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Biomedical subjects

Laurie G Jacobs

Publications and source records attributed to Laurie G Jacobs.

9 recordsLinked to original sources
PubMed2006

Warfarin pharmacology, clinical management, and evaluation of hemorrhagic risk for the elderly.

Elderly patients as a group may present more of a challenge in managing warfarin therapy because of alterations in pharmacokinetics from other medications, diet, and disease; pharmacodynamic changes; increased risk for hemorrhage; and difficulty in monitoring. The elderly, however, may derive the most benefit from warfarin therapy for certain indications, such as the prevention of stroke in atrial fibrillation or recurrent events following deep venous thrombosis. Warfarin can be managed as effectively as in other populations with careful attention to these issues.

Age Factors↗
PubMed2003

Managing respiratory symptoms at the end of life.

Early and clear discussion and articulation of preferences about interventions with increasing burdens and diminishing benefits is helpful in identifying the goals of care and planning management for patients who have unremitting terminal illnesses. The development of respiratory symptoms such as dyspnea, cough, and hiccups is common and can often be anticipated. Aggressive evaluation and treatment should be pursued and offered to palliate symptoms at the end of life.

Age Factors↗
PubMed2003

Prophylactic anticoagulation for venous thromboembolic disease in geriatric patients.

Venous thromboembolic disease (VTED) occurs commonly in geriatric medical patients, causing significant morbidity and mortality. Although VTED is preventable, prophylactic anticoagulation is underused. Awareness of the clinical risk factors that contribute to VTED in the elderly is essential for identifying candidates for prophylaxis. Iatrogenic risk factors include venous catheterization, transvenous pacemaker placement, hormone replacement therapy, and immobilization or prolonged bed rest. Medical conditions associated with increased risk include a previous episode of VTED, myocardial infarction, heart failure, severe lung disease, cancer, and neurological conditions associated with paresis. Obstacles to the widespread usage of VTED prophylaxis in geriatric medical patients include the clinically silent nature of VTED, underestimation of the risk and clinical effect of VTED in this population, and concerns about the cost and safety of anticoagulant therapy in this population. Clinical practice guidelines devised specifically for geriatric medical patients facilitate rational use of thromboprophylaxis in this population. The safety, efficacy, cost-effectiveness, and convenience of low-molecular-weight heparins for thromboprophylaxis are reflected in their increasing prominence in clinical practice guidelines and clinical use.

Aged↗
PubMed2002

Can "Palliative Care Reports" improve end-of-life care for hospitalized patients?

Improvement in the care of dying hospitalized patients was sought by providing evaluative feedback to individual physicians (n = 46) and nurses in three biannual "Palliative Care Reports." Hospitalized adult patients (n = 194) for whom "death was probable" were prospectively identified from the critical care or geriatric services, and a "palliative care" social work evaluation provided. Educational sessions on palliative care were held for physicians and nurses. Medical record review and family interviews were used to generate 10 scores per patient, which evaluated satisfaction with care, relief of symptoms (pain, dyspnea, gastrointestinal, psychological), and the timeliness of care planning. Subjective comments from a quality improvement committee and focussed educational material was also included. Despite these efforts, no change in the cohort's median report scores occurred over the 18 months, but several institutional policies were examined and altered, and interest and support for a palliative care consultation service was obtained.

Adult↗
PubMed2002

Hospital care at the end of life: an institutional assessment.

Decisions about care at the end of life are not only influenced by doctor-patient-family relationships and physician practice, but also by institutional "culture." An institutional assessment of the quality of care provided to dying hospitalized patients was undertaken to characterize and identify factors influencing it and to find opportunities for improvement. An analysis of hospital data, three physician and nursing focus group discussions, structured review of records of targeted patients (61) who had an "expected death," and interviews with 31 surviving family members of the targeted patients served as the basis for an institutional needs assessment intended to precede the development of a quality improvement program to improve hospital care of patients at the end of life. Data were primarily gathered regarding older adults, including a significant number of nursing home residents. The assessment led to a methodology for developing a quality improvement program based upon feedback to physicians and nurses regarding the quality of end-of-life care.

Adult↗