Journal of the American Geriatrics Society
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Randomized Controlled Trial Clinical Trial
Empowerment of the older patient? A randomized, controlled trial to increase discussion and use of advance directives.
To see if an educational intervention directed at older outpatients would lead to increased use or discussion of advance directives and to characterize patients' reasons for not obtaining advance directives. ⋯ Promoting advance directive use is a complicated task. Barriers other than information and access to documents appear to be involved and need to be addressed in future efforts.
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To determine the surgical procedures being done on long-term care (level 2) nursing home residents and the resultant in-hospital morbidity and mortality. ⋯ Although retrospective and limited to inpatient data, in-hospital surgical mortality in this very frail population was low, comparable to series in unselected geriatric populations. However, major complications were very common. Primary hip surgery repair may have been too frequently done. A multi-institution, prospective trial would be useful to assess functional outcome of surgery in this population.
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This study reports the economic contributions of nursing home practice to an academic department of family practice as well as the fiscal impact of referrals from nursing home practice on an academic medical center. Payment to primary physician faculty for nursing home service did not fully compensate for faculty effort. Nevertheless, these services did result in significant revenues to consulting physicians and the University Hospital. ⋯ The average nursing home patient provided $3,744 in charges and $2,403 in income to the academic medical center per year, with $1,813 going to the hospital and $331 to consulting physicians. Even though primary care is not well reimbursed, a relatively small number of patients have the capacity to create substantial income for consulting physicians and the hospital. The study does not address whether these nursing home referrals to the hospital utilized disproportionately high hospital resources.
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To test the hypothesis that many nursing home residents with an apparently blunted fever response (maximum temperature less than 101 degrees F) may actually have a significant change in temperature (delta T greater than or equal to 2.4 degrees F) which is not recognized because of a low baseline temperature. ⋯ Establishing a nursing home patient's basal temperature and monitoring for changes in temperature (delta T greater than 2.4 degrees F) and/or lowering the threshold for recognition of fevers (to 99 degrees or 100 degrees F) in nursing home residents with a change in function should assist in early recognition of infections.