A literature review of local and systemic considerations for endodontic treatments in older adults.

OBJECTIVES: The aim of this literature review was to summarise the clinical important findings on the endodontic treatment outcome in older patients (≥60 years old) with pulpal/periapical disease considering local and systemic factors from a body of knowledge that is heterogeneous in methods or disciplines. BACKGROUND: Due to the increasing number of older patients in the endodontic practice, and the current trend for tooth preservation, the need for clinicians to have a better understanding of age-related implications that may influence the required endodontic treatment in older adults to retain their natural dentition is indispensable. METHODS: PubMed/Medline and Embase was searched by a medical librarian using specific terms based on inclusion/exclusion criteria. The reference list was hand-seached for additional relevant publications between 2005-2020. A combination of these terms was performed uing Boolean operators and MeSH terms. RESULTS: Of the 1577 publications identified manually and electronically, 25 were included to be fully reviewed by the examiners. The data was derived from three systematic reviews, one systematic and meta-analysis, three case series, four prospective and 14 retrospective cohorts. Overall, there was heterogeneity in reporting as well as limitations in most studies. CONCLUSIONS: The outcome of endodontic treatment (ET) either nonsurgical or surgical or combination of these is not affected by older age. ET can be the treatment of choice in older patients wiht pulpal/periapical disease. There is no evidence that older age per se affects the outcome of any type of endodontic treatment.

Adherence to Measuring What Matters: Description of an Inpatient Palliative Care Service of an Urban Teaching Hospital.

BACKGROUND: Benefits of palliative care have been extensively described; however, reports on adherence to national quality indicators are limited. OBJECTIVES: This study focuses on describing the characteristics of patients who were seen at an urban academic hospital and their care team's adherence to 5 out of 10 Measuring What Matters (MWM) quality indicators. DESIGN: Retrospective chart review Setting/Subjects: Patients seen by inpatient palliative care service from January 2014 to December 2015 in an urban academic hospital. MEASUREMENTS: Patient age, gender, ethnicity, disease category, discharge end point, life-sustaining preferences, surrogate decision-maker documentation, and initial palliative assessment were analyzed using descriptive, parametric, and nonparametric statistics. RESULTS: During two years, 1272 patients were seen by the inpatient palliative care service. Fifty-one percent of patients were male, with an average age of 68 years. The majority were Caucasian (57%) and African American (41%). Life-limiting illnesses included were cancer, complex chronic illnesses, and gastrointestinal illness. Adherence to comprehensive palliative care assessment was measured at 64%; initial visit assessment for physical symptoms was 38%; code status preference was 99%; care consistent with preference in vulnerable elders was 99%; and surrogate documentation was noted at 33%. Compared to hospital patients discharged without hospice, patients discharged with hospice care had consults with higher adherence to comprehensive assessment and surrogate documentation quality standards (p < 0.05). CONCLUSIONS: Adherence to MWM measures was variable. Subjects discharged with hospice services were more likely to receive comprehensive assessment within 5 days of admission and surrogate documentation compared to those subjects without hospice care.

Outcomes of Palliative Care Consults With Hospitalized Veterans.

Families and patients receive emotional support and better care planning after palliative care consultations.

Rate of change in kidney function and the risk of death: the case for incorporating the rate of kidney function decline into the CKD staging system.

Chronic kidney disease (CKD) is associated with increased risk of death. A wave of recent studies used longitudinal data to examine the effect of the rate of decline of kidney function on the risk of death. The results from these studies show that there is an independent and graded association between the rate of kidney function decline and the risk of death. There is a need to incorporate the rate of decline in the definition of CKD. This redefinition of CKD will transform a static definition into a dynamic one that more accurately describes the disease state in an individual patient.

Antioxidants and hormones as antiaging therapies: high hopes, disappointing results.

No single agent has been shown to truly reverse aging or increase longevity in humans. This article reviews the evidence of efficacy (or lack thereof) for two types of agents touted as antiaging therapies: antioxidants (vitamin E, vitamin C, and carotenoids) and hormones (growth hormone, testosterone, dehydroepiandrosterone, and vitamin D).

Cancer in older men: a gender-based review.

Cancer is a common condition of the older male. Risk factors for developing a malignancy include genetic, environmental and life style features. Cancer epidemiology and prognosis differ depending on the age and gender of the population being studied. In the group of men older than 65 years, the most common malignant tumors are prostate, lung, colon and pancreatic cancer. Treatment options vary depending on the stage of the tumor when it is diagnosed, and the decision for therapeutic versus palliative interventions will depend upon the functional status, comorbidity and personal wishes of the patients.

Trauma hepático en el Hospital Regional Simón Bolívar: 1989 - 1993 / Hepatic injury at Hospital Simón Bolívar

En esta investigación se presentan los datos encontrados acerca del trauma hepático en el Hospital Regional Simón Bolívar en el período comprendido entre Marzo de 1989 y Marzo de 1993. El estudio estuvo dirigido a establecer el manejo inicial del paciente con trauma abdominal en el servicio de urgencias, su posterior valoración quirúrgica, los hallazgos intraoperatorios y las complicaciones posteriores al trauma hepático. La información hallada se correlacionó con la revisión hecha sobre el trauma hepático y el protocolo de manejo. No hay clasificación estandar aceptada universalmente para el trauma hepático y las diferencias reportadas entre unas y otras son insignificantes. Se encontró que la morbilidad y la mortalidad tienen una correlación lineal ya que no solamente es el daño del parénquima hepático del que depende el pronóstico sino también de la magnitud de la intervención quirúrgica, hallazgo de heridas asociadas y complicaciones postoperatorias. Las excepciones son el daño de la vena retrohepática que tiene una mortalidad independiente. De ésto concluímos que el manejo del paciente con trauma hepático debe ser integral para asegurar el buen pronóstico