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Lubart E, Boguslavsky T, Goltsman G, Muhtaseb S, Matveychuk A. The incidence of acute renal failure and high mortality rate in elderly patients hospitalized with community acquired pneumonia. Exp Gerontol 2023; 179:112242. [PMID: 37343811 DOI: 10.1016/j.exger.2023.112242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/14/2023] [Accepted: 06/15/2023] [Indexed: 06/23/2023]
Abstract
Community acquired pneumonia is associated with high mortality and health care costs, especially in old age. The clinical presentation of pneumonia in the elderly may be asymptomatic or atypical. One of the known complication is an acute kidney injury. The purpose of our study was to estimate the incidence of this complication in elderly patients hospitalized with pneumonia in our geriatric hospital. From a group of 180 elderly patients hospitalized with community-acquired pneumonia 34.4 % developed acute kidney injury. In this group, 51.6 % of patients died compared to 14.4 % in the group of patients without acute kidney injury (p < 0.001). The lower level of e-GFR was significantly associated with mortality (p < 0.001): out of seven patients with e-GFR level of 15-29 mg/mmol, five patients died (71.4 %). Elderly patients with community-acquired pneumonia suffering acute kidney injury experienced worse in-hospital outcomes; mortality rate was significantly higher in our study. We found a relationship between low level of e-GFR and mortality. Clinicians should be alert for early detection and prevention of kidney injury in patients admitted with pneumonia.
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Affiliation(s)
- E Lubart
- The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Acute Geriatric Department, Shmuel Harofe Geriatric Medical Center, POB 2, Beer Yaakov, Israel
| | - T Boguslavsky
- The Faculty of Medicine, Technion, Haifa, Israel; Shoham Geriatric Medical Center, Ha-nadiv road, Pardes Hana 3707101, Israel
| | - G Goltsman
- The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Internal Medicine D Department, Asaf Harofe Medical Center, Zrifin 70300, Israel
| | - S Muhtaseb
- Acute Geriatric Department, Shmuel Harofe Geriatric Medical Center, POB 2, Beer Yaakov, Israel
| | - A Matveychuk
- The Faculty of Medicine, Technion, Haifa, Israel; Shoham Geriatric Medical Center, Ha-nadiv road, Pardes Hana 3707101, Israel.
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Lubart E. The Working Processes and Safety Measures Reduce Falls in a Multilevel Geriatric Hospital. Gerontol Geriatr Med 2022. [DOI: 10.24966/ggm-8662/100125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Fall is a common event in elderly that could harm independence, prolongs hospitalization and increases mortality, as well as becoming a burden on health systems.
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Lubart E, Gal G, Mizrahi EH, Tzabary A, Baumohl E, Pinco E, Idkiedek Z, Ali EH, Berger M, Goltsman G. Time to resolution of infection in COVID-19 patients: the experience of a tertiary medical center in Israel. Jpn J Infect Dis 2021; 75:144-147. [PMID: 34470961 DOI: 10.7883/yoken.jjid.2021.215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
With the coronavirus disease spreading, reports indicated that young patients are usually asymptomatic with a short convalescence period. The current study compares the time to resolution of infection in symptomatic versus asymptomatic patients. Seventy- six patients aged 44.4±23.3 years were admitted to the COVID-19 Unit during the study period. Data was collected from patients' records. Throat and nasal swabs for the RT-PCR COVID-19 were collected. Time to resolution of infection was defined as the number of days from the date of the first COVID-19 positive outcome to the second consecutive negative PCR results. Most patients showed between 1-6 COVID-19 signs and symptoms (71.1%) and the rest were asymptomatic. No association was found between the time to resolution of infection and the presence of COVID-19 signs and symptoms (symptomatic: Md 10.0 95% CI 8.4-11.6; asymptomatic: Md 15.0 95% CI 10.5-15.5; p=0.54). Age was not correlated with the number of COVID-19 signs and symptoms (r=0.13, p=0.37) and with the time to resolution of infection (r=0.06, p=0.58). In mild to moderate symptomatic patients, the time to resolution of infection from COVID-19 is not different from asymptomatic patients.
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Affiliation(s)
- Emily Lubart
- Internal medicine department. The Sackler Faculty of Medicine, Tel Aviv University, Israel.,Acute Geriatric Department A. Shmuel Harofe Geriatric Medical Center, Israel
| | - Gilad Gal
- School of Behavioral Sciences, Tel Aviv-Yaffo Academic College, Israel
| | - Eliyahu H Mizrahi
- Internal medicine department. The Sackler Faculty of Medicine, Tel Aviv University, Israel.,Acute Geriatric Department A. Shmuel Harofe Geriatric Medical Center, Israel
| | - Ahuva Tzabary
- Acute Geriatric Department A. Shmuel Harofe Geriatric Medical Center, Israel
| | - Ehuda Baumohl
- Acute Geriatric Department A. Shmuel Harofe Geriatric Medical Center, Israel
| | - Erica Pinco
- Acute Geriatric Department A. Shmuel Harofe Geriatric Medical Center, Israel
| | - Zuhdi Idkiedek
- Acute Geriatric Department A. Shmuel Harofe Geriatric Medical Center, Israel
| | - Eisa Haj Ali
- Acute Geriatric Department A. Shmuel Harofe Geriatric Medical Center, Israel
| | - Maya Berger
- Acute Geriatric Department A. Shmuel Harofe Geriatric Medical Center, Israel
| | - Galina Goltsman
- Internal medicine department. The Sackler Faculty of Medicine, Tel Aviv University, Israel.,Internal medicne G department, Asaf Harofeh Medical Center, Israel
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Goltsman G, Gal G, Mizrahi EH, Mardanov S, Pinco E, Lubart E. The impact of intensive staff education on rate of Clostridium difficile-associated disease in hospitalized geriatric patients. Aging Clin Exp Res 2020; 32:2393-2398. [PMID: 31776858 DOI: 10.1007/s40520-019-01424-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 11/15/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Toxin-producing Clostridium difficile is the most common cause of nosocomial diarrhea in geriatric units. AIM The purpose of study was to check the impact of intensive staff education on rate of Clostridium difficile-associated disease in hospitalized geriatric patients. METHODS The sampling frame was all patients suffering from diarrhea checked for Clostridium difficile toxin during the years 2017-2018. Clostridium difficile-positive patients were compared to a similar number of Clostridium difficile toxin-negative patients. The data were compared to our previous study, followed by medical staff's educational program for Clostridium difficile control and prevention. RESULTS Among 217 patients with diarrhea, 60 (27.6%) were positive for Clostridium difficile toxin. The study group tended to be of older age (p = 0.06), and showed higher rate of functional impairment (p < 0.001) and mortality (p < 0.001) than Clostridium difficile toxin negative patients. The rate of Clostridium difficile toxin-positive patients did not significantly differ between the previous and current studies (20.0% and 27.6%, respectively). CONCLUSIONS AND DISCUSSION In spite of findings, that patients tended to be older, with high rate of mortality, the rate of Clostridium difficile did not change from the previous study.
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Affiliation(s)
- G Goltsman
- Internal Medicine Department, The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Internal Medicine G Department, Asaf Harofeh Medical Center, Zerifin, 70300, Israel
| | - G Gal
- School of Behavioral Sciences, Tel Aviv-Yaffo Academic College, Jaffa, Israel
| | - E H Mizrahi
- Internal Medicine Department, The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Acute Geriatric Department A, Shmuel Harofe Geriatric Medical Center, POB 2, Be'er Ya'akov, Israel
| | - S Mardanov
- Acute Geriatric Department A, Shmuel Harofe Geriatric Medical Center, POB 2, Be'er Ya'akov, Israel
| | - E Pinco
- Acute Geriatric Department A, Shmuel Harofe Geriatric Medical Center, POB 2, Be'er Ya'akov, Israel
| | - Emily Lubart
- Internal Medicine Department, The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
- Acute Geriatric Department A, Shmuel Harofe Geriatric Medical Center, POB 2, Be'er Ya'akov, Israel.
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Goltsman G, Baumohl Y, Gal G, Buckman Z, Proshkin V, Lubart E. To check or not to check. Rectal ESBL colonization in hospitalized elderly patients. Am J Infect Control 2018; 46:1236-1239. [PMID: 29866634 DOI: 10.1016/j.ajic.2018.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 05/16/2018] [Accepted: 05/16/2018] [Indexed: 10/14/2022]
Abstract
BACKGROUND The worldwide spread of extended-spectrum-beta-lactamase (ESBL) producing bacteria has affected health care. ESBL confers resistance to the majority of beta-lactam antibiotics. MATERIALS AND METHODS We intended to quantify the rates of rectal ESBL-positive and negative patients that eventually developed fever and urinary tract infection (UTI). All rectal ESBL-positive patients were to be initially treated with the conventional antibiotics that have anti-ESBL activity (amikacin or ertapenem), while ESBL-negative patients were given ceftriaxone. RESULTS Most patients were rectal ESBL-positive (60.7%). Fever was in 51% patients; 67.8% of them developed signs and symptoms of UTI. Most patients with UTI were urinary ESBL-positive (79%), most rectal ESBL-negative patients were urinary ESBL-negative (75%), (χ2 = 18.5, df = 1, P < .001). Overall mortality was higher in the febrile group (39, 34.8%) versus the afebrile (1, 0.9%) (χ2 = 42, df = 1, P < .001). The mortality rate in the febrile group was significantly higher in the rectal ESBL-positive patients (χ2 = 7.5, df = 1, P = .006). DISCUSSION The direct correlation of rectal ESBL-positive and negative and respectively urinary ESBL-positive and negative patients' advocate for the use of antibiotics with anti-ESBL activity as an empiric treatment of rectal ESBL-positive patients with suspected UTI. CONCLUSION In our opinion, it is worthwhile to identify rectal ESBL-positivity on hospital admission.
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Mizrahi E, Harel N, Heymann A, Lubart E, Leibovitz A, Malik Gadot E, Barkan R. The relation between gain in cognition during rehabilitation on functional outcome among hip fracture adult patients with and without pre- hip fracture dementia. Arch Gerontol Geriatr 2018; 78:177-180. [DOI: 10.1016/j.archger.2018.06.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 06/25/2018] [Accepted: 06/28/2018] [Indexed: 01/23/2023]
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Leibovitz A, Yarovoy A, Sharshar N, Buckman Z, Mizrahi EH, Lubart E. Clostridium difficile-associated disease: A primary clinical evaluation of elderly patients in a geriatric hospital. Am J Infect Control 2016; 44:1158-1160. [PMID: 27375063 DOI: 10.1016/j.ajic.2016.03.069] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 03/14/2016] [Accepted: 03/14/2016] [Indexed: 11/23/2022]
Abstract
The purpose of this study was to screen all cases of Clostridium difficile-associated disease during a 2-year period in a geriatric hospital to determine the incidence and clinical characteristics related to this risk. Twenty percent of suspected cases were diagnosed as positive and analyzed. The C difficile disease-associated clinical factors were ischemic heart disease and chronic obstructive pulmonary disease. Use of acetylsalicylic acid, other nonsteroidal anti-inflammatory drugs, and steroids were more frequently found in the non-C difficile group. There were fewer cases in men than in women and more in patients residing in skilled nursing wards.
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Affiliation(s)
- Arthur Leibovitz
- Shmuel Harofeh Geriatric Medical Center affiliated with Sackler School of Medicine, Tel-Aviv University, Israel
| | - Alexandra Yarovoy
- Shmuel Harofeh Geriatric Medical Center affiliated with Sackler School of Medicine, Tel-Aviv University, Israel
| | - Nataly Sharshar
- Shmuel Harofeh Geriatric Medical Center affiliated with Sackler School of Medicine, Tel-Aviv University, Israel
| | - Zvi Buckman
- Maccabi Health Care Services, Rishon L'Zion, Israel
| | - Eliyahy Haim Mizrahi
- Shmuel Harofeh Geriatric Medical Center affiliated with Sackler School of Medicine, Tel-Aviv University, Israel
| | - Emily Lubart
- Shmuel Harofeh Geriatric Medical Center affiliated with Sackler School of Medicine, Tel-Aviv University, Israel.
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Lubart E, Yarovoy A, Gal G, Krakover R, Leibovitz A. QT Interval Length in Elderly Prostatic Cancer Patients on Anti-Testosterone Treatment. Isr Med Assoc J 2015; 17:356-359. [PMID: 26233994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
UNLABELLED Background: QT segment prolongation is a high risk factor for fatal arrhythmias. Several studies have indicated a possible relation between low testosterone levels and QT interval prolongation. OBJECTIVES To compare the QT interval length in elderly patients with prostate carcinoma who were on anti-testosterone treatment and those who were not. METHODS We screened the electrocardiograms (ECGs) of 100 prostate cancer patients divided into two groups: 50 patients on anti-testosterone drug treatment and 50 patients not. QT interval length was measured according to the accepted methods. RESULTS The mean QTc 12 leads in the entire group was 0.45 ± 0.04 sec, which is close to the upper limit. Mean QTc was actually longer in the control group and there was no QTc difference between the groups after adjustment for possible confounders. Prolonged QTc 12-lead ECG (48% in treated and 54% in non-treated) and lead L2 QT interval (50% in treated and 56% in non-treated) did not differ significantly between the groups. The analysis of QTc 12-lead ECG indicated no significant effects of anti-testosterone drug treatment. Only the use of furosemide was associated with QT prolongation. CONCLUSIONS The results of this preliminary study do not support our initial concern of an alarmingly prolonged QT interval in the anti-testosterone treated group. However, further prospectively designed studies are needed. In the meanwhile we call for a close follow-up of the QT interval length in patients receiving anti-testosterone treatment.
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Lubart E, Leibovitz A, Shapir V, Segal R. On-spot rheumatology consultations in a multilevel geriatric hospital. Isr Med Assoc J 2014; 16:33-36. [PMID: 24575502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Musculoskeletal and joint disorders are extremely common in the elderly. They directly affect mobility, gait stability, quality of life, and independence. OBJECTIVES To assess the nature of joint problems encountered in a geriatric inpatient population and evaluate the contribution of a rheumatologist. METHODS We reviewed the rheumatology consultation records that were conducted in a geriatric medical center over a 10 year period. RESULTS A total of 474 consultations were held; most of these patients (86%) were hospitalized in the acute geriatric departments, 10% in the rehabilitation ward and 4% in the long-term care wards. Some patients were seen more than once. A rheumatologic joint problem was the main reason for hospitalization in 53% of these patients. Monoarthritis was the most frequent complaint (50%), followed by pauciarticular arthritis (two to five joints) in 30% of patients. Arthrocentesis, diagnostic and therapeutic, was performed in 225 patients, most of them in knee joints (81%). The most frequent diagnosis was osteoarthritis with acute exacerbation (28%), followed by gout (18%), pseudo-gout (9%) and rheumatoid arthritis (9%). In 86 cases (18%) the diagnosis was a non-specific rheumatologic problem: arthralgia, nonspecific generalized pain, or fibromyalgia. CONCLUSIONS Prompt and appropriate evaluation, as well as arthrocentesis and treatment initiation, including local injections, were made possible by the presence of an in-house rheumatologist.
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Affiliation(s)
- Emily Lubart
- Department of Geriatric Medicine, Shmuel Harofeh Geriatric Medical Center, Beer Yaakov, Israel.
| | - Arthur Leibovitz
- Department of Geriatric Medicine, Shmuel Harofeh Geriatric Medical Center, Beer Yaakov, Israel
| | - Vadim Shapir
- Department of Geriatric Medicine, Shmuel Harofeh Geriatric Medical Center, Beer Yaakov, Israel
| | - Refael Segal
- Department of Geriatric Medicine, Shmuel Harofeh Geriatric Medical Center, Beer Yaakov, Israel
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Lubart E, Segal R, Wainstein J, Marinov G, Yarovoy A, Leibovitz A. Evaluation of an intra-institutional diabetes disease management program for the glycemic control of elderly long-term care diabetic patients. Geriatr Gerontol Int 2013; 14:341-5. [PMID: 23750823 DOI: 10.1111/ggi.12104] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2013] [Indexed: 12/30/2022]
Abstract
AIM Increasing numbers of nursing home elderly patients suffer from diabetes requiring individually optimized glycemic control. This is a complicated challenge because of their high comorbidity level, and heterogeneous and changing eating status varying from independent to dysphagia and enteral feeding. In order to cope with these complex needs, we developed and implemented a diabetes disease management program. The purpose of the present study was to evaluate this program. METHODS We used the point prevalence approach by checking for fasting blood glucose, glycated hemoglobin and other routine biochemical tests. Eating status was evaluated by the Functional Outcome Swallowing Scale. Details about the diabetes disease management program are given in the text. RESULTS A total of 86 (36%) of the 234 patients on the study day were diabetics. Of these, 80 were eligible for the study. Their mean fasting blood glucose was 143.1 ± 60.6 mg/dL. The mean glycated hemoglobin level was 7.23 ± 1.39%. CONCLUSION No case of hypoglycemia was detected on the examination day, or during the preceding 3 weeks. No significant difference was found among the different Functional Outcome Swallowing Scale categories. These results are within satisfactory range for this category of patients suggesting that our diabetes disease management program contributes to a better glycemic control.
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Affiliation(s)
- Emily Lubart
- Geriatric Department, Shmuel Harofeh Medical Center, Beer Yaakov, Israel
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Lubart E, Segal R, Megid S, Yarovoy A, Leibovitz A. QT interval disturbances in elderly residents of long-term care facilities. Isr Med Assoc J 2012; 14:244-246. [PMID: 22675843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND The QT interval reflects the total duration of ventricular myocardial repolarization. Disturbed QT--either prolonged or shortened--is associated with arrhythmia and is life-threatening. OBJECTIVES To investigate an elderly population for disturbed QT interval. METHODS We conducted a cross-sectional study on residents of long-term care wards in a geriatric hospital. Excluded were those with pacemaker, atrial fibrillation or bundle branch block. The standard 12 lead and lead 2 electrocardiograms in the patients' files were used for the evaluation of QT interval. RESULTS We screened the ECGs of 178 residents. QTc prolongation based on the mean 12 ECG leads was detected in 48 (28%), while 45 (25%) had prolonged QTc based on lead L2. Factors associated with QT prolongation were male gender, chronic renal failure and diabetes mellitus. Short QT was found in 7 residents (4%) and was not related to any parameter. CONCLUSIONS About one-third of the elderly long-term care residents in our study had QT disturbances. Such a considerable number warrants close QT interval follow-up in predisposed patients.
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Affiliation(s)
- Emily Lubart
- Shmuel Harofe Geriatric Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.
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Zabari A, Lubart E, Ganz FD, Leibovitz A. The effect of a pain management program on the rehabilitation of elderly patients following hip fracture surgery. Isr Med Assoc J 2012; 14:104-106. [PMID: 22693791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Pain following hip fracture and internal fixation is a major factor during the treatment of elderly patients on rehabilitation programs. A proactive pain management program was instituted in our geriatric rehabilitation ward in 2005. OBJECTIVES To compare retrospectively two groups of patients, one before and one after implementation of the proactive pain management program. METHODS The study group comprised 67 patients and the control group 77 patients. Pain in the study group was evaluated daily by the visual analogue scale (VAS) and the outcome of the rehabilitation process by the Functional Independence Measure (FIM). During the study period (2003-2006) no changes were made in the rehabilitation team, methods or facilities other than introduction of the pain control program. We compared the FIM scores between admission and discharge in both groups. RESULTS Improvement in FIM scores between admission and discharge was significantly higher in the study group than in the control group (11.07 +/- 7.9 vs. 8.4 +/- 7.3, P < 0.03). There was no significant difference between the average lengths of stay. CONCLUSIONS These data support the view that the proactive monitoring of pain in surgical hip fracture patients is associated with a better outcome of the rehabilitation process.
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Affiliation(s)
- Ahuva Zabari
- Geriatric Medical Center, Shmuel Harofe Hospital, Beer Yaakov, Israel
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Lubart E, Segal R, Haimov E, Dan M, Baumoehl Y, Leibovitz A. Bacteremia in a Multilevel Geriatric Hospital. J Am Med Dir Assoc 2011; 12:204-7. [DOI: 10.1016/j.jamda.2010.02.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2010] [Accepted: 02/19/2010] [Indexed: 10/19/2022]
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Lubart E, Segal R, Mishiev R, Buchman R, Leibovitz A. Community physicians' knowledge on basic health care for elderly persons in Israel: comparing findings from 2006 to 1996. Gerontol Geriatr Educ 2010; 31:174-180. [PMID: 20509063 DOI: 10.1080/02701961003795821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Community physicians should be knowledgeable of basic geriatrics to cope with the challenges posed by the growing number of older patients and their complex needs. A survey of knowledge in basic health care for elderly persons, carried out by our team in 1996, revealed that it was insufficient. The authors repeated this survey in 2006, by using the same methodology, namely, a mailed questionnaire sent to 500 randomly sampled community physicians. No significant changes were found after this 10-year period. Likewise, no difference was evidenced between physicians that participated in geriatric training of any kind and those who did not. This lack of change requires health system leaders to coordinate their efforts and develop efficient teaching programs to prevent similar findings 10 years from now.
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Affiliation(s)
- Emily Lubart
- Geriatric Department, Geriatric Medical Center, Shmuel Harofe Hospital, Beer Yaakov, Israel
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Lubart E, Segal R, Pankin M, Madjar J, Leibovitz A. [The screen for caregiver burden of demented patients]. Harefuah 2009; 148:520-572. [PMID: 19899254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Most elderly individuals with dementia live in the community with the assistance of their caregivers, usually their family members. Their strength is essential for continuing home care and avoiding or postponing institutionalization. The screen for caregiver burden (SCB) is a 25 item scale, in use for the evaluation of caregivers of demented persons in the USA. A recent study in the USA showed that answers to 7 of those 25 questions, rapid screen for caregiver burden (RSCB), are sufficiently indicative and may replace and simplify the application of this questionnaire. In this study, the authors translated the SCB into Hebrew and tested it on 94 caregivers of demented elderly patients. The study results suggest that the shortened cluster of 7 items could also be used in Israel and is adequately indicative for the evaluation of the caregiver's burden.
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Affiliation(s)
- Emily Lubart
- Shmuel Harofe Hospital, Geriatric Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Segal R, Dan M, Eger G, Lubart E, Leibovitz A. Staphylococcus aureus colonization in the nasopharynx of nasogastric tube-fed patients in a long-term care facility. Eur J Clin Microbiol Infect Dis 2009; 28:1147-9. [PMID: 19437051 DOI: 10.1007/s10096-009-0747-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2008] [Accepted: 04/15/2009] [Indexed: 10/20/2022]
Abstract
The purpose of this paper is to investigate whether the presence of a nasogastric tube (NGT) for feeding has an impact on the nasal colonization by Staphylococcus aureus. Three groups of frail elderly were examined: 76 patients fed by NGTs and 52 orally fed patients in skilled nursing wards, and 33 orally fed patients in regular nursing wards. Samples from the nasal and oral cavities were cultured for S. aureus and susceptibility testing for oxacillin was performed. The prevalence of S. aureus (either oxacillin-susceptible or oxacillin-resistant) in the NGT-fed group was not significantly different to that in the two orally fed groups nor the nostril in which the NGT was placed. A significant correlation in colonization was found between the two nares and between the nares and oral cavity in the same patient (r > 0.45, P < 0.005) for both oxacillin-susceptible and oxacillin-resistant S. aureus. The presence of NGTs for feeding in elderly frail patients is not associated with higher rates of S. aureus colonization in the nares or oral cavity.
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Affiliation(s)
- R Segal
- Shmuel Harofeh Geriatric Medical Center, Beer Yaacov 70350, Israel.
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Segal R, Iaina A, Lubart E, Leikin I, Leibovitz A. Metabolic alkalosis in skilled nursing patients. Arch Gerontol Geriatr 2009; 48:173-7. [DOI: 10.1016/j.archger.2008.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2007] [Revised: 12/27/2007] [Accepted: 01/08/2008] [Indexed: 11/26/2022]
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Lubart E, Lidgi M, Leibovitz A, Rabinovitz C, Segal R. Mortality of patients hospitalized for active tuberculosis in Israel. Isr Med Assoc J 2007; 9:870-873. [PMID: 18210928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND Pulmonary tuberculosis continues to cause of mortality, particularly in developing countries. Despite modern anti-TB treatment, the elderly and immigrants from TB-endemic countries are at risk. Multidrug resistance has yet to be resolved.. OBJECTIVES To determine the mortality rate and predictors of mortality among patients hospitalized with TB in Israel. METHODS We evaluated the medical records of 461 patients with active pulmonary TB who were hospitalized in the respiratory care department during the 5 year period 2000-2004. Data included demographic, clinical, laboratory and radiological findings, drug resistance as well as adverse reactions to anti-TB treatment. RESULTS Three main ethno-geographic groups were observed: 253 patients from the former USSR, 130 from Ethiopia, and 54 of Israeli origin (as well as 24 residents of other countries). Of the 461 patients 65 (13%) died in hospital. The factors that were best predictors of mortality were older age, ischemic heart disease, cachexia, prior corticosteroid treatment, hypoalbuminemia and pleural effusion (P < 0.005 for all). The ethno-geographic factor and the presence of multidrug-resistant bacteria had no significant effect on mortality in our study group. CONCLUSIONS The mortality rate in our study was relatively low, and there was no significant difference between the three ethno-geographic groups.
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Affiliation(s)
- Emily Lubart
- Department of Respiratory Care, Shmuel Harofe Medical Center, Beer Yaakov, Israel
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Leibovitz A, Baumoehl Y, Lubart E, Yaina A, Platinovitz N, Segal R. Dehydration among Long-Term Care Elderly Patients with Oropharyngeal Dysphagia. Gerontology 2007; 53:179-83. [PMID: 17264513 DOI: 10.1159/000099144] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2006] [Accepted: 12/04/2006] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Long-term care (LTC) residents, especially the orally fed with dysphagia, are prone to dehydration. The clinical consequences of dehydration are critical. The validity of the common laboratory parameters of hydration status is far from being absolute, especially so in the elderly. However, combinations of these indices are more reliable. OBJECTIVE Assessment of hydration status among elderly LTC residents with oropharyngeal dysphagia. METHODS A total of 28 orally fed patients with grade-2 feeding difficulties on the functional outcome swallowing scale (FOSS) and 67 naso-gastric tube (NGT)-fed LTC residents entered the study. The common laboratory, serum and urinary tests were used as indices of hydration status. The results were considered as indicative of dehydration and used as 'markers of dehydration', if they were above the accepted normal values. RESULTS The mean number of dehydration markers was significantly higher in the FOSS-2 group (3.8 +/- 1.3 vs. 2 +/- 1.4, p = 0.000). About 75% of these FOSS-2 patients had > or =4 dehydration markers versus 18% of the NGT-fed group (p = 0.000). A low urine output (<800 ml/day) was significantly more common in the FOSS-2 group (39 vs. 12%, p = 0.002). Above normal values of blood urea nitrogen (BUN), BUN/serum creatinine ratio (BUN/S(Cr)), urine/serum osmolality ratio (U/S(Osm)), and urine osmolality U(Osm), were significantly more frequent in the dehydration-prone FOSS-2 group. This combination of 4 indices was present in 65% of low urine output patients. In contrast, it was present in only 36% of the higher urine output patients (p = 0.01). Patients with a 'normal' daily urine output (>800 ml/day) also had a significant number (2 +/- 1.5) of positive indices of dehydration. CONCLUSIONS Dehydration was found to be common among orally fed FOSS-2 LTC patients. Surprisingly, probable dehydration, although of a mild degree, was not a rarity among NGT-fed patients either. The combination of 4 parameters, BUN, BUN/S(Cr ), U/S(Osm) and U(Osm), offers reasonable reliability to be used as an indication of dehydration status in daily clinical practice.
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Affiliation(s)
- A Leibovitz
- Shmuel Harofe Hospital, Geriatric Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Abstract
OBJECTIVES To examine the prevalence and nature of postprandial hypotension (PPH) in orally fed (OF), nasogastric tube (NGT)-fed, and percutaneous endoscopic gastrostomy (PEG)-fed older people. DESIGN Prospective comparative study. SETTING Nursing and skilled nursing wards of three geriatrics hospitals. PARTICIPANTS Three groups (OF, PEG, NGT) of long-term care patients (50 in each cohort) were enrolled. MEASUREMENTS Blood pressure (BP) and heart rate measurements were obtained just before lunch and at 15-minute intervals for 90 minutes after the completion of the meal. The meals were similar in caloric content and composition. RESULTS PPH was evidenced in 64 (43%) patients. No significant intergroup (OF, PEG, NGT) differences were present. In 68% of PPH patients, the systolic BP (SBP) drop appeared within 30 minutes, and 70% reached their systolic nadir at 60 minutes. In 31%, the SBP drop was registered on only one measurement, whereas in 25%, the drop was detected on five to six measurements. All parameters were without notable intergroup differences. CONCLUSION In enterally fed elderly patients (NGT or PEG), the rate and pattern of PPH are similar and not significantly different from that observed in OF patients.
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Affiliation(s)
- Emily Lubart
- Shmuel Harofe Geriatric Medical Center, Beer-Yaakov; and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Lubart E, Leibovitz A, Baumoehl Y, Klein C, Gil I, Abramovitz I, Gurevitz A, Habot B. Progressing stroke with neurological deterioration in a group of Israeli elderly. Arch Gerontol Geriatr 2005; 41:95-100. [PMID: 15911042 DOI: 10.1016/j.archger.2004.12.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2004] [Revised: 11/25/2004] [Accepted: 12/09/2004] [Indexed: 10/25/2022]
Abstract
Progressing stroke with neurological deterioration (PSND), i.e., neurological deterioration of patients during the first days following a stroke, although not an infrequent event, has hitherto been addressed only by few studies. This is the first investigation conducted in Israel with the aim to determine its prevalence and characteristics. Data regarding 140 patients with first ever stroke were collected prospectively between May 1999 and October 2000. All patients underwent a thorough daily neurological examination over the first 7 days, using the Canadian Neurological Scale. Most (90%), patients had hemiparesis, with dysarthria, aphasia and dysphagia being the most frequent associated neurological deficits. Thirty percent of the patients were on anti-aggregant therapy prior to the stroke. The prevalence of PSND was 23%. The 1-month in-hospital death rate of these PSND patients was 31%. Univariate analysis showed that previous anti-aggregant therapy, Parkinson's disease (PD), obesity, hyperlipidemia, and presence of aphasia were significantly more frequent in the PSND group. In addition, these patients arrived earlier to the emergency room. However, logistic regression analysis showed that only PD and obesity could possibly be considered as predictors for development of PSND. The prevalence as well as the death rate of PSND in this group of Israeli elderly is within the range reported in the literature. However, prior anti-aggregant treatment and PD, are here reported for the first time as associated conditions. Future research will possibly clarify the links between these entities and PSND.
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Affiliation(s)
- Emily Lubart
- Shmuel-Harofeh Hospital, Geriatric Medical Center, POB 2, Be'er-Ya'akov 70350, Israel.
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Leibovitz A, Baumoehl Y, Habot B, Gil I, Lubart E, Kaplun V, Segal R. Management of adverse clinical events by duty physicians in a nursing home. Aging Clin Exp Res 2004; 16:314-8. [PMID: 15575126 DOI: 10.1007/bf03324557] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND AIMS The nature of adverse clinical events (ACE) during duty hours (16:00-08:00 and holidays), as well as the way they are addressed by duty physicians (DP) in a nursing home (NH) are the subject of this study. METHODS Data, including medical details concerning ACEs and the resultant referrals to hospital, were collected prospectively during 183 consecutive days in a 90-bed NH. RESULTS Ninety-six residents experienced 370 ACEs, representing an average of one for every 44.5 patient days. The highest rate of events was during evening hours (18:00-21:00). The most prevalent ACE was fever (32%). Most cases (53%) were treated by the DPs on site. No intervention was needed in 19% of cases, whereas 28% of ACEs (104 cases) were referred to the Emergency Room (ER) of a general hospital. Sixty-six percent of these were actually admitted. The rate of ER referral of residents was one for every 158 patient days. About 40% of the referred patients had been discharged from hospital the previous week. High fever was the commonest cause for referral: 47%. During the working hours of the study period, the rate of referral by the staff physician was only 1 for every 915 patient days. Only 17% of these had high fever. CONCLUSIONS Evening rounds by staff physicians, strengthening of working relations with hospital physicians, as well as fostering intravenous treatment in NHs, are suggested as means for reducing hospital transfers. A standardized method for the reporting of ACEs and referrals to hospitals should be adopted in order to facilitate comparisons between NHs and to evaluate its use as a quality indicator.
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Lubart E, Leibovitz A, Segal R, Baumoehl Y, Shapira A, Gurewitz A, Habot B. [Relatives' satisfaction with the care of elderly patients in skilled nursing wards]. Harefuah 2004; 143:573-5, 623, 622. [PMID: 15523808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
BACKGROUND Skilled Nursing Wards (SNW) in Israel are purposely equipped and staffed for treatment of patients that, in addition to functional dependence, suffer from active diseases which require close medical supervision. Patients' surveys on satisfaction with health care are increasingly accepted as an element of quality assessment. However, given the high rate of communication disorders present in these patients, this method is not feasible for use in SNWs. OBJECTIVE We initiated a survey of patients' relatives--based on a questionnaire specifically designed to reflect their satisfaction with the level of care provided. METHODS Respondents were asked to rank their level of satisfaction with medical, nursing and structural aspects of the care in the SNW on a 1-5 Likert Scale. RESULTS Relatives of 147 SNW residents answered the questionnaire. The overall level of satisfaction was high, all components being ranked at 4.2 or above. Four point fifty-five was the average rating given to the medical component of the care, 4.39 to the nursing aspect and 4.32 to the structural section. Five points were awarded to the medical component by 60% of the participants, to the nursing element by 55% of respondents and to the structural section by 40% of respondents. No differences were observed between the rankings of frequent and less frequent visitors. All respondents were highly cooperative and expressed their appreciation of the initiative to perform a satisfaction survey. CONCLUSION The results show that the families of the skilled nursing patients that participated in this study are satisfied with the health care provided to their relatives. Such surveys contribute to the quality of care and should be considered for routine/periodical use in long-term care settings.
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Affiliation(s)
- Emily Lubart
- Shmuel Harofeh Hospital, Geriatric Medical Center, Be'er Ya'akov, Israel
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Lubart E, Leibovitz A, Shapira A, Tischenko O, Peled Z, Baumoehl Y, Habot B. Satisfaction with the care of institutionalized psychogeriatric patients, as reflected by a survey of their relatives. Arch Gerontol Geriatr 2004; 38:45-50. [PMID: 14599703 DOI: 10.1016/s0167-4943(03)00083-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The patients' satisfaction is an important aspect of quality of care assessment in long-term care institutions. However, many psychogeriatric patients are institutionalized at an advanced stage of their disease, when they are unable to communicate properly and cannot be questioned about their satisfaction with the care received in these psychogeriatric settings. Therefore we initiated a survey of patients' relatives based on a questionnaire purposely designed, to evaluate their satisfaction with the medical, nursing and structural components of the institutional care. The relatives of 101 patients, representing 79% of the patients in four psychogeriatric wards, responded to the questionnaire. The level of satisfaction with the care was high, as reflected by the fact that over 75% of the respondents rated the overall question about satisfaction with the medical, nursing, and structural components with the maximum of five points. The high correlation between the summative and the overall satisfaction supports and even strengthens this view. Another finding was the reluctance of most relatives to be involved in the personal care of the patients. Our study concluded that the relatives do appreciate the efforts of the staff and understand the constraints imposed by the nature of the patients' condition. Moreover, both families and staff welcomed this study and mentioned its contribution in improving communication.
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Affiliation(s)
- Emily Lubart
- Shmuel Harofe Hospital, Geriatric Medical Center, P.O. Box 2, 70350 Be'er-Ya'acov, Israel.
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Leibovitz A, Blumenfeld O, Segal R, Lubart E, Baumoehl Y, Habot B. Gender-associated findings in postmortem examinations of elderly patients: an increased rate of pulmonary embolism in women. Isr Med Assoc J 2003; 5:340-2. [PMID: 12811951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
BACKGROUND While age at death is on the rise, the number of postmortem examinations is declining and is disproportionately low among the elderly population. Research on, the subject of gender-associated pathology in the elderly is also scarce. OBJECTIVE To seek eventual gender-related differences in autopsies of elderly patients. METHODS We analyzed the data extracted from a published report on 93 PMEs performed at a geriatric hospital during the past 20 years. RESULTS Ninety-three autopsies, representing 1.2% of the 8,101 deaths during these 20 years, were performed. Forty-five of the deceased were women and 48 were men. The incidence of pulmonary embolism was significantly higher in women (28%) than in men (10%) (P < 0.02). There was no significant difference in the gender distribution of the other diagnoses. CONCLUSION Gender distribution of PME-based causes of death in elderly patients revealed a significant rate of pulmonary embolism in women. A thorough search of the medical literature revealed two previous studies with similar findings. Further research will determine whether pulmonary embolism is more frequent or whether it has a worse prognosis in frail elderly women.
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Affiliation(s)
- Arthur Leibovitz
- Geriatric Medical Center, Shmuel Harofeh Hospital, Beer Yaakov, Israel
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Lubart E, Leibovitz A, Berkman P, Baumohl Y, Habot B. Preliminary evaluation of a convalescence cardiac unit for older patients as a model of "transitional facility" from hospital to home. J Am Med Dir Assoc 2001; 2:302-4. [PMID: 12812535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
OBJECTIVES The increasing number of older cardiac patients combined with the tendency to reduce hospital stays created the need for a Convalescence Cardiac Unit (Con.CU). It functions as a transitional facility for elderly patients discharged from hospitals after cardiac events, and was established within a geriatric medical center using existing infrastructure and staff. METHODS Patients from 5 neighboring general hospitals (including 23 internal medicine wards and 3 departments of cardiac surgery) were offered the option of one week stay in the Con.CU after discharge. During the stay in the unit they received medical supervision as well as counsel on matters of nutrition and physical activity. RESULTS 78 patients were admitted during the first 14 months. Forty patients were after coronary artery bypass grafts (CABG) (51%)30 after acute myocardial infarction (MI) (38%). The average age was 75 +/- 2.5 (SD). Medical complications developed in 57%. Most of these patients were treated by the local staff. Five cases had to be readmitted to the hospital they came from. Elderly cardiac patients that chose the option of Con.CU and their families expressed high appreciation regarding this experience and its contribution in facilitating return home. CONCLUSION This innovative model is aimed to improve continuity of care for elderly cardiac patients and provide them with a new service in this era of "early discharge" from hospitalization. Geriatric settings striving to diversify their services, and medical directors required to contribute to policy development may learn from this experience.
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Affiliation(s)
- E Lubart
- Shmuel Harofe Hospital, Geriatric Medical Center, affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Leibovitz A, Lubart E, Rabinovich H, Baumohl L, Platinovich N, Habot B. A 10-year perspective on the patients referred to a geriatric rehabilitation complex: the influence of managed care. J Am Med Dir Assoc 2001; 2:1-3. [PMID: 12812597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
OBJECTIVE In the past 10 years, HMOs have used managed care to reduce patients referrals for rehabilitation in our Geriatric Rehabilitation Complex (GRC). DESIGN This study compares data regarding patients referred for rehabilitation for 4 months in 1998 with data from a similar study we performed in 1989. SETTING The GRC, which is part of a 396-bed geriatric hospital, includes a 36-bed ward complemented by departments of physical and occupational therapy, a speech therapy unit, and a rehabilitation psychologist. It is supported by modern rehabilitation equipment and facilities and is staffed by experienced, highly qualified academic personnel. RESULTS The overall number of patients referred for rehabilitation decreased by 36% during this period. However, the average age of patients is higher, the number of patients with Recc. Stroke dominates, and length of stay was reduced by 20%. CONCLUSION Although the rehabilitation needs of older people are increasing, fewer patients are referred to our GRC. Those who are referred are older, and their condition is more complicated; nevertheless, their length of stay has also been reduced. These are the results of HMO policies to refer older patients to new "rehabilitation settings" that charge lower prices while offering services of still unproved quality. As geriatricians, it is our duty to prevent cost considerations from overtaking the need to maximizing functional recovery.
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Affiliation(s)
- A Leibovitz
- Geriatric Medical Center, Shmuel Harofe Hospital, affiliated to the Sackler School of Medicine, Tel-Aviv University, Israel
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Abstract
OBJECTIVE Aspirin is known to have a bimodal effect on the renal handling of uric acid (UA). High dosages (>3 gm/day) are uricosuric, while low dosages (1-2 gm/day) cause UA retention. Although very-low-dose (mini-dose) aspirin is used increasingly as a platelet aggregation inhibitor, no studies have been published on whether aspirin's renal effects occur at dosages of <0.5 gm/day. The aim of the present study was to evaluate the effects of commonly used mini-dosages of aspirin on renal function and UA handling in elderly patients. METHODS The study included 49 elderly inpatients (age 61-94). Patients were excluded if they had renal failure, hyperuricemia, gout, or a history of bleeding, or if they were receiving anticoagulants, aspirin, or nonsteroidal antiinflammatory drugs. Previous medications and diet were kept unchanged. Aspirin was administered as follows: 75 mg/day (week 1), 150 mg/day (week 2), 325 mg/day (week 3), and 0 mg/day (week 4). Baseline and weekly samples of blood and urine were evaluated for UA, creatinine, blood urea nitrogen, creatinine clearance, UA excretion, UA clearance, and plasma levels of aspirin. RESULTS At the lowest dosage, aspirin caused a 15% decrease in the rate of UA excretion (P = 0.045 by t-test), which was associated with a slight but significant increase in serum levels of UA (P = 0.009). These effects on UA levels were gradually reduced with increasing dosages of aspirin (multivariate analysis of variance with repeated measures showed no statistically significant difference in the rate of UA excretion between weeks 1-3 and week 0 [baseline], but the difference in serum UA levels for the same comparison was statistically significant [P = 0.038]). Generally, creatinine and UA clearance rates paralleled each other during aspirin treatment. However, 1 week after aspirin was discontinued, creatinine clearance remained decreased while UA clearance returned to baseline. Plasma aspirin concentrations were low and variable. However, patients with above-median aspirin levels had significantly greater changes in serum creatinine levels, urinary UA excretion rates, and UA clearance rates following the first week of aspirin treatment. Hypoalbuminemia and concomitant treatment with diuretics enhanced the effects of aspirin on renal function and UA retention. CONCLUSION Mini-dose aspirin, even at a dosage of 75 mg/day, caused significant changes in renal function and UA handling within 1 week in a group of elderly inpatients, mainly in those with preexisting hypoalbuminemia. Given the widespread (and often unmonitored) use of mini-dose aspirin, especially among the elderly, these findings call for clinician alertness as well as for further studies to clarify the mechanisms underlying these phenomena.
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