Long-term care

Approximately 500,000 Americans suffer strokes each year. Many of the 80% that survive suffer paralysis and impaired vision and speech, often needing rehabiUtation and/or long-term care. Hence, whereas treatment using rt-PA is likely to be expensive (costs are 2200/dose for treating heat attacks), the benefits of rt-PA could outweigh costs. In the case of heart attacks, the 10 times less expensive microbiaHy derived streptokinase can be used. There is currentiy no competing pharmaceutical for treatment of strokes (18,19). Consequentiy, the cost of manufacture of rt-PA may not be as dominant an issue as would be the case of other types of bioproducts. 

The American College of Apothecaries represents pharmacists whose practices can best be described as emphasizing prescription and related products. Some pharmacists practice as consultants and providers to long-term care health faciUties, eg, nursing homes. Both state and U.S. laws have mandated closer control of dmg products in such units. The American Association of Consultant Pharmacists has been formed to serve the needs of such pharmacists. 

Martin Knapp is Professor of Health Economics and Director of the Centre for the Economics of Mental Health at the Institute of Psychiatry, and Professor of Social Policy at the London School of Economics and Political Science, London, UK. Much of his work focuses on the economic aspects of mental health services and health policy. He is also actively involved in work looking at economic aspects of long-term care for older people. 

Environmental surfaces in a long-term care facility... 

Greig, J. D. and Lee, M. B. (2009). Enteric outbreaks in long-term care facilities and recommendations for prevention A review. Epidemiol. Infect. 137,145-155. 

Ohwaki, K., Nagashima, H., Aoki, M., Aoki, H., and Yano, E. (2009). A foodborne norovirus outbreak at a hospital and an attached long-term care facility. Jpn. J. Infect. Dis. 62, 450-454. 

Wu, H. M., Fornek, M., Schwab, K. J., Chapin, A. R., Gibson, K., Schwab, E., Spencer, C., and Henning, K. (2005). A norovirus outbreak at a long-term-care facility The role of environmental surface contamination. Infect. Control Hosp. Epidemiol. 26, 802-810. 

TBW depletion (often referred to as dehydration ) is typically a more gradual, chronic problem compared to ECF depletion. Because TBW depletion represents a loss of hypotonic fluid (proportionally more water is lost than sodium) from all body compartments, a primary disturbance of osmolality is usually seen. The signs and symptoms of TBW depletion include CNS disturbances (mental status changes, seizures, and coma), excessive thirst, dry mucous membranes, decreased skin turgor, elevated serum sodium, increased plasma osmolality, concentrated urine, and acute weight loss. Common causes of TBW depletion include insufficient oral intake, excessive insensible losses, diabetes insipidus, excessive osmotic diuresis, and impaired renal concentrating mechanisms. Long-term care residents are frequently admitted to the acute care hospital with TBW depletion secondary to lack of adequate oral intake, often with concurrent excessive insensible losses. 

The consultant pharmacist is reviewing the care of AN, who is a 79-year-old male resident of a long-term care facility. According to his records, he has received phenytoin and phenobarbital ever since suffering a stroke 12 years ago. There is no record of a seizure in his chart, and the nursing staff has not observed a seizure since he arrived at the facility 2 years ago. His family recalls that he had 1 seizure around the time of his stroke, but has not had any more seizures. 

Despite the growing emphasis on pain management, pain often remains undertreated and continues to be a problem in hospitals, long-term care facilities, and the community. In one series of reports, 50% of seriously ill hospitalized patients reported pain however, 15% were dissatisfied with pain control, and some remained in pain after hospitalization.14,15... 

People who live in nursing homes and other long-term care facilities that house those with long-term illnesses... 

Pressures sores, also known as decubitous ulcers or bedsores, affect 1.5 to 3 million Americans annually.35 The cost of healing pressure sores can be substantial, with current estimates ranging from 2000 to 70,000 per wound.35 Although the prevalence of pressure sores is highest in long-term care facilities, 57% to 60% of new pressure sores actually develop in the hospital, most commonly in intensive-care and orthopedic patients. Elderly patients and those with spinal cord injuries are most at risk36... 

Many potential indications for EN exist (Table 98-2). PN was used extensively previously for many of these conditions. Advances in EN technology now allow many patients with these conditions to receive EN. EN is administered in both institutional (e.g., hospital and long-term care facility) and home settings. 

A number of EN formulas are marketed commercially Hospitals and long-term care facilities usually limit their formularies of EN formulas, stocking only a limited number of... 

International Pharmaceutical Abstracts. International Pharmaceutical Abstracts [104], published semimonthly, is an abstracting/indexing publication which covers all pharmaceutical literature. IPA covers approximately 700 worldwide pharmaceutical, medical, herbal, cosmetics, and health-related publications. IPA features all abstracts from American Society of Health-System Pharmacist s Annual, Midyear Clinical, and Home, Hospice, and Long-Term Care Meetings, coverage of state pharmacy journals, and American Pharmaceutical Association and American College of Clinical Pharmacy meeting abstracts. IPA indicates articles that offer CE credit. IPA is commercially available in several formats. 

Intravenous (i.v.) solutions are commonly administered to patients in hospitals, long-term care facilities, and ambulances. They are used primarily to replace body fluids and to serve as a vehicle for injecting drugs into the body. The advantages of this pharmaceutical dosage form include the rapid onset of action, the ability to treat patients unable to take medication orally and the ability to administer a medication unavailable in any other dosage form. 

Long-term care facility residents, regardless of vaccination status, when an outbreak has occurred in the institution. 

Occupational indications Health-care personnel and employees of long-term care and assisted-living facilities. 

Bolus EN is most commonly used in long-term care residents who have a gastrostomy. This method has the advantage of requiring little administra-... 

In long-term care facilities, where vaccination is most effective against complications, the aims of the vaccination campaign are fulfilled, at least in part. However, according to reliable evidence the usefulness of vaccines in the community is modest. The apparent high effectiveness of the vaccines in preventing death from all causes may reflect a baseline imbalance in health status and other systematic differences in the two groups of participants. 

Influenza is responsible for several thousand deaths each year. Individuals over the age of 65, residents of long-term care facilities, and patients with long-term health problems (i.e., diabetes, HIV or AIDS, heart disease, kidney disease, lung disease, cancer) are at highest risk for severe influenza and complications. Yearly vac-... 

FDA Black Box OBRA regulated in U.S. Long Term Care... 

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