The prevalence of Alzheimer's disease (AD) and AD-related dementias (ADRD) in acute ward-hospitalized elderly patients is not well known, owing principally to misclassification and undercoding of AD and ADRD on hospital discharge abstract forms (DAFs). The aims of this study were to evaluate the prevalence of AD and ADRD, as evaluated by the DAF in elderly patients hospitalized in acute wards, and to compare clinical severity, length of stay, comorbidity, and number of diagnostic procedures in patients with AD versus ADRD to explain the different reimbursement costs of DRG12 (AD) versus DRG429 (ADRD). From the inpatient DAF database of the Casa Sollievo della Sofferenza Hospital, the DAFs of patients aged 65 years or over discharged from January 1, 2001, to March 31, 2003, with principal or secondary diagnoses of AD (ICD9-CM code 331) or ADRD (ICD9-CM codes from 290.0 to 290.43) were extracted and grouped by APR-grouper version 12. Age, gender, length of stay, principal and secondary diagnoses and procedures, and APR-DRG severity index (SI) and mortality risk (MR) were evaluated in these patients. Senile dementia was reported in 294 patients (0.58 percent, N = 50,253). In 123 patients (41.8 percent) dementia was the principal diagnosis, whereas in 171 patients (58.2 percent) dementia was reported on the DAF as a secondary diagnosis. Of the 123 patients with a principal diagnosis of dementia, 35 patients were included in the DRG-12 (AD) and 88 patients were included in the DRG-429 (ADRD). No differences were found in mean age, length of stay, comorbidity, or number of diagnostic procedures, as well as in the APR-DRG SI and APR-DRG MR between AD and ADRD patients. Conversely, reimbursement amounts were established as Euro4,033 for DRG-12 (AD) and Euro2,952 for DRG-429 (ADRD). AD and ADRD are undercoded in elderly hospitalized patients. The limits of the ICD9-CM classification system and the influence of reimbursement amounts may influence the coding reports by physicians.
LUTS is an acronym that refers to symptoms affecting the lower urinary tract, which are very common in elderly subjects (between 60 and 70%), and often associated with, but not always caused by, benign prostatic hypertrophy (BPH). BPH is a chronic condition characterized by an increase in the number of cells, particularly in the transition area of the prostate. BPH involves a compression of the surrounding tissues, consequently obstructing vescical voiding. Nycturia and urgency represent the most prevalent symptoms and those with the greatest impact on quality of life measured as urinary-specific healthrelated quality. The prevalence of BPH is directly proportional to age; therefore, the absolute number of subjects affected is growing throughout the world. BPH is one of the most common medical conditions affecting those over 50. The overall cost for the diagnosis and treatment of BPHrelated LUTS, in the US, has been estimated at approximately 1.1 billion US$/year, compared to total annual expenditure for urological conditions of some 9 billion and this cost continues to increase. The quick prostate test, which was developed by the Italian Urology Society (SIU), is an easy to use instrument that can be utilized in first-level screening for evaluation of the male population with LUTS. This test can be used both in patients not on pharmacological treatment and as a therapy-monitoring instrument. A positive response to one of the questions is sufficient for requesting a more in-depth investigation, which may provide indications on the therapeutic strategy to be taken. Definition of lower urinary tract symptomsLUTS is an acronym that refers to symptoms affecting the lower urinary tract, which are very common in elderly subjects, and often associated with, but not always caused by, benign prostatic hypertrophy (BPH). 1,2Anatomically speaking, the lower urinary tract consists of the bladder, bladder outlet, prostate, distal sphincter mechanism and urethra. BPH is undoubtedly the most common cause of LUTS, but they can also be caused by: i) overactive bladder; ii) prostatitis; iii) nocturnal polyuria; iv) urinary tract infections; v) prostate cancer; vi) other genital/urinary system tumours; vii) significant comorbidities (for example diabetes, congested heart failure, metabolic disease and obesity, medical nephropathy, vascular disease, etc.); viii) concomitant the rapies; ix) bladder stones; x) prior pelvic surgery; xi) trauma; xii) individual or combined central/peripheral nervous system abnormalities. These situations must be kept in careful consideration in differential diagnosis, when choosing a treatment option. 2One approach, that is not however universally accepted, is to divide LUTS into obstructive (or pertaining to the voiding phase) and irritative (or pertaining to the filling phase) ( Table 1).
Our findings argue against an association between ecNOS polymorphism and preeclampsia and support the hypothesis for a different pathogenesis of GH in respect to EH.
Hypercalcemia is ideally detected by the measurement of serum ionised calcium. Because this is not widely available, in common clinical practice "albumin-corrected" calcium values are often utilized. Our study investigated whether the method used to measure serum albumin concentration may significantly interfere in the derived serum calcium values and, consequently, in the identification of hypercalcemic patients. In 170 consecutive patients admitted to our Department of Internal Medicine we measured serum total calcium, total protein, and albumin by colorimetric method; albumin concentration was also derived by electrophoresis assessment. After correcting serum calcium for colorimetrically (CA) and electrophoretically (EA) measured albumin values, the detected frequencies of hypercalcemia were compared, utilizing different cut-off limits (i.e. 11.0, 10.4 and 10.2 mg/dl). In our patients, the CA values were significantly lower than EA levels. As a consequence, EA-corrected calcium, as well as total calcium concentration were significantly lower than CA-corrected values. This may also account for the very different prevalence of hypercalcemic patients identified by serum total, EA-corrected and CA-corrected calcium values. Our data therefore indicate the importance of the method of albumin measurement in the determination of "corrected" calcium concentration.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.