老年病房三年铜绿假单胞菌的感染分布及耐药性变迁

目的了解2008-2010年老年病房患者感染铜绿假单胞菌耐药性变迁,为临床合理使用抗菌药物提供依据。方法采用法国生物梅里埃公司的VPI微生物自动鉴定系统,对2008-2010年老年病房住院患者的各类临床标本进行细菌分离、鉴定,药敏试验采用纸片扩散法检测头孢他啶等15种抗生素敏感性,并对药敏结果进行分析。结果 2008-2010年老年病房患者感染铜绿假单胞菌分离率分别为10.46%、15.07%、18.92%,3年均以老年呼吸内科检出率最高,标本分布以痰液为主,该菌在三年中对常用药物耐药率呈明显上升趋势。但铜绿假单胞菌对抗菌药物的耐药率小于30%的药物有亚胺培南、多粘菌素、阿米卡星。结论重视铜绿假单胞菌耐药性变迁的抗菌药物压力和减少该菌感染的危险因素,是有效防止该菌耐药性增高和耐亚胺培南铜绿假单胞菌产生的关键。     

Colorectal surgery in octogenarian patients—outcomes and predictors of morbidity

Introduction  Surgery for elderly patients pose a constant challenge. This study aims to review the outcome and find predictors of adverse outcome in octogenarians undergoing major colorectal resection for cancer. Methods  A review of 121 octogenarians who underwent colorectal cancer surgery between September 1992 and May 2008 was performed. Comorbidities were quantified using the weighted Charlson Comorbidity Index and ASA classification. CR-POSSUM scores and ACPGBI scores and the predicted mortality rates were calculated. Outcome measures were morbidity rates and 30-day mortality rates. Results  The patients had a mean age of 83.5 years (range, 80–99). The mean index of comorbidity was 3.1 (2–7) and 12.5% of patients were classified ASA III and above. The mean predicted mortality rate based on CR-POSSUM and ACPGBI scoring models were 11.2% and 5.4% respectively. The overall observed morbidity rate was 30.7% and 30-day mortality was 1.6. Factors found on bivariate analysis to be significantly associated with an increased risk of morbidity were tumor presenting with complication, comorbid coronary heart disease, serum urea levels, ASA classification ≥3 and comorbidity index 3 of 5 ≥ 5. Multivariate analysis revealed the latter two factors to be independent predictors of morbidity. Conclusion  Octogenarians undergoing major colorectal resection have an acceptable perioperative morbidity and mortality rate and survival rate and should not be denied surgery based on age alone. Comorbidity index scores and ASA scores are useful tools to identify poor risk patients.     

Assessment and management of hearing loss in older people in Belgium,Portugal and Turkey

Hearing loss, usually due to presbycusis, is frequent in old age and goes often undetected or untreated. Older subjects with hearing loss have increasing communication problems, reduced quality of life, isolation, depression and also feelings of frustration and discouragement. Hearing loss is also linked to cardiovascular problems, depression and dementia. Despite its relevance, country-level epidemiological data on age-related incidence and prevalence of presbycusis are limited, and no specific data in different geriatric settings are usually available. Population screening programs similar to those in infants are not widely implanted, although both primary care providers and geriatricians have incorporated strategies to detect hearing loss. No guidelines are available on when and how to screen and manage hearing loss in old age. Management of presbycusis is usually directed by ENT specialists, in cooperation with audiologist. These may be hospital-based or work in for profit centres, depending on the country. Funding of hearing aids by health care providers is limited, so some patients do not have access to them due to their high cost. Attitudes towards hearing loss, including considering it an inevitable age-related problem, may also limit access to care. Cochlear implants are still anecdotal in older patients in most countries. There is still a long way to go in the detection and management of hearing loss in older people. Systematic screening, careful assessment and treatment guidelines will have to be developed and implemented, both at country and European level.     

Hormonal changes and their impact on cognition and mental health of ageing men

Demographic changes resulting in ageing of the world's population have major implications for health. As men grow older, circulating levels of the principal androgen or male sex hormone testosterone (T) decline, while the prevalence of ill-health increases. Observational studies in middle-aged and older men have shown associations between lower levels of T and poorer mental health in older men, including worse cognitive performance, dementia and presence of depressive symptoms. The role of T metabolites, the more potent androgen dihydrotestosterone (DHT) and the oestrogen receptor ligand estradiol (E2) in the pathophysiology of cognitive decline are unclear. Studies of men undergoing androgen deprivation therapy in the setting of prostate cancer have shown subtle detrimental effects of reduced T levels on cognitive performance. Randomised trials of T supplementation in older men have been limited in size and produced variable results, with some studies showing improvement in specific tests of cognitive function. Interventional data from trials of T therapy in men with dementia are limited. Lower levels of T have also been associated with depressive symptoms in older men. Some studies have reported an effect of T therapy to improve mood and depressive symptoms in men with low or low-normal T levels. T supplementation should be considered in men with a diagnosis of androgen deficiency. Beyond this clinical indication, further research is needed to establish the benefits of T supplementation in older men at risk of deteriorating cognition and mental health.     

External validation of the clinical indications of computed tomography (CT) of the head in patients with low-energy geriatric hip fractures

IntroductionOn evaluation of the clinical indications of computed tomography (CT) scan of head in the patients with low-energy geriatric hip fractures, Maniar et al. identified physical evidence of head injury, new onset confusion, and Glasgow Coma Scale (GCS) < 15 as predictive risk factors for acute findings on CT scan. The goal of the present study was to validate these three criteria as predictive risk factors for a larger population in a wider geographical distribution.Patients and methodsPatients ≥65 years of age with low-energy hip fractures from 6 trauma centers in a wide geographical distribution in the United States were included in this study. In addition to the relevant patient demographic findings, the above mentioned three criteria and acute findings on head CT scan were gathered as categorical variables.ResultsIn total 799 patients from 6 centers were included in the study. There were 67 patients (8.3%) with positive acute findings on head CT scan. All of these patients (100%) had at least one criteria positive. There were 732 patients who had negative acute findings on head CT scan with 376 patients (51%) having at least one criteria positive and 356 patients (49%) having no criteria positive. Sensitivity of 100% and negative predictive value of 100% was observed to predict negative acute findings on head CT scan when all the three criteria were negative.ConclusionWith the observed 100% sensitivity and 100% negative predictive value, physical evidence of acute head injury, acute retrograde amnesia, and GCS < 15 can be recommended as a clinical decision guide for the selective use of head CT scans in geriatric patients with low energy hip fractures. All the patients with positive acute head CT findings can be predicted in the presence of at least one positive criterion. In addition, if these criteria are used as a pre-requisite to order the head CT, around 50% of the unnecessary head CT scans can be avoided.     

伊贝沙坦对老年高血压病人左心室质量及血压变异性的影响

目的观察伊贝沙坦对老年高血压患者血压变异性和左心室质量的影响。方法选择87例轻、中型老年高血压患者,服用伊贝沙坦3个月,比较治疗前、后24h收缩压、舒张压、左心室质量的变化。结果服药3个月后24h及日间收缩压变异性、舒张压变异性、夜间收缩压变异性、24h及日间平均压变异性明显降低(P<0.05);24h收缩压和舒张压及左心室质量均较治疗前下降(P<0.05)。结论伊贝沙坦是一种疗效好并能平稳、持续安全降压且尤为适合老年高血压患者的药物。     

肠内营养支持老年脑血管意外病人的护理观察

目的观察老年脑血管意外患者施行肠内营养支持的效果及护理。方法将48例老年脑血管意外需要行肠内营养支持的患者随机分为实验组和对照组各24例。实验组给予较为完善的营养设计和护理(包括营养液的选择和配制、无菌技术的操作、输注的温度、速度及供给方式等),对照组则常规方式治疗。比较两组的营养状况指标、胃肠道情况和并发症的发生情况。结果实验组的清蛋白、氮平衡与对照组比有显著性差异(P<0.05),实验组的胃肠道反应较对照组减少,对照组的并发症与实验组比较有显著性差异(P<0.05)。结论肠内营养是一种方便、安全、有效的临床营养支持方法;对肠道粘膜屏障具有明显的保护作用。较为系统的、合理的营养设计和护理,可以使患者得到合理的营养支持,减少胃肠道的反应和并发症的发生。     

上海市53所老年护理医院出院患者疾病构成的帕累托图分析

目的了解上海市老年人主要病种、多发病种，探讨老年护理医院疾病监控重点。方法运用帕累托图分析2004-2006年上海市53所老年护理医院出院患者疾病构成情况。结果心血管疾病、脑卒中后遗症、慢性支气管炎、脑血管疾病、肿瘤、糖尿病和老年痴呆症的累计构成占老年护理医院出院病例疾病构成的90％以上。结论上海市老年护理院出院病例疾病病种相对比较集中，特别是心脑血管疾病、脑卒中后遗症和慢性支气管炎等应作为老年护理医院工作的重点。