Table 3 - uploaded by Claire Wagner
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People with coronary heart disease have recourse to a palliative intervention such as Coronary Artery Bypass Grafting (CABG).
Opsomming
Persone met ‘n koronêre hartsiekte is soms genoodsaak om ‘n hartomleiding (CABG), wat ‘n tydelike intervensie ter verligting is, te ondergaan.
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... 11 In a South African study including 19 patients who were assessed 1-day pre-and 1-week post-operatively, 63% demonstrated cognitive change in various neuropsychological domains, with significant post-operative decline noted for specific tasks of the Grooved Pegboard Test (fine motor co-ordination), the Rey Auditory Verbal Learning Test (verbal learning and memory) and the Trail Making Test (motor speed and attention). 12 The reasons for the widely varying incidence of cognitive decline are multifactorial, and make comparisons difficult; firstly, there are a large number of neuro-psychological tests that assess the different cognitive domains. 13,14 Secondly, the intervals between cognitive screening pre-operatively and the operation date vary across studies, and range from weeks to months. ...
Background: Coronary artery bypass graft (CABG) surgery has been found to be associated with post-operative cognitive decline. Despite the large and growing numbers being conducted in South Africa, the associated or ensuing cognitive symptoms or impairment have received little research attention.
Aim: The aim of this pilot study was to describe the nature and extent of subjective cognitive complaints (SCCs) and objective cognitive impairments in patients 6-week post-CABG surgery in a clinical sample in KwaZulu-Natal (KZN) Province, South Africa.
Setting: A cross-sectional survey was conducted among outpatients attending their 6-week post-CABG surgical review at a cardiology clinic in a KZN provincial hospital.
Method: Socio-demographic and clinical data were captured, with SCCs being determined by using standardised questions; cognition was assessed with the Montreal cognitive assessment (MoCA).
Results: The mean age of the sample (n = 28) was 58.72 years. The mean MoCA score was 23.96 (SD = 4.32); 60.71% (n = 17) screening positive ( 25/30) and more likely to be older, male, hypertensive and diabetic. A third (n = 9; 35.71%) reported at least one new SCC; their mean age was 55.36 years which was lower than those without subjective complaints (59.81).
Conclusions: Subjective and objective cognitive impairments were evident in patients 6-week post-CABG surgery identifying a need for longitudinal cognitive screening both pre- and post- operatively in patients undergoing CABG surgery.
... the examinee to switch between connecting numbers and letters in series. It assesses visual search, motor coordination, and attention (Knight et al., 2006; Spreen & Strauss, 1998). Lezak et al. (2004) report high reliability coefficients across different studies for the TMT (r = 0.60-0.90). The TMT is used widely in South African clinical settings. Cassimjee et al. (2004) used the TMT successfully to assess South African coronary artery bypass patients after surgery. ...
To determine the age-specific rates of hospital discharge, cost per day, and overall in-hospital 1- and 4-year mortality for seniors who required hospitalization for the treatment of community-acquired pneumonia (CAP).
Retrospective analysis of two administrative health service databases.
Province of Alberta, Canada.
Residents of Alberta aged 18 and older.
Hospital abstracts and vital statistics from April 1, 1994, to March 31, 1999, were analyzed, and mortality and cost outcomes statistically modeled by regression.
There were 8,500 annual hospital discharges for CAP costing more than $40 million per year. The overall in-hospital all-cause mortality rate was 12%, and the 1-year mortality rate was 26%. The mean age of pneumonia cases increased (P<.000) from 62.8 in 1994/1995 to 67.2 in 1998/1999. The proportion of hospital discharges in those aged 85 and older was 13% in 1994/1995, increasing to 18% in 1998/1999 (P<.000). The age-specific hospital discharge rate and length of hospitalization increased with age. After adjustment for other factors using modeling, it was found that the relative risk (RR) of in-hospital and 1-year mortality increased with age, the RR of using special medical care and higher-than-average daily hospital cost decreased with age, and the RR of greater-than-average daily hospital cost was not associated with an increase in comorbidity. Total costs per hospital stay were similar in patients aged 85 and older to those in patients aged 65 to 74, despite a one-third longer length of stay, which was consistent with reduced use of special medical care in those aged 85 and older.
The increased use of hospital resources for CAP in the setting of an aging population may have been partially avoided because of limitations in care provided for seniors aged 85 and older.
To assess the predictive value of risk factors in the European System for Cardiac Operative Risk Evaluation (EuroSCORE) for cardiac surgery on octogenarians.
An observational study of octogenarians undergoing cardiac surgery and average-aged controls matched according to the cardiac surgical procedure.
A university hospital.
One hundred sixty-two consecutive patients 80 years or older who underwent cardiac surgery between January 1, 2001, and June 30, 2003, and 162 average-aged controls.
None.
Risk factors according to the EuroSCORE (The European System for Cardiac Risk Evaluation) model and EuroScore algorithm without an age component (EuroSCOREex) were evaluated. The EuroSCORE model and EuroSCOREex predicted mortality (odds ratio 1.4) and morbidity (odds ratio 1.2 and 1.3, respectively) equally well in both age groups. Adding age group information into the EuroSCOREex model in combined data, the odds ratio estimate was 3.5 for age group. The 30-day mortality of octogenarians was 8.6% versus 1.9% in controls (p < 0.01). Incidences of organ-related complications were comparable. Octogenarians spent more days in the hospital's intensive care unit and surgical ward than did controls (3.4 +/- 3.3 days v 2.7 +/- 3.1 days, p < 0.01; 9.9 +/- 5.8 days v 8.6 +/- 3.8 days, p = 0.02). Only 31 (19.1%) octogenarians were discharged home, whereas the corresponding number was 66 (40.7%) in controls (p < 0.01).
Risk factors other than age were not higher in octogenarians, and the EuroSCORE model predicted mortality and morbidity. Age was an important single risk factor predicting mortality.
