Aging clinical and experimental research
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Comparative Study
Comparison of prognostic value of two kinds of severity scoring systems for hospital mortality prediction of elderly patients with acute kidney injury.
Outcome prediction is important in clinical practice. Despite significant improvements in therapeutics, the mortality associated with acute kidney injury (AKI) in elderly patients remains high. Several severity scoring systems have been used in hospital mortality prediction of patients, but little is known of their significance in elderly patients with AKI. The aim of this study is to evaluate the ability of version II of Acute Physiology and Chronic Health Evaluation (APACHE II) and Acute Tubular Necrosis Individual Severity Index (ATN-ISI) on predicting the hospital mortality of elderly patients with AKI. ⋯ APACHE II and ATN-ISI scoring systems can predict the hospital mortality of elderly AKI patients. However, APACHE II performs better than ATN-ISI.
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Multicenter Study Clinical Trial
Controlled-release oxycodone tablets after transdermal-based opioid therapy in patients with cancer and non-cancer pain.
Several publications and guidelines stress the efficacy and safety of opioid-based therapy for cancer and non-cancer pain management. The first point of the World Health Organization (WHO) guidelines recommends that, if possible, analgesics should be given by mouth. This advice fully matches the European Society for Medical Oncology (ESMO) guidelines, which advise that opioids should be titrated to take effect as rapidly as possible. The European Association for Palliative Care (EAPC) guidelines specify that transdermal fentanyl should be administered only in patients with stable analgesic requirements. The aim of this study was to assess the efficacy and influence on the quality of life of controlled- release (CR) oxycodone in patients who had obtained no or only partial pain relief after transdermal (TTD)-based opioid therapy. ⋯ Switching from transdermal opioid to oxycodone CR treatment is effective and leads to patients' improved satisfaction and quality of life.
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Case Reports
Spinal anterior epidural hematoma in an elderly man with unrecognized lupic anticoagulant taking warfarin.
Spinal epidural hematoma (SEH) is a rare acute condition defined as a hematoma occurring at spinal epidural level. It is defined as "spontaneous" (SSEH) when possible causes have been ruled out; in other cases, clotting disorders and systemic lupus erythematosus have been associated with SEH. If identified rapidly, SEH can be completely cured, with complete recovery in about 50% of cases. ⋯ Following a rehabilitation program, the patient had complete neurological recovery. Although the epidural lesion might have been a true case of SSEH, anticoagulation therapy and AL may have played a role in the pathogenesis, spread and spontaneous resolution of SEH. In cases of acute thoracic pain, associated with signs and symptoms of spinal cord compression, the diagnosis of SEH, which is a potentially devastating condition, must be carefully investigated by clinicians.
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Comprehensive geriatric assessment (CGA) may benefit frail or chronically ill patients in the emergency department (ED), but take too much time to be performed routinely in ED. An alternative approach is to use first a screening tool to detect high-risk patients and then perform CGA in these patients only. This systematic review focuses on the use and value of CGA in ED for evaluation of older patients and its influence on adverse outcomes. This approach is compared with an alternative one using existing screening tools, validated in ED, to detect high-risk patients needing subsequent CGA. This review ends by suggesting a short assessment of CGA to be used in ED and ways to improve home discharge management from ED. ⋯ The selected studies demonstrated that screening of high-risk patients is more efficient than age-based screening, and that CGA performed in ED, followed by appropriate interventions, improves outcomes.
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Hospital admissions from Nursing Homes (NHs) are associated with high mortality. Identifying people with a poor prognosis admitted from NHs is essential to inform appropriate clinical decision making. ⋯ Simple and readily available hospital admission parameters predict not only the in-patient mortality but also longer term outcome for NH residents who require acute hospital admission. Further studies are required to examine whether opportunities exist to intervene and improve outcome in this patient population.