Quality of life of older Australians receiving home nursing services for complex care needs.

Older Australians may live up to 10 years in ill health, most likely chronic disease-related. Those with multimorbidity report more healthcare visits, poorer health and take more medications compared with people with a single chronic disease. They are also at higher risk of hospital admission and poor quality of life. People living with multimorbidity are considered to have "complex care" needs. A person-centred approach to healthcare has led to increasing use of in-home nursing support, enabling older people to receive care at home. Our prospective observational study describes the profile and management of home-based care for older people with complex care needs and examines changes in their quality of life over 12 months. Routinely collected data were analysed, including demographics, medical history, medications and the visit activity of staff providing care to participants. Additional health-related quality of life and hospitalisation data were collected via quarterly surveys and analysed. Fifty-two participants (mean age 76.6 years, 54% female) with an average of eight diagnosed health conditions, received an average of four home care visits per week. Almost half the participants were hospitalised once during the 12-month period and experienced a significant decline in overall quality of life and in the dimensions measuring independent living and relationships over the study period. If ageing in place with good quality of life is to be realised by older adults with multimorbidity, support services including home nursing need to consider both the biomedical and social determinants perspectives when addressing health and social care needs.

The incidence of herpes zoster in cutaneous lupus erythematosus (CLE), dermatomyositis (DM), pemphigus vulgaris (PV), and bullous pemphigoid (BP).

BACKGROUND: Herpes zoster is a common condition that causes significant morbidity. OBJECTIVE: This study determined the incidence of zoster in patients with cutaneous lupus erythematosus (CLE), dermatomyositis (DM), pemphigus vulgaris (PV), and bullous pemphigoid (BP). METHODS: In this retrospective cohort study the electronic medical records of 186 patients with CLE, 103 with DM, 83 with PV, 44 with BP, and 152 healthy control patients were reviewed to confirm positive diagnoses of zoster. RESULTS: The incidence of zoster per 1000 person-years was 29.4 in CLE, 55.4 in DM, 18.6 in PV, 10.2 in BP, and 3.9 in healthy control subjects. The mean age (SD) in years was 46.1 (14.9) for CLE, 52.2 (14.5) for DM, 51.8 (13.5) for PV, 71.44 (11.8) for BP, and 48.2 (18.2) for healthy control subjects. The incidence of zoster was significantly higher in the CLE (P = .0177) and DM (P = .0070) groups than the healthy control subjects, all of whom were of a similar mean age. LIMITATIONS: The limitations of this study are the sample size, referral bias, and retrospective nature. CONCLUSION: The incidence of zoster in patients with CLE and, particularly, DM was significantly higher than that of the healthy control subjects.

Piriformis syndrome versus radiculopathy following lumbar artificial disc replacement.

STUDY DESIGN: Case series. OBJECTIVE: To describe the presentation, diagnostic challenges, and treatment of five patients with piriformis syndrome after lumbar artificial disc replacement. SUMMARY OF BACKGROUND DATA: Until recently, spinal fusion was considered the standard for surgical treatment of severe lumbar degenerative disc disease. However, artificial disc replacement now offers an alternative solution. Piriformis syndrome results from entrapment of the sciatic nerve at the greater sciatic notch, with symptoms of pain and numbness radiating from the buttock to the foot, mimicking radiculopathy. METHODS: In this case series, we report five patients who developed piriformis at our institution after artificial disc replacement. RESULTS: Five patients, aged 35 to 46 years, developed some or all of the following symptoms in the affected leg after artificial disc replacement: posterior leg and buttock pain, calf weakness, and toe and ball of foot numbness and tingling. The onset of symptoms ranged from 6 days to 8 months postoperative, and became debilitating over time. Each patient was diagnosed with piriformis syndrome through physical examination. Three of the patients received a piriformis injection and reported 50% to 100% pain relief lasting 1 to 3 weeks. The patients subsequently underwent physical therapy that provided relief of their piriformis syndrome-related pain and enabled them to resume their normal activities. CONCLUSION: Piriformis syndrome has not previously been described in the literature as a sequela of lumbar artificial disc replacement. Our case series indicates that this complication may be underdiagnosed. Careful consideration after artificial disc replacement is required if the patient presents with buttock, leg or foot pain, and/or numbness. It is important for physicians to recognize the symptoms of piriformis syndrome and to differentiate piriformis syndrome from nerve root compression and irritation or referred pain from spinal structures. Although controversial, the proper diagnosis of piriformis syndrome may have prevented some of these patients from undergoing unnecessary surgical procedures.