The purpose of this study was to compare the prevalence of pressure ulcers among newly hospitalized nursing home residents and among newly hospitalized patients from nonnursing home settings. Study participants were at least 65 years old and admitted through the emergency department to one of two study hospitals. Research nurses ascertained the presence of pressure ulcers (stage 1-4) by visual skin assessment on the third day following admission to the hospital unit. Other data were collected by clinical examination, interview, and medical record review. The prevalence of preexisting pressure ulcers at the time of admission was 26.2% among those admitted from a nursing home and 4.8% among those admitted from another living situation (odds ratio 5.5, 95% confidence interval 4.3-7.1). After adjustment for confounders, the association between admission from a nursing home and pressure ulcer prevalence on admission was reduced (odds ratio 1.51, 95% confidence interval 1.03-2.23). These results indicate that admission from a nursing home is a potent marker for pressure ulcer risk and that the excess risk is largely mediated by the higher prevalence of pressure ulcer risk factors among patients admitted from a nursing home. The results highlight the importance of continuity of care across transitions between care settings.
These results suggest that these infections in less ill patients have a higher attributable impact on subsequent mortality than in more severely ill patients. Focusing interventions to prevent bloodstream infections in less severely ill patients would be expected to have a greater benefit in terms of mortality reduction.
Disparities in cancer occurrence and cancer outcomes are caused by the disproportionate accrual of risks among racial/ethnic minority, low-income, and uninsured groups across the prevention, detection, and treatment spectrum. Reducing cancer disparities requires efforts in each arena. This article describes one local initiative to improve screening and detection rates among uninsured, low-income, and minority older adults living in Maryland using funding from the Cigarette Restitution Fund. The authors present useful findings on screening volume and results to characterize the impact of the program, indicating that, in addition to the 120 cancers identified, as many as 300 colorectal cancers may have been prevented by polypectomy in the program.
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