How different are complications that affect the older adult inpatient?

Objective: The incidence and cost of complications occurring in older and younger inpatients were compared. Design: Secondary analysis of hospital-recorded diagnosis and costs for multiday-stay inpatients in 68 public hospitals in two Australian states. Main outcome measures: A complication is defined as a hospital-acquired diagnosis that required additional treatment. The Australian Classification of Hospital-Acquired Diagnoses system is used to identify these complications. Results: Inpatients aged >70 years have a 10.9% complication rate, which is not substantially different from the 10.89% complication rate found in patients aged <70 years. Examination of the probability by single years, however, showed that the peak incidence associated with the neonatal period and childbirth is balanced by rates of up to 20% in patients >80 years. Examining the adult patient population (40–70 years), we found that while some common complications are not age specific (electrolyte disorders and cardiac arrhythmias), others (urinary tract and lower respiratory tract infections) are more common in the older adult inpatient. Conclusion: For inpatients aged >70 years, the risks of complications increase. The incidence of hospital-acquired diagnoses in older adults differs significantly from incidence rates found in younger cohorts. Urinary tract infection and alteration to mental state are more common in older adult inpatients. Surprisingly, these complexities do not result in additional costs when compared with costs for the same complications in younger adults. Greater awareness of these differing patterns will allow patient safety efforts for older patients to focus on complications with the highest incidence and cost.

Academic potential and cognitive functioning of long-term survivors after childhood liver transplantation

This cross-sectional study assessed intellect, cognition, academic function, behaviour, and emotional health of long-term survivors after childhood liver transplantation. Eligible children were >5 yr post-transplant, still attending school, and resident in Queensland. Hearing and neurocognitive testing were performed on 13 transplanted children and six siblings including two twin pairs where one was transplanted and the other not. Median age at testing was 13.08 (range 6.52-16.99) yr; time elapsed after transplant 10.89 (range 5.16-16.37) yr; and age at transplant 1.15 (range 0.38-10.00) yr. Mean full-scale IQ was 97 (81-117) for transplanted children and 105 (87-130) for siblings. No difficulties were identified in intellect, cognition, academic function, and memory and learning in transplanted children or their siblings, although both groups had reduced mathematical ability compared with normal. Transplanted patients had difficulties in executive functioning, particularly in self-regulation, planning and organization, problem-solving, and visual scanning. Thirty-one percent (4/13) of transplanted patients, and no siblings, scored in the clinical range for ADHD. Emotional difficulties were noted in transplanted patients but were not different from their siblings. Long-term liver transplant survivors exhibit difficulties in executive function and are more likely to have ADHD despite relatively intact intellect and cognition.

Efecto de diferentes niveles de energía conservando la relación energía-proteína en piensos de inicio y finalización en pollos de engorde

En el presente estudio se compararon cuatro dietas con diferentes niveles de energía 2,940, 3,040, 3,140 y 3,240 (Kcal EM/Kg de alimento), los cuales fueron ajustados a los requerimientos nutricionales en cuanto a la relación caloría proteína recomendados por la Hubbard Farm, Inc. (1991). Durante un periodo de 56 días los broilers fueron evaluados en la granja avícola "Buenos Aires" que pertenece a la Tip Top Industrial S.A. se utilizaron 803 pollos de engorde de un día de nacidos de la línea Hubbard, los que fueron distribuidos aleatoriamente en tres unidades experimentales proporcionales a los cuatro tratamientos existentes, estos distribuidos en un diseño completamente al azar y sometidos a la prueba de Tukey el que proporciona la superioridad existente entre tratamientos. Se encontraron diferencias significativas (P<0.05) entre tratamientos en las variables peso vivo, ganancia de peso y conversión alimenticia pero no así para el consumo alimenticio. Los tratamientos T1 T2, T3 y T4 presentaron mortalidad al final del periodo de 2.57, 4.41, 7.88 y 10.89 (%) respectivamente y rendimiento en la canal del 84.45 % para todos los tratamientos. Se concluyó que las dietas más energéticas proporcionaban las mejores conversiones alimenticias y las mayores ganancias de peso. Y a medida que se incrementaba el nivel energético en las dietas los costos alimenticios también se incrementaban. La fórmula más económica es el T1 (2940 Kcal EM/Kg de alimento, 21.63 y 18.89 % de proteína para inicio y finalización) durante todas las semanas de estudio. El momento óptimo para la matanza es la sexta semana para el T 1 (2940 Kcal EM/Kg de alimento, 21.63 y 18.89 % de proteínas) y T2 (3040 Kcal EM/Kg de alimento, 22.36 y 19.15 % de proteínas) por efecto de los costos alimenticios.