Using Formal Knowledge to Support Episodic Evidence-Based Nursing Care.

Applying evidence-based medicine prevents medical errors highlighting the need for applying Clinical Guidelines (CGs) to improve patient care by nurses. However, nurses often face challenges in utilizing CGs due to patient-specific needs. Developing a Clinical Decision Support System (CDSS) can provide real-time context-sensitive CG-based recommendations.

Supporting the Episodic Application of Clinical Guidelines over Significant Time Periods.

Medical errors contribute significantly to morbidity and mortality, emphasizing the critical role of Clinical Guidelines (GLs) in patient care. Automating GL application can enhance GL adherence, improve patient outcomes, and reduce costs. However, several barriers exist to GL implementation and real-time automated support.

Is there a difference in metabolic outcome between different enteral formulas?

Background: Despite appropriate enteral nutrition, many elderly patients do not reach a good metabolic outcome. Two nutrition formulas are commonly used in Israel with no evidence-based medicine to indicate preference of one over the other.

Methods: We describe a 2-month observational study of patients fed by 1 of the 2 formulas.

Are we giving too much iron? Low-dose iron therapy is effective in octogenarians.

Purpose: Elderly patients are vulnerable to the dose-dependent adverse effects of iron replacement therapy. Our study examines whether low-dose iron therapy can efficiently resolve iron-deficiency anemia in patients over the age of 80 years and reduce adverse effects.

Subjects And Methods: Ninety hospitalized patients with iron-deficiency anemia were randomized to receive elemental iron in daily doses of 15 mg or 50 mg as liquid ferrous gluconate or 150 mg of ferrous calcium citrate tablets for 60 days.

Percutaneous endoscopic gastrostomy; evidence of different prognosis in various patient subgroups.

Background: As there are no prospective randomised trials about percutaneous endoscopic gastrostomy (PEG) insertion, the medical staff and caregivers encounter great difficulty in deciding when and if to perform this procedure.

Objective: To explore which variables are associated with increased mortality after PEG insertion.

Design: Prospective observational study.

[Primary esophageal achalasia in octogenarians: does it really exist?].

Unlabelled: Recent case reports described primary esophageal achalasia (PEA) at an older age, even in the very elderly. However, very few cases over the age of eighty were published and there is no data on the clinical presentation and the appropriate treatment at this age. A retrospective record review at a six-hundred bed university-affiliated hospital revealed the diagnosis of PEA in eleven patients over the age of eighty (age range 81-90 years), during a 5-year period.

Non-alcoholic fatty liver disease--a common and benign finding in octogenarian patients.

Background: Non-alcoholic fatty liver disease (NAFLD), a common entity in the general population, has been shown to be linked with insulin resistance and metabolic syndrome. Several of the components of the metabolic syndrome are more common in the aged population. The aims of the current study were to determine in the aged, the prevalence and the clinical presentation of NAFLD, as well as the relation to the underlying metabolic abnormalities.

Safety of anticoagulation therapy in well-informed older patients.

Background: In older populations, oral anticoagulation therapy (OAT) is underused by physicians, mainly because of fear of bleeding complications. The aim of this study was to determine the incidence of bleeding complications and associated risk factors in a large heterogeneous group of older patients.

Methods: Combined retrospective and prospective cohort study conducted in geriatric and internal medicine departments.

Low incidence of delirium in very old patients after surgery for hip fractures.

Objective: The authors sought to determine the incidence of delirium, its predisposing and precipitating factors, and its implications for rehabilitation outcomes and mortality in elderly patients.

Methods: This was a prospective cohort study, conducted in Gedera, Israel, from August 2001 to January 2002, with 137 consecutive patients over age 75, with hip fractures, who were admitted to the orthopedic section of the emergency department. They were evaluated at admission, 1 week after the surgery for hip fracture, and 1 month after surgery.

Hypoglycemia as a predictor of mortality in hospitalized elderly patients.

Background: Hypoglycemia during hospitalization occurs in patients with and without diabetes. The aims of this study were to determine the incidence, associated risk factors, and short- and long-term outcome of hypoglycemia among hospitalized elderly patients.

Methods: This is a case-control study conducted at geriatric and medicine departments.

Diagnosis of iron deficiency anemia in the elderly by transferrin receptor-ferritin index.

Background: The diagnosis of iron deficiency anemia (IDA) in the elderly is difficult because of the prevalence of chronic diseases, which can cause anemia with high ferritin levels, even in the presence of iron deficiency. Therefore, we studied the sensitivity and specificity of a serum transferrin receptor assay, which is not affected by chronic diseases, in the diagnosis of IDA in elderly patients.

Methods: We performed a prospective controlled study of 49 consecutive male and female patients older than 80 years who were admitted to an acute geriatric department.