scholarly journals 1432: ASSESSING THE IMPACT OF FLUID RESUSCITATION VOLUMES IN THE SEPTIC GERIATRIC POPULATION

2021 ◽  
Vol 50 (1) ◽  
pp. 718-718
Author(s):  
Adele Venable ◽  
Patrick Ratliff
Keyword(s):  
Fluid Resuscitation ◽  
Geriatric Population ◽  
The Impact

scholarly journals Effects of capillary refill time-vs. lactate-targeted fluid resuscitation on regional, microcirculatory and hypoxia-related perfusion parameters in septic shock: a randomized controlled trial

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Ricardo Castro ◽  
Eduardo Kattan ◽  
Giorgio Ferri ◽  
Ronald Pairumani ◽  
Emilio Daniel Valenzuela ◽  
...  
Keyword(s):  
Septic Shock ◽  
Randomized Controlled Trial ◽  
Fluid Resuscitation ◽  
Controlled Trial ◽  
Tissue Perfusion ◽  
Capillary Refill Time ◽  
Capillary Refill ◽  
Randomized Controlled ◽  
Microcirculatory Flow ◽  
The Impact

Abstract Background Persistent hyperlactatemia has been considered as a signal of tissue hypoperfusion in septic shock patients, but multiple non-hypoperfusion-related pathogenic mechanisms could be involved. Therefore, pursuing lactate normalization may lead to the risk of fluid overload. Peripheral perfusion, assessed by the capillary refill time (CRT), could be an effective alternative resuscitation target as recently demonstrated by the ANDROMEDA-SHOCK trial. We designed the present randomized controlled trial to address the impact of a CRT-targeted (CRT-T) vs. a lactate-targeted (LAC-T) fluid resuscitation strategy on fluid balances within 24 h of septic shock diagnosis. In addition, we compared the effects of both strategies on organ dysfunction, regional and microcirculatory flow, and tissue hypoxia surrogates. Results Forty-two fluid-responsive septic shock patients were randomized into CRT-T or LAC-T groups. Fluids were administered until target achievement during the 6 h intervention period, or until safety criteria were met. CRT-T was aimed at CRT normalization (≤ 3 s), whereas in LAC-T the goal was lactate normalization (≤ 2 mmol/L) or a 20% decrease every 2 h. Multimodal perfusion monitoring included sublingual microcirculatory assessment; plasma-disappearance rate of indocyanine green; muscle oxygen saturation; central venous-arterial pCO2 gradient/ arterial-venous O2 content difference ratio; and lactate/pyruvate ratio. There was no difference between CRT-T vs. LAC-T in 6 h-fluid boluses (875 [375–2625] vs. 1500 [1000–2000], p = 0.3), or balances (982[249–2833] vs. 15,800 [740–6587, p = 0.2]). CRT-T was associated with a higher achievement of the predefined perfusion target (62 vs. 24, p = 0.03). No significant differences in perfusion-related variables or hypoxia surrogates were observed. Conclusions CRT-targeted fluid resuscitation was not superior to a lactate-targeted one on fluid administration or balances. However, it was associated with comparable effects on regional and microcirculatory flow parameters and hypoxia surrogates, and a faster achievement of the predefined resuscitation target. Our data suggest that stopping fluids in patients with CRT ≤ 3 s appears as safe in terms of tissue perfusion. Clinical Trials: ClinicalTrials.gov Identifier: NCT03762005 (Retrospectively registered on December 3rd 2018)

Pressure injuries in the ageing population

2017 ◽  
pp. 401-408
Author(s):  
Cindy Kiely ◽  
Magdalena Pupiales
Keyword(s):  
Older Adult ◽  
Pressure Ulcers ◽  
Adult Population ◽  
Incidence Rates ◽  
Population Pressure ◽  
Ageing Population ◽  
Geriatric Population ◽  
Bony Prominence ◽  
Older Adult Population ◽  
The Impact

The prevalence of pressure ulcers has been reported to range from 4.1 to 32.2% in the older adult population. Pressure ulcers, also known as decubitus ulcers, bedsores, and pressure sores, are defined as localized injury to the skin and/or underlying structures, usually over a bony prominence as result of pressure or pressure in combination with shear. Within the geriatric population, prevalence and incidence rates tend to be high due to multifactorial risk factors such as comorbidities, changes in functional status, nutritional habits, medications affecting the skin, and physiological changes. The impact of pressure ulcers spans physical, emotional, social, and economic dimensions, and is of concern throughout the healthcare continuum. The aim of this chapter is to illustrate the aetiologic complexity of pressure ulcers in the geriatric population and summarize a comprehensive approach to prevention and management of pressure ulcers.

271: FLUID RESUSCITATION IN CRITICALLY ILL PATIENTS WITH SHOCK: THE IMPACT OF COMORBIDITIES

2016 ◽  
Vol 44 (12) ◽  
pp. 145-145
Author(s):  
Ordessia Charran ◽  
Sherif Elmahdy ◽  
Matthew Schreiber
Keyword(s):  
Critically Ill ◽  
Fluid Resuscitation ◽  
Critically Ill Patients ◽  
The Impact

scholarly journals THE IMPACT OF AN INTERPROFESSIONAL SIMULATION ON TEAM COMMUNICATION AT THE END OF LIFE

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S150-S151
Author(s):  
Anne Halli-Tierney ◽  
Megan E Lippe ◽  
Alexandra Stanley ◽  
Allison Ricamato ◽  
Robert E McKinney
Keyword(s):  
Social Work ◽  
Nursing Students ◽  
End Of Life ◽  
Communication Skills ◽  
End Of Life Care ◽  
Accurate Information ◽  
Life Care ◽  
Team Communication ◽  
Geriatric Population ◽  
The Impact

Abstract It is increasingly important that healthcare professionals understand how to care for patients at the end of life, especially as 75% of hospital deaths occur in the geriatric population. Many new healthcare profession graduates feel under-prepared to provide end-of-life care. Healthcare education programs must provide education on interprofessional communication and end-of-life care. This study explored the effects of an interprofessional end-of-life simulation on medical, social work, and nursing students’ communication skills. Across three simulation phases, teams were required to communicate with the patient (high-fidelity manikin), family members (scripted actors), and team members about treatment option, change in patient’s condition, and withdrawal of life-sustaining measures. A total of 16 teams participated in the simulation, with each team comprised of nursing students (n=7-8), social work students (n=1), and medical students or residents (n=1). Team communication skills were assessed using the Gap Kalamazoo Communication Skills Assessment Form. The average communication score for teams reflected fair to good communication (M=28.81, SD=5.55). The best communication domains were “Shares information” (n=8), “Communicates accurate information” (n=6), and “Builds a relationship” (n=5). The worst domains were “Demonstrates empathy” (n=7), “Provides closure” (n=6), and “Builds a relationship” (n=5). This simulation provides an interactive educational mechanism by which to educate interprofessional healthcare students on communication and care of patients at the end of life.

scholarly journals The impact of fluid resuscitation via colon on patients with severe acute pancreatitis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Tongtian Ni ◽  
Ying Chen ◽  
Bing Zhao ◽  
Li Ma ◽  
Yi Yao ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Severe Acute Pancreatitis ◽  
Fluid Resuscitation ◽  
Early Stage ◽  
Pure Water ◽  
Complementary Therapy ◽  
Kaplan Meier ◽  
Before And After ◽  
First Onset ◽  
The Impact

AbstractSevere acute pancreatitis (SAP) is a life-threatening disease. Fluid Resuscitation Via Colon (FRVC) may be a complementary therapy for early controlled fluid resuscitation. But its clinical application has not been reported. This study aims to explore the impact of FRVC on SAP. All SAP patients with the first onset within 72 h admitted to the hospital were included from January 2014 to December 2018 through electronic databases of Ruijin hospital and were divided into FRVC group (n = 103) and non-FRVC group (n = 78). The clinical differences before and after the therapy between the two groups were analyzed. Of the 181 patients included in the analysis, the FRVC group received more fluid volume and reached the endpoint of blood volume expansion ahead of the non-FRVC group. After the early fluid resuscitation, the inflammation indicators in the FRVC group were lower. The rate of mechanical ventilation and the incidence of hypernatremia also decreased significantly. Using pure water for FRVC was more helpful to reduce hypernatremia. However, Kaplan–Meier 90-day survival between the two groups showed no difference. These results suggest that the combination of FRVC might benefit SAP patients in the early stage of fluid resuscitation, but there is no difference between the prognosis of SAP patients and that of conventional fluid resuscitation. Further prospective study is needed to evaluate the effect of FRVC on SAP patients.

scholarly journals The Effect of Statins in Epilepsy: A Systematic Review

2018 ◽  
Vol 09 (04) ◽  
pp. 478-486 ◽  
Author(s):  
Loraine De Jesús Quintana-Pájaro ◽  
Yancarlos Ramos-Villegas ◽  
Eileen Cortecero-Sabalza ◽  
Andrei F. Joaquim ◽  
Amit Agrawal ◽  
...  
Keyword(s):  
Systematic Review ◽  
Epileptiform Activity ◽  
Experimental Studies ◽  
Level Of Evidence ◽  
Neuroprotective Effects ◽  
Geriatric Population ◽  
Necrosis Factor Alpha ◽  
Hmg Coa Reductase ◽  
Coa Reductase ◽  
The Impact

ABSTRACT Background and Objectives: Statins are inhibitors of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase, used for the management of hypercholesterolemia and related atherosclerotic diseases. Several studies have indicated the neuroprotective effects of statins on several neuropathological conditions. However, the role of these medications in epilepsy is still unclear. The purpose is to evaluate and summarize the level of evidence on the efficacy of statins in neuronal hyperexcitability and the neuroinflammatory processes of epilepsy. Methods: A systematic review was performed. Eligibility Criteria: This review involved studies conducted in humans and nonhuman experimental models, covering the use of an inhibitor of HMG-CoA reductase, alone or accompanied by another medication, in epilepsy. Information Sources: A systematic literature search was performed in PubMed, Embase, Ebsco Host, Scopus, Science Direct, Medline, and LILACS. Risk of Bias: It was evaluated with the Newcastle–Ottawa Scale and the experimental studies were evaluated using the GRADE tool. Results: Twenty articles of the 183 evaluated were included. Sixteen studies were conducted in animal models and four studies in humans. Most studies in mice reported a reduction in epileptiform activity and reduction in systemic inflammation with the treatment of statins, potentially influencing epilepsy control. Few studies in humans were performed in the geriatric population with variable results (neuroinflammation, seizure prevention, cell death, prevention of kindling, increase in convulsive threshold, increase in latency, decrease in frequency of crisis, and reduction in mortality) related to reduction in the rate of hospitalizations, mortality, and prevention of epilepsy. Studies in mice found a decrease in interleukin-1β (IL-1β), IL-6, and tumor necrosis factor alpha and an increase in IL-10 and endothelial nitric oxide synthase. Conclusions: The possible antiepileptic mechanism of statins may be related to the reduction in neuroinflammation mediated by a decrease in pro-inflammatory cytokines and action in the nitrergic system. Further studies evaluating the impact of statins on seizure control are necessary.

scholarly journals Mechanical Evaluation of Polymer Composite Hip Protectors

2010 ◽  
Vol 2010 ◽  
pp. 1-6 ◽  
Author(s):  
Jose Daniel Diniz Melo ◽  
Ayrles S. Gonçalves Barbosa ◽  
Ricardo Oliveira Guerra
Keyword(s):  
Polymer Composite ◽  
Hip Fractures ◽  
Impact Load ◽  
Cost Effective ◽  
Ethylene Vinyl Acetate ◽  
Geriatric Population ◽  
Hip Protectors ◽  
Energy Absorbing ◽  
The Impact

Hip fractures often result in serious health implications, particularly in the geriatric population, and have been related to long-term morbidity and death. In most cases, these fractures are caused by impact loads in the area of the greater trochanter, which are produced in a fall. This work is aimed at developing hip protectors using composite materials and evaluating their effectiveness in preventing hip fractures under high impact energy (120 J). The hip protectors were developed with an inner layer of energy absorbing soft material and an outer rigid shell of fiberglass-reinforced polymer composite. According to the experimental results, all tested configurations proved to be effective at reducing the impact load to below the average fracture threshold of proximal femur. Furthermore, an addition of Ethylene Vinyl Acetate (EVA) to the impacted area of the composite shell proved to be beneficial to increase impact strength of the hip protectors. Thus, composite hip protectors proved to be a viable alternative for a mechanically efficient and cost-effective solution to prevent hip fractures.

scholarly journals 556 - The Impact of COVID-19 pandemic on elderly’s mental health

2021 ◽  
Vol 33 (S1) ◽  
pp. 96-97
Author(s):  
Sofia Ramos Ferreira ◽  
Daniela Pereira ◽  
Horácio Firmino
Keyword(s):  
Mental Health ◽  
Elderly Population ◽  
Current Knowledge ◽  
The Elderly ◽  
World Health ◽  
Negative Consequences ◽  
Physical And Mental Health ◽  
Geriatric Population ◽  
Health Organization ◽  
The Impact

Background:Since the disease caused by the SARS-Cov-2 virus was declared a pandemic by the World Health Organization, countries around the globe adopted measures of social distancing to limit the spread of the virus. Although social distancingmeasures are essential preventive mechanisms, they can promote feelings of loneliness and influence the onset or exacerbation of psychiatric disorders. Current knowledge about the impact of COVID-19 on mental health - and in particular on mental health of the geriatric population - is still scarce.Research Objective:The present review aimed to analyze the COVID-19 pandemic impact on the elderly´s mental health and to suggest measures that can mitigate this impact.Method:A non-systematic review of the literature, through bibliographic research in Pubmed and Embase databases - using the keywords “COVID-19", “SARS-CoV-2", “Coronavirus”, “Aging”, “Older adults”, “Elderly”, “Quarantine” and “Mental health” -was performed.Preliminary results of the ongoing study:The available literature points towards a likely increase in mental disorders as a result of the COVID-19 pandemic. This phenomena may be particularly relevant in the elderly population. Several measures – pharmacological and non-pharmacological – can help to maintain the physical and mental health of the elderly.Conclusion:The COVID-19 pandemic had an important impact in elderly’s mental health. This subject should be addressed by profissionals/caregivers and measures tominimize negative consequences are in order.

scholarly journals Impact of Electrotherapy or Muscle Training on Quality of Life in Urinary Incontinence of Male Geriatric Population- A Protocol

2021 ◽  
Author(s):  
Ashish Wasudeorao Bele ◽  
Mohd Irshad Qureshi
Keyword(s):  
Quality Of Life ◽  
Urinary Incontinence ◽  
Pelvic Floor ◽  
Strength Training ◽  
Controlled Trial ◽  
Well Being ◽  
Muscle Training ◽  
Geriatric Population ◽  
The Impact

Introduction: Urinary Incontinence (UI) is the involuntary loss of urine with social alienation, loss of sexual activity and other psychosocial issues which may affect the Quality of Life (QOL) and psychosocial well-being of patients. Electrotherapy may play an important role in the treatment of incontinence by means of stimulating the weakened structures which helps in control of micturition. Various electrotherapeutic currents including Faradic, Galvanic, Inferential Therapy (IFT), Russian currents along with the pelvic floor muscles strength training may be helpful in UI. Aim: To find the impact of electrotherapy or training of muscle on QOL in male geriatric population of incontinence of urine. Materials and Methods: This randomised controlled trial will be carried out on geriatric male patients attending Acharya Vinoba Bhave Rural Hospital, Sawangi (Meghe), Wardha as well as on patients from geriatric homes and nearby PHCs. They will be screened for UI. The participants will be divided into three groups each of which will receive Faradic stimulation, Russian current stimulation and Pelvic Floor Muscle Training (PFMT) exercises respectively. The study will be carried out between October 2020 to October 2022. The data will be collected and analysed utilising inferential and descriptive statistics by using Chi-Square test and student’s t-test (unpaired and paired) and software for analysis will be SPSS 22.0 version and Graph pad prism 6.0 version and level of significance will be considered as p<0.05 and results will be obtained. Conclusion: In male geriatric population, muscle strength training or electrotherapy can reduce urine incontinence.

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