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Predicting Discharge to Institutional Long‐Term Care After Stroke: A Systematic Review and Metaanalysis 下载免费PDF全文
Jennifer K. Burton MBChB Eilidh E. C. Ferguson MBChB Amanda J. Barugh PhD Katherine E. Walesby MBBS Alasdair M. J. MacLullich PhD Susan D. Shenkin MD Terry J. Quinn MD 《Journal of the American Geriatrics Society》2018,66(1):161-169
Background/Objectives
Stroke is a leading cause of disability worldwide, and a significant proportion of stroke survivors require long‐term institutional care. Understanding who cannot be discharged home is important for health and social care planning. Our aim was to establish predictive factors for discharge to institutional care after hospitalization for stroke.Design
We registered and conducted a systematic review and meta‐analysis (PROSPERO: CRD42015023497) of observational studies. We searched MEDLINE, EMBASE, and CINAHL Plus to February 2017. Quantitative synthesis was performed where data allowed.Setting
Acute and rehabilitation hospitals.Participants
Adults hospitalized for stroke who were newly admitted directly to long‐term institutional care at the time of hospital discharge.Measurements
Factors associated with new institutionalization.Results
From 10,420 records, we included 18 studies (n = 32,139 participants). The studies were heterogeneous and conducted in Europe, North America, and East Asia. Eight studies were at high risk of selection bias. The proportion of those surviving to discharge who were newly discharged to long‐term care varied from 7% to 39% (median 17%, interquartile range 12%), and the model of care received in the long‐term care setting was not defined. Older age and greater stroke severity had a consistently positive association with the need for long‐term care admission. Individuals who had a severe stroke were 26 times as likely to be admitted to long‐term care than those who had a minor stroke. Individuals aged 65 and older had a risk of stroke that was three times as great as that of younger individuals. Potentially modifiable factors were rarely examined.Conclusion
Age and stroke severity are important predictors of institutional long‐term care admission directly from the hospital after an acute stroke. Potentially modifiable factors should be the target of future research. Stroke outcome studies should report discharge destination, defining the model of care provided in the long‐term care setting. 相似文献3.
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New Institutionalization in Long‐Term Care After Hospital Discharge to Skilled Nursing Facility 下载免费PDF全文
Addie Middleton PhD DPT Shuang Li PhD Yong‐Fang Kuo PhD Kenneth J. Ottenbacher PhD OTR James S. Goodwin MD 《Journal of the American Geriatrics Society》2018,66(1):56-63
Background/Objectives
Approximately half of individuals newly admitted to long‐term care (LTC) nursing homes (NHs) experienced a prior hospitalization followed by discharge to a skilled nursing facility (SNF). The objective was to examine characteristics associated with new institutionalizations of older adults on this care trajectory.Design
Retrospective cohort study.Setting
SNFs and LTC NHs.Patients
Medicare fee‐for‐service beneficiaries admitted to 7,442 SNFs in 2013 (N = 597,986).Measurements
We used demographic and clinical characteristics from Medicare data and the Minimum Data Set. We defined “new institutionalization” as LTC NH residence for longer than 90 non‐SNF days, starting within 6 months of hospital discharge.Results
For individuals who survived 6 months after hospital discharge, the overall rate of new LTC institutionalizations was 10.0% (N = 59,736). Older age, white race, being unmarried, Medicaid eligibility, higher income, more comorbidities, cognitive impairment, depression, functional limitations, hallucinations and delusions, aggressive behavior, incontinence, and pressure ulcers were associated with higher adjusted odds of new LTC institutionalization. In analyses stratified according to race and ethnicity, higher income was associated with lower odds of LTC institutionalization for whites (odds ratio (OR) = 0.92, 95% confidence interval (CI) = 0.89–0.96) and greater odds for blacks (OR = 1.40, 95% CI = 1.27–1.55) and Hispanics (OR = 1.44, 95% CI = 1.25–1.66). Moderate or severe depression, functional limitations, hallucinations and delusions, aggressive behavior, and being unmarried were stronger risk factors for LTC for cognitively intact individuals than for those with moderate to severe cognitive impairment. Being unmarried and having more comorbidities were stronger predictors in those aged 66 to 70 than in those aged 81 to 85 and 91 and older.Conclusion
Associations between risk factors and new LTC institutionalizations varied according to race and ethnicity, age, and level of cognitive function. Programs that target older adults at greater risk may be an effective strategy for reducing new institutionalizations and fostering aging in place. 相似文献6.
Low On‐Treatment Platelet Reactivity Predicts Long‐Term Risk of Bleeding After Elective PCI 下载免费PDF全文
Mirko D. Čolić M.D. B.Sc. Branko M. Čalija M.D. Bratislav M. Milosavljević M.D. Aleksandra G. Grdinić M.D. Lazar G. Angelkov M.D. Ph.D. Dragan Ž. Sagić M.D. Ph.D. Peter Kruzliak M.D. Ph.D. Jelena M. Marinković M.D. Ph.D. Rade M. Babić M.D. Ph.D. FSCAI Igor B. Mrdović M.D. Ph.D. 《Journal of interventional cardiology》2015,28(6):531-543
Background
Bleeding after percutaneous coronary interventions (PCI) is an important complication with impact on prognosis.Aim
To evaluate the predictive value of enhanced platelet responsiveness to dual antiplatelet therapy with aspirin and clopidogrel, for bleeding, after elective PCI.Methods and Results
We performed multiple electrode aggregometry (MAE) platelet functional tests induced by arachidonic acid (ASPI) and adenosine‐diphosphate (ADP) before PCI, and 24 hours after PCI, in 481 elective PCI patients who were followed‐up for an average of 15.34 ± 7.19 months. Primary end point was the occurrence of any bleeding, while ischemic major adverse cardiovascular event (MACE) was a secondary endpoint. The incidence of total, BARC ≤ 2, and BARC ≥ 3 bleeding, according to BARC classification, was 19, 18, and 1%, respectively. Groups with any, and BARC ≤ 2 bleeding, had a lower average value of MAE ADP test after 24 hours, compared to the group without bleeding: 45.30 ± 18.63 U versus 50.99 ± 19.01 U; P = 0.005; and 45.75 ± 18.96 U versus 50.99 ± 18.99 U; P = 0.01; respectively. Female gender (HR 2.11; CI 1.37–3.25; P = 0.001), previous myocardial infarction (HR 0.56; CI 0.37–0.85; P = 0.006), lower body mass (HR 0.78; CI 0.62–0.98; P = 0.03), and MAE ADP test after 24 hours (HR 0.75; CI 0.61–0.93; P = 0.009) were the independent predictors for any bleeding by Cox univariate analysis. After adjustment, MAE ADP test after 24 hours, was the only independent predictor for any (HR 0.7; CI 0.56–0.87; P = 0.002), and BARC ≤ 2 (HR 0.71; CI 0.56–0.89; P = 0.003) bleeding, by Cox multivariate analysis.Conclusion
MAE ADP test before and after PCI, was associated with any, and BARC ≤ 2 bleeding after elective PCI.7.
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Panita Limpawattana Nipaporn Intarasattakul Jarin Chindaprasirt Somsak Tiamkao 《Clinical gerontologist》2013,36(1):19-31
Perception of caregiver burden among stroke survivors varies based on socioeconomic and cultural backgrounds. The objectives of this study were to identify the burdens among Thai caregivers of older stroke survivors, characteristics of caregivers and severity of caregiver burden. Caregivers of older stroke survivors were randomly interviewed (March–June, 2012). Information on baseline characteristics and caregiver burden using Zarit Burden Inventory (ZBI) was collected. One hundred one participants were assessed. The mean ZBI was 21.6 ± 14.5 [95% CI, 18.7–24.8]. More than half of caregivers reported no burden (54.5%). High burdens were associated with low self-reported income, high numbers of basic activities of daily living needed and coexisting musculoskeletal conditions. The observed low degree of burden might be the result of the sociocultural view of the study participants. 相似文献
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Prognostic Effect of Changes in Physical Function Over Prior Year on Subsequent Mortality and Long‐Term Nursing Home Admission 下载免费PDF全文
Thomas M. Gill MD Ling Han MD PhD Evelyne A. Gahbauer MD MPH Linda Leo‐Summers MPH Heather G. Allore PhD 《Journal of the American Geriatrics Society》2018,66(8):1587-1591
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Immunoadsorption as a Long‐Term Therapy in Recurrent Focal Segmental Glomerulosclerosis After Renal Transplantation 下载免费PDF全文
Silvius Frimmel Steffen R. Mitzner Sebastian Koball 《Therapeutic apheresis and dialysis : official peer-reviewed journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy》2017,21(1):108-109
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Slow Gait Speed and Risk of Long‐Term Nursing Home Residence in Older Women,Adjusting for Competing Risk of Mortality: Results from the Study of Osteoporotic Fractures 下载免费PDF全文
Jennifer G. Lyons MPH Kristine E. Ensrud MD MPH John T. Schousboe MD PhD Charles E. McCulloch PhD Brent C. Taylor PhD Timothy C. Heeren PhD Sherri O. Stuver ScD Lisa Fredman PhD 《Journal of the American Geriatrics Society》2016,64(12):2522-2527
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Pamala A. Pawloski PharmD Ann M. Geiger PhD MPH Reina Haque PhD MPH Aruna Kamineni PhD MPH Hassan Fouayzi MS Jessica Ogarek MS Hans V. Petersen MS Jaclyn L. F. Bosco PhD MPH Soe Soe Thwin PhD MS Rebecca A. Silliman MD PhD Terry S. Field DSc 《Journal of the American Geriatrics Society》2013,61(6):888-895
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The objectives of the study were to compare different aspects of social support between caregiving partners of men with AIDS and partners of healthy men and to examine the association of social support with positive and negative mood. Data were collected in a longitudinal study of 244 gay male caregivers and 61 comparison gay male noncaregivers. Measures included perceived positive support; social conflict; sought support; amount, types, and sources of received support; relationships with family; and positive and negative mood. Cross-sectional analyses and changes between baseline and 2 years were examined. No significant differences were found between the caregivers and noncaregivers in most aspects of social support. Regression analyses showed (a) caregiver status was associated with positive and negative mood (caregivers reported lower positive mood and higher negative mood) at baseline, but not at 2 years; (b) perceived support was the only variable significantly associated with positive mood at baseline and at 2 years; and (c) social conflict (at both times) and perceived support, amount of received support, and having a family confidant (at one of the time periods) were associated with negative mood. The findings support the importance of distinguishing between perceptual and behavioral aspects of social support and their relation to both positive and negative mood. 相似文献