scholarly journals Frailty and cognitive impairment: Unique challenges in the older emergency surgical patient

2016 ◽  
Vol 98 (03) ◽  
pp. 165-169 ◽  
Author(s):  
SJ Moug ◽  
M Stechman ◽  
K McCarthy ◽  
L Pearce ◽  
PK Myint ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Patient Outcomes ◽  
Early Recognition ◽  
Acute Onset ◽  
Surgical Patients ◽  
Surgical Patient ◽  
Research Areas ◽  
Hospital Stays ◽  
Short And Long Term

Introduction Older patients (>65 years of age) admitted as general surgical emergencies increasingly require improved recognition of their specific needs relative to younger patients. Two such needs are frailty and cognitive impairment. These are evolving research areas that the emergency surgeon increasingly requires knowledge of to improve short- and long-term patient outcomes. Methods This paper reviews the evidence for frailty and cognitive impairment in the acute surgical setting by defining frailty and cognitive impairment, introducing methods of diagnosis, discussing the influence on prognosis and proposing strategies to improve older patient outcomes. Results Frailty is present in 25% of the older surgical population. Using frailty-scoring tools, frailty was associated with a significantly longer hospital stay and higher mortality at 30 and 90 days after admission to an acute surgical unit. Cognitive impairment is present in a high number of older acute surgical patients (approximately 70%), whilst acute onset cognitive impairment, termed delirium, is documented in 18%. However, patients with delirium had significantly longer hospital stays and higher in-hospital mortality than those with cognitive impairment. Conclusions Improved knowledge of frailty and delirium by the emergency surgeon allows the specialised needs of older surgical patients to be taken into account. Early recognition, and consideration of minimally invasive surgery or radiological intervention alongside potentially transferable successful elective interventions such as comprehensive geriatric assessment, may help to improve short- and long-term patient outcomes in this vulnerable population.

Antagonism by modafinil of the psychomotor and cognitive impairment induced by sleep-deprivation in 12 healthy volunteers

1991 ◽  
Vol 6 (2) ◽  
pp. 93-97 ◽  
Author(s):  
G Bensimon ◽  
D Benoit ◽  
L Lacomblez ◽  
E Weiller ◽  
D Warot ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Sleep Deprivation ◽  
Healthy Volunteers ◽  
Controlled Study ◽  
Long Term Memory ◽  
Double Blind ◽  
Flicker Fusion Frequency ◽  
Short And Long Term ◽  
Psychotropic Compound

SummaryModafinil is a new psychotropic compound with central α1, adrenergic-stimulant activity in animals. In the present study, its pharmacological activity in man was evaluated in the sleep-deprivation induced psychomotor and cognitive impairment paradigm. This was a double-blind placebo-controlled study involving 12 healthy volunteers. Standard psychomotor and memory tasks were used, including critical flicker fusion frequency determination (CFF), choice reaction time and short- and long-term memory evaluation. Results revealed a clear antagonism by modafinil of the psychomotor and cognitive impairment induced by sleep-deprivation in most tasks 6 h after drug administration, and marginal effects 18 h after. These results therefore support a psychostimulant activity of modafinil in man.

scholarly journals Getting to the Heart of the Matter: An Overview of Cardiac Toxicity Related to Cancer Therapy

2015 ◽  
Vol 9s2 ◽  
pp. CMC.S19704 ◽  
Author(s):  
Carine E. Hamo ◽  
Michelle Weisfelner Bloom
Keyword(s):  
Radiation Therapy ◽  
Side Effects ◽  
Cancer Therapy ◽  
Patient Outcomes ◽  
Cancer Survival ◽  
Cardiac Toxicity ◽  
Early Recognition ◽  
Cancer Therapies ◽  
Cardiovascular Side Effects

With the improvement in cancer survival, long-term cardiotoxicity has become an area of increased interest. Various cancer therapies, including chemotherapy and radiation therapy can lead to cardiac toxicities with both acute and chronic manifestations. Awareness and early recognition can lead to improvement in cardiac survival and patient outcomes. The focus of this review is to summarize the cancer therapy agents most often associated with cardiovascular side effects, highlighting their mechanism of action and strategies for surveillance and prevention.

Intrathecal baclofen therapy and multiple sclerosis: outcomes and patient satisfaction

2006 ◽  
Vol 21 (2) ◽  
pp. E6 ◽  
Author(s):  
John R. Vender ◽  
Mary Hughes ◽  
Betsy D. Hughes ◽  
Sydney Hester ◽  
Stephen Holsenback ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Patient Outcomes ◽  
Test Dose ◽  
Intrathecal Baclofen ◽  
Response To Therapy ◽  
Intrathecal Baclofen Therapy ◽  
Short And Long Term ◽  
Term Response ◽  
Common Variable

ObjectIn this study the authors provide an assessment of intrathecal baclofen (ITB) therapy and evaluate patient outcomes and satisfaction.MethodsRecords for patients with multiple sclerosis who were selected as candidates for ITB therapy were reviewed for their response to test dose, surgical technique, surgery- and pump-related complications, and short- and long-term response to therapy. Family and caregiver assessments of the value of ITB therapy were also reviewed.ConclusionsIntrathecal baclofen therapy is safe and effective. Most patients and caregivers express satisfaction with the therapy and would recommend it to other patients. Spasm frequency appears to be the single most common variable positively affected by therapy.

scholarly journals 180 Cognitive disorders in takotsubo syndrome: incidence, short, and long term outcome. Results from a prospective multi-centre registry

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Adriana Mallardi ◽  
Francesco Santoro ◽  
Alessandra Leopizzi ◽  
Enrica Vitale ◽  
Massimo Iacoviello ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Old Age ◽  
Neurological Disorders ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Takotsubo Syndrome ◽  
Long Term Follow Up ◽  
Short And Long Term

Abstract Aims Takotsubo syndrome (TTS) is an acute and reversible left ventricular dysfunction, whose pathophysiological mechanisms are not completely known. There are evidence suggesting a possible link between neurological disease and TTS. Aim of the study was to evaluate incidence and prognostic value of cognitive neurological disorders among TTS patients. Methods and results 379 consecutive patients were enrolled in a prospective multicentre registry. History, clinical features, echocardiographic parameters, in-hospital complications and long-term Follow-up events of all patients were recorded. Cognitive neurological disorders included Alzheimer disease, old age dementia and cognitive impairment for other causes. Prevalence of cognitive neurological disorders among TTS patients was 5.5% (num = 21). Among this subset of patients 48% (num = 10) had Alzheimer syndrome, 24% (num = 5) old age dementia and 28% (num = 6) cognitive impairment for other causes. Compared to the control group, these patients were older (81 ± 5 vs. 71 ± 12, P = 0.01) and predominantly men (24% vs. 9%, P = 0.01). No differences in term of cardiovascular risk factors and left ventricular ejection fraction at admission and discharge were found among the two groups. TTS patients with cognitive neurological disorders experienced higher rate of in-hospital complications (62% vs. 28%, P = 0.01), that were mainly driven by higher rate of pulmonary oedema (14% vs. 9%, P = 0.01), cardiogenic shock (29% vs. 8%, P = 0.01), death (24% vs. 4% P = 0.01), ischaemic stroke (10% vs. 4%, P = 0.01), and left ventricular thrombi (10% vs. 3%, P = 0.01). At long-term follow-up patients with cognitive neurological disorders when compared to those without, experienced higher rate of mayor cardiovascular events (48% vs. 16%, P = 0.01), cardiovascular re-hospitalization (14% vs. 10%, P = 0.01) and death (43% vs. 9%, P = 0.01). Conclusions TTS patients with cognitive neurological disorders had an increased risk of in and out of hospital mayor cardiac adverse events and mortality at short and long-term follow-up.

Rethinking Sedation in the ICU

2014 ◽  
Author(s):  
Sinead Galvin ◽  
Lisa Burry ◽  
Sangeeta Mehta
Keyword(s):  
Mechanical Ventilation ◽  
Patient Outcomes ◽  
Critically Ill Patients ◽  
Randomized Trials ◽  
Drug Exposure ◽  
Pain Anxiety ◽  
Patient Interaction ◽  
Monitoring Strategies ◽  
Short And Long Term

Analgesic and sedative medications are commonly given to manage pain, anxiety, and delirium in critically ill patients; such agents are also used to facilitate painful procedures and to promote greater tolerance of mechanical ventilation. The manner in which we administer, titrate, and monitor analgesia and sedation in the ICU can have an impact on both short- and long-term patient outcomes. The benefit of sedation strategies that limit drug exposure and promote greater wakefulness and patient interaction has been demonstrated in several randomized trials. The overall objective of sedation in the ICU has changed, such that a calm, comfortable, awake, and interactive patient is the goal. This can be achieved using an individualized, restrictive, goal-directed, and protocolized approach to analgo-sedation. This chapter discusses specific medications for analgo-sedation, administration, and monitoring strategies, and how these strategies relate to delirium in the ICU.

scholarly journals The Association of Nurse–Physician Teamwork and Mortality in Surgical Patients

2019 ◽  
Vol 42 (4) ◽  
pp. 245-253
Author(s):  
Xiao Linda Kang ◽  
Heather M. Brom ◽  
Karen B. Lasater ◽  
Matthew D. McHugh
Keyword(s):  
Nursing Education ◽  
Patient Outcomes ◽  
Nurse Staffing ◽  
Surgical Patients ◽  
Surgical Patient ◽  
Failure To Rescue ◽  
Cross Sectional ◽  
Interprofessional Teamwork ◽  
Orthopedic Procedure ◽  
Education Levels

In this study we describe nurse–physician teamwork, estimate its association with surgical patient outcomes (30-day mortality and failure-to-rescue), and determine whether these relationships depend upon other modifiable hospital nursing characteristics (nurse staffing and education levels) known to be associated with patient outcomes. This cross-sectional analysis included linked data from 29,391 nurses representing 665 acute care hospitals and 1,321,904 adult patients who underwent a general surgical, vascular, or orthopedic procedure. Surgical patients cared for in hospitals with better nurse–physician teamwork had significantly lower odds of 30-day mortality (odds ratio [OR] = 0.95) and failure-to-rescue (OR = 0.95). In addition, the odds of death and failure-to-rescue were lower for patients in hospitals with both higher nurse–physician teamwork and more favorable patient-to-nurse staffing ratios. Similar trends were observed related to nursing education levels. Improving interprofessional teamwork is one strategy to improve patient outcomes with the added importance of also considering additional features of their nursing workforce.

Recent updates on biomarkers of exposure and systemic toxicity in e-cigarette users and EVALI

2021 ◽  
Author(s):  
Samantha R McDonough ◽  
Irfan Rahman ◽  
Isaac Kirubakaran Sundar
Keyword(s):  
Potential Toxicity ◽  
Regulatory Decision ◽  
Research Areas ◽  
Epigenetic Biomarkers ◽  
Biomarkers Of Exposure ◽  
Drastic Increase ◽  
Novel Biomarkers ◽  
Short And Long Term ◽  
Traditional Tobacco

Electronic nicotine delivery systems (ENDS), or e-cigarettes, are emerging tobacco products that produce aerosols by heating e-liquids, which most often consist of propylene glycol and vegetable glycerin along with various flavoring compounds, bypassing the combustion that occurs in the use of traditional tobacco cigarettes. These products have seen a drastic increase in popularity in recent years both as smoking cessation devices as well as among younger generations, due in large part to the widespread perception among consumers that e-cigs are significantly less harmful for health than traditional tobacco cigarettes. Due to the novelty of ENDS as well as their rapidly increasing use, research into biomarkers of e-cig exposure and toxicity have lagged behind their popularity, leaving important questions about their potential toxicity unanswered. Research into potential biomarkers of acute, chronic e-cig use and E-cigarette- or Vaping-Associated Lung Injury is necessary for informing both clinical and regulatory decision-making. We aim to provide an updated review of recent research into potential circulating, genomic, transcriptomic and epigenetic biomarkers of exposure to and toxicity of e-cigs. We additionally highlight research areas that warrant additional study to gain better understanding of health risks associated with ENDS use, as well as to provide validation of existing data and methods for measuring and analyzing e-cig-associated biomarkers in human and animal biofluids, tissues and cells. This review also highlights ongoing efforts within the WNY Center for Research on Flavored Tobacco for research into novel biomarkers in extracellular vesicles that may be associated with short- and long-term ENDS use.

Cognitive impairment assessment and interventions to optimize surgical patient outcomes

2020 ◽  
Vol 34 (2) ◽  
pp. 225-253
Author(s):  
Tasneem F. Hasan ◽  
Roger E. Kelley ◽  
Elyse M. Cornett ◽  
Richard D. Urman ◽  
Alan D. Kaye
Keyword(s):  
Cognitive Impairment ◽  
Patient Outcomes ◽  
Surgical Patient

scholarly journals Preventive effect of ursodeoxycholic acid on parenteral nutrition-associated liver disease in infants

2014 ◽  
Vol 142 (3-4) ◽  
pp. 184-188 ◽  
Author(s):  
Dusica Simic ◽  
Irina Milojevic ◽  
Dragana Bogicevic ◽  
Miodrag Milenovic ◽  
Vladimir Radlovic ◽  
...  
Keyword(s):  
Birth Weight ◽  
Parenteral Nutrition ◽  
Ursodeoxycholic Acid ◽  
Average Duration ◽  
Surgical Patients ◽  
Control Group ◽  
Surgical Patient ◽  
Significant Difference ◽  
The Difference

Introduction. Parenteral nutrition-associated cholestasis is well recognized phenomenon in the term and preterm infant receiving long-term parenteral nutrition. Objectives. The aim of this study was to evaluate the effect of ursodeoxycholic acid (UDCA) use on cholestasis in newborns on prolonged TPN. Methods. A total of 56 infants were enrolled in this retrospective study: control group consisted of lower (1500 g) birth weight infants (n=30), as well as the group of pediatric (n=11) and surgical patients (n=15) treated with UDCA. Blood chemistries were obtained two times weekly. Results. All of 56 newborns developed cholestasis but duration of parenteral nutrition (PN) before onset of cholestasis was significantly longer in UDCA treated patients. Average duration of PN before the onset of cholestasis in control group of patients was 25 days in distinction from treated pediatric and surgical patients (39 and 34 days, respectively). The peak serum conjugated bilirubin (CB), AST, ALT and alkaline phosphatase (AP) levels were significantly lower in the treated groups. There was no significant difference among treated pediatric and surgical patients and between lower and higher birth weight infants considering the CB, ALT, AST and AP peak. Duration of cholestasis was significantly decreased in all treated groups. There was a significant difference in time needed to achieve complete enteral intake between pediatric and surgical patient group. Conclusion. Cholestasis developed significantly later in treated groups than in the controls. UDCA appears to be very successful in reducing the symptoms of cholestasis. The difference in efficacy of UDCA treatment between lower and higher birth weight infants could not be proven.

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