THE IMPACT OF FRAILTY ON POST-ACUTE REHABILITATION OUTCOMES IN OLDER ADULTS

2014 ◽  
pp. 1-4
Author(s):  
R. ROMERO-ORTUNO ◽  
C. TIERNAN ◽  
L. COGAN
Keyword(s):  
Primary Care ◽  
Discharge Rate ◽  
Acute Hospital ◽  
Care Programme ◽  
Rehabilitation Outcomes ◽  
Rehabilitative Care ◽  
Significant Difference ◽  
One Year ◽  
Acute Rehabilitation ◽  
The Impact

We assessed the correlations of the Frailty Instrument for primary care of the Survey of Health,Ageing and Retirement in Europe (SHARE-FI on admission: non-frail, pre-frail, frail) with the outcomes of aShort-term Post-Acute Rehabilitative Care programme (N=172 admissions over one-year period, 95 of whichwere frail). SHARE-FI correlated with age (non-frail: mean 79.2 years; frail: 83.6; P<0.001). Adjusting for age,SHARE-FI correlated with longer length of stay (non-frail: median 30 days; frail: 42; P=0.047), higher rate ofemergency transfer to acute hospital (non-frail: 2.4%; frail: 21.1%; P=0.004), and lower home discharge rate(non-frail: 97.6%; frail: 81.9%; P=0.009). While frailty correlated with more disability on admission anddischarge, there was no statistically significant difference in Barthel Index (BI) improvement across frailtycategories (all groups had median BI improvement of ≥2 points, P=0.247). The post-acute rehabilitation of thefrail is worthwhile but requires more time and access to acute hospital facilities.

scholarly journals An Effectiveness Trial of STEADI in an Outpatient, Primary Care Practice

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 774-774
Author(s):  
David Rein ◽  
Madeleine Hackney ◽  
Michele Dougherty ◽  
Camille Vaughan ◽  
Laurie Imhof ◽  
...  
Keyword(s):  
Primary Care ◽  
Medication Review ◽  
Primary Care Practice ◽  
Controlled Trial ◽  
Care Practice ◽  
Strength Assessment ◽  
Randomized Controlled ◽  
Study Team ◽  
One Year ◽  
The Impact

Abstract The STEADI Options trial uses a randomized, controlled-trial design to assess the effectiveness and cost-effectiveness of the STEADI Initiative . Beginning March, 2020, we will randomize 3,000 adults ≥ 65 years of age at risk for falls seen in an Emory Clinic primary care practice to: (1) full STEADI; (2) a STEADI-derived gait, balance, and strength assessment with physical therapy referrals; (3) a STEADI-derived medication review and management; or (4) usual care. This presentation will discuss decisions made by the study team to facilitate implementation of STEADI including electronically conducting screening prior to the date of encounter, the use of dedicated nursing staff to conduct assessments, implementation of strength, balance, orthostatic hypotension, and vision testing, methods to facilitate medication review, and communication of assessment information to providers. The results from this study will be used to estimate the impact of STEADI on falls, service utilization, and costs over one year.

Primary care physician services and the frequency of comorbidities in patients with acute myocardial infarction

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
R King ◽  
D Giedrimiene
Keyword(s):  
Myocardial Infarction ◽  
Primary Care ◽  
Acute Myocardial Infarction ◽  
Primary Care Physician ◽  
Care Physician ◽  
Adverse Outcomes ◽  
Coronary Syndrome ◽  
Number Of Patients ◽  
Significant Difference ◽  
The Impact

Abstract Funding Acknowledgements Type of funding sources: None. Background The management of patients with multiple comorbidities represents a significant burden on healthcare each year. Despite requiring regular medical care to treat chronic conditions, a large number of these patients may not receive proper care. Significant disparities have been identified in patients with multiple comorbidities and those who experience acute coronary syndrome or acute myocardial infarction (AMI). Only limited data exists to identify the impact of comorbidities and utilization of primary care physician (PCP) services on the development of adverse outcomes, such as AMI. Purpose The primary objective was to analyze how PCP services utilization can be associated with comorbidities in patients who experienced an AMI. Methods This study was based on retrospective data analysis which included 250 patients admitted to the Hartford Hospital Emergency Department (ED) for an AMI. Out of these, 27 patients were excluded due to missing documentation. Collected data included age, gender, medications and recorded comorbidities, such as hypertension, hyperlipidemia, diabetes mellitus (DM), chronic kidney disease (CKD) and previous arrhythmia. Each patient was assessed regarding utilization of PCP services. Statistical analysis was performed in order to identify differences between patients with documented PCP services and those without by using the Chi-square test. Results The records allowed for identification of documented PCP services for 172 out of 223 (77.1%) patients. The most common comorbidities were hypertension and hyperlipidemia: in 165 (74.0%) and 157 (70.4%) cases respectively. The most frequent comorbidity was hypertension: 137 out of 172 (79.7%) in pts with PCP vs 28 out of 51 (54.9%) without PCP, and significantly more often in patients with PCP, p&lt; 0.001. Hyperlipidemia was the second most frequent comorbidity: in 130 out of 172 (75.6%) vs 27 out of 51 (52.9%) accordingly, and also significantly more often (p&lt; 0.002) in patients with PCP services. The number of comorbidities ranged from 0-5, including 32 (14.3%) patients without comorbidities: 16 (9.3%) with a PCP and 16 (31.4%) without PCP services. The majority of patients - 108 (48.5% of 223), had 2-3 documented comorbidities: 89 (51.8%) had two and 19 (34.6%) had three. The remaining 40 (17.9%) patients had 4-5 comorbidities: 37 (21.5%) of them with a PCP and 3 (10.3%) without, with a significant difference (p &lt; 0.001) found for patients with a higher number of comorbidities who utilized PCP services. Conclusions Our study shows that the majority of patients who presented with an AMI had one or more comorbidities. Furthermore, patients who did not utilize PCP services had fewer identified comorbidities. This suggests that there may be a significant number of patients who experienced AMI with undiagnosed comorbidities due to not having access to PCP services.

scholarly journals Composition of raw milk from conventional and organic dairy farming

2016 ◽  
Vol 32 (2) ◽  
pp. 133-143 ◽  
Author(s):  
Denis Kucevic ◽  
Snezana Trivunovic ◽  
Vladan Bogdanovic ◽  
Ksenija Cobanovic ◽  
Dobrila Jankovic ◽  
...  
Keyword(s):  
Statistical Significance ◽  
Raw Milk ◽  
Farming System ◽  
Dairy Farming ◽  
Milk Samples ◽  
High Statistical Significance ◽  
Significant Difference ◽  
Organic Dairy ◽  
One Year ◽  
The Impact

Possible differences between composition of raw milk due to dairy farming system (organic vs conventional) as well as seasonal variations were investigated. The samples were analysed during one year. A total of 6.782 samples of raw milk were collected (4.496 from organic farming). Dairy farms were located in the northern part of Republic of Serbia (Province of Vojvodina). The principle of analysis of raw milk samples was in accordance with the methodology by midinfrared spectrometry and flow cytometry. The fixed effect of system of farming and season (winter, spring, summer and fall) have shown a high statistical significance (P < 0.01) on all examined milk parameters except fat, total solids and somatic cell count, where the impact was slightly lower (P < 0.05). Significant difference wasn't found in number of bacterial colonies (P > 0.05). Composition of milk is also affected by a number of other factors, therefore it is recommended to involve factors such as nutrition of dairy cows, breed and farm management.

scholarly journals Routes to Diagnosis for Suspected Sarcoma: The Impact of Symptoms and Clinical Findings on the Diagnostic Process

Sarcoma ◽  
2016 ◽  
Vol 2016 ◽  
pp. 1-12 ◽  
Author(s):  
Heidi Buvarp Dyrop ◽  
Peter Vedsted ◽  
Mathias Rædkjær ◽  
Akmal Safwat ◽  
Johnny Keller
Keyword(s):  
Primary Care ◽  
Clinical Findings ◽  
Diagnostic Process ◽  
Time Intervals ◽  
Local Hospital ◽  
Doctor Visit ◽  
Presenting Symptoms ◽  
One Year ◽  
The Impact ◽  
Diagnostic Intervals

Background and Objectives. Sarcoma patients often experience delay before diagnosis. We examined the association between presenting symptoms/signs and time intervals for suspected sarcoma patients.Methods. 545 consecutive patients suspected for sarcoma referred over a one-year period were included. Median time intervals in routes to diagnosis were collected from medical records and questionnaires.Results. 102 patients (18.7%) had a sarcoma; 68 (12.5%) had other malignancies. Median interval for the patient (time from first symptom to first doctor visit), primary care, local hospital, sarcoma center, diagnostic, and total interval for sarcoma patients were 77, 17, 29, 17, 65, and 176 days, respectively. Sarcoma patients visited more hospital departments and had longer median primary care (+10 days) and diagnostic intervals (+19 days) than patients with benign conditions. Median primary care (−19 days) and sarcoma center (−4 days) intervals were shorter for patients with a lump versus no lump. Median patient (+40 days), primary care (+12 days), diagnostic (+17 days), and total intervals (+78 days) were longer for patients presenting with pain versus no pain. GP suspicion of malignancy shortened local hospital (−20 days) and total intervals (−104 days).Conclusions. The main part of delay could be attributed to the patient and local hospitals. Length of time intervals was associated with presenting symptoms/signs and GP suspicion.

scholarly journals Seasonal variation in the prevalence of profound hyponatremia (<125 mmol/l) in patients on admission to an acute hospital in Japan

2019 ◽  
Vol 28 (3) ◽  
pp. 211-213 ◽  
Author(s):  
Nobukazu Sasaki ◽  
Yuji Aoki
Keyword(s):  
Salt Intake ◽  
Medical Center ◽  
Relevant Literature ◽  
Warm Season ◽  
Cold Season ◽  
Acute Hospital ◽  
Drug Induced ◽  
Increased Risk ◽  
Significant Difference ◽  
The Impact

Hyponatremia is a common but important electrolyte disorder mostly complicated with other diseases. Recently, we experienced a case of a hypertensive patient in her seventies taking a thiazide diuretic, who presented with disorientation due to severe hyponatremia (serum sodium level, 104 mmol/l) on admission. Taking this opportunity, patients with profound hyponatremia (<125 mmol/l) on admission were investigated. Patients newly admitted to Matsumoto Medical Center (an acute hospital) were surveyed retrospectively for one year from May 1, 2016 to April 30, 2017. Patients with profound hyponatremia on admission were selected, and their clinical characteristics were evaluated. A total of 108 out of 4223 patients (2.6%; 67 men, 41 women) showed profound hyponatremia, and 101 out of 108 patients were 65 years old and over. The prevalence of profound hyponatremia in the warm season of April to October (3.1%, 76 in 2444 patients) was significantly ( p = 0.002, χ2 test) higher than that in the cold season of November to March (1.8%, 32 in 1779 patients). The monthly prevalence tended to correlate with the monthly average temperature of the local area ( r = 0.517, p = 0.085). There were six patients treated with thiazide diuretics in the warm season, while there were no such patients in the cold season, not reaching a significant difference ( p = 0.240). The present study demonstrated an increased risk of hyponatremia in elderly patients during the warm season. Considering also the relevant literature, health professionals should pay enough attention to thiazide- or drug-induced hyponatremia and the impact of water/salt intake for heat exposure.

Improved Outcome After Reduced Intensity Allogeneic Hematopoietic Stem Cell Transplantation (RI-HCT) for Myelodysplastic Syndrome (MDS) Using Tacrolimus/Sirolimus-Based Gvhd Prophylaxis.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 2771-2771 ◽  
Author(s):  
Ryotaro Nakamura ◽  
Joycelynne Palmer ◽  
Pablo Parker ◽  
Anthony Stein ◽  
Tracey Stiller ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Chronic Gvhd ◽  
Unrelated Donor ◽  
Hematopoietic Stem ◽  
Gvhd Prophylaxis ◽  
Significant Difference ◽  
One Year ◽  
The Impact ◽  
Bone Marrow Blasts ◽  
Improved Outcome

Abstract Abstract 2771 Poster Board II-747 We previously reported an encouraging result with RI-HCT for MDS (Bone Marrow Transplant 2007; 40:843-50) using flugarabine/melphalan conditioning and cyclosporine (CSA)/mycophenolate (MMF) as GVHD prophylaxis. In order to further improve upon the outcome in the RI-HCT setting, we initiated a series of clinical trials at City of Hope National Medical Center designed to evaluate the impact of tacrolimus (FK)/sirolimus (SIRO)-based GVHD prophylaxis. Here we report the combined, updated results from a consecutive case-series of 89 patients with MDS (including AML progressed from MDS) who underwent RI-HCT from 2000 to 2008 and received either CSA/MMF (n =44) or FK/SIRO (n=45)-based GVHD prophylaxis. All patients received fludarabine 125 mg/m2 plus melphalan 140 mg/m2 followed by an allogeneic HCT (peripheral blood: n=83, bone marrow: n=6) from an HLA-identical sibling (SIB: n=35) or unrelated donor (MUD: n=54). Additional ATG was given to 12 patients. For MUD transplants a short course of methotrexate was added to CSA/MMF or FK/SIRO. The median age was 59 years (range: 20-71) and 31 (35%) patients were female, 58 (65%) were male. Diagnoses at transplant were RA (n=21), RARS (n=1), RAEB/RAEBT (n=36), and AML from prior MDS (n=31). Cytogenetic risk was low in 15 (17%), intermediate in 37 (41.5%), high in 37 (41.5%) patients. By IPSS criteria (for MDS only), 2 patients had low, 24 had int-1, 20 had int-2, and 12 had high-risk MDS. Twenty-seven patients had therapy-related MDS including 14 with prior autologous HCT. The median follow-up time for surviving patients was 39 months (range: 24-68) for the CSA/MMF group and 17 months (range: 4-39) for the FK/SIRO group. All but two patients (1 in CSA/MMF, 1 in FK/SIRO) engrafted with the median neutrophil recovery at 15 days (range: 11-55). The baseline patient, disease and transplant characteristics were similar between CSA/MMF and FK/SIRO, except for an increased percentage of therap-related MDS in the CSA/MMF group (43% vs. 18%, p<0.01). The median donor chimerism by STR at day 30 post-transplant was 100% in both groups (p=0.6). FK/SIRO was associated with a significantly reduced one-year non-relapse mortality (NRM) (11.4%) compared with CSA/MMF (36.2%, p=0.01). This improvement in NRM translated into a trend for improved overall survival (81.4% vs. 52.3%, p=0.1) and disease-free survival (72.2% vs. 52.3%, p=0.08) at one year. While we observed no significant difference in acute GVHD grade II-IV between CSA/MMF and FK/SIRO, FK/SIRO was associated with a significant reduction in grade IV GVHD (0% versus 26%, p<0.01) and a trend for III-IV GVHD (31% vs. 55%, p=0.1). There was no significant difference in chronic GVHD between FK/SIRO (60%) and CSA/MMF (56%, p=0.8). In multivariate analysis, the use of FK/SIRO was independently associated with improved NRM after adjusted for donor type, therapy-related MDS, %bone marrow blasts, and HLA match status (Table). In conclusion, FK/SIRO-based GVHD prophylaxis was associated with an improved outcome after RI-HCT for MDS attributable to the reduced risk for severe acute GVHD.Variables for NRMHazard Ratio (95% CI)p-valueDe novo (n=62) Therapy-related (n=27)baseline 0.75 (0.31–1.89)0.55Sibling donor (n=35) Unrelated donor (n=54)baseline 2.17 (0.70–6.74)0.18Bone marrow blasts < or =10% (n=67) Bone marrow blasts >10% (n=22)baseline 2.13 (0.92–4.96)0.08HLA match (sibling donor or 10/10 MUD, n=72)HLA < mismatch MUD (<10/10 match, n=17)baseline 6.26 (2.11–18.55)0.001FK/SIRO (n=45) CSA/MMF (n=44)baseline 6.58 (2.15–20.14)0.001 Disclosures: Off Label Use: cyclosporine, cellcept, tacrolimus, sirolimus, and methotrexate for GVHD prophylaxis.

scholarly journals Therapeutic itinerary of people with tuberculosis in face with their health needs

2019 ◽  
Vol 23 (3) ◽  
Author(s):  
Aliéren Honório Oliveira ◽  
Antonio Germane Alves Pinto ◽  
Maria do Socorro Vieira Lopes ◽  
Tânia Maria Ribeiro Monteiro de Figueiredo ◽  
Edilma Gomes Rocha Cavalcante
Keyword(s):  
Primary Care ◽  
Disease Management ◽  
Qualitative Study ◽  
Health Needs ◽  
Smear Microscopy ◽  
Structured Interviews ◽  
X Ray ◽  
Entrance Door ◽  
One Year ◽  
The Impact

Abstract Objective: To describe the therapeutic itinerary of people with tuberculosis in face of their health needs. Method: Descriptive, qualitative study. Semi-structured interviews were carried out with ten patients. Hermeneutic-dialectic method of analysis and concept of therapeutic itinerary as driver of the analysis. Results: Most had classic symptoms at the beginning, however there was a case with coughing for more than one year. Entrance door, access to diagnosis and treatment were predominant in Primary Care, through smear microscopy and X-ray; patients had to pay for exams. Decentralization of treatment for other services when necessary or by link with the professional. The patient followed the decisions of the professionals and the support of relatives; prejudice regarding the disease was noted. Conclusions and implications for practice: Fragility in disease management, importance of bonding and family. It should be considered the impact of the disease and the need to support patients to ensure continuity of care.

scholarly journals THE IMPACT OF TARGETED TRAINING OF MEDICAL INTERNS ON THE SURVIVAL OF CARDIAC ARREST IN THE EMERGENCY ROOM

2021 ◽  
Vol 9 (11) ◽  
pp. 1167-1176
Author(s):  
Benmessaoudfz a ◽  
◽  
Tadilijawad b ◽  
Kettani Ali ◽  
Ahlam Chaieri ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Medical Training ◽  
Discharge Rate ◽  
National Registry ◽  
Primary Objective ◽  
University Hospital ◽  
Significant Difference ◽  
Medical Interns ◽  
The Impact

Introduction:The prognosis of patients with cardiac arrest is closely related to the quality of cardiopulmonary resuscitation (CPR). The aim of this work was to assess the impact of targeted training on CPR, in accordance with the latest international recommendations, on the management of cardiac arrests in SAUV. Methods:This is a prospective study carried out between January 1 and December 31, 2011 at the SAUV of Ibn Sina University Hospital in Rabat, including all adult patients who experienced cardiac arrest after admission. The main primary objective is to evaluate the impact of targeted training of medical interns on the survival of cardiac arrest in the ER expressed by the Hospital Discharge Survival (HDS) rate. Secondary objectives include the rate of recovery of circulatory activity (RCA), 48-hour survival, and quality of CPR performance. Results:342 patients were included, 159 before and 183 after training. There was no significant difference in terms of recovery from spontaneous circulation, 48h survival or discharge rate at home without sequelae. On the other hand, there was a statistically significant improvement in all the quality criteria for performing CPR. Conclusion:This work shows that the introduction of short training courses such improves the quality of CPR. The lack of impact on the improvement of patient survival seems to be related to numerous shortcomings, in particular basic medical training in emergency medicine, organization and protocolization of care, equipment of emergency rooms, supervision of emergency clerkship and the existence of a CA national registry. These are all areas to be developed in order to improve the prognosis of CA in our hospital structure.

scholarly journals Subtidal littering: Indirect effects on soft substratum macrofauna?

2008 ◽  
Vol 9 (2) ◽  
pp. 35 ◽  
Author(s):  
I. AKOUMIANAKI ◽  
P. KONTOLEFAS ◽  
S. KATSANEVAKIS ◽  
A. NICOLAIDOU ◽  
G. VERRIOPOULOS
Keyword(s):  
Community Structure ◽  
Sediment Surface ◽  
Long Run ◽  
Significant Difference ◽  
Before And After ◽  
Soft Substratum ◽  
One Year ◽  
The Impact ◽  
Control Surfaces ◽  
Macrofauna Community

Changes in macrofauna community structure, abundance and species richness were examined both before and one year after the deployment of plastic and glass bottles at littered (litter density: 16 items / 100 m2) and non-littered (control) surfaces at three unimpacted coastal areas of the western Saronikos Gulf (Greece). In parallel, LOI% at the adjacent sediments and changes in the composition of feeding types of the megaepifauna that colonized the litter were examined across treatments. Significant changes in macrofauna community structure were demonstrated between before and after littering. At only one of the sites was there detected a significant difference in macrofauna community structure between control and littered plots after littering. This difference was linked with a significant increase in the abundance of opportunistic polychaete species and LOI% levels in the sediment surface due to the entrapment of macrophytal debris within the littered surface. The study did not show a consistent direct response of macroinfauna community to litter and the associated megafauna. Unlike the megafauna attracted by litter items, soft-substratum macrofauna is less responsive to the addition of novel hard substrates in adjacent sediments. Alternatively, it could be that the impact of littering with small items triggers a macrofauna response detectable in the long-run.

Expression of P-selectin, von Willebrand and endothelin-1 after carotid artery stenting

VASA ◽  
2011 ◽  
Vol 40 (3) ◽  
pp. 199-204 ◽  
Author(s):  
Xia ◽  
Yang ◽  
Qu ◽  
Cheng ◽  
Wang
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Endothelin 1 ◽  
Significant Difference ◽  
Group 2 ◽  
One Year ◽  
Von Willebrand ◽  
The Impact ◽  
Group 1

Background: This study was designed to investigate the impact of carotid artery stenting (CAS) on plasma levels of P-selectin, von Willebrand (vWF) and endothelin-1. Patients and methods: Sixty-seven patients who received CAS were divided into group 1 (one stent for a simple lesion, n = 38) and group 2 (two stents for complex lesions, n = 29). The levels of P-selectin, vWF and endothelin-1 were measured before CAS, 1 h, 6h, 24 h and 2 weeks after the stenting. Results: Sixty-one patients completed one-year follow up. Restenosis was noted in 14 (23 %) patients, among these three (4.8 %) had a restenosis of > 50 % of the vascular lumen. In all patients, the levels of P-selectin, vWF and endothelin-1 increased immediately after CAS (P < 0.05 or < 0.01). The levels of vWF and endothelin-1 in group 2 were higher than in group 1 (P < 0.05 or 0.01). There was no significant difference in P-selectin and endothelin-1 between the restenosis and non-restenosis group (P > 0.05). The 24 h vWF in patients with restenosis were higher than in non-restenosis group (P < 0.05). Conclusions: CAS results in a significant increase in plasma P-selectin, vWF and endothelin-1. The post-CAS levels of P-selectin, vWF and endothelin-1 are related to the extent of endothelial injury. Whether they are associated with restenosis 12 months after the treatment requires further investigation.

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