成都市社区老年人义齿修复情况调查

目的 调查老年人义齿修复及待修复情况，为社区医疗有关措施的提出提供依据。方法 对成都市武侯区三个居民点老年人的义齿修复需要、不良修复及待修复情况进行调查。结果 可摘局部义齿、总义齿及全冠修复率分别为39.39％、87．25％和58．06％，不良修复率高达40．91％；上颌活动义齿、下颌活动义齿及全冠的待修复率分别为60．39％、56．07％和5．10％。结论 该地区社区老年人牙缺失后修复率较低、在已修复者的义齿中亦有相当比例不合格。     

ERA附着体义齿修复后满意度的调查分析

目的 了解牙列缺损患者行太极扣(ERA)附着体义齿和卡环可摘局部义齿修复后的主观感觉和咀嚼功能.方法 选择肯氏Ⅰ类牙列缺损患者60例,30例制作ERA附着体义齿共35件,30例制作卡环可摘局部义齿共33件.戴牙后3个月通过问卷调查,了解患者戴用义齿后的适应情况、满意程度及咀嚼功能的变化等.结果 患者对ERA附着体义齿和卡环可摘局部义齿两种修复方式比较认为,在总的满意度、美观、舒适度、咀嚼功能、语言、适应期、食物结构改变等方面,前者明显优于后者(P<0.05).结论 ERA附着体义齿在美观及功能上不仅能满足患者的要求,而且远优于卡环可摘局部义齿.     

老年糖尿病患者义齿修复的临床探讨

多数老年人都患有不同程度的牙列缺损和缺失,选择烤瓷冠固定义齿修复、固定活动联合修复以及种植义齿的人越来越多,但由于价格、心理、生理等因素,活动义齿修复仍是主要方法。本文对90例老年糖尿病患者的义齿修复治疗情况进行总结分析,以尽量改善和提高修复效果。1临床资料1·1     

老年人重度He磨耗的修复治疗

目的：探讨老年人重度He磨耗的He重建修复。方法：对38例重度He磨耗的老年患者采用He垫式义齿或固定义齿修复治疗。在修复前和修复后3个月，1年、2年进行定期检查，测定咀嚼效能，进行对比分析。结果：该方法有效地恢复正中He关系及正常的咀嚼功能，改善美观，使用效果良好，结论：He垫式义齿和固定义齿是老年人重度He磨耗的有效修复治疗方法。     

用下颌阻生智齿固位修复牙槽嵴吸收的下颌牙列缺失

作者将病人口腔中的阻生及埋伏智齿按照基牙所需的形态要求进行处理,然后用作基牙,再行下颌总义齿的修复,使单纯由粘膜支持的下颌总义齿变为由粘膜与基牙共同支持,从而明显改善了义齿的固位,提高了修复效果。     

口腔知识宣教对老年义齿修复效果的影响

2001年10月-2004年1月，笔者对13例老年义齿修复患者行相关知识宣教，取得较好效果。现报告如下。     

老年患者总义齿磨光面外形制作的临床观察

老年患者总义齿修复效果不佳,一直是临床口腔修复工作的难点,也严重影响老年患者的生活质量.总义齿磨光面是指义齿与唇、颊和舌肌接触的部分.磨光面的外形是由不同的斜面构成.义齿磨光面与水平力量有关,其外形使口腔内舌与唇颊肌肉的力量处于平衡状态,才有利于义齿的稳定和固定[1].总义齿的设计和制作是一个复杂的过程,义齿磨光面的外形常常被忽视,技术员往往按常规将磨光面外形制作成凹面形[2].这种方法对大多数患者是适合的,但对于老年患者,牙槽骨与唇颊肌严重萎缩,这样的外形影响义齿的固定,并容易造成食物在义齿磨光面滞留,影响修复效果.我们根据老年患者个体的情况,采用对总义齿磨光面外形塑形,再由技术员制作义齿的方法,改善了老年患者总义齿的修复效果。     

中老年患者活动义齿修复后的问题及对策

目的探讨中老年患者牙列缺损、牙列缺失采用活动义齿修复后,口腔内余留牙的健康状况、义齿的卫生状况及使用当中的注意事项等。方法选取中老年患者70例,针对其不同症状,设计制作不同义齿,并配合专业指导性修复治疗,随访1-5 a。结果患者出现不同程度的基牙患龋残根、残冠,牙垢、牙结石、食物软垢,分别通过给予根管治疗、设计覆盖义齿,指导使用假牙快洁片、对义齿进行定期消毒、清洁后,义齿使用情况和口腔卫生状况均有提高。结论中老年患者义齿修复后要定期复查,加强义齿修复后的口腔自我保健及对患者家人、陪护的口腔卫生宣教,提高口腔保健意识。     

90例全口义齿患者对美观满意度调查

目的老年人戴用全口义齿的满意度调查。方法调查90例需要重新修复全口义齿的病例旧义齿使用情况,调查内容包括患者牙槽嵴情况、人工牙磨耗程度及义齿基托形态等,戴用全口义齿后面下1／3距离、颌位关系、面部丰满度、合平面、人工牙排列位置,患者重新义齿修复的原因及对旧义齿的满意度等。结果患者对旧义齿美观满意度为55．5％,咀嚼功能满意度为58．6％。重新修复原因分别为：义齿固位不良者86．7％,面部欠丰满者45．6％,咀嚼无力者38．9％,人工牙不满意者37．8％,黏膜疼痛者23．3％,义齿损坏者21．1％。患者主观评价旧义齿面下1／3距离短和面部欠丰满分别为67．7％和45．6％。旧义齿基托边缘过薄占57．8％,合平面偏高、偏低分别占23．3％、12．2％,人工牙排在牙槽嵴顶占96．7％,人工牙磨耗占90％。结论老年人全口义齿修复有美观的要求。成功的全口义齿应能最大程度地取代失去的组织,因此印模时应能正确复制前庭沟的宽度,人工牙应排列在唇、颊向内的力与舌向外的力保持平衡的原天然牙的位置。牙槽嵴条件丰满的患者尽量选用瓷牙或硬质树脂牙。     

纯钛支架义齿与钴铬合金支架义齿的咀嚼效率及临床修复效果

目的 比较纯钛支架义齿与钴铬合金支架义齿的咀嚼效率,评估其临床修复效果.方法 回顾性分析该院2005年1月至2009年1月口腔科收治入院的Kennedy I类牙列缺损患者200例临床资料,观察两种材料支架义齿试戴时就位是否顺利以及初戴2 w内调改情况,两种材料修复3个月、3个月～3年义齿性口炎发生情况;并对义齿的美观度、语音功能、咀嚼功能、固位功能、舒适度临床效果进行评估.采用光密度法分别于纯钛支架义齿和钴铬合金支架义齿修复后3个月、3个月～3年时测试其咀嚼效率.结果 纯钛支架义齿修复3个月、3个月～3年就位、初戴2 w调改均优于钴铬合金支架义齿修复(P＜0.05);纯钛支架义齿修复3个月、3个月～3年义齿性口炎发生明显少于钴铬合金支架义齿修复(P＜0.05);纯钛支架义齿修复3个月、3个月～3年咀嚼功能、固位功能、舒适度等满意度均优于钴铬合金支架义齿修复(P＜0.05);纯钛支架义齿的咀嚼效率在修复后3年时较钴铬合金支架义齿为高(P＜0.05).结论 纯钛支架义齿咀嚼效率的恢复优于钴铬合金支架义齿,可在临床推广.     

Effectiveness of seat belts in automobiles

Studies in other countries have demonstrated that properly worn seatbelts dramatically reduce the likelihood and seriousness of injuries in motor vehicle accidents. However, in the western region of Mexico, they are very rarely worn, due to the erroneous belief that its use does not protect, and may even harm its wearer. In order to ascertain its benefit or lack of it, we undertook a survey, comparing the degree of severity of lesions sustained, as well as the mortality, between a group of 15 patients who wore seatbelts and another of 35 patients who did not wear them; all patients were treated at the Emergency Room of the Hospital de Especialidades del Centro Médico de Occidente, after suffering car accidents. Among the first group, only one patient required hospitalization and there were no deaths. In the second group, all 35 patients had to be hospitalized, eight had sequelae and nine died. We conclude that seatbelts effectively protect the wearer against death and limit the severity of the injuries suffered during car accidents. We propose that educational campaigns to convince the public as to the benefits of its use should be carried out, and after a reasonable interval its use should be mandated by law.     

Correlates of attributing new disability to old age. Study of Osteoporotic Fractures Research Group

OBJECTIVES: To describe women who attribute new disability to old age and to identify demographic, medical, behavioral, and psychosocial characteristics that correlate with attributing new disability to old age. DESIGN: Prospective cohort study with 4-year follow-up. SETTING: Four geographic regions of the United States. PARTICIPANTS: 9704 women aged > or = 67 years participating in the Study of Osteoporotic Fractures. Of these, 657 who reported no disability at baseline but at follow-up reported difficulty carrying out 1 or more of 13 functional activities were eligible for our analysis. MEASUREMENTS: All women reporting difficulty in any functional activity at follow-up were asked "What is the main condition that causes you to have difficulty or prevents you from (doing the activity)?" and were shown a card listing 14 medical conditions as well as the option "old age," from which they could choose only one response. Women attributing difficulty or inability in 1 or more functional activities to old age were classified as attributing new disability to old age. We examined the relationship between attributing new disability to old age and the following characteristics measured at baseline: age, level of education, medical comorbidity, cognitive function, body mass index (BMI), gait speed, grip strength, visual acuity, physical activity level, smoking status, social network level, and depressed mood. RESULTS: Overall, 13.5% of women attributed new disability to old age. Age was a strong independent correlate of attributing new disability to old age: compared with women age 67 to 69, the odds of attributing new disability to old age for women age 70 to 79 was 3.6 times as large (95% confidence interval [CI] = 1.6-8.3), and for women age 80 or over was 5.5 times as large (95% CI = 2.1-14.7). The only other characteristic that remained an independent correlate of attributing new disability to old age was grip strength; for each decile decrease in grip strength, a woman's odds of attributing new disability to old age increased by 9% (odds ratio [OR] = 1.09, 95% CI = 1.01-1.19). CONCLUSIONS: Despite great advances in geriatric medicine, old age is still perceived as a causal agent in functional decline, especially among our oldest patients. Further study is needed to determine whether, how often, and under what circumstances older adults who attribute new disability to old age have medical conditions amenable to interventions that could preserve their functioning and improve their quality of life.     

External catheter use and urinary tract infections among incontinent male nursing home patients

In order to examine the relative frequency of urinary tract infection (UTI) and bacteriuria among male nursing home patients managed with and without external catheters (EC), we prospectively followed four cohorts of patients (EC worn continuously, N = 30; EC worn at night only, N = 19; incontinent without catheter, N = 13; and continent, N = 30) for a total of 497 patient months at risk. The proportion of patients with EC worn continuously who had at least one episode of bacteriuria (87%) and at least one UTI (40%), and the incidence of UTI (0.08 episodes per patient-month at risk) was significantly higher than among continent or incontinent patients without EC. Patients with EC at night only had an intermediate frequency of these findings. Differences in clinical and functional status characteristics among the four cohorts, in addition to the use of EC, could have contributed to the higher frequencies of bacteriuria and UTI. None of the clinical characteristics we examined were associated with the development of UTI among patients with EC. Further studies are necessary to identify factors associated with UTI among patients who are managed by EC so that effective preventive strategies can be developed and targeted to patients at high risk.     

Impact of the 1987 revised AIDS case definition in Denmark: a follow-up study 2 years after its adoption.

We present a follow-up study on Danish AIDS patients notified according to the latest revision of the AIDS case definition during the first 2 years after its adoption. A total of 271 adult AIDS cases were notified in the period of study (Jan. 1, 1988-Dec. 31, 1989). 60 patients (22%) met only the revised AIDS case definition and of these 17 patients (28%) developed diseases meeting the old AIDS case definition. Thus, AIDS reporting increased by 28% due to the change in case definition, the impact being 19% after adjusting for patients developing old case diseases. No time trend in the impact was found. We estimated the cumulative percent of cases meeting the new case definition who subsequently will develop diseases meeting the old definition as 15% after 6 months and 51% after 18 months. The revision produced a disproportionate increase in reporting of female cases (p less than 0.05), transfusion cases (p less than 0.01) and to a lesser extent of heterosexual cases, while the impact on reporting of homo/bisexual men showed a decrease (p less than 0.01). Cases notified with new case definition diseases were older than cases notified with old diseases. Among patients meeting only the new case definition, 25 died and 18 (30%) had not developed old case diseases before death. We found no difference in survival rates between patients within the 2 groups of case definition. Among patients meeting the new definition we found no differences in HIV antigenemia or CD4 cell count between those developing diseases meeting old case definition and those who did not.     

Critical care use during the course of serious illness

Despite its expense and importance, it is unknown how common critical care use is. We describe longitudinal patterns of critical care use among a nationally representative cohort of elderly patients monitored from the onset of common serious illnesses. A retrospective population-based cohort study of elderly patients in fee-for-service Medicare is used, with 1,108,060 Medicare beneficiaries at least 68 years of age and newly diagnosed with serious illnesses: 1 of 9 malignancies, stroke, congestive heart failure, hip fracture, or myocardial infarction. Medicare inpatient hospital claims from diagnosis until death (65.1%) or fixed-right censoring (more than 4 years) were reviewed. Distinct hospitalizations involving critical care use (intensive care unit or critical care unit) were counted and associated reimbursements were assessed; repeated use was defined as five or more such hospitalizations. Of the cohort, 54.9% used critical care at some time after diagnosis. Older patients were much less likely to ever use critical care (odds ratio, 0.31; comparing patients more than 90 years old with those 68-70 years old), even after adjustment. A total of 31,348 patients (2.8%) were repeated users of critical care; they accounted for 3.6 billion dollars in hospital charges and 1.4 billion dollars in Medicare reimbursement. We conclude that critical care use is common in serious chronic illness and is not associated solely with preterminal hospitalizations. Use is uneven, and a minority of patients who repeatedly use critical care account for disproportionate costs.     

Implantable cardioverter-defibrillator use in elderly patients receiving cardiac resynchronization: A meta-analysis

BackgroundImplantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy (CRT) reduce sudden cardiac death and all-cause mortality in patients with heart failure with reduced ejection fraction (HFrEF). Current guidelines do not suggest any upper age limit for ICD and CRT but recommend avoidance of ICD and CRT in frail patients with a life expectancy of less than 1 year. It remains unclear whether elderly patients undergoing CRT derive the same additional benefit from ICDs as younger patients. We aimed to assess the use of ICDs in elderly compared to younger patients receiving CRT.MethodsWe searched electronic databases, up to April 11, 2016, for all studies reporting on ICD use stratified by age in patients who received CRT. We used random-effects meta-analysis models to calculate the summarized baseline characteristics and rates of implantation of ICD among patients enrolled in the studies.ResultsWe retained six observational studies enrolling 613 patients ≥75 years old and 2810 patients <75 years old. The aggregate mean age was 82.7 years for the elderly patients compared to 66.3 years in the younger patients. There was a significantly lower use of ICDs in elderly patients compared to that in younger patients (37.9% versus 64.3%) (odds ratio: 0.26; 95% confidence intervals: 0.14-0.46; p < 0.0001).ConclusionsIn conclusion, ICD was less frequently used in patients ≥75 years old receiving CRT compared to younger patients receiving CRT. Future studies that evaluate the efficacy and effectiveness of ICDs in elderly patients with indications for CRT are needed to guide management of this increasing population.     

Footwear and Hip Fracture‐related Fails in Older People

Objective : To describe features of footwear worn at the time of hip fracture‐related falls. Method : Subjects were 107 persons (mean age 77 years) admitted with a hip fracture‐related fall to a hospital in the Illawarra region of New South Wales, Australia, between February 1995 and February 1996. All subjects resided in private homes or hostels at the time of their fall. An interviewer‐administered questionnaire was used to collect data from participants on foot problems, falls history, and age and use of footwear worn at the time of hip fracture. A standardised approach was used to physically examine features of footwear worn at the time of fracture. Results : Most subjects wore slippers (33 %} or were not wearing any footwear (24%) when they fell and fractured their hip. Among the 79 subjects in footwear, most (70%) fell in footwear they wore every day and 43% of their footwear was less then six moths old. Participants chose to wear their footwear for comfort, not safety. Conclusion : Enthusiasm for developing a ‘;safe shoe’ should be tempered somewhat by the fact that many people who suffer a hip fracture are not wearing shoes at the time they fall.     

Guidance for the prevention and treatment of the post-thrombotic syndrome

The post-thrombotic syndrome (PTS) is a frequent, potentially disabling complication of deep vein thrombosis (DVT) that reduces quality of life and is costly. Clinical manifestations include symptoms and signs such as leg pain and heaviness, edema, redness, telangiectasia, new varicose veins, hyperpigmentation, skin thickening and in severe cases, leg ulcers. The best way to prevent PTS is to prevent DVT with pharmacologic or mechanical thromboprophylaxis used in high risk patients and settings. In patients whose DVT is treated with a vitamin K antagonist, subtherapeutic INRs should be avoided. We do not suggest routine use of elastic compression stockings (ECS) after DVT to prevent PTS, but in patients with acute DVT-related leg swelling that is bothersome, a trial of ECS is reasonable. We suggest that selecting patients for catheter-directed thrombolytic techniques be done on a case-by-case basis, with a focus on patients with extensive thrombosis, recent symptoms onset, and low bleeding risk, who are seen at experienced hospital centers. For patients with established PTS, we suggest prescribing 20–30 mm Hg knee-length ECS to be worn daily. If ineffective, a stronger pressure stocking can be tried. We suggest that intermittent compression devices or pneumatic compression sleeve units be tried in patients with moderate-to-severe PTS whose symptoms are inadequately controlled with ECS alone. We suggest that a supervised exercise training program for 6 months or more is reasonable for PTS patients who can tolerate it. We suggest that management of post-thrombotic ulcers should involve a multidisciplinary approach. We briefly discuss upper extremity PTS and PTS in children.     

Reversal of target-specific oral anticoagulants

The target-specific oral anticoagulants represent the first new oral anti-thrombotic therapy in over 50 years and have the potential to make therapy easier and hence more accessible to many patients. Like any new therapy, the potential benefits must be weighed against the potential challenges and one of the most concerning aspects of the new target-specific oral anticoagulants is the lack of a proven method to reverse their effect. Unlike the vitamin K antagonist, i.e. warfarin, there is no specific antidote for these medications. This paper will review the limited data on the use of non-specific therapies to reverse anticoagulation for the new agents. We hope to prepare clinicians who are faced with a patient who has serious bleeding or needs emergent surgery while taking dabigatran, rivaroxaban or apixaban.     

Results of a survey of community-acquired-pneumonia and evaluation of old and new Japanese Respiratory Society guidelines]

We evaluated the usefulness of domestic and foreign guidelines for the diagnosis and treatment of patients with community-acquired-pneumonia at 23 institutions in 6 prefectures of the Tohoku Area, from December 2003 to November 2004. Based on the old and new Japanese Respiratory Society (JRS) guidelines, we evaluated severity, clinical efficacy and detection of atypical pneumonia. As for severity, the old guidelines led to the diagnosis of an excessive number of 'severe' cases. On the other hand, patients were appropriately diagnosed as having mild, moderate, severe, or very severe disease based on the new JRS guidelines (2005). The severity classification often correlated with the Pneumonia Severity Index (PSI) of the IDSA guidelines. The efficacy rate for patients who were prescribed the recommended drug according to the old JRS guidelines was 85.7% and for those who did not use the recommended drug it was 68.7% (p < 0.001).