Some studies have shown a negative association between age and serum albumin. Several of these studies included older people with known disease. Disease may reduce albumin in any age group. Other studies have shown no association between age and albumin. To investigate the association of age and albumin, albumin levels were determined in 241 apparently healthy subjects aged 55 to 101. A small but consistent negative regression slope of about 4% per decade was found for those aged over 70. Because the relationship to age was small, the finding of hypoalbuminemia in an elderly patient generally should be attributed to disease rather than age alone.

formal continuing medical education (CME) programs, pocket cards listing high-risk medications, messaging in the electronic medical record suggesting therapeutic alternatives to high-risk medications, focused therapeutic interchange initiatives, and dissemination of "frequently asked questions" documents. These tools are designed to explain, teach, and reinforce the message that many drugs adversely affect older patients by leading to falls, fractures, and functional and cognitive decline, and sometimes to unnecessary and costly hospitalizations and nursing home placements.For example, recent attention at KP has focused on suggesting safer alternatives to skeletal muscle relaxants and long-acting benzodiazepines. Educational presentations to practitioners include suggestions for safer medications, as well as nonpharmacologic interventions, in treating musculoskeletal pain. Another initiative provided education about alternatives to antihistamines such as diphenhydramine, hydroxyzine, and promethazine. Specific recommendations were made regarding alternatives (based on the indication, such as sleep or cough) including nonpharmacologic treatment strategies as appropriate.KP regions have programs devoted to caring for patients who are older, frail, or have multiple chronic conditions. Many such programs include the opportunity for a clinical pharmacy specialist to participate in evaluating and reconciling those patients' medications, especially during transitions in care settings such as from hospital to home.In KP of Georgia, one such program includes an interdisciplinary team consisting of a geriatrician, nurse care manager, nurse, and clinical pharmacy specialist. The team evaluates and treats older patients identified as high risk through predictive modeling based upon chronic medical conditions and other factors. Much of the work is conducted telephonically, using the electronic health record to document and communicate recommendations to the patients and their treating physicians. In many cases, the clinical pharmacist works closely with the patient's primary care physician (PCP) to implement changes under the PCP's supervision. The team thoroughly evaluates overall functional and health status, including review of all prescribed and over-the-counter medications and supplements, and makes recommendations for changes to optimize regimens and patient safety. Annual program evaluation includes measurement of number of program enrollees identified as having been prescribed medications on the Healthcare Effectiveness Data and Information Set (HEDIS) high risk list, and whether the team recommended/made changes to the regimen. New tools are being developed to enhance the team's effectiveness in addressing this issue. B y the year 2030, nearly 1 in 5 U.S. residents is expected to be aged 65 years or older; this age group is projected to more than double in number from 38.7 million in 2008 to more than 88.5 million in 2050.1,2 Likewise, the population aged 85 years or older is expected to increase almost 4-fold, from...

Cryptosporidium is a common cause of acute, self-limiting gastroenteritis in otherwise healthy subjects. In immunocompromised patients, however, infection with this organism can be life threatening. The possible factors that allowed transmission of Cryptosporidium from a patient with acquired immune deficiency syndrome to nursing staff are examined in this article.

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BackgroundPrimary care is at the forefront of COPD management. A person-centred approach is advocated, yet patients have difficulty in articulating their needs to health care professionals (HCPs). The Support Needs Approach for Patients (SNAP) tool aims to enable patients to identify and express their support needs but its validity is unknown.AimTo establish the face, content and criterion validity of the SNAP tool in advanced COPD.MethodTwo-stage mixed method primary care study involving patients with advanced COPD, and their carers. Stage 1: Face and content validity assessed though focus groups involving patients and carers (n = 12), considering the appropriateness, relevance and completeness of the SNAP tool. Data analysed using thematic analysis within a Framework Approach. Stage 2: Content and criteria validity assessed in a postal survey through patient self-completion of the SNAP tool and disease impact measures (Chronic Respiratory Questionnaire, COPD Assessment Test, and Hospital Anxiety and Depression Scale). Content validity assessed using summary statistics; criterion validity via correlations between tool items and impact measures.ResultsThe SNAP tool has good face, content and criterion validity. Patients and carers found the tool patient-friendly and potentially useful. No items on the tool were redundant, and clear correlations were found between tool items and the majority of items/sub-scales of the impact measures.ConclusionThe SNAP tool has good face validity; content and criteria validity will be reported. It has the potential to facilitate person-centred care by enabling patients to express their support needs to HCPs. Future work will pilot SNAP in clinical practice.