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1.
Nolte F Schumann C Klein S Reinwald M Hofmann WK 《Journal of cancer research and clinical oncology》2012,138(6):953-957
Background
Myelodysplastic syndromes (MDS) are mainly a disease of the elderly. Commonly, MDS patients are treated in an outpatient setting making hematological/oncological private practices (PP) an important backbone in the management of MDS patients.Methods
To gain more insights into the characteristics of patients with MDS treated in hematological/oncological PP and to evaluate the daily diagnostic routines and classification systems used, we performed questionnaire-based analyses. Moreover, to investigate whether characteristics of MDS in PP differ from patients treated in specialized MDS centers in university hospitals (UH), we compared both cohorts of MDS patients.Results
In total, 197 patients in PP and 165 patients in UH were enrolled. Patients in UH were significantly younger as compared to PP. Furthermore, in UH, a greater proportion of patients with international prognostic scoring system (IPSS) higher risk were found, whereas patients with IPSS lower risk were more frequent in PP. In addition, patients in UH had significantly lower hemoglobin levels and platelet counts compared to PP.Conclusion
Our data show that PP and UH are approached by different MDS patient cohorts resulting in different diagnostic workups of MDS patients. 相似文献2.
Schwickert L Klenk J Stähler A Becker C Lindemann U 《Zeitschrift für Gerontologie und Geriatrie》2011,44(6):387-392
Background and objective
With the growing incidence of upper arm fractures among older people, innovative treatment strategies will be needed in geriatric rehabilitation. A pilot study was designed to test the feasibility of robotic-assisted rehabilitation after proximal humeral fractures.Patients and methods
Within a sample of 8?older patients (79.5?±?6.12?years), functional ability, quality and range of movement, self-rated impairment, quality of life, and user satisfaction were measured in an observational pre-/postdesign. During rehabilitation robotic-assisted training was applied.Results
Training motivation and acceptance were high in this sample, showing improvements in functional ability (p?=?0.03), quality of movement (p?=?0.02), range of motion, self-evaluation (p?=?0.01), and quality of life.Conclusion
This pilot study highlights the possible implementation of robotic-assisted rehabilitation after proximal humeral fractures in geriatric rehabilitation. The measurement and training protocol was suitable to document progress in rehabilitation. 相似文献3.
Peter A. Singer MD MPH FRCPC Elaine C. Thiel RN Irving Salit MD FRCPC William Flanagan LLM C. David Naylor MD DPhil FRCPC 《Journal of general internal medicine》1997,12(12):729-735
Objective
To determine whether persons living with HIV find a disease-specific advance directive more acceptable than a generic directive.Design
Randomized clinical trial.Setting
HIV consumer organization and hospital-based HIV clinic.Participants
Volunteer sample of persons with HIV.Interventions
The disease-specific HIV Living Will, the generic Centre for Bioethics Living Will, or both.Measurements and main results
Of 101 participants who received both advance directives, 78 (77.2%) preferred the disease-specific HIV Living Will and 23 (22.8%) preferred the generic Centre for Bioethics Living Will (p<.001). Most participants who preferred the HIV Living Will did so because it was more specific or relevant to their situation.Conclusions
Persons living with HIV prefer a disease-specific to a generic advance directive. They should be offered a disease-specific advance directive. Our findings should also encourage investigators to develop and evaluate disease-specific advance directives in other clinical settings. 相似文献4.
Prof. Dr. K. Hager M. Brecht O. Krause V. Grosse 《Zeitschrift für Gerontologie und Geriatrie》2014,47(5):379-384
Background
Cognitive impairment or dementia influence the results of geriatric treatment. The aim of the study was to quantify this influence.Patients and methods
Data of 2527 patients from the years 2006 to 2009 were analysed in order to quantify the influence of cognition measured with the Mini Mental Status Examination (MMSE) on the improvement of activities of daily living as reflected by the Functional Independence Measure (FIM).Results
Impaired cognition is accompanied by a lower FIM score on admission and on discharge. But the improvement of the FIM of slightly cognitively impaired patients (MMSE 20–26) is the same as in patients without cognitive impairment (MMSE 27–30). Patients with a MMSE below 20 points have smaller improvements in their FIM score but nevertheless 40?% of the patients with a MMSE of 10–19 and still 30?% of the patients with a MMSE of 0–9 points show better improvements than the average of all patients.Conclusion
Patients with a MMSE below 20 should not generally be excluded from geriatric treatment, but individual factors should be considered. 相似文献5.
von Renteln-Kruse W Dapp U Anders J Pröfener F Schmidt S Deneke C Fertmann R Hasford J Minder C 《Zeitschrift für Gerontologie und Geriatrie》2011,44(4):250-255
Background
Decline in functional competence is a major determinant of older persons?? needs, the development of dependency, use of care, clinical outcome and mortality. The interactions between rising life expectancy and changes in morbidity and disability warrant interdisciplinary research on functional disability, health promotion and prevention. The LUCAS (Longitudinal Urban Cohort Ageing Study) research consortium was established to study particular aspects of functional competence, its changes with ageing, to detect preclinical signs of functional decline, and to address questions on how to maintain functional competence and to prevent adverse outcome. The questions originate from problems encountered in practical health care provision in different settings, i.e. community, hospital and nursing home.Methods
The subprojects apply a longitudinal cohort follow-up study, an embedded randomised controlled intervention, cross-sectional comparative, and prospective intervention studies.Conclusion
The results will provide instruments to screen for preclinical signs of functional decline and concrete recommendations to sustain independence and prevent adverse outcomes in older age in daily practice. 相似文献6.
Chunzhen Tan BSc Yee Sien Ng MBBS MRCP FAMS Gerald C. H. Koh MBBS MMed PhD Deidre A. De Silva MBBS MRCP FAMS Arul Earnest PhD Sylvaine Barbier MSc 《Journal of general internal medicine》2014,29(6):885-890
BACKGROUND
Disability is prevalent among patients treated in Internal Medicine (IM), but its impact on length of inpatient stay (LOS) is unknown. Current systems of patient management and resource allocation are disease-focused with scant attention paid to functional impairment. Earlier studies in selected cohorts suggest that disability prolongs LOS.OBJECTIVE
To investigate the relationship of disability with LOS in IM, controlling for comorbidity.DESIGN
Prospective cohort study.PATIENTS
We charted 448 patients from an IM team admitted between 2008 and 2012 for sociodemographic, disease, biochemical and functional characteristics. Each IM team is on duty for one month annually, and patients were hence recruited for one month each year.MAIN MEASURES
Disability was measured using the Functional Independence Measure (FIM) recorded at discharge. Comorbidity was measured using the Charlson Comorbidity Index (CCI).KEY RESULTS
Of the 448 patients, 57.4 % were male with mean age 68.6 years. The mean LOS was 9.58 days. The mean motor and cognitive FIM scores were 57.1 and 25.7, respectively. The mean CCI score was 2.69. Thirty-four percent had major social issues impacting discharge plans. The five most common diagnoses for admission were pneumonia (8.9 %), urinary tract infection (7.8 %), cellulitis (7.6 %), heart failure (7.1 %) and falls (6.0 %). Both cognitive and motor FIM scores were negatively correlated with longer LOS (P?<?0.001). On multivariate analysis, variables independently associated with longer LOS included the motor FIM score (P?<?0.001), presence of social issues such as caregiver unavailability (P?<?0.001), non-realistic patient expectations (P?=?0.001) and administrative issues impeding discharge (P?=?0.016).CONCLUSION
Disability predicts LOS in IM patients, and thus their comprehensive care should involve functional assessment. As social and administrative factors were also independently associated with LOS, there is a need to involve social workers and administrators in a multidisciplinary approach towards optimizing LOS. 相似文献7.
BACKGROUND
Serious lapses in patient care result from failure to follow-up test results.OBJECTIVE
To systematically review evidence quantifying the extent of failure to follow-up test results and the impact for ambulatory patients.DATA SOURCES
Medline, CINAHL, Embase, Inspec and the Cochrane Database were searched for English-language literature from 1995 to 2010.STUDY SELECTION
Studies which provided documented quantitative evidence of the number of tests not followed up for patients attending ambulatory settings including: outpatient clinics, academic medical or community health centres, or primary care practices.DATA EXTRACTION
Four reviewers independently screened 768 articles.RESULTS
Nineteen studies met the inclusion criteria and reported wide variation in the extent of tests not followed-up: 6.8% (79/1163) to 62% (125/202) for laboratory tests; 1.0% (4/395) to 35.7% (45/126) for radiology. The impact on patient outcomes included missed cancer diagnoses. Test management practices varied between settings with many individuals involved in the process. There were few guidelines regarding responsibility for patient notification and follow-up. Quantitative evidence of the effectiveness of electronic test management systems was limited although there was a general trend towards improved test follow-up when electronic systems were used.LIMITATIONS
Most studies used medical record reviews; hence evidence of follow-up action relied upon documentation in the medical record. All studies were conducted in the US so care should be taken in generalising findings to other countries.CONCLUSIONS
Failure to follow-up test results is an important safety concern which requires urgent attention. Solutions should be multifaceted and include: policies relating to responsibility, timing and process of notification; integrated information and communication technologies facilitating communication; and consideration of the multidisciplinary nature of the process and the role of the patient. It is essential that evaluations of interventions are undertaken and solutions integrated into the work and context of ambulatory care delivery. 相似文献8.
Jannique GZ van Uffelen Marijke Hopman-Rock Marijke JM Chin A Paw Willem van Mechelen 《BMC geriatrics》2005,5(1):1-9
Background
The objective of this article is to describe the design of an evaluation of the cost-effectiveness of systematic home visits by nurses to frail elderly primary care patients. Pilot objectives were:- To determine the feasibility of postal multidimensional frailty screening instruments;
- to identify the need for home visits to elderly.
Methods
Main study: The main study concerns a randomized controlled in primary care practices (PCP) with 18 months follow-up and blinded PCPs. Frail persons aged 75 years or older and living at home but neither terminally ill nor demented from 33 PCPs were eligible. Trained community nurses- visit patients at home and assess the care needs with the Resident Assessment Instrument-Home Care, a multidimensional computerized geriatric assessment instrument, enabling direct identification of problem areas;
- determine the care priorities together with the patient;
- design and execute interventions according to protocols;
- and visit patients at least five times during a year in order to execute and monitor the care-plan.
- Three brief postal multidimensional screening measures to identify frail health among elderly persons were tested on percentage complete item response (selected after a literature search):
- Vulnerable Elders Screen,
- Strawbridge's frailty screen, and
- COOP-WONCA charts.
- Three nurses visited elderly frail patients as identified by PCPs in a health center of 5400 patients and used an assessment protocol to identify psychosocial and medical problems. The needs and experiences of all participants were gathered by semi-structured interviews.
Discussion
The design holds several unique elements such as early identification of frail persons combined with case-management by nurses. From two pilots we learned that of three potential postal frailty measures, the COOP-WONCA charts were completed best by elderly and that preventive home visits by nurses were positively evaluated to have potential for quality of care improvement. 相似文献9.
Johannes SM Hobbelen Frans RJ Verhey Jacobus HJ Bor Rob A de Bie Raymond TCM Koopmans 《BMC geriatrics》2007,7(1):1-6
Background
We studied whether the twelve-month use of a standard computer would induce complaints of upper limb pain or functional limitations in older novice computer users.Methods
Participants between 64 and 76 of age were randomly assigned to an Intervention group (n = 62), whose members received a personal computer and fast Internet access at their homes, or a No Intervention control group (n = 61), whose members refrained from computer use during the twelve month study period.Results
Difference scores between baseline and twelve months assessments on both complaint (SFS) and functional health scales (SF-36) did not differ between groups (all p > .05).Conclusion
Prolonged, self-paced use of a standard computer interface does not put older persons at a risk of upper limb complaints or reduce functional health in older adults. 相似文献10.
Steffen Christensen Anders Riis Mette Nørgaard Henrik T Sørensen Reimar W Thomsen 《BMC geriatrics》2007,7(1):1-8
Background
We investigated if personal socioeconomic position (SEP) factors and neighborhood characteristics were associated with incident mobility impairment in the elderly.Methods
We used data from the Cardiovascular Health Study, a longitudinal, population-based examination of coronary heart disease and stroke among persons aged 65 and older in the United States.Results
Among 3,684 persons without baseline mobility impairment, lower baseline SEP was associated with increased risk of incident mobility disability during the 10-year follow-up period, although the strengths of these associations varied by socioeconomic indicator and race/sex group.Conclusion
Among independent-living elderly, SEP affected development of mobility impairment into later life. Particular effort should be made to prevent or delay its onset among the elderly with low income, education, and/or who live in economically disadvantaged neighborhoods. 相似文献11.
M. Rossi F. Turati P. Lagiou D. Trichopoulos L. S. Augustin C. La Vecchia A. Trichopoulou 《Diabetologia》2013,56(11):2405-2413
Aims/hypothesis
The role of diet in the prevention of diabetes remains uncertain. The aim of this study was to investigate two different dietary aspects, i.e. adherence to the Mediterranean diet and glycaemic load (GL), in relation to diabetes occurrence.Methods
We analysed data from the Greek cohort of the population-based European Prospective Investigation into Cancer and Nutrition (EPIC). From a total of 22,295 participants, actively followed for a median of 11.34 years, 2,330 cases of incident type 2 diabetes were recorded. All participants completed a validated, interviewer-administered semi-quantitative food frequency questionnaire at enrolment. From this information, we calculated a ten point Mediterranean diet score (MDS), reflecting adherence to the traditional Mediterranean diet, as well as the dietary GL. We estimated HRs and the corresponding 95% CIs of diabetes using Cox proportional hazards regression models adjusted for potential confounders.Results
A higher MDS was inversely associated with diabetes risk (HR 0.88 [95% CI 0.78, 0.99] for MDS ≥6 vs MDS ≤3). GL was positively associated with diabetes (HR 1.21 [95% CI 1.05, 1.40] for the highest vs the lowest GL quartile). A significant protection of about 20% was found for a diet with a high MDS and a low GL.Conclusions/interpretation
A low GL diet that also adequately adheres to the principles of the traditional Mediterranean diet may reduce the incidence of type 2 diabetes. 相似文献12.
Brian K. Ahmedani PhD Gregory E. Simon MD Christine Stewart PhD Arne Beck PhD Beth E. Waitzfelder PhD Rebecca Rossom MD Frances Lynch PhD Ashli Owen-Smith PhD Enid M. Hunkeler MA Ursula Whiteside PhD Belinda H. Operskalski MPH M. Justin Coffey MD Leif I. Solberg MD 《Journal of general internal medicine》2014,29(6):870-877
BACKGROUND
Suicide prevention is a public health priority, but no data on the health care individuals receive prior to death are available from large representative United States population samples.OBJECTIVE
To investigate variation in the types and timing of health services received in the year prior to suicide, and determine whether a mental health condition was diagnosed.DESIGN
Longitudinal study from 2000 to 2010 within eight Mental Health Research Network health care systems serving eight states.PARTICIPANTS
In all, 5,894 individuals who died by suicide, and were health plan members in the year before death.MAIN MEASURES
Health system contacts in the year before death. Medical record, insurance claim, and mortality records were linked via the Virtual Data Warehouse, a federated data system at each site.KEY RESULTS
Nearly all individuals received health care in the year prior to death (83 %), but half did not have a mental health diagnosis. Only 24 % had a mental health diagnosis in the 4-week period prior to death. Medical specialty and primary care visits without a mental health diagnosis were the most common visit types. The individuals more likely to make a visit in the year prior to death (p?<?0.05) tended to be women, individuals of older age (65+ years), those where the neighborhood income was over $40,000 and 25 % were college graduates, and those who died by non-violent means.CONCLUSIONS
This study indicates that opportunities for suicide prevention exist in primary care and medical settings, where most individuals receive services prior to death. Efforts may target improved identification of mental illness and suicidal ideation, as a large proportion may remain undiagnosed at death. 相似文献13.
Hiroshi Okumura Yasuto Uchikado Masataka Matsumoto Tetsuhiro Owaki Yoshiaki Kita Tetsuro Setoyama Itaru Omoto Ken Sasaki Koichi Megumi Koji Minami Sumiya Ishigami Shoji Natsugoe 《Esophagus》2013,10(3):149-152
Background
Myelodysplastic syndrome (MDS) is a clinical condition with pancytopenia, dysfunction of neutrophils and poor prognosis caused by dysplasia of the bone marrow. MDS patients tend to have other malignant diseases, and the treatment is complicated because of high morbidity and mortality. Moreover, esophageal cancer is one of the most aggressive cancers, and its surgical treatment has high morbidity.Methods
Among 450 patients with esophageal cancer who underwent surgical treatment, 4 (0.8 %) had MDS. We describe esophageal cancer patients with MDS who underwent radical surgical treatment and estimate the perioperative management and postoperative outcome.Results
Two patients underwent transhiatal resection involving lower esophagectomy and proximal gastrectomy, and two other patients underwent thoracoscopic thoracoabdominal resection. Important critical points for the surgical treatment of esophageal cancer patients with MDS were as follows: hematological examination for patients with cytopenia, surgical indication for patients with WHO classification of RA or RARS and IPSS of low or intermediate-1 risk, planning transfusions for patients with thrombocytopenia, expecting postoperative complications such as pneumonia or bleeding, and careful follow-up for the early detection of relapse of disease.Conclusion
With careful management, we were able to treat esophageal cancer patients with MDS surgically. 相似文献14.
O.-P. Ryynänen P. Nousiainen E.J.O. Soini S. Tuominen 《Zeitschrift für Gerontologie und Geriatrie》2013,46(5):449-455
Aim
The goal of the present work was to measure the efficacy of a multicomponent programme designed to provide tailored support for the caregivers of disabled persons.Subjects
A total of 135 caregivers–care receiver dyads were randomly divided into an intervention group (n?=?66) and a control group (n?=?69). One-third of the care receivers were demented, and two-thirds had other diseases.Setting
Health centres (publicly funded primary health care systems) in 8 rural and urban communities in southeast Finland.Intervention
The multicomponent support programme for the caregivers consisted of a 2-week rehabilitation period. The control group received standard care.Outcome measurements
Continuation of the caregiver and care receiver relationship, care receiver mortality at the 2-year follow-up as well as the health-related quality of life (15D scale) and Zung’s depression scale of the caregiver at the 1-year follow-up were evaluated.Results
At the 2-year follow-up, the caregiver–care receiver relationship was terminated for any reason in 11 cases (17%) in the intervention group, and in 25 cases (36%) in the control group. After adjusting, the primary outcome (i.e., termination of care giving for any reason) indicated statistical significance (p?=?0.04) with a hazard rate of 1.83 (95% confidence interval 1.03–3.29). With a similar adjustment, the difference in mortality and placement to institutional care between the two groups demonstrated a trend towards statistical significance. The caregivers’ health, as related to quality of life and depressive symptoms, remained unchanged in both groups at the 1-year follow-up.Conclusion
These results indicate that a tailored support programme for caregivers may help the caregiver to continue the caregiver–care receiver relationship and delay institutionalization. 相似文献15.
Andrew A Smith Soo B Chan Carusone Kathleen Willison Tamara J Babineau Stephanie D Smith Tom Abernathy Tom Marrie Mark Loeb 《BMC geriatrics》2005,5(1):1-8
Background
The objective of this study was to examine the Minimum Data Set (MDS) and Geriatric Depression Scale (GDS) as measures of depression among nursing home residents.Methods
The data for this study were baseline, pre-intervention assessment data from a research study involving nine nursing homes and 704 residents in Massachusetts. Trained research nurses assessed residents using the MDS and the GDS 15-item version. Demographic, psychiatric, and cognitive data were obtained using the MDS. Level of depression was operationalized as: (1) a sum of the MDS Depression items; (2) the MDS Depression Rating Scale; (3) the 15-item GDS; and (4) the five-item GDS. We compared missing data, floor effects, means, internal consistency reliability, scale score correlation, and ability to identify residents with conspicuous depression (chart diagnosis or use of antidepressant) across cognitive impairment strata.Results
The GDS and MDS Depression scales were uncorrelated. Nevertheless, both MDS and GDS measures demonstrated adequate internal consistency reliability. The MDS suggested greater depression among those with cognitive impairment, whereas the GDS suggested a more severe depression among those with better cognitive functioning. The GDS was limited by missing data; the DRS by a larger floor effect. The DRS was more strongly correlated with conspicuous depression, but only among those with cognitive impairment.Conclusions
The MDS Depression items and GDS identify different elements of depression. This may be due to differences in the manifest symptom content and/or the self-report nature of the GDS versus the observer-rated MDS. Our findings suggest that the GDS and the MDS are not interchangeable measures of depression. 相似文献16.
17.
Zhang Z Xie D Kurichi JE Streim J Zhang G Stineman MG 《Journal of general internal medicine》2012,27(8):901-910
Background
Few predictive indexes for long-term mortality have been developed for community-dwelling elderly populations. Parsimonious predictive indexes are important decision-making tools for clinicians, policy makers, and epidemiologists.Objective
To develop 1-, 5-, and 10-year mortality predictive indexes for nationally representative community-dwelling elderly people.Design
Cohort study.Setting
The Second Longitudinal Study of Aging (LSOA II).Participants
Nationally representative civilian community-dwelling persons at least 70?years old. We randomly selected 60% of the sample for prediction development and used the remaining 40% for validation.Main Measures
Sociodemographics, impairments, and medical diagnoses were collected from the LSOA II baseline interviews. Instrumental activities of daily living (IADLs) stages were derived to measure functional status. All-cause mortality was obtained from the LSOA II Linked Mortality Public-use File.Results
The analyses included 7,373 sample persons with complete data, among which mortality rates were 3.7%, 23.3%, and 49.8% for 1, 5, and 10?years, respectively. Four, eight, and ten predictors were identified for 1-, 5-, and 10-year mortality, respectively, in multiple logistic regression models to create three predictive indexes. Age, sex, coronary artery disease, and IADL stages were the most essential predictors for all three indexes. C-statistics of the three indexes were 0.72, 0.74, and 0.75 in the development cohort and 0.72, 0.72, and 0.74 in the validation cohort for 1-, 5-, and 10-year mortality, respectively. Five risk groups were defined based on the scores.Conclusions
The 1-, 5-, and 10-year mortality indexes include parsimonious predictor sets maximizing ease of mortality prediction in community settings. Thus, they may provide valuable information for prognosis of elderly patients and guide the comparison of alternative interventions. Including IADL stage as a predictor yields simplified mortality prediction when detailed disease information is not available. 相似文献18.
19.
Anders J Pröfener F Dapp U Golgert S Daubmann A Wegscheider K von Renteln-Kruse W Minder CE 《Zeitschrift für Gerontologie und Geriatrie》2012,45(4):271-278
Purpose
The goal of this work was to characterise and distinguish persons without (fit), with earliest signs (pre-frail) or accelerated functional decline (frail) during self-referral (geriatric centre) or preventive home visits.Methods
After screening independently living older people in an urban longitudinal cohort (n?=?1,995) using a self-administered questionnaire, they were functionally classified as fit, pre-frail or frail. In 10% randomly selected samples of these cohort parts a comprehensive extended gerontological-geriatric assessment (EGGA) was administered.Results
Fit, pre-frail and frail samples are significantly different regarding comorbidity, medication, mobility, fall risk, instrumental activities of daily living and use of social support but not nutrition. The best indicator to discriminate fit versus frail was exhaustion (mobility tiredness).Conclusion
Competence is essential regarding health in old age. Identification of resources and risks by comprehensive assessment is useful before planning interventions to prevent frailty or its progression. 相似文献20.
Kertesz SG Khodneva Y Richman J Tucker JA Safford MM Jones B Schumacher J Pletcher MJ 《Journal of general internal medicine》2012,27(7):808-816