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Background: Unplanned hospital readmission is concerning health care providers and is frequently used as a quality indicator for hospital care. Objectives: This study was conducted in order to examine the rate and associated factors for 30-day readmission in internal medicine units at King Abdulaziz University Hospital, Jeddah. Methods: We retrospectively collected data for patients who had readmission within 30 days of hospital discharge from January 2010 to December 2013. We obtained the following information for all patients: patient demographics, admitting medical service, diagnosis at the first admission, presence of hypoxia, sepsis, and hospital length of stay at the first admission. We then compared the data for patients with 30-day readmissions to those who did not have readmission within 30 days Results: Of the 3838 patients who had hospital admission within the study period, 678 (17.7%) had readmission within 30 days. The mean patient age was 52 years (SD, 21.2 years). Patients who had readmission within 30 days were more likely to be female; older than 65 years of age; diabetic; hypertensive; bed ridden; and to have a history of stroke, bed sores and/or sepsis (all P values ≤0.001, except for stroke, P=0.003). Conclusion: Our study showed that about 18% of patients had readmission within 30 days. Those patients were of older age, with comorbidities like, diabetes or stroke or were bedridden.

ALS is a degenerative disease which affects the patients muscular activity in feet and hands, leading to a bed ridden status. The loss of independency affects their will to live, for this reason an environmental control system to handle the home appliances and make telephone calls is proposed. The system uses a tablet as a visual human interface so that the patient can select the desired appliance by selecting the corresponding item on the tablet screen. Based on the remaining patient’s abilities an input device that detects slight finger movement is proposed. In this paper three types of input devices are considered and their performance is evaluated by four ALS patients. Their comments about the usage of the devices are discussed in this work. Finally the environmental control was implemented on an ALS patient home and their impressions were satisfactory for the patients, relatives and care-givers.

We are reporting a case of ischaemic fasciitis which occurred in a 55-year-old female with no debilitating or long bed ridden history. She presented with a large swelling over left gluteal region. On evaluation, swelling was found to be of size, 5x5 cm, slightly tender and with induration. The operative findings led to a probable diagnosis of a calcified lesion, due to its hard consistency. However, the microscopic picture was typical of ischaemic fasciitis, because of its characteristic central necrosis, vascular and atypical fibroblastic proliferations. Also seen was presence of foreign body giant cell reactions, inflammatory cells and extravasated RBCs. Ischaemic fasciitis is a very rare pseudo sarcomatous proliferation of atypical fibroblasts, which has been described to be located over bony protuberances and said to develop most often in immobile elderly or debilitated patients. Recognition of this distinct entity as a reactive process, mostly associated with debilitation is rare in occurrence.

The problem of Alzheimer’s disease (AD) is staggering. Economically, the United States government spent 87.5 billion dollars in 1996 on nursing homes (1). It is estimated that between 42% to 85% of the nursing home residents have dementia (1,2). In the elderly the great majority of these demented patients suffer from AD. Remarkably only twenty percent of AD patients are in the nursing homes. Consequently, one out of sixteen Americans are involved in eldercare. These costs are estimated to grow. The percent of Americans over age 65 will grow from the current 14% to twenty-five percent in the year 2030 (3). This means the number of American cases of AD will double from the current 4,000,000 to eight million cases. From a macroeconomic and demographic view, AD is a huge problem. From a personal level AD is a tragic illness. It is a progressive, unremitting neurodegenerative disease always resulting in death over a course that varies from three to twenty years. Clinically, the symptoms begin with brief lapses in ability to recall words or complete calculations. The end stage is a bed ridden, wheel chair bound speechless cachectic incontinent nursing home patient requiring total care. Contrary to common belief, AD is a total body disease. Autopsy results dem

Samária Ali Cader,1 Rodrigo Gomes de Souza Vale,1 Victor Emmanuel Zamora,2 Claudia Henrique Costa,2 Estélio Henrique Martin Dantas11Laboratory of Human Kinetics Bioscience, Federal University of Rio de Janeiro State, 2Pedro Ernesto University Hospital, School of Medicine, State University of Rio de Janeiro, Rio de Janeiro, BrazilBackground: The purpose of this study was to evaluate the extubation process in bed-ridden elderly intensive care patients receiving inspiratory muscle training (IMT) and identify predictors of successful weaning.Methods: Twenty-eight elderly intubated patients in an intensive care unit were randomly assigned to an experimental group (n = 14) that received conventional physiotherapy plus IMT with a Threshold IMT® device or to a control group (n = 14) that received only conventional physiotherapy. The experimental protocol for muscle training consisted of an initial load of 30% maximum inspiratory pressure, which was increased by 10% daily. The training was administered for 5 minutes, twice daily, 7 days a week, with supplemental oxygen from the beginning of weaning until extubation. Successful extubation was defined by the ventilation time measurement with noninvasive positive pressure. A vacuum manometer was used for measurement of maximum inspiratory pressure, and the patients' Tobin index values were measured using a ventilometer.Results: The maximum inspiratory pressure increased significantly (by 7 cm H2O, 95% confidence interval [CI] 4–10), and the Tobin index decreased significantly (by 16 breaths/min/L, 95% CI −26 to 6) in the experimental group compared with the control group. The Chi-squared distribution did not indicate a significant difference in weaning success between the groups (Χ2 = 1.47; P = 0.20). However, a comparison of noninvasive positive pressure time dependence indicated a significantly lower value for the experimental group (P = 0.0001; 95% CI 13.08–18.06). The receiver-operating characteristic curve showed an area beneath the curve of 0.877 ± 0.06 for the Tobin index and 0.845 ± 0.07 for maximum inspiratory pressure.Conclusion: The IMT intervention significantly increased maximum inspiratory pressure and significantly reduced the Tobin index; both measures are considered to be good extubation indices. IMT was associated with a reduction in noninvasive positive pressure time in the experimental group.Keywords: inspiratory muscle training, rehabilitation, extubation

The phagocytic ability of polymorphonuclear cells and macrophages from aged, bed ridden patients was investigated. Phagocytosis of carbon in aged bed ridden patients did not differ from that of young controls, and extent of upregulation of granulocytes phagocytosis in response to elevation of incubation temperature was also similar between the two groups. Morphological changes of macrophages in response to ingestion of colloidal carbon was more prominent in young controls. These data suggest that a depressed phagocytosis is not an important factor in the increased susceptibility to infections of aged bed ridden patients, although the reactivity of macrophages may be more closely related to the infection defence.

Summary This case report illustrates the multiple complications experienced by a sickle cell anaemia patient. Although he enjoyed fairly good health till age 16 years; he subsequently suffered grade four bilateral femoral head necrosis, cerebella infarct and cerebral atrophy from cumulative effect of repetitive vasoocclussion, recurrent overwhelming septicaemia, fixed flexion deformities and decubitous ulcer as a sequelae of earlier complications. He eventually became bed ridden. Financial constraint seriously compounded these problems. The determinants, of which type of the wide-ranging complications of SCD a particular patient will eventually develop, remain elusive.

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Case1.—In April, 1895, a patient presented herself for treatment suffering from a well-developed Graves' disease. Exophthalmia was not marked, but the cardiac frequency and the thyroid enlargement was present. Tremor, loss of flesh and bowel symptoms made the case one of undoubted Graves' disease. She submitted to partial thyroidectomy under chloroform and made a nice recovery. Two years afterward I received word from her through a friend that she was well and strong, able to attend her duties and suffering none of the former symptoms. Case2.—In 1898 a patient was sent me who suffered from a similar condition. She was 52 years of age, very thin, having lost a great many pounds of flesh, suffered from recurring diarrhea and was very weak, practically bed ridden. The pulse rate was 140 to 160, the thyroid very large and vascular, exophthalmia not marked. The right lobe being the larger was

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