Articles: patients.
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The shift of age distribution within the population of industrialized societies has led to an increased need of treating diseases in elderly patients and at the same time bearing an increased operative risk. Today, the development of surgical techniques and intensive care treatment enables us to carry out numerous procedures in geriatric patients. Innovative surgical techniques like minimal invasive surgery with minor trauma due to the surgical approach changed patient's categories, also. ⋯ Contrasting experiences made in most other countries and especially in the third world, in Germany economic restrictions have not been encountered as of yet. Economical conditions, an increase in surgical procedures in elderly patients and advances in medical science will continue to change the surgical patient's characteristics profoundly. From the physicians viewpoint we have actively participate in this development by personal interaction with the patient, by interdisciplinary cooperation and prompt social and political action.
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Although tens of thousands of Salmonella infections occur annually in this country, most involve the gastrointestinal tract with involvement of the urinary tract being quite infrequent.1-3 I would like to report a case of urosepsis due to Salmonella with eventual development of metastatic osteomyelitis of a rib that proved refractory to treatment. A 59-year-old Latin American male who resided in the Texas Rio Grande Valley presented to an emergency room with inability to void, having first noted a decreased urinary stream and dribbling a few months earlier. In-and-out bladder catheterization yielded 700 cc of urine, and he was sent out on co-trimoxazole one double-strength tablet twice daily. ⋯ Forty-eight hours postoperatively, the patient suffered an acute myocardial infarction and expired. Postmortem revealed severe coronary artery disease. No additional focus of Salmonella infection was found.
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Comparative Study
A comparison of patients' communication-related responses during intubation and after extubation.
The purpose of this exploratory pilot study was to examine patients' communication-related responses during intubation and after extubation, and to determine whether differences in patients' report of responses at these two points in time, if present, were associated with demographic and situational variables. ⋯ Results provide direction for larger longitudinal prospective and retrospective studies with larger samples that examine patients' recall of their responses during intubation, especially related to communication.
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The Health Centre at Kirkjubaejarklaustur serves a large rural district with a population a little over 600. Agriculture and various services including tourism are the main occupations. Almost 20% of the population are over 65 years of age, which is an unusually high figure compared to the rest of the country. Ambulance transports are one of the health centre's responsibilities. Most of these are surface transports to hospitals, 200-250 kilometres away. ⋯ Ambulance transport including the preparation of the sick or injured person is an important part of health care in this region. General practitioners need to be well versed in emergency medicine and ambulance attendants in preparing the patient for transport. Therefore continuing education is an important factor in this discussion. Tourism in the summertime may prompt the need for increased staffing in the health care sector. There is no indication that helicopter transport will replace surface transport in the near future except in special cases as it has been. Good primary health care and regular access to physicians in the nursing home setting decrease the need for ambulance transport. Further studies in the area of ambulance transport especially concerning tourists and the elderly are needed in the Icelandic context. Both groups are on increase and will probably be more in demand of emergency medical services such as ambulance transports.