[Situation of acute inpatient geriatric patients. A retrospective analysis of health care processes of geriatric and non-geriatric patients with acute myocardial infarction]. / Akutstationäre Versorgungssituation geriatrischer Patienten. Retrospektive Analyse der Versorgungsverläufe geriatrischer und nichtgeriatrischer Patienten mit akutem Myokardinfarkt.

BACKGROUND: Although cardiovascular diseases belong to the most frequent causes of inpatient treatment of older people the specific characteristics of geriatric patients in the acute care unit still receive marginal attention. The aim of this study was the descriptive representation of clinical health care processes of geriatric and non-geriatric patients with acute myocardial infarction. PATIENTS AND METHODS: Using a retrospective document analysis 83 medical patient records were examined with regard to nursing, therapeutic as well as medical measures and social counseling. The classification in geriatric and non-geriatric patients was based on a predefined list of criteria. RESULTS: In the study a total of 48 geriatric and 35 non-geriatric patients could be identified. There was a comprehensive need for support of nursing and therapeutic care, a high frequency of complications and a long length of stay as well as specifics concerning the place of discharge in geriatric patients. CONCLUSIONS: Complex problems and special care needs of geriatric patients with acute myocardial infarction were shown. This vulnerable group of patients should be given more attention in acute care. Further investigations with a prospective character are necessary in order to detect the specific needs of geriatric patients in acute care.

Early identification of patients with native valve infectious endocarditis at risk for major complications by initial clinical presentation and baseline echocardiography.

Early identification of a high risk patient subgroup with infective endocarditis which develops a major complication (emboli, congestive heart failure, surgery for valve replacement, or death) during hospitalization would reduce morbidity, mortality and cost. Thus, for 74 patients with native valve infective endocarditis with documented vegetation by transthoracic two-dimensional echocardiogram, we reviewed 67 variables: history (15), physical examination (9), hematology/miscellaneous (7), chest X-ray (2), electrocardiogram (4), transthoracic two-dimensional echocardiograms (15) and hospital course (15). There were 48 men and 26 women, ages 45 +/- 19 years: 35 intravenous drug abusers and 39 non-users. There were 32 mitral, 21 tricuspid, 20 aortic, and 1 pulmonic valve vegetations; mean vegetation size was 1.4 +/- 0.9 cm2. Over the course of their hospitalization, 14 patients died (19%), 27 developed congestive heart failure (36%), 27 had systemic emboli (36%), and 22 required surgery (30%). The incidence of complications (death, heart failure or embolic events) did not differ between the drug abusers and non-users. Initial complaint of dyspnea on admission predicted the subsequent development of heart failure (P < 0.001), and a pre-admission embolus predicted a second in-hospital embolus (P < 0.001). Left atrial size, ventricular systolic or diastolic dimension did not effect prognosis. Importantly, a vegetation > 1.8 cm2 was 100% specific but only 30% sensitive for predicting the development of a complication. Vegetation mobility, shape, and number of cusps involved were not predictive. However, aortic valve vegetations had significantly more complications than those on the mitral valve (P < 0.03). By discriminant function analysis, 87% of major complications were predicted with the patient profile of having aortic valve vegetation, dyspnea on admission, prolonged preadmission fever, and no history of drug abuse; 75% of patients who developed heart failure were predicted by their having aortic valve vegetation, dyspnea, hypotension (systolic < 90 mm Hg), and no history of drug abuse; and 77% of patients requiring surgery were predicted by their having larger vegetation size, rales, and leftward shift of white blood cells. Thus, in native valve bacterial endocarditis with transthoracic echocardiographic documented vegetations, non-drug abusers with aortic vegetations, preadmission prolonged fevers, dyspnea, emboli and larger sized vegetations are at high risk for developing a major complication during their hospitalization.

Reducing atherogenic risk in hyperlipemic humans with flax seed supplementation: a preliminary report.

The effect on serum lipids of a flax seed supplement consisting of three slices of flax seed-containing bread and 15 g of ground flax seed was studied in 15 hyperlipemic subjects on long-term intake (800 IU/day) of vitamin E. The flax seed, which was high in alpha-linolenic acid and fiber, and which has been reported to lower serum cholesterol in elderly subjects, was provided in a 3-month feeding trial. Serum total and low-density lipoprotein cholesterol levels were reduced significantly; high-density lipoprotein cholesterol did not change during flax seed consumption. Thrombin-stimulated platelet aggregation decreased with the supplement. Serum lipid oxidation products decreased significantly during the washout period.

Relationship between serum lipid peroxidation products in hypercholesterolemic subjects and vitamin E status.

The relationship of serum lipid peroxidation products in hypercholesterolemic subjects to their vitamin E intake was examined in 15 such subjects with no other associated significant disease process in a 3 month trial with vitamin E supplementation. These patients with elevated serum cholesterol levels also have elevated thiobarbituric acid reactive substances (TBARS) and lipid oxidation products (LOPS). Vitamin E supplementation of 800 IU daily normalized the lipid peroxidation products but did not significantly change serum lipids.

Effects of canola oil on serum lipids in humans.

Previous work in this laboratory had shown in a pilot study that canola oil could lower blood pressure and serum cholesterol levels. Attempting to extend this work to a larger cohort over a longer period, a 4-month study using a 30 ml/day addendum of canola oil as the replacement of the edible oils in the usual diet was undertaken in 36 hypercholesterolemic and/or hypertriglyceridemic subjects. Serum low-density-lipoprotein cholesterol (LDL-C) decreased from 173 +/- 9.0 to 160 +/- 10.0 mg/dl, p less than 0.025. Blood pressure, total cholesterol, and high-density-lipoprotein cholesterol (HDL-C) did not change significantly even though the HDL subfractions did, HDL2 decreasing and HDL3 increasing.