Nursing Home Residents Hospitalization at the End of Life: Experience and Predictors in Portuguese Nursing Homes.

(1) Background: Nursing Home (NH) residents are a population with health and social vulnerabilities, for whom emergency department visits or hospitalization near the end of life can be considered a marker of healthcare aggressiveness. With the present study, we intend to identify and characterize acute care transitions in the last year of life in Portuguese NH residents, to characterize care integration between the different care levels, and identify predictors of death at hospital and potentially burdensome transitions; (2) Methods: a retrospective after-death study was performed, covering 18 months prior to the emergence of the COVID-19 pandemic, in a nationwide sample of Portuguese NH with 614 residents; (3) Results: 176 deceased patients were included. More than half of NH residents died at hospital. One-third experienced a potentially burdensome care transition in the last 3 days of life, and 48.3% in the last 90 days. Younger age and higher technical staff support were associated with death at hospital and a higher likelihood of burdensome transitions in the last year of life, and Palliative Care team support with less. Advanced Care planning was almost absent; (4) Conclusions: The studied population was frail and old without advance directives in place, and subject to frequent hospitalization and potentially burdensome transitions near the end of life. Unlike other studies, staff provisioning did not improve the outcomes. The results may be related to a low social and professional awareness of Palliative Care and warrant further study.

Laparoscopic cholecystectomy in acute cholecystitis in the elderly.

BACKGROUND/AIMS: Benefits of using laparoscopic cholecystectomy (LC) in the elderly with acute cholecystitis (AC) is still questionable. Our aim is to carry out a comparative analysis of that intervention in two groups of patients: under 65 years old, and over or equal to 65 years old. METHODOLOGY: This study corresponds to 249 LCs carried out during 4 years at the Emergency and Surgery Department of Hospital de S. João; 2 groups of individuals were considered: group A--under 65 years old, and group B--65 years old or over. The first consisted of 168 cases (88 men and 80 women, mean age 48.34 years (+/- 11.80)); and the second included 81 patients (40 men and 41 women, mean age 75.73 years (+/- 6.87)). The diagnosis was made on the basis of clinical symptoms, leukocytosis and ultrasound. RESULTS: The comparative analysis between these two groups provided the following results: 1) Mortality: 0% in A vs. 4.76% in B (P = 0.007); 2) Overall postoperative complications: 5.36% in A vs. 22.2% in B (P < 0.001); 3) Surgical complications: 4.76% in A vs. 14.8% in B (P = 0.468); 4) Intraoperative complications: 4.76% in A vs. 4.94% in B (P = 0.007); 5) Reoperations: 2.98% in A vs. 7.41% in B (P = 0.022); 6) Conversion: 12.50% in A vs. 17.28% in B (P = 0.447); 7) Lesion of the Main Bile Duct: 1.79% in A vs. 2.47% in B (P = 0.447); 8) Hospital Stay, equal to or less than 4 days: 72.62% in A vs. 27.16% in B (P <0.001). CONCLUSIONS: LC is a safe and efficient intervention in the treatment of acute cholecystitis in the elderly, although with greater morbidity and longer hospital stay, when compared with younger patients.

Durability of long-term outcome of laparoscopic Nissen - comparison of the results at 5 and 10 years after surgery .

BACKGROUND/AIMS: It is not sufficiently clear whether the continued good outcomes obtained with laparoscopic Nissen operation after a short follow-up will continue after several years. The aim of our re-search was to make a comparative analysis of the quality of life and presence of symptoms 5 and 10 years after surgery. METHODOLOGY: 123 cases (69 men and 74 women) average age of 49.78 years (+12.13) were studied with average follow-up of 10.15 years. The quality of life was assessed based on a personal modified Gigli questionnaire with 32 items. RESULTS: The overall analysis revealed that the levels of quality of life decreased from 2006 (74.72) to 2011 (70.04) but remain significantly higher than those recorded prior to surgery (57.28). Of the 123 cases, 115 were satisfied with the surgery (93.5%) and 8 were not (6.5%);of the latter, six were undergoing antidepressant treatment. In 4 cases it was necessary to re-operate, 1 for dysphagia and 3 due to relapse. CONCLUSIONS: Al-though the results recorded in 2011 are slightly lower than those obtained in 2006, they remain well above those recorded before surgery. Therefore, the laparoscopic Nissen operation continues to be an excellent operation in the treatment of GERD

Infectious factors in acute acalculous cholecystitis.

BACKGROUND/AIMS: The infection is shown as a secondary phenomenon in lithiasic acute cholecystitis. However, its importance in acute gallbladder inflammation without lithiasis has not been sufficiently clarified. In this context, we tried to investigate this issue by resorting to animal research. Similarly we studied the repercussions of Diclofenac (NSAID) in bacteriological features of the bile in the operated animals. METHODOLOGY: We provoked acute cholecystitis in pigs by the ligature of biliary pedicle associated to the gallbladder introduction of "Lysophosphatidylcoline". Two series of animals were used: P1 (pigs not treated with Diclofenac) with 17 pigs and P2 (pigs treated with Diclofenac) with 23. In the latter group we associated the administration of Diclofenac given before the production of acute cholecystitis and administered for 4 days. The microbiology of the bile was studied in 34 pigs. The following parameters were valorized: histological gallbladder lesions and microorganisms in bacteriological examination of the bile. RESULTS: Severe lesions of acute cholecystitis were registered in 82.3% of the animals. Positive bile cultures were registered in 64.1% of group P1 and 65.5% in the group P2. The simultaneous administration of Diclofenac in the P2 group did not cause a regression of gallbladder lesions or in microbial agents in the bile in relation to the first group (P = 0.649, and P = 0.781, respectively). CONCLUSIONS: Our investigations allow us to conclude by valorization the infection factor in acute acalculous cholecystitis. On the other hand, the absence of repercussion of Diclofenac in acute acalculous cholecystitis was demonstrated not only in histological gallbladder lesions, but also in bile infection.