Assessment and Management of Older People in the General Hospital Setting

Worldwide, populations are ageing. Older people, particularly centurions, represent the fastest growing sector and are counted as the success of the society. But not everyone ages successfully and enjoys good health. Many older people have multiple long-term medical, physical, mental, psychological and social problems. This can result in reduced quality of life, higher cost and poorer health outcome including increased mortality. Chronic diseases are associated with disability and low self-reported general health. In addition, physiological changes of ageing and consequent loss of functional reserve of the organ systems lead to the increased physical disability and dependency. Therefore, geriatric medicine could warrant a more holistic approach than general adult medicine. Nearly two-thirds of people admitted to hospital are over 65 years old and an increasing number are frail or have a diagnosis of dementia [1]. Our current training not only generates relatively low number of geriatricians but there also remains a huge need for better staff training and support to provide safe, holistic and dignified care. The cornerstone of modern geriatric medicine is the comprehensive geriatric assessment (CGA). This is defined as multidimensional, interdisciplinary diagnostic process that aims to determine a frail older person’s medical conditions, mental health, functional capability and social circumstances in order to develop a coordinated and integrated plan for treatment, rehabilitation and long-term follow-up [2]. All older people admitted to hospital with an acute medical illness, geriatric syndromes including falls, incontinence, delirium or immobility, unexplained functional dependency or need for rehabilitation warrant CGA. CGA could screen for treatable illnesses, establish the key diagnosis leading to hospital admission and formulate a rational therapeutic plan thus resulting in the improved outcome. This chapter starts with an introduction to the ageing nation and impact of ageing on hospitals. This will be followed by discussing physiological changes of ageing and the various components of multidisciplinary assessment for older people admitted to hospital with an acute illness that could lead to high-level holistic care. It also covers a wide range of issues and challenges which medical team/multidisciplinary teams often come across during routine care of acutely unwell older people. The chapter concludes by a literature review on current evidence on the effectiveness of CGA and recommendations to enhance clinical care

Monitoring Economic and Social Changes within NSW Water Sharing Plan Areas: A Participatory Approach

This paper presents a participatory approach being used to monitor the changes in economic and social indicators within the Water Sharing Plan areas in NSW. The approach entails close cooperation and input from the stakeholders comprising engagement and scoping; profiling, literature review and media scanning; indicators selection; data collection; and analysis and reporting over time. The monitoring data on the key economic and social indicators will be used for review of the Water Sharing Plans as well as further refinement and development of water policies in NSW. This framework provides the basis for developing similar monitoring programs.Monitoring, Irrigation Industry, Water Sharing Plans, Economic and Social Indicators, Methodology, Participatory Approach, Land Economics/Use, Research Methods/ Statistical Methods,

Retrospective study of enormity of cancer in a tertiary care centre in Punjab, India

Background: Cancer is uncontrolled growth of cells with potential of local invasion and distant metastasis. The risk of developing cancer is affected by important demographic and geographic factors in addition to specific risk factors associated with individual cancers. Cancer is uncontrolled growth of cells with potential of local invasion and distant metastasis. The risk of developing cancer is affected by important demographic and geographic factors in addition to specific risk factors associated with individual cancers.Methods: This was a retrospective and an observational study comprising of 142 histopathologically diagnosed cases of cancer . Study was carried out in the department of Pathology using retrospective data of the year 2017 from January till December.  Hematological malignancies were not included.Results: At the end of study highest incidence of GIT and oral cancer was observed in 35.2% samples followed by cancer breast 28.1% and uterus and adnexa in 15.4%. In 6% and 4.2% of biopsies cancer of skin and soft tissues and prostate was verified respectively.  Very few cases of thyroid, renal, lymphnode and bladder cancers were observed in the present study.Conclusions: Awareness and screening programs regarding risk factors of cancer and its early diagnosis along with stringent action by the Government to restrict the use of pesticides is the need of the hour to control cancer in Punjab

‘What happens next?’ An exploration of how general practitioners talk to men presenting with possible symptoms of prostate cancer

Prostate cancer is the most common form of cancer amongst men in the UK. It is also the second most common cause of death in the UK. The strongest risk factors for developing the condition are increased age, family history and African-Caribbean ethnicity. Detection methods have problems with reliability, specificity and being unpleasant. Further, there are debates about the effectiveness of treatments. Treatments are also associated with a number of temporary or long term side effects, including erectile dysfunction and incontinence. Issues related to masculinity and how men are often unwilling to seek help or delay in presenting to general practitioners further complicate detection and treatment. NICE (2008) recommend that decisions about testing are made on an individual by individual basis. It is recommended that general practitioners advise men about issues of detection in order for them to make an informed decision about testing. This study aimed to explore how general practitioners approach such conversations and issues related to the construct of masculinity. Semi structured interviews were completed with 14 general practitioners in the UK. Data were analysed using thematic analysis. Overall, participants had a number of different approaches and strategies to managing conversations. Four overarching themes were identified, ‘dilemmas and differences’, ‘being men’, ‘awareness, action and assertiveness’ and ‘significance of gender and age’. Participants described how issues related to masculinity might have impacted whether men sought help. However, adopting a proactive approach and coming from higher socio-economic status may have modified these. General practitioners may benefit from further training about managing uncertainties around detection and treatment given the increased emphasis on primary care involvement following treatment for cancer in secondary care. Further research involving examination of live consultations may be useful to gain another perspective on how general practitioners manage such conversations

Impact of hospital design on acutely unwell patients with dementia

Increasing emphasis on patient privacy and satisfaction has seen more 100% single-room hospitals opened across the UK. Few studies have addressed the impact of these new hospital designs (single rooms) on clinical outcomes specifically for acutely unwell frail patients with dementia. The objective of this study was to profile and compare the clinical outcomes of acutely unwell patients with dementia admitted to two different hospital environments. This prospective observation study was conducted for 100 dementia patients admitted at Ysbyty Ystrad Fawr (hospital with 100% single rooms) and Royal Gwent Hospital (traditional multi-bed wards) under the same University Health Board. The length of stay (LoS) was significantly longer for patients admitted to single rooms. The clinical profile of the patients was similar in both hospitals and has no association with LoS. There was no significant difference in terms of incidence of inpatient falls, fall-related injury, discharge to a new care home, 30-day readmission, or mortality. The single room environment appears to influence LoS, as previously reported; however, following the introduction of quality improvement initiatives to prevent inpatient falls, single rooms do not appear to be associated with higher inpatient fall incidence. We propose more research to understand the relationship between single rooms and LoS

A prospective study of metformin versus myoinositol plus d-chiroinositol combination therapy in polycystic ovarian syndrome

Background: Polycystic ovarian syndrome (PCOS) is one of the most common endocrine disorders in women of reproductive age. Insulin resistance and resultant hyperinsulinemia contribute to hyperandrogenism in these patients. Weight loss or pharmacologic interventions that lower insulin levels reduce androgen levels. This study was planned to evaluate efficacy of metformin versus myoinositol plus d-chiroinositol combination therapy in PCOS patients and its effects on clinical, hormonal and radio diagnostic dimensions.Methods: This was a prospective study for nine months. 50 newly diagnosed PCOS patients from the Department of Obstetrics and Gynaecology, Government Medical College (GMC), Amritsar, were randomly divided into 2 groups. One group was given metformin 500 mg twice daily and another myoinositol plus d-chiroinositol 1000 mg twice daily for 9 months. Follow up was done at 3, 6, 9 months. At each visit, ultrasonography and hormone levels were evaluated. Informed consent was taken. The approval of the Institutional Ethics Committee, GMC, Amritsar was also obtained.Results: The percentage change in free testosterone levels (22.46±6.47) and insulin levels (34.24±15.02) show statistically significant decrease in group 2 (p<0.001). There was statistically significant (p<0.05) fall in AMH levels (22.41±7.78) in group 1. There was no statistically significant difference between the 2 groups in ovarian volume on ultrasonography, random blood glucose levels, luteinizing hormone (LH), follicle-stimulating hormone (FSH) levels, estrogen and progesterone levels.Conclusions: It was observed that both treatments are equally effective in the treatment of polycystic ovarian syndrome with better tolerability in myoinositol and d-chiroinositol group

Klippel Trenaunay Weber syndrome with unilateral polycystic kidney disease: a rare presentation

Klippel Trenaunay Weber syndrome (KTWS) is a rare disease characterized by hemihypertrophy, variceal enlargement of the veins, and arteriovenous (AV) malformations. Renal involvement in KTWS is not known except in rare case reports. Herein, we present a case of KTWS with unilateral polycystic kidney. A 52-year-old male was admitted due to pain left lumbar region for the last three months. The physical findings were increased diameter and increased length of the left leg compared with the right one, diffuse variceal enlargements on left leg, portwine stain on left side on neck, thorax, abdomen, left upper limb and left lower limb and a few hemangiomatous lesions on the left leg. Radiographic findings were cystic lesions in the left kidney, varicose veins in left leg, and hypertrophy of the soft tissues of the proximal left leg. Color Doppler of left lower limb showed incompetence of the saphenofemoral junction. He was diagnosed to have KTWS with these findings. Renal function tests of the patient were in the normal range. Patient’s only complain was left lumbar region pain, mild in intensity. Patient was managed symptomatically