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Biomedical subjects

S Voeks

Publications and source records attributed to S Voeks.

10 recordsLinked to original sources
PubMed1994

Pneumonia in a nursing home.

The authors studied nursing home residents serologically to determine whether atypical organisms were causes of radiologic pneumonia. The study was conducted at the Wisconsin Veterans Home, a facility with on-site microbiology and x-ray. Over one year, serologic examinations for Legionella, Mycoplasma, and Chlamydia were conducted for the residents who had pneumonia. Cultures and mortality were reviewed. Fifty-six episodes were studied (mean resident age 78 years). There was no fourfold titer change. Seventeen quality sputum specimens revealed Streptococcus pneumoniae (5), normal flora (4), Hemophilus influenzae (4), Moraxella catarrhalis (3), Staphylococcus aureus (1), and beta-hemolytic Streptococcus, not group A (1). The two-month mortality was 21%. This study did not result in serologic confirmation of atypical organisms' causing pneumonia. Antibiotic choice should be based on coverage of prevalent organisms, including Hemophilus influenzae, Moraxella, and Staphylococcus, as well as clinical features.

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PubMed1993

Sensitivity and positive predictive value of clinical signs of hypogonadism in elderly men.

One hundred three ambulatory elderly men had serum free testosterone (FT) assessed as part of a study of bone loss. The FT was analyzed using radioimmunoassay. Each participant was questioned regarding the presence of erections adequate for sexual activity and the presence of sexual desire. Each was examined for decreased axillary and pubic hair. A FT of less than 9.0 pg/mL was found in eight subjects. The sensitivity of the clinical predictors as an indicator of a low FT value ranged from 43% to 86%, while positive predictive value ranged from 12% to 19%. The abnormal clinical signs and symptoms investigated in this study obviously have mechanisms in addition to hypogonadism. A history of adequate erections ruled out a low FT value in all but 1 of 44 cases.

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PubMed1991

Thyroid stimulating hormone elevation without antithyroid antibody elevation in nursing home patients.

OBJECTIVES: To investigate the relationship between antithyroid antibody elevation and thyrotropin (TSH) elevation. SETTING: Large state veterans home. METHODS: Seven hundred seventy-six residents were screened for TSH elevation. Seventy-two residents with TSH elevation and no history of thyroid disease or recent iodine exposure later had determinations of antithyroglobulin and antimicrosomal antibodies. The relationship between TSH levels and antibody titers was explored. RESULTS: Eleven percent of the residents had TSH elevation. Thirty-two percent of men and 64% of women with TSH elevation had elevation of antithyroid antibodies. Those residents with the highest antithyroid antibody titers had significantly greater TSH elevation. CONCLUSION: Previous investigators have found similar percentages of individuals with TSH elevation who lack antithyroid antibody elevation. We hypothesize that TSH elevation without elevated antibody titers may be the result of a previously described involutional histologic lesion of the thyroid.

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PubMed1991

Readmissions and acuity in the nursing home--how will the nursing homes manage?

Decreased hospital length of stay and the shift of location of death from the hospital to the nursing home have increased the burden of care that must be provided by nursing home staff. Complex interaction of multiple disease states was the dominant factor in the readmission of nursing home residents to hospitals within 30 days of their previous discharge. Advanced nursing practice provided by gerontological nurse practitioners can monitor acute and chronic illnessess and decrease rates of hospitalization, as well as provide educational expertise to improve the nursing assessment and planning skills of the nursing home staff.

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PubMed1991

Misleading elevation of the free thyroxine index in nursing home residents.

The significance of an elevated free thyroxine index (FTI) as an indicator of hyperthyroidism was studied while screening 651 elderly nursing home residents. Eleven subjects had FTI elevations. Most of these patients were chronically ill and/or malnourished. Clinical assessment, repeated FTI determinations, and subsequent measurements of levels of triiodothyronine, free thyroxine by equilibrium dialysis, and thyrotropin (thyroid-stimulating hormone) by sensitive assay showed that all subjects with FTI elevation were euthyroid. The FTI elevation in the chronically ill institutionalized elderly patient is not necessarily an expression of hyperthyroidism.

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PubMed1991

Effect of a sensitive thyrotropin-stimulating hormone assay on dosing of L-thyroxine.

The Wisconsin Veterans Home has had a special interest in thyroid disease since 1986. Until recently, dosage adjustment of L-thyroxine in residents with primary hypothyroidism was accomplished by individual physicians guided by standard thyroid function tests. A shift to a sensitive thyrotropin-stimulating hormone (TSH) assay provided an opportunity to assess the frequency of sensitive TSH suppression secondary to excessive doses of L-thyroxine which would not be recognized by the standard TSH assay. We reviewed the charts of 46 residents who were not acutely ill and had been in the facility at least 6 months. Sensitive TSH was determined while on a stable dose of L-thyroxine for a minimum of 6 weeks. Six residents (13%) had low sensitive TSH levels indicating an excessive dose of L-thyroxine. The application of the sensitive TSH assay resulted in dose reduction.

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PubMed1990

Do the elderly sue physicians?

We reviewed malpractice data from the state of Wisconsin for 1983 and 1984 to determine the frequency and the outcome of malpractice litigation by the elderly. Research data were obtained from court dockets filed with Wisconsin's Patients Compensation Panel and from 281 attorneys who provided the age for 431 claimants. The results showed that 10.0% of malpractice suits in Wisconsin were filed by the elderly during the study years. When we compared the frequency of litigation with the use of the health care system (number of hospitalizations and inpatient days), the elderly were significantly less likely than younger persons to initiate malpractice litigation despite greater exposure to potential negligence. However, once a malpractice suit was filed, there was no significant difference between older and younger litigants in the disposition of the case or in the likelihood of being the prevailing party when a finding or award was made. These findings suggest that the elderly are less likely to file malpractice claims against health care providers than would be expected given their use of the health care system. This finding may be related to social, economic, and legal barriers to malpractice litigation by older adults.

Adult↗