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Biomedical subjects

V Shats

Publications and source records attributed to V Shats.

15 recordsLinked to original sources
PubMed1999

[Reactive increase in blood pressure on immobilization, but not hypertension, prevents pressure ulcers].

Of 135 geriatric patients immobilized for at least 2 days, 37 (27.4%) had pressure ulcers (PU). Those without PU were the control comparison group. Gender, length of immobilization, number of blood pressure determinations and proportion with hypertension were similar in those with and without PU. Those with PU were slightly older than those in the comparison group: 75.5 +/- 8.8 and 74.7 +/- 9.6 years, respectively (p > 0.05). Of 66 patients with acute ischemic stroke, reactive increase of systolic or diastolic blood pressure to 140/90 mm Hg or above following immobilization, was seen in 60.6% and 22.7% of patients, respectively, and there were PU in 12.1%. Of 17 with recurrent ischemic stroke, corresponding figures were: 41.2%, 23.5% (p > 0.05), and 47.1% (p < 0.01). In 7 patients with previous ischemic stroke corresponding figures were: 14.3% and 0% (p < 0.01) and 100% (p < 0.001). In 36 operated for fracture of the femur, corresponding figures were: 50%, 11.1% (p > 0.05), and 27.8% (p > 0.05). For 9 patients with severe infections, sepsis or pneumonia, the corresponding figures were: 22.2% and 0.0% (p > 0.05), and 44.4% (p < 0.04). The proportion of patients with reactive increase in systolic blood pressure on immobilization was lower in the PU group than in the controls, 27% vs 59.2%, (p < 0.001). The corresponding figures for reactive increase in diastolic blood pressure were similar, 8.1% and 20.4%, respectively (p > 0.05). The mean systolic blood pressure on immobilization was higher in the control than in the PU group, 145.4 +/- 21.7 and 130.8 +/- 14.9 mm Hg, respectively (p < 0.001). The corresponding figures for the mean diastolic blood pressure were similar, 81.2 +/- 10.5 and 75.7 +/- 8.9 mm Hg, respectively (p < 0.01). An increase in systolic blood pressure on immobilization reduced the risk of developing PU (p < 0.05). There was no significant statistical relation between diagnosis of hypertension and proportion of patients with PU (p > 0.05). Of 67 patients with hypertension, in 23.9% and 74.6% of them there was no increase in systolic or diastolic blood pressure, respectively. Statistical difference between lack of diastolic or systolic response was very significant (p < 0.001). Reactive increase of blood pressure, but not hypertension, predicts reduced risk of PU on immobilization in the hospitalized elderly. Diminished reactive increase of blood pressure in response to stress of any kind may be a criterion of frailty and reduced physiological reserves. Efforts to reduce elevated blood pressure when a patient is immobilized appear irrational.

Aged↗
PubMed1999

[Maximal age of patients as a reflection of health neglect of the geriatric population].

In publications relating to the health of the elderly there are 2 ways of presenting maximal ages, collective (for example: 70+ years) and individual maximal age (for example 70 years). While enabling assessment up to a certain age, data from subjects above the maximal age stated in the research will not be included. From the literature of the past 10 years, there were selected 764 disease parameters (PD) and 177 parameters of aging (PA). Among them 667 (70.9%) and 274 (29.1%) were parameters with collective and exact maximal ages, respectively. The lack of reference by authors to ages above 70 to 79 (or 70+ to 79+) and 80 to 89 (or 80+ to 89+) was calculated from the medical literature, and estimated as significant, and for ages above 80 to 89 was estimated as minimally significant, in regard to their focus on health data in the elderly. In different groups of parameters, 24% to 32% of maximal ages indicated significant and 25% to 65% minimal lack of reference. Maximal ages of PA were higher than those of PD (p < 0.001), so lack of reference to health of the elderly was more significant when PD were studied as compared to PA. Lack of reference was more significant in studies of hospitalized and ambulatory patients and people living within the community. Usually authors checked all the populations of people living in nursing homes, but the total number of parameters relating to the latter, was very small, only 5.1% of the total number of parameters, so the populations of nursing homes did not reach the attention of the researchers. Collective maximal ages are more often used in geriatric journals, including the Journal of the American Geriatric Society, as opposed to general and gerontological journals, although this approach seems to be too sweeping in the assessment of health of the elderly.

Age Factors↗
PubMed1996

[Is diabetes mellitus a risk factor for pressure ulcers?].

Among patients hospitalized in 1983-1992 were 416 (239 women) who were immobilized for at least 2 hours due to stroke, orthopedic surgery, or sepsis. 128 (30.8%) had pressure ulcers (PU); 100 (31.2%) had diabetes (DM), including 12 with IDDM and 118 with NIDDM; age (mean +/- SD) was 74.3 +/- 9.5 years. Those with IDDM and NIDDM were younger (70.9 +/- 10.5 and 71.5 +/- 8.4 years, respectively) than the nondiabetic (75.7 +/- 9.6 years; p > 0.05 and < 0.001, respectively). Those with PU were older (76.6 +/- 9.0 vs 73.3 +/- 9.6 years, p < 0.01). Incidence of PU in patients without DM was similar to that in those with NIDDM (30.4 vs 27.1%; no difference even after age-adjustment). However, incidence of PU was significantly higher in those with IDDM than in those without DM (75.0 vs 30.4%, p < 0.01). According to Medline (last 2 years screened), and EBSCO Physician Medline Plus (last 5 years screened), only 5 publications referred to DM as a risk factor for PU. According to our data NIDDM does not appear to be a risk factor for PU, but a causative role for IDDM deserves further study. Increased risk of diabetic foot, infections in ulcers and wounds, and slow healing in DM do not justify considering NIDDM a risk factor for PU.

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PubMed1995

[Falls in the geriatric department: responsibility of the care-giver and the hospital].

During a 4-year prospective study there were 94 falls in 60 patients hospitalized in our geriatric department, mostly in dependent women. There was a "responsibility group," in which 19 of the falls occurred (20.2%). These included 14 while the patient was being cared for by nurses or relatives, and 5 due to defective fixation of bed side-walls. In the comparison group there were 75 falls while the patient was alone. Risk of falling was increased by cardiovascular conditions, including low blood pressure and arrhythmias, and by dementia, paralysis and low score for activity of daily living (ADL). Impulsiveness of patients was an important cause, making falls unpredictable and difficult to prevent even while under proper care. Diazepam (Assival, Valium) in those with a low ADL (27.5 +/- 16.5) and a relatively high mental test (7 +/- 2.1) seemed dangerous in the responsibility group, possibly due to increased impulsiveness. Nitrazepam (Numbon) appeared to be dangerous in ambulatory patients of the comparison group when both ADL and mental tests were relatively high (53.5 +/- 17.5 and 8.2 +/- 2.3, respectively). Mean ADL (33.7 +/- 20.8) in all patients decreased after falls by -2.8 +/- 9.4 (p < 0.00001). In the responsibility group it decreased by -5 +/- 13.2 (p < 0.16), and after falls during visits of relatives, by -14 +/- 7.1 (p < 0.23). In the comparison group it decreased by -1.9 +/- 7.1 (p < 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)

Accidental Falls↗
PubMed1993

[Cost-effectiveness of disposable diapers versus catheters in dependent patients].

Disposable diapers for incontinent elderly patients are expensive. Cost-effectiveness analysis in this prospective study showed that diapers reduced prevalence of urinary tract infections and of infected pressure sores. The saving resulting from this reduction in morbidity lowers the cost of diapers by 40% per month. This advantage, and especially improvement in the patients' health, hygiene and quality of life, justify the use of disposable diapers. Catheters were used mostly in patients in a vegetative state, while diapers were used in the preceding stages.

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PubMed1990

[General and epidemiologic aspects of pressure sores].

Computed analysis showed that 23 of 100 patients immobilized by cerebrovascular accidents (CVA) and 33 (42.3%) of 78 postoperative patients had pressure sores (PS). Mean ages of those with PS in these 2 groups were 70.3 +/- 7.5 and 76.2 +/- 6.5 years, respectively; 31.1% and 38.5% were males and 27.4% and 36.1% were married. The presence of family did not prevent development of PS nor improve results of treatment, perhaps due to low patient motivation caused by poor general condition and depression. Immobilization of CVA patients with and without PS, was 97.6 +/- 154.7 and 34.7 +/- 95.8 days, respectively, and in the postoperative group 50.4 +/- 149.9 and 29.1 +/- 78.1 days. The number of PS in each patient was 2.2 +/- 1.2 and 1.6 +/- 1.0, respectively. PS were localized mostly on buttocks in both groups, but the lateral aspects of the body (trochanters, shoulders) and the heels were affected more often in the CVA than in the postoperative patients. Despite the higher incidence of PS in the postoperative patients and their greater age, their prognosis was better: treatment and hospitalization were shorter, results of treatment, including functional status on discharge, were better; a greater proportion were discharged to home; and mortality was significantly lower. This difference seems to be related to the fact that in the postoperative patients PS were mostly acute decubiti related to surgical stress and drug sedation, while in the post-CVA patients they resulted from the much more prolonged periods of immobilization.

Aged↗