Pacing in older people

2011 ◽  
Vol 21 (4) ◽  
pp. 312-330
Author(s):  
Honey E Thomas ◽  
Michael S Cunnington ◽  
Janet M McComb
Keyword(s):  
Clinical Practice ◽  
Older People ◽  
Effective Treatment ◽  
Older Patients ◽  
System Function ◽  
Cardiac Pacemakers ◽  
Pacemaker Therapy ◽  
Barriers To Access ◽  
Different Types

SummaryThe vast majority of cardiac pacemakers are implanted in older people. Pacing is a safe and effective treatment for patients with symptomatic bradyarrhythmias. This review provides a clinician's guide to the essential aspects of modern pacemaker therapy in older patients, including aetiology and epidemiology of bradycardia. We discuss some barriers to access to pacing. We review indications for pacemakers, and describe pacing system function, including the different types of pacemakers used. We also review clinical outcomes following pacing, follow-up requirements and problems encountered in clinical practice. Finally, we discuss ethical and end of life considerations with these devices.

Neuropsychological assessment in older people: old principles and new directions

2000 ◽  
Vol 6 (5) ◽  
pp. 362-370 ◽  
Author(s):  
Robin G. Morris ◽  
Claire Worsley ◽  
David Matthews
Keyword(s):  
Older Adults ◽  
Clinical Practice ◽  
Older People ◽  
Neuropsychological Assessment ◽  
Rating Scales ◽  
Clinical Psychologist ◽  
Narrow Sense ◽  
New Directions ◽  
Different Types ◽  
Common Clinical Practice

Neuropsychological assessment, in the broader sense, is common clinical practice with older adults because of the widespread use of mental status examinations and dementia rating scales. In the more narrow sense, a neuropsychological assessment conducted by a clinical psychologist or clinical neuropsychologist is used less frequently and for more specific purposes. This paper outlines these uses and provides a brief overview of the different types of test that might be used, with a clinical example to illustrate the type of information gained. This review is designed not to be comprehensive, but to provide a pointer towards the latest trends in test development.

scholarly journals Factors Associated with Sarcopenia and 7-Year Mortality in Very Old Patients with Hip Fracture Admitted to Rehabilitation Units: A Pragmatic Study

Nutrients ◽  
2019 ◽  
Vol 11 (9) ◽  
pp. 2243 ◽  
Author(s):  
Vincenzo Malafarina ◽  
Concetta Malafarina ◽  
Arantzazu Biain Ugarte ◽  
J. Alfredo Martinez ◽  
Itziar Abete Goñi ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Older People ◽  
Hospital Stay ◽  
Grip Strength ◽  
Older Patients ◽  
Hand Grip Strength ◽  
Factors Associated ◽  
Hand Grip ◽  
Risk Of Mortality

Background: Admitted bedridden older patients are at risk of the development of sarcopenia during hospital stay (incident sarcopenia). The objective of this study was to assess the factors associated with sarcopenia (incident and chronic) and its impact on mortality in older people with hip fracture. Methods: A multicenter, pragmatic, prospective observational study was designed. Older subjects with hip fracture admitted to two rehabilitation units were included. Sarcopenia was assessed at admission and at discharge according to the revised EWGSOP (European Working Group on Sarcopenia in Older People) consensus definition. The mortality was evaluated after 7 years of follow-up. Results: A total of 187 subjects (73.8% women) age 85.2 ± 6.3 years were included. Risk factors associated to incident and chronic sarcopenia were undernutrition (body mass index—BMI and Mini Nutritional Assessment−Short Form—MNA-SF), hand-grip strength and skeletal muscle index. During follow-up 114 patients died (60.5% sarcopenic vs. 39.5% non-sarcopenic, p = 0.001). Cox regression analyses showed that factors associated to increased risk of mortality were sarcopenia (HR: 1.67, 95% CI 1.11–2.51) and low hand-grip strength (HR: 1.76, 95% CI 1.08–2.88). Conclusions: Older patients with undernutrition have a higher risk of developing sarcopenia during hospital stay, and sarcopenic patients have almost two times more risk of mortality than non-sarcopenic patients during follow-up after hip fracture.

scholarly journals Person-Centred Care Including Deprescribing for Older People

Pharmacy ◽  
2019 ◽  
Vol 7 (3) ◽  
pp. 101 ◽  
Author(s):  
Heather Smith ◽  
Karen Miller ◽  
Nina Barnett ◽  
Lelly Oboh ◽  
Emyr Jones ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Older People ◽  
Shared Decision Making ◽  
Real Life ◽  
Decision Making Process ◽  
Shared Decision ◽  
Good Communication ◽  
Values And Beliefs

There is concern internationally that many older people are using an inappropriate number of medicines, and that complex combinations of medicines may cause more harm than good. This article discusses how person-centred medicines optimisation for older people can be conducted in clinical practice, including the process of deprescribing. The evidence supports that if clinicians actively include people in decision making, it leads to better outcomes. We share techniques, frameworks, and tools that can be used to deprescribe safely whilst placing the person’s views, values, and beliefs about their medicines at the heart of any deprescribing discussions. This includes the person-centred approach to deprescribing (seven steps), which incorporates the identification of the person’s priorities and the clinician’s priorities in relation to treatment with medication and promotes shared decision making, agreed goals, good communication, and follow up. The authors believe that delivering deprescribing consultations in this manner is effective, as the person is integral to the deprescribing decision-making process, and we illustrate how this approach can be applied in real-life case studies.

Conclusions: Cancer biology, a moveable feast

2019 ◽  
pp. 463-468
Keyword(s):  
Clinical Practice ◽  
Effective Treatment ◽  
Cancer Biology ◽  
Heterogeneous Group ◽  
Malignant Tumours ◽  
Neoplastic Lesion ◽  
Different Types ◽  
Basic Characteristics ◽  
Knowledge Of Cancer ◽  
Amount Of Knowledge

The increasing amount of knowledge we are acquiring has improved our understanding of cancer biology and the way we classify tumours in clinical practice in order to provide a personalised, more effective treatment. Tumours include a large number of different types of abnormal growths. The main division, into benign and malignant, is based on the ability of a neoplastic lesion to produce metastases during the natural course of the disease. Malignant tumours are a heterogeneous group of lesions, which are brought together under the generic name of cancer and its synonymous. Although we recognize a tumour as malignant intuitively, to be able to define choose, and describe what are the basic characteristics common to all the types of cancers is challenging and it could be argued whether it is actually possible and/or correct to attempt it. Recent breakthroughs in biology have certainly improved our knowledge of cancer and the treatment available. However, we are also constantly unveiling new layers of complexity that need development of new tools in order to be dealt with.

What Does Evidence-Based Practice Mean to You? A Follow-Up Study Examining School-Based Speech-Language Pathologists' Perspectives on Evidence-Based Practice

2020 ◽  
Vol 29 (2) ◽  
pp. 688-704
Author(s):  
Katrina Fulcher-Rood ◽  
Anny Castilla-Earls ◽  
Jeff Higginbotham
Keyword(s):  
Clinical Practice ◽  
Research Evidence ◽  
Evidence Based Practice ◽  
Evidence Based ◽  
Clinical Expertise ◽  
Speech Language Pathologists ◽  
School Based ◽  
Research Findings ◽  
Ebp Implementation

Purpose The current investigation is a follow-up from a previous study examining child language diagnostic decision making in school-based speech-language pathologists (SLPs). The purpose of this study was to examine the SLPs' perspectives regarding the use of evidence-based practice (EBP) in their clinical work. Method Semistructured phone interviews were conducted with 25 school-based SLPs who previously participated in an earlier study by Fulcher-Rood et al. 2018). SLPs were asked questions regarding their definition of EBP, the value of research evidence, contexts in which they implement scientific literature in clinical practice, and the barriers to implementing EBP. Results SLPs' definitions of EBP differed from current definitions, in that SLPs only included the use of research findings. SLPs seem to discuss EBP as it relates to treatment and not assessment. Reported barriers to EBP implementation were insufficient time, limited funding, and restrictions from their employment setting. SLPs found it difficult to translate research findings to clinical practice. SLPs implemented external research evidence when they did not have enough clinical expertise regarding a specific client or when they needed scientific evidence to support a strategy they used. Conclusions SLPs appear to use EBP for specific reasons and not for every clinical decision they make. In addition, SLPs rely on EBP for treatment decisions and not for assessment decisions. Educational systems potentially present other challenges that need to be considered for EBP implementation. Considerations for implementation science and the research-to-practice gap are discussed.

“Bridging Gaps – Improving Outcomes”: Problem domains in schizophrenia research, treatment and policy

2016 ◽  
Vol 13 (03) ◽  
pp. 118-120
Author(s):  
W. Wölwer ◽  
W. Gaebel ◽  
V. Toeller
Keyword(s):  
Clinical Practice ◽  
Mental Healthcare ◽  
Knowledge Gaps ◽  
Everyday Clinical Practice ◽  
Treatment Gaps ◽  
Different Types

Summary Background: The provision of mental healthcare for patients with schizophrenia is still characterized both by knowledge gaps and by treatment gaps in everyday clinical practice. Aim: This article discusses the different types of treatment gaps in schizophrenia and describes actions taken to overcome these gaps especially in Europe.

Automatic Remote Monitoring of Implantable Cardiac Devices in Clinical Practice – The Lumos-T Safely Reduces Routine Office Device Follow-up (TRUST) Trial

2010 ◽  
Vol 6 (3) ◽  
pp. 87
Author(s):  
Niraj Varma ◽  
Keyword(s):  
Clinical Practice ◽  
Remote Monitoring ◽  
Home Monitoring ◽  
Implantable Devices ◽  
Cardiac Device ◽  
Cardiac Devices ◽  
Enhance Patient Safety ◽  
Implantable Cardiac Devices ◽  
Post Implantation

The use of implantable electronic cardiac devices is increasing. Post-implantation follow-up is important for monitoring both device function and patient condition; however, clinical practice is inconsistent. For example, implantable cardioverter–defibrillator follow-up schedules vary from every three months to yearly according to facility and physician preference and the availability of resources. Importantly, no surveillance occurs between follow-up visits. By contrast, implantable devices with automatic remote monitoring capability provide a means for performing constant surveillance, with the ability to identify salient problems rapidly. The Lumos-T Reduces Routine Office Device Follow-up Study (TRUST) demonstrated that remote home monitoring reduced clinic burden and allowed early detection of patient and/or system problems, enabling efficient monitoring and an opportunity to enhance patient safety. The results of the trial have significant implications for the management of patients receiving all forms of implantable electronic cardiac device.

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