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1
Chandra, Ronald, Jose M. Mandei, Jeanette I. Ch Manoppo, Rocky Wilar, Ari L. Runtunuwu, and Phey Liana. "Serum nitric oxide and pediatric sepsis outcomes." Paediatrica Indonesiana 54, no. 4 (August 31, 2014): 213. http://dx.doi.org/10.14238/pi54.4.2014.213-8.
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Background Sepsis is the complex pathophysiologic responsesof the host against systemic infection. Sepsis can cause severeconditions such as septic shock and multiple organ failure.Although we have a better understanding of the molecular basisof sepsis as well as aggressive therapy, the mortality rate remainshigh, between 20-80%. Nitric oxide (NO) is one of the mediatorsassociated with cardiovascular failure, apoptosis and organdysfunction in sepsis.Objective To evaluate for a possible correlation between NOlevels and outcomes in pediatric sepsis.Methods A prospective cohort study was conducted at thepediatric intensive care unit (PICU) of Prof. Dr. R.D. KandouGeneral Hospital in Manado, from June to November 2012. Fortychildren aged one month to five year old, fulfilled the InternationalPediatrics Sepsis Consensus Conference 2 005 criteria were recruited.Nitrite oxide metabolites (nitrite and nitrate) levels were measuredusing a calorimetric assay kit (Cayman®, Catalog No.780001)from venous blood specimens collected at admission. All patientsreceived antibiotics empirically within an hour of the diagnosis.Outcomes of patients recorded were survivor or died, and lengthof stay in PICU.Results Mann-Whitney U test revealed a significant differencebetween median serum NO levels ins urvivors and those who died(18.60 vs. 36.50 fLM/L, respectively; P= 0.016).Conclusion Serum NO concentration is higher in those whodied than in survivors of pediatric sepsis. Specific NO inhibitionmay be beneficial in decreasing morbidity and mortality in thiscondition.
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Draper, Brian, and Lee-Fay Low. "Psychiatric services for the “old” old." International Psychogeriatrics 22, no. 4 (March 15, 2010): 582–88. http://dx.doi.org/10.1017/s1041610210000293.
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ABSTRACTBackground: Few studies have specifically examined mental health service delivery to persons aged over 84 years, often described as the “old” old. Our aim was to compare mental health service provision in Australia to persons aged 85 years and over with the “young” old and other age groups. We hypothesized that the “old” old would differ from the “young” old (65–84 years) by diagnostic category, rates of specialist psychiatric hospital admission, and use of Medicare funded psychiatric consultations in the community.Methods: Mental health service delivery data for 2001–02 to 2005–06 was obtained from Medicare Australia on consultant psychiatrist office-based, home visit and private hospital services subsidized by the national healthcare program and the National Hospital Morbidity database for separations (admitted episodes of patient care) from all public and most private hospitals in Australia on measures of age, gender, psychiatric diagnosis, location and type of psychiatric care.Results: Use of specialist psychiatric services in the community per annum per 1000 persons declined with age in men and women from 137.28 and 191.87 respectively in those aged 20–64 years to 11.84 and 14.76 respectively in those over 84 years. However, men and women over 84 years received psychiatric home visits at 377% and 472% respectively of the rates of persons under 65. The annual hospital separation rate per 1000 persons for specialist psychiatric care was lowest in those aged over 84 (3.98) but for inpatient non-specialized psychiatric care was highest in those over 84 (21.20). Depression was the most common diagnosis in specialized psychiatric hospitalization in those aged over 84 while organic disorders predominated in non-specialized care in each age group over 64 years with the highest rates in those aged over 84.Conclusion: Mental health service delivery to persons aged over 84 is distinctly different to that provided to other aged groups being largely provided in non-specialist hospital and residential settings.
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Jeyamurugan, Kokila, and Ratna B. Basak. "Child Life Specialists in Pediatric Hospital Care." OBM Integrative and Complementary Medicine 05, no. 03 (May 12, 2020): 1. http://dx.doi.org/10.21926/obm.icm.2003034.
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Child life specialists (CLS) are trained providers who form part of a pediatric multidisciplinary and pediatric palliative care team. Their role is invaluable to mitigate the stress and anxiety of children during hospitalization. They may use various strategies in children like play, art and music therapy and pet therapy, to help self-express and cope with painful procedures.We present a brief narrative on CLS with a case of a 10- year- old Hispanic boy who had metastatic osteosarcoma.The case illustration is from a prior institute that one of the coauthors was associated with.
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Gadhade, Jyoti B., Rajesh S. Hiray, and Balasaheb B. Ghongane. "Carbamazepine induced Stevens Johnson Syndrome: a case report from a tertiary care hospital." International Journal of Basic & Clinical Pharmacology 7, no. 8 (July 23, 2018): 1654. http://dx.doi.org/10.18203/2319-2003.ijbcp20183039.
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Stevens Johnson Syndrome is a rare but life-threatening skin disease and Carbamazepine is considered as one of the most common cause. The reported frequency of serious Carbamazepine hypersensitivity reaction is between 1/1000 and 1/10000 new exposures to the drug. Here, we report a case of a 40 year old female patient, who developed multiple ulcerative lesions all over the body three days after starting treatment with Carbamazepine for Trigeminal Neuralgia. (Worldwide Unique Number- 2017-58502 and AMC Report Number- BJGMC-Pune/Nov-2017/BBG-1860) Stevens Johnson Syndrome was diagnosed. Carbamazepine was withdrawn, and the patient was treated with topical and intravenous antibiotics. A biopsy was done which confirmed the diagnosis of Stevens Johnson Syndrome.
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Nechowska, Aoife, Theophilus Samuels, and Sameer Ranjan. "Overdose admissions to a district general hospital intensive care unit." BJPsych Open 7, S1 (June 2021): S95. http://dx.doi.org/10.1192/bjo.2021.285.
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AimsThis audit aimed to analyse the patient population coming into East Surrey Hospital's Intensive Care Unit from 1993 to 2019.BackgroundThe Office for National Statistics (ONS) published a report in August 2019 on ages most likely to die by suicide and drug poisoning. Their data showed that Generation X were dying by this method in greater numbers than other age groups. This is in contrast with data from 1990s for England and Wales which showed people in their 20s were most likely to die by suicide or poisoning. This audit set out to look at admission data from an intensive care unit (ICU) in a district general hospital in Surrey over a similar period of time.MethodPatient records from 1993 to September 2019 were accessed using the WardWatcher database. To access the maxim number of admissions qualifying under the aims, the database was accessed by searching under “admission comments” for: overdose, self-harm, poison, suicide. These reports were downloaded and the lists were checked against each other to delete duplicates. This gave a total of 331 patients. The data were analysed by year, according to age, gender, season, psychiatric diagnoses and previous overdose attempts. Their outcomes were checked against recorded deaths. There was not enough information to investigate method of overdose.ResultA total of 331 patient records were accessed. The youngest patient was 15 years old, the oldest was 84 years old. The age dataset was non-parametrically distributed with the median age of 43 years (IQR 33-51 years). The age distributions for each year appeared symmetrical but total numbers for each year were small. The population was split as 191 female (58%) and 141 male (42%). 16 patients died on the ICU on admission with an overdose, 5% of total numbers, of which 19% had a previous overdose attempts and 44% had a psychiatric diagnosis. The youngest death was 22 and the oldest was 81 years old. The average age was 47 years, with the spread consistent in the 2000s and 2010s.ConclusionThe results from East Surrey Hospital's ICU do not reflect the analysis from the ONS. The mean age for each year has remained similar. Numbers for the audit were small and admission criteria to the ICU prescribe that the patient be critically unwell and may not be indicative of the total admissions to a district general hospital.
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Poudel, Arjun, Nancye M. Peel, Lisa Nissen, Charles Mitchell, Len C. Gray, and Ruth E. Hubbard. "Potentially Inappropriate Prescribing in Older Patients Discharged From Acute Care Hospitals to Residential Aged Care Facilities." Annals of Pharmacotherapy 48, no. 11 (August 26, 2014): 1425–33. http://dx.doi.org/10.1177/1060028014548568.
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Background: The frequency of prescribing potentially inappropriate medications (PIMs) in older patients remains high despite evidence of adverse outcomes from their use. Little is known about whether admission to hospital has any effect on appropriateness of prescribing. Objectives: This study aimed to identify the prevalence and nature of PIMs and explore the association of risk factors for receiving a PIM. Methods: This was a prospective study of 206 patients discharged to residential aged care facilities from acute care. All patients were at least 70 years old and were admitted between July 2005 and May 2010; their admission and discharge medications were evaluated. Results: Mean patient age was 84.8 ± 6.7 years; the majority (57%) were older than 85 years, and mean (SD) Frailty Index was 0.42 (0.15). At least 1 PIM was identified in 112 (54.4%) patients on admission and 102 (49.5%) patients on discharge. Of all medications prescribed at admission (1728), 10.8% were PIMs, and at discharge, of 1759 medications, 9.6% were PIMs. Of the total 187 PIMs on admission, 56 (30%) were stopped and 131 were continued; 32 new PIMs were introduced. Of the potential risk factors considered, in-hospital cognitive decline and frailty status were the only significant predictors of PIMs. Conclusions: Although admission to hospital is an opportunity to review the indications for specific medications, a high prevalence of inappropriate drug use was observed. The only associations with PIM use were the frailty status and in-hospital cognitive decline. Additional studies are needed to further evaluate this association.
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Mishra, Ipsita, Rukma Narkar, Vaibhav Pathak, Arun Kumar Choudhury, and Anoj Kumar Baliarsinha. "Classic CAH Presenting in Adulthood: Experience From a Tertiary Care Hospital in Eastern India." Journal of the Endocrine Society 5, Supplement_1 (May 1, 2021): A124. http://dx.doi.org/10.1210/jendso/bvab048.249.
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Abstract Classic CAH presenting in adulthood: Experience from a tertiary care hospital in Eastern India: Congenital adrenal hyperplasia(CAH) is one of the most common genetic disorders transmitted as an autosomal recessive trait. Of the various forms CAH due to 21-hydroxylase deficiency is most common. Based on the clinical phenotype CAH can be classified as classic and non-classic form. It is very rare for classic CAH to present in adulthood. We describe 3 patients with classic CAH presenting in adulthood. Case 1: 21 year old female presented with complaint of not attaining menarche. She had features of virilisation t with a modified Ferriman Gallwey(FG) score of 18/36, pubic hair stage 4 and atrophied breasts. Genital examination revealed clitoromegaly (CI-100 mm2) with Prader stage 2. Biochemical evaluation revealed elevated levels of serum testosterone (257.2 ng/dl), 17-hydroxy progesterone(332 ng/ml), DHEAS(417 µg/dl) and PRA of 34ng/ml/hr. Case 2: 30 year old female presented with complaint of primary infertility for 5 years. She had history of delayed menarche at 20 years and oligomenorrheic cycles since last 10 years. On examination there was hirsutism with a modified FG score of 15/36, pubic hair stage 5 with atrophied breasts. Genital examination revealed symmetrical genitalia with nonpalpable gonads, clitiromegaly(CI=135mm2) and a single urogenital opening (Prader stage 3). Biochemical evaluation revealed elevated levels of serum testosterone (812ng/dl), 17-hydroxy progesterone (164.8 ng/ml), DHEAS (503 µg/dl) and PRA of 42ng/ml/hr. Case 3: 26 year old female presented with complaint of noticing excessive hair growth in androgen dependent areas. On examination there was short stature,modified FG score 16/36, pubic hair stage 5 with atrophied breasts. Genital examination revealed clitoromegaly (CI=75mm2) with Prader stage 2. Biochemical evaluation revealed elevated levels of serum testosterone (254.2 ng/dl), 17-hydroxy progesterone (351.8 ng/ml), DHEAS (296.2 µg/dl) and PRA of 30ng/ml/hr. Karyotype in all the three patients was 46,XX. All our patients had serum testosterone values in tumorous range, however imaging studies didnot reveal any evidence of malignancy in the adrenals except for occurrence of a single right adrenal nodule of size 2×2.1cm with precontrast HU of <10 and absolute contrast washout of >60% in case 2. Based on clinical and biochemical findings a diagnosis of classic CAH was made. They were started on corticosteroid and mineralocorticoid replacement. In all of the above three patients none of them had been evaluated for the presenting complaints prior to visiting our centre. Failure of implementation of neonatal screening for CAH in many centres in India and the social stigma associated with genital ambiguity are contributory to the delay in diagnosis of CAH.
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Rosenvinge, H. P. "The role of the psychogeriatric day hospital." Psychiatric Bulletin 18, no. 12 (December 1994): 733–36. http://dx.doi.org/10.1192/pb.18.12.733.
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In the currant climate of the implications of the Community Care Act and health service reforms, defining the role and function of the psychogeriatric day hospital is crucial, particularly its distinction from day centre care. This paper describes this role and key issues in day hospital planning. It was presented to the Wessex Specialists in Old Age Psychiatry and accepted by them as a consensus document.
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Brennan, Sarah, and Rajdeep Routh. "Hospital Anticipatory Care Planning for Inpatients of Organic Old Age Psychiatry Wards (NHS Lanarkshire)." BJPsych Open 7, S1 (June 2021): S176—S177. http://dx.doi.org/10.1192/bjo.2021.480.
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AimsTo improve practice of Hospital Anticipatory Care Planning for inpatients of Organic Old Age Psychiatry wards in NHS Lanarkshire.BackgroundHospital Anticipatory Care Plans (HACPs) are important components of care for inpatients with progressive and life-limiting conditions. HACPs provide guidance on treatment escalation and limitation for individual patients, in the event that they become acutely unwell. In the Old Age Psychiatry Department at NHS Lanarkshire, HACP standards are as follows: HACP forms should be completed within 2 weeks of admissionHACP information leaflets should be provided to relatives/carersHACPs should be discussed with relatives/carersIf a patient without an HACP becomes acutely unwell, an HACP should be made, and the responsible Consultant informedHACP should be discussed within the multi-disciplinary team (MDT)HACPs should be regularly reviewedHACP and DNACPR forms should be kept at the front of the notesSuperseded HACPs should be marked as obsoleteMethodInpatient notes were reviewed in October 2019 and compared against the above standards.The findings were presented at the Clinical Governance Meeting and Old Age Psychiatry Teaching Group in December 2019.An ‘HACP Checklist’ was also created to prompt good practice.Inpatient notes were reviewed again in July 2020.Data from both time periods were compared.ResultThere was an improvement in:The proportion of patients who had an HACP - from 59% to 96%The proportion of patients who had an HACP made within 2 weeks of admission - from 35% to 78%Documentation of HACP discussions with relatives/carers - documented for 77% of patients (from 47%)Timing of HACP discussions with relatives/carers - took place within 2 weeks for 52% of patients (from 29%)Documentation of HACP discussion by MDT - documented for 73% of patients (from 29%)HACP Information Leaflets were only distributed to one patient's relatives/carers across both time pointsMedical emergencies for patients with no HACP were infrequent and so comparison could not be madeHACPs were reviewed less frequently in July 2020 than in October 2019HACP forms and DNACPR forms were always filed appropriatelySuperseded HACP forms were always appropriately marked as obsoleteConclusionHACP practice mostly improved from October 2019 to July 2020. This may have been due to increased awareness of HACP Standards, following the presentation of initial data to inpatient teams.A much larger influence, however, was likely to be the COVID-19 pandemic and associated efforts to improve HACP practice throughout the Health Board.
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Babamahmoodi, Farhang, and Abdolreza Babamhmoodi. "Recovery from Intracranial Hemorrhage Due to Leptospirosis." Case Reports in Medicine 2011 (2011): 1–3. http://dx.doi.org/10.1155/2011/504308.
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Intracranial hemorrhage is a rare and fatal presentation of leptospirosis. In this paper we present the case of a 51-year-old male farmer who lives in northern Iran. He came to our hospital with a severe headache. A paraclinical evaluation showed clear signs of thrombocytopenia, and a brain MRI revealed left temporoparietal hemorrhage. Our preliminary diagnosis was Leptospirosis, and after 26 days of hospital care the patient was discharged in good condition. This paper will educationally help physicians in better diagnosis and treatment of leptospirosis.
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Bhandari, Tika Ram, Sudha Shahi, Rajeev Bhandari, and Rajesh Poudel. "Laparoscopic Cholecystectomy in the Elderly: An Experience at a Tertiary Care Hospital in Western Nepal." Surgery Research and Practice 2017 (2017): 1–5. http://dx.doi.org/10.1155/2017/8204578.
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Background. The incidence of gallstone increases with increasing age. No studies have been reported in the elderly population with laparoscopic cholecystectomy from developing nations. The aim of this study was to compare perioperative outcomes of laparoscopic cholecystectomy between the elderly (≥60 years old) and the young (<60 years old).Methods. From July 2015 to June 2016, a retrospective review of medical records of 78 elderly patients (≥60 years old) and 164 young patients (<60 years old) who underwent laparoscopic cholecystectomy was done. The patients’ demographics and perioperative outcomes were analyzed.Results. Median ages were 65 years (range: 60–80) and 45 years (range: 21–59) for the elderly group and the young group. The majority of patients were female (62.8 and 72%). There were no significant differences in the conversion rate (9 and 7.9%,P=0.78), postoperative complications (17.9 and 14.6%,P=0.50), and length of stay in the hospital (4 days for both groups,P=0.35) between the two groups. There was no mortality in either of the groups.Conclusion. Our results of laparoscopic cholecystectomy in elderly patients are comparable with those in young patients. Therefore, laparoscopic cholecystectomy is safe even in the elderly population.
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Tiwary, Abhishek, Ajwani Rimal, Buddhi Paudyal, Keshav Raj Sigdel, and Buddha Basnyat. "Poor communication by health care professionals may lead to life-threatening complications: examples from two case reports." Wellcome Open Research 4 (January 22, 2019): 7. http://dx.doi.org/10.12688/wellcomeopenres.15042.1.
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We report two cases which highlight the fact how poor communication leads to dangerously poor health outcome. We present the case of a 50-year-old woman recently diagnosed with rheumatoid arthritis from Southern Nepal presented to Patan hospital with multiple episodes of vomiting and oral ulcers following the intake of methotrexate every day for 11 days, who was managed in the intensive care unit. Similarly, we present a 40-year-old man with ileo-caecal tuberculosis who was prescribed with anti-tubercular therapy (ATT) and prednisolone, who failed to take ATT due to poor communication and presented to Patan Hospital with features of disseminated tuberculosis following intake of 2 weeks of prednisolone alone. These were events that could have been easily prevented with proper communication skills. Improvement of communication between doctors and patients is paramount so that life-threatening events like these could be avoided.
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Bravell, Marie Ernsth, Bo Malmberg, and Stig Berg. "End-of-life care in the oldest old." Palliative and Supportive Care 8, no. 3 (September 2010): 335–44. http://dx.doi.org/10.1017/s1478951510000131.
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AbstractObjective:The aim of this study was to describe the last year of life of a sample of the oldest old, focusing on care trajectories, health, social networks, and function in daily life activities.Method:Data originated from the NONA study, a longitudinal study of 193 individuals among the oldest old living in a Swedish municipality. During this longitudinal study, 109 participants died. Approximately one month after their death, a relative was asked to participate in a telephone interview concerning their relative's last year of life. One hundred two relatives agreed to participate.Results:Most of the elderly in this sample of the oldest old (74.5%) died at an institution and the relatives were mostly satisfied with the end-of-life care. The oldest old relatives estimated that the health steadily declined during the last year of life, and that there was a decline in performing of daily life activities. They also estimated that those dying in institutions had fewer social contacts than those dying in a hospital or at home.Significance of results:Care at end of life for the oldest old is challenged by problems with progressive declines in ability to perform activities of daily living and health. The findings also highlight the need to support social networks at eldercare institutions.
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Mohammad, Amrallah A., Abdullah S. Al-Zahrani, and Hani M. El-Khatib. "Double primary cancers registered in a tertiary care hospital: review of two cases." Forum of Clinical Oncology 5, no. 1 (August 14, 2014): 6–10. http://dx.doi.org/10.2478/fco-2014-0002.
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Abstract In our centre, among 1965 registered cancer patients between May 2011 and December 2013, we report three cases with multiple primary malignant neoplasms. One of them was excluded due to lack of data, and so we present the remaining two cases. The first case is an 82-year-old female patient with colon and thyroid cancer and the second case is a 61-year-old female patient with colon and breast cancer. Both cases were metachronous and discovered accidently during the regular follow up, and managed with a curative intent. Conclusion: It is important for the clinicians to keep in mind that individuals with cancer are at increased risk for subsequent primary malignancies, which must be differentiated from recurrent or metastatic disease.
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Huxley, Peter. "Resettlement and community care: ‘The Mental Hospital as an Institution’ revisited." Psychiatric Bulletin 17, no. 5 (May 1993): 279–82. http://dx.doi.org/10.1192/pb.17.5.279.
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For almost four decades social policy has been directed at the closure of old mental hospitals and the resettlement in the community of large numbers of patients. Research into resettlement shows that, on the whole, individual needs are recognised, service responses are reasonably well planned, and that individual welfare has not deteriorated, at least in the short-term (Knapp et al, 1992; TAPS, 1993). Furthermore, those who receive services under the resettlement schemes are said to be better served than those who receive routine care on discharge from hospital (Allen et al, 1992).
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Trimble, Alice, and Richard Partridge. "Smoke on the water: A case report of chronic renal failure resulting from the ingestion of smoke machine fluid." Journal of the Intensive Care Society 18, no. 1 (June 23, 2016): 57–58. http://dx.doi.org/10.1177/1751143716653768.
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We report the case of an 18-year-old male admitted to the Intensive Care Unit in Basingstoke and North Hampshire Hospital, who developed chronic kidney disease following the ingestion of smoke machine fluid. Smoke machine fluid may contain ethylene glycol, and a diagnosis of ethylene glycol toxicity with calcium oxalate nephropathy was made. This case resulted in a National Poisons Information Service internal review of the subject and a new TOXBASE entry for smoke machine fluid ingestion.
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Pant, Narayan Dutt, Subhash Prasad Acharya, Raju Bhandari, Uday Narayan Yadav, Dil Bahadur Saru, and Manisha Sharma. "Bacteremia and Urinary Tract Infection Caused byChromobacterium violaceum: Case Reports from a Tertiary Care Hospital in Kathmandu, Nepal." Case Reports in Medicine 2017 (2017): 1–4. http://dx.doi.org/10.1155/2017/7929671.
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Chromobacterium violaceumis ubiquitous in the environment of tropical and subtropical regions but the infections caused by this organism are rare and the urinary tract infections caused by it are even rarer. Due to the propensity for hematogenous spread leading to fatal sepsis, the infections caused byChromobacterium violaceumhave high mortality rate (65–80%) with death occurring in as less as one week of acquiring infection. So, prompt proper treatment is necessary for successful treatment of the infections but, due to the rarity of the infections caused by the organism, there is limited awareness among the clinicians regarding the infections caused by this organism. Here, we reported a case of urinary tract infection caused byChromobacterium violaceumin a 84-year-old male, who was a kidney patient, and another case of bacteremia caused by the same bacterium in a road traffic accident patient (22-year-old male), both of which were managed with the timely suitable treatment.
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Dratcu, Luiz, Alistair Grandison, and Antony Adkin. "Acute hospital care in inner London: splitting from mental health services in the community." Psychiatric Bulletin 27, no. 03 (March 2003): 83–86. http://dx.doi.org/10.1192/s0955603600001574.
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Acute hospital care in psychiatry has been described as inefficient and disorganised (Muijen, 1999). Worrying as it may be, this is neither new nor surprising. Following the closure of large mental institutions and the advent of community care, hospital services were supposed to provide acute in-patient care as part of a wider system. Long-term needs of patients in the community should henceforth be met by community services that would be fully equipped and resourced to undertake this task. However, it was not long before acute wards were overwhelmed by occupancy rates of 100% and above, particularly in inner cites (Powell et al, 1995). The reason for the ‘bed crisis' that followed seems essentially twofold: community services were neither equipped nor resourced as required, and the number of acute beds was not adjusted to the ensuing demand. As hospital care has come to represent the only option for many patients whose needs could not be met in the community, acute wards have become overcrowded and ‘a bizarre and illogical mixture … of old and young, male and female, psychotic and depressed, retarded and agitated and voluntary and detained’ (Muijen, 1999).
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Dratcu, Luiz, Alistair Grandison, and Antony Adkin. "Acute hospital care in inner London: splitting from mental health services in the community." Psychiatric Bulletin 27, no. 3 (March 2003): 83–86. http://dx.doi.org/10.1192/pb.27.3.83.
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Acute hospital care in psychiatry has been described as inefficient and disorganised (Muijen, 1999). Worrying as it may be, this is neither new nor surprising. Following the closure of large mental institutions and the advent of community care, hospital services were supposed to provide acute in-patient care as part of a wider system. Long-term needs of patients in the community should henceforth be met by community services that would be fully equipped and resourced to undertake this task. However, it was not long before acute wards were overwhelmed by occupancy rates of 100% and above, particularly in inner cites (Powell et al, 1995). The reason for the ‘bed crisis' that followed seems essentially twofold: community services were neither equipped nor resourced as required, and the number of acute beds was not adjusted to the ensuing demand. As hospital care has come to represent the only option for many patients whose needs could not be met in the community, acute wards have become overcrowded and ‘a bizarre and illogical mixture … of old and young, male and female, psychotic and depressed, retarded and agitated and voluntary and detained’ (Muijen, 1999).
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Corcoran, Eleanor, Alice Guerandel, and Margo Wrigley. "The day hospital in psychiatry of old age – what difference does it make?" Irish Journal of Psychological Medicine 11, no. 3 (September 1994): 110–15. http://dx.doi.org/10.1017/s0790966700014762.
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AbstractObjective: Two day hospitals were established in North Dublin in 1989 to play a key role in the first old age psychiatry service in the Republic of Ireland. The purpose of this study was to identify the characteristics and needs of day hospital attenders, to carry out a preliminary evaluation of the role of the day hospitals in meeting these needs, and make recommendations for future developments. Method: All 237 regular attenders between March 1989 and 1992 were included. Demographic, social, medical and psychiatric data including CAGE questionnaire, Folstein mini-mental state, and Clifton Assessment Procedures for the Elderly survey version, were recorded at initial assessment. Data on duration and outcome of attendance, use of inpatient, general hospital and community care services were collected from a retrospective study of records and subjected to statistical analysis. Results: The average age was 78 years (SD 6yrs); 139 (59%) patients had organic and 98 (41%) had functional psychiatric disorders; 198 (84%) patients had a medical problem. In the functional group, 24 (25%) required acute admission; 70 (71%) patients were managed in the community. Twenty eight (29%) patients required residential care or had died on average 8 months after initial contact. In the group with dementia 104 (75%) had CAPE scores C/D/E at initial assessment, indicating high dependency. Eighty eight (63%) patients were in residential care or dead on average 8 months later. Conclusions: Day hospital treatment enabled elderly patients with functional psychiatric illness to be treated in the community with low usage of beds. It provided only short/medium term care for patients with dementia, who had little support from statutory services. A comprehensive network of services is necessary to support highly dependent patients in the community.
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Gough, Claire, Claire Hutchinson, Chris Barr, Anthony Maeder, and Stacey George. "Transition from hospital to home during COVID-19: A case report from an Australian transitional care program." Allied Health Scholar 2, no. 1 (February 26, 2021): 1–19. http://dx.doi.org/10.21913/tahs.v2i1.1572.
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Aim and Background: With the ongoing COVID-19 global pandemic, consideration for vulnerable groups, including our ageing population has been of great concern. Social isolation has been recommended to protect older adults with chronic diseases and reduce the spread of the virus, as well as to prevent healthcare services becoming overwhelmed. Yet social isolation presents its own health risks.
Methods: In this paper, we provide commentary on the lived experience of returning home from hospital during the COVID-19 pandemic. This case report details the experience of an 83-year-old female, who was living and mobilising independently in her own home, prior to hospital admission following a fall and resultant head injury.
Results: The participant returned home during the COVID-19 pandemic with a community transition care program which included assistance with cleaning tasks, shopping, and physiotherapy over a 45-day period.
Conclusions: COVID-19 has illuminated the issue of social isolation and increased awareness of its negative health effects at a global level. As society eases restrictions and returns to a new ‘normal’, many older adults will remain socially isolated. Ongoing allied health intervention is required to ensure quality of life through the latter years and to support older adults through periods of social distancing.
Keywords: transition care; COVID-19, social isolation, community participation
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Piers, Ruth, Eva Van Braeckel, Dominique Benoit, and Nele Van Den Noortgate. "Early resuscitation orders in hospitalized oldest-old with COVID-19: A multicenter cohort study." Palliative Medicine 35, no. 7 (May 24, 2021): 1288–94. http://dx.doi.org/10.1177/02692163211018342.
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Background: In particular older people are at risk of mortality due to corona virus disease 2019 (COVID-19). Advance care planning is essential to assist patient autonomy and prevent non-beneficial medical interventions. Aim: To describe early (taken within 72 h after hospital admission) resuscitation orders in oldest-old hospitalized with COVID-19. Setting/participants: A cohort of patients aged 80 years and older admitted to the acute hospital in March and April 2020 with COVID-19 were retrospectively recruited from 10 acute hospitals in Belgium. Recruitment was done through a network of geriatricians. Results: Overall, 766 octogenarians were admitted of whom 49 were excluded because no therapeutic relationship with the geriatrician and six because of incomplete case report form. Early decisions not to consider intensive care admission were taken in 474/711 (66.7%) patients. This subgroup was characterized by significantly higher age, higher number of comorbidities and higher frailty level. There was a significant association between the degree of the treatment limitation and the degree of premorbid frailty ( p < 0.001). Overall in-hospital mortality was 41.6% in patients with an early decision not to consider intensive care admission (67.1% in persons who developed respiratory failure vs 16.7% in patients without respiratory failure ( p < 0.001)). Of 104 patients without early decision not to consider intensive care admission but who developed respiratory failure, 59 were eventually not transferred to intensive care unit with in-hospital mortality of 25.4%; 45 were transferred to the intensive care unit with mortality of 64.4%. Conclusions: Geriatricians applied all levels of treatment in oldest-old hospitalized with COVID-19. Early decisions not to consider intensive care admission were taken in two thirds of the cohort of whom more than 50% survived to hospital discharge by means of conservative treatment.
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Durnford, Sahra, Harry Bulstrode, Andrew Durnford, Aabir Chakraborty, and Nicholas T. Tarmey. "Temporising an extradural haematoma by intraosseous needle craniostomy in the District General Hospital by non-neurosurgical doctors – A case report." Journal of the Intensive Care Society 19, no. 1 (October 2, 2017): 76–79. http://dx.doi.org/10.1177/1751143717734997.
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We report the case of a 69-year-old man admitted to the emergency department of a UK district general hospital with an extradural haematoma following closed head injury. He deteriorated rapidly before transfer to the regional neurosurgical centre and was treated with decompression of the extradural haematoma through an EZ-IO™ intraosseous needle in our department, with telephone guidance from the neurosurgeon. We believe this to be the first reported use of this technique in a district general hospital.
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Talaie, Haleh, Sayed Masoud Hosseini, Maryam Nazari, Mehdi Salavati Esfahani, and Behjat Barari. "Risk Factors of Hospital-acquired Thrombocytopenia in Toxicological Intensive Care Unit." International Journal of Medical Toxicology and Forensic Medicine 10, no. 3 (October 21, 2020): 32256. http://dx.doi.org/10.32598/ijmtfm.v10i3.32256.
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Background: Platelet count is a readily available biomarker predicting disease severity and risk of mortality in the intensive care units (ICU). This study aims to describe the frequency, to assess the risk factors, and to evaluate the impact of thrombocytopenia on patient outcomes in a Toxicological ICU (TICU).Methods: In this prospective observational Cohort study, we enrolled 184 patients admitted to our TICU from October 1st, 2019, to August 23rd, 2020. Mild/moderate and severe thrombocytopenia were defined as at least one platelet counts less than 150×103/μL and 50×103/μL during the ICU stay, respectively.Results: Of 184 enrolled patients, 45.7% had mild to moderate thrombocytopenia and 5.4% had severe thrombocytopenia. Old age (OR: 1.042, 95%CI: 1.01-1.075, P=0.01), male gender (OR: 4.348, 95%CI: 1.33-14.22, P=0.015), increased international normalized ratio (INR) levels (OR: 3.72, 95%CI: 1.15-112, P=0.028), and administration of some medications including heparin (OR: 3.553, 95%CI: 1.11-11.36, P=0.033), antihypertensive drugs (OR: 2.841, 95%CI: 1.081-7.471, P=0.034), linezolid (OR: 13.46, 95%CI: 4.75-38.13, P<0.001), erythromycin (OR: 19.58, 95%CI: 3.23-118.86, P=0.001), and colistin (OR: 10.29, 95% CI 1.44-73.69, P=0.02) were the risk factors of hospital-acquired thrombocytopenia. The outcomes of patients with normal platelet count were significantly better than those who developed thrombocytopenia (P<0.001).Conclusion: We found that thrombocytopenia could develop in almost 50% of patients admitted to TICU, which is associated with poor prognosis. Additionally, the platelet counts should be closely monitored to administer some medications (heparin, antihypertensive drug, and linezolid), especially in old patients.
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Nayak, Nirajan, N. Baral, N. Bahadur, S. Gokhale, S. Gowda, D. Hamal, D. R. Bhatta, and K. S. Rao. "Listeria meningitis in a three year old immunocompetent child: a case report from a tertiary care hospital in Nepal." Nepal Medical College Journal 20, no. 4 (December 31, 2018): 187–90. http://dx.doi.org/10.3126/nmcj.v20i4.26434.
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Listeria. monocytogenes may cause meningitis, meningoencephalitis, brain abscess, pyogenic arthritis, osteomyelitis, and liver abscesses in the pediatric age group. Listeria meningitis, though common in infants, is extremely infrequent in immunocompetent children. The course of meningoencephalitis by Listeria is often severe and even fatal, especially in those having an underlying predisposing condition. We hereby report a case of meningitis due to L. monocytogenes in a previously healthy three year old female child. The case is reported for its rarity and fatal outcome in an immunocompetent child. A three year old female child was referred to Manipal Teaching Hospital, a tertiary care hospital in western Nepal after three days of treatment with IV ceftriaxone for fever, excessive sleepiness and cough. The child had developed all features of meningitis and was kept on IV ceftriaxone and vancomycin. Culture of her CSF and blood grew L. monocytogenes. However, before the culture and sensitivity report for switch over of the antibiotics could be available, the child died in spite of supportive management for seizures, hypoxia and hypotension. This was an uncommon pathogen to cause meningitis considering the age of the child and her immune status. Thus there should always be a high index of suspicion among the clinicians and microbiologists for such rare pathogens which might be intrinsically resistant to many empirically administered antibiotics.
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Ture, Zeynep, Tugba Ustuner, Ario Santini, Serhat Aydogan, and İlhami Celik. "A Comparison of Nosocomial Infection Density in Intensive Care Units on Relocating to a New Hospital." Journal of Critical Care Medicine 6, no. 3 (August 11, 2020): 175–80. http://dx.doi.org/10.2478/jccm-2020-0028.
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AbstractBackgroundThe study aimed to investigate the changes in nosocomial infection density after patients were transferred to the intensive care unit (ICU) of a new-build hospital.MethodsThe types and rates of nosocomial infections were obtained for a one-year period retrospectively before leaving the old hospital premises and for a one-year periods after moving into the new hospital. The intensive care unit in the “old” premises was comprised of a 17-bedded hall, and thirty-three nurses shifted to work forty-eight hours a week, with each nurse assigned to provide care for two patients. The intensive care unit in the “new” premises consisted of single rooms, each with twenty-eight beds.ResultsThe median nosocomial infection density decreased from 23 to 15 per 1000 in-patient days. The catheter-related urinary tract infection rate decreased from 7.5 to 2.6 per100 catheter days.ConclusionsTreatment of patients in the new hospital resulted in a decrease in nosocomial infection density.
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Shahid, Rizwana, Muhammad Umar, Raja Bilal Zafar, Shazia Zeb, Saima Ambreen, and Muhammad Omar Akram. "Comorbidity of COVID-19 related Fatalities in Tertiary Care Hospitals of Rawalpindi, Pakistan." Journal of Rawalpindi Medical College 24, Supp-1 (July 17, 2020): 32–36. http://dx.doi.org/10.37939/jrmc.v24isupp-1.1422.
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Objectives: To assess the COVID-19 associated fatalities with respect to demographics, comorbidity, critical illness, and length of hospital stay in tertiary care hospitals.
Subjects & Methods: A retrospective hospital data-based research was done among 216 COVID-19 associated mortalities registered in 4 tertiary care hospitals Holy Family Hospital (HFH), Benazir Bhutto Hospital (BBH), District Head Quarters Hospital (DHQ) and Rawalpindi Institute of Urology & Transplantation (RIU & T) affiliated with Rawalpindi Medical University from 29th March-15th June 2020. The data was gathered by consecutive sampling pertinent to demographics, hospital stay, comorbidity, critical illness, and ventilator or oxygen support. The length of hospital stay among fatalities with and without comorbidity was compared by an independent sample z-test. Data were analyzed by using SPSS version 25.0.
Results: Of the total 216 COVID-19 related mortalities, 150(69.4%) were males and 66(30.6%) were females. The mean age of fatalities was 55.66 ± 13.97 years. About 76.7% of dying males were 41-70 years old while 56.1% of females dying of COVID-19 were 41-60 years old. Most (60.8%) of study subjects had hypertension followed by diabetes (53.8%), Ischemic Heart Disease (17.5%), and respiratory disorders (12.3%). About 75% of the critically ill patients needed a ventilator for respiratory support. Length of hospital stay was determined to have a statistically insignificant association (P > 0.10) with the presence or absence of comorbidity among COVID-19 patients. Critical illness had a highly significant association (P < 0.000) with ventilator support among COVID-19 related mortalities.
Conclusion: People 41-70 years should preferably adopt stringent precautions for protection against COVID-19. Comorbid states chiefly hypertension, diabetes, cardiac and respiratory diseases need special consideration amid COVID-19 pandemic to abstain from adverse health outcomes.
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Sitompul, Ratna, and Saleha Sungkar. "Hospital-based analysis of eye diseases at Karitas Hospital, Southwest Sumba, 2015." Medical Journal of Indonesia 27, no. 3 (October 12, 2018): 213–9. http://dx.doi.org/10.13181/mji.v27i3.2686.
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Background: This study aimed to determine the profile of eye diseases at Karitas Hospital in Southwest Sumba during 2015.Methods: The cross-sectional and descriptive study was conducted by analyzing medical records of 1706 patients who presented with eye complaints at Karitas Hospital, Southwest Sumba, in 2015. Complete medical records were recovered from 1363 patients, who served as subjects for this study.Results: Thirty-six percent of subjects were elderly (>55 years old) and 9.9% were children (<18 years old). Female patients comprised 56.4% of the study population and males 43.6%. Non-infectious eye diseases dominated (89.8%; 95%CI: 88.2%–91.4%) compared to infectious diseases (8.2%; 95%CI: 6.7%–9.7%) and mixed cases (2%; 95%CI: 1.3%–2.7%). Avoidable causes of blindness, cataract (34%), and refractive error (17.3%), were mostly found among non-infectious cases, while conjunctivitis (52.7%) and keratitis (17%) were the most commonly encountered infectious diseases.Conclusion: Eye diseases at Karitas Hospital in Southwest Sumba mostly comprised non-infectious diseases. The most commonly noted non-infectious diseases were cataracts and refractive errors, while conjunctivitis and keratitis were the most commonly found infectious diseases. Due to the high amount of patients seeking eye care within Southwest Sumba, ophthalmologists and proper equipment are needed at the Karitas Hospital.
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Oyedeji, Olusola Adetunji. "Malaria in a 2-Month-Old HIV-Exposed Nigerian Infant: Challenges of Care." Journal of the International Association of Providers of AIDS Care (JIAPAC) 18 (January 1, 2019): 232595821984905. http://dx.doi.org/10.1177/2325958219849052.
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Background: Reports on malaria and HIV coinfections in exposed infants from tropical countries are scarce. Results: The case of a 2-month-old HIV-exposed Nigerian infant who presented with intermittent fever at a Nigerian tertiary hospital is reported. The rarity of the case and the challenges associated with making the diagnosis informed our decision to report the case. Conclusion: Diagnosing malaria in HIV-exposed infants in early infancy requires a high index of suspicion, good knowledge of the clinical presentation, and appropriate microbiological investigations for sepsis and malaria. Further studies need to be conducted on the association between malaria and HIV exposure.
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Tran, Hung, Susan Claster, Paula K. Groncy, Theodore Zwerdling, Susan Shannon, Erin Felkel, and Amanda M. Termuhlen. "Acute Healthcare Utilization for Patients with Sickle Cell Disease within a Community Based Hospital System." Blood 120, no. 21 (November 16, 2012): 4246. http://dx.doi.org/10.1182/blood.v120.21.4246.4246.
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Abstract Abstract 4246 Background: Analysis of administrative databases indicates high acute health care utilization in 18 to 30 year old patients with sickle cell disease (SCD). Thirty-day re-hospitalization rates are higher in SCD than any other disease studied. Administrative databases may misrepresent clinical care due to coding errors. We undertook a study of acute health care utilization in a community-based healthcare system that provides comprehensive pediatric sickle cell care up to age 21 years of age, but without a dedicated adult clinic in place. Methods: This study is a retrospective chart review (1/1/2009-12/31/2010) using discharge ICD-9-CM codes for sickle cell disease in primary or secondary diagnoses at Long Beach Memorial Medical Center/Miller Children's Hospital. To assess clinical care for SCD in our community, we examined 14- and 30-day readmissions and Emergency Department (ED) encounters following an index admission. Results: We identified 174 unique patients and 563 acute care encounters (readmission plus ED visits). Median patient age was 15 years (range 7 days to 65 years). There was a female predominance (96 female;78 male). Insurance coverage distribution overall was 67.5% public, 26.6% private, 3.9 % uninsured, and 0.5% unknown. The percent of patients with at least one 14-day and one 30-day readmission was 7.2% and 14.5% of those 10 or less (n=55), 10.9% and 16.4% of those 11–20 (n=55), 41.0% and 51.3% of 21–30 year old (n=39), and 16% and 28% of those over age 30 years (n=25). The ED treat and release rate within 14 days of discharge from an inpatient hospitalization was 9.5% of acute care encounters and occurred entirely in the over 30 yr old population. The overall rate within 30 days was 9.9% (6.3% acute care encounters in </= 10 yr olds, 0% 11 to 20, 2.5% 21–30, and 14% for over 30 year olds). The median number of 30-day acute care encounters for the entire population per patient per year was 1.62; 1.22 in </= 10 yr olds, 1.28 for 11–21 yr olds, 2.41 for 21–30 yr olds, and 2.0 for those over 30 yrs old. A few patients (5.2%) had 11+ encounters in a two-year period – the majority (67%) were 21–30 years old. Acute care encounters per patient per year in public vs. privately insured patients were: 1.30 and 0.95 for ages </= 10 yrs (80.0% public insurance), 1.27 and 1.32 for ages 11–20 (58.2% public insurance), 2.70 and 1.69 for ages 21–30 (74.4% public insurance), and 2.77 and 1.20 for those over 30 years old (60% public insurance). The six uninsured patients (1 each 11–20 and 21–30 yrs old, 4 >30 yrs old) had 1.2 encounters/patient/year. Length of stay and discharge diagnoses did not differ between the index admission and readmission in any age group. Acute care encounters within 30 days vs. index hospitalization were due to pain (90% vs. 92%), surgery (3.1% vs. 3.7%), acute chest syndrome (2.5% vs. 1.9%), childbirth (1.8% vs.0%), and for other reasons (2.5%, 2.5%). Conclusions: We confirmed previous database studies that the highest rate of 14- and 30-day readmission and the highest number of acute care encounters/patient/year occurs in 21–30 year olds. A small number of patients, the majority aged 21–30 years, account for >11 encounters in the two-year study period. There were more encounters for 21–30 and 31+ year olds for those publicly vs. privately insured. There was minimal use of the ED to treat and release following a hospital discharge in SCD patients under the age of 31. Dissecting the multiple reasons for the high number of encounters and rehospitalizations may result in decreasing acute health care utilization by persons with SCD, especially for patients greater than 21years old. Disclosures: No relevant conflicts of interest to declare.
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Lubasch, Johanna Sophie, Susan Lee, Christoph Kowalski, Marina Beckmann, Holger Pfaff, and Lena Ansmann. "Hospital Processes and the Nurse-Patient Interaction in Breast Cancer Care. Findings from a Cross-Sectional Study." International Journal of Environmental Research and Public Health 18, no. 15 (August 3, 2021): 8224. http://dx.doi.org/10.3390/ijerph18158224.
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(1) Background: Evidence suggests that organizational processes of hospitals have an impact on patient-professional interactions. Within the nurse-patient interaction, nurses play a key role providing social support. Factors influencing the nurse-patient interaction have seldomly been researched. We aimed to examine whether the process organization in hospitals is associated with breast cancer patients’ perceived social support from nurses.; (2) Methods: Data analysis based on a cross-sectional patient survey (2979 breast cancer patients, 83 German hospitals) and information on hospital structures. Associations between process organization and perceived social support were analyzed with logistic hierarchical regression models adjusted for patient characteristics and hospital structures.; (3) Results: Most patients were 40–69 years old and classified with UICC stage II or III. Native language, age and hospital ownership status showed significant associations to the perception of social support. Patients treated in hospitals with better process organization at admission (OR 3.61; 95%-CI 1.67, 7.78) and during the hospital stay (OR 2.11; 95%-CI 1.04; 4.29) perceived significantly more social support from nurses.; (4) Conclusions: Designing a supportive nursing work environment and improving process organization in hospitals may create conditions conducive for a supportive patient-nurse interaction. More research is needed to better understand mechanisms behind the associations found.
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Grøndahl, Vigdis Abrahamsen, Jörg W. Kirchhoff, Kirsti Lauvli Andersen, Lise Aagaard Sørby, Hilde Marie Andreassen, Eli-Anne Skaug, Anne Karine Roos, Liv Solveig Tvete, and Ann Karin Helgesen. "Health care quality from the patients’ perspective: a comparative study between an old and a new, high-tech hospital." Journal of Multidisciplinary Healthcare Volume 11 (October 2018): 591–600. http://dx.doi.org/10.2147/jmdh.s176630.
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Cannon, Charlotte. "The Acute Medicine – Speciality Interface: Experience in a District General Hospital." Acute Medicine Journal 10, no. 2 (April 1, 2011): 89–90. http://dx.doi.org/10.52964/amja.0477.
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The Great Western Hospital was opened in 2002. It was built as a PFI hospital, moving services from the old Princess Margaret Hospital situated in central Swindon. The Great Western Hospital is conveniently situated near junction 15 of the M4 and therefore has excellent transport links. The Acute Medical Unit (AMU) was purpose built adjacent to the Emergency Department and in close proximity to Emergency Department Radiology. Details of the Acute Medical Unit layout are summarised in Table 2.
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El-Metwally, Ashraf, Nesreen Suliman Alwallan, Ali Amin Alnajjar, Nida Zahid, Khalid Alahmary, and Paivi Toivola. "Discharge against Medical Advice (DAMA) from an Emergency Department of a Tertiary Care Hospital in Saudi Arabia." Emergency Medicine International 2019 (November 28, 2019): 1–6. http://dx.doi.org/10.1155/2019/4579380.
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Background. The discharge against medical advice (DAMA) in the Emergency Department (ED) is an issue of great concern because it may result in adverse consequences at a later stage. The reported worldwide prevalence of DAMA ranges from 0.07 to 20% for emergency admissions. The outcomes of DAMA can have significantly damaging effects, causing possible relapses of disease, readmission, and increases in medical costs for the patient. Therefore, it is imperative to identify the predictors of DAMA in ED. Methods. It was a cross-sectional study. The medical records used were those of all the patients (n = 11513) admitted to the Emergency Department (ED) of King Abdullah Bin Abdulaziz University Hospital (KAAUH) in Riyadh, Saudi Arabia, between 2017 and 2018. A thorough analysis was performed using IBM SPSS Statistics version 22. Descriptive statistics were reported for quantitative and categorical variables and assessed by independent t-test/chi-square/ANOVA (analysis of variance), where appropriate. Unadjusted and adjusted odds ratios with their 95% CI (confidence interval) were reported by performing logistic regression. A p value of ≤0.05 was considered statistically significant throughout the study. Results. The prevalence of DAMA in our study was 1%. In a multivariable analysis, after adjusting for the other covariates, we observed a significant interaction between age and gender. It was observed that the odds of DAMA for ≤40-year-old males were 3.12 times higher than those of a ≤40-year-old female (p value < 0.1). To further investigate this interaction, men and women were modeled separately in multivariable models using the same covariates. We found that, for men, the effect of age (≤40 years) was significant (OR = 3.94, 95% CI 1.31–11.80, p=0.014), while, for women, the effect of age (≤40 years) was not as pronounced (OR = 1.27, 95% CI = 0.66–2.42, p=0.27). Conclusions. Our study concluded that DAMA was more likely among younger male patients (≤40 years of age). Most of the patients with DAMA were presented to the urgent care of the Emergency Department. We recommend that patients be given some financial support to bear the expenses of the hospital stay from the healthcare facility or from the state. Future studies should assess the socioeconomic status of the patients and estimate the cost that is incurred by the patients.
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Lazenby, J. Mark, and Jodi Olshvevski. "Place of Death among Botswana'S Oldest Old." OMEGA - Journal of Death and Dying 65, no. 3 (November 2012): 173–87. http://dx.doi.org/10.2190/om.65.3.a.
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Botswana, a country in sub-Saharan Africa, has been in the midst of an HIV/AIDs pandemic that has halted its previously lengthening life expectancy trend. However, one group to escape immediate effects on falling life span is the oldest old age group (> 80 years). Their roles in the community due to the pandemic, however, have changed. Place of death is an important consideration in end-of-life care for older adults, and one which has been well studied in the Global North. The purpose of this article is to determine where Botswana's oldest old die (home or hospital), and to see whether cause of death, gender, or residence in a city, town, or rural area is associated with place of death. We use death certificate data from 2005 and 2006 to describe where the oldest old Batswana (the name for the people of Botswana) died, home or hospital. Two-thirds died at home. The mean age at death was 88.46 (± 6.21) years; more were female (56.9%); and of known causes of death, cardiovascular disease was the leading cause (16.8%). Most stated causes of death (62.4%) were listed as “unknown.” Most oldest-old Batswana died in rural areas (70.1%), and in rural areas, proportionally more oldest old died at home compared to cities and towns. On multivariate analysis, being a woman > 80 years of age at death predicted home death. Future longitudinal study needs to determine preferences of place of death and the quality of death of Batswana > 80 years, especially women.
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Almeida, Miriam de Abreu, Graziella Badin Aliti, Elenara Franzen, Elisabeth Gomes da Rocha Thomé, Margarita Rubin Unicovsky, Eneida Rejane Rabelo, Maria Luiza Machado Ludwig, and Maria Antonieta Moraes. "Prevalent nursing diagnoses and interventions in the hospitalized elder care." Revista Latino-Americana de Enfermagem 16, no. 4 (August 2008): 707–11. http://dx.doi.org/10.1590/s0104-11692008000400009.
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OBJECTIVES: to identify the prevalent nursing diagnoses (ND) in the hospitalized elder care; to compare the prevalent ND with the duration of hospital stay and with the prescribed cares for their respective diagnoses. METHOD: Transversal historical study carried through in Porto Alegre, RS, by analyzing patient records age e•60 years old, interned in clinical unities of a university hospital. RESULTS: 1665 records were analyzed; the four prevalent NANDA nursing diagnoses - within 62 identified ones - were: Self-Care Deficit - Bathing/Hygiene, Imbalanced Nutrition - Less than Body Requirements, Risk for Infection and Ineffective Breathing Patterns, varying from 14 to 17 days of hospital stay. THE MAIN CARES WERE: aiding bed bath, communicating diet acceptance, implementing routines of care in venous puncture and checking respiratory pattern. CONCLUSION: four prevalent ND were identified with the appropriate prescribed care. However, other care could have been established as a priority.
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Dedic, A., K. Nieman, AJJC Bogers, and M. Witsenburg. "Transcatheter closure of a traumatic ventricular septum defect resulting from a stab wound." European Heart Journal: Acute Cardiovascular Care 4, no. 1 (September 26, 2013): 96–99. http://dx.doi.org/10.1177/2048872613507119.
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A 25-year-old man with a ventricular septal defect resulting from a stab wound to his chest was admitted to our hospital. Because of extensive comorbidity and favourable location, transcatheter closure with an Amplatzer device was preferred over surgical repair. Ventricular septal defects are an uncommon complication of cardiac trauma, but when they do occur from this cause, they often have more dramatic consequences. Transcatheter closure is an attractive, less-invasive alternative in patients with increased surgical risk, multiple previous surgical interventions, or poorly accessible defects.
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Le, Thong Q. "Case report of brachycephalic obstructive airway syndrome in brachycephalic dogs from Veterinary Specialist Service Hospital, Australia." Journal of Agriculture and Development 19, no. 03 (June 30, 2020): 28–38. http://dx.doi.org/10.52997/jad.5.03.2020.
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This report aimed to study symptoms and causes of brachycephalic obstructive airway syndrome (BOAS) in brachycephalic dogs and to determine appropriate surgical procedures for these symptoms by reviewing literatures and examining four case studies conducted at Veterinary Specialist Service Hospital, Underwood, Queensland, Australia. The cases included a 6-year 3-month-old Staffordshire Bull Terrier (case 1), a 1-year 5-month-old French Bulldog (case 2), an 8-month-old French Bulldog (case 3), and an 8-year 8-month Pug (case 4). Those dogs went to the Veterinary Specialist Service in a worsen state of respiratory problems, including the upper respiratory noise (case 1, 2, 3), decrease in exercise tolerance, respiratory struggling (case 1, 3), regurgitation (case 1), coughing, sleeping difficulty, respiratory stridor (case 2), nasal discharge, dyspnea, bloating, and tachypnea (case 4). Examinations revealed the causes including the elongated soft palate (case 1, 2, 3, 4), stenotic nostrils (case 2, 3, 4), tonsils inflammation (case 3) and everted laryngeal saccules (case 4). After surgery, the dogs were recovered in intensive care unit within 2 days, and then discharged. Scheduled re-examination one week later showed improvement in the respiratory health in all cases. Overall, major complications occur in 10% of cases; however, this surgery is vital and can be totally applied in Vietnam where brachycephalic dogs have become a popular companion.
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Ghazanfor, Ramlah, Maham Tariq, Mehwish Changez, Sara Malik, Ghulam Khadija, Hina Hanif, and Javaria Malik. "Adenoid cystic carcinoma of breast: A case report in breast clinic at a Tertiary Care Hospital." Professional Medical Journal 27, no. 07 (July 10, 2020): 1533–36. http://dx.doi.org/10.29309/tpmj/2020.27.07.4113.
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Incidence of adenoid cystic carcinoma of breast ranges from 0.1% to 1%. Its rare occurrence makes its surgical management options debatable. However rarity of metastasis contributes to an encouraging prognosis inspite of its triple negative receptor status. Herein, we report the case of a 60 year old woman who presented with a breast lump that turned out to be adenoid cystic carcinoma.
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Tarhan, Bedirhan, Sydur Rahman, Diana Halloran, Jeremy Sites, Avni Bhatt, Kathleen Ryan, Maritza Plaza-Verduin, and Thao Vu. "An Unusual Visit from an Old Foe: Oral Presentation of Syphilis in a Teenage Patient." Case Reports in Pediatrics 2021 (August 16, 2021): 1–3. http://dx.doi.org/10.1155/2021/7755914.
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The authors report an atypical case of secondary syphilis in an adolescent female presenting to a tertiary-care center with fever, weight loss, oral sores, painful inguinal lymphadenopathy, and transient macular rash. Given the lower prevalence of syphilis in adolescent females, this infection was not included on the initial differential diagnosis. The evolving presentation of syphilis over time complicates the diagnosis and management of these infections, as it did for the patient in this report. The authors provide a detailed discussion of the patient’s clinical findings, including the protean features of syphilis infection. This case is particularly relevant to the fields of general pediatrics and pediatric hospital medicine.
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Zhao, Rongrong, Houxiu Zhou, and Jingci Zhu. "Factors Associated with Willingness to Choose the Way for Old-Age Care: A Population-Based Cross-sectional Study in Chongqing, China." INQUIRY: The Journal of Health Care Organization, Provision, and Financing 58 (January 2021): 004695802110201. http://dx.doi.org/10.1177/00469580211020196.
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The objective of this study is to investigate the factors associated with the willingness for old-aged care and the demands for health care among elders, which might provide a reference for the establishment of health care strategies. A cross-sectional study was conducted via questionnaires among 1553 randomly selected residents aged 65 or older from Chongqing, China during 2016. Data of demographics, and demands for old-age care and health care services were collected. Descriptive analysis was used to examine the characteristics of the respondents. A chi-squared test and multiple logistic regression were performed to explore the relevant factors associated with the preference of old-age care among older people in Chongqing. We found that 85.4% of the respondents were willing to select home-based care: family old age care (55.9%), and its combination form for old-age care: family old age care plus community old age care (29.5%) old age care. Multivariable logistic regression analysis showed that willingness to choose family old age care for old-age care was associated with lower monthly income, more children, worse commercial insurance, better health status, and shorter distance to their children. Most older adults had the demands for health-related services, including regular check-up, regular health seminars, establishment of health files. Hospital was the most acceptable provider for care services, and there was a preference for long-term care and emergency call among the elders. The majority of older Chinese prefer the family old age care and its combination form with community old age care for old-age care, and demand for a variety of health-related services. Home- and community-based care with sound and perfect medical and health mechanism should be the main pattern of old-age care system in China.
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Holt, James D. "Navigating Long-Term Care." Gerontology and Geriatric Medicine 3 (January 1, 2017): 233372141770036. http://dx.doi.org/10.1177/2333721417700368.
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Americans over age 65 constitute a larger percentage of the population each year: from 14% in 2010 (40 million elderly) to possibly 20% in 2030 (70 million elderly). In 2015, an estimated 66 million people provided care to the ill, disabled, and elderly in the United States. In 2000, according to the Centers for Disease Control and Prevention (CDC), 15 million Americans used some form of long-term care: adult day care, home health, nursing home, or hospice. In all, 13% of people over 85 years old, compared with 1% of those ages 65 to 74, live in nursing homes in the United States. Transitions of care, among these various levels of care, are common: Nursing home to hospital transfer, one of the best-studied transitions, occurs in more than 25% of nursing home residents per year. This article follows one patient through several levels of care.
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Nayak, Niranjan, Nisha Baral, Rajani Shrestha, Ranjana Parajuli, Deependra Hamal, Dhrama Raj Bhatta, Supram Gowda, and Shishir Gokhale. "HAFNIA ALVEI BACTEREMIA FOLLOWING BRONCHOPNEUMONIA IN AN ELEVEN MONTH OLD CHILD: A CASE REPORT FROM A TERTIARY CARE HOSPITAL IN NEPAL." International Journal of Advancement in Life Sciences Research 1, no. 2 (April 15, 2018): 22–25. http://dx.doi.org/10.31632/ijalsr.2018v01i02.004.
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Madaan, Priyanka, Deepak Agrawal, Deepak Gupta, Atin Kumar, Prashant Jauhari, Biswaroop Chakrabarty, R. M. Pandey, Vinod Kumar Paul, M. C. Misra, and Sheffali Gulati. "Clinicoepidemiologic Profile of Pediatric Traumatic Brain Injury: Experience of a Tertiary Care Hospital From Northern India." Journal of Child Neurology 35, no. 14 (August 4, 2020): 970–74. http://dx.doi.org/10.1177/0883073820944040.
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Traumatic brain injury is an important cause of acquired brain injury. The current study brings to light the clinicoepidemiologic profile of pediatric traumatic brain injury in India. Retrospective record analysis of children (aged ≤ 16 years) with traumatic brain injury presenting to an apex-trauma-center in North India over 4 years was done. Of more than 15 000 patients with a suspected head injury, 4833 were children ≤16 years old. Of these, 1074 were admitted to the inpatient department; 65% were boys with a mean age at presentation being 6.6 years. Most patients (85%) had a Glasgow Coma Scale score of 13 to 15 at presentation while Glasgow Coma Scale scores of ≤8 was seen in 10% of patients. Neuroimaging (computed tomography [CT]) abnormalities were seen in 12% of patients, with the commonest abnormality being skull fracture, followed by contusions, and extradural hemorrhage. Around 2% of patients required decompressive craniotomy whereas 3% of patients succumbed to their illness. Among the inpatients with pediatric traumatic brain injury, two-thirds were boys with a mean age at presentation of 7.6 years. Severity of traumatic brain injury varied as mild (64%), moderate (11%), and severe (25%). The most common mode of injury was accidental falls (59%) followed by road traffic and rail accidents (34%). Neuroimaging abnormalities were seen in half of inpatients with pediatric traumatic brain injury, with the commonest abnormality being skull fracture. Pediatric head injuries are an important public health problem and constitute a third of all head injuries. They are more common in boys, and the most common modes of injury are accidental falls, followed by road traffic accidents.
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Christie, A. B. "Scottish Action on Dementia: a new response to an old problem." Psychiatric Bulletin 15, no. 3 (March 1991): 158–59. http://dx.doi.org/10.1192/pb.15.3.158.
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Scottish Action on Dementia had its origins in informal meetings of individuals drawn from a variety of health care professions with a shared concern about the inadequacies of provision for dementia sufferers in Scotland in the mid 1980s. At the heart of these concerns lay the absence of any effective response to two major documents – the Timbury Report and SHAPE (Scottish Hospital Authorities Plans for the Eighties). Both accorded the highest priority to care of the elderly, particularly those suffering from mental illness, and had been accepted by all the principal parties concerned as the blueprint for health care policies in Scotland in the 1980s. The sober realities of 1985 prompted the founding members of Scottish Action on Dementia (SAD) to set themselves up as a multidisciplinary forum with three principal functions – to promote public education and awareness of dementia and its implications for sufferers, families and society at large; to act as an independent pressure group; and to monitor activities in the field of dementia care with a view to promoting and maintaining high standards. Five years later these objectives remain unchanged.
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Glezos, JD, JE Albrecht, and RD Gair. "Pneumonitis after Inhalation of Mercury Vapours." Canadian Respiratory Journal 13, no. 3 (2006): 150–52. http://dx.doi.org/10.1155/2006/898120.
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A 43-year-old man presented to hospital with pneumonia but only after discharge from hospital did he admit to deliberate prior inhalation of mercury. His pulmonary involvement appeared to resolve almost completely with antibiotics and supportive care. Nevertheless, persisting elevated urinary excretion of mercury required two courses of chelation therapy. No serious systemic sequelae were observed.
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Buleshov, M. A., B. S. Turdalieva, U. Yu Chulpanov, D. M. Buleshov, A. M. Buleshova, N. S. Zhanabaev, and K. E. Ospanov. "Assessment of Medical and Social Effectiveness of Innovative High-tech Cardiac Surgery Care for Patients with Acute Myocardial Infarction." Revista Gestão Inovação e Tecnologias 11, no. 2 (June 5, 2021): 229–39. http://dx.doi.org/10.47059/revistageintec.v11i2.1656.
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The present research aims at comprehensive analysis to determine the effectiveness of cardiac surgery in patients in the acute period of myocardial infarction in comparison with patients who received drug treatment. A comparative assessment of the level of hospital mortality was carried out in the groups of patients of senior working age, elderly and old age, dividing them into patients who received cardiac surgery (main group) and drug treatment (comparison group). Among the patients of working age, 284 were assigned to the main group and 272 to the comparison group; among the patients of elderly age, 104 were assigned to the main group and 363 to the comparison group; and among the patients of old age, there were 9 patients in the main group and 235 patients in the comparison group. For reliable difference between the compared indicators, the authors determined the relative risk of socio-hygienic factors in terms of mortality rate and the significant limit of mortality formation, taking into account that the factor the relative risk of which is more than one is significant. The significant difference in mortality in hospital between patients who received high-tech medical services (HTMS) and the group of patients who did not undergo such high-tech heart surgery was found only in the elderly patients (65-74 years old), p = 0.002 (chi-square). The number of deaths in hospital from myocardial infarction in the main group increases with age. Mathematical modeling showed that the level of hospital mortality is also influenced by the provision of the hospital with qualified cardiologists, specialized bed and special medical equipment.
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Furuno, Jon P., Brie N. Noble, Kristi N. Horne, Jessina C. McGregor, Miriam R. Elman, David T. Bearden, Eric W. Walsh, and Erik K. Fromme. "Frequency of Outpatient Antibiotic Prescription on Discharge to Hospice Care." Antimicrobial Agents and Chemotherapy 58, no. 9 (July 7, 2014): 5473–77. http://dx.doi.org/10.1128/aac.02873-14.
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ABSTRACTThe use of antibiotics is common in hospice care despite limited evidence that it improves symptoms or quality of life. Patients receiving antibiotics upon discharge from a hospital may be more likely to continue use following transition to hospice care despite a shift in the goals of care. We quantified the frequency and characteristics for receiving a prescription for antibiotics on discharge from acute care to hospice care. This was a cross-sectional study among adult inpatients (≥18 years old) discharged to hospice care from Oregon Health & Science University (OHSU) from 1 January 2010 to 31 December 2012. Data were collected from an electronic data repository and from the Department of Care Management. Among 62,792 discharges, 845 (1.3%) patients were discharged directly to hospice care (60.0% home and 40.0% inpatient). Most patients discharged to hospice were >65 years old (50.9%) and male (54.6%) and had stayed in the hospital for ≤7 days (56.6%). The prevalence of antibiotic prescription upon discharge to hospice was 21.1%. Among patients discharged with an antibiotic prescription, 70.8% had a documented infection during their index admission. Among documented infections, 40.3% were bloodstream infections, septicemia, or endocarditis, and 38.9% were pneumonia. Independent risk factors for receiving an antibiotic prescription were documented infection during the index admission (adjusted odds ratio [AOR] = 7.00; 95% confidence interval [95% CI] = 4.68 to 10.46), discharge to home hospice care (AOR = 2.86; 95% CI = 1.92 to 4.28), and having a cancer diagnosis (AOR = 2.19; 95% CI = 1.48 to 3.23). These data suggest that a high proportion of patients discharged from acute care to hospice care receive an antibiotic prescription upon discharge.
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Goujon, D., R. Muto, C. Vayssier-Belot, H. Masson, and P. Grandin. "Liaison psychiatry as a part of a multifocal treatment in a general hospital." European Psychiatry 33, S1 (March 2016): S389. http://dx.doi.org/10.1016/j.eurpsy.2016.01.1403.
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We report here three clinical cases as exemples of our rich and frequent collaboration between the department of psychiatry and the department of medecine, nephrology and hemodialysis. This work can serve as a basis for further reflection in order to improve mutual demands. We based our description on three patients chosen for their homogeneity in demand, rapidity of evaluation, the same clinician who evaluated the demand. Either case: a 42-year-old woman, who was admitted for alteration of general state, severe headaches and chronic addiction to alcohool, 71-year-old woman sufferring from recurrent unipolar depression who came for somatic exploration and severe weight loss or 55-year-old man who was transferred from cardio-pulmonary intensive care unit after a volontary ingestion of neuroleptic- were reevaluated by the psychiatrist and the special follow-up was indicated as the patient was discharded from internal medecine department. We were interested in studying how important to the patient this indication turned to be on time.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Beck, Anne Marie. "Nutritional interventions among old people receiving support at home." Proceedings of the Nutrition Society 77, no. 3 (February 8, 2018): 265–69. http://dx.doi.org/10.1017/s002966511700413x.
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With the focus of care shifting from the hospital to the community, supportive nutritional care to old people is to become an important issue to address in the community, since undernutrition has serious consequences, both for the quality of life and for the health care costs. Several modifiable nutritional risk factors relate to undernutrition. Unfortunately, the problem with (risk of) undernutrition is aggravated due to a lack of alertness among e.g. health care staff, leading to insufficient attention for systemic screening and nutritional care. Only a few of the existing screening tools have been validated among old people receiving support at home. Few studies have assessed the beneficial effect of nutritional support among old people in their own home, and recently, it was concluded that such have shown limited effects. One reason may be that the nutritional interventions performed have not taken the multiple nutritional risk factors afore-mentioned into consideration when formulating the action/treatment plan and hence not used a multidisciplinary approach. Another reason may be that the intervention studies have not used validated screening tools to identify those old people most likely to benefit from the nutritional support. However, three recent studies have used a multidisciplinary approach and two have proven a beneficial effect on the quality of life of the old people and the health care costs. These findings suggest that when planning nutritional intervention studies for old people receiving support at home, modifiable nutritional risk factors should be taken into consideration, and a multidisciplinary approach considered.