scholarly journals Characteristic Factors of Aspiration Pneumonia to Distinguish from Community-Acquired Pneumonia among Oldest-Old Patients in Primary-Care Settings of Japan

Geriatrics ◽  
2020 ◽  
Vol 5 (3) ◽  
pp. 42 ◽  
Author(s):  
Toshie Manabe ◽  
Kazuhiko Kotani ◽  
Hiroyuki Teraura ◽  
Kensuke Minami ◽  
Takahide Kohro ◽  
...  
Keyword(s):  
Primary Care ◽  
Nursing Home ◽  
Aspiration Pneumonia ◽  
Oldest Old ◽  
Community Acquired Pneumonia ◽  
The Body ◽  
Stepwise Logistic Regression ◽  
Old Patients ◽  
Old Adults ◽  
Primary Care Settings

Background: Aspiration pneumonia (AsP), a phenotype of community-acquired pneumonia (CAP), is a common and problematic disease with symptomless recurrence and fatality in old adults. Characteristic factors for distinguishing AsP from CAP need to be determined to manage AsP. No such factorial markers in oldest-old adults, who are often seen in the primary-care settings, have yet been established. Methods: From the database of our Primary Care and General Practice Study, including the general backgrounds, clinical conditions and laboratory findings collected by primary care physicians and general practitioners, the records of 130 patients diagnosed with either AsP (n = 72) or CAP (n = 58) were extracted. Characteristic factors associated with the diagnosis of AsP were statistically compared between AsP and CAP. Results: The patients were older in the AsP group (median 90 years old) than in the CAP group (86 years old). The body temperature, heart rate, and diastolic blood pressure were lower in the patients with AsP than in those with CAP. Witnessed meal dysphagia by families and caregivers was reported only in AsP. Living in a nursing home, comorbidities of cerebral infarction and dementia (as positive factors) and hypertension (as a negative factor) were considered predictive to diagnose AsP in a stepwise logistic regression analysis. Conclusions: Among oldest-old adults in primary-care settings, living in a nursing home and the dysphagia risks are suggested to be characteristic factors for diagnosing AsP. Age and some relevant clinical information may help manage AsP and also be useful for families and caregivers.

scholarly journals Therapeutic inertia in proteinuria management among type 2 diabetes (T2DM) patients in primary care settings: prevalence and associated risk factors

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
FU Leung Chan ◽  
Yim Chu Li ◽  
Xiao Rui Catherine Chen
Keyword(s):  
Primary Care ◽  
Logistic Regression ◽  
Clinical Practice ◽  
Stepwise Logistic Regression ◽  
Continuous Variables ◽  
Cross Sectional ◽  
Case Register ◽  
Negatively Associated ◽  
Therapeutic Inertia ◽  
Primary Care Settings

Abstract Background Therapeutic inertia (TI), defined as physicians’ failure to increase therapy when treatment goals are unmet, is an impediment to chronic disease management. This study aimed to identify the prevalence of TI in proteinuria management among T2DM patients managed in primary care settings and to explore possible associating factors. Methods This was a cross-sectional study. T2DM patients with proteinuria (either microalbuminuria or macroalbuminuria) and had been followed up in 7 public primary care clinics of the Hospital Authority of Hong Kong from 1 Jan, 2014 to 31 Dec, 2015 were included. The prevalence of TI in proteinuria management and its association with patients’ demographic and clinical parameters and the working profile of the attending doctors were explored. Student’s t test and analysis of variance were used for analyzing continuous variables and Chi square test was used for categorical data. Multivariate stepwise logistic regression was used to determine the association between TI and the significant variables from patients' and doctors' characteristics. Results Among the 22,644 T2DM patients identified in the case register, 5163 (26.4%) patients were found to have proteinuria. Among the sampled 385 T2DM patients with proteinuria, TI was identified in 155 cases, with a prevalence rate of 40.3%. Male doctor, doctor with longer duration of clinical practice and have never received any form of Family Medicine training were found to have a higher TI. Patients with microalbuminuria range and lower systolic and diastolic blood pressure (BP) were also found to have higher TI. Logistic regression study revealed that patients’ systolic BP level and microalbuminuria range of proteinuria were negatively associated with the presence of TI, whereas doctor’s year of clinical practice being over 20 years and patients being treated with submaximal dose of medication were positively associated with the presence of TI. Conclusions TI is commonly present in proteinuria management among T2DM patients, with a prevalence of 40.3% in primary care. Systolic BP and microalbuminuria range of urine ACR were negatively associated with the presence of TI, whereas submaximal ACEI/ARB dose and doctors practicing over 20 years were positively associated with the presence of TI. Further studies exploring the strategies to combat TI are needed to improve the clinical outcome of T2DM patients.

scholarly journals Physical activity promotion for multimorbid patients in primary care settings: A protocol for a systematic review evaluating health benefits and harms.

2020 ◽  
Author(s):  
Simone Schweda ◽  
Inga Krauß
Keyword(s):  
Quality Of Life ◽  
Physical Activity ◽  
Systematic Review ◽  
Primary Care ◽  
Health Benefits ◽  
The Body ◽  
Cochrane Library ◽  
Primary Care Settings ◽  
Activity Promotion

Background: To date multimorbidity has not received much attention in health policies, even though multiple chronic diseases put high demands on the health care system in industrial nations. Enormous costs of care and a physically, mentally and socially reduced quality of life are common consequences of multimorbidity. Physical activity (PA) has a positive preventive and therapeutic effect on common non-communicable . The objective of this study will be to evaluate the halth benefits and harms of PA interventions for sedentary adults with multimorbidity in primary care settings. Methods: This is the study protocol for a systematic review. We will serach PubMed, MEDLINE (Ovid), Web of Science, CINHAL and the Cochrane Library (from inception onwards). In addition, clinical trial registers and reference lists of included studies will be searched. We will include randomised controlled trials, quasi-experimental and non-randomised trials examining the health benefits and harms of PA interventions with or without additional lifestyle interventions for sedentary adult patients with multimorbidity (e.g. two or more chronic non-communicable diseases) in primary care. Eligible control groups will be standard care, placebo or medications. Two reviewers will independently screen all citations, abstracts data and full text articles. The primary outcomes will be health related quality of life and mortality. Secondary outcomes will include cardiovascular fitness, muscular strength and disease specific outcomes (e.g. depression score), biomarkers as well as control of metabolic risk factors (e.g. blood pressure, HBA1c, body weight) and any adverse event. The study methodological quality will be appraised using appropriate tools. If feasible, we will conduct random effects meta-analysis. Additional analyses will be conducted to explore the potential sources of heterogeneity (e.g. study design, geographical location, or type of intervention). Strength of the body of evidence will be assessed according to the Grading of Recommendations Assessment (GRADE). Discussion: This review will evaluate the evidence on health benefits and harms of PA interventions for sedentary adults with multimorbidity in primary care settings. We anticipate our findings to be of interest to patients, their families, caregivers and healthcare professionals in selecting and conducting optimal health promotion programs. Possible implications for further research will be discussed.

Incidence of all-cause adult community-acquired pneumonia in primary care settings in France

2018 ◽  
Vol 48 (6) ◽  
pp. 389-395 ◽  
Author(s):  
H. Partouche ◽  
A. Lepoutre ◽  
C. Buffel du Vaure ◽  
T. Poisson ◽  
L. Toubiana ◽  
...  
Keyword(s):  
Primary Care ◽  
Community Acquired Pneumonia ◽  
Primary Care Settings

scholarly journals CAPPRIC Study—Characterization of Community-Acquired Pneumonia in Spanish Adults Managed in Primary Care Settings

2021 ◽  
Vol 9 (3) ◽  
pp. 508
Author(s):  
Jesús Molina ◽  
Amelia González-Gamarra ◽  
Leovigildo Ginel ◽  
Mª Peláez ◽  
Juan Juez ◽  
...  
Keyword(s):  
Primary Care ◽  
Prospective Observational Study ◽  
Community Acquired Pneumonia ◽  
Hospitalization Rate ◽  
Empiric Antibiotic Therapy ◽  
Radiographic Findings ◽  
Primary Care Settings ◽  
Significant Burden ◽  
Empiric Antibiotic

The real burden of community-acquired pneumonia (CAP) in non-hospitalized patients is largely unknown. This is a 3-year prospective, observational study of ambulatory CAP in adults, conducted in 24 Spanish primary care centers between 2016–2019. Sociodemographic and clinical variables of patients with radiographically confirmed CAP were collected. Pneumococcal etiology was assessed using the Binax Now® test. Patients were followed up for 10 ± 3 days. A total of 456 CAP patients were included in the study. Mean age was 56.6 (±17.5) years, 53.5% were female, and 53.9% had ≥1 comorbidity. Average incidence of CAP was 1.2–3.5 cases per 1000 persons per year. Eighteen patients (3.9%) were classified as pneumococcal CAP. Cough was present in 88.1% of patients at diagnosis and fever in 70.8%. Increased pulmonary density (63.3%) and alveolar infiltrates with air bronchogram (16.6%) were the most common radiographic findings. After 14.6 ± 6.0 days (95% CI = 13.9–15.3), 65.4% of patients had recovered. Hospitalization rate was 2.8%. The most frequently prescribed antibiotics were quinolones (58.7%) and β-lactams (31.1%). In conclusion, one-third of CAP patients did not fully recover after two weeks of empiric antibiotic therapy and 2.8% required hospitalization, highlighting the significant burden associated with non-hospitalized CAP in Spain.

scholarly journals Use of Video-Enabled Tablet for Virtual Care Among Older Veterans

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 197-197
Author(s):  
Maria Yefimova ◽  
Jiaqi Hu ◽  
Cindie Slightam ◽  
Liberty Greene ◽  
Camila Chaudhary ◽  
...  
Keyword(s):  
Primary Care ◽  
Older Patients ◽  
Oldest Old ◽  
Age Groups ◽  
Old Patients ◽  
Younger Patients ◽  
Care Services ◽  
Virtual Care ◽  
Primary Care Services ◽  
Home Based

Abstract With the proliferation of virtual care, healthcare systems are exploring ways to bridge the digital divide among vulnerable patients. Department of Veterans Affairs (VA) is distributing devices for qualifying Veterans to enable video visits with medical providers at home, yet their use among older patients is unknown. This retrospective cohort study used administrative data to characterize the use of VA-loaned iPads among older Veterans compared to younger Veterans and identify demographic predictors of utilization. Among 16,385 patients who were shipped a VA-loaned iPad in 2014-2019, 33.66% (n=5,516) were over 65 years old, and 3.1% (n=503) were over the age of 85. Two thirds (n=6799) of younger patients had a video visit (mean=3 visits) with provider using iPad in the 6 months since shipment, compared to 50% (n=253) of 85+ year-olds (mean=1.8 visits). Most common types of virtual visits for the oldest old patients were for geriatrics or home-based primary care, compared to mental health visits among younger patients. Logistic regression identified characteristics of older patients who were more likely to use iPads, such a marital status, urban location, and lower disease burden, which is similar to their younger counterparts. While older age groups used VA-loaned tablets less frequently, those who engaged with the devices were similar in demographics as their younger counterparts. Older patients used iPads differently, with higher engagement in geriatric and primary care services. Providing devices for virtual care may allow health systems to more easily reach older patients in the comfort of their home.

scholarly journals PRIMARY CARE ATTRIBUTES IN TRADITIONAL UNITIES AND WITH FAMILY HEALTH STRATEGY, AN OLDEST-OLD PATIENTS PERSPECTIVE

2020 ◽  
Vol 20 (5) ◽  
pp. 247-265
Author(s):  
Joel Hirtz do Nascimento Navarro ◽  
Cintia Cristina Sulzbach ◽  
Angelo Jose Gonçalves Bós
Keyword(s):  
Primary Care ◽  
Oldest Old ◽  
Family Health ◽  
Old Patients ◽  
Health Strategy ◽  
Family Health Strategy ◽  
Patients Perspective

Central Nervous System Depressants and Risk of Hospitalization due to Community-Acquired Pneumonia in very Old Patients

2020 ◽  
Vol 15 (2) ◽  
pp. 131-136
Author(s):  
Jeronimo Espinosa ◽  
Paulino A. Alvarez ◽  
Veronica Castro ◽  
Maria F. Caceres ◽  
Maria C. Soler-Riera ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Drug Interactions ◽  
Community Acquired Pneumonia ◽  
Old Patients ◽  
Very Old ◽  
Old Adults ◽  
Increased Risk ◽  
Wide Range ◽  
Very Old Patients

Background: Central Nervous System (CNS) depressants like antipsychotics, opioids, benzodiazepines and zolpidem are frequently used by patients of a wide range of ages. Uncertainty remains about their effect in very old adults (>80 years old) and their potential for pharmacodynamic and pharmacokinetic drug-drug interactions in this population. Objective: To assess if the use of CNS depressants is associated with a higher risk of hospitalization due to community-acquired pneumonia (CAP) in very old patients. Methods: In this prospective study, 362 patients over 80 years of age who had been consequently admitted to the general ward of a teaching hospital were examined. Each patient was assessed, by our pharmacovigilance team within 24 hours of admission, to identify outpatient medication use and potential drug-drug interactions. Results: The overall use of CNS depressants as a group was not associated with a higher risk of admission due to CAP in very old patients (55% vs. 49%; OR=1.28 [0.76-2.16], p=0.34). However, the use of antipsychotics was associated with a higher rate of admissions due to CAP in this population (OR=1.98 [1.10-3.57], p=0.02). No association was seen between opioids (p=0.27), zolpidem (p=0.83), or benzodiazepines (p=0.15) and the rate of admissions due to CAP in these patients. Moreover, pharmacodynamic or pharmacokinetic interactions leading to CNS depression were equally found in patients admitted for CAP and those admitted for other reasons. Conclusion: The use of antipsychotics in very old adults was associated with an increased risk of hospital admission due to CAP. This suggests that the use of these medications in this population should be done with caution. No association was observed with opioids, benzodiazepines and zolpidem with the latter outcome.

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