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Biomedical subjects

B Leff

Publications and source records attributed to B Leff.

18 recordsLinked to original sources
PubMed2000

Prevalence, effectiveness, and predictors of planning the place of death among older persons followed in community-based long term care.

BACKGROUND: Little is known about whether patients plan for the site of their death and whether such planning is effective. OBJECTIVE: To determine the prevalence, effectiveness, and predictors of planning the place of death among older homebound persons followed in a community-based, physician-led house call program. DESIGN: Retrospective chart review. SETTING: A geographically defined catchment area in southeast Baltimore, Maryland. PATIENTS: One hundred twenty-five patients who died between July 1995 and November 1998 who were followed in a physician-led house call program. MAIN OUTCOME MEASURES: Presence of a plan to die in a specific place and concordance between planned and actual place of death. RESULTS: Eighty patients (64%) made a plan to die in a specific place, and these plans were executed successfully in 73 cases (91%). The median time between formulating a plan to die in a specific place and death was 36 days. In logistic regression analysis, making a plan to die in a specific place was positively associated with an advance directive of Do Not Resuscitate (DNR) (odds ratio (OR) 11.7, confidence interval (CI) 3.7, 32.5) and negatively associated with the lack of an identifiable main medical problem other than being homebound (OR 0.17; CI, 0.02-0.88). CONCLUSIONS: Among a group of frail older persons living in the community, planning to die in a particular place was common and implemented successfully most of the time. Providing physician care at home may facilitate improved end-of-life care for older persons.

Activities of Daily Living↗
PubMed1999

Home hospital program: a pilot study.

OBJECTIVE: To evaluate the basic safety and feasibility of hospital care at home (Home Hospital (HH)) for treating acutely ill older persons requiring hospitalization. DESIGN: Prospective case series SETTINGS AND PARTICIPANTS: Community-dwelling persons aged 65 and older requiring acute hospital admission for community-acquired pneumonia, chronic heart failure, chronic obstructive airways disease, or cellulitis. RESULTS: Seventeen subjects were treated in HH. One hundred twenty-two could not be enrolled because they presented for admission at times when HH was not operational. Six patients refused to enroll in HH. Subjects treated in HH had comparable clinical outcomes to those treated in the acute hospital and were highly satisfied with HH. Charges for HH care were 60% of those for the acute hospital care. CONCLUSIONS: In this pilot study, HH was safe, feasible, highly satisfactory, and cost-effective for certain acutely ill older persons who required acute hospitalization.

Acute Disease↗
PubMed1998

House calls.

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Aged↗
PubMed1998

Acceptability to patients of a home hospital.

OBJECTIVE: To examine the acceptability to older patients of receiving care in the home for acute medical conditions that require hospital level care by current standards. DESIGN: Interviews with patients during hospitalization regarding their views of a hypothetical "home hospital." PARTICIPANTS: Patients (n = 87) admitted to a community-based academic medical center with a primary diagnosis of pneumonia, congestive heart failure, or chronic obstructive airway disease, their nurses (n = 111), and resident physicians (67). MEASUREMENTS: A questionnaire was developed to measure several domains of acceptability and expectations for care. RESULTS: A majority of patients agreed that treatment in a home hospital would be more comfortable compared with treatment in a hospital (78.5%), would be less likely to result in an infection (62.5%), and would not be a burden to their family (71.8%). There was less certainty that medical care at home can be as good as in the hospital (56.9%). Nearly three-quarters (72.3%) of patients would choose home hospital if it were available. CONCLUSION: Patients may be ready to accept home hospital as an alternative for acute care. The acceptability of home hospital to acutely ill older patients is a critical factor in the development of this alternative for care and has the potential for improving satisfaction with care, reducing complications, hastening return to function, and, possibly, of lowering costs of care.

Acute Disease↗
PubMed1998

Future directions: alternative approaches to traditional hospital care-home hospital.

The acute hospital may be a difficult environment for many older patients and is an expensive site of care for payers. Home hospital is an emerging model of care that allows an older person with acute medical illness to avoid an inpatient hospital admission by bringing the critical elements of hospital care to the home. Challenges associated with the development and study of home hospitals as well as several specific home hospital models are reviewed. The need for continued study and the potential of home hospital are discussed.

Aged↗
PubMed1997

The PACE program.

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Activities of Daily Living↗
PubMed1997

Prospective evaluation of clinical criteria to select older persons with acute medical illness for care in a hypothetical home hospital.

OBJECTIVE: To evaluate criteria to select older persons who need hospitalization for common acute medical illnesses for care in a hypothetical home hospital. DESIGN: Prospective record review. SETTING AND PARTICIPANTS: Patients aged 65 and older admitted to the general medical service of a community-based university hospital. MEASUREMENTS: We developed illness-specific selection criteria to identify older persons with certain acute medical conditions for treatment in a hypothetical home hospital. The selection criteria were reviewed prospectively against all community-dwelling older patients admitted to the general medical service of a community-based university hospital over a 2-month period. We determined eligibility for home hospital admission based on information available at the time of admission and then tracked the patient's hospital course. RESULTS: One hundred fifty-seven admissions of 143 patients were reviewed. The selection criteria identified 33% of patients admitted to the acute hospital with one of the three target diagnoses as eligible for a home hospital model of care had it been available. Eligible patients experienced shorter lengths of stay (3.7 vs 5.4 days, P = .012), fewer mean number of procedures performed (0.98 vs 1.70, P = .001), fewer mean number of complications (0.17 vs 0.56, P = .010), and fewer events that could be handled only in the acute hospital setting (P = .036). In addition, in logistic regression analysis, three criteria for home hospital ineligibility, pulmonary congestion associated with ischemic chest pain (odds ratio 6.85, 95% CI 2.64, 17.81), the presence of an acute coexisting illness requiring hospitalization independent of the target conditions (odds ratio 2.66, 95% CI 1.11, 6.41), and significant pulmonary congestion after initial treatment (odds ratio 14.4, 95% CI 1.77, 117.41) were significantly associated with items difficult to accomplish at home. CONCLUSIONS: Criteria can be delineated that identify older persons with acute medical illnesses who may be suitable for treatment in a home hospital.

Acute Disease↗
PubMed1994

Discontinuing feeding tubes in a community nursing home.

This study retrospectively reviews the experience of a 126-bed community nursing home at weaning tube-fed residents. All patients admitted to facility over a 6-year period who were tube fed were included in the review (N = 15). All tube-fed residents had a sustained trial of oral feeding. Tube feedings were discontinued if oral intake was sufficient. Fifteen tube-fed patients were admitted over the period studied. Seven residents were retrained to eat and were weaned from tube feeds. We conclude that some residents admitted to our nursing home with feeding tubes can be weaned from them. Prospective studies using a larger sample are needed to better delineate the nature of the weaning process and to define the clinical characteristics that predict the ability to wean.

Aged↗
PubMed1975

A club approach to social work treatment within a home dialysis program.

This article discusses one approach to helping patients and their families cope with the stresses of a program where dialysis treatments are performed at home. The "Home Dialysis Club" includes many facets and levels of group work treatment. The need for support is unending for families with this difficult life-style. The club approach offers ongoing services with flexibility to change as needs change.

Family↗
PubMedDate not supplied

Cardiovascular and respiratory consequences of tension pneumothorax.

The physiologic responses to acute pneumothorax were investigated in awake, standing sheep. Pleural pressure (Ppl) was raised in graded increments by injecting air from a 500 ml syringe into the pleural cavity of eight sheep to produce pneumothorax volumes of 0, 17, 35 and 45 ml.kg-1. At the maximum value of 45 ml.kg-1 (approximately equal to 1,400 ml), Ppl at end-expiration was raised to 10 +/- 2 mmHg (mean +/- SD) whereas end-inspiratory Ppl remained negative in half the sheep as the result of increased thoracic pressure swings. The most striking haemodynamic impairment was a 22% fall in stroke volume. Cardiac output, however, remained fixed at baseline values as a result of a 28% rise in heart rate. Although hypotension has been commonly held as a consequence of severe pneumothorax, mean systemic arterial pressure increased, rising by 19% in the entire group at the maximal pneumothorax tolerated. Pulmonary gas exchange was significantly disrupted by pneumothorax, as indicated by both a 40% fall in Pao2 and a 19% reduction in arterial oxygen content. Despite a reduction in tidal volume, the sheep initially remained eucapnic by generating an increased respiratory rate and slightly increasing minute-ventilation. However, at pneumothorax volumes of 45 ml X kg-1, the sheep were no longer able to sustain minute-ventilation and a small rise in PaCO2 followed. The reduced arterial oxygen content and the fixed cardiac output led to a progressive reduction in systemic oxygen transport.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗