Ariba Khan

Can the Electronic Health Record Identify Vulnerable Older Adults in Need of a Palliative Care Assessment in the Hospital Setting

vides useful information that a significant portion of PN use was inappropriate in elderly adults, and the finding underlines the importance of audit and evaluation of nutritional status by a nutritional support team. Half of PN support in the present work was using Kabiven because it can be infused through a peripheral line, whereas TPN requires a central venous catheter for infusion, the use of which may carry the risk of infection in elderly adults. Therefore, Kabiven was preferred as PN support to avoid TPN-associated central line infection. In conclusion, physicians and nutritional support teams should carefully evaluate the indication for PN in elderly adults to avoid the inappropriate use of PN.

Pyogenic Liver Abscess in a Frail Older Adult

1. Karacan I. Painful nocturnal penile erections. JAMA 1971;215:1831. 2. Ferini-Strambi L, Oldani A, Zucconi M et al. Sleep-related painful erections: Clinical and polysomnographic features. J Sleep Res 1996;5: 195–197. 3. Karsenty G, Werth E, Knapp PA et al. Sleep-related painful erections. Nat Clin Pract Urol 2005;2:256–260. 4. van Driel MF, Elzevier HW et al. The treatment of sleep-related painful erections. J Sex Med 2008;5:909–918. 5. Isidori AM, Giannetta E, Greco EA et al. Effects of testosterone on body composition, bone metabolism and serum lipid profile in middle-aged men: A meta-analysis. Clin Endocrinol 2005;63:239–361.

Case Report:: Nausea and Vomiting Caused By a Rare Case of Gastric Volvulus

1. Bywaters EG. Still’s disease in the adult. Ann Rheum Dis 1971;30:121– 133. 2. Yamaguchi M, Ohta A, Tsunematsu T et al. Preliminary criteria for classification of adult Still’s disease. J Rheumatol 1992;19:424–430. 3. Rogues AM, Vidal E, Boudinet F et al. Breast cancer with systemic manifestations mimicking Still’s disease. J Rheumatol 1993;20:1786– 1787. 4. Shibuya Y, Matuo K, Kawada T et al. Adult onset Still’s disease associated esophageal cancer: A case report. Ryumachi 2003;43:577– 582. 5. Wu N, Li Q, Gu CX et al. Paraneoplastic syndrome mimicking adult-onset Still’s disease caused by advanced lung cancer: A case report. BMC Cancer 2011;11:487. 6. Inoue R, Kato T, Kim F et al. A case of adult-onset Still’s disease (AOSD)like manifestations abruptly developing during confirmation of a diagnosis of metastatic papillary thyroid carcinoma. Mod Rheumatol 2012;22:796– 800. 7. Magadur-Joly G, Billaud E, Barrier JH et al. Epidemiology of adult Still’s disease: Estimate of the incidence by a retrospective study in west France. Ann Rheum Dis 1995;54:587–590. 8. Ertugrul BM, Gencer P, Ozturk B et al. Adult-onset Still’s disease in an 83-year-old. J Am Geriatr Soc 2012;60:162–164.

Neurosyphilis: An Uncommon Cause of Dementia.

adults because of accompanying diseases. Systemic lupus erythematosus is rare, especially in older people. A search of the literature for LO-SLE uncovered three SLE cases in individuals aged 90 and older, each of whom had different clinical presentations and organ involvement, although they had in common that they met fewer diagnostic criteria than younger individuals and were treated less aggressively. The current case differs from these three because of renal involvement and hemolytic anemia. The current case fulfills four of the revised American College of Rheumatology criteria for SLE diagnosis: Coombs-positive hemolytic anemia, proteinuria, ANA positivity, and anti-dsDNA positivity. After excluding chronic infections, malignancy, and other connective tissue disorders common in this age group, this individual was diagnosed with SLE. Because of his advanced age, absence of major organ involvement, and accompanying comorbidities low-dose corticosteroid treatment was started. Clinical response and nearly normal laboratory results after treatment supported the diagnosis. In older adults with high sedimentation rate, anemia, fatigue, and weight loss, after excluding infectious diseases and malignancies, rheumatological diseases should always be screened for, and LO-SLE must be considered.

Models for predicting incident delirium in hospitalized older adults: a systematic review

Purpose The purpose of this systematic review is to summarize the reported risk prediction models and identify the most prevalent factors for incident delirium in older inpatient populations (age ≥ 65 years). In the future, these risk factors could be used to develop a delirium risk prediction model in the electronic health record that can be used by the Hospital Elder Life Program to reduce the incidence of delirium. Methods A medical librarian customized and conducted a search strategy for all published articles on delirium prediction models using an array of electronic databases and specific inclusion and exclusion criteria. Then, a geriatrician and two research associates assessed the quality of the selected studies using the Newcastle-Ottawa Scale (NOS). Results A total of 4,351 articles were identified from initial literature search. After review, data were extracted from 12 studies. The quality of these studies was assessed using NOS and ranged from 4 to 8. The most common risk factors reported were dementia, decreased functional status, high blood urea nitrogen-to-creatinine ratio, infection and severe illness. Conclusions The most prevalent factors associated with incidence of delirium in hospitalized older patients identified by this systematic review could be used to develop an electronic health record-generated risk prediction model to identify inpatients at risk of developing delirium.

Acute Care for Elders (ACE) Tracker and e-Geriatrician Telemedicine Programs

The Acute Care for Elders (ACE) Program was developed, implemented, and results published by Dr. Seth Landefeld, Dr. Robert Palmer, and colleagues 20 years ago. This model of care has been described in an earlier chapter indicating the need to address the growing older adult patient population with increasingly complex care needs when hospitalized. This chapter describes how Aurora Health Care in Wisconsin has widely disseminated this model of care within its large system, leveraging the electronic health record (EHR) and other technology tools.

Innovative Approach to Measure Delirium in Hospitalized Older Adults Using the Electronic Health Record

To the Editor: The Acute Care for the Elderly (ACE) Tracker is an innovative clinical decision support tool generated from the electronic health record (EHR). The EHR delirium marker is derived from variables noted on the ACE Tracker: nursing documentation in the EHR, use of physical restraints, and pharmacological treatment for delirium (use of quetiapine, haloperidol, olanzapine, or risperidone). The combining of these data elements is consistent with a previous study. The EHR delirium marker was intended to be used by the healthcare team during interdisciplinary team meetings and remote consultation by the “e-Geriatrician.” The purpose of this investigation was to examine the validity of the EHR delirium marker in identifying individuals with delirium.

A Survey of Concerns in End-of-Life Care: Perspective from Pakistan.

Leicester Gill and Matt Davidson, Unit of Health-Care Epidemiology, University of Oxford, built the linked data sets over many years. Conflict of Interest: None of the authors has any conflict of interest to disclose. The Unit of Health-Care Epidemiology was funded by the English National Institute for Health Research to build the linked data sets. The salary of RG is partly funded by Public Health England. The study itself received no specific funding. Author Contributions: All authors: study concept and design, data interpretation, critical revision of manuscript, approval of final version. RG: first draft, data analysis. Sponsor’s Role: None. The views expressed in this paper do not necessarily reflect those of the funding bodies.

Primary hyperparathyroidism in an older woman with multiple comorbidities: a case study

It is thought that bacterial or yeast infection causes the discoloration of the dorsal tongue in BHT. Prevention and treatment of BHT includes avoiding risk factors and practicing good oral hygiene, especially brushing of the posterior tongue. Several topical and systemic therapies have been used for this condition, including corticosteroids, antifungals, and vitamin preparations, but none of these treatments is recommended because the condition is benign. Previous reports suggested that Bacillus subtilis or candida infection may cause BHT. Based on the results of animal experiments, it has been suggested that Bacillus subtilis varietas niger infection causes BHT. It has also been reported that Bacillus subtilis infection caused BHT. A previously reported case of BHT was successfully treated using a short course of an antifungal medication (fluconazole). Cefditoren pivoxil is a third-generation oral cephalosporin with a broad spectrum of activity against pathogens, including gram-positive and -negative bacteria, that are resistant to hydrolysis by many common beta-lactamases and may be effective for the treatment of Bacillus subtilis infection. This case supports previous reports that bacterial infection can cause BHT, because the short course of oral antibiotics resulted in dramatic improvement, but it is likely that BHT also has several other causes. Although prolonged antibiotic therapy may cause BHT, this case shows that a short course of antibiotics with activity against the causative pathogen may be effective for the treatment of BHT caused by bacterial infection.

Splenic Marginal Zone Lymphoma Involving the Breast: Lessons in Patient-Centered Care

makes evolutionary sense. For example, one does not need to be stung repeatedly by wasps before one finally remembers to avoid them; a single exposure is forever sufficient. Although emotional and declarative memories appear to follow different paths, it is not clear whether decrements in memory function also follow separate paths in memory disease. Herein is presented a case of a woman with vascular dementia in whom emotional memory was relatively spared.