scholarly journals EXTREMELY OLD PATIENTS HOSPITALIZED IN INTERNAL MEDICINE: WHAT ABOUT THEIR ANEMIA?

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
. Maria Luigia Randi ◽  
Fabrizio Fabris
Keyword(s):  
Internal Medicine ◽  
Oldest Old ◽  
Point Of View ◽  
General Point ◽  
Hematologic Neoplasms ◽  
Old Patients ◽  
Risk Of Death ◽  
Moderate Anemia ◽  
Discharge Letter ◽  
Duration Of Hospitalization

In the western countries about half of the hospitalized patients are anemic. Generally, these patients are old, often with multiple diseases and anemia worsens the prognosis finally increasing the risk of death. We describe here a monocentric, observational study that evaluates 249 consecutive adult patients (160 women and 89 men) with anemia admitted in the internal medicine department over 5 months period. They represent 71.5% of all patients admitted in the study period. Demographic, historic and clinical data, laboratory tests, duration of hospitalization, re-admission at 30 days and death were recorded. Patients were stratified by age (75-84= old, >85 years= oldest-old), anemia severity, and etiology of anemia. In 37 old and 25 oldest-old patients anemia was mild, in 43 old and 46 oldest-old moderate and in 20 old and 7 oldest-old severe in agreement with WHO criteria. Moderate anemia was significantly more common in oldest-old (p=0.01) The causes of anemia were iron deficiency in 19 patients, other deficiencies in 5, chronic diseases in 68, hematologic neoplasms in 11, multifactorial in 43 and undetermined in 32. Oldest-old have higher frequency of multifactorial anemia (p=0.04) while hematologic neoplasms were more common in old patients (p=0.03). Most patients with undetermined anemia had mild/moderate forms.An anti-anemic treatment, mainly blood transfusion, was adopted in 100% of oldest-old patients and in 60% of old (p= 0.04). Anemia (and/or its treatment) was reported in the discharge letter in 19 old and in 22 oldest old patients. From a general point of view, physicians seem to disregard anemia, in the context of more important pathologic conditions. In oldest-old patients, multifactorial anemia seems to be consider only “one more cause of disability”. When a border line anemia occurs, even if it can represent a relevant adverse condition in frailty, is poorly considered.     

scholarly journals Beers AGS 2019 criteria in very old hospitalized patients

2020 ◽  
Vol 66 (7) ◽  
pp. 918-923
Author(s):  
Milton Luiz Gorzoni ◽  
Ronaldo Fernandes Rosa
Keyword(s):  
Internal Medicine ◽  
Oldest Old ◽  
Regular Insulin ◽  
Feeding Tube ◽  
Hospitalized Patients ◽  
Tube Placement ◽  
Potentially Inappropriate Medications ◽  
Old Patients ◽  
Very Old ◽  
The Common

SUMMARY OBJECTIVE To define the rates and types of potentially inappropriate medications (PIMs) for older adults according to the Beers AGS 2019 criteria in oldest-old patients (aged ≥80 years) hospitalized in an Internal Medicine ward. METHODS A retrospective analysis of prescriptions from medical records of oldest-old patients hospitalized in an Internal Medicine Teaching-Hospital ward using the Beers AGS 2019 criteria was performed. Data was also collected for gender, mean age, days of hospitalization, presence of feeding tube, delirium, and polypharmacy (≥5 drugs/day). The drugs listed in Table 2 of the Beers criteria were considered PIMs. RESULTS The series comprised 39 very old patients (22 men, 17 women), with a mean age of 86.3±4.7 years and hospitalization of 22.8±21.3 days. All patients were admitted via the Emergency Room. Feeding tube placement and polypharmacy occurred in 84.6% of cases and delirium in 71.8%. The prescription of a total of 16 drugs considered PIM was detected by the Beers AGS 2019 criteria (mean 1.8 ± 1.0 PIM per patient). Main prescribed PIMs were Metoclopramide “if necessary” [IN] (41.0% of cases), Omeprazole (38.5%), Regular Insulin [IN] (23.1%), Haloperidol [IN] (18.0%), Quetiapine and Amiodarone (10% each). CONCLUSION In the present series of oldest-old hospitalized patients, significant rates of PIM were found, especially for drugs prescribed as “If Necessary”, thereby increasing the risk of side-effects to that of the common polypharmacy in this age group.

Treating Cancer and No-Cancer Pain in Older and Oldest Old Patients

2015 ◽  
Vol 21 (13) ◽  
pp. 1706-1714 ◽  
Author(s):  
G. Colloca ◽  
F. Lattanzio ◽  
L. Balducci ◽  
G. Onder ◽  
G. Ronconi ◽  
...  
Keyword(s):  
Cancer Pain ◽  
Oldest Old ◽  
Old Patients

Treating Heart Failure in Older and Oldest Old Patients.

2015 ◽  
Vol 21 (13) ◽  
pp. 1659-1664 ◽  
Author(s):  
Davide Vetrano ◽  
Fabrizia Lattanzio ◽  
Anna Martone ◽  
Francesco Landi ◽  
Vincenzo Brandi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Oldest Old ◽  
Old Patients

scholarly journals Emergency department use by oldest-old patients from 2005 to 2010 in a Swiss university hospital

2013 ◽  
Vol 13 (1) ◽  
Author(s):  
Sarah Vilpert ◽  
Hélène Jaccard Ruedin ◽  
Lionel Trueb ◽  
Stéfanie Monod-Zorzi ◽  
Bertrand Yersin ◽  
...  
Keyword(s):  
Emergency Department ◽  
Oldest Old ◽  
University Hospital ◽  
Emergency Department Use ◽  
Old Patients

scholarly journals Lessons from the COVID-19 Pandemic on the Use of Artificial Intelligence in Digital Radiology: The Submission of a Survey to Investigate the Opinion of Insiders

Healthcare ◽  
2021 ◽  
Vol 9 (3) ◽  
pp. 331
Author(s):  
Daniele Giansanti ◽  
Ivano Rossi ◽  
Lisa Monoscalco
Keyword(s):  
Artificial Intelligence ◽  
General Purpose ◽  
Point Of View ◽  
General Point ◽  
Thoracic Radiography ◽  
Digital Radiology ◽  
Electronic Survey ◽  
Radiology Technicians ◽  
Medical Radiology ◽  
Great Development

The development of artificial intelligence (AI) during the COVID-19 pandemic is there for all to see, and has undoubtedly mainly concerned the activities of digital radiology. Nevertheless, the strong perception in the research and clinical application environment is that AI in radiology is like a hammer in search of a nail. Notable developments and opportunities do not seem to be combined, now, in the time of the COVID-19 pandemic, with a stable, effective, and concrete use in clinical routine; the use of AI often seems limited to use in research applications. This study considers the future perceived integration of AI with digital radiology after the COVID-19 pandemic and proposes a methodology that, by means of a wide interaction of the involved actors, allows a positioning exercise for acceptance evaluation using a general purpose electronic survey. The methodology was tested on a first category of professionals, the medical radiology technicians (MRT), and allowed to (i) collect their impressions on the issue in a structured way, and (ii) collect their suggestions and their comments in order to create a specific tool for this professional figure to be used in scientific societies. This study is useful for the stakeholders in the field, and yielded several noteworthy observations, among them (iii) the perception of great development in thoracic radiography and CT, but a loss of opportunity in integration with non-radiological technologies; (iv) the belief that it is appropriate to invest in training and infrastructure dedicated to AI; and (v) the widespread idea that AI can become a strong complementary tool to human activity. From a general point of view, the study is a clear invitation to face the last yard of AI in digital radiology, a last yard that depends a lot on the opinion and the ability to accept these technologies by the operators of digital radiology.

Changes in the Prognosis of Functional Psychoses Since the Days of Kraepelin

1967 ◽  
Vol 113 (501) ◽  
pp. 813-822 ◽  
Author(s):  
Örnulv Ödegård
Keyword(s):  
Special Problem ◽  
Point Of View ◽  
General Point ◽  
Course Of Illness ◽  
Dynamic Reasoning ◽  
Starting Point ◽  
Functional Psychoses ◽  
External Conditions ◽  
Point Of Departure ◽  
The Universe

My choice of Kraepelin as a point of departure for this lecture has definite reasons. If one wants to stay within the field of clinical psychiatry (as opposed to psychiatric history), that is as far back as one can reasonably go. By this no slight is intended upon the pre-Kraepelinian psychiatrists. For our topic Henry Maudsley would indeed have been a most appropriate starting point, and by no means for reasons of courtesy. His general point of view is admirably sound as a basis for the scientific study of prognosis in psychiatry. I quote: “There is no accident in madness. Causality, not casualty, governs its appearance in the universe, and it is very far from being a good and sufficient practice simply to mark its phenomena and straightway to pass on as if they belonged not to an order but to a disorder of events that called for no explanation.” On the special problem of prognosis he shows his clinical acumen by stating that the outlook is poor when the course of illness is insidious, but this only means that these cases develop their psychoses on the basis of mental deviations which go very far back in the patient's life, so that in fact they are generally in a chronic stage at the time of their first admission to hospital. Here he actually corrects a mistake which is still quite often made. He shows his dynamic attitude when he says that prognosis is to a large extent modified by external conditions, in particular by the attitude of friends and relatives. Maudsley's dynamic reasoning was limited by the narrow framework of the degeneration hypothesis of those days. He had a sceptical attitude towards classification, which he regarded as artificial and dangerously pseudo-exact. His own classification was deliberately provisional, with very wide groups. He held that a description of various sub-forms of chronic insanity was useless, as it would mean nothing but a tiresome enumeration of unconnected details.

Endovascular treatment of diabetic peripheral arterial disease in older and oldest old patients: a retrospective study

2017 ◽  
Vol 30 (2) ◽  
pp. 205-207 ◽  
Author(s):  
Cristina Gatti ◽  
Sara Cecchini ◽  
Paolo Fabbietti ◽  
Fabio Romagnoli ◽  
Stefano Ricci
Keyword(s):  
Retrospective Study ◽  
Peripheral Arterial Disease ◽  
Endovascular Treatment ◽  
Oldest Old ◽  
Arterial Disease ◽  
Old Patients ◽  
Peripheral Arterial

Effectiveness of nurse-led hospital-based heart failure programmes in octagenarians and nonagenarians: is age important?

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
G Guerrero ◽  
L Alcoberro ◽  
J Vime ◽  
E Calero ◽  
E Hidalgo ◽  
...  
Keyword(s):  
Heart Failure ◽  
Usual Care ◽  
Cox Regression ◽  
Oldest Old ◽  
Primary Diagnosis ◽  
Care Group ◽  
Old Patients ◽  
End Point ◽  
Period 2 ◽  
Intervention Modality

Abstract Background Efficacy of HF programmes in oldest old (octogenarians and nonagenarians) has not been fully explored. Methods We conducted a natural experiment evaluating all patients after hospitalization for heart failure as primary diagnosis between January 2017 and January 2019. We compared outcomes between patients discharged during Period #1, before the implementation of the program with patients discharged during Period #2, after the implementation of the 7-step bundle of interventions. We explored the interaction between age group (<80 vs. ≥80 years old) by the intervention modality (HF programme vs. usual care). Primary end-point was the combined end-point of all-cause death or all-cause hospitalization at 6 months after discharge from the index hospitalization. Results The study enroled 440 patients. Mean age of the whole cohort was 75±9 years. In the oldest old subgroup (n=160), mean age was 84±3. No differences were found in baseline characteristics of patients between usual care and HF program. 30-day all-cause readmission was significantly reduced in patients in the HF programme group compared to patients in the usual care group in both age strata. In unadjusted Cox regression analyses in the oldest old group, management of patients in the HF programme was significanty associated with a reduction in the risk of the primary end-point (HR: 0.50; 95% CI [0.29–0.85]; p=0.011). Conclusions Management of patients in a nurse-led integrated care-based heart failure programme results in reduction of all-cause death or all-cause hospitalizations in oldest old patients. Event-free survival cumulative curves. Funding Acknowledgement Type of funding source: None

Underappreciated Predictors for Postdischarge Mortality in Acute Hospitalized Oldest-Old Patients

Gerontology ◽  
2006 ◽  
Vol 52 (2) ◽  
pp. 92-98 ◽  
Author(s):  
Mitsunaga Iwata ◽  
Masafumi Kuzuya ◽  
Yoshimi Kitagawa ◽  
Yusuke Suzuki ◽  
Akihisa Iguchi
Keyword(s):  
Oldest Old ◽  
Old Patients

scholarly journals I.—The Metamorphosis of the Lizard Gabbros

1886 ◽  
Vol 3 (11) ◽  
pp. 481-489 ◽  
Author(s):  
J. J. H. Teall
Keyword(s):  
Mechanical Energy ◽  
Earth Pressure ◽  
Careful Consideration ◽  
Point Of View ◽  
Igneous Rocks ◽  
General Point ◽  
Present Moment ◽  
General View ◽  
Original Rock ◽  
The Subject

If we take a general view of the present position of geological science, we are struck by the fact that, although there is substantial agreement amongst geologists on matters relating to the origin of the rocks usually designated as aqueous and igneous, the greatest diversity of opinion prevails with regard to the circumstances under which the so-called metamorphic rocks have been produced. Every fragment of evidence calculated to throw light on the origin of these rocks, therefore, deserves the most careful consideration. Of recent years special attention has been directed to the effects of mechanical energy in modifying the mineralogical and structural characters of rocks originally formed by aqueous and igneous agencies; and a suspicion has been aroused that it is in this direction that we must look for a solution of many of the problems connected with the origin of the crystalline schists. A visit to the Lizard Peninsula of Cornwall during the present summer has convinced me of the immense importance of this view so far as that district is concerned. That portion of the peninsula which lies south of a line drawn from Porthalla on the east to Polurrian Cove on the west is formed.partly of igneous rocks—such as gabbro, greenstone, serpentine, and granite—and partly of crystalline schists. The igneous rocks, in certain places, become foliated and sohistose and sometimes show a definite banding due to a variation in the relative proportions of the different constituents. In other words they present characters which are usually regarded as distinctive of the crystalline schists. There is, moreover, evidence to show that these characters are mainly the result of a yielding to earth-pressure subsequent to the consolidation of the original rock. At the present moment, having just returned from the district, I am unable to treat the subject from a general point of view with any prospect of success; but it has occurred to me that some details with regard to one of the rocks may not be without interest to members of the Association.

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