Older Adult Population

Geriatric medicine is a specialty of medicine concerned with physical, mental, functional, and social conditions in acute, chronic, rehabilitative, preventive, and end-of-life care in older patients. Geriatric palliative care integrates the complementary specialties of geriatrics and palliative care to provide comprehensive care for older patients entering the later stage of their lives and their families. This chapter provides physician assistants with an overview of palliative care in older adults, the differences between palliative care and hospice, the understanding and managing of geriatrics syndrome, symptom management in older patients and the complexities of end of life, discussion of goals of care, and communicating with geriatric patients and families.

Development and content validity of the Barth Syndrome Symptom Assessment (BTHS-SA) for adolescents and adults

Background Barth Syndrome (BTHS) is a rare genetic disorder that presents as a complex of debilitating symptoms and reduced life expectancy. Well-developed, BTHS-specific assessments measuring primary signs and symptoms of BTHS are not currently available, making it difficult to evaluate treatment effects in BTHS clinical studies. The objective of this research was to develop symptom-focused patient-reported outcome (PRO) measures for use in clinical studies with adolescents and adults with BTHS. Methods Concept elicitation interviews (CEIs) with pediatric (n = 18, age < 16 years) and adult (n = 15, age ≥ 16 years) individuals with BTHS and/or their caregivers were conducted to identify signs and symptoms relevant to BTHS and important to individuals with the condition. Based on CEI results, questionnaire construction activities were conducted to create unique adolescent and adult versions of the Barth Syndrome-Symptom Assessment (BTHS-SA). The questionnaires were evaluated in cognitive debriefing interviews (CDIs) with adolescents (n = 12; age 12- < 16 years) and adults (n = 12; age ≥ 16 years) with BTHS to assess relevance and readability of the tools. Results During the CEIs, a total of 48 and 40 signs and symptoms were reported by the pediatric and adult groups, respectively; 31 were reported by both age groups. Fatigue/tiredness and muscle weakness were the symptoms most frequently reported by both pediatric and adult patients with BTHS as important to improve with an effective treatment. The CEI results informed construction of a nine-item version of the BTHS-SA for adolescents and an eight-item version for adults. Developed for daily administration, each version asks respondents to rate symptom severity “at its worst” over the 24 h prior to administration. CDIs with both adolescents and adults with BTHS demonstrated that each BTHS-SA version was reflective of the disease experience and that respondents could interpret the questionnaire as intended and provide responses that accurately reflected their symptom experience. Conclusions The BTHS-SA adolescent and adult versions are content-valid PRO measures that can be used to evaluate severity of disease-specific symptoms in future clinical trials. Given the lack of available and well-developed assessments in this underserved therapeutic area, these tools fulfill a need for clinical researchers developing treatments for individuals with BTHS.

Respiratory Neuropathy as an Important Component of Critical Illness Polyneuromyopathy

ABSTRACT. The attention of neurologists, neurosurgeons, intensive care physicians has been attracted recently by the new PICS (Post Intensive Care Syndrome) symptom complex (PIC) or PIC syndrome — Post Intensive Care Syndrome. One of the most severe options for PIT syndrome is critical illness polymyoneuropathy (CIP). Polyneuropathy (Critical illness polyneuropathies, or CIP) and myopathy (Critical illness myopathies, or CIM) are common complications of critical care. Several syndromes of muscle weakness are combined under the term «Intensive care unit-acquired weakness» or ICUAW. Respiratory neuropathy is a special case of PMCS, where respiratory failure is associated with damage to the neuromuscular apparatus of external respiration. The clinical consequence of respiratory neuropathy is an unsuccessful weaning from ventilator and a long stay of patients in ICU. This systematic review of the literature is an analysis of publications devoted to the main pathogenetic mechanisms of the development of CIP and respiratory neuropathy, diagnostic methods, new therapeutic approaches to the treatment of ICU patients with respiratory neuropathy. The special attention is given to the problem of acute muscle wasting, diagnosis and correction of proteinenergy metabolism disorders in patients with respiratory neuropathy.

Lexical phrases with anthroponymic components in medical terminology

This article analyzes anthroponymic component language chunks in medical terminology. The research focuses on a large group of medical fixed phrases containing anthroponyms in their component composition. The main attention is paid to structural, semantic and etymological analysis. The basic lexical sets of anthroponymic component language chunks have been distinguished. The main sources and models of lexical phrases used in the formation of medical terms have been defined. The collected material allows us to state that the words syndrome, symptom and disease, being the structural core of medical phraseological units, are often distinguished in the phraseological units analyzed. The dependent component in a noun phrase is represented by an anthroponym. As a rule, this is the name of the scientist who made important discoveries in the medical field. Much attention is paid to the proper name semantics as part of a phraseological unit. Based on the etymological analysis of the material under study, the classification of medical phraseological units with a proper name component has been developed. The analysis showed that the origin of phraseological units with a proper name is based on real personalities, scientists, ancient and biblical mythology, literary works associated with the names of characters. Phraseological combinations associated with national and cultural specifics are of outstanding interest for linguistic analysis. The study showed that a proper name is a special linguistic sign that involves ethnic culture. The article discusses lexical chunks formed by metaphorical transfer in detail. The metaphorical transfer of names in the terminological system is noticed regularly, which is due to the constant development of medical terms’ new names and meanings formation through the scientific rethinking of common words.