Yan Press

Effectiveness of Vitamin B12 in Treating Recurrent Aphthous Stomatitis: A Randomized, Double-Blind, Placebo-Controlled Trial

Background: The frequency of recurrent aphthous stomatitis (RAS), the most common oral mucosa lesions seen in primary care, is up to 25% in the general population. However, there has been no optimal therapeutic approach. Our objective was to confirm our previous clinical observation of the beneficial treatment of RAS with vitamin B12. Methods: A randomized, double-blind, placebo-controlled trial was done using primary care patients. A sublingual a dose of 1000 mcg of vitamin B12 was used in patients in the intervention group for 6 months. Results: In total, 58 patients suffering from RAS participated in the study: 31 were included in the intervention group and 27 were included in control group. All parameters of RAS among patients in the intervention group were recorded and compared with the control group. The duration of outbreaks, the number of ulcers, and the level of pain were reduced significantly (P < .05) at 5 and 6 months of treatment with vitamin B12, regardless of initial vitamin B12 levels in the blood. During the last month of treatment a significant number of participants in the intervention group reached “no aphthous ulcers status” (74.1% vs 32.0%; P < .01). Conclusion: Vitamin B12 treatment, which is simple, inexpensive, and low-risk, seems to be effective for patients suffering from RAS, regardless of the serum vitamin B12 level.

The diagnosis of delirium among elderly patients presenting to the emergency department of an acute hospital

Delirium is prevalent among elderly people presenting to an emergency department (ED). However, despite the fact that delirium is associated with longer hospital stays, an increased rate of institutionalization and higher mortality (especially in the case of undiagnosed delirium), this condition often goes undiagnosed by ED doctors. We examined the rate of mental status assessment and the prevalence of delirium in the ED among patients older than 65 years in a large teaching hospital in Southern Israel via a retrospective chart review. Surprisingly we found no diagnosis of delirium in the medical charts of representative sample of 319 elderly people. Furthermore, only 12.5% of people received either an adequate or even a partially adequate mental status assessment by the ED doctors. We attribute these negative findings not to a low incidence of delirium but probably to a combination of a heavy workload along with a lack of adequate training of ED physicians. We suggest that part of the solution involves providing appropriate education to ED physicians as well as adding a geriatric consultant to the ED roster.

Validation of the Hebrew Version of the MoCA Test as a Screening Instrument for the Early Detection of Mild Cognitive Impairment in Elderly Individuals

Introduction: The English version of the Montreal Cognitive Assessment (MoCA) test has been shown to be reliable in screening for mild cognitive impairment (MCI). However, the sensitivity and specificity of the Hebrew version of this instrument are yet to be determined. Methods: The study population consisted of 2 groups of older individuals, 74 patients diagnosed with MCI and 80 patients who were cognitively asymptomatic. Cognitive evaluation included the Mini-Mental State Examination (MMSE), Mindstreams computerized cognitive assessment, and the MoCA test. Results: The Hebrew version of MoCA distinguished between cognitively asymptomatic older individuals and those with MCI, with a sensitivity of 94.6% and a specificity of 76.3%, using a cutoff of 26/30 points. Conclusions: The Hebrew version of the MoCA test is effective for identifying MCI in older patients. As a screening instrument for MCI, its higher sensitivity makes it preferable o the MMSE, which is used extensively in the clinical setting.

Orthostatic hypotension and drug therapy in patients at an outpatient comprehensive geriatric assessment unit.

Objective: To assess the rate of orthostatic hypotension and factors associated with it among elderly patients who underwent a comprehensive, ambulatory geriatric assessment. Methods: The study included patients 65 years and older who were assessed in the outpatient comprehensive geriatric assessment unit. Data were collected from the computerized medical record including sociodemographic data, lifestyle, falls, blood pressure, BMI, functional and cognitive status, medications, and comorbidity. Results: The study population consisted of 571 patients who underwent assessment over a nine-year period. The mean age was 83.7u200a±u200a6.1, 35.9% were men, and 183 (32.1%) were diagnosed with orthostatic hypotension. Multiple drugs, in general, and multiple drugs with the potential to cause orthostatic hypotension in particular increased the risk for orthostatic hypotension after adjustment for age, sex, chronic comorbidity, and supine systolic blood pressure ≥150u200ammHg [odds ratio (OR)u200a=u200a1.09, 95% confidence interval (CI): 1.03–1.14 and ORu200a=u200a1.22, 95% CI: 1.08–1.37, respectively]. In addition, &agr;-blockers and calcium channel blockers increased the risk for orthostatic hypotension after similar adjustments (ORu200a=u200a1.82, 95% CI: 1.01–3.16 and ORu200a=u200a1.66, 95% CI: 1.11–2.48, respectively). Similarly, two additional drug types increased the risk for orthostatic hypotension: selective serotonin reuptake inhibitors (ORu200a=u200a2.09, 95% CI: 1.33–3.19) and tricyclic antidepressants (ORu200a=u200a4.36, 95% CI: 1.85–10.06). There were no specific associations between age, cognitive and functional state, morbidity (as measured by the Charlson Comorbidity Index), and specific diseases, and orthostatic hypotension. Conclusion: The results of the present study reinforce evidence of an association between drug therapy and orthostatic hypotension.

An intervention program to reduce the number of hospitalizations of elderly patients in a primary care clinic

BackgroundThe elderly population consumes a large share of medical resources in the western world. A significant portion of the expense is related to hospitalizations.ObjectivesTo evaluate an intervention program designed to reduce the number of hospitalization of elderly patients by a more optimal allocation of resources in primary care.MethodsA multidimensional intervention program was conducted that included the re-engineering of existing work processes with a focus on the management of patient problems, improving communication with outside agencies, and the establishment of a system to monitor quality of healthcare parameters. Data on the number of hospitalizations and their cost were compared before and after implementation of the intervention program.ResultsAs a result of the intervention the mean expenditure per elderly patient was reduced by 22.5%. The adjusted number of hospitalizations/1,000 declined from 15.1 to 10.7 (29.3%). The number of adjusted hospitalization days dropped from 132 to 82 (37.9%) and the mean hospitalization stay declined from 8.2 to 6.7 days (17.9%). The adjusted hospitalization cost (

Depressive symptomatology as a risk factor for increased health service utilization among elderly patients in primary care

/1,000 patients) dropped from

Orthostatic Hypotension and Mortality in Elderly Frail Patients A Retrospective Cross-Sectional Study

32,574 to

Patients visiting the complementary medicine clinic for pain: a cross sectional study

18,624 (42.8%). The overall clinic expense, for all age groups, dropped by 9.9%.ConclusionImplementation of the intervention program in a single primary care clinic led to a reduction in hospitalizations for the elderly patient population and to a more optimal allocation of healthcare resources.

Aromatherapy for the Treatment of Patients with Behavioral and Psychological Symptoms of Dementia: A Descriptive Analysis of RCTs

Depression may play an important role in determining frequent physician visits in the older population. Our aim is to examine the relationships between socio-demographic variables, co-morbidity, memory complaints, functional status, depressive symptomatology, and health care utilization among community dwelling older patients. The study was conducted in urban primary health care clinics in Beer-Sheva, Israel. Two groups were identified: low care utilizers (LCU), with ≤ 6 visits to family physicians (FP)/year and high care utilizers (HCU) with ≥ 16 visits to FP/year. Data were collected during a structured face-to-face individual interview. The study population included 180 patients, of them 86 (47.7%) were LCU and 94 (52.2%) were HCU. In all clinical measurements the HCU group indicators were statistically significant worse off than the LCU group: average depressive symptoms (5.6 vs. 2.5, p<0.01), memory complaints (57.5% vs. 23.3%, p<0.01), Barthel Index (BI) (89.9 vs. 96.0, p<0.001), OARS (10.8 vs. 12.5, p<0.01), and co-morbidity: total cumulative score (TCS) of Charlson comorbidity index (CCI) (2.2 vs. 1.3, p<0.01). Our study raises the possibility that at least one of the reasons for over-utilization of health services by older residents in the community is depressive symptomatology.

Modern Society and Prospects of Low Vitamin B12 Intake

AbstractOrthostatic hypotension (OH) is a common problem in the elderly age group, and some studies have reported an association between OH and increased mortality. We evaluated possible associations between OH and mortality in a retrospective study of frail elderly patients who came for a comprehensive geriatric assessment.The study included all patients ≥65 years who were assessed in the outpatient Comprehensive Geriatric Assessment Unit. Data were collected from the computerized medical record, including blood pressure, sociodemographic data, lifestyle, falls, pulse rate, body mass index, functional and cognitive status, and comorbidity. Data on mortlaity were also collected.The study population consisted of 571 patients who underwent assessment over a 9-year study period. The mean age was 83.7u200a±u200a6.1, 35.9% were males, and 183 (32.1%) were diagnosed with OH. Systolic OH (OHS) was more common than diastolic OH (25.2% vs 15.6%). In univariate analyses, OHS was associated with increased overall mortality. Over the follow-up period, 30.2% of the OHS patients died compared with 22.3% (Pu200a=u200a0.037), but in the Cox models there was no statistically significant associations between OHS and overall mortality. In contrast, age, burden of comorbidity, a low high-density lipoprotein level, and low creatinine clearance were independent predictors of increased overall mortality.In a population of frail elderly patients with a high burden of comorbidity, OH was not an independent risk factor for overall mortality.