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 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The treatment of pressure sores in elderly patients requires careful documentation and a comprehensive treatment plan, which takes into account the patient's overall situation. The treatment has to be evidence based. At the moment only three recommendations can be based on two or more prospective, randomized clinical studies: to use a dressing to maintain a moist environment at the wound/dressing interface, to reduce the risk of infection and enhance wound healing by hand washing, wound cleansing and debridement and to institute a systemic antibiotic treatment for patients with advancing cellulitis, sepsis and osteomyelitis. For other treatment options such as topical negative pressure, maggot therapy, electromagnetic therapy, therapeutic ultrasound or growth factors, the data at present are not sufficient to support general use in pressure sore treatment.
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PMID:[Treatment of pressure sores in elderly patients]. 1510 79

Classical familial amyloid polyneuropathy may have a course with progressive renal impairment. We studied 62 patients (24 males, 38 females) with FAP, transthyretin variant V30M, and end-stage renal disease (ESRD) treated with hemodialysis, all referred to a single center over a period of 11 years. Clinical course, morbidity and survival after dialysis were analyzed. Patient's mean age at first dialysis was 51.5 +/- 10.7 years, and mean duration of neuropathy was 10.2 +/- 3.8 years. The most frequent form of presentation of FAP nephropathy was nephrotic proteinuria with renal dysfunction. In the year prior to dialysis, renal function declined rapidly, and fluid overload was the main indication to initiate treatment. The presence of decubitus ulcers, significant disability, venous catheter for definitive vascular access for long-term treatment, and permanent bladder catheter, were related to death during the first year of dialysis. The mean duration of renal replacement therapy was 21 months, with a 54.5% one year, and 38.4% two year treatment survival. However, when the duration of neurological symptoms at first dialysis exceeded 10 years, survival was significantly lower. Infections, (41% were decubitus ulcers with sepsis) were the cause of early, as well as late mortality. Early creation of vascular access for hemodialysis, surveillance of skin wounds, and intervention on neurogenic bladder are essential to improve the prognosis of ESRD in FAP.
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PMID:End-stage renal disease and dialysis in hereditary amyloidosis TTR V30M: presentation, survival and prognostic factors. 1518 96

DISTURBING EPIDEMIOLOGICAL DATA: Over the past decade there has been a continuous progression in the percentage of Staphylococcus aureus strains resistant to methicillin (MRSA), a slight progression in coagulase-negative staphylococci strains resistant to methicillin and a spectacular progression of enterococci resistant to glycopeptides, not only in hospitals but also in intensive care settings. The increase in nosocomial septicemia is currently a major patient safety issue. HIGHER MORTALITY IN BACTEREMIC PATIENTS: The excess mortality globally observed in cases of bacteremia (compared with patients without bacteremia) is markedly enhanced with regard to secondary bacteremia. Bacteremia is responsible for a significant increase in the overall duration of hospitalization. PROGNOSTIC FACTORS OF STAPHYLOCOCCI BACTEREMIA: The mortality rate is significantly higher in patients in whom initial therapy was inappropriate compared with those in whom it was adequate. The isolation of MRSA strains is a negative prognostic factor. PATIENTS AT RISK OF MRSA BACTEREMIA: Independent risk factors for MRSA bacteremia include prior exposure to antibiotics, a nosocomial origin, a history of hospitalization within the 6 preceding months, and the presence of a decubitus ulcer. To avoid MRSA bacteremias related to catheters, alternatives should be found to their use, all hygiene rules should be carefully respected, the insertion point should be carefully disinfected and protected, and the catheter should be removed as rapidly as possible.
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PMID:[Challenges, treatment strategies and clinical progression of MRSA bacteremia]. 1532 Apr 40

Sacral pressure sore treatment requires a multidisciplinary approach, the surgical procedures following nutritional and medical status rehabilitation, spasticity control and sepsis treatment. Serial surgical debridement might also precede flap coverage. Gluteal flaps design such as rotation, transposition or V-Y advancement is selected according to the shape and size of the sore. Our experience with 74 patients with 95 flaps includes 38 rotation flaps, 28 V-Y and 8 transposition flaps. Twenty one patients had bilateral gluteal V-Y flaps. Only 2 transposition flaps had marginal necrosis that healed per secundam. Delayed healing occurred in 12 cases due to sepsis, that healed spontaneously in 10 cases and required surgical reintervention for excision and flap reposition in 2. Prolonged bed immobilization, postoperative antibiotic therapy and late suture removal are important factors in surgical success.
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PMID:The treatment of the sacral pressure sores in patients with spinal lesions. 1598 52

Little is known as to what happens to people with Huntington's disease (HD) at the end of life. Exploratory analysis was performed for all admissions of people with HD in the Nationwide Inpatient Sample database, a 20% stratified sample of all US hospitalizations, from 1996 to 2002. Using the principal diagnosis and procedure, admission cohorts were determined. The common HD-associated reasons for admission were pneumonia (including aspiration, 22%), psychiatric (21.5%), debilitation (hypovolemia, nutritional deficiencies, and decubitus ulcers, 15.5%), trauma (5.7%), and nonpulmonary infections (urinary tract infections and sepsis, 11.%). Twenty-two percent were admitted for medical problems unrelated to HD. Emergency departments were the most frequent source of admission (60%), most had Medicare or Medicaid as the expected payer (80.6%), 54.4% of all admissions were discharged to long-term care facilities (LTCFs), and 3.7% died. The highest mortality was seen in the pneumonia (7.68%) and sepsis (7.39%) cohorts. Of the elective admissions, between 49.71% and 60.31% were discharged to LTCFs, representing new LTCF admissions. Based on this exploratory analysis, hospitalized HD patients are admitted late in the course of their illness, are severely disabled, and are commonly discharged to LTCFs. With 60.31% of the discharges representing new LTCF admissions, this finding shows that there is no going home from the hospital for people with HD.
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PMID:No going home for hospitalized Huntington's disease patients. 1758 Mar 77

A 51-year-old man with poliomyelitis was admitted to emergency because of a severe decubitus ulcer on his right hip that was associated with infection. His general condition deteriorated and he was malnourished and dehydrated. Despite adequate hyperalimentation and antibiotic administration, laboratory data indicated pancytopenia 4 days later. He was diagnosed as having secondary hemophagocytosis (HPS) associated with methicillin-sensitive Staphylococcus aureus sepsis due to decubitus inflammation based on bone marrow aspiration and a blood culture. Although granulocyte colony stimulating factor, packed red blood cell transfusions, platelet transfusions, and antibiotics gradually improved the pancytopenia, the patient died of massive gastrointestinal tract bleeding.
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PMID:Secondary hemophagocytic syndrome in a patient with methicillin-sensitive Staphylococcus Aureus bacteremia due to severe decubitus ulcer. 1659 99

This study estimates that Medicare extra payments under the hospital prospective payment system (PPS) range from about $700 per case of decubitus ulcer to $9,000 per case of postoperative sepsis in the five types of adverse events identifiable in Medicare claims. Medicare extra payment for the five types of events totals more than $300 million per year, accounting for 0.27 percent of annual Medicare hospital spending. But these extra payments cover less than a third of the extra costs incurred by hospitals in treating these adverse events. We conclude that both Medicare and hospitals gain financially by improving patient safety.
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PMID:Medicare payment for selected adverse events: building the business case for investing in patient safety. 1721 Oct 41

Elder neglect, one of the 6 forms of elder maltreatment, is difficult to diagnose and is underreported both in the scientific literature and to law enforcement. Recognizing fatal neglect is even more challenging especially with concurrent organic disease. Many entities can mimic elder neglect, and many age-related changes can result in pathology that may be confused with maltreatment. We retrospectively reviewed all forensic cases of individuals age sixty-five years and older which were referred for autopsy. Cases of fatal neglect were analyzed as to age, sex, race, cause of death, location of incident, perpetrator, victim-to-perpetrator relationship, and autopsy and ancillary findings. The cases studies totaled 8. The age range was 74 to 94 years. Two were white, 6 black, one male, and 7 female. The causes of death were sepsis due to severe decubitus ulcers and severe dehydration. Five cases occurred in the victim's home, and 3 occurred in an institution (nursing home/care facility). In 5 cases, the perpetrators were family members. The pathophysiology of aging with respect to elder maltreatment is reviewed.
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PMID:Elder neglect and the pathophysiology of aging. 1752 70

This article presents an overview of nutritional, herbal, and homeopathic treatment options from complementary and alternative medicine (CAM) as adjuncts in stroke prevention, treatment, and rehabilitation. Despite many promising leads, the evidence does not favor recommendation of most of these treatments from a public health policy perspective. However, simple preventive interventions such as use of a high-quality multivitamin/multimineral supplement in patients with undernutrition may improve outcomes with minimal long-term risk. Natural agents such as the antioxidant alphalipoic acid, certain traditional Asian herbal mixtures, and some homeopathically prepared remedies show promise for reducing infarct size and associated impairments. A number of nutrients and herbs may assist in treatment of stroke-related complications such as pressure sores, urinary tract infections, and pneumonia. Individualized homeopathy may even play a helpful adjunctive role in treatment of sepsis. However, a great deal of systematic research effort lies ahead before most of the options discussed would meet mainstream medical standards for introduction into routine treatment regimens.
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PMID:Adjunctive care with nutritional, herbal, and homeopathic complementary and alternative medicine modalities in stroke treatment and rehabilitation. 1769 56

Small-bowel volvulus around the superior mesenteric artery is a very unusual cause of small-intestinal obstruction, which may result in intestinal ischemia and necrosis. A 45-year-old woman, who had received a living-donor liver transplant with a right lobe graft for fulminant hepatic failure 5 years earlier, underwent a liver biopsy and was placed in the right decubitus position. Abdominal pain, high fever, tachycardia, and altered mental status developed quickly, suggesting abdominal sepsis. Computed tomography (CT) showed a "target sign," representing a counter-clockwise rotation of the mesenteric pedicle. However, without laparotomy, the symptoms subsided completely within 12 h by her lying strictly in the left decubitus position. A second CT scan showed an orthotopic untwisted jejunum. Although many complications associated with percutaneous liver biopsy have been described, to our knowledge this is the first report of positioning-associated intestinal volvulus after a liver biopsy.
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PMID:Small-intestinal volvulus around the superior mesenteric artery as an extremely rare positioning-associated complication after percutaneous liver biopsy. 1851 44


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