Clinics in geriatric medicine
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Bradyarrhythmias and tachyarrhythmias are common in elderly patients as a result of aging and acquired cardiac disease. Antiarrhythmic drugs are effective in elderly patients for the management of supraventricular and ventricular arrhythmias; however, dosing of drugs must be performed with care because of age-related changes in drug pharmacokinetics, the presence of concomitant disease, and frequent drug-drug interactions. Despite the large number of antiarrhythmic drugs having different electrophysiologic actions, as described in this article, only the β-blockers have been shown to be effective in reducing mortality and to lack proarrhythmic actions.
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Atrial fibrillation (AF) is an increasingly prevalent disease in the elderly. Patients with AF are at increased risk of ischemic stroke, resulting in significant morbidity and mortality. ⋯ Appropriate risk stratification for stroke should be performed for all patients with AF to guide antithrombotic therapy. For patients at lower stroke risk, bleeding risk stratification tools can also be used when the benefit of anticoagulant therapy is unclear.
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Clin. Geriatr. Med. · Aug 2012
ReviewPatient-reported outcomes for total hip and knee arthroplasty: commonly used instruments and attributes of a "good" measure.
Although the effectiveness of THA and TKA as interventions for end-stage degenerative joint disease has been well established, the use of instruments that measure outcome from the patient's perspective are relatively poorly investigated. Considering the increasing prevalence, associated risks, and high personal and financial cost associated with THA and TKA, patient-reported outcomes are required to ensure optimal selection of patients, and that postoperative outcomes outweigh the burden associated with surgical procedures. It is clear from the information presented that clinicians need to consider a number of factors when selecting a "good" patientreported outcome for use in their TJA patients. ⋯ It is clear that further studies are required, particularly to fill some of the gaps regarding known psychometric properties of patient-reported outcomes for THA and TKA. Based on data acquired in THA and TKA patients for the instruments reviewed, it appears that OA-specific and TJA-specific measures for which patients have been involved in the developmental process (HOOS, KOOS, WOMAC, Oxford Hip and Knee Scores) can more consistently be considered "good" patient-reported outcomes for THA and TKA. Clinicians wishing to evaluate a broader range of dimensions may choose to complement these with one of the generic measures evaluated, bearing in mind the practical issues and psychometric limitations of these instruments when applied to THA and TKA patients.
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Patient satisfaction is an important outcome measurement in TKA/THA surgery. Patient satisfaction can be evaluated from 2 perspectives, determinants of satisfaction and components of satisfaction.(5) In total joint arthroplasty, improvements in satisfaction can be achieved by examining these perspectives. Patient satisfaction is one of the many PROMs used in orthopedic surgery and is an integral part of the growing sentiment to evaluate surgery from the patient's perspective as well as from the surgeon's. The importance of measuring outcomes from the patient perspective is integral to today's patient-centered models of care.
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Clin. Geriatr. Med. · Aug 2012
ReviewMinimally invasive total hip and knee arthroplasty-implications for the elderly patient.
Overall, it can be concluded that because of the aging society, an increasing number of elderly people will be undergoing total joint arthroplasty. These elderly patients have an increased risk for serious complications after primary THA or TKA. However, the overall complication rates remain low. ⋯ MIS total joint arthroplasty aims at decreasing the surgical incision and minimizing damage to the underlying soft tissue to accelerate postoperative recovery and an earlier return to normal function. A critical look at the literature on MIS shows that the term minimally invasive is often used for a conventional total joint arthroplasty performed through a smaller skin incision. Research has shown promising results of using MIS in elderly patients; it seems that compared with younger patients, elderly patients benefit more from a minimally invasive approach.