Background: Patients receiving hospice or palliative care often receive antimicrobial therapy; however the effectiveness of antimicrobial therapy for symptom management in these patients is unknown. Objective: The study's objective was to systematically review and summarize existing data on the prevalence and effectiveness of antimicrobial therapy to improve symptom burden among hospice or palliative care patients. Design: Systematic review of articles on microbial use in hospice and palliative care patients published from January 1, 2001 through June 30, 2011. Measurements: We extracted data on patients' underlying chronic condition and health care setting, study design, prevalence of antimicrobial use, whether symptom response following antimicrobial use was measured, and the method for measuring symptom response. Results: Eleven studies met our inclusion criteria in which prevalence of antimicrobial use ranged from 4% to 84%. Eight studies measured symptom response following antimicrobial therapy. Methods of symptom assessment were highly variable and ranged from clinical assessment from patients' charts to the Edmonton Symptom Assessment Scale. Symptom improvement varied by indication, and patients with urinary tract infections (two studies) appeared to experience the greatest improvement following antimicrobial therapy (range 67% to 92%). Conclusion: Limited data are available on the use of antimicrobial therapy for symptom management among patients receiving palliative or hospice care. Future studies should systematically measure symptom response and control for important confounders to provide useful data to guide antimicrobial use in this population.

BACKGROUND. Antibiograms have effectively improved antibiotic prescribing in acute-care settings; however, their effectiveness in skilled nursing facilities (SNFs) is currently unknown.

BACKGROUND: Little is known regarding the prevalence or risk factors for non-comprehension and noncompliance with discharge instructions among older adults. OBJECTIVE: To quantify the prevalence of noncomprehension and non-compliance with discharge instructions and to identify associated patient characteristics. RESEARCH DESIGN: Prospective cohort study. SUBJECTS: Four hundred and fifty adults aged ≥ 65 admitted to medical and surgical units of a tertiary care facility and meeting inclusion criteria. MEASURES: We collected information on demographics, psycho-social factors, discharge diagnoses, and medications using surveys and patient medical records. Domains within discharge instructions included medications, follow-up appointments, diet, and exercise. At 5 days post-discharge, we assessed comprehension by asking patients about their discharge instructions, and compared responses to written instructions from medical charts. We assessed compliance among patients who understood their instructions. RESULTS: Prevalence of non-comprehension was 5 % for follow-up appointments, 27 % for medications, 48 % for exercise and 50 % for diet recommendations. Age was associated with non-comprehension of medication [odds ratio (OR) 1.07; 95 % confidence interval (CI) 1.04, 1.12] and follow-up appointment (OR 1.08; 95 % CI 1.00, 1.17) instructions. Male sex was associated with noncomprehension of diet instructions (OR 1.91; 95 % CI 1.10, 3.31). Social isolation was associated with noncomprehension of exercise instructions (OR 9.42; 95 % CI 1.50, 59.11) Depression was associated with noncompliance with medication (OR 2.29; 95 % CI 1.02, 5.10) and diet instructions (OR 3.30; 95 % CI 1.24, 8.83). CONCLUSIONS: Non-comprehension of discharge instructions among older adults is prevalent, multifactorial, and varies by domain.

This study investigates cognitive deficits and alterations in resting state functional connectivity in civilian mild traumatic brain injury (mTBI) participants with high and low symptoms. Forty-one mTBI participants completed a resting state fMRI scan and the Automated Neuropsychological Assessment Metrics (ANAM) during initial testing (<10 days of injury) and a one month follow up. Data were compared to 30 healthy control subjects. Results from the ANAM demonstrate that mTBI participants performed significantly worse than controls on the code substitution delayed subtest (p=0.032) and weighted throughput score (p=0.001). Among the mTBI patients, high symptom mTBI participants performed worse than those with low symptoms on the code substitution delayed (p=0.017), code substitution (p=0.012), repeated simple reaction time (p=0.031), and weighted throughput score (p=0.009). Imaging results reveal that during the initial visit, low symptom mTBI participants had reduced interhemispheric functional connectivity (IH-FC) within the lateral parietal lobe (p=0.020); however, during follow up, high symptom mTBI participants showed reduced IH-FC compared to the control group within the dorsolateral prefrontal cortex (DLPFC) (p=0.013). Reduced IH-FC within the DLPFC during the follow-up was associated with reduced cognitive performance. Together, these findings suggest that reduced rs-FC may contribute to the subtle cognitive deficits noted in high symptom mTBI participants compared to control subjects and low symptom mTBI participants.