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Home Residency (home + residency)
Selected AbstractsBlood Cultures Do Not Change Management in Hospitalized Patients with Community-acquired PneumoniaACADEMIC EMERGENCY MEDICINE, Issue 7 2006Prasanthi Ramanujam MD Objectives: To determine if blood cultures identify organisms that are not appropriately treated with initial empiric antibiotics in hospitalized patients with community-acquired pneumonia, and to calculate the costs of blood cultures and cost savings realized by changing to narrower-spectrum antibiotics based on the results. Methods: This was a retrospective observational study conducted in an urban academic emergency department (ED). Patients with an ED and final diagnosis of community-acquired pneumonia admitted between January 1, 2001, and August 30, 2003, were eligible when the results of at least one set of blood cultures obtained in the ED were available. Exclusion criteria included documented human immunodeficiency virus infection, immunosuppressive illness, chronic renal failure, chronic corticosteroid therapy, documented hospitalization within seven days before ED visit, transfer from another hospital, nursing home residency, and suspected aspiration pneumonia. The cost of blood cultures in all patients was calculated. The cost of the antibiotic regimens administered was compared with narrower-spectrum and less expensive alternatives based on the results. Results: A total of 480 patients were eligible, and 191 were excluded. Thirteen (4.5%) of the 289 enrolled patients had true bacteremia; the organisms isolated were sensitive to the empiric antibiotics initially administered in all 13 cases (100%; 95% confidence interval = 75% to 100%). Streptococcus pneumoniae and Haemophilus influenzae were isolated in 11 and two patients, respectively. The potential savings of changing the antibiotic regimens to narrower-spectrum alternatives was only 170. Conclusions: Appropriate empiric antibiotics were administered in all bacteremic patients. Antibiotic regimens were rarely changed based on blood culture results, and the potential savings from changes were minimal. [source] A Pilot Study Analyzing Mortality of Adults With Developmental Disabilities Residing in Nursing Homes in ConnecticutJOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES, Issue 3 2010Gerard J. Kerins Abstract A review of mortality cases for persons with intellectual disabilities (ID) in the state of Connecticut (USA) revealed that the majority of deaths in residential settings occurred in nursing homes. However, it was not clear why individuals with ID were residing in nursing homes, or what brought them there. The authors conducted a preliminary study to elicit better understanding of the circumstances resulting in nursing home residency for people with ID. Charts for a small sample of deaths occurring in nursing homes were examined and select data extracted, including basic demographic data, the previous residential setting, the length of stay, medical conditions, case management intensity, and documented rationale for continued nursing home residency. The data revealed that many individuals were admitted to nursing homes at an earlier age than for the nondisabled general population. People with ID stayed in these residences longer, and died later than the general population of nondisabled individuals admitted to nursing homes. About half the sample received case management on at least an annual basis; a third had no documented case management. Lack of appropriate alternate residential settings, lack of support services for families, and lack of case management resources for adults with ID residing in nursing homes in Connecticut are all apparent from the findings. Failure to use existing resources such as group homes to their potential capacity, and other similar policies should be re-examined. [source] A prospective study of the effect of nursing home residency on mortality following hip fractureANZ JOURNAL OF SURGERY, Issue 6 2010Ian A. Harris Abstract Background:, The strength of nursing home residence as a prognostic indicator of outcome following hip fracture has not previously been examined in Australia. The aim of the study was to examine the influence of nursing home residency on mortality after sustaining an acute hip fracture. Methods:, A prospective study of all adults aged 65 years and over presenting to a single tertiary referral hospital for management of a proximal femoral fracture between July 2003 and September 2006. Residential status was obtained at admission. Patients were followed up to September 2007 (minimum 12 months). Relative risk values for mortality were calculated comparing nursing home residents with non-nursing home residents. Survival analysis was performed. Results:, Relative risk of death was higher in nursing home patients compared with non-nursing home patients. The difference was greater in the immediate period (30 days) post-injury (relative risk 1.9, 95% confidence interval 1.0,3.6, P= 0.04) than after 12 months (relative risk 1.5, 95% confidence interval 1.2,1.8, P= 0.001). Survival analysis showed that 25% of patients in the nursing home group died by 96 days post-injury, compared with 435 days in the non-nursing home group. Conclusions:, Nursing home residence confers an increased risk of death following hip fracture; this difference is greater in the immediate post-injury period. The relative risk of death decreases over time to equal previously reported comparative mortality rates between nursing home residents and community dwellers without hip fracture. [source] | ||||||||||