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Biomedical subjects

T E Finucane

Publications and source records attributed to T E Finucane.

At least 37 records · Page 2Linked to original sources
PubMed1995

Malnutrition, tube feeding and pressure sores: data are incomplete.

PURPOSE: To review data about the relationship between pressure sores and (1) nutritional status, (2) nutrient intake, and (3) tube feeding. DATA SOURCES: Medline search of terms associated with "decubitus ulcer" combined with terms associated with "pressure sore" from 1985 through August 1994. Hand review of all issues of the journal Decubitus (now Advances in Wound Care) through June 1994 and the Journal of Parenteral and Enteral Nutrition from January 1987 through May-June 1994. Review of bibliography of pertinent articles. A small survey of experts. STUDY SELECTION: Articles where the title, Me SH terms, or abstract suggested an examination of the relationship between nutrition and pressure sores, and those suggested by the experts, were reviewed. DATA EXTRACTION: Study designs were disparate. Results were simply tabulated. RESULTS: In seven studies, low serum albumin was associated with development or presence of pressure sores; in five it was not. Most measures of nutritional status were not associated with pressure sore outcomes. Poor nutritional intake was associated with poor pressure sore outcome in four of seven studies. Tube feeding was positively associated with presence of pressure sores in one study. Special nutrition support was ineffective in improving pressure sore outcome in a second. Two studies showed better healing in patients receiving high-protein formula: in one, all patients were tube fed; in the other, route of feeding was not stated. CONCLUSION: Data about the relationship between malnutrition and pressure sores are incomplete and contradictory. No randomized trials of tube feeding as prevention or treatment of pressure sores has been done. Routine use of tube feeding to prevent or treat pressure sores is not clearly supported by data.

Enteral Nutrition↗
PubMed1995

Predictors of nursing home placement in community-based long-term care.

OBJECTIVE: To identify predictors for nursing home placement among a group of frail older patients receiving formal home care services. DESIGN: Retrospective chart review. SETTING: A geographically defined catchment area of southeast Baltimore, Maryland. PATIENTS: A total of 334 homebound patients who started using the Elder Housecall Program (EHP), a multidisciplinary team providing in-home care and housed at the Johns Hopkins Geriatrics Center, between 1986 and 1989. MEASUREMENTS: Independent variables, based on the chart review, were age, sex, diagnosis, functional status, and caregiver conditions at entry into EHP. Dependent variable was nursing home placement until December 31, 1991. MAIN RESULTS: Cox proportional hazards analysis indicated that significant predictors were diabetes mellitus, bowel incontinence, and three caregiver characteristics: living separate from the patient, having time conflicts because of a job, and being stressed by caregiving. CONCLUSION: Among this group of frail older people, caregiver problems were significant predictors of nursing home placement, but functional disabilities generally were not. These results suggest the need for geriatricians to be alert to the psychosocial aspects of patients and their caregivers.

Adult↗
PubMed1995

The medical director in non-institutional long-term care programs.

Non-institutional long-term care is a broad, poorly defined, rapidly developing field. The need for it, the technologic ability to provide it, and the amount of money spent on it are all growing. Reconciling the public's reluctance to support social programs with the inevitable overlap of social and medical needs in the care of the frail elderly presents a serious challenge in formulating policy. Medical directors of programs in non-institutional long-term care will have to face governmental constraints and will be responsible for developing and implementing new policy in the future.

Aged↗
PubMed1994

Permanent cardiac pacemakers in the elderly.

OBJECTIVE: To review (1) Changes in cardiac impulse generation, conduction, and ventricular filling in normal aging and disease; (2) Pacemaker technology and nomenclature; (3) Expert guidelines about pacemaker use; (4) Studies of pacemaker effectiveness and utilization. DESIGN: Articles were identified through a Medline search, review of articles' bibliographies, and contact with pacemaker manufacturer representatives for information on device features and costs. These articles were reviewed, and the relevant data are presented. RESULTS: Abnormalities in impulse generation and conduction are common in the elderly. Pacemaker use is higher in the elderly than in other population groups. Hemodynamic changes associated with aging include an increased contribution of atrial contraction to ventricular filling. Pacemakers, which maintain the synchrony between the atria and ventricles, may be particularly advantageous in the elderly for this reason. Rate-responsive ventricular pacemakers improve the quality of life compared with fixed rate devices in some patients over the age of 75. Dual-chamber, sequential pacemakers are more likely to reduce symptoms of pacemaker syndrome than ventricular pacemakers and probably also prolong survival and reduce risk of atrial fibrillation in certain groups of patients. However, dual chamber devices are more expensive and require more frequent follow-up. Pacemaker utilization can vary widely by region. Decisions about pacemakers require explicit tradeoffs between risk and quality of life on one hand and cost on the other. In many clinical situations, there is controversy as to whether pacemakers should be used. CONCLUSIONS: Pacemakers provide definite benefits to some patients, whereas in others, the likelihood of benefit is uncertain. More sophisticated devices may provide some additional benefit, but they are more costly. Further data is still required to define precisely which groups of patients substantially benefit from complex and expensive pacing modalities compared with simpler ones.

Age Factors↗
PubMed1994

How do we know?

Home care personnel working with physicians meet with terms every day that may not be clear to them. In an effort to preclude misinterpretations, mistakes, or time expended trying to clarify instructions, this article covers some of the terminology that might occur in physician orders, on records, or in the medical literature.

Clinical Medicine↗
PubMed1992

Advance directives.

Explore the source record for details and available documents.

Advance Directives↗
PubMed1991

The incidence of attempted CPR in nursing homes.

We studied the frequency with which cardiopulmonary resuscitation (CPR) is attempted on residents of American nursing homes. Each author (all members of the Clinical Practice Committee of the American Geriatrics Society) completed a questionnaire in 1989 about policy and practice regarding CPR during 1988 in each of three to seven nursing homes, by questioning the medical or nursing director or the administrator. Because of the vagaries of nursing home record-keeping, data from some homes were allowed when they were "accurate to within 10%." Data from 58 nursing homes, totalling 10,836 bed-years were available. In 33 of these homes, accounting for 5,425 bed-years, CPR was never attempted. CPR was more likely to be foregone in nursing homes with religious affiliation than in nursing homes without (13 of 17 vs 18 of 38; chi 2 = 4.0; P less than 0.05). Religious affiliation was unknown for three nursing homes. Academic affiliation (10 of 16 vs 20 of 37 in non-affiliated nursing homes) and non-profit status (14 of 19 vs 16 of 23 in for-profit nursing homes) did not significantly affect the likelihood that CPR would never be used. In 31 of 54 nursing homes with explicit do not resuscitate (DNR) policies, CPR was never performed, compared to 2 of 4 homes without such policies. For nursing homes with complete data, there were 1,196 deaths in 32 facilities where CPR was never attempted compared to 1,294 deaths for 24 nursing homes with CPR. For 22 nursing homes without CPR, there were 2,172 emergency room transfers compared to 1,363 emergency room transfers in 18 nursing homes where CPR was attempted.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1990

The outcome of CPR initiated in nursing homes.

To determine outcomes following attempted cardiopulmonary resuscitation initiated in nursing homes, we retrospectively reviewed ambulance and hospital records for all 705 people aged 65 or over who underwent attempted resuscitation by ambulance crews in 1987 in Baltimore City and Baltimore County. From medic unit encounter forms we noted whether or not the address of origin was a nursing home and to what hospital the person was taken. Hospital records were then examined to determine outcomes: death in the emergency room, death during consequent hospitalization, or live discharge. Complete information was obtained for all 117 nursing-home residents and for 580 of 588 nonresidents. When attempted resuscitation was begun in a nursing home, only two patients survived to hospital discharge, whereas 61 nonresidents (11%) survived after a mean stay of 14 days. Of the 115 nursing-home residents who did not survive to hospital discharge, 102 (89%) were pronounced dead in the emergency room, two (2%) more died within 24 hours of admission, and the remaining 11 (9%) died after an average stay of five days. Of the 519 nonresidents who died before discharge, 433 (83%) were pronounced dead in the emergency room, 16 (3%) died in the first 24 hours, and 70 (14%) lived an average of nine days. One of the two nursing-home residents who survived was an 87-year-old woman who spent 30 days in the hospital and died eight months after returning to the nursing home, demented, cachectic, with a large sacral pressure sore.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1989

Deciding about resuscitation in a nursing home. Theory and practice.

This study examines how plans about cardiopulmonary resuscitation (CPR) were made, what relevant orders were written, and what actual events occurred at the time of death in a nursing home. A chart review of 119 residents who died in a 233-bed nursing home in 1987 found one who underwent (unsuccessful) CPR. Nine records were unusable. The remaining 109 cases, none of which involved CPR, were studied. Documentation of discussions about CPR between physicians and residents or their surrogates was present in 90 charts. Of 85 residents with cognitive impairment, four were included in the CPR discussion and surrogates were consulted for 66. In 15, no discussion was documented. Of 24 residents without documented cognitive impairment, 11 were consulted. For nine others, surrogates were asked, and in four no discussion was recorded. One resident and three surrogates requested CPR. All others who were asked accepted a do-not-resuscitate (DNR) order. For 67 residents DNR orders were written. In six of these cases, physicians wrote the order without documenting consultation with resident or surrogate. For five residents orders to resuscitate (full code orders) were written. For 37 residents no order about CPR was recorded. Of the 42 residents who died without a DNR order, 37 were found dead by nursing staff, but in only one case was a physician contacted urgently. In this nursing home advance planning about CPR was frequently undertaken. Regardless of planning or the orders in the chart, CPR was a rare event.

Aged↗