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Areas covered: This review focuses on the use of systemic treatments in elderly psoriatic patients and their efficacy and safety data, analyzing the available literature evidences.
Expert opinion: Conventional agents should be carefully evaluated in each patient considering the possible organ impairment, comorbidities, concomitant medications and contraindications. Apremilast is an appropriate treatment for elderly patients. Biologics represent a safe option for a long-term management of psoriasis. Etanercept, adalimumab, ustekinumab, secukinumab, ixekizumab, and brodalumab have not been associated to a higher risk of adverse events in the elderly. 相似文献
Objective
To determine adverse event rates for adult cranial neuro-oncologic surgeries performed at a high-volume quaternary academic center and assess the impact of resident participation on perioperative complication rates.Patients and Methods
All adult patients undergoing neurosurgical intervention for an intracranial neoplastic lesion between January 1, 2009, and December 31, 2013, were included. Cases were categorized as biopsy, extra-axial/skull base, intra-axial, or transsphenoidal. Complications were categorized as neurologic, medical, wound, mortality, or none and compared for patients managed by a chief resident vs a consultant neurosurgeon.Results
A total of 6277 neurosurgical procedures for intracranial neoplasms were performed. After excluding radiosurgical procedures and pediatric patients, 4151 adult patients who underwent 4423 procedures were available for analysis. Complications were infrequent, with overall rates of 9.8% (435 of 4423 procedures), 1.7% (73 of 4423), and 1.4% (63 of 4423) for neurologic, medical, and wound complications, respectively. The rate of perioperative mortality was 0.3% (14 of 4423 procedures). Case performance and management by a chief resident did not negatively impact outcome.Conclusion
In our large-volume brain tumor practice, rates of complications were low, and management of cases by chief residents in a semiautonomous manner did not negatively impact surgical outcomes. 相似文献Objective
To assess the effect of race on the incidence of aortic stenosis (AS) and utilization and outcomes of aortic valve replacement (AVR).Patients and Methods
Patients older than 60 years hospitalized with a primary diagnosis of AS and those who underwent AVR between 2003 and 2014 were included. Adjusted and unadjusted incidence of AS-related hospitalizations, utilization rates of AVR, in-hospital morbidity and mortality, and resource utilization was compared between whites and African Americans (AAs).Results
Between January 1, 2003, and December 31, 2014, the incidence of AS-related admissions increased from 13 (95% CI, 12.8-13.2) to 26 (95% CI, 25.7-26.4) cases per 100,000 patient-years in whites and from 3 (95% CI, 3.5-3.8) to 9.5 (95% CI, 9.4-9.8) cases per 100,000 patient-years in AAs (P<.001). The incidence density ratio decreased from 4.3 (95% CI, 2.27-6.6) in 2003 to 2.7 (95% CI, 1.1-3.8) in 2014. The ratio of AVR to AS-related admissions was 11.3% in whites and 6.7% in AAs (P<.001). Crude in-hospital mortality after AVR was higher in AAs (6.4% vs 4.7%; P<.001). However, after propensity score matching, in-hospital morality after isolated AVR was not significantly different between AAs and whites (4.7% vs 3.7%; P=.12). African Americans also had longer hospitalizations (12±12 days vs 10±9 days; P<.001), higher rates of nonhome discharge (32.1% vs 27.2%; P=.004), and higher cost of hospitalization ($55,631±$37,773 vs $52,521±$38,040; P<.001).Conclusions
African Americans undergo AVR less than whites. The underlying etiology of this disparity is multifactorial, but may be related to a lower incidence of AS in AAs. Aortic valve replacement is associated with similar risk-adjusted in-hospital mortality but higher cost and longer hospitalizations in AAs than in whites. 相似文献- Implications for Rehabilitation
Oral hygiene care is crucial for stroke patients as it can prevent oral health problems and potentially life threatening events (such as aspiration pneumonia).
Despite oral hygiene care being relative simple to perform, it is often neglected during stroke rehabilitation.
A large-scale national survey was conducted to understand “intentions to” and “performance of” oral hygiene care to stroke patients using the Theory of Planned Behavior social cognition model.
These study findings may have implications and use in promoting oral hygiene care to stroke patients:i) by understanding the pathways and influences to perform oral hygiene care.ii) to conduct health promotion and health education based on behavioral models such as Theory of Planned Behavior.