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West Jerusalem, Israel

Jaul E.,Herzog Hospital | Jaul E.,Hebrew University of Jerusalem
Drugs and Aging | Year: 2010

Pressure ulcers (pressure sores) continue to be a common health problem, particularly among the physically limited or bedridden elderly. The problem exists within the entire health framework, including hospitals, clinics, long-term care facilities and private homes.For many elderly patients, pressure ulcers may become chronic for no apparent reason and remain so for prolonged periods, even for the remainder of the patients lifetime. A large number of grade 3 and 4 pressure ulcers become chronic wounds, and the afflicted patient may even die from an ulcer complication (sepsis or osteomyelitis).The presence of a pressure ulcer constitutes a geriatric syndrome consisting of multifactorial pathological conditions. The accumulated effects of impairment due to immobility, nutritional deficiency and chronic diseases involving multiple systems predispose the aging skin of the elderly person to increasing vulnerability.The assessment and management of a pressure ulcer requires a comprehensive and multidisciplinary approach in order to understand the patient with the ulcer. Factors to consider include the patients underlying pathologies (such as obstructive lung disease or peripheral vascular disease), severity of his or her primary illness (such as an infection or hip fracture), co-morbidities (such as dementia or diabetes mellitus), functional state (activities of daily living), nutritional status (swallowing difficulties), and degree of social and emotional support; focusing on just the wound itself is not enough. An understanding of the physiological and pathological processes of aging skin throws light on the aetiology and pathogenesis of the development of pressure ulcers in the elderly.Each health discipline (nursing staff, aides, physician, dietitian, occupational and physical therapists, and social worker) has its own role to play in the assessment and management of the patient with a pressure ulcer. The goals of treating a pressure ulcer include avoiding any preventable contributing circumstances, such as immobilization after a hip fracture or acute infection. Once a pressure ulcer has developed, however, the goal is to heal it by optimizing regional blood flow (by use of a stent or vascular bypass surgery), managing underlying illnesses (such as diabetes, hypothyroidism or congestive heart failure) and providing adequate caloric and protein intake (whether through use of dietary supplements by mouth or by use of tube feeding). If the ulcer has become chronic, the ultimate goal changes from healing the wound to controlling symptoms (such as foul odour, pain, discomfort and infection) and preventing complications, thereby contributing to the patients overall well-being; providing support for the patients family is also important. Recent advances in wound dressings allow for greater control of symptoms and prevention of complications, and have also enabled the affected patient to be integrated more readily into the family setting and in the community at large. Ethical and end-of-life issues must also be addressed soon after the wound has become chronic.This article discusses the pathogenesis of pressure ulcer development in the elderly in relation to concomitant diseases, risk factor assessment and the management of such ulcers. © 2010 Adis Data Information BV. All rights reserved. Source


Greenberg D.,Herzog Hospital | Huppert J.D.,Hebrew University of Jerusalem
Current Psychiatry Reports | Year: 2010

The earliest descriptions of obsessive-compulsive disorder (OCD) were religious, as was the understanding of their origins. With the emancipation, religion in OCD was relegated to its status today: a less common symptom of OCD in most Western societies known as scrupulosity. The frequency of scrupulosity in OCD varies in the literature from 0% to 93% of cases, and this variability seems predicated on the importance of religious belief and observance in the community examined. Despite the similarities between religious ritual and compulsions, the evidence to date that religion increases the risk of the development of OCD is scarce. Scrupulosity is presented as a classic version of OCD, with obsessions and compulsions, distress, and diminished functioning similar to those of other forms of OCD. The differentiation between normal religiosity and scrupulosity is presented, and the unique aspects of cognitive-behavioral therapy in treating scrupulosity, especially in religious populations, are reviewed. © Springer Science+Business Media, LLC 2010. Source


Jaul E.,Herzog Hospital | Jaul E.,Hebrew University of Jerusalem
Ostomy Wound Management | Year: 2011

Local (extrinsic) and systemic (intrinsic) risk factors for the development of pressure ulcers over bony prominences such as the sacrum, coccyx, ischium, gluteal area, and leg area (heels) have been extensively studied and documented. Several case studies have described (but little is known about) pressure ulcers in atypical anatomical locations. A descriptive pilot study was conducted to document the occurrence, cause, prevention, assessment, and treatment of pressure ulcers in atypical anatomical locations. Thirty-two (32) patients (53% female) in a skilled geriatric long-term care nursing department participated in the 6-month study. All patients were immobile (100%) and most had feeding (91%) and neurological problems (80%). All care was provided by a multidisciplinary team. Twenty-six (26) new ulcers developed during the course of the study. Of those, 13 (40% occurrence rate) were in an atypical location and were found to have an uncommon pathogenesis. A review of the data showed that six (6) pressure ulcers were associated with medical devices (tubes, catheters, and tapes for affixation), four (4) with increased spasticity, and three (3) with bone deformity. The ulcers associated with medical devices (iatrogenic) were observed at the site of insertion or device placement; ulcers associated with spasticity or bone deformity were noted at the site of increased muscle tone and pressure. Using a multidisciplinary specialty and team approach, underlying risk factors were addressed as part of the wound care protocol. Although the study duration was short and the sample size small, these results suggest that the incidence of atypical pressure ulcers in immobile patients with multiple comorbidities may be underreported and underestimated. Additional studies are needed to increase awareness and understanding about the scope of this problem and to develop targeted approaches to prevention and care. Source


Levy H.B.,HbL PharmaConsulting | Marcus E.-L.,Herzog Hospital | Christen C.,University of Michigan
Annals of Pharmacotherapy | Year: 2010

OBJECTIVE: To provide a comparative overview of explicit criteria that have been developed since 2003 for inappropriate prescribing in older adults and to contrast these newer criteria with the most recent Beers criteria, published in 2003. DATA SOURCES: MEDLINE and Google Scholar searches were performed from 2003 through July 2010. Within MEDLINE, MeSH terms included aged, drug prescriptions, medication errors, and polypharmacy. Free-text search terms included elderly, guideline adherence, inappropriate prescribing, and medications. Related articles, as identified by MEDLINE, were used as well. Free-text search was performed on Google Scholar, using "potentially inappropriate prescribing elderly." Additional articles were identified in reference lists of key articles. STUDY SELECTION AND DATA EXTRACTION: Studies were selected if they were published after the most recent revision of the Beers criteria in 2003 and addressed the development and application of explicit criteria for the elderly. We independently reviewed pertinent literature to extract key information. DATA SYNTHESIS: The first explicit criteria published were the Beers criteria, and most research regarding inappropriate medication use applied these criteria. Criteria developed subsequent to the Beers criteria include the French Consensus Panel list, STOPP (Screening Tool of Older Persons' Prescription) and START (Screening Tool to Alert doctors to Right Treatment), the Australian Prescribing Indicators tool, and the Norwegian General Practice Criteria. Newer criteria offer several improvements on the Beers criteria, namely drug-drug interactions, omission of potentially beneficial therapy, and more broadly applicable criteria across international borders. CONCLUSIONS: Although no criteria may ever be globally applicable, STOPP and START make significant advances. Regional drug availability, economic considerations, and clinical practice patterns impact criteria selection. Research to validate the several newer criteria in various practice settings and to explore the effect of adhering to the guidelines on patient outcomes is warranted. Data from such research will aid practitioners in identifying preferred criteria. Source


Weinstock M.,Hebrew University of Jerusalem | Luques L.,Hebrew University of Jerusalem | Poltyrev T.,Hebrew University of Jerusalem | Bejar C.,Hebrew University of Jerusalem | Shoham S.,Herzog Hospital
Neurobiology of Aging | Year: 2011

Oxidative stress and glial activation occur in the aging brain. Ladostigil is a new monoamine oxidase (MAO) and acetylcholinesterase (AChE) inhibitor designed for the treatment of Alzheimer's disease. It has neuroprotective and antioxidant activities in cellular models at much lower concentrations than those inhibiting MAO or AChE. When ladostigil (1 mg/kg/day) was given for 6 months to 16-month-old rats it prevented the age-related increase in activated astrocytes and microglia in several hippocampal and white matter regions and increased proNGF immunoreactivity in the hippocampus towards the levels in young rats. Ladostigil also prevented the age-related reduction in cortical AChE activity and the increase in butyrylcholinesterase activity in the hippocampus, in association with the reduction in gliosis. The immunological and enzymatic changes in aged rats were associated with improved spatial memory. Ladostigil treatment had no effect on memory, glial or proNGF immunoreactivity in young rats. Early treatment with ladostigil could slow disease progression in conditions like Alzheimer's disease in which oxidative stress and inflammatory processes are present. © 2009 Elsevier Inc. Source

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