Predicting Post-Discharge Outcome

1995 ◽  
Vol 58 (9) ◽  
pp. 370-372 ◽  
Author(s):  
J L Frankum ◽  
J Bray ◽  
M S Ell ◽  
I Philp
Keyword(s):  
Elderly Patients ◽  
Health Professionals ◽  
Elderly Care ◽  
Predictive Ability ◽  
Occupational Therapist ◽  
Successful Outcome ◽  
Post Discharge ◽  
Primary Nurse ◽  
High Level ◽  
Discharge From Hospital

The ability of members of the multidisciplinary team and of elderly patients themselves to predict how patients will cope at home influences the successful outcome of discharge from hospital. Following the introduction of structured assessment of the physical, psychological and social function of patients on an acute elderly care unit, a study was undertaken to compare the predictive ability of the primary nurse, the patient and the occupational therapist. Overall, results suggested a high level of accuracy of predictions. There was a trend for the occupational therapist to predict more accurately (83.6%) than the patient (80.7%) or the primary nurse (72.5%). Where the predictions were incorrect, the patients erred on the side of optimism (78% optimistic) whereas the nurses were more pessimistic (69% pessimistic). Further studies to look at the reliability of outcome predictions by health professionals and the patients themselves would be useful in the overall management of the discharge of elderly people from hospital.

scholarly journals Informing Discharge Plans. Assessments of Elderly Patients in Australian Public Hospitals: A Field Study

2004 ◽  
Author(s):  
Karen Grimmer ◽  
Esther May ◽  
Anna Dawson ◽  
Claudia Peoples
Keyword(s):  
Elderly Patients ◽  
Discharge Planning ◽  
Wound Care ◽  
Public Hospitals ◽  
Assessment Instruments ◽  
Assessment Practices ◽  
Post Discharge ◽  
Common Assessments ◽  
Discharge From Hospital ◽  
The Relationship

This paper describes assessment practices related to discharging elderly patients from Australian acute public hospitals. Common assessments were of cognition, continence, wound care, hygiene needs, nutrition, mobility and self-care. Nurses and social workers commonly took non-standardised assessment approaches, whilst therapists were more likely to use published assessment instruments. Patients’ perspectives were rarely incorporated into assessments. The relationship between many common assessment items and patients’ ability to manage safely after discharge from hospital was unclear. The validity of assessment items, the reliability with which assessments were taken, ‘normal’ variability in responses, and interpretation of instrument ‘scores’ with respect to post-discharge independence were rarely considered.This study highlighted the need to consider organisational and professional barriers to good discharge planning practices, the purpose, frequency, validity and accuracy of discharge-related assessments, patients’ and carers concerns, health professionals’ capacity, opportunity and commitment to share assessment findings relative to planning discharge.

scholarly journals Prediction of Post-Discharge Bleeding in Elderly Patients with Acute Coronary Syndromes: Insights from the BleeMACS Registry

2018 ◽  
Vol 118 (05) ◽  
pp. 929-938 ◽  
Author(s):  
Alberto Garay ◽  
Francesc Formiga ◽  
Sergio Raposeiras-Roubín ◽  
Emad Abu-Assi ◽  
José Sánchez-Salado ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Acute Coronary Syndromes ◽  
Predictive Ability ◽  
Roc Curves ◽  
Risk Scores ◽  
Bleeding Complications ◽  
Severe Bleeding ◽  
Post Discharge ◽  
Coronary Syndrome ◽  
Coronary Syndromes

Background A poor ability of recommended risk scores for predicting in-hospital bleeding has been reported in elderly patients with acute coronary syndromes (ACS). No study assessed the prediction of post-discharge bleeding in the elderly. The new BleeMACS score (Bleeding complications in a Multicenter registry of patients discharged with diagnosis of Acute Coronary Syndrome), was designed to predict post-discharge bleeding in ACS patients. We aimed to assess the predictive ability of the BleeMACS score in elderly patients. Methods We assessed the incidence and characteristics of severe bleeding after discharge in ACS patients aged ≥ 75 years. Bleeding was defined as any intracranial bleeding or bleeding leading to hospitalization and/or red blood transfusion, occurring within the first year after discharge. We assessed the predictive ability of the BleeMACS score according to age by Fine–Gray proportional hazards regression analysis, calculating receiver-operating characteristic (ROC) curves and the area under the ROC curves (AUC). Results The BleeMACS registry included 15,401 patients of whom 3,376/15,401 (21.9%) were aged ≥ 75 years. Elderly patients were more commonly treated with clopidogrel and less often treated with ticagrelor or prasugrel. Of 3,376 elderly patients, 190 (5.6%) experienced post-discharge bleeding. The incidence of bleeding was moderately higher in elderly patients (hazard ratio [HR], 2.31, 95% confidence interval [CI], 1.92–2.77). The predictive ability of the BleeMACS score was moderately lower in elderly patients (AUC, 0.652 vs. 0.691, p = 0.001). Conclusion Elderly patients with ACS had a significantly higher incidence of post-discharge bleeding. Despite a lower predictive ability in older patients, the BleeMACS score exhibited an acceptable performance in these patients.

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).

Paediatric post-discharge pain and parent perceptions of support from an Australian nurse practitioner led acute pain service

2021 ◽  
pp. 136749352110147
Author(s):  
Elizabeth M. Forster ◽  
Catherine Kotzur ◽  
Julianne Richards ◽  
John Gilmour
Keyword(s):  
Pain Management ◽  
Acute Pain ◽  
Nurse Practitioner ◽  
Parental Support ◽  
Transition Period ◽  
Short Form ◽  
Acute Pain Service ◽  
Cross Sectional Survey ◽  
Post Discharge ◽  
Discharge From Hospital

Poorly managed post-operative pain remains an issue for paediatric patients. Post-discharge telephone follow-up is used by an Australian Nurse Practitioner Acute Pain Service (NpAPS) to provide access to effective pain management post-discharge from hospital. This cross-sectional survey design study aimed to determine the pain levels of children following discharge and parent views on participation in their child’s pain management and perceptions of support from the NpAPS. Parents completed the Parents’ Postoperative Pain Measure–Short Form (PPPM-SF) and factors affecting parents’ participation in children’s pain management questionnaire (FPMQ). Results indicated that pain score was high, especially on the day of discharge and 24 hours post-discharge. Parents, despite feeling supported by the NpAPS, experienced uncertainty, emotional responses and expressed concerns about communication and coordination of care. The clinically significant pain levels of the majority of children on the day of discharge and day post-discharge from hospital are a concern. Worry and uncertainty among parents, particularly on the day and first night of discharge, suggest this transition period where responsibility of clinical management of pain is handed over to parents may require greater focus for parental support.

scholarly journals A cohort study of survival following discharge from hospital in rural Tanzanian children using linked data of admissions with community-based demographic surveillance

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Oscar Mukasa ◽  
Honorati Masanja ◽  
Don DeSavigny ◽  
Joanna Schellenberg
Keyword(s):  
Linked Data ◽  
Cox Regression ◽  
District Hospital ◽  
Rural Setting ◽  
Post Discharge ◽  
Community Based ◽  
Related Data ◽  
Clinical Surveillance ◽  
Additional Support ◽  
Discharge From Hospital

Abstract Background To illustrate the public health potential of linking individual bedside data with community-based household data in a poor rural setting, we estimated excess pediatric mortality risk after discharge from St Francis Designated District Hospital in Ifakara, Tanzania. Methods Linked data from demographic and clinical surveillance were used to describe post-discharge mortality and survival probability in children aged < 5 years, by age group and cause of admission. Cox regression models were developed to identify risk factors. Results Between March 2003 and March 2007, demographic surveillance included 28,910 children aged 0 to 5 years and among them 831 (3%) were admitted at least once to the district hospital. From all the children under the demographic surveillance 57,880 person years and 1381 deaths were observed in 24 months of follow up. Survivors of hospital discharge aged 0–5 years were almost two times more likely to die than children of the same age in the community who had not been admitted (RR = 1.9, P < 0.01, 95% CI 1.6, 2.4). Amongst children who had been admitted, mortality rate within a year was highest in infants (93 per 1000 person years) and amongst those admitted due to pneumonia and diarrhoea (97 and 85 per 1000 person years respectively). Those who lived 75 km or further from the district hospital, amongst children who were admitted and survived discharge from hospital, had a three times greater chance of dying within one year compared to those living within 25 km (adjusted HR 3.23, 95% CI 1.54,6.75). The probability of surviving the first 30 days post hospitalization was 94.4% [95% CI 94.4, 94.9], compared to 98.8% [95% CI 97.199.5] in non-hospitalized children of the same age in the commuity. Conclusion This study illustrates the potential of linking health related data from facility and household levels. Our results suggest that families may need additional support post hospitalization.

scholarly journals Ventilatory defects and treatable traits in very elderly patients

2021 ◽  
Vol 104 (2) ◽  
pp. 003685042110131
Author(s):  
João Gaspar-Marques ◽  
Teresa Palmeiro ◽  
Iolanda Caires ◽  
Paula Leiria Pinto ◽  
Nuno Neuparth ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Elderly Patients ◽  
Elderly Care ◽  
Airflow Limitation ◽  
The Novel ◽  
Z Score ◽  
Very Elderly ◽  
Chronic Respiratory Diseases ◽  
Novel Association ◽  
Peripheral Pulse

Though the approach used to classify chronic respiratory diseases is changing to a treatable-traits (TT) approach, data regarding very elderly patients is lacking. The objectives of this study were to assess TT frequency in very elderly patients and to study the link between extrapulmonary TT and ventilatory defects. Individuals (≥75 years) residing in elderly care centres answered a standardised questionnaire, underwent spirometry, atopy and fractional exhaled nitric oxide assessments and had their blood pressure and peripheral pulse oximetry measured. Pulmonary, extrapulmonary and behavioural TT were evaluated. Outcome variables were an airflow limitation (post-bronchodilator z-score FEV1/FVC<−1.64) and a restrictive spirometry pattern (z-score FEV1/FVC ≥ +1.64 and z-score FVC<−1.64). Seventy-two percent of the individuals who took part in the study ( n = 234) were women, and the median age of participants was 86 (IQR: 7.4). At least one pulmonary TT was identified in 105 (44.9%) individuals. The most frequent extrapulmonary TTs were: persistent systemic inflammation (47.0%), anaemia (34.4%), depression (32.5%) and obesity (27.4). Airflow limitation was exclusively associated with smoking (OR 5.03; 95% CI 1.56–16.22). A restrictive spirometry pattern was associated with cognitive impairment (OR: 3.89; 95% CI: 1.55–9.79). A high frequency of various TTs was found. The novel association between a restrictive spirometry pattern and cognitive impairment highlights the urgency of clinical research on this vulnerable age group.

scholarly journals Management of the Crooked Nose

2016 ◽  
Vol 7 (3) ◽  
pp. 168-172
Author(s):  
Jessica W Scordino ◽  
Frederick J Stucker
Keyword(s):  
Surgical Techniques ◽  
Successful Outcome ◽  
Open Approach ◽  
Form And Function ◽  
Crooked Nose ◽  
Self Image ◽  
Level Of Satisfaction ◽  
High Level ◽  
And Function ◽  
Nasal Function

ABSTRACT Aim: To describe an approach for the diagnosis and management of patients presenting with crooked nose. Background Patients with crooked nose suffer from functional ailments, most significant nasal obstruction, as well as esthetic concerns which may impact their self-image as well as others’ perception of them. As such, management of the crooked nose is an especially challenging task in that it demands careful attention to both nasal function and appearance. There are a plethora of surgical techniques which may be utilized, and the surgeon's approach must be tailored to each individual patient's presentation. Technique Accurate diagnosis is imperative for a successful outcome and relies on a thorough history and careful physical examination. Surgical intervention may be addressed by either an endonasal or open approach based on the location and severity of the deformity. It is helpful to break down the nose in vertical thirds when planning your surgical approach. Different techniques are used to address the upper third comprising the nasal bones, middle third composed of the upper lateral cartilages and septum, and the lower third composed of the lower lateral cartilages and caudal septum. Conclusion Management of the crooked nose is a technically challenging endeavor that highlights the need to address both form and function for a successful outcome. Effective treatment can significantly improve a patient's quality of life leading to a high level of satisfaction for both the patient and the surgeon. How to cite this article Scordino JW, Stucker FJ. Management of the Crooked Nose. Int J Head Neck Surg 2016;7(3):168-172.

scholarly journals Population Ageing and Its Challenges: Filial Responsibilities for Elderly Parents in Lithuania

2013 ◽  
Vol 52 (1) ◽  
pp. 22-33
Author(s):  
Margarita Gedvilaitė-Kordušienė
Keyword(s):  
Elderly Care ◽  
The Elderly ◽  
Demographic Ageing ◽  
Elderly Parents ◽  
Financial Difficulties ◽  
Working Lives ◽  
Structure Changes ◽  
Working Age ◽  
And Gender ◽  
High Level

The paper addresses the questions of demographic ageing at the beginning of the 21st century and the attitudes about who should be responsible for the elderly care in Lithuania. The analysis of age structure changes revealed three ways of demographic ageing: ‘from below’ (the youngest part of the population is decreasing), ‘from above’ (the oldest part of the population is increasing), and decrease of the young working-age population. The analysis of ageing in Lithuania in the context of the EU revealed that Lithuania has moved from the group of the demographically youngest countries to the group of the oldest ones. This has happened in one decade and illustrates rapid ageing in Lithuania. Within such context, the question “Who should be responsible for the elderly care?” is of particular importance. Based on the second wave of the Generations and Gender Survey (conducted in 2009), the responses who should take care of the elderly are contradictory. The biggest part of respondents is in favour of the division of responsibilities for the elderly care between family and society. The same part of respondents considers this to be family responsibility. Meanwhile, financial support is mainly considered to be the responsibility of the society. The analysis of filial responsibilities for elderly parents revealed a high level of normative solidarity. Most respondents agree with the statement where the support type for elderly parents is not defined (i.e. that children should take responsibility for caring for their parents when parents are in need). When the types of support are defined, the respondents are also likely to agree (i.e. children ought to provide financial help for their parents when their parents are having financial difficulties; children should have their parents to live with them when parents can no longer look after themselves). Less agreement was found on the statement requiring the reorganisation of children’s lives in order to fulfil filial responsibilities (i.e. that children should adjust their working lives to the needs of their parents) and on the statement measuring gender division in care provision for elderly parents (i.e. when parents are in need, daughters should take more caring responsibility than sons). The differences in attitudes between children’s, parents’ and grandparents’ generations were not statistically significant. The logistic regressions revealed that significant predictors enhancing the chances of agreement on filial responsibilities are respondents’ gender, age, partnership and occupational statuses and type of residential area.

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