Bilateral Inferior Altitudinal Defects Secondary to Stroke: A Case Series

2015 ◽  
Vol 77 (3) ◽  
pp. 23
Author(s):  
Stacey Chong ◽  
Tammy :abreche ◽  
Patricia Hrynchak ◽  
Michelle Steenbakkers
Keyword(s):  
Newborn Infants ◽  
Case Series ◽  
Care Facility ◽  
The Elderly ◽  
The United States ◽  
Visual Field Defects ◽  
Term Care ◽  
Long Term Care Facility ◽  
Risk Of Death ◽  
Increased Risk

Strokes or cerebrovascular accidents are the third leading cause of death in Canada, comprising 6% of all deaths in the country.1 The elderly and the very young (fetus or newborn infants) are at highest risk for having a stroke with an associated increased risk of death or lasting neurological disability. According to the National Stroke Association recovery guidelines, 10% of stroke survivors will recover almost completely, 25% will recover with minor impairments, 40% will survive with moderate to severe impairments that require specialized care, 10% will require care in a long-term care facility, and 15% will die shortly after the stroke. The National Stroke Association estimates that there are 7 million people in the United States that have survived a stroke and are living with impairments. The Heart and Stroke Foundation’s 2013 Stroke Report has estimated that 315,000 Canadians are living with the effects of stroke. This case series serves as a reminder that, although rare, bilateral inferior altitudinal visual field defects can also occur as the result of a stroke, to highlight the difficulties of orientation and mobility that can result, and to offer potential rehabilitative strategies.

scholarly journals 1824. Herpes Simplex Encephalitis: Outcomes from a 10-Year Retrospective Single-Center Case Series

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S39-S40
Author(s):  
Christina A Snider ◽  
Jona Banzon ◽  
Adarsh Bhimraj ◽  
Gary W Procop ◽  
Johanna Goldfarb
Keyword(s):  
Overall Survival ◽  
Herpes Simplex ◽  
Cleveland Clinic ◽  
Case Series ◽  
Care Facility ◽  
The United States ◽  
Initial Symptom ◽  
Term Care ◽  
Risk Of Death

Abstract Background Herpes simplex virus (HSV) is the most common cause of infectious encephalitis in the United States. While early treatment with acyclovir has improved acute management, long-term morbidity and mortality remain high and warrant further characterization. Methods We retrospectively identified adult patients (≥18 years) with HSE admitted to the Cleveland Clinic Main Campus and affiliated regional hospitals from April 2006 to June 2016. HSE diagnosis was concordant with Infectious Disease Society of America Encephalitis Guidelines. HSE diagnosis was confirmed in that HSV-1 DNA was detected in cerebrospinal fluid (CSF) by polymerase chain reaction (PCR) assay for all patients included in this study. Patients for which HSV-2 was detected in the CSF were excluded to avoid inclusion of HSV meningitis. Clinical information was collected in a REDCap database and analyzed by descriptive statistics. Patients were indexed at the date of admission, and Kaplan–Meier analysis was used to estimate overall survival. Results We identified 32 patients with confirmed HSE. The median patient age was 62 years (interquartile range [IQR] 45–72). All patients received treatment with intravenous (IV) acyclovir, with a median treatment duration of 24 days (IQR 19–30). The median time from initial symptom onset to IV acyclovir treatment was 5 days (IQR 3–8). Three patients (9%) died during the hospitalization course, 16 (50%) were discharged to a nursing facility, 11 (35%) returned home, and two (6%) transitioned to an acute care facility (Figure 1). Within three months of discharge, 15 (47%) patients were readmitted, six (19%) of which readmitted for HSE relapse. The overall survival rate at one month was 84% and 74% at 12 months (Figure 2). At outpatient follow-up, cognitive deficits were self-reported by 19 (66%) patients, followed in frequency by motor (31%) and sensory deficits (7%). Conclusion Despite appropriate treatment with IV acyclovir, HSE survivors frequently experienced severe morbidities after initial hospitalization, including HSE relapse, discharge to long-term care facilities, and neurocognitive impairment. Risk of death was highest within one month of admission. Further investigation is needed to optimize treatment of HSE to improve mortality and to reduce permanent neurologic deficits. Disclosures All Authors: No reported Disclosures.

scholarly journals A pulmonary tuberculosis outbreak in a long-term care facility

2015 ◽  
Vol 144 (7) ◽  
pp. 1455-1462 ◽  
Author(s):  
C.-C. LAI ◽  
Y.-C. HSIEH ◽  
Y.-P. YEH ◽  
R.-W. JOU ◽  
J.-T. WANG ◽  
...  
Keyword(s):  
Long Term Care ◽  
Latent Tuberculosis ◽  
Care Facility ◽  
The Elderly ◽  
Term Care ◽  
Ltbi Treatment ◽  
Long Term Care Facility ◽  
Increased Risk ◽  
Care Facilities

SUMMARYIn long-term care facilities (LTCFs), the elderly are apt to be infected because those with latent tuberculosis infections (LTBIs) are at an increased risk for reactivation and post-primary TB disease. We report an outbreak of TB in staff and residents in a LTCF. An outbreak investigation was conducted after two TB cases were reported from the LTCF. A tuberculin skin test (TST), bacteriological examination and chest radiograph were administered to all facility staff and residents. An outbreak is defined as at least two epidemiologically linked cases that have identicalMycobacterium tuberculosisgenotype isolates. This outbreak infected eight residents and one staff member, who were confirmed to have TB in a LTCF between September 2011 and October 2012. Based on the Becker method, the latent and infectious periods were estimated at 223·6 and 55·9 days. Two initial TST-negative resident contacts were diagnosed as TB cases through comprehensive TB screening. Observing elderly people who have a negative TST after TB screening appears to be necessary, given the long latent period for controlling a TB outbreak in a LTCF. It is important to consider providing LTBI treatment for elderly contacts.

scholarly journals 1416. Medicare Spending on Urinary Tract Infections: A Retrospective Database Analysis

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S793-S793
Author(s):  
Kate Sulham ◽  
Eric Hammelman
Keyword(s):  
Care Facility ◽  
The Elderly ◽  
The United States ◽  
Fee For Service ◽  
Multicenter Cohort Study ◽  
Term Care ◽  
Long Term Care Facility ◽  
Home Based ◽  
Tract Infections ◽  
Medicare Spending

Abstract Background Medical visits for UTIs represent 1%-6% of all healthcare visits (~7 million visits) and are estimated to cost the United States (US) healthcare system at least &1.6 billion annually. UTIs are associated with significant morbidity; particularly among the elderly, where UTIs are most prevalent. Little is known about the specific costs to Medicare of UTI; here, we seek to examine overall Medicare spending on UTI. Methods We conducted a retrospective multicenter cohort study of the Medicare fee-for-service (FFS) data. Patients were included for analysis if the following criteria were met: (1) enrolled in Medicare FFS from January 1, 2016 through December 31, 2019, (2) not enrolled in Medicare Advantage during that time period, (3) did not have any UTI diagnoses in 2016, and (4) enrolled in Medicare Part D. Individuals were categorized as having uncomplicated UTI (uUTI), complicated UTI (cUTI), or those who first had a uUTI that progressed to a cUTI (uUTI to cUTI). Medicare spending in the 12 months post-diagnosis was calculated, and patients were stratified by home- or institutionally-based (eg, nursing home, long-term care facility, etc.). Results 2,330,123 patients were included for analysis; 92% were home-based, 8% were institutionally-based. Mean Charlson Comorbidity Index (CCI) across all patients was 2.16. In the 12 months after initial diagnosis, average Medicare spend was &33,984, &9,941 of which was UTI-related. Annual UTI-related costs were approximated &9,000 for home-based vs. &21,444 for institutionally-based patients. Mean drug spend per patient on antibiotics was &872. Broadly, uUTI patients were least expensive, followed by cUTI patients, with uUTI to cUTI patients being most expensive. Higher costs for were observed for institutionally-based patients, largely due to more frequent acute hospitalizations and more Part A-paid skilled nursing stays. Conclusion UTI-related spending represents approximately one-third of total annual Medicare spend for patients diagnosed with a UTI. Given average Medicare spending of approximately &12,000 per person in 2019, UTI is associated with substantially increased per patient cost and represents a significant source of spending for Medicare. Disclosures Kate Sulham, MPH, Spero Therapeutics (Consultant) Eric Hammelman, MBA, AbbVie Pharmaceuticals (Consultant)Edwards Lifesciences (Consultant)Genentech (Consultant)Spero Therapeutics (Consultant)Vertex Pharmaceuticals (Consultant)

scholarly journals COVID-19 vaccine prioritization of incarcerated people relative to other vulnerable groups: An analysis of state plans

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0253208
Author(s):  
Rachel Strodel ◽  
Lauren Dayton ◽  
Henri M. Garrison-Desany ◽  
Gabriel Eber ◽  
Chris Beyrer ◽  
...  
Keyword(s):  
Phase 1 ◽  
Care Facility ◽  
Document Analysis ◽  
Health Department ◽  
The United States ◽  
Vulnerable Groups ◽  
Term Care ◽  
Long Term Care Facility ◽  
Increased Risk ◽  
Allocation Plans

Background Carceral facilities are epicenters of the COVID-19 pandemic, placing incarcerated people at an elevated risk of COVID-19 infection. Due to the initial limited availability of COVID-19 vaccines in the United States, all states have developed allocation plans that outline a phased distribution. This study uses document analysis to compare the relative prioritization of incarcerated people, correctional staff, and other groups at increased risk of COVID-19 infection and morbidity. Methods and findings We conducted a document analysis of the vaccine dissemination plans of all 50 US states and the District of Columbia using a triple-coding method. Documents included state COVID-19 vaccination plans and supplemental materials on vaccine prioritization from state health department websites as of December 31, 2020. We found that 22% of states prioritized incarcerated people in Phase 1, 29% of states in Phase 2, and 2% in Phase 3, while 47% of states did not explicitly specify in which phase people who are incarcerated will be eligible for vaccination. Incarcerated people were consistently not prioritized in Phase 1, while other vulnerable groups who shared similar environmental risk received this early prioritization. States’ plans prioritized in Phase 1: prison and jail workers (49%), law enforcement (63%), seniors (65+ years, 59%), and long-term care facility residents (100%). Conclusions This study demonstrates that states’ COVID-19 vaccine allocation plans do not prioritize incarcerated people and provide little to no guidance on vaccination protocols if they fall under other high-risk categories that receive earlier priority. Deprioritizing incarcerated people for vaccination misses a crucial opportunity for COVID-19 mitigation. It also raises ethical and equity concerns. As states move forward with their vaccine distribution, further work must be done to prioritize ethical allocation and distribution of COVID-19 vaccines to incarcerated people.

scholarly journals FEDERAL POLICY SUPPORTS AND GAPS IN ADDRESSING RACIAL-ETHNIC HEALTH DISPARITIES IN U.S. LONG-TERM CARE FACILITIES

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S161-S161
Author(s):  
Rebecca L Mauldin ◽  
Kathy Lee ◽  
Antwan Williams
Keyword(s):  
Long Term Care ◽  
Federal Policy ◽  
Care Facility ◽  
Well Being ◽  
The United States ◽  
Term Care ◽  
Long Term Care Facility ◽  
Care Facilities

Abstract Older adults from racial and ethnic minority groups face health inequities in long-term care facilities such as nursing homes and assisted living facilities just as they do in the United States as a whole. In spite of federal policy to support minority health and ensure the well-being of long-term care facility residents, disparities persist in residents’ quality of care and quality of life. This poster presents current federal policy in the United States to reduce racial and ethnic health disparities and to support long-term care facility residents’ health and well-being. It includes legislation enacted by the Patient Protection and Affordable Care Act of 2010 (ACA), regulations of the U.S. Department of Health and Human Services (DHHS) for health care facilities receiving Medicare or Medicare funds, and policies of the Long-term Care Ombudsman Program. Recommendations to address threats to or gaps in these policies include monitoring congressional efforts to revise portions of the ACA, revising DHHS requirements for long-term care facilities staff training and oversight, and amending requirements for the Long-term Care Ombudsman Program to mandate collection, analysis, and reporting of resident complaint data by race and ethnicity.

Abstract T P405: Improvement in Midline Shift is Associated with Survival After Decompressive HemiCraniectomy in Large Hemispheric Infarctions

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Joanna I Ramiro ◽  
Rajat Dhar ◽  
Eli Feen ◽  
Abhay Kumar
Keyword(s):  
Hospital Mortality ◽  
Care Facility ◽  
Imaging Data ◽  
Midline Shift ◽  
Term Care ◽  
Nihss Score ◽  
Decompressive Hemicraniectomy ◽  
Long Term Care Facility ◽  
Risk Of Death ◽  
Neuro Imaging

Background and Purpose: It remains uncertain which patients with malignant edema after large hemispheric infarction (LHI) remain at risk of death despite decompressive hemicraniectomy (DHC). We investigated factors associated with in-hospital mortality in a cohort of patients with LHI who underwent DHC. Methodology: This retrospective cohort study conducted over a five-year period identified 24 LHI patients who underwent DHC. Patient demographics, pre- and post-DHC clinical and neuro-imaging data were recorded (including midline shift [MLS] at the level of lateral ventricles). These variables were then analyzed in relation to in-hospital mortality. Results: Patients were predominantly male (17/24), with mean age of 55±15 years and baseline NIHSS score of 18.5± 4. Despite DHC, performed at a median of 52 hours, mortality still occurred in 9 patients (38%), with 11 (46%) going to acute rehabilitation and remainder to long-term care facility (LTC). Patients had a mean pre-operative MLS of 11 ± 3 mm. When compared with a head CT obtained 48 hours after DHC, MLS improved the most in patients going to rehabilitation (by 6 ± 4.2 mm), compared to those going to LTC (3.2 ± 5 mm), while the least improvement was seen in those who died (1 ± 5 mm). Survivors had significant improvement in MLS (5.3 ± 4.4 mm) compared to the non-survivors (1 ± 5 mm), p = 0.04. The survivors were also significantly younger (50 ± 17 years) compared to those who died (62 ± 7 years). Thirteen patients (54% of the cohort) received intracranial pressure (ICP) monitors ipsilateral to the infarct during DHC but measured ICPs were statistically similar in survivors vs non-survivors. Other variables (baseline NIHSS score, MLS and time to surgery) did not predict death in the cohort. Conclusion: Mortality remains high in LHI patients even after DHC. Improvement in MLS after DHC appears to separate survivors from non-survivors while post-DHC ICPs do not. However, our sample size is small and additional studies with larger population sizes are required for validation of our findings.

scholarly journals Silencing and Silence: Language and Specialized Listening in a Long-Term Institution for the Elderly

2020 ◽  
pp. 1-9
Author(s):  
Simone Maximo Pelis ◽  
Nirvana Ferraz Santos Sampaio
Keyword(s):  
Long Term Care ◽  
Care Facility ◽  
The Elderly ◽  
Term Care ◽  
Term Care Facility ◽  
Long Term Care Facility ◽  
Methodological Perspective ◽  
Alternative System

This article presents the result of research developed with the language of elderly residents at the Long Term Care Facility for the Elderly - ILPI, in Vitória da Conquista, Bahia, Brazil. In response to the initial questions as to whether institutionalization affects the language of the elderly, whether the re-signification of verbal by non-verbal speech occurs, and whether silence, as language is part of an alternative system of possible meaning for the elderly, it was perceived that language in institutionalized long-lived individuals it reveals that in response to diversified processes of silencing, they have instituted silence as a possibility of reframing, and structuring of meaning. We collected data through the filming and recording of the elderly in enunciative-discursive situations, considering the uniqueness of each subject's history and their respective crossings as well as the condition of production of the narratives based on the concept of data-finding by Maria HadlerCoudry (1), aligned with notions relevant to Linguistics in the theoretical-methodological perspective of Discursive Neurolinguistics.

scholarly journals 972. Asymptomatic Carriage of Clostridiodes difficile and Risk of Subsequent Infection

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S38-S38
Author(s):  
Katrina Espiritu ◽  
Michael Vernon ◽  
Donna Schora ◽  
Lance Peterson ◽  
Kamaljit Singh
Keyword(s):  
Care Facility ◽  
The United States ◽  
Term Care ◽  
Asymptomatic Carriers ◽  
Long Term Care Facility ◽  
Patient Demographics ◽  
Asymptomatic Carriage ◽  
Admission Screening ◽  
History Of ◽  
Healthcare Associated

Abstract Background C. difficile is one of the most common healthcare-associated infections in the United States. Studies of patients with asymptomatic carriage of toxigenic C. difficile have reported conflicting results on the risk of subsequent C. difficile infection (CDI). Older studies suggest that the risk was low and colonization may be protective. Subsequent studies indicate that asymptomatic carriers have a 6-fold greater risk of developing CDI. The aims of our study were to assess the burden of asymptomatic C. difficile carriage and risk of subsequent CDI. Methods Adult inpatients at NorthShore University HealthSystem, Illinois hospitals between August 1, 2017 and February 28, 2018 were eligible for the study. Focused admission screening of patients at high risk of C. difficile carriage was performed: (1) history of CDI or colonization, (2) prior hospitalization past 2 months, or (3) admission from a long-term care facility. A rectal swab was collected and tested using the cobas® Cdif Test (Roche) real-time PCR. The development of hospital onset CDI (HO-CDI) in colonized patients was monitored prospectively for at least 2 months. HO-CDI testing of colonized patients was performed using the Cepheid GeneXpert RT-PCR. HO-CDI was defined as patients hospitalized for at least 72 hours with 3 or more episodes of diarrhea/24 hours, in the absence of other potential causes of diarrhea. Patient demographics were collected using a standardized form and data analyzed using VassarStats. Results There were 6,104 patients enrolled in the study and 528 (8.7%) were positive on admission for toxigenic C. difficile carriage. The mean age of colonized patients was 75.5 years (range 24–103) and 56.4% (298 patients) were females. Of 528 colonized patients, 21 (4%) had a positive CDI test. A total of 7 patients (1.3%) developed HO-CDI. Mean time to positive HO-CDI was 46.1 days (range 5–120 days). Of 5,576 patients that were negative for C difficile carriage on admission, 14 (0.3%) patients developed HO-CDI. The relative risk of HO-CDI was 5.28 (95% CI: 2.14–13.03, P = 0.05). Conclusion We found that 8.7% of at-risk admissions were asymptomatic toxigenic C. difficile carriers. While only 1.3% developed HO-CDI, asymptomatic carriers had a 5 times higher risk of subsequent CDI compared with non-carriers. Disclosures All authors: No reported disclosures.

Palliative Management of Parkinson Disease: Focus on Nonmotor, Distressing Symptoms

2008 ◽  
Vol 21 (4) ◽  
pp. 262-272 ◽  
Author(s):  
Jack J. Chen ◽  
Dominick P. Trombetta ◽  
Hubert H. Fernandez
Keyword(s):  
Parkinson Disease ◽  
Long Term Care ◽  
Functional Dependence ◽  
Care Facility ◽  
The United States ◽  
Elderly Persons ◽  
Motor Complications ◽  
Term Care ◽  
Increased Risk

Parkinson disease is a progressive neurodegenerative disease that commonly affects elderly persons. In the absence of neuroprotective or curative therapies, currently available therapies only provide symptomatic benefit. Progression to advanced Parkinson disease is often accompanied by functional dependence with increased risk of admission to a long-term care facility. The prevalence of Parkinson disease in long-term care facilities, within the United States, has been estimated to be between 5.2% and 10%. Patients with advanced Parkinson disease also experience other distressing motor and nonmotor conditions, such as motor complications, dementia, depression, gastrointestinal distress, orthostatic hypotension, pain, and psychosis, which can be a challenge for clinicians to manage. The presence of distressing symptoms along with the fact that Parkinson disease remains incurable necessitate discussion on a palliative care approach to this disorder. This article discusses the symptomatic management of distressing symptoms encountered in the long-term care resident with Parkinson disease, including motor complications and nonmotor features.

Geriatric Teams in the Long-term Care Facility

1988 ◽  
Vol 1 (3) ◽  
pp. 195-201
Author(s):  
Ruthanne R. Ramsey
Keyword(s):  
Health Care ◽  
Long Term Care ◽  
Care Delivery ◽  
Care Facility ◽  
The Elderly ◽  
Term Care ◽  
Term Care Facility ◽  
Long Term Care Facility ◽  
Inpatient Settings

Geriatric teams have emerged as an accepted method of health care delivery to the elderly patient in ambulatory and acute inpatient settings. As one model of specialized health care teams, geriatric teams vary in structure, membership, and type. The purposes may be diverse, ranging from providing primary care to multidimensional functional and diagnostic assessment. Geriatric teams have convincingly demonstrated benefit to the care of the elderly. Overcoming significant barriers to their formation, geriatric teams are beginning to develop in long-term care facilities as a result of economic and educational pressures. However, the unique environment and needs of the long-term care facility have resulted in differences in leadership, membership, and structure of long-term care teams. Pharmacist involvement in the long-term care geriatric team could benefit the facility, patient care, and the profession. The key to future involvement by pharmacists in teams appears to depend on their interest, ability to acquire necessary skills, and demonstration of unique professional contributions.

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