ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1992.tb01880.x

年代:1992

数据来源: WILEY

摘要:

ObjectiveTo determine the surgical procedures being done on long‐term care (level 2) nursing home residents and the resultant in‐hospital morbidity and mortality.DesignA retrospective chart review of inpatient medical records from two hospitals, identified by computerized search of medical records and/or referral by directors of nursing of area nursing homes.SettingPatients originated in skilled‐care nursing homes in New Castle County, Delaware, USA. Surgery was performed in the area's two major hospitals, one a 1000‐bed regional referral and teaching hospital, and the other a 300‐bed community hospital.PatientsResidents of skilled‐care nursing homes (level 2) who underwent major surgery between January 1979 and December 1989.Measurements and Main ResultsEighty procedures were performed in 74 patients. Many different types of procedures were done. After primary repair of hip fracture the most common procedures were non‐orthopedic extremity and abdominal surgeries. Three deaths occurred (mortality 3.8%), and all were in patients undergoing emergency surgery who were classified above American Society of Anesthesiology Class 3. Serious complications occurred in 43% of the procedures and were most commonly cardiopulmonary and psychiatric, including profound depression in four. Antibiotic‐associated colitis occurred in three patients and required a second surgical procedure in one. Fewer adverse outcomes were seen in patients undergoing elective surgical procedures with spinal or local anesthesia than in patients receiving general anesthesia.ConclusionsAlthough retrospective and limited to inpatient data, in‐hospital surgical mortality in this very frail population was low, comparable to series in unselected geriatric populations. However, major complications were very common. Primary hip surgery repair may have been too frequently done. A multi‐institution, prospective trial would be useful to assess functional outcome of surgery

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1992.tb01821.x

年代:1992

数据来源: WILEY

摘要:

ObjectiveCompare lipid response, side effect profile and toxicity of younger (<50 years) versus older (50 to 70 years) hypercholesterolemic subjects taking wax‐matrix sustained‐release niacin (Endur‐acin®).Study DesignAn 8‐week randomized double‐blind placebo controlled trial.SettingGeneral community.ParticipantsVolunteers from community cholesterol screening programs and chart review of patients at family practice clinics. Male and female subjects, age 20 to 70, with baseline low density lipoprotein cholesterol level within the 75th to 95th percentile, excluded if on medications that affect lipids or if a history of diabetes, gout, peptic disease, or liver disease is present.InterventionNicotinic acid dosage schedules were 1,000 mg/day, 1,250 mg/day, 1,500 mg/day, or 2,000 mg/day for 8 weeks.Main Outcome MeasuresChange in blood lipids and blood chemistries, side effects, and pill compliance.Results158 subjects (79%) completed the study. Higher dose groups (1,500 mg and 2,000 mg) demonstrated improvements in total cholesterol, LDL‐cholesterol, HDL cholesterol, and total‐to‐HDL‐cholesterol ratio (P<0.05) compared to baseline and controls. Higher‐dose older subjects demonstrated significantly greater improvements than younger subjects on comparable doses for total cholesterol, HDL cholesterol, total‐to‐HDL‐cholesterol ratio, and triglycerides,P<0.02). Adherence to medication schedules was better and incidence of side effects and toxicity no greater in older subjects compared to younger.ConclusionWax‐matrix niacin (Endur‐acin®) was shown to be effective and well tolerated for the pharmacological treatment of hypercholesterolemia. Older persons, ages 50 to 70, appear to experience greater benefits with no greater side effects when compared to yo

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1992.tb01822.x

年代:1992

数据来源: WILEY

摘要:

ObjectiveTo evaluate the use of percutaneous transluminal coronary angioplasty (PTCA) in elderly coronary artery disease (CAD) patients.DesignA prospective study of patients 60 years and older undergoing de novo PTCA. We analyze patient risk factors, underlying disease, and clinical outcomes, with at least 3‐year follow‐up. Comparisons between different age strata among these patients are made to clarify differences between the young old (60 to 69 years), the middle old (70 to 79 years), and the very old (80 years and older).SettingBeth Israel Hospital, Boston, both a primary care and tertiary care teaching hospital.Patients907 consecutive elderly cardiac patients referred for PTCA are studied.InterventionsPTCA's were completed using the newest catheter technologies as they became available. All patients were premedicated with aspirin and dipyridamole, and all were anticoagulated with heparin.ResultsSubdivision by age demonstrates that the majority (67%) of patients aged 60 to 69 were males, but females were preponderant (61%) in those aged 80 and older. Octogenarians also had lower incidence of hypercholesterolemia, tobacco use, and family history of CAD, and a higher frequency of CHF, angina, and previous MI. Although total procedure‐complications increased with age, critical complications (MI, reocclusion, CABG, death) did not. Primary procedural success was similar in all age strata, but older patients had a higher prevalence of multi‐vessel disease and longer hospital stay. Follow‐up shows that most patients did well after PTCA; there was no increase in repeat PTCA, CABG, and MI with age.ConclusionsWhile advanced age is associated with changes in risk and clinical parameters for CAD patients, age alone is not a reasonable criterion to limit the us

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1992.tb01823.x

年代:1992

数据来源: WILEY

摘要:

ObjectiveTo evaluate the effects of low‐power light therapy on pain and disability in elderly patients with degenerative osteoarthritis of the knee.DesignPartially double‐blinded, fully randomized trial comparing red, infrared, and placebo light emitters.PatientsFifty patients with degenerative osteoarthritis of both knees were randomly assigned to three treatment groups: red (15 patients), infrared (18 patients), and placebo (17 patients). Infrared and placebo emitters were double‐blinded.InterventionsSelf‐applied treatment to both sides of the knee for 15 minutes twice a day for 10 days.Main Outcome MeasuresShort‐Form McGill Pain Questionnaire, Present Pain Intensity, and Visual Analogue Scale for pain and Disability Index Questionnaire for disability were used. We evaluated pain and disability before and on the tenth day of therapy. The period from the end of the treatment until the patient's request to be retreated was summed up 1 year after the trial.ResultsPain and disability before treatment did not show statistically significant differences between the three groups. Pain reduction in the red and infrared groups after the treatment was more than 50% in all scoring methods (P<0.05). There was no significant pain improvement in the placebo group. We observed significant functional improvement in red‐ and infrared‐treated groups (p<0.05), but not in the placebo group. The period from the end of treatment until the patients required retreatment was longer for red and infrared groups than for the placebo group (4.2 ± 3.0, 6.1 ± 3.2, and 0.53 ± 0.62 months, for red, infrared, and placebo, respectively).ConclusionsLow‐power light therapy is effective in relieving pain and disability in degenerative osteoart

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1992.tb01824.x

年代:1992

数据来源: WILEY

摘要:

ObjectiveTo determine whether RUG reimbursement categories accurately predict requirements for care in nursing homes.DesignProspective descriptive study of residents in lower reimbursement categories according to RUG.SettingThree nursing homes in New York City.ParticipantsConvenience sample of 173 residents who agreed to participate, not significantly different from 201 who did not agree to participate.Main MeasuresChart review; assessment of residents' cognitive and functional abilities; nursing assistants' ratings of residents' functional abilities, behavioral problems, the amount of effort required in care; and time‐motion studies of staff‐resident interactions.ResultsBoth the residents' RUG classification (P<0.01) and the level of ADL independence (P<0.001) had significant impacts on the staff effort required in their care, with more dependent residents requiring greater effort. The residents' level of cognitive impairment also had a significant impact on the staff effort, with the severely impaired requiring greater effort (P<0.05). The time‐motion analysis indicated that residents within the same RUG category differed in the number of staff‐resident interactions based on their level of cognitive impairment.ConclusionsCognitive impairment is a significant morbidity (or co‐morbidity) in determining the quantity of staff effort required by the resident, and behavioral interventions are an important care component. There is marked heterogeneity within lower (RUG) reimbursement categories which translates into strikingly different care req

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1992.tb01825.x

年代:1992

数据来源: WILEY

摘要:

ObjectiveTo identify prognostic indicators for geriatric patients discharged from an acute care hospital.DesignProspective observational study.SettingBase line assessment at discharge from an acute care hospital; reassessment after 1 year at home.PatientsOne hundred‐seventy‐eight consecutive patients over 70 years of age (mean age ± SD = 75.6 ± 13.1 years, range 70–95 years, 52% males); 56% were dependent in one or more Activities of Daily Living, 21% had abnormal Mini Mental State Scores.Main Outcome Measuresmortality, increasing physical dependence, health care utilization.ResultsMortality was directly related to a low ADL score at hospital discharge (Odds Ratio = 3.31, Confidence Limits = 1.91–5.75), neoplastic diseases (OR = 3.59, CL = 2.01–6.43), cardiovascular diseases (OR = 2.47, CL = 1.40–4.36), and drug use, expressed as the total number of individual preparations prescribed at discharge (OR = 1.72, CL = 1.05–2.83). Low ADL score, cardiovascular and neoplastic diseases were also predictive of increasing physical dependency. The use of health care services, quantified by an appropriately designed score, did not correlate with any of the baseline variables, with the implication that the use of the health care services was not proportional to the need for care. Conclusions: Elderly subjects at major risk of death and disability can be easily identified at discharge by a simple assessment of their medical and f

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1992.tb01826.x

年代:1992

数据来源: WILEY

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1992.tb01872.x

年代:1992

数据来源: WILEY

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1992.tb01873.x

年代:1992

数据来源: WILEY

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1992.tb01874.x

年代:1992

数据来源: WILEY