Changes in Treatment of Very Elderly Patients Six Weeks after Discharge from Geriatrics Department

We assessed the prescriptions of patients hospitalized in a geriatric unit and subsequently discharged. This prospective and observational study was conducted over a two-month period in the geriatrics department (acute and rehabilitation units) of a university hospital. Patients discharged from this department were included over a two-month period. Prescriptions were analyzed at admission and discharge from the geriatrics department (DGD), and six weeks after DGD. We included 209 patients, 63% female, aged 86.8 years. The mean number of medications prescribed was significantly higher at DGD than at admission (7.8 vs. 7.1, p = 0.003). During hospitalization, 1217 prescriptions were changed (average 5.8 medications/patient): 52.8% were initiations, 39.3% were discontinuations, and 7.9% were dose adjustments. A total of 156 of the 209 patients initially enrolled completed the study. Among these patients, 81 (51.9%) had the same prescriptions six weeks after DGD. In univariate analysis, medications were changed more frequently in patients with cognitive impairment (p = 0.04) and in patients for whom the hospital report did not indicate in-hospital modifications (p = 0.007). Multivariate analysis found that six weeks after DGD, there were significantly more drug changes for patients for whom there were changes in prescription during hospitalization (p < 0.001). A total of 169 medications were changed (mean number of medications changed per patient: 1.1): 52.7% discontinuations, 34.3% initiations, and 13% dosage modifications. The drug regimens were often changed during hospitalization in the geriatrics department, and a majority of these changes were maintained six weeks after DGD. Improvements in patient adherence and hospital-general practitioner communication are necessary to promote continuity of care and to optimize patient supervision after hospital discharge.

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Association Between Dialysate Sodium Concentration And Interdialytic Weight Gain In Patients Undergoing Twice Weekly Haemodialysis

10.21203/rs.3.rs-131271/v1 ◽

2020 ◽

Author(s):

Soraiya Manji ◽

Jasmit Shah ◽

Ahmed Twahir ◽

Ahmed Sokwala

Keyword(s):

Weight Gain ◽

Univariate Analysis ◽

Sodium Concentration ◽

University Hospital ◽

Exact Test ◽

Interdialytic Weight Gain ◽

Significant Difference ◽

Blood Pressures ◽

The Mean ◽

Dialysate Sodium

Abstract BackgroundChronic kidney disease is highly prevalent across the globe with more than two million people worldwide requiring renal replacement therapy. Interdialytic weight gain is the change in body weight between two sessions of haemodialysis. Higher interdialytic weight gain has been associated with an increase in mortality and adverse cardiovascular outcomes. It has long been questioned whether using a lower dialysate sodium concentration during dialysis would reduce the interdialytic weight gain and hence prevent these adverse outcomes.MethodsThis study was a single blinded cross-over study of patients undergoing twice weekly haemodialysis at the Aga Khan University Hospital, Nairobi and Parklands Kidney Centre. It was conducted over a twelve-week period and patients were divided into two groups: dialysate sodium concentration of 137meq/l and 140meq/l. These groups switched over after a six-week period without a washout period. Univariate analysis was conducted using Fisher’s exact test for categorical data and Mann Whitney test for continuous data. Results41 patients were included in the analysis. The mean age was 61.37 years, and 73% were males. The mean duration for dialysis was 2.53 years. The interdialytic weight gain was not significantly different between the two groups (2.14 for the 137meq/l group and 2.35 for the 140meq/l group, p = 0.970). Mean blood pressures were as follows: pre-dialysis: DNa 137meq/l: systolic 152.14 ± 19.99, diastolic 78.99 ± 12.20, DNa 140meq/l: systolic 156.95 ± 26.45, diastolic 79.75 ± 11.25 (p = 0.379, 0.629 respectively). Post-dialysis: DNa 137meq/l: systolic 147.29 ± 22.22, diastolic 77.85 ± 12.82 DNa 140meq/l: systolic 151.48 ± 25.65, diastolic 79.66 ± 15.78 (p = 0.569, 0.621 respectively). ConclusionThere was no significant difference in the interdialytic weight gain as well as pre dialysis and post dialysis systolic and diastolic blood pressures between the two groups. Therefore, using a lower dialysate sodium concentration does not appear useful in altering the interdialytic weight gain although further studies with a larger sample size are warranted.

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Sexual Outcomes and Motherhood Plans of The Mayer Rokitansky Küster Hauser Syndrome Patients Operated with Uncu Modified Remnant-Supported Laparoscopic Double-Layer Peritoneal Pull-Down Vaginoplasty Technique

10.22541/au.162500822.23659107/v1 ◽

2021 ◽

Author(s):

Kiper Aslan ◽

Tansu Gurbuz ◽

Adnan Orhan ◽

Isil Kasapoglu ◽

Kemal Ozerkan ◽

...

Keyword(s):

Double Layer ◽

University Hospital ◽

Long Term Results ◽

Complication Rates ◽

Mrkh Syndrome ◽

Sexual Outcomes ◽

Vaginal Length ◽

Uterine Transplantation ◽

Hospital Patients ◽

The Mean

Objective: To determine the sexual outcomes and motherhood plans of the Mayer Rokitansky Küster Hauser (MRKH) Syndrome patients operated with Uncu Modified Remnant-Supported Laparoscopic Double-Layer Peritoneal Pull-Down Vaginoplasty operation Design: Cohort Study Setting: Tertiary University Hospital Patients: Women with MRKH syndrome Methods: This study involves the patients with MRKH syndrome who underwent Uncu Modified Remnant-Supported Laparoscopic Double-Layer Peritoneal Pull-Down Vaginoplasty Operation between the years 2008-2020. The first step of the study is about our surgical technique outcomes. The second step consists of long-term results for sexual functioning which was assessed by female sexual function index (FSFI) survey and motherhood plans by another survey. Main Outcome Measure: FSFI and Motherhood Survey Results Results Total 42 patients with MRKH syndrome underwent vaginoplasty operation. At least one year after surgery all patients was physically examined. The mean vaginal length was 8.4 + 1.9 cm. The mean FSFI score was 31.5 + 3.9 (min:24-max:36) Thirty-six of the patients answered a survey about motherhood. Thirty-one of the patients (86%) had a desire for motherhood. Most of the patients (21/31 – 68%) choose uterine transplantation as a first option. Three of the patients (9.6%) choose mater option and seven patients (22.5%) wants to be a mother by adoption. Conclusion: Uncu Modified Remnant-Supported Laparoscopic Double-Layer Peritoneal Pull-Down Vaginoplasty Operation is a satisfactory option for patients with MRKH syndrome with high FSFI scores and low complication rates. But creating only a neovagina is not enough for these patients, because of nearly 70% motherhood desire by uterine transplantation.

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Transcatheter Vs. Surgical Closure of Atrial Septal Defects in Adults

Proceedings of the Latvian Academy of Sciences Section B Natural Exact and Applied Sciences ◽

10.1515/prolas-2017-0054 ◽

2018 ◽

Vol 72 (1) ◽

pp. 16-22

Author(s):

Ainārs Rudzītis ◽

Kristaps Šablinskis ◽

Baiba Luriņa ◽

Irina Cgojeva-Sproģe ◽

Aļona Grāve ◽

...

Keyword(s):

University Hospital ◽

Success Rates ◽

Surgical Closure ◽

Septal Defects ◽

Atrial Septal Defects ◽

Study Results ◽

Hospital Patients ◽

The Mean ◽

Asd Closure ◽

Surgical Group

Abstract Percutaneous transcatheter device closure of secundum atrial septal defects (ASD) has now largely replaced surgical closure in most centres. The aim of this study was to compare results of transcatheter and surgical ASD closure in adults in Latvia during the years 2002–2014 and to analyse long-term outcomes of transcatheter closure. We analysed data from 334 patients with secundum ASD who underwent ASD closure in Pauls Stradiņš Clinical University Hospital. Patients were included into device or surgical closure groups. In the device group, three follow-ups were made 1, 6, and 12 months after the procedure. No follow-up data were available for surgical arm patients beyond their hospitalisation period. The mean age of patients was 45.3 ± 19.9 years for the device group and 40.0 ± 16.9 years for the surgical group (p = 0.023). The mean secundum ASD size in the device and surgical groups was 14.2 ± 5.6 mm and 28.7 ± 10.0 mm, respectively (p < 0.001). No differences were observed regarding procedure success rates: 99.2% in the device group and 100% in the surgical group (p = 0.451). Periprocedural complications generally were more common in the surgical closure group. The study results show a successful introduction of the percutaneous ASD closure method in Latvia with good early and late outcomes and without significant differences in procedure success rate compared to surgical closure.

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Is it the Time to Implement the Routine Use of Distress Thermometer Among Egyptian Cancer Patients?

Tumori Journal ◽

10.1177/0300891620914151 ◽

2020 ◽

Vol 106 (1_suppl) ◽

pp. 21-21

Author(s):

N Abdel Aziz ◽

GH Elgohary ◽

S Khallaf ◽

S Mohamed ◽

W Abozeed ◽

...

Keyword(s):

Cancer Patients ◽

Hematological Malignancies ◽

Univariate Analysis ◽

Distress Thermometer ◽

University Hospital ◽

Treatment Quality ◽

Egyptian Patients ◽

Different Types ◽

The Mean

Background: Emotional distress is common among cancer patients (25-30 %), as a result of the serious diagnosis and suffering from aggressive treatment. This may negatively affect their participation in treatment, quality of life, and satisfaction with care. To best of our knowledge, it has not been studied before in Egypt, this study aims to implement the distress thermometer in Egyptian cancer patients as a screening tool for the distress and its associated factors. Methods: The Arabic version of DT that has been recently validated was used in this study to screen patients. Egyptian Patients diagnosed with different types of hematological malignancies and solid cancers who were following at three Oncology Centers (South Egypt Cancer Institute, Assiut University Hospital, and Mansura University Oncology department) were recruited. All Patients were asked to rate their distress in the past week on an 11-point visual analog scale ranging from 0 (no distress) to 10 (extreme distress), then, they were asked to fill in the Problem List (PL), to check whether or not they had any of the problems listed during the previous 7 days. Univariate and multivariate analyses were used to identify the significant problems correlated with the patient distress at a cut-off score of 4. Results: A total of 550 patients agreed to participate. The mean age was 51.3 (18–85) years. Different types of solid and hematological malignancies were included; the most common three types were breast cancer (32.7 %), gastrointestinal cancer (23%), and hematological malignancies (15.5 %). The patients’ average DT score was 3.7. The most frequent problems were fatigue (49%), worry (47%), fear (44 %), and pain (42%). The univariate analysis showed a significant correlation between the DT at Cut – off the value of 4 and transportation, dealing with children, depression, fears, sadness, sleep, loss of usual activity, and fatigue. Multivariate analysis confirmed the transportation, depression, fears, sadness, sleep and fatigue as independent factors for such distress. Conclusion: Egyptian cancer patients are suffering from significant distress at a cut value of 4. We recommend the involvement of the psycho-oncology service for all cancer patients at the time of diagnosis.

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Complications and outcomes of routine endoscopy in the very elderly

Endoscopy International Open ◽

10.1055/s-0043-120569 ◽

2018 ◽

Vol 06 (02) ◽

pp. E224-E229 ◽

Cited By ~ 3

Author(s):

Ryoichi Miyanaga ◽

Naoki Hosoe ◽

Makoto Naganuma ◽

Kenro Hirata ◽

Seiichiro Fukuhara ◽

...

Keyword(s):

Elderly Patients ◽

Univariate Analysis ◽

Significant Risk ◽

The Elderly ◽

University Hospital ◽

World Health ◽

Very Elderly ◽

Independent Risk Factors ◽

Health Organization ◽

Elderly Cohort

Abstract Background and study aims In Japan, the elderly population has been increasing annually. The number of elderly patients for whom esophagogastroduodenoscopy (EGD) and colonoscopy (CS) is indicated also has been rising. The aim of this study was to evaluate the safety and efficacy of routine endoscopy in a cohort of octogenarians aged 85 years and older – defined by the World Health Organization as the very elderly. Patients and methods A total of 5,586 patients underwent EGDs, and 2,484 patients underwent CSs performed at the Keio University Hospital from January to September 2014. One hundred eighty-five EGDs and 70 of the CS were performed in the very elderly. Six hundred nine EGDs and 262 CS were performed on younger patients (aged forties). Statistical analysis was performed by univariate and multivariate analyses. Results On univariate analysis, the rate of adverse events (AEs) in the very elderly was significantly higher compared to the younger group (6.3 % vs. 1.1 %; P < 0.01). Moreover, the very elderly cohort received substantial therapeutic intervention as compared to the younger (16.9 % vs. 6.9 %; P < 0.01). On multivariate analysis, independent risk factors of AEs included: very elderly patients (odds ratio (OR) 3.30, 95 % confidence interval (CI) 1.05 – 10.35), inpatients (OR 3.22, 95 % CI 1.34 – 7.74), and use of pethidine hydrochloride prescription (OR 3.44, 95 % CI 1.51 – 7.81). Conclusions Routine endoscopy in the very elderly incurs a significant risk of AEs, particularly when combined with pethidine hydrochloride prescription.

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Association between dialysate sodium concentration and interdialytic weight gain in patients undergoing twice weekly haemodialysis

BMC Nephrology ◽

10.1186/s12882-021-02401-2 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Soraiya Manji ◽

Jasmit Shah ◽

Ahmed Twahir ◽

Ahmed Sokwala

Keyword(s):

Weight Gain ◽

Univariate Analysis ◽

Sodium Concentration ◽

Adverse Outcomes ◽

University Hospital ◽

Interdialytic Weight Gain ◽

Significant Difference ◽

Blood Pressures ◽

The Mean ◽

Dialysate Sodium

Abstract Background Chronic kidney disease is highly prevalent across the globe with more than 2 million people worldwide requiring renal replacement therapy. Interdialytic weight gain is the change in body weight between two sessions of haemodialysis. Higher interdialytic weight gain has been associated with an increase in mortality and adverse cardiovascular outcomes. It has long been questioned whether using a lower dialysate sodium concentration during dialysis would reduce the interdialytic weight gain and hence prevent these adverse outcomes. Methods This study was a single blinded cross-over study of patients undergoing twice weekly haemodialysis at the Aga Khan University Hospital, Nairobi and Parklands Kidney Centre. It was conducted over a twelve-week period and patients were divided into two groups: dialysate sodium concentration of 137 meq/l and 140 meq/l. These groups switched over after a six-week period without a washout period. Univariate analysis was conducted using Fisher’s exact test for categorical data and Mann Whitney test for continuous data. Results Forty-one patients were included in the analysis. The mean age was 61.37 years, and 73% were males. The mean duration for dialysis was 2.53 years. The interdialytic weight gain was not significantly different between the two groups (2.14 for the 137 meq/l group and 2.35 for the 140 meq/l group, p = 0.970). Mean blood pressures were as follows: pre-dialysis: DNa 137 meq/l: systolic 152.14 ± 19.99, diastolic 78.99 ± 12.20, DNa 140 meq/l: systolic 156.95 ± 26.45, diastolic 79.75 ± 11.25 (p = 0.379, 0.629 respectively). Post-dialysis: DNa 137 meq/l: systolic 147.29 ± 22.22, diastolic 77.85 ± 12.82 DNa 140 meq/l: systolic 151.48 ± 25.65, diastolic 79.66 ± 15.78 (p = 0.569, 0.621 respectively). Conclusion There was no significant difference in the interdialytic weight gain as well as pre dialysis and post dialysis systolic and diastolic blood pressures between the two groups. Therefore, using a lower dialysate sodium concentration does not appear useful in altering the interdialytic weight gain or blood pressure although further studies are warranted with a larger sample size, taking into account residual renal function and longer duration for impact on blood pressures.

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Intestinal parasite survey of Kyungpook National University Hospital patients

The Korean Journal of Parasitology ◽

10.3347/kjp.1971.9.2.47 ◽

1971 ◽

Vol 9 (2) ◽

pp. 47 ◽

Cited By ~ 11

Author(s):

Dong Wik Choi ◽

Sung Deok Park ◽

Jae Woun Kim ◽

Doo Hong Ahn ◽

Young Myung Kim

Keyword(s):

Intestinal Parasite ◽

University Hospital ◽

Hospital Patients ◽

National University

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CLINICAL FEATURES, INDICATIONS AND RESULT OF TRACHEOTOMY

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2017.3.7 ◽

2017 ◽

pp. 50-55

Author(s):

Duc Luu Ngo ◽

Tu The Nguyen ◽

Manh Hung Ho ◽

Thanh Thai Le

Keyword(s):

Clinical Features ◽

University Hospital ◽

Female Ratio ◽

Tube Obstruction ◽

Level Ii ◽

Study Results ◽

Male Female Ratio ◽

Hospital Patients ◽

Level I

Background: This study aims to survey some clinical features, indications and results of tracheotomy at Hue Central Hospital and Hue University Hospital. Patients and method: Studying on 77 patients who underwent tracheotomy at all of departments and designed as an prospective, descriptive and interventional study. Results: Male-female ratio was 4/1. Mean age was 49 years. Career: farmer 44.2%, worker 27.2%, officials 14.3%, student 7.8%, other jobs 6.5%. Respiratory condition before tracheotomy: underwent intubation 62.3%, didn’t undergo intubation 37.7%. Period of stay of endotracheal tube: 1-5 days 29.2%, 6-14 days 52.1%, >14 days 18.7%. Levels of dyspnea before tracheotomy: level I 41.4%, level II 48.3%, level III 0%, 10.3% of cases didn’t have dyspnea. Twenty cases (26%) were performed as an emergency while fifty seven (74%) as elective produces. Classic indications (37.7%) and modern indications (62.3%). On the bases of the site, we divided tracheostomy into three groups: high (0%), mid (25.3%) and low (74.7%). During follow-up, 44 complications occurred in 29 patients (37.7%). Tracheobronchitis 14.3%, tube obstruction 13%, subcutaneous empysema 10.4%, hemorrhage 5%, diffcult decannulation 5.2%, tube displacement 3.9%, canule watery past 2.6%, wound infection 1.3%. The final result after tracheotomy 3 months: there are 33 patients (42.9%) were successfully decannulated. In the 33 patients who were successfully decannulated: the duration of tracheotomy ranged from 1 day to 90 days, beautiful scar (51.5%), medium scar (36.4%), bad scar (12.1%). Conclusions: In tracheotomy male were more than female, adult were more than children. The main indication was morden indication. Tracheobronchitis and tube obstruction were more common than other complications. Key words: Tracheotomy

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RESULTS OF THE SUTURE OF THE PERFORATION BY SINGLE-PORT LAPAROSCOPIC SURGERY (SPLS) FOR THE PERFORATED DUODENAL ULCER TREATEMENT

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2014.4_5.18 ◽

2014 ◽

pp. 126-132

Author(s):

Huu Tri Nguyen ◽

Van Lieu Nguyen

Keyword(s):

Duodenal Ulcer ◽

Laparoscopic Surgery ◽

Single Port ◽

Previous History ◽

University Hospital ◽

Safe Procedure ◽

Perforated Duodenal Ulcer ◽

Analgesic Requirement ◽

Duodenal Ulcers ◽

The Mean

Background Single-port laparoscopic surgery (SPLS) was increasingly used on several surgical diseases. The aim of this study is evaluation of the results of the suture of the perforation by SPLS for the perforated duodenal ulcer treatement. Methods From January 2012 to July 2014, 35 patients with perforated duodenal ulcers underwent simple suture of the perforations by SPLS at Hue University Hospital and Hue Central Hospital. Results The mean age was 45.9 ± 14.4 years. The sex ratio (male/female) was 16.5 and the mean of BMI was 19.2 ± 2.3. There was one patient (2.9%) with previous history of laparoscopic repair of perforated duodenal ulcer. The duration of the symptoms was 9.9 ± 12.3 hours. 97.1% of patients had the perforations of the anterior wall of the duodenum. The mean size of the perforation was 4.7 ± 3.4 mm (2 – 22mm). 2.9% of patients had the perforations of the posterior wall of the duodenum. The rate of the conversion to the open surgery was 2.9%. The mean operative time was 75.8 ± 33.7min, and the mean hospital stay was 5.8 ± 1.4 days. The mean of the analgesic requirement time was 2.9 ± 0.8 days. The wound length was 1.9 ± 0.1 cm. There was 5.9% of the patients had wound infection. There was no operation-related mortality. Conclusions Simple suture of the perforation by single-port laparoscopic surgery is a feasible and safe procedure, and it may be a scarless surgical technique for perforated duodenal ulcers treatement. Key words: single-port laparoscopic surgery, perforated duodenal ulcer

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EVALUATION OF LONGO’S HEMORRHOIDECTOMY AT HUE UNIVERSITY HOSPITAL

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2012.6.10 ◽

2012 ◽

pp. 79-85

Author(s):

Van Lieu Nguyen ◽

Doan Van Phu Nguyen ◽

Thanh Phuc Nguyen

Keyword(s):

Hospital Stay ◽

Perioperative Complications ◽

University Hospital ◽

Anal Pain ◽

Stapled Hemorrhoidectomy ◽

Fourth Degree ◽

Duration Of Hospital Stay ◽

The Mean ◽

Good For

Introduction: Since Longo First described it in 1998, Stapled Hemorrhoidectomy has been emerging as the procedure of choice for symtomatic hemorrhoid. Several studies have shown it to be a safe, effective and relative complication free procedure. The aim of this study was to determine the suitability of (SH) as a day cas procedure at Hue University Hospital. Methods: From Decembre 2009 to April 2012, 384 patients with third- degree and fourth-degree hemorrhoids who underwent Stapled Hemorrhoidectomy were included in this study. Parameters recorded included postoperative complications, analegic requirements, duration of hospital stay and patient satisfaction. Follow-up was performed at 1 month and 3 months post-operative. Results: Of the 384 patients that underwent a Stapled Hemorrhoidectomy 252 (65,7%) were male and 132 (34,3%) were female. The mean age was 47,5 years (range 17-76 years. Duration of hospital stay: The mean day was 2,82 ± 1,15 days (range 1-6 days). There were no perioperative complications. There was one case postoperative complication: hemorrhage; Follow-up after surgery: 286 (74,4%) patients had less anal pain, 78 (20,3%) patients had moderate anal pain, 3 (0,8%) patients had urinary retention; Follow-up after one month: good for 325 (84,6%) patients, average for 59 (15,4%) patients; Follow-up after three months: good for 362 (94,3%) patients, average for 22 (5,7%) patients. Conclusion: Our present study shows that Stapled Hemorrhoidectomy is a safe, reduced postoperative pain, shorter hospital stay and a faster return to unrestricted daily activity

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