Bilateral facial palsy in an older person

2020 ◽  
Vol 49 (5) ◽  
pp. 887-888
Author(s):  
Jean-Loup Méreaux ◽  
Benjamin Hébant ◽  
Nicolas Magne ◽  
Gérald Quesney ◽  
Romain Lefaucheur
Keyword(s):  
Infectious Disease ◽  
Lyme Disease ◽  
Facial Palsy ◽  
Related Species ◽  
Older Patients ◽  
Clinical Signs ◽  
Older Person ◽  
Older Patient ◽  
Infected Tick ◽  
Outdoor Activities

Abstract Lyme disease is an infectious disease caused by the Borrelia burgdorferi spirochetes and other related species that are transmitted through an infected tick bite. We report the case of an older patient presenting with bilateral facial palsy due to Lyme disease. Multiple non-specific clinical signs preceded facial palsy with falls, fatigue and pain of both legs especially during the night. Our case illustrates the difficulty to diagnose this infectious disease, especially in older patients who have rare outdoor activities and a low risk of tick exposure.

COVID-19: how nuclear medicine can provide a differential diagnosis in very dubious case

Coronaviruses ◽  
2020 ◽  
Vol 01 ◽  
Author(s):  
Maria Silvia De Feo ◽  
Viviana Frantellizzi ◽  
Giuseppe De Vincentis
Keyword(s):  
Infectious Disease ◽  
Differential Diagnosis ◽  
Ct Scan ◽  
Imaging Technique ◽  
False Negative ◽  
Clinical Signs ◽  
Negative Results ◽  
Infectious Disease Department ◽  
False Negative Results ◽  
99Mtc Hmpao

Background: We present the case of a 55-year-old woman, admitted to the Infectious Disease Department of Policlinico Umberto I, Rome, in mid-March 2020, with suspicion of COVID-19 infection. Objective: The rRT-PCR was negative and the following CT scan, performed to exclude false-negative results and help diagnosis, was inconclusive. Methods: It was decided to submit the patient to 99mTc-HMPAO-labelled leukocyte scan. Results: This exam led to the diagnosis of infective endocarditis. Conclusion: In the present pandemic scenario, 99mTc-HMPAO-labelled leukocyte scan represents a reliable imaging technique for differential diagnosis with COVID-19 in patients with confusing clinical signs, possible false-negative rRT-PCR results and inconclusive CT scan.

scholarly journals Better Medicines for Older Patients: Considerations between Patient Characteristics and Solid Oral Dosage Form Designs to Improve Swallowing Experience

Pharmaceutics ◽  
2020 ◽  
Vol 13 (1) ◽  
pp. 32
Author(s):  
Nélio Drumond ◽  
Sven Stegemann
Keyword(s):  
Patient Population ◽  
Older Patients ◽  
Negative Impact ◽  
Water Soluble ◽  
Oral Dosage ◽  
Oral Drug ◽  
Older Patient ◽  
Coating Materials ◽  
Esophageal Transit ◽  
Patient Centric

Oral drug administration provided as solid oral dosage forms (SODF) remains the major route of drug therapy in primary and secondary care. There is clear evidence for a growing number of clinically relevant swallowing issues (e.g., dysphagia) in the older patient population, especially when considering the multimorbid, frail, and polymedicated patients. Swallowing impairments have a negative impact on SODF administration, which leads to poor adherence and inappropriate alterations (e.g., crushing, splitting). Different strategies have been proposed over the years in order to enhance the swallowing experience with SODF, by using conventional administration techniques or applying swallowing aids and devices. Nevertheless, new formulation designs must be considered by implementing a patient centric approach in order to efficiently improve SODF administration by older patient populations. Together with appropriate SODF size reductions, innovative film coating materials that can be applied to SODF and provide swallowing safety and efficacy with little effort being required by the patients are still needed. With that in mind, a literature review was conducted in order to identify the availability of patient centric coating materials claiming to shorten esophageal transit times and improve the overall SODF swallowing experience for older patients. The majority of coating technologies were identified in patent applications, and they mainly included well-known water soluble polymers that are commonly applied into pharmaceutical coatings. Nevertheless, scientific evidence demonstrating the benefits of given SODF coating materials in the concerned patient populations are still very limited. Consequently, the availability for safe, effective, and clinically proven solutions to address the increasing prevalence of swallowing issues in the older patient population is still limited.

scholarly journals Implementation of the acutely presenting older patient (APOP) screening program in routine emergency department care

2021 ◽  
Author(s):  
Laura C. Blomaard ◽  
Bas de Groot ◽  
Jacinta A. Lucke ◽  
Jelle de Gelder ◽  
Anja M. Booijen ◽  
...  
Keyword(s):  
Emergency Department ◽  
High Risk ◽  
Older Patients ◽  
Screening Program ◽  
Admission Rate ◽  
Older Patient ◽  
Hospital Admission Rate ◽  
High Risk Patients ◽  
Risk Patients

Abstract Objective The aim of this study was to evaluate the effects of implementation of the acutely presenting older patient (APOP) screening program for older patients in routine emergency department (ED) care shortly after implementation. Methods We conducted an implementation study with before-after design, using the plan-do-study-act (PDSA) model for quality improvement, in the ED of a Dutch academic hospital. All consecutive patients ≥ 70 years during 2 months before and after implementation were included. The APOP program comprises screening for risk of functional decline, mortality and cognitive impairment, targeted interventions for high-risk patients and education of professionals. Outcome measures were compliance with interventions and impact on ED process, length of stay (LOS) and hospital admission rate. Results Two comparable groups of patients (median age 77 years) were included before (n = 920) and after (n = 953) implementation. After implementation 560 (59%) patients were screened of which 190 (34%) were high-risk patients. Some of the program interventions for high-risk patients in the ED were adhered to, some were not. More hospitalized patients received comprehensive geriatric assessment (CGA) after implementation (21% before vs. 31% after; p = 0.002). In 89% of high-risk patients who were discharged to home, telephone follow-up was initiated. Implementation did not influence median ED LOS (202 min before vs. 196 min after; p = 0.152) or hospital admission rate (40% before vs. 39% after; p = 0.410). Conclusion Implementation of the APOP screening program in routine ED care did not negatively impact the ED process and resulted in an increase of CGA and telephone follow-up in older patients. Future studies should investigate whether sustainable changes in management and patient outcomes occur after more PDSA cycles.

scholarly journals 30MEASURING THE PROCESS OF CARE OF FRAIL OLDER PATIENTS IN HOSPITAL: THE FRAIL OLDER PATIENT ADMISSION QUESTIONNAIRE (FOPAQ)

2017 ◽  
Vol 46 (suppl_1) ◽  
pp. i1-i22 ◽  
Author(s):  
R Hyatt ◽  
J K Taylor ◽  
M Robertson ◽  
J Dean ◽  
J Finch ◽  
...  
Keyword(s):  
Older Patients ◽  
Patient Admission ◽  
Process Of Care ◽  
Older Patient

scholarly journals Clinical Evidence of Lyme Disease in Dogs and Disease Awareness Among Students and Veterinarians in Veracruz, Mexico

2019 ◽  
Vol 1 (2) ◽  
Author(s):  
Blanca Paola Boria-Gamboa ◽  
José Alfredo Villagómez-Cortés ◽  
David Itzcoatl Martínez-Herrera
Keyword(s):  
Differential Diagnosis ◽  
Lyme Disease ◽  
Professional Practice ◽  
Clinical Evidence ◽  
Clinical Signs ◽  
Small Animal ◽  
Apparent Absence ◽  
Veterinary Students ◽  
Disease Awareness ◽  
Veterinary Curriculum

Background: Lyme disease is a relatively new and zoonotic canine pathology mostly unknown by people involved in the management and care of dogs.  Objective: to assess the knowledge about Lyme disease by veterinarians and veterinary students in Veracruz, Mexico. Methodology: three questionnaires were designed and applied to 290 individuals (40 small animal veterinarians, 50 in other professional practice and 200 veterinary students). Results and discussion: in general, the three groups were unaware about the disease, although there is a high interest in learning about this problem. Graduates from seven universities included in this study stated that Lyme disease was not part of the veterinary curriculum in their schools. Five clinical cases suggestive of Lyme disease occurring in dogs in the area were detected at the time of this research. Conclusion: although the presence of the agent causing Lyme disease has not been demonstrated in the studied area due to the lack of laboratory support and the apparent absence of the vector, it cannot be ruled out; furthermore, it is important that veterinary practitioners and student alike be aware of the potential presence of Lyme disease, paying particular attention to differential diagnosis when resembling clinical signs are observed.

The impact of a time target on older patients attending the emergency department

2010 ◽  
Vol 27 (Suppl 1) ◽  
pp. A2.1-A2
Author(s):  
Sue Mason
Keyword(s):  
Emergency Department ◽  
Older Patients ◽  
Age Groups ◽  
Unintended Consequences ◽  
Older Patient ◽  
Younger Patients ◽  
Patient Level ◽  
Level Data ◽  
Younger Age ◽  
The Impact

IntroductionThe 4 h emergency standard for English acute trusts was introduced in 2003 and became full established by 2008 at 98% for all Emergency Department (ED) patients to be seen and discharged. This study examined the impact of the target for older patients attending departments.MethodsRoutine patient level data was received from 15 English EDs representing 774 095 individual patient attendances during May and June for 2003 to 2006. The data were used to determine the distribution of the total time spent in the EDs. Attendances were compared for older patients (65 years and above) with younger age groups.ResultsA total of 145 596 attendances were for patients aged 65+ years (18.9%). Across each year analysed, these older patients have a significantly longer median total time in the ED than those younger than 65 years (162 min vs 103 min, p<0.001). In addition, older patients are significantly more likely to leave the emergency department in the last 20 min prior to 4 h (12.4% vs 5.2% in those <65 years, p<0.001). This proportion is growing year on year in both the admitted and discharged categories of patients. Finally, older patients are significantly more likely to breach the 4-h than their younger counterparts (16.6% vs 6.3%, p<0.001).ConclusionsThere are some unintended consequences of introducing the 4 h target in UK emergency departments. While the target has reduced overall time in departments, the older patient appears to be disadvantaged relative to younger patients. Older patients are more likely to be ‘rushed through’ to other unmonitored areas of the hospital just prior to the target or to breach the target altogether. This finding calls in to question the benefits that the target is conveying for individual patients, and especially the most vulnerable in society.

Preventing skin tears among older adults in general practice

2021 ◽  
Vol 32 (10) ◽  
pp. 402-406
Author(s):  
Sarah Jane Palmer
Keyword(s):  
Quality Of Life ◽  
Risk Factors ◽  
Older Patients ◽  
Care Plan ◽  
Older Patient ◽  
Practice Nurses ◽  
Skin Tears ◽  
The Right ◽  
Chronic Problem

In this article, Sarah Jane Palmer discusses the importance of the prevention of skin tears and the role practice nurses can play Skin tears can present a complex and chronic problem for an older patient with fragile skin, and can be very disabling, reducing quality of life dramatically in some cases. The right care is essential from all members of the wider team caring for older patients, in order to identify risk factors for skin tears, as well as formulating a care plan of prevention that relates to these risk factors. Good skin care is essential, as well as patient education, and identifying ongoing issues with the patient's health that present a factor to consider when caring for them, such as mobility issues. Self-care should be encouraged where possible, and the correct use and choice of emollients that are pH balanced is crucial. By preventing skin tears we not only give the patient a far better quality of life, but we also reduce the need for very limited NHS resources.

Presentation of stroke in the older person

2020 ◽  
pp. 25-32
Author(s):  
Jagdish Sharma
Keyword(s):  
Older People ◽  
Ischaemic Stroke ◽  
Older Patients ◽  
Clinical Presentation ◽  
Cerebral Haemorrhage ◽  
Older Person ◽  
Younger Patients ◽  
Age Related ◽  
Atypical Presentations ◽  
Symptoms And Signs

‘Presentation of stroke in the older person’ outlines the varied patterns of clinical presentation of stroke in the older person, looking at common and the less common syndromes. Symptoms and signs in older people can be very subtle, often difficult to diagnose, and challenge even the most astute of clinicians. Most stroke presentations in older patients are similar to those in younger patients with respect to Oxford Community Stroke Project classification. However, atypical presentations can lead to diagnostic challenges in older patients due to the interaction between age-related cerebral and circulatory changes and comorbidities. The presentation of ischaemic stroke with its different vascular patterns, is discussed. Cerebral haemorrhage is explored in the context of its presentation patterns.

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