Early Tracheotomy in the Elderly Results in Less Pneumonia

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P70-P71
Author(s):  
Glenn Todd Schneider ◽  
Nathan P. Christensen ◽  
Timothy D Doerr
Keyword(s):  
Elderly Patients ◽  
Demographic Data ◽  
Group Versus ◽  
Lower Mortality ◽  
Ventilator Associated Pneumonia ◽  
Medical Comorbidities ◽  
Total Admission ◽  
Admission Time ◽  
Significant Difference ◽  
Early Tracheotomy

Objective To determine if early tracheotomy in elderly patients (age > 65) results in less ventilator associated pneumonia, mortality and morbidity. Methods This is a retrospective chart review of 158 ICU patients aged >65 who underwent tracheotomy from March 2003 to June 2007. Patient demographic data, admission criteria, medical comorbidities, disposition, outcome, and ventilation data were collected and analyzed. Results 158 patients were included in the study. 43 patients were included in the early tracheotomy group (continuous intubation time <7 days), and 115 patients were included in the late tracheotomy group. There were no statistically significant differences in the demographics of the 2 groups including age, gender, race, reason for intubation (respiratory failure, airway obstruction, etc), or medical comorbidities including COPD. A highly statistically significant difference in the rate of ventilator associated pneumonia was noted in the early vs. late tracheotomy group (23.3% vs 52.6%, p<0.0009). There were more intubations per patient noted in the early tracheotomy group versus the late tracheotomy group (2.2 vs 1.5, p<0.0001). The total admission time was also shorter in the early tracheotomy group (27.0 days vs 39.0 days, p<.0171). There was no difference noted in mortality, although there was a general trend of lower mortality in the early tracheotomy group (20.1% vs 32.1%, p<0.1683). Conclusions Early tracheotomy in elderly patients is associated with less ventilator associated pneumonia, more frequent intubations, less total admission time, and a trend towards lower mortality.

scholarly journals Is limited aortic resection more justified in elderly patients with type A acute aortic dissection?

2020 ◽  
Author(s):  
Wei Qin ◽  
Cunhua Su ◽  
Liangpeng Li ◽  
Michael Carmichael ◽  
Fuahua Huang ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Elderly Patients ◽  
Acute Aortic Dissection ◽  
Group Versus ◽  
Type A ◽  
Surgical Approaches ◽  
Elephant Trunk ◽  
Aortic Repair ◽  
Aortic Replacement ◽  
Significant Difference

Abstract Objective This study compared limited aortic repair (ascending, and /or hemi-arch replacement) versus extended-arch repair (ascending, arch and proximal descending aortic replacement) used for patients aged 65 or older, who had type A acute aortic dissection (AAD), analyzing the influence of the extent of aortic repair on outcomes. Methods From January, 2001 to December, 2015, 103 patients aged 65 or older underwent operation due to type A AAD in Nanjing First Hospital. The cohort was divided into two subgroups according to the surgical approaches, including limited aortic replacement (LAR, n = 41) and total arch replacement + stent elephant trunk implantation (TAR + SET, n = 62). Results There was no significant difference in gender, age, hypertension, diabetes, smoking, PCI history, atrial fibrillation, pericardial effusion, aortic valve insufficiency (≥ moderate), shock situation before operation, and Euro-score II between the two groups except limb malperfusion and tear location. The cross-clamp time, CPB time, intubation time, ICU stay time and hospital time were all significantly less in the LAR group than in the TAR + SET group. A total of 89 patients were discharged home successfully after operation, with a difference of hospital mortality (P = 0.04). The overall survival rates at 5-year follow-up were 82.5 ± 6.0% in LAR group and 75.2 ± 5.6% in TAR + SET group, but with no difference (p = 0.151). The freedom from adverse aortic events at 5-year was 84.3 ± 6.5% in LAR group versus 97.9 ± 2.1% in TAR + SET group, with a statistical difference (p = 0.03). Conclusion These findings support limited aortic resection is acceptable for elderly patients with type A AAD if surgical principles allow.

Early tracheotomy in elderly patients results in less ventilator-associated pneumonia

2009 ◽  
Vol 140 (2) ◽  
pp. 250-255 ◽  
Author(s):  
Glenn Todd Schneider ◽  
Nathan Christensen ◽  
Timothy D. Doerr
Keyword(s):  
Elderly Patients ◽  
Ventilator Associated Pneumonia ◽  
Early Tracheotomy

scholarly journals Clinical results of shock wave lithotripsy treatment in elderly patients with kidney stones: Results of 1433 patients

2020 ◽  
Vol 92 (4) ◽  
Author(s):  
Cevahir Ozer ◽  
Mehmet Ilteris Tekin
Keyword(s):  
Elderly Patients ◽  
Kidney Stones ◽  
Demographic Data ◽  
Age Groups ◽  
Clinical Results ◽  
Stone Disease ◽  
Complication Rates ◽  
Age Group ◽  
Adult Age ◽  
Significant Difference

Objective: In this study, it was aimed to evaluate the efficacy and safety of SWL treatment in elderly patients with kidney stones. Materials and methods: Data from a total of 3024 patients who underwent SWL treatment for urinary tract stone disease in three centers of our university were evaluated retrospectively. A total of 1433 patients in the adult age group treated for single kidney stones were included in the study. The patients were divided into 3 groups (18-40, 41-64 and ≥ 65) years depending on their age. Demographic data, stone parameters, stone-free rate (SFR) and clinically insignificant residual fragment (CIRF) rate, number of SWL sessions and complication rate were analyzed according to the age groups. Results: The mean age of the patients was 47.38 ± 13.24 years. Stone size was significantly lower in the 18-40 years age group compared to other groups (p = 0.000) and the stones were mostly located on the right side in this age group (p = 0.007). There was no significant relationship between age groups and gender, stone localization, and number of SWL sessions. The overall SFR was 66.4%. Although the SFR was lower (61.4%) and the rate of multiple sessions (27.2%) was higher in ≥ 65 years group, there was no statistically significant difference between age groups regarding SFR, CIRF, need for additional sessions, and complication rates. Conclusions: Due to its similar clinical results, treatment of SWL should not be ignored as a treatment option in the geriatric patient group with kidney stones.

scholarly journals Effect of oral care on bacterial colonization and Ventilator-Associated Pneumonia

2020 ◽  
Vol 11 (SPL4) ◽  
pp. 162-166
Author(s):  
Parimala L ◽  
Kavitha K ◽  
Sangeetha R ◽  
Mary Bhagyalatha R
Keyword(s):  
Bacterial Colonization ◽  
Demographic Data ◽  
Oral Care ◽  
Study Finding ◽  
Structured Interview ◽  
Control Group ◽  
Ventilator Associated Pneumonia ◽  
Significant Difference ◽  
Clinical Consequences ◽  
Experimental Group

Oral care is significant as it influences both health and clinical consequences of escalated care patients. Oropharyngeal intrusion by microorganisms is basic being developed of nosocomial pneumonia (ventilator-associated pneumonia/VAP) in intensive care units. The present study aims to assess the effectiveness of nesting on posture comfort among low birth weight babies. A quantitative quasi-experimental research design was conducted among 60ventilator supported patients in which 30 were allotted to experimental and 30 to control group. Observational sampling- checklist technique was used to select samples. A semi-structured interview was used to collect demographic data, and pneumonia checklist was assessed. Selected samples on 1st day of intubation in the experimental group and were provided oral care with 0.2% chlorhexidine every 6thhourly till 3rd day (72hours) and maintained pneumonia checklist respiratory rate, PaO2, BUN value, WBC count, platelet count and temperature. For the selected samples of the control group, oral care procedure was not applied. The study finding clearly infers that there was a significant difference in the Day 13 scores of pneumonia checklist variables except for temperature between the experimental and control group which proves the effectiveness of oral care on bacterial colonization and ventilator-associated pneumonia in the experimental group than the patients in the control group who had undergone normal hospital routine measures.

scholarly journals Is limited aortic resection more justified in elderly patients with type A acute aortic dissection?

2020 ◽  
Author(s):  
Wei Qin ◽  
Cunhua Su ◽  
Liangpeng Li ◽  
Michael Carmichael ◽  
Fuahua Huang ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Elderly Patients ◽  
Acute Aortic Dissection ◽  
Group Versus ◽  
Type A ◽  
Surgical Approaches ◽  
Elephant Trunk ◽  
Aortic Repair ◽  
Aortic Replacement ◽  
Significant Difference

Abstract Background: This study compared limited aortic repair (ascending, and /or hemi-arch replacement) versus extended-arch repair (ascending, arch and proximal descending aortic replacement) used for patients aged 65 or older, who had type A acute aortic dissection (AAD), analyzing the influence of the extent of aortic repair on outcomes.Methods: From January, 2001 to December, 2015, 103 patients aged 65 or older underwent operation due to type A AAD in Nanjing First Hospital. The cohort was divided into two subgroups according to the surgical approaches, including limited aortic replacement (LAR, n=41) and total arch replacement + stent elephant trunk implantation (TAR+SET, n=62). Results: There was no significant difference in gender, age, hypertension, diabetes, smoking, PCI history, atrial fibrillation, pericardial effusion, aortic valve insufficiency (≥ moderate), shock situation before operation, and Euro-score II between the two groups except limb malperfusion and tear location. The cross-clamp time, CPB time, intubation time, ICU stay time and hospital time were all significantly less in the LAR group than in the TAR+SET group. A total of 89 patients were discharged home successfully after operation, with a difference of hospital mortality (P=0.04). The overall survival rates at 5-year follow-up were 82.5±6.0% in LAR group and 75.2±5.6% in TAR+SET group, but with no difference (p=0.151). The freedom from adverse aortic events at 5-year was 84.3±6.5% in LAR group versus 97.9±2.1% in TAR+SET group, with a statistical difference (p=0.03). Conclusion: These findings support limited aortic resection is acceptable for elderly patients with type A AAD if surgical principles allow.

Parent’s Experiences from the Treatment of their Children at the Physic Children’s Surgery Clinic in Skopje.

2020 ◽  
Vol 4 (1) ◽  
Author(s):  
M. Trajchevska ◽  
A. Lleshi ◽  
S. Gjoshev ◽  
A. Trajchevski
Keyword(s):  
Health Care ◽  
Health Status ◽  
Independent Predictor ◽  
Demographic Data ◽  
Parental Satisfaction ◽  
Pediatric Care ◽  
Simple Random Sample ◽  
Significant Independent Predictor ◽  
Cross Sectional ◽  
Significant Difference

Background: The respect of the needs and wishes of the patients is in the focus of the human health system. The experience of the parents in terms of child’s health care may be used as an indicator of quality of the health care. Material and methods: The research is a quantitative analytical cross-sectional study. In accordance with the inclusion and exclusion criteria, simple random sample of 207 parents / guardians is covered, whose children in the period of three months, had been hospitalized in the hospital department JZUU Pediatric Surgery Clinic in Skopje.It was used a two parted questionnaire. The first part is a standardized questionnaire (Parent Experience of Pediatric Care - PECP), and the second part concerns the general socio-demographic data of the parent/guardian. Statistical evaluation was performed using appropriate statistical programs (Statistics for Windows 7,0 and SPSS 17.0). Results: In accordance with the age of the parents, the survey respondents were divided into two groups: a) age ≤ 33 years - 107 (51.69%) and b) age> 33 years - 100 (48.31%).Significant independent predictor of parental satisfaction from the receipt of their child to the clinic research confirms the age of the parent under / over 33 years due to 4.1% of the change in satisfaction (R2 = 0,041). Parents generally believe that their children's room of the clinic is "good", without significant difference between parental satisfaction from both age groups (Mann-Whitney U Test Z = -0,9613 p = 0,3364). Significant independent predictor of parental satisfaction from the room of their child improves the health status after treatment due to 6% of the change in satisfaction (R2 = 0,060). Parents generally believe that testing and treatment of their children in the clinic was "very good" and an independent significant predictor is to improve the health status after the treatment - 7,8% (R2 = 0,078). Conclusions: Regardless of the generally good parental satisfaction about health care for their children, it is necessary to continuously monitor the status of the clinic in order to consider the possible deficiencies and needs of intervention.

Effect of Chewing Gum on Bowel Motility in Women Undergoing Post-Operative Cesarean Section

2018 ◽  
Vol 3 (06) ◽  
Author(s):  
Dr.Randa Mohammed AboBaker
Keyword(s):  
Cesarean Section ◽  
Hospital Stay ◽  
Demographic Data ◽  
Length Of Hospital Stay ◽  
Chewing Gum ◽  
Control Group ◽  
Controlled Clinical Trial ◽  
Bowel Motility ◽  
Gum Chewing ◽  
Significant Difference

Postoperative Ileus (POI) is one of the most common problems after obstetrics, gynecologic and abdominal surgeries. Sham feeding, such as gum chewing, accelerates the return of bowel function and the length of hospital stay. The present study aims to evaluate the effect of chewing gum on bowel motility in women undergoing post-operative cesarean section. Intervention study was used at the Postpartum Department of Maternity and Children Hospital, KSA. A randomized controlled clinical trial research design. Through a convenience technique, 80 post Caesarian Section (CS) women were included in the study. Data were collected through three tools: Tool (I): Socio-demographic data and reproductive history interview schedule. Tool (II): Postoperative Assessment Sheet. Tool (III): Outcomes of gum chewing and the length of hospital stay.  Method: subjects were assigned randomly into two groups of (40) the experimental and (40) the control. Subjects in the study group were asked to chew two pieces of sugarless gum for 30 min/three times daily in the morning, noon, and evening immediately after recovery from anesthesia and in Postpartum Department; while subjects in the control group followed the hospital routine care. Each woman in both groups was tested abdominally using a stethoscope to auscultate the bowel sounds and asked to report immediately the time of either passing flatus or stool. Results: illustrated that a highly statistically significant difference was observed between the two groups concerning their gum chewing outcomes. Where, P = 0.000. The study concluded that gum chewing is safe, well tolerated and appears to be effective in reducing the incidence and consequences of POI following CS.

A novel approach utilizing laser acupuncture teletherapy for management of elderly-onset rheumatoid arthritis: A randomized clinical trial

2021 ◽  
pp. 1357633X2110098
Author(s):  
Aya Sedky Adly ◽  
Afnan Sedky Adly ◽  
Mahmoud Sedky Adly ◽  
Mohammad F Ali
Keyword(s):  
Rheumatoid Arthritis ◽  
Virtual Reality ◽  
Elderly Patients ◽  
Aerobic Exercise ◽  
Health Professionals ◽  
Post Treatment ◽  
Laser Acupuncture ◽  
Virtual Reality Training ◽  
Significant Difference ◽  
Elderly Onset

Introduction Rheumatoid arthritis (RA) disease is a systemic progressive inflammatory autoimmune disorder. Elderly-onset RA can be assumed as a benign form of RA. Until recently, face-to-face therapeutic sessions between health professionals and patients are usually the method of its treatment. However, during pandemics, including coronavirus disease 2019 (COVID-19), teletherapeutic sessions can extensively increase the patient safety especially in elderly patients who are more vulnerable to these infections. Thus, the aim of this study was to evaluate a novel teletherapy approach for management of elderly patients suffering from RA by utilizing laser acupuncture. Methods A teletherapy system was used for management of elderly patients suffering from RA. Sixty participants were allocated randomly into two groups and the ratio was 1:1. Patients in the first group were treated with laser acupuncture and telerehabilitation sessions, which consisted of aerobic exercise and virtual reality training. Patients in the second group received telerehabilitation sessions, which consisted of aerobic exercise and virtual reality training. Evaluation of patients was done by using the Health Assessment questionnaire (HAQ), the Rheumatoid Arthritis Quality of Life (RAQoL) questionnaire, and the analysis of interleukin-6 (IL-6), serum C-reactive protein (CRP), plasma adenosine triphosphate (ATP) concentration and plasma malondialdehyde (MDA). Results A statistically significant difference was found in CRP, RAQoL, IL-6 and MDA between the pre- and post-treatments in the first group ( p < 0.05) favouring the post-treatment group, while the HAQ showed a statistically significant difference between pre- and post-treatments ( p < 0.05) in both groups. Statistically significant post-treatment differences were also observed between the two groups ( p < 0.05) in RAQoL, CRP, ATP and MDA, favouring the first group. Discussion Laser acupuncture teletherapy could be suggested as a reliable treatment method for elderly patients suffering from RA, as it can provide a safe and effective therapeutic approach. Teletherapy provided safer access to health professionals and patients while giving a high patient satisfaction value with a relatively lower cost (ClinicalTrials.gov Identifier: NCT04684693).

scholarly journals Prehospital time of suspected stroke patients treated by emergency medical service: a nationwide study in Thailand

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Phantakan Tansuwannarat ◽  
Pongsakorn Atiksawedparit ◽  
Arrug Wibulpolprasert ◽  
Natdanai Mankasetkit
Keyword(s):  
Emergency Medical Service ◽  
Medical Service ◽  
Life Support ◽  
Demographic Data ◽  
National Database ◽  
Stroke Patients ◽  
Emergency Medical ◽  
Significant Difference ◽  
Suspected Stroke ◽  
Prehospital Time

Abstract Background This work was to study the prehospital time among suspected stroke patients who were transported by an emergency medical service (EMS) system using a national database. Methods National EMS database of suspected stroke patients who were treated by EMS system across 77 provinces of Thailand between January 1, 2015, and December 31, 2018, was retrospectively analyzed. Demographic data (i.e., regions, shifts, levels of ambulance, and distance to the scene) and prehospital time (i.e., dispatch, activation, response, scene, and transportation time) were extracted. Time parameters were also categorized according to the guidelines. Results Total 53,536 subjects were included in the analysis. Most of the subjects were transported during 06.00-18.00 (77.5%) and were 10 km from the ambulance parking (80.2%). Half of the subjects (50.1%) were served by advanced life support (ALS) ambulance. Median total time was 29 min (IQR 21, 39). There was a significant difference of median total time among ALS (30 min), basic (27 min), and first responder (28 min) ambulances, Holm P = 0.009. Although 91.7% and 88.3% of the subjects had dispatch time ≤ 1 min and activation time ≤ 2 min, only 48.3% had RT ≤ 8 min. However, 95% of the services were at the scene ≤ 15 min. Conclusion Prehospital time from EMS call to hospital was approximately 30 min which was mainly utilized for traveling from the ambulance parking to the scene and transporting patients from the scene to hospitals. Even though only 48% of the services had RT ≤ 8 min, 95% of them had the scene time ≤ 15 min.

scholarly journals Comparison of intravenous sedation using midazolam during dental treatment in elderly patients with/without dementia: a prospective, controlled clinical trial

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yuichi Tatsuno ◽  
Yoshinari Morimoto ◽  
Megumi Hayashi ◽  
Takatoshi Iida
Keyword(s):  
Regression Analysis ◽  
Cognitive Impairment ◽  
Elderly Patients ◽  
Multiple Regression Analysis ◽  
Multiple Regression ◽  
Intravenous Sedation ◽  
Negative Group ◽  
Severe Dementia ◽  
Positive Group ◽  
Significant Difference

AbstractThe effects of intravenous sedation with midazolam on the cerebral function of elderly patients with severe dementia are unclear. This study aimed to evaluate its effects on parameters such as brainwaves and cerebral blood flow (CBF) and compare them between elderly individuals with dementia and without cognitive impairment. Ten patients with severe dementia and 10 without cognitive impairment were registered. The bispectral index (BIS) and normalized tissue hemoglobin index (nTHI), which reflects CBF using near-infrared spectroscopy, were measured. Midazolam was administered until a Modified Observer’s Assessment of Alertness/Sedation score of 2 was reached. The chi-squared, Mann–Whitney U, Wilcoxon signed-rank, and Friedman tests and multiple regression analysis were used for comparisons. Whereas a similar decline in BIS values was observed in both groups after midazolam administration (P < 0.018), there was a significant decrease by 9% in the nTHI of the dementia-positive group (P < 0.013). However, there was no significant difference in the nTHI between the dementia-positive and dementia-negative group according to the multiple regression analysis (P = 0.058). In the dementia-negative group, none of the measured values differed from the baseline values. In the dementia-positive group, sedation with midazolam resulted in a 9% decrease in the CBF.

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