Characteristics of centenarians admitted to a community teaching hospital

BACKGROUND: The "oldest old" are the most rapidly growing segment of society, and clinicians will increasingly encounter this age group in this century. METHODS: To describe the characteristics of a special subgroup of the oldest old, the centenarians, we conducted a retrospective case series analysis of all patients 100 years of age and above admitted to a large community teaching hospital. RESULTS: Thirty-nine patients with a mean age of 101.3 years were admitted a total of 57 times during the 5-year study period. The main reasons for admission were hip fracture, stroke, and urinary tract infection. Patients admitted from nursing facilities were taking more medications than community dwelling patients, and patients who were confused on admission were more likely to be readmitted. Only 2 patients died. CONCLUSIONS: Polypharmacy is common in centenarians, especially in institutionalized patients, and confusion may be a useful predictor of subsequent readmission. In-hospital mortality, however, is low in this population.     

Radiographic features in 1016 adults admitted to hospital with acute asthma.

A retrospective review was carried out of the radiographic features of 1016 adults admitted to hospital with acute asthma over a 4-year time period. The radiographic features were classified into five groups: (I) normal, 536 patients (52.9%); (II) features compatible with obstructive lung disease, 323 patients (31.8%); (III) complications of asthma including infection, segmental or greater atelectasis, one case of pneumomediastinum and one case of pneumothorax, 83 patients (8.2%); (IV) unimportant incidental findings, six cases (0.6%); and (V) important incidental findings including tuberulosis, heart failure, and bronchial neoplasm, 68 cases (6.7%). We conclude that in this large series of patients presenting with asthma symptoms severe enough to merit admission there is an incidence of clinically significant radiographic abnormalities of approximately 15%. Admission chest radiography is therefore indicated in adults who are hospitalized with acute asthma.     

Drug misuse among patients admitted to a general hospital

Aims In this paper we report the prevalence of prescribed drugs of misuse and illicit drugs used by patients admitted to a general hospital and the level of detection of drug problems by general medical staff.

Design This is a prospective questionnaire survey, interview and case note review.

Setting This study is a snapshot of one week's admission to a general hospital.

Findings Of the 408 people approached, 285 (70%) participated in the study. One hundred and sixty‐six people (62%) reported misuse of drugs at some time in their lives. Of these, 46 (17%) reported use of illegal drugs at some time in their lives, 22 (8%) in the past year, and 7 (2.6%) in the previous month. The most frequently reported drug type used ever, in the past year, and in the previous month, was over‐the‐counter medication and sedatives. All nine dependent patients identified by the interview were polydrug users and were significantly younger. Two of these patients were assessed for substance misuse by the medical staff.

Conclusion This study suggests that younger patients should be asked about their drug use, especially their use of more readily available drugs. At present, few questions are being asked by health professionals, leaving drug misuse to continue to drain both healthcare and society's resources.     

Pathway for patients admitted with gastroenteritis to a military hospital

As part of the Clinical Effectiveness Programme, a care pathway was developed for use within the isolation facility in a military hospital in Iraq. The development of the care pathway was necessary to provide direction and to standardize the care provided. A care pathway using a structured and planned approach was developed, critically appraised and amended to ensure evidence-based and patient-focused care. This article provides an amended methodology for the development of further pathways suitable for use within military nursing based on the standard pathway produced by De Lue (2002). The production of the pathway and supporting guideline will ensure standardized care for patients admitted with gastroenteritis.     

Administration of blood transfusions to adults in general hospital settings: a review of the literature

The Serious Hazards of Transfusion (SHOT) haemovigilance scheme for the United Kingdom and Republic of Ireland has clearly indicated that there are avoidable risks to which recipients of blood transfusion are exposed. Sometimes errors in practice have led to serious and even fatal consequences, particularly when a haemolytic response occurs due to an incompatible transfusion. Despite the risks, blood transfusion is an important and frequently life-saving therapy and its use in clinical practice is common. This paper discusses recently published national guidelines for the care of recipients of blood transfusion in the light of a review of the literature relevant to the administration of blood transfusions to adults in general hospital settings. Recommendations for practitioners, managers and teachers are offered in relation to preventing errors and to patient care associated with blood transfusion in the context of contemporary emphasis upon evidence based care.     

Group B streptococcal bacteremia in nonpregnant adults at a community teaching hospital.

BACKGROUND: Group B streptococcal bacteremia in nonpregnant adults continues to be a significant infection. METHODS: We reviewed medical records of nonpregnant adult patients with group B streptococcal bacteremia from 1995 to 1999 and compared the findings with data from a similar study in our institution between 1980 and 1984. RESULTS: There were 36 episodes of group B streptococcal bacteremia. The mean age was 70 years. Most of the cases (94%) were community-acquired. The most common underlying disease was diabetes mellitus (49%). The most common sources of group B streptococcal bacteremia were pneumonia and soft tissue infections. The overall mortality rate was 16.7%. CONCLUSIONS: Group B streptococcal bacteremia is still found mainly in the elderly, with significant underlying disease, particularly diabetes mellitus. The spectrum of infection has included lymphadenitis, ascending cholangitis, mastitis, prostatitis, and toxic shock syndrome. The mortality has decreased significantly during the past 15 years (16.7% vs 67.9%).     

杭州市健康人群血液流变学及血脂测定结果分析

目的 了解血流变学及血脂结果 在健康人群中的关系.方法 547例健康体检者男322例,女225例,女性平均年龄为(45.96±11.51岁),男性平均年龄为(44.27±11.35)岁,并按年龄段分为五组;分别用全自动血流变仪测定血液流变学指标及全自动血生化仪测定总胆固醇(TC)、甘油三酯(TG)、高密度胆固醇(HDL)、低密度胆固醇(LDL)、载脂蛋白Al(APOA)、载脂蛋白B(APOB)指标.结果 男性组与女性组血流变指标LBV、MBV、HBV、HBVI、LBVI、CV比较,差异均有统计学意义(t=3.20～11.73,P均＜0.05),男性组与女性组血脂指标除总胆固醇外,TC、TG、HDL、LDL、APOA1、APOB差异均有统计学意义(t=2.34～11.12,P均＜0.05).年龄段在4l～50岁的男性血液流变学与血脂结果 比较,差异均有统计学意义(r=-0.33～0.25,P均＜0.05).结论 322例男性体检41岁以上组血液流变学与血脂检测结果 呈显著相关性,对此类人群应在健康体检中引起重视.     

Low blood glutathione levels in healthy aging adults.

The objective of this investigation was to test the hypothesis that blood glutathione levels are lower in aging human subjects as previously found in blood and tissues of standard rodent models of aging. Thus a study was conducted with 39 men and 130 women, 20 to 94 years old, who were selected by the criteria of being ambulatory, healthy, and free from diabetes mellitus, thyroid disease, anemias, and cancer. The reference group was comprised of the 20- to 39-year-old subjects, whose blood glutathione levels were 547 +/- 53.5 micrograms/10(10) erythrocytes (mean +/- SD) for 40 individuals and defined the reference range (95% confidence limits) of 440 to 654. Based on the 440 micrograms/10(10) erythrocyte cutoff, the incidence of low blood glutathione content in the older subjects increased significantly, particularly in the 60- to 79-year-old group. Their glutathione levels were 452 +/- 86.8 micrograms/10(10) erythrocytes, 17% lower than the reference group (p < 0.001). These findings demonstrate an increased incidence of low glutathione levels in apparently healthy elderly subjects, who thus may be at risk because of a decreased capacity to maintain many metabolic and detoxification reactions mediated by glutathione.     

Length of stay and hospital costs among patients admitted to hospital by family physicians

Objective

To compare length of stay and total hospital costs among patients admitted to hospital under the care of family physicians who were their usual health care providers in the community (group A) and patients admitted to the same inpatient service under the care of family physicians who were not their usual health care providers (group B).

Design

Retrospective observational study.

Setting

A large urban hospital in Vancouver, BC.

Participants

All adult admissions to the family practice inpatient service between April 1, 2006, and June 30, 2008.

Main outcome measures

Ratio of length of stay to expected length of stay and total hospital costs per resource intensity weight unit. Multivariate linear regression was performed to determine the effect of admitting group (group A vs group B) on the natural logarithm transformations of the outcomes.

Results

The median acute length of stay was 8.0 days (interquartile range [IQR] 4.0 to 13.0 days) for group A admissions and 8.0 days (IQR 4.0 to 15.0 days) for group B admissions. The median (IQR) total hospital costs were $6498 ($4035 to $11 313) for group A admissions and $6798 ($4040 to $12 713) for group B admissions. After adjustment for patient characteristics, patients admitted to hospital under the care of their own family physicians did not significantly differ in terms of acute length of stay to expected length of stay ratio (percent change 0.6%, P = .942) or total hospital costs per resource intensity weight unit (percent change −2.0%, P = .722) compared with patients admitted under the care of other family physicians.

Conclusion

These findings suggest that having networks of family physicians involved in hospital care for patients is not less efficient than having family physicians provide care for their own patients.     

The reactions of 40 patients unexpectedly admitted to hospital

• ? Forty patients (21 men and 19 women) unexpectedly informed that they were to be admitted to hospital were interviewed about their reactions from the time they knew of the imminent admission up until the admission itself. The interviews were carried out shortly after admission to a medical ward.
• ? Patients' reactions were numerous and diverse. The most common reaction was relief at being admitted. Other reactions were related to anticipating the hospital experience, feelings about their predicament, and concern about life beyond their stay in hospital.
• ? Men and women expressed a similar number of reactions, but those who had previously been in hospital expressed fewer reactions than those who had not.
• ? The findings are discussed and the implications for practice are considered.

     

Outcomes of patients admitted to a chronic ventilator-dependent unit in an acute-care hospital.

The outcomes in 61 patients admitted to a chronic ventilator-dependent unit (CVDU) at Saint Marys Hospital in Rochester, Minnesota, during an 18-month period are summarized. This unit was designed for patients who could not be weaned from mechanical ventilators after repeated attempts. Most patients had been ventilator dependent for more than 21 days, but some patients were admitted to the CVDU after briefer periods if special circumstances suggested that weaning from mechanical ventilation would be difficult. The unit was organized to provide a multidisciplinary approach to the general medical and respiratory management of these patients, including a physiologic evaluation of the respiratory system to determine the actual cause of ventilator dependence and complete medical, nursing, and psychosocial assessments to help adopt a plan of care and weaning from the ventilator. Of the numerous causes for ventilator dependence in this study group, chronic obstructive pulmonary disease was the most frequent underlying diagnosis. Of the 61 patients admitted to the CVDU, 58 survived, and 53 were liberated from the mechanical ventilator. Ultimately, 35 patients were dismissed directly home from the CVDU. Five of these patients required nocturnal mechanical ventilation. An additional eight patients were dismissed home after rehabilitation. After being weaned from mechanical ventilation, 11 patients were eventually transferred to nursing homes, and 3 additional patients were transferred to a local hospital or physical medicine unit. One patient remains in the CVDU. Thus, the CVDU has successfully liberated patients from ventilator dependence. In addition, because of a decreased need for nursing care, the unit has been cost-effective.     

Prevalence and treatment of pain in adults admitted to Italian hospitals.

BACKGROUND: Very few studies have been conducted on the presence and control of pain in Italian hospitals. AIMS: The present study estimates pain prevalence and therapy in Italian hospitalised patients. METHODS: In the autumn of 2000, a survey was taken on 4523 inpatients throughout Italy. All eligible patients were given a questionnaire with two Numerical Rating Scales (NRS) concerning their pain intensity at interview and over the previous 24 h. Nurses were given a second questionnaire asking for information on analgesic treatment and another NRS about the pain they supposed the patient felt. RESULTS: At interview, 91.2% (95%CI: 90.3-92.1%) of the patients reported pain; 46.6% reported severe pain. The prevalence of severe pain was significantly lower in women and was double in general medicine wards compared to surgical wards. The degree of agreement between the pain reported by the patient and the pain scores given by the nurse was poor (Cohen K=0.318). Only 28.5% of the inpatients had taken analgesics in the past 24 h and the probability of receiving analgesic treatment was higher for women (adjusted OR=1.33, 95%CI: 1.14-1.54) and lower for general medicine compared to surgical wards (adjusted OR=0.55, 95%CI: 0.45-0.64), while it was unrelated both to the patient's self-reported pain and to level of pain assessed by the nurse. CONCLUSIONS: Pain affects an impressively high percentage of inpatients and is largely untreated and unrecognised in Italian wards. Educational intervention is required to improve the knowledge and attitudes of health professionals towards the approach and handling of patients in pain.