Clinics in geriatric medicine
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This article describes: the origin and evolution of house calls; what is uniquely gained from house calls for both patients and providers; key clinical issues managed at home; evidence that house calls improve outcomes; organization of house call practices; and changes in Medicare reimbursement, technology, and interdisciplinary team care that have influenced the delivery of home-based medical care.
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Clin. Geriatr. Med. · Nov 2008
ReviewEvaluation and management of the elderly patient at risk for postoperative delirium.
Geriatric patients are at a high risk for the development of postoperative delirium. By recognizing predisposing and precipitating risk factors, preventive measures can be undertaken to reduce this risk. Accurate and timely diagnosis is essential, and we offer therapeutic strategies to help reduce the high morbidity and mortality of this important condition.
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Clin. Geriatr. Med. · Nov 2008
ReviewPerioperative cardiac evaluation: assessment, risk reduction, and complication management.
Perioperative cardiac complications are among the most feared outcomes after surgery. Using evidence-based guidelines and expert opinion, physicians can perform a risk assessment and decide whether further cardiac testing, medical therapy, or coronary intervention is necessary to optimize the patient's medical condition prior to surgery. This article reviews the major concepts and recommendations from the ACC guidelines for preoperative cardiac evaluation and perioperative management to reduce risk. Medical management of the major postoperative cardiac complications is also discussed.
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Postoperative pulmonary complications are an important source of surgical morbidity. In this paper, the authors review recent studies that shed light on emerging risk factors, a multifactorial index for respiratory failure, and the value of specific risk reduction strategies. Novel risk factors include advanced age, congestive heart failure, pulmonary hypertension, and obstructive sleep apnea. Important risk reduction strategies include postoperative lung expansion maneuvers, the selective use of nasogastric tubes, epidural analgesia, and inspiratory muscle training.
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Guidelines for diabetes foot care are available and should be part of the routine care and evaluation of all elderly patients who have diabetes. Those individuals who have good sensation, good vascularity, without foot deformities, and are capable of reaching and seeing their feet may do well with education and reasonable approaches to footwear and foot care. ⋯ An experienced team familiar with the progression of illness should follow those who have ulcers. Guidelines are presented for the management of outpatient and inpatient therapy of foot ulcers.