Health problems in elderly patients during the first post-stroke year

Background

A wide range of health problems has been reported in elderly post-stroke patients.

Aim

The aim of this study was to analyse the prevalence and timing of health problems identified by patient interviews and scrutiny of primary health care and municipality elderly health care records during the first post-stroke year.

Methods

A total of 390 consecutive patients, ≥65 years, discharged alive from hospital after a stroke event, were followed for 1 year post-admission. Information on the health care situation during the first post-stroke year was obtained from primary health care and municipal elderly health care records and through interviews with the stroke survivors, at 1 week after discharge, and 3 and 12 months after hospital admission.

Results

More than 90% had some health problem at some time during the year, while based on patient record data only 4–8% had problems during a given week. The prevalence of interview-based health problems was generally higher than record-based prevalence, and the ranking order was moderately different. The most frequently interview-reported problems were associated with perception, activity, and tiredness, while the most common record-based findings indicated pain, bladder and bowel function, and breathing and circulation problems. There was co-occurrence between some problems, such as those relating to cognition, activity, and tiredness.

Conclusions

Almost all patients had a health problem during the year, but few occurred in a given week. Cognitive and communication problems were more common in interview data than record data. Co-occurrence may be used to identify subtle health problems.     

An Arthroscopic Hip Documentation Form

Hip arthroscopy is becoming increasingly popular. A simple, precise, and practical means of recording arthroscopic findings will be useful for diagnostic, research, and audit purposes. Basic principles of cartography exist to produce two-dimensional paper representations of our spherical planet. We used the same principles to produce a two-dimensional map of the acetabulum and femoral head. The resulting hip diagram shows the acetabulum as viewed from the side and the femoral head as viewed from above. The ligamentum teres is attached to the medial margin of the head. The head–neck junction and part of the femoral neck is shown at the opposite margin of the ligamentum teres. The hip documentation form is simple, precise, and accurate. We use it to record our findings at hip arthroscopy, which we have used to assist us in our practice.     

Weight and height documentation: Does ICU measure up?

BackgroundReliable assessment and documentation of weight and height are essential for the accurate delivery of many critical care interventions.MethodsWe conducted a 3-month retrospective, cross-sectional, single-centre audit to determine the prevalence of weight and height documentation in the clinical records of patients admitted to the intensive care unit (ICU) for the period from 3 months prior to hospital admission up to hospital discharge.ResultsOne hundred forty-one index ICU admissions were identified from October–December 2015 with 138 medical records available for analysis. Median (interquartile range) age was 64.5 (50.8–75.3) years, the majority were male (60.9%, 84/138), and the ICU admission Acute Physiology and Chronic Health Evaluation II score was 19.0 (14.0–25.0). Overall, weight and height were recorded in 90 (65.2%) and 63 (45.6%) patients, respectively. For elective postoperative admissions (n = 20), weight and height were recorded in 20 (100%) and 19 (95%) patients. For emergency medical and surgical admissions, 70 (59.3%) and 44 (37.2%) patients had weight and height recorded in both the 3-month period prior to hospital admission and the in-hospital period. A moderate, positive correlation was shown, r = 0.55, P < 0.001, with a longer hospital length of stay being associated with a greater number of weight and height records for each patient. In the emergency patient cohort, 81.7% (n = 215/263) of weight- and/or height-based interventions occurred before or during the ICU admission, of which 69.9% (n = 184/263) required consideration of ideal body weight.ConclusionMeasurement and medical record documentation of weight and height is infrequently performed in ICU patients. Given the clinical requirement for accurate measurement and documentation, further research to understand the barriers to perform and document this important process of care is necessary.     

The determination of total burn surface area: How much difference?

Burn depth and burn size are crucial determinants for assessing patients suffering from burns [1]. Therefore, a correct evaluation of these factors is optimal for adapting the appropriate treatment in modern burn care. Burn surface assessment is subject to considerable differences among clinicians [2].     

An audit of propofol administration in the intensive care unit: Infusion pump–recorded versus electronically documented amounts

BackgroundAlthough propofol is widely used for sedation in intensive care units around Australia, evaluation of bedside nursing practices of the administration of propofol have been limited. We investigated whether there was a discrepancy between the amount of propofol delivered by the infusion pump and that recorded electronically and consequently patient exposure to avoidable harms.AimsThe aim of this research was to compare the total amount of propofol administered to intensive care patients via a programmable infusion pump with that documented in the electronic medical record (EMR). Secondary objectives were to ascertain the percentage of 1) patients exposed to a propofol dose greater than recommended and 2) daily energy requirements administered as propofol infusion.MethodsThis was a prospective, observational study of total propofol delivered to 50 patients in a 14-bed metropolitan, Australian intensive care unit. Infusion pump data and entries from the EMR were collated.ResultsPropofol sedation was administered for a median 18 (interquartile range: 14–47) hours with median total propofol 3025 mg (interquartile range: 1840–7755 mg) by pump and 3250 mg (interquartile range: 1915–6960 mg) by EMR, i.e. 1.9 (interquartile range: 1.3–2.3) mg/kg/hour by pump (correlation coefficient = 0.99). The total bolus propofol documented in the EMR was a median 330 mg (interquartile range: −838 to −124) less than the pump amount. Nineteen (38%) patients had no EMR-documented propofol boluses yet had received at least one bolus via the pump. In two of 50 (4%) patients, the pump propofol infusion dose was above the recommended maximum safe dose of 4 mg/kg/h.ConclusionIn this cohort of patients, the bolus administration of propofol was frequently not documented, potentially placing some patients at risk of drug-related toxicity. Further research to develop and implement strategies to improve the documentation of propofol administration is indicated.     

18F-FDG PET对乳腺癌复发和转移的诊断价值

目的汇总分析^18F-脱氧葡萄糖（FDG）PET诊断乳腺癌复发和转移的文献，评价其诊断效能。方法检索1995年1月～2005年8月Medline、循证医学数据库（EBMR）、中国生物医学文献数据库光盘版（CBMdisc）中的中文和英文文献，对纳入文献进行质量评价，异质性检验，用统计分析软件计算综合受试者工作特征（SROC）曲线方程，绘制SROC曲线，得到灵敏度、特异性和综合优势比。结果14篇文献被纳入，进行SROC分析，综合灵敏度和特异性分别为88．6％和85．6％，综合优势比为60．3。结论^18F—FDG PET对乳腺癌复发和转移有诊断价值。     

True lies — photographic misinterpretation in plastic surgery

Consistent photographic technique pre and postoperatively is essential in plastic surgery. Poor and nonuniform technique can give misleading results or some tricks can be used on purpose to improve results. For a plastic surgeon it is important to know and recognize these tricks to objectively evaluate photographs. The most important factors for uniform photographic technique are: light, lens, distance, background, and patient's position. In the future 3D cameras connected to a personal computer will give more possibilities to objectively quantify results in plastic surgery.This paper was presented at the 7th euraps (innsbruck Australia 16.-19.5.96) and at the XXVI Scandinavian. Congress of Plastic Surgery (Stockholm, Sweden 13.16.6.96).