"Asset stripping" the declining mental hospital.

A psychogeriatric day hospital was developed from a long-stay back ward of a large mental hospital whose population of patients had decreased by half. Women in the 70-80 age group with varying degrees of dementia benefited most from such facilities. In view of the current cut-back in Government spending one of the greatest assets in providing a comprehensive service for the elderly mentally infirm may well be found in the declining mental hospital.     

Ribotyping and biotyping of<Emphasis Type="Italic">Staphylococcus epidermidis</Emphasis> isolated from hospital environment

The Staphylococcus strains acquired from scrapings from hospital environments were identified to the species level based on their biochemical properties. From the monitored sample the Staphylococcus epidermidis strains were selected for more accurate typing and tested on their virulence factor and ribotyped. The biotyping of S. epidermidis did not show any considerable intraspecific variation of these isolates and there were no atypical reactions, with the exception of three strains (out of 33). In contrast, the results of ribotyping showed greater heterogeneity of strains and unequivocally demonstrated the relation between the ribotype and the place of sample drawing. In addition to this fact, the found ribotypes repeat in the same environment in the long-term which suggests the occurrence and persistence of the same strains of conditionally pathogenic bacteria in hospital environment. We showed that ribotyping is a suitable method for precise and reliable detection of some coagulase-negative staphylococci.     

The work of an Rh committee; experiences in a private general hospital

An Rh committee was formed at Saint John's Hospital in Santa Monica to provide preadmission consultation on all potential Rh and ABO problems and to maintain a file of information on Rh-negative patients in the delivery room. It is urged that no patient go to the delivery room without the known Rh-ABO type as part of the labor record. All obstetrical patients at the hospital are given "obstetrical information cards" for use as a memorandum on the labor record. A pink card identifies the Rh-negative patient. The program keeps the staff "Rh-conscious" and has improved teamwork among the obstetricians, pediatricians, nurses and the laboratory.     

Experiencia de una Unidad de Prevención de Caídas de un hospital de cuidados intermedios

Introduction

The aim of this study is to determine clinical features and interventions in patients attended in our hospital falls prevention unit.

Material and methods

Medical records and evaluation protocols from October 2010 to June 2012 were reviewed. Results are expressed in means and standard deviation.

Results

We studied 68 patients: 53 came due to falls (77.9%), and 15 (22%) due to gait disorders. The mean age was 77.6±7.9. Number of women: 63 (92.6%). Previous Barthel Index was 94/100, cognitive impairment 23 (33.8%), polypharmacy 69.1%, orthostatic hypotension 18 (26.4%). Walking speed 0.66± 0.19 m/s and Time up and go to (TUG) 16.6±4.5 s. Post-urography detected vestibular dysfunction in 34 patients (77%). Clinical cause of fall and/or gait disorder was multifactorial in 33 (48.5%), Parkinsonism 19 (27.9%), chronic pain/arthropathy 8 (11.4%), and vestibular syndrome 8 (11.4%). Two-thirds (45; 66.1%) of the patients began Physical therapy, and vitamin D was given to 47 (69.1%). Phone calls were made to patients and/or their relatives and noted that after 3 months of the treatment: 48 (70.5%) had no fall; 59 (86.7%) patients followed the recommendations, and 57 (83.8%) were satisfied.

Conclusions

In this sample of older patients, mostly female with a good functional and cognitive condition, the causes of the falls were multifactorial in the half of the cases, and the post-urography detected vestibular changes in the half of the patients.     

Implantación de una Unidad de Ortogeriatría de Agudos en un hospital de segundo nivel

Background

Patients with hip fracture (HF), due to their characteristics, require a specific support. The Acute Orthogeriatric Unit (OGU) has been shown to be one of the most beneficial.

Objective

To evaluate the main variables of HF patients treated at an OGU and compare them with the previous referral model (RC).

Material and methods

A prospective observational study with retrospective control was conducted on 169 patients, split into two groups. In the RC group, patients were admitted to conventional trauma ward. In the OGU group, an early geriatric assessment was performed, and patients were simultaneously attended daily by the orthopaedic surgeon, nurse and geriatrician, and the surgery times, work load, discharge and destination, were planned in a weekly meeting with the rest of professionals.

Results

A total of 71 patients were included in the RC group and 96 in the OGU group. The preoperative characteristics were similar, except for a slightly higher comorbidity in the OGU group. The OGU patients were operated on earlier (3.82±2.08 vs 4.61±2.5 days; P<.32), and overall hospital stay was reduced by 28% (11.84±4.04 vs 16.46±8.4 days; P<.001). The functional efficiency (Barthel Index at discharge-Barthel Index at admission/overall stay - stay before surgery) was higher in the OGU group (1.56±0.7 vs 2.61±1.1; P<.05). There were no differences in functional status, mortality or discharge location.

Conclusions

The OGU is a level of care that provides effective medical care in HF patients in general hospitals.     

Meningitis; a review of one year's cases from an active children's hospital service

Fifty-six cases of bacterial meningitides, other than tuberculous, observed in a period of one year on an active children's hospital medical service were reviewed. All age groups were involved but most commonly infected were patients in the first year of life. There was no inordinate incidence of infection with any one kind of organism in any specific age bracket, except possibly for infection with enteric organisms which in the present series occurred preponderantly in infants less than six months old. Meningococcus and H. influenza type B were the most common organisms; they were the infecting agents in 71 per cent of cases. Of the immediate complications noted, subdural effusions were the most common (23 per cent of this series). In all except two cases, effusion was resolved by multiple aspirations. In two cases craniotomy was done with good results. Ten electroencephalograms were made and all were abnormal. In most of the patients, multiple antibiotic and chemotherapeutic drugs were used, parenterally during the first few days of hospitalization and then orally as tolerated. Intraspinal therapy was not given. Four of the 56 patients died.     

Body temperature measurements in the clinic; evaluation of practice in a Norwegian hospital

(1) The aim of this study was to determine the degree of agreement between the requirements of medical staff for body temperature measurements for clinical use, as defined in a previous study, and current practice in two departments in a Norwegian university hospital.

(2) The results showed that few of the highest-ranked requirements for body temperature measurements were regarded by health personnel as having been fulfilled.

(3) It will be necessary to change current practice in order to obtain agreements between these requirements and the performance of temperature measurements. This will help to improve the basis for diagnosis and treatment and provide more efficient body temperature measurement.

Trasplante renal en mayores de 60 años en un hospital de Colombia

Introduction

Kidney transplantation is the treatment of choice in patients with end- stage renal disease. Renal transplantation in without fear of ethical conflicts is the best treatment option in the elderly. The objective is to describe the demographic and clinical characteristics of patients over 60 years old with at least one year of renal transplantation in a single center of Colombia.

Methods

This is a cohort study of patients over 60 years old from a single center in Bogota, Colombia. About 28 patients were analyzed between June 2004 and March 2012.

Results

The mean age was 65 years old, with 89% males. The main cause of chronic kidney disease was diabetic nephropathy, followed by hypertensive nephrosclerosis. Most of them (96.4%) were deceased donor transplants with a mean age of 40 years old, cold ischemia time was 12 hours and there was a mismatch of 3.25 (±1.29). Major comorbidities were hypertension, diabetes, dyslipidemia, and coronary arterial disease. Almost 17% had delayed graft dysfunction. Serum creatinine at 6 and 12 months was 1.27 mg/dl (±0.31) and 1.25 mg/dl (±0.33), respectively. Only 10% of patients had acute cellular rejection. Humoral rejections were not documented. The patient survival at 1 year was 89.7%, and death-censored graft survival was 96.4%. The most frequent cause of death was acute myocardial infarction.

Conclusions

Proper selection of kidney transplant recipients shows satisfactory results in survival, with low morbidity in patients older than 60 years.