Do geriatric interventions reduce emergency department visits? A systematic review.

Background: Hospital emergency departments (EDs) serve an aging population with an increased burden on health resources. Few studies have examined the effects of comprehensive geriatric assessment interventions on ED use. This study aimed to systematically review the literature and compare the effects of these interventions on ED visits.

Assessment of the work environment of multidisciplinary hospital staff.

Purpose: The purpose of this article is to investigate the performance of scales to assess the work environment of hospital professional staff, other than nurses or physicians.

Design/methodology/approach: A survey was conducted among professional (non-nursing or medical) staff at a 300-bed urban, university-affiliated Canadian hospital. A total of 24 work environment items were adapted from a scale previously validated among nursing staff.

Disclosure of Alzheimer's disease. Senior citizens' opinions.

Objective: To determine the proportion of elderly people without dementia who would want disclosure of a diagnosis of Alzheimer's disease (AD), for themselves or for their spouses, and to verify whether the availability of medication would influence their decision.

Design: A cross-sectional survey with a semistructured questionnaire completed during face-to-face interviews.

Setting: Medical and surgical outpatient clinics in St Mary's Hospital Center.

Delirium predicts 12-month mortality.

Background: Delirium has not been found to be a significant predictor of postdischarge mortality, but previous research has methodologic limitations including small sample sizes and inadequate control of confounding. This study aimed to determine the independent effects of presence of delirium, type of delirium (incident vs prevalent), and severity of delirium symptoms on 12-month mortality among older medical inpatients.

Methods: A prospective, observational study of 2 cohorts of medical inpatients was conducted with patients 65 years or older: 243 patients had prevalent or incident delirium, and 118 controls had no delirium.

Detection of delirium using the confusion assessment method.

Delirium in hospitalized elderly patients is a phenomenon requiring a lot of nursing attention. It is also a disorder contributing to poor health outcomes in this population. Because of their 24-hour work schedule, nurses are frequently the first to observe acute changes in patients' mental health status and to initiate early interventions.

The impact of geriatric post-discharge services on mental state.

Objective: To determine the impact of geriatric post-discharge services on mental state.

Methods: Three computer databases, MEDLINE, HealthSTAR and the Cochrane Database of Systematic Reviews were searched for relevant articles; the bibliographies of retrieved articles were searched for additional references.

Results: 11 trials were located that met the four inclusion criteria: (i) original study; (ii) published in English or French; (iii) controlled trial (randomized or non-randomized) of a geriatric post-discharge service; and (iv) including at least one measure of mental state.

Use of medications with anticholinergic effect predicts clinical severity of delirium symptoms in older medical inpatients.

Background: Use of anticholinergic (ACH) medications is a biologically plausible and potentially modifiable risk factor of delirium, but research findings are conflicting regarding its association with delirium.

Objectives: To evaluate the longitudinal association between use of ACH medications and severity of delirium symptoms and to determine whether this association is modified by the presence of dementia.

Patients And Methods: A total of 278 medical inpatients 65 years and older with diagnosed incident or prevalent delirium were followed up with repeated assessments using the Delirium Index for up to 3 weeks.

Postpartum acquired factor VIII inhibitors: results of a survey.

Postpartum factor VIII inhibitors are rare; thus, collecting clinical and treatment data may provide valuable information in guiding patient management. This paper reports the results of a survey of United States and Canadian hemophilia centers on 14 patients with postpartum acquired factor VIII inhibitors. Patients ranged in age from 23 to 40 years.

Impact of geriatric home screening services on mental state: a systematic review.

The purpose of this report was to determine the impact of geriatric home screening services on mental state. Two computer databases, MEDLINE and HealthSTAR, were searched for relevant articles published from January 1975 to June 1997, and the bibliographies of retrieved articles were searched for additional references. Seven trials were located that met the four inclusion criteria: (a) original study; (b) published in English or French; (c) controlled trial (randomized or nonrandomized) of a geriatric home screening service; and (d) the trial included at least one measure of mental state.

Impact on human resources: Core Laboratory versus laboratory information system versus modular robotics.

Technological advances in laboratory systems have had a great impact on human resources. Surviving the changes requires an in-depth understanding of the technology to implement the appropriate operational model. St.

Depression in elderly medical inpatients: a meta-analysis of outcomes.

Objective: To determine the prognosis of elderly medical inpatients with depression.

Data Sources: A MEDLINE search for relevant articles published from January 1980 to September 1996 and a search of the PSYCH INFO database for articles published from January 1984 to September 1996. The bibliographies of identified articles were searched for additional references.

Idiopathic musical hallucinations in the elderly.

The purpose of this study was to determine the phenomenology and treatment of idiopathic musical hallucinations in the elderly by reviewing all relevant case reports. A systematic literature search yielded 32 case reports that met the following four inclusion criteria: (1) published in English, French, or Italian; (2) cases aged 65 years of age or older; (3) absence of major focal neurologic disease; and (4) absence of drug toxicity. Information was subsequently abstracted from each case reported and tabulated.

Tests for the analysis of variance of crossover designs with correlated errors.

The usual analysis of variance based on ordinary least squares (OLS) may be inappropriate to analyze the crossover designs because of correlations within subjects arising from the repeated measurements. The tests used with OLS are compared with three alternative tests that take into account the structure of the covariance matrix for testing the treatment and carryover effects under the assumption of multivariate normality. A modified F-test approximation and a test derived from a Pearson curve fit are shown to give adequate control over Type I error compared to the OLS tests and to tests following an empirical generalized least squares analysis.

Markers of in vivo activation of coagulation. Interrelationships change with intensity of oral anticoagulation.

Measures of markers of in vivo activation of coagulation were assessed in patients on stable long-term oral anticoagulant therapy and analyzed with respect to the International Normalized Ratio (INR). The range of F1+2, FPA, and antithrombin--enzyme complex results (ATM) were significantly lower as compared to normals. Plasmin-antiplasmin complexes were unaffected by anticoagulation.

Risperidone-induced neuroleptic malignant syndrome: a case report and review.

Objectives: 1. To report the case of a 53-year-old patient who developed neuroleptic malignant syndrome (NMS) - a rare but potentially life-threatening complication of neuroleptic therapy - 4 days after treatment with risperidone was initiated. 2.

Effect of CI-988 on cholecystokinin tetrapeptide-induced panic symptoms in healthy volunteers.

A randomized, placebo-controlled, double-blind, three-way crossover design was used to evaluate the effectiveness of single oral 100 mg doses of CI-988, a cholecystokinin B (CCKB) antagonist, in attenuating panic symptoms induced by intravenous injection of cholecystokinin-tetrapeptide (CCK-4). Thirty healthy men received the following treatments on three separate occasions: placebo capsules/placebo, placebo capsules/CCK-4, or CI-988 capsules/CCK-4. There was no marked difference in the number, time to onset, or duration of panic symptoms between CI-988/CCK-4 and placebo/CCK-4.

Excimer photorefractive keratectomy after undercorrected radial keratotomy.

Radial keratotomy has been used for the treatment of myopia since 1979. Until recently, patients with undercorrected myopia had recourse only to repeated keratotomy. Now patients undercorrected after two or more radial keratotomy procedures can be treated with the excimer laser to reduce the residual myopia.

Systematic intervention for elderly inpatients with delirium: a randomized trial.

Objective: To assess a systematic intervention in cases of delirium in elderly inpatients.

Design: Randomized, controlled trial.

Setting: University-affiliated, primary acute care hospital.

Imipramine antagonism of the panicogenic effects of cholecystokinin tetrapeptide in panic disorder patients.

Eleven panic disorder patients who panicked in response to exogenous cholecystokinin tetrapeptide (CCK-4) were rechallenged after chronic treatment with imipramine. In the rechallenge the patients displayed a marked reduction in the number and intensity of panic symptoms, duration of symptoms, frequency of panic attacks, and cardiovascular responsiveness. This study demonstrates that imipramine can antagonize the panicogenic effects of CCK-4.

Anxiety sensitivity and response to cholecystokinin tetrapeptide in healthy volunteers.

The authors determined whether fear of anxiety symptoms mediates panicogenic responses to cholecystokinin tetrapeptide (CCK-4) in healthy subjects. Individuals with a preexisting high level of anxiety sensitivity (N = 10) experienced significantly more catastrophic cognitions and fear of somatic symptoms than did subjects with low (N = 9) or medium (N = 17) anxiety sensitivity, but they were not more susceptible to experiencing a panic attack. Thus, cognitive factors do not appear to be critical determinants of CCK-4-induced panic attacks.

Complex visual hallucinations in macular degeneration.

A previously healthy elderly patient with a recent onset of macular degeneration presented for evaluation of elaborate complex visual hallucinations. The patient's psychiatric evaluation and level of cognitive functioning were normal. A diagnosis of organic hallucinosis secondary to macular degeneration was made, and the hallucinations ceased with increased sensory stimulation in the hospital.