxmd.com/read/28216064/internal-fixation-of-acetabular-fractures-in-an-older-population-using-the-timi-approach-midterm-results-of-a-prospective-study
#17
Rene Aigner, Ralf Hellige, Sabine Knippel, Ludwig Oberkircher, Steffen Ruchholtz, Benjamin Buecking
INTRODUCTION: The incidence of geriatric acetabular fractures continues to increase due to demographic changes. In the elderly, anterior column fractures are common, and standard approaches are associated with a considerable risk for surgery-associated complications. Therefore, a minimally invasive approach was developed in our department. The aim of this study was to examine early and mid-term results regarding the use of this novel two-incision minimally invasive (TIMI) approach in patients aged over 55 years with acetabular fractures...
February 3, 2017: Injury
https://www.readbyqxmd.com/read/28215925/-elderly-patients-and-intensive-care-systematic-review-and-geriatrician-s-point-of-view
#18
H Vallet, B Riou, J Boddaert
The global population is aging and intensive care unit admission rate of elderly patients is dramatically increasing. The objective of this review is to provide an overview of the literature about the management of elderly patients in intensive care unit and more specifically about epidemiology, admission criteria, mortality, functional prognosis and ethical aspects. We also discuss the data on cardiorespiratory arrest, shock, acute respiratory failure and delirium. The mortality rate of patients over 80 years old in intensive care unit can reach up to 70% at 1year, but is dependent on many factors, such as comorbidities or frailty...
February 16, 2017: La Revue de Médecine Interne
https://www.readbyqxmd.com/read/28210101/acute-kidney-injury-in-elderly-intensive-care-patients-from-a-developing-country-clinical-features-and-outcome
#19
Laís Gabriela Yokota, Beatriz Motta Sampaio, Erica Rocha, André Luís Balbi, Daniela Ponce
AIM: The elderly are at high risk of acute kidney injury (AKI) because of structural and functional degeneration over time and with the aging of the population, the demand for intensive care unit (ICU) admission for older patients has risen recently. However, data from developing countries are scarce. This study aimed to describe the incidence of AKI in elderly patients admitted to ICU from a developing country, to determine the most frequent etiologies for renal impairment and identify its risk factors and outcome...
2017: International Journal of Nephrology and Renovascular Disease
https://www.readbyqxmd.com/read/28205241/septic-transfusion-case-caused-by-a-platelet-pool-with-visible-clotting-due-to-contamination-with-staphylococcus-aureus
#20
Maria Loza-Correa, Yuntong Kou, Mariam Taha, Miloslav Kalab, Jennifer Ronholm, Patrick M Schlievert, Michael P Cahill, Robert Skeate, Christine Cserti-Gazdewich, Sandra Ramirez-Arcos
BACKGROUND: Contamination of platelet concentrates (PCs) with Staphylococcus aureus is one of the most significant ongoing transfusion safety risks in developed countries. CASE REPORT: This report describes a transfusion reaction in an elderly patient diagnosed with acute myeloid leukemia, transfused with a 4-day-old buffy coat PC through a central venous catheter. The transfusion was interrupted when a large fibrous clot in the PC obstructed infusion pump flow...
February 16, 2017: Transfusion
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