The Impact of Aged Patients on Hospital Use and Income

: In recent years, the development of Assisted Reproductive Technique, the egg and embryo donation changed substantially the role of the uterus in recent years. It provided a higher chance for a pregnancy even in women over 45 years or post-menopause. In fact, the number of aged patients and in peri/post-menopause in pregnancy is nowadays increasing, but it increases obstetrical and neonatal related problems. The human uterus is richly innervated and modified especially during pregnancy and labor, and it is endowed with different sensory, parasympathetic, sympathetic and peptidergic neurofibers. They are differently distributed in uterine fundus, body and cervix, and they are mainly observed in the stroma and around arterial vessel walls in the myometrial and endometrial layers. Many neurotransmitters playing important roles in reproductive physiology are released after stimulation by adrenergic or cholinergic nerve fibers (the so called sympathetic/parasympathetic co-transmission). Immunohistochemical study demonstrated the localization and quantitative distribution of neurofibers in the fundus, the body and cervix of young women of childbearing age. : Adrenergic and cholinergic effects of the autonomous nervous system are the most implicated in the uterine functionality. In such aged women, the Adrenergic and AChE neurofibers distribution in the fundus, body and cervix is progressively reduced by increasing age. Adrenergic and AChE neurotransmitters were closely associated with the uterine arteries and myometrial smooth muscles, and they reduced markedly by ageing. The Adrenergic and AChE neurofibers decreasing has a dramatical and negative impact on uterine physiology, as the reduction of pregnancy chance and uterine growth, and the increase of abortion risk and prematurity.

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The impact of services quality on patient trust and satisfaction for aged patients

Advances in Usability Evaluation Part II ◽

10.1201/b12324-31 ◽

2012 ◽

pp. 272-279

Keyword(s):

Services Quality ◽

Patient Trust ◽

Aged Patients ◽

The Impact

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Hematogenous thrombophilia as an additional risk factor for cerebral circulation disorders

Тромбоз, гемостаз и реология ◽

10.25555/thr.2021.4.0996 ◽

2021 ◽

Author(s):

И.В. Куртов ◽

С.П. Кривова ◽

Р.К. Хайретдинов ◽

И.Л. Давыдкин

Keyword(s):

Risk Factor ◽

Factor Viii ◽

Blood Coagulation ◽

Genetic Polymorphisms ◽

Additional Risk Factor ◽

Factor Viii Level ◽

Aged Patients ◽

Additional Risk ◽

Viii Level ◽

The Impact

Введение. Гематогенная тромбофилия служит дополнительным фактором риска нарушений мозгового кровообращения (НМК). Цель исследования: изучить влияние повышенного уровня фактора VIII и нарушений в системе фибринолиза на НМК у пациентов с сочетанной патологией системы свертывания крови. Материалы и методы. Обследовано 20 пациентов с перенесенными ишемическими инсультами в возрасте от 36 до 56 лет. Определяли показатели плазменного, тромбоцитарного звеньев гемостаза, системы фибринолиза, а также генетические полиморфизмы системы гемостаза. Результаты. У всех пациентов выявлены различные сочетания генетических полиморфизмов, связанных с изменениями антикоагулянтного звена гемостаза, а также дефекты системы фибринолиза и коагуляционного звена гемостаза, что является дополнительным фактором риска НМК. Заключение. У пациентов молодого и среднего возраста, перенесших острое НМК по ишемическому типу, необходимо исследование системы свертывания крови, включающее определение содержания фактора VIII в крови, показателей системы фибринолиза и уровня гомоцистеина. Background. Hematogenous thrombophilia is an additional risk factor for cerebral circulatory disorders (ССD). Objectives: to study the impact of increased factor VIII level and disturbances of fibrinolysis system on ССD in patients with combined pathology of blood coagulation. Patients/Methods. We examined 20 patients with ischemic strokes aged from 36 to 56 years. The parameters of plasma hemostasis, platelet function, fibrinolysis system, as well as the genetic polymorphisms of hemostasis system were determined. Results. All patients had different combinations of genetic polymorphisms associated with anticoagulant hemostasis changes, as well as defects in fibrinolysis system and coagulation hemostasis that is an additional risk factor for ischemic stroke. Conclusions. In young and middle-aged patients with history of acute ischemic ССD, it is necessary to study blood coagulation, including the determination of blood factor VIII level, fibrinolysis system parameters and homocysteine content.

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The Impact of Geriatric Medical Services on Mental State

International Psychogeriatrics ◽

10.1017/s1041610293001425 ◽

1993 ◽

Vol 5 (1) ◽

pp. 91-101 ◽

Cited By ~ 2

Author(s):

Martin G. Cole

Keyword(s):

Mental Health ◽

Mental Health Professionals ◽

Mental State ◽

Controlled Trial ◽

Medical Services ◽

Medical Patients ◽

Aged Patients ◽

Computer Data ◽

Validity Criteria ◽

The Impact

The purpose of this paper was to determine the impact of geriatric medical services on mental state by reviewing all controlled trials of such services. Two computer data bases were searched for relevant articles published from January 1980 to August 1990, and the bibliographies of retrieved articles were searched for additional references. Eleven reports were located that met the four inclusion criteria: original study, published in English or French, controlled trial (nonrandomized or randomized) of a geriatric medical service, and inclusion of at least one measure of mental state in the study. Ten reports met the validity criteria for intervention studies. There was little evidence that geriatric medical services improved the mental state of aged patients; all trials had limitations in design and measures. These findings challenge mental health professionals in two ways: first, services must be developed to address the apparently unmet mental health needs of aged medical patients; second, research methods must be developed to measure the impact of these services.

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Second-generation hormonotherapy in prostate cancer and bone microenvironment

Endocrine Related Cancer ◽

10.1530/erc-21-0118 ◽

2021 ◽

Author(s):

Wafa Bouleftour ◽

Karima Boussoualim ◽

Sandrine Sotton ◽

Cecile Vassal ◽

Thierry Thomas ◽

...

Keyword(s):

Prostate Cancer ◽

Hormone Therapy ◽

Independent Living ◽

Second Generation ◽

Health Management ◽

Bone Microenvironment ◽

Mineral Density ◽

Aged Patients ◽

Androgen Synthesis ◽

The Impact

Prostate cancer (Pca) is the most commonly diagnosed cancer affecting men in France. Before the age of 75 years old, 1 in 8 French men will have Pca. Androgen deprivation therapies (ADT) remain the standard of care. Such therapies induces significant bone loss. Bone-remodelling cycle depends on the androgen synthesis signalling pathways. Furthermore, age-specific hormonal decline plays a key role in the decrease in bone mass. As a result, the older the patients, the more likely they are to have osteoporosis if they are treated with hormone therapy. Their risk of osteoporotic fracture has an impact on their quality of live and their capacity of independent living. In recent years, newer hormone therapies (acetate abiraterone, enzalutamide, apalutamide and darolutamide) have proved efficient in metastatic castration-resistant Pca (mCRPC) patients as well as in hormone naïve patients, and actually in non-metastatic diagnosis. The combination of these treatments with ADT highly inhibit androgen production pathways. They are prescribed to aged patients undergoing bone density loss after first generation anti-androgen treatment. Specific recommendations for bone health management in Pca patients are currently lacking. To date, bone mineral density in patients treated with second-generation hormone therapy has never been assessed in a prospective study. This review aims at reviewing what is known about the impact of second-generation hormonotherapy on bone microenvironment.

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Unintended Consequence of High-Dose Vitamin C Therapy for an Oncology Patient: Evaluation of Ascorbic Acid Interference With Three Hospital-Use Glucose Meters

Journal of Diabetes Science and Technology ◽

10.1177/1932296820932186 ◽

2020 ◽

pp. 193229682093218

Author(s):

Brooke M. Katzman ◽

Brandon R. Kelley ◽

Gayle R. Deobald ◽

Nikki K. Myhre ◽

Sean A. Agger ◽

...

Keyword(s):

Ascorbic Acid ◽

Vitamin C ◽

High Dose ◽

Oncology Patient ◽

Glucose Meter ◽

High Doses ◽

The Impact ◽

Very High ◽

High Dose Vitamin ◽

Hospital Use

The use of high-dose vitamin C in cancer care has offered promising results for some patients. However, the intravenous (IV) doses used for these patients can reach concentrations that interfere with some strip-based glucose meters. We characterized the impact of vitamin C interference, from standard to the very high doses used for some cancer protocols, using three different hospital-use glucose meters. For two of the three devices tested, increasing concentrations of ascorbic acid caused false elevations in the glucose measurements. The third glucose meter did not provide inaccurate results, regardless of the vitamin C concentration present. Rather, above a certain threshold, the device generated error messages and no results could be obtained.

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Evaluation of Early Versus Late Postdischarge Medication Reconciliation on Readmission Rates and Emergency Department Visits

Journal of Pharmacy Practice ◽

10.1177/0897190017710525 ◽

2017 ◽

Vol 31 (3) ◽

pp. 279-283 ◽

Cited By ~ 1

Author(s):

Tina Joseph ◽

Rebecca A. Barros ◽

Elise Kim ◽

Bupendra Shah

Keyword(s):

Emergency Department ◽

Clinical Pharmacist ◽

Medication Reconciliation ◽

Emergency Department Visits ◽

Optimal Timing ◽

Significant Difference ◽

The Impact ◽

Late Group ◽

Hospital Use

Background: The current literature speculates ideal postdischarge follow-up focusing on transitions from hospital to home can range anywhere between 48 hours and 2 weeks. However, there is a lack of evidence regarding the optimal timing of follow-up visit to prevent readmissions. Objective: The purpose of this study is to evaluate the impact of early (<48 hours) versus late (48 hours-14 days) postdischarge medication reconciliation on readmissions and emergency department (ED) use. Methods: In this retrospective study, data for patients who had a clinic visit with a primary care provider (PCP), clinical pharmacist, or both for postdischarge medication reconciliation were reviewed. Primary outcome included hospital use rate at 30 days. Secondary outcomes included hospital use rate at 90 days and hospital use rate with a postdischarge PCP follow-up visit, clinical pharmacist, or both at 30 days. Results: One hundred sixty patients were included in the analysis: 31 early group patients and 129 late group patients. There was no significant difference on hospital use at 30 days in patients who received early or late groups (32.3% vs 21.8%, P = .947). There was also no significant difference on hospital use at 90 days in patients in early versus late group (51.6% vs 50.3%, P = .842). The type of provider (PCP vs pharmacists) conducting postdischarge medication reconciliation did not show significance on hospital use at 30 days (19.9% vs 21.4%, P = .731). Conclusion: Results from this study suggest patients can be seen up to 14 days postdischarge for medication reconciliation with no significant difference on hospital use.

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Abstract 2648: Design of Carotid Intima-Media Thickness Trials

Circulation ◽

10.1161/circ.118.suppl_18.s_760-a ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Gregory W Evans ◽

Mike K Palmer ◽

Daniel H O’Leary ◽

John R Crouse ◽

Michiel L Bots ◽

...

Keyword(s):

Sample Size ◽

Treatment Effect ◽

Subclinical Atherosclerosis ◽

Intima Media Thickness ◽

Carotid Intima Media Thickness ◽

Double Blind ◽

Aged Patients ◽

Media Thickness ◽

The Impact

Carotid artery intima-media thickness (CIMT) assessed by B-mode ultrasound is an accepted marker for subclinical atherosclerosis commonly used in clinical trials. Their sample size and power calculations apply 2-sample independent t-tests and within group variance in progression rates from the literature. However, this approach obscures the impact of differences in study designs including length of follow-up and differences in the number of and interval between ultrasound scans. These effects can be assessed using common sample size formula for longitudinal models, but this approach requires decomposition of the total variance into between and within subject components that have not generally been reported in the literature. Here, we derive these variance components for the Measuring Effects on intima-media Thickness: an Evaluation of Rosuvastatin (METEOR) study, a randomized, double-blind trial that demonstrated treatment with 40 mg rosuvastatin significantly slowed CIMT progression in middle-aged patients with a low Framingham risk of coronary heart disease and subclinical atherosclerosis (baseline maximum CIMT ≥1.2-<3.5mm). We examined the impact of differing follow-up periods, use of intermediate scans, and use of duplicate scans using both sample size calculations and actual analyses based on subsets of the METEOR data. Reductions in study length or number of scans result in increased variances and larger sample sizes to detect a given treatment effect. Table shows the impact of duplicate scans at baseline and end of the 2-year study, with and without intermediate scans performed every 6 months, on the sample size required to detect a treatment effect of 0.012 mm/year. These results underscore the importance of considering the number and spacing of ultrasound exams explicitly during study design, and suggest that reductions in scanning frequency may seriously erode study power and/or increase costs by requiring recruitment of additional subjects.

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Degenerative Cervical Myelopathy in Higher-Aged Patients: How Do They Benefit from Surgery?

Journal of Clinical Medicine ◽

10.3390/jcm9010062 ◽

2019 ◽

Vol 9 (1) ◽

pp. 62 ◽

Cited By ~ 1

Author(s):

Oliver Gembruch ◽

Ramazan Jabbarli ◽

Ali Rashidi ◽

Mehdi Chihi ◽

Nicolai El Hindy ◽

...

Keyword(s):

Elderly Patients ◽

Cervical Myelopathy ◽

Age Groups ◽

Age Group ◽

Group Effect ◽

Significant Group Effect ◽

Aged Patients ◽

Significant Group ◽

Degenerative Cervical Myelopathy ◽

The Impact

Background: Degenerative cervical myelopathy (DCM) is the most common reason for spinal cord disease in elderly patients. This study analyzes the preoperative status and postoperative outcome of higher-aged patients in comparison to young and elderly patients in order to determine the benefit to those patients from DCM surgery. Methods: A retrospective analysis of the clinical data, radiological findings, and operative reports of 411 patients treated surgically between 2007 and 2016 suffering from DCM was performed. The preoperative and postoperative neurological functions were evaluated using the modified Japanese Orthopedic Association Score (mJOA Score), the postoperative mJOA Score improvement, the neurological recovery rate (NRR) of the mJOA Score, and the minimum clinically important difference (MCID). The Charlson Comorbidity Index (CCI) was used to evaluate the impact of comorbidities on the preoperative and postoperative mJOA Score. The comparisons were performed between the following age groups: G1: ≤50 years, G2: 51–70 years, and G3: >70 years. Results: The preoperative and postoperative mJOA Score was significantly lower in G3 than in G2 and G1 (p < 0.0001). However, the mean mJOA Score’s improvement did not differ significantly (p = 0.81) between those groups six months after surgery (G1: 1.99 ± 1.04, G2: 2.01 ± 1.04, G: 2.00 ± 0.91). Furthermore, the MCID showed a significant improvement in every age-group. The CCI was evaluated for each age-group, showing a statistically significant group effect (p < 0.0001). Analysis of variance revealed a significant group effect on the delay (weeks) between symptom onset and surgery (p = 0.003). The duration of the stay at the hospital did differ significantly between the age groups (p < 0.0001). Conclusion: Preoperative and postoperative mJOA Scores, but not the extent of postoperative improvement, are affected by the patients’ age. Therefore, patients should be considered for DCM surgery regardless of their age.

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