A comparison of seriously ill patients with or without AIDS requiring prolonged mechanical ventilation.

PURPOSE: The aim of this study was to compare differences in underlying diagnoses, weaning outcomes, discharge disposition, and survival in prolonged mechanical ventilator (PMV)-dependent patients with and without AIDS. METHODS: Ninety consecutive AIDS patients requiring PMV were retrospectively matched with 90 clinically similar non-AIDS patients to form matched cohorts to determine differences in their outcomes. RESULTS: AIDS patients had more acute diagnoses requiring PMV, whereas non-AIDS patients had more chronic diagnoses (P < .001). Weaning outcomes were alike with 31 (35%) AIDS and 37 (41%) non-AIDS patients successfully weaned. More AIDS patients went home, and fewer, to nursing facilities (P = .04). In each cohort, successfully weaned patients had significantly longer survival than their unweaned counterparts (all P < .001). Successful weaning reduced the risk of death in AIDS and non-AIDS patients (hazard ratios, 0.29 and 0.20; 95% confidence intervals, 0.17-0.50 and 0.11-0.36, respectively; all P < .001). CONCLUSIONS: AIDS had little effect on weaning success or survival. Successful weaning increased survival regardless of a diagnosis of AIDS. The AIDS patients had more home discharges and fewer to nursing facilities, which likely resulted from the AIDS patients having more acute illnesses leading to PMV than the non-AIDS patients.

Meckel's diverticulum: a review.

Meckel's diverticulum is the most prevalent congenital abnormality of the gastrointestinal tract. This anomaly is due to the incomplete obliteration of the omphalomesenteric duct during the 7th week of gestation and is classically located 2 feet proximal to the ileocecal valve. Variations of this congenital malformation have been recorded based on location, size, and form. While most of the population may be asymptomatic, clinical manifestation, including gastrointestinal bleed and intestinal obstruction, can emerge. Despite the frequency of Meckel's diverticulum, it is commonly misdiagnosed due to its mimicry of appendicitis. This article aimed to review this derailment of embryological development.

Influence of age on rehabilitation outcomes and survival in post-acute inpatient cardiac rehabilitation.

PURPOSE: To investigate the relationship of increasing age to clinical characteristics, rehabilitation outcomes, and long-term survival in a post-acute inpatient cardiac rehabilitation program. METHODS: The study population consisted of all 364 consecutive cardiac rehabilitation patients admitted over a 4-year period to an inpatient cardiac rehabilitation program in a long-term acute care hospital.Admission and discharge comparisons were made between 3 age cohorts: 65 years (n = 117), 65 to 74 years (n = 127), and ≥ 75 years (n = 120). Patients were followed through January, 2010 for survival. RESULTS: The 3 cohorts on admission differed significantly in Functional Independence Measure, estimated Glomerular Filtration Rate, smoking and hypertension histories, body mass index, and cardiac diagnoses (all P < .05) but not in Simplified Acute Physiology Score II, Cumulative Illness Rating Scale for Geriatrics, or left ventricular ejection fraction. There were no cohort differences in rehabilitation outcomes of physical function, inpatient days, and discharge disposition. Survival was longest in the youngest cohort whereas the 2 older cohorts had similar survivals (P < .01; log-rank test). All 3 cohorts had at least 40% survival at 8 years. Cox regression analyses showed that the comorbidity burden as quantified by the Cumulative Illness Rating Scale for Geriatrics was the only predictor of death in all cohorts (all P ≤ .002). CONCLUSIONS: This study provided evidence that post-acute inpatient cardiac rehabilitation programs equally benefited both elderly patients and younger patients. These programs are valuable in the continuum of care for elderly patients who are not yet ready for discharge to home following a serious cardiac event.