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Frailty Index and Its Association with the Onset of Postoperative Delirium in Older Adults Undergoing Elective Surgery
Abstract: Background The association of frailty based on the accumulation of deficits with postoperative delirium (POD) has been poorly examined. We aimed to analyze this association in older patients undergoing elective surgery. Methods Preoperative data was used to build a 30-item frailty index (FI) for participants of the PAWEL-study. Delirium was defined by a combination of I-CAM and chart review. Using logistic regressions models we analysed the association between frailty and POD adjusting for age, sex, smoking, alcohol consumption, education and type of surgery. Results Among 701 participants (mean age 77.1, 52.4% male) median FI was 0.27 (Q1 0.20| Q3 0.34), with 528 (75.3%) frail par...
Evidence Gap on Antihyperglycemic Pharmacotherapy in Frail Older Adults
Abstract: Background Although antihyperglycemic pharmacotherapy in frail older adults with type 2 diabetes mellitus (T2DM) is challenging, recommendations from international guidelines are mainly based on indirect evidence from trials not including frail participants. Objective This systematic review investigated the effectiveness and safety of pharmacotherapy in frail older adults with T2DM. Material and methods Randomized (RCT) and non-randomized prospective clinical trials (non-RCT) were searched in three electronic databases (Medline, Embase, Central) up to October 2018. Trials in older adults with T2DM who were assessed as significantly or severely impaired by defined cut-off scores of ...
Life's Bulldozer Moments
Donato Tramuto felt bulldozed by life as a child when he lost most of his hearing to an ear infection that left him isolated and treated as a failure. A succession of tragedies rocked his world, including a last minute decision to change his plans to fly out of Logan Airport on 9/11 on the same LA-bound flight that claimed the lives of his close friends. In this poignant and penetrating book, Tramuto, a successful health care entrepreneur and global philanthropist, recounts the business and life lessons he learned and shows that adversity can lead to success. He shows anyone bulldozed by life how to pull themselves out of the rubble, dust themselves off and find meaning and purpose.
Good Health at Low Cost 25 Years on
In this book, an international team of authors have sought to understand how five countries have made progress towards the ultimate goal of Good health at low cost in recent decades (and what happened to others that were viewed as successes 25 years ago). They take a holistic approach, demonstrating the strengths of collaboration across disciplines and continents. In doing so, they provide important lessons for other countries seeking to emulate success.
Social Poison
This comparative history examines the divergent paths taken by Britain and France in managing opiate abuse during the late nineteenth and early twentieth centuries. Though the governments of both nations viewed rising levels of opiate use as a problem, Britain and France took opposite courses of action in addressing the issue. The British sanctioned maintenance treatment for addiction, while the French authorities did not hesitate to take legal action against addicts and the doctors who prescribed drugs to them. Drawing on primary documents, Howard Padwa examines the factors that led to these disparate approaches. He finds that national policies were influenced by shifts in the composition o...
Neonatal Neural Rescue
Worldwide more than one million babies die annually from perinatal asphyxia and its associated complications such as neonatal encephalopathy - one of the major causes of cerebral palsy and cognitive deficiencies in children aside from prematurity. Cooling the head - or the entire body - minimizes neuronal death, enabling the neonatal brain to be 'rescued' thus greatly improving developmental outcomes. Hypothermic neural rescue therapy has revolutionized the treatment of this condition and is a major recent achievement in neonatal medicine. This landmark book provides a brief scientific underpinning of hypothermic neural rescue therapy and lays out the evidence base for good practice. Internationally recognized authorities give practical advice, drawn from personal experience, on how to deliver hypothermia in the neonatal intensive care unit. A valuable addition to any neonatal unit, this is essential reading for neonatologists, neonatal nurses and paediatric neurologists.
Endoscopic Ear Surgery
Endoscopic Ear Surgery: Principles, Indications, and Techniques Increasingly used as an adjunctive tool in the diagnosis and management of ear disease, middle ear endoscopy has the potential to decrease patient morbidity, prevent disease recurrence, and reduce costs. Its capacity to uncover "hidden" anatomy within the small dimensions of the ear has made it essential for functional surgery, allowing surgeons to preserve key anatomic structures such as the cochlea and facial nerve. Now for the first time, the physicians who pioneered this groundbreaking minimally invasive technique review its indications, advantages, disadvantages, and surgical approaches: Written by the foremost leaders in t...
