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Recombinant human erythropoietin (rHuEPO) is used as doping a substance. Anti‐doping efforts include urine and blood testing and monitoring the athlete biological passport (ABP). As data on the performance of these methods are incomplete, this study aimed to evaluate the performance of two common urine assays and the ABP. In a randomized, double‐blinded, placebo‐controlled trial, 48 trained cyclists received a mean dose of 6000 IU rHuEPO (epoetin β) or placebo by weekly injection for eight weeks. Seven timed urine and blood samples were collected per subject. Urine samples were analyzed by sarcosyl‐PAGE and isoelectric focusing methods in the accredited DoCoLab in Ghent. A selection of samples, including any with false presumptive findings, underwent a second sarcosyl‐PAGE confirmation analysis. Hematological parameters were used to construct a module similar to the ABP and analyzed by two evaluators from an Athlete Passport Management Unit. Sensitivity of the sarcosyl‐PAGE and isoelectric focusing assays for the detection of erythropoietin abuse were 63.8% and 58.6%, respectively, with a false presumptive finding rate of 4.3% and 6%. None of the false presumptive findings tested positive in the confirmation analysis. Sensitivity was highest between 2 and 6 days after dosing, and dropped rapidly outside this window. Sensitivity of the ABP was 91.3%. Specificity of the urine assays was high; however, the detection window of rHuEPO was narrow, leading to questionable sensitivity. The ABP, integrating longitudinal data, is more sensitive, but there are still subjects that evade detection. Combining these methods might improve performance, but will not resolve all observed shortcomings., World Anti‐Doping Agency methods for detection of recombinant human erythropoietin were evaluated in cyclists. Detection in urine by sarcosyl‐PAGE had a sensitivity of 63.8% and isoelectric focusing of 58.6%, sensitivity peaked between 2 and 6 days after dosing, rapidly dropping outside this window. False presumptive finding rates were 4.3% and 6%, respectively, but none of the false presumptive findings tested positive in the confirmation analysis. Sensitivity of the athlete biological passport that integrates longitudinal hematological data was 91.3%.

Patient safety is an essential component of quality of care, especially when the complexity of care has reached extreme levels. Currently achieving this safety is considered a basic strategy of the National Health System. Nuclear Medicine departments have certain peculiarities that make them special in terms of patient safety, with situations that go beyond the common health care practice of other departments. Namely, that both encapsulated and non-encapsulated ionizing radiation is used in daily practice, and numerous groups of professionals must be coordinated to undertake positron emission tomography (PET) specifically, from the clinical management unit itself, and from other departments of the hospital (as well as companies outside the hospital itself and the Public Health System). The objective of this paper was to identify the risks to which a patient who is to be explored through PET can be exposed in a Nuclear Medicine department and draw up a risk map for the PET process. The methodology used is part of the proposal of the Ministry of Health (2007), and its practical implementation (given the limited literature available on Nuclear Medicine), follows as far as possible that of related care areas (radiodiagnosis and radiotherapy). For this purpose, a multidisciplinary team of professionals directly related to the PET process was created, using the modal analysis of faults and effects methodology to identify possible failures, their causes and the potential adverse events causing each. As a final step, a risk map was created, locating the previously identified faults at each stage of the process. This paper exposes the PET process, and describes the risks that patients might run when a PET scan is required, as well as the adverse events deriving from it. All this is shown in a risk map of the PET process.

RESUMEN Introducción: Las heridas de difícil cicatrización o complejas que aquejan a un alto porcentaje de la población, además de afectar a la calidad de vida de quien las padece, repercute en un alto coste económico, en tiempo de enfermería y en estancias hospitalarias. Objetivo: Conocer el coste económico, las heridas complicadas, el coste medio para el cierre y la media de días para el mismo que ha tenido cada profesional de enfermería comparado con la enfermera de práctica avanzada (EPA) en heridas crónicas complejas (HCC) de la Unidad. Metodología: Estudio descriptivo longitudinal del total de los informes de valoración de heridas generados desde la aplicación de heridas en DIRAYA (sistema de información asistencial corporativo para todo el Servicio Andaluz de Salud, historia de salud única de todos los episodios asistenciales del ciudadano) y que necesitaron materiales de cura en ambiente húmedo suministrados por la Unidad de Gestión Clínica (UGC). El estudio se desarrolló en la UGC de Algarrobo, perteneciente al Área de Gestión Sanitaria Este de Málaga-Axarquía, desde junio 2019 hasta junio 2020. Se trata de una muestra conceptual, ya que se ha incluido a toda la población de enfermeros y enfermeras de la UGC y las correspondientes hojas emitidas por ellos. Resultados: Durante el periodo de estudio se registraron un total de 416 heridas en la Unidad, de las cuales se cerraron 338, el 81,2%. La EPA trató el 22,6% del total de las heridas (94 heridas) y resolvió el 90,4% de ellas, siendo el coste medio para el cierre de las heridas de 21,3 €, en un plazo medio de 30,7 días, mientras que el resto de profesionales tuvo que tratar de media 32,2 heridas y se resolvieron de media el 76,7%, siendo el coste medio para el cierre de una herida de 36,2 € en un plazo medio de 172,1 días. Conclusiones: La introducción de la EPA en HCC en la UGC ha llevado a la Unidad a un mejor resultado en cuanto a gasto en materiales y al acortamiento de los días para la resolución de las heridas, lo que influye en una mejor calidad de vida para aquellos que las padecen. Además, la introducción de la EPA ha servido de revulsivo para los profesionales y les ha llevado a un mejor hacer en su trabajo con las heridas, lo que influye tanto en su autoestima profesional como en los pacientes a los que tratan.

Se presenta el análisis preliminar de cuencas atmosféricas con origen en el Valle de Sogamoso, Boyacá, Colombia, mediante la modelación del comportamiento de las parcelas de aire como herramienta para la planificación territorial. El estudio de caso se sitúa en uno de los corredores industriales de mayor emisión de contaminantes en Colombia, por tanto, es importante conocer el comportamiento de las variables meteorológicas, la topografía de la zona y la dinámica atmosférica que allí se desarrolla como consecuencia de relacionar las dos variables, para lograr la conformación y delimitación de la cuenca atmosférica. Se calculó por medio del modelo HYSPLIT, las trayectorias de parcelas de aire hacia adelante durante los meses de febrero y abril, estableciendo las temporadas secas y húmedas del año 2015. Se observó la circulación de parcelas de aire provenientes del Valle, hacia territorios que han presentado altos índices en contaminación atmosférica para el contaminante PM10 y se evidenció la relación de las variables meteorológicas y topográficas para delimitar la cuenca. Se proponen criterios para la planificación y ordenamiento territorial desde el enfoque de cuencas atmosféricas como unidad de gestión regional y apoyo a los sistemas de monitoreo de calidad del aire, con el fin de establecer una variable ambiental como eje principal para la toma de decisiones territoriales.

Introduction: Breastfeeding is one of the most natural and best forms of preventive medicine for the newborns. Lack of optimal breastfeeding contributes to about over million preventable child deaths every year. Despite numerous benefits of breastfeeding and continuous efforts to improve breastfeeding practices, breastfeeding rates are far from optimal. Problems faced by lactating mothers while breastfeeding are main reason leading to non-exclusive breastfeeding or early termination of breastfeeding. This descriptive study is aimed at examining breastfeeding problems among women visiting Lactation Management Unit [LMU] at Bhutan’s national referral hospital in Thimphu. Methods: Data of all 2751 women-infant pair visiting Lactation management unit of Jigme Dorji Wangchuck National Referral Hospital with breastfeeding problems were double entered into Epi Data (version 3.1). Using STATA, descriptive statistical analyses were carried to examine common breastfeeding problems among the lactating mothers. Exclusive breastfeeding rates were also examined among the group. Results: The commonest types of breastfeeding problem were nipple sore (60.8%), incorrect breastfeeding techniques (12.9%), and nipple problems (8.2%). Teenage, first timers, caesarean delivery, preterm infants, underweight infants, and mothers with full time paid job were more likely to suffer from breastfeeding problems. Conclusion: Breastfeeding interventions for timely correction of breastfeeding techniques early in postnatal units could warrant prevention of up to 73.7% breastfeeding problems and thus, promoting exclusive breastfeeding and preventing early termination of breastfeeding.

// Yiran Wang 2, 4, * , Qijin Wang 3,* , Xianzhao Wei 1 , Jie Shao 1 , Jian Zhao 1 , Zicheng Zhang 4 , Ziqiang Chen 1 , Yushu Bai 1 , Ning Wang 2 , Yajie Wang 2 , Ming Li 1 and Xiao Zhai 1 1 Department of Orthopedics, Changhai Hospital, Second Military Medical University, Shanghai, China 2 Department of Oncology, Changhai Hospital, Second Military Medical University, Shanghai, China 3 Department of Endocrinology, Changhai Hospital, Second Military Medical University, Shanghai, China 4 Graduate Management Unit, Changhai Hospital, Second Military Medical University, Shanghai, China * These authors have contributed equally to this work Correspondence to: Xiao Zhai, email: zhaixiao@smmu.edu.cn Ming Li, email: limingchspine@126.com Keywords: bibliometric, citation, H-index, exosome, VOSviewer Abbreviations: MCF: Michigan Cancer Foundation - 7 Received: February 04, 2017 Accepted: March 22, 2017 Published: April 19, 2017 ABSTRACT Background: Exosomes are small vesicles of endosomal origin, and they can be used for the diagnosis and the treatment. However, limited data were for the evaluation of the trend of exosome researches. This study aims to investigate the trend of exosome researches and compare the contribution of research from different regions, organizations and authors. Methods: Exosome related publications from 2007 to 2016 were retrieved from the Web of Science database. Excel, GraphPad Prism 5 and VOSviewer software were used to analyze the research trend. Results: A total of 1852 papers were identified and were cited 62967 times. The United States accounted for 38.8% of the articles, 42.0% of the citations, and the highest H-index (76). China ranked the second in the number of articles, but the sixth in citation frequency (4337) and the fourth in H-index (36). The journals, PLoS ONE and J Biol Chem had the highest number of publications. The author, Gabrielsson S., has published the most papers in this field (22). The keyword “ribonucleic acid” was mentioned the most at 746 times, and the words, “stem cell”, “drug resistance” and “monocyte cell factor” were the latest hotspots appeared around 2015. Conclusion: Literature growth related to exosome is expanding rapidly. The quality of the articles from China still requires improvement. Recent studies focus on the relationship with tumor, and “stem cell”, “drug resistance” and “michigan cancer foundation-7” may be the newest topics that should be closely followed in exosome research.

Firat University Scientific Research Projects Management Unit: T-638 Firat University Scientific Research Projects Management Unit: T-638

Among 186 retrospectively evaluated patients with multidrug-resistant tuberculosis, 33.9% were cured, 6.6% completed treatment, 25% died, 18.3% were lost to follow-up, 2.2% failed treatment, and 13.8% were still undergoing treatment by the end of the study period. Rural residence was a risk factor for loss to follow-up (odds ratio [OR], 3.315; P = .016), whereas baseline body weight40 kg (OR, 2.175; P = .042) and resistance to ofloxacin (OR, 2.889; P = .025) were risk factors for death. Despite programmatic management, treatment outcomes of the current cohort were distressing.

12039 Background: Geriatric assessments and interventions improve the outcomes of hospitalized older adults with cancer, but their implementation in developing countries is limited. We studied the effect of a specialized geriatrician-led inpatient geriatric management unit compared with a conventional internal medicine ward on the outcomes of hospitalized Mexican older adults with cancer. Methods: This retrospective study included patients aged ≥65 with solid tumors who had a cancer-related hospitalization at a public academic center in Mexico City between March 2015 and October 2018. Patients hospitalized in the geriatric management unit (cases) were paired in a 1:2 fashion with those in internal medicine wards (controls). Pairing was done by age (+/- 5 years), tumor type, and admission date (+/- 3 months). We studied the effect of being hospitalized in the geriatric management unit on length of stay (LOS), incidence of delirium, hospital-acquired complications, and in-hospital mortality. Multivariate logistic regression models for each outcome were created using variables which were significant on univariate analysis. Results: 300 patients (100 cases, 200 controls, median age 75) were included. The most common tumors were gastrointestinal (GI) (53%) and genitourinary (25%). Both groups were comparable regarding baseline comorbidities (Charlson index 8.5 vs. 7.7, p = 0.99) and illness severity at admission (NEWS2 score 2.6 vs. 2.3, p = 0.82). No difference in median LOS was found between cases and controls (9.1 vs. 9.5 days, p = 0.34). Diagnosis of a GI tumor (OR 3.4, 95% CI 1.3-5.5), hospital-acquired complications (OR 4.9, 95% CI 2.5-7.3), and delirium (OR 5.5, 95% CI 2.3-8.7) were associated with longer LOS. 14% of patients in both groups had delirium. Hospitalization in the geriatric management unit reduced the risk of delirium (OR 0.35, 95% CI 0.1-0.9), while a higher Charlson index (OR 1.2, 95% CI 1.0-1.4), NEWS2 score (OR 1.2, 95% CI 1.1-1.4), and hospital-acquired complications (OR 7.3, 95% CI 2.9-18.5) increased it. 34% of patients developed hospital-acquired complications. Diagnosis of a GI tumor (OR 1.9, 95% CI 1.1-3.3) and higher NEWS2 score (OR 1.2, 95% CI 1.1-1.4) increased the risk of hospital-acquired complications. No differences in in-hospital mortality were seen between cases and controls (12% vs. 10%, p = 0.59). A higher NEWS2 score at admission (OR 1.4, 95% CI 1.2-1.7) and delirium (OR 10.7, 95% CI 3.2-36.3) increased the risk of death. Conclusions: Among older Mexican adults hospitalized for a cancer-related diagnosis, receiving care in a geriatric management unit led to a significant decrease in the risk of delirium. No improvements were seen in LOS, complications, or in-hospital mortality, which were associated with tumor and patient-related characteristics. Geriatric co-management can lead to improved geriatric outcomes in developing countries with limited resources.

Onaga Etelis coruscans is an important component of the commercial deep-water handline fishery in Hawaii and is one of the more valuable species because of its local popularity. This species is part of a management unit called the Deep 7, a data-poor fishery comprising six snapper and one grouper species for which information about age, growth, longevity and maturity is incomplete. Although some life history information is available for onaga, prior estimates of maximum age (~10–20 years) likely suffered from underestimation of age, whereas two recent studies provided estimates that were similar to the work presented here—a refined age reading protocol revealed age estimates up to 55 years. This maximum age estimate and the age reading protocol used on onaga otoliths were validated using bomb radiocarbon dating. Using an otolith reference image age reading protocol that relied on the validated otolith sections, almost all onaga otoliths covering nearly the full body size range were used to generate valid growth parameters that may be sexually dimorphic. An empirical estimate of age at the length at which 50% of individuals reach maturity (L50) is 11 years, and fish near the minimum retention size in Hawaii (1 lb (~0.45kg) or ~30-cm fork length) may be just 2–3 years old.

Specialized units for the assessment and management of concerning behaviors towards public figures have been set up in various jurisdictions. Their efficacy has been demonstrated descriptively and in terms of reduction in concern rates. This study of 100 consecutive cases from the Fixated Threat Assessment Centre (FTAC) in the UK uses a novel measure of outcome in the form of reduction in behaviors of concern and in police call-outs/stops, using data culled from police and health service records. It adopts a mirrored design, comparing individuals over 12-month and 2-year periods before and after FTAC intervention. It demonstrates significant reductions in both numbers of individuals involved in, and number of actual incidents of, concerning communication and problematic approach, as well as police call-outs/stops. Most results are consistent across subgroups with regard to gender, previous convictions, concern level, compulsory hospitalization and grievance-driven behavior. Such threat assessment units reduce risky behavior and save police time and, possibly, costs. Copyright © 2016 John Wiley & Sons, Ltd.

Syncope is a common symptom, experienced by 15% of persons less than 18 years old and up to 23% of elderly nursing home residents, so it is important to consider optimizing strategies for the management of these patients. The strategy selected will inevitably differ from place to place. However, an organized structure offers more cost-effective care. This article discusses possible health care delivery models for syncope management and reviews the current status of the organization of syncope care, to show the value of a multidisciplinary approach to the organized management of patients with syncope.

Introduction There are few data available on the optimal number of lung cancer patients needed to generate and compare estimates of quality between units managing lung cancer. The number of lung cancer patients per management unit varies considerably in Norway, where there are 42 hospitals that treated between 1 and 454 lung cancer patients in 2011. Aims To estimate the differences in quality indicators that are of sufficient importance to change a pulmonary physician's lung cancer management program, and to estimate the size of the patient samples necessary to detect such differences. Method Twenty-six physicians were asked about the relative differences from a national average of quality indicators that would change their own lung cancer management program. Sample sizes were calculated to give valid estimates of quality of a management unit based on prevalence of quality indicators and minimally important differences (MID). Results The average MID in quality indicators that would cause a change in management varied from 18% to 24% among 26 chest physicians, depending on the indicator. Conclusions To generate precise estimates for quality control of lung cancer care in Norway, the number of management units must be reduced. Given the present willingness of chest physicians to change their procedures for management of lung cancer according to the results of quality control indicators, we recommend a maximum of 10 units with a minimum of 200 incident lung cancer patients per year for each management center.

Objetivos. El objetivo general de este estudio es desarrollar e implementar un mapa de riesgos encaminado a la mejora de la seguridad de los pacientes en la Unidad de Gestión Clínica de Cirugía Oral y Maxilofacial del Complejo Hospitalario Universitario de Granada para minimizar la incidencia de efectos adversos y lograr una mejora de la calidad asistencial. Métodos. Se analizó retrospectivamente la situación actual de la Seguridad del paciente en la Unidad de gestión clí- nica, enfocando la metodología de trabajo a través de un equipo interdisciplinar y elaboración de un cronograma. El trabajo se realizó secuencialmente a través de las siguientes fases: análisis de la situación actual de la seguridad del paciente en la Unidad mediante dos sistemas de análisis: DAFO y PITELO, y elaboración de un flujograma del proceso de atención al paciente empleando el análisis metodológico AMFE; elaboración y consenso del proceso de atención del paciente; identificación de los posibles efectos adversos; cálculo del índice de prioridad de riesgo; elaboración de las Acciones Preventivas para los fallos y causas detectados; creación del mapa de riesgos específico de la unidad. Resultados. El análisis DAFO y PITELO constata como principales debilidades la insuficiente formación de los profesionales sanitarios sobre la seguridad del paciente y la infranotificación de efectos adversos, así como la ausencia de retroalimentación entre la Unidad de registro de efectos adversos y los mismos. Entre sus fortalezas destaca la existencia de líderes implicados en la mejora de la calidad. El catálogo muestra los 33 efectos adversos identificados en la Unidad, clasificando sus fallos y causas, y detallando sus correspondientes medidas preventivas. Conclusiones. La elaboración de un mapa de riesgos permite determinar el circuito del paciente de Cirugía Oral y Maxilofacial, y elaborar un catálogo de efectos adversos con la finalidad de asegurar y mejorar la calidad asistencial., Aims. The main aim of this study is to develop and implement a risk map in order to improve the patient safety strategy of the Oral Surgery Clinical Management Unit in the University Hospital Complex of Granada to minimize the incidence of adverse effects and gaining improvement of healthcare quality. Methods. The current situation of patient safety of the Oral Surgery Clinical Management Unit was analyzed retrospectively, focusing the methodology through an interdisciplinary team and elaborating a schedule. The work was carried out sequentially through the following phases: analysis of the current situation of patient safety in the Unit through the analysis systems SWOT and PITELO, and elaboration of a flow chart of the patient care process using the AMFE methodological analysis; elaboration and consensus of the patient care process; identification of possible adverse effects; calculation of the risk priority index; setting of the preventive actions for the detected failures and causes; and creation of the map of specific risks of the Unit. Results. The SWOT and PITELO analysis found that the insufficient training of health professionals on patient safety and the underreporting of adverse effects, as well as the lack of feedback between the adverse effects registry Unit and the same, are the main weaknesses. Among its strengths, there are leaders involved on improving quality. The catalog shows the 33 adverse effects identified in the Unit, classifying their failures and causes, and detailing their corresponding preventive measures. Conclusions. The elaboration of a risk map allows to determine the circuit of the Oral Surgical patient, and to elaborate a catalog of adverse effects with the purpose of assuring and improving the quality of care.

Malnutrition and functional decline are common in older inpatients admitted to subacute care settings. However the association between changes in nutritional status and relevant functional outcomes remains under-researched. This study examined changes in nutritional status, function and mobility in patients admitted to a Geriatric Evaluation and Management (GEM) unit who had a length of stay (LOS) longer than 21 days. A prospective, observational study. Two GEM units at St Vincent’s Hospital Melbourne, Australia. Patients admitted to the GEM units who stayed longer than 21 days were included in the study. Patients were assessed on admission and prior to discharge using the Subjective Global Assessment (SGA), Functional Independence Measure (FIM) motor domain and the Modified Elderly Mobility Scale (MEMS). Fifty-nine patients (Mean age 84.0 ± 7 years) met the required length of stay and were included in the study. Fifty-four per cent (n=32) were malnourished on admission (SGA B/C) and 44% (n=26) were malnourished on discharge. Twenty-two per cent (n=13) improved SGA category, 75% remained stable (n=44) and 3% deteriorated (n=2) from admission to discharge. Total Motor FIM scores significantly increased from admission to discharge in both the improved (p

Background Polypharmacy and inappropriate drug use is associated with negative health outcomes among older people. Various interventions for improving drug treatment have been evaluated, but the majority of studies are limited by the use of surrogate outcomes or suboptimal design. Thus, the potential for clinically significant improvements from different interventions is still unclear. The main objective of this study is therefore to evaluate the effect upon patient-relevant endpoints of a cooperation between geriatricians and general practitioners on complex drug regimens in home-dwelling elderly people. Methods This is a cluster randomised, single-blind, controlled trial where general practitioners are invited to participate with patients from their lists. The patients must be 70 years or older, use at least seven different medications and have their medications administered by the home nursing service. We plan to recruit 200 patients, with randomisation at physician level. The intervention consists of three main parts: (1) clinical geriatric assessment of the patient, combined with a thorough review of their medications; (2) a meeting between the geriatrician and general practitioner, where the two physicians combine their competence and knowledge and discuss the drug list systematically; (3) clinical follow-up, depending on the medication changes that have been done. The study period is 24 weeks, and the patients are assessed at baseline, 16 and 24 weeks. The primary outcome measure is health-related quality of life according to the 15D instrument. Secondary outcome measures include physical and cognitive functioning, medication appropriateness, falls, carer burden, use of health services (hospital or nursing home admissions, use of home nursing services) and mortality. Discussion Our choice of patient-relevant outcome measures will hopefully provide new knowledge on the potential for clinical improvements after performing comprehensive medication reviews in home-dwelling elderly people receiving polypharmacy. Trial registration ClinicalTrials.gov, NCT02379455 . Registered on 27 February 2015.

Objective: To analyse the impact of a multidisciplinary and decentralised safety committee in the paediatric management unit, and the joint implementation of a computing network application for reporting medication errors, monitoring the follow-up of the errors, and an analysis of the improvements introduced. Materials and methods: An observational, descriptive, cross-sectional, pre-post intervention study was performed. An analysis was made of medication errors reported to the central safety committee in the twelve months prior to introduction, and those reported to the decentralised safety committee in the management unit in the nine months after implementation, using the computer application, and the strategies generated by the analysis of reported errors. Measured variables: Number of reported errors/10,000 days of stay, number of reported errors with harm per 10,000 days of stay, types of error, categories based on severity, stage of the process, and groups involved in the notification of medication errors. Results: Reported medication errors increased 4.6-fold, from 7.6 notifications of medication errors per 10,000 days of stay in the pre-intervention period to 36 in the post-intervention, rate ratio 0.21 (95% CI; 0.11–0.39) (P .05). The notification of potential errors or errors without harm per 10,000 days of stay increased 17.4-fold (rate ratio 0.005, 95% CI; 0.001–0.026, P 0,05. Se multiplica por 17,4 la notificación de errores sin daño o potenciales por 10.000 días de estancia, razón de tasas: 0,005 (IC 95%: 0,001–0,026) p

English Abstract; Journal Article; There is currently around one million people receiving oral anticoagulants in Spain. The drug most used is acenocoumarol, which requires coagulation monitoring to ensure that the patient is within its normal therapeutic range. Patients usually start this treatment in a hospital clinic and, when they are stabilised, they are referred to primary care, where they are followed-up by their community nurses. The usual practice is that nurses are responsible for changes in the dose when the patients are outside the range. This practice is not performed by hospital nurses, despite having sufficient experience and knowledge to adequately manage these types of patients. An Advanced Nursing Practice model has been introduced into the Haematology management unit of the Hospital Universitario Virgen de la Victoria, Málaga. This involves various aspects of attention and care of patients on anticoagulant therapy, and includes adjusting the doses of their treatment following a catalogue of therapeutic and diagnostic ranges. Yes En la actualidad, en nuestro país, alrededor de un millón de personas reciben anticoagulación oral. El fármaco más empleado es el acenocumarol, que requiere de controles de coagulación para constatar que el paciente se encuentra dentro de su rango terapéutico. Los pacientes suelen empezar este tratamiento en una consulta hospitalaria y, cuando se encuentran estabilizados, son derivados a Atención Primaria (AP), donde son seguidos por sus enfermeras comunitarias. La práctica habitual es que estas enfermeras asuman los cambios de dosis cuando los pacientes están fuera de rango; no obstante este aspecto no es realizado por las enfermeras hospitalarias a pesar de disponer suficiente experiencia y conocimientos para un adecuado manejo de este tipo de pacientes. En la UGC de hematología del Hospital Universitario Virgen de la Victoria de Málaga se ha implantado un modelo de Enfermería de Práctica Avanzada que incluye diversos aspectos de la atención y cuidados a los pacientes en terapia antitrombótica, entre los que se encuentran la dosificación de su tratamiento siguiendo un catálogo de rangos terapéuticos y diagnósticos.

Background and Objectives Reports suggest that repeat users of detoxification services are less likely to get rehabilitated. The goal of this study is to determine rates and predictors of detoxification unit visits among individuals who are chronically homeless with severe drinking problems compared to those who are housed and in the general homeless population. Methods Visit records (n = 1027) from all inner city Toronto detoxification units (n = 5) by men (n = 169) over a 6 year period were analyzed and linked to structured interview data for three populations: chronically homeless individuals with severe drinking problems (CHDP, n = 50); members of the general homeless population (GH, n = 61); and low-income housed individuals (LIH, n = 58). Results The CHDP group had 4.13 (3.86, 4.39) detoxification unit admissions per year, 18.1 (95% CI 12.5–23.7) and 33 (95% CI 21–46) times higher than the GH and LIH groups respectively. Admission rates were 43.8 % (95% CI 32.7–54.9%) higher in the winter than summer months for the CHDP group. The proportions of stays that involved police, leaving without discharge, and staying two days or less were 74%, 75%, and 89% among CHDP, GH, and LIH subjects. Conclusions and Scientific Significance Rather than being a resource for achieving abstinence, frequent short visits, treatment non-compliance, higher winter visit rates suggest that detoxification units are more likely used by individuals as shelter; high rates of admission related police involvement suggest that they continue to be used as an alternative to judicial intervention into public inebriation. (Am J Addict 2013; 22:226–232)

Clinical decision making can be challenging regarding the emergency department (ED) management of patients with recent syncope. Several models of the syncope management unit are summarized in this article. Assessment of patients with recent syncope in a specialized evaluation unit, such as an emergency department-based syncope management unit, holds great promise in terms of reducing hospital admissions, reducing costs and improving outcomes for patients with syncope.

Syncope, a clinical syndrome, has many potential causes. The prognosis of a patient experiencing syncope varies from benign outcome to increased risk of mortality or sudden death, determined by the etiology of syncope and the presence of underlying disease. Because a definitive diagnosis often cannot be established immediately, hospital admission is frequently recommended as the "default" approach to ensure patient's safety and an expedited evaluation. Hospital care is costly while no studies have shown that clinical outcomes are improved by the in-patient practice approach. The syncope unit is an evolving practice model based on the hypothesis that a multidisciplinary team of physicians and allied staff with expertise in syncope management, working together and equipped with standard clinical tools could improve clinical outcomes. Preliminary data have demonstrated that a specialized syncope unit can improve diagnosis in a timely manner, reduce hospital admission and decrease the use of unnecessary diagnostic tests. In this review, models of syncope units in the emergency department, hospital and outpatient clinics from different practices in different countries are discussed. Similarities and differences of these syncope units are compared. Outcomes and endpoints from these studies are summarized. Developing a syncope unit with a standardized protocol applicable to most practice settings would be an ultimate goal for clinicians and investigators who have interest, expertise, and commitment to improve care for this large patient population.

Objective To identify the pitfalls in accurate antenatal diagnosis of bladder exstrophy (BE) and cloacal exstrophy (CE), and thus understand the challenges for antenatal counselling. Methods A prospectively maintained bladder exstrophy database of antenatal and live born referrals for BE/CE was used to identify patients. Data were collected about the antenatal scan findings and the outcome of pregnancy. Results Between 2003 and 2009, 40 new babies with BE/CE were referred and of them 10 had an antenatal diagnosis. Five patients did not have a diagnosis despite suspicious findings noted on antenatal scans and another three had a wrong diagnosis of BE/CE. Of the 16 referrals with antenatal suspicion of BE/CE, 5 opted for termination. At the 20-week scan, it was possible to identify the gender of the fetus in 3/16 cases only. Conclusions Only a quarter of the babies born with BE/CE had received an antenatal diagnosis. Raising awareness about the condition amongst radiographers, and facilitating further scanning by a specialist fetal management unit if suspicious findings are noted, is crucial for improving the rate of detection. An antenatal diagnosis may not be reliable, and difficulty in identifying gender at the 20-week scan adds to the complexity of antenatal counselling. Magnetic resonance imaging and karyotyping may provide additional helpful information.

SummaryBackgroundHeart failure is the leading cause of hospital admissions and an economic burden. In accordance with European guidelines, a dedicated heart failure unit was created in René Dubos Hospital (Pontoise, France) in 2002.AimTo evaluate the impact of an in-hospital heart failure management unit on heart failure prognosis.MethodsWe conducted a descriptive study of all-cause in-hospital mortality and heart failure related readmission rates in the year after the first admission for heart failure, from January 1997 to December 2007. The Chi2 test, a trend test and linear regression were performed.ResultsThere were no significant differences in patient characteristics (age, sex, diabetes mellitus, left ventricular ejection fraction

Chronic wasting disease (CWD), a prion disease affecting North American cervids, has been discovered in at least 12 states and provinces throughout the continent. Since 2002, a number of states and provinces have initiated surveillance programs to detect CWD in native cervid populations. However, many questions remain about the appropriate methods, geographic scope, and number of samples required for an effective CWD surveillance program. We provide an improved statistical method to calculate the probability of detecting CWD in primary sample units (e.g., county or deer management unit) that also considers deer abundance and the nonrandom distribution of CWD and hunter harvests. We used this method to analyze data from a statewide CWD detection program conducted in Wisconsin during the autumns of 2002 and 2003 to determine the distribution of CWD in white-tailed deer (Odocoileus virginianus). Deer heads were collected at hunter registration stations, and brainstem (obex) and retropharyngeal lymph nodes were removed for disease testing. Our analysis includes samples from35,000 deer collected outside the known affected area. The probability of detecting chronic wasting disease at a prevalence of 1% varied from 0.89 toor =0.99 among the 56 primary sample units. Detection probabilities for 1% CWD prevalence were0.9 in 55 primary sample units, and0.99 in 10. Detection probabilities will be higher in areas where CWD prevalence exceeds 1%. CWD-positive deer were detected in eight primary sample units surrounding the known affected area during surveillance activities. Our approach provides a novel statistical technique to accommodate nonrandom sampling in wildlife disease surveillance programs.

JAVMA, Vol 230, No. 11, June 1, 2007 V who may become involved in the organized response to any disaster or emergency must understand the basic concepts and components of the ICS. The ICS is the functional field organization and management unit of the NIMS and provides for coordination of personnel, equipment, and other resources at the scene of a disaster. The NIMS is a part of the NRP dictated by HSPD-5 (management of domestic incidents). The NRP provides a method for making federal assistance available, when requested, in those instances when state and local response efforts are overwhelmed. Other provisions of the NIMS include coordination of the many agencies involved in any disaster response, training and certification of personnel for specific activities, and classification and management of resources. In addition to creation of the NIMS, the NRP assigns and coordinates various roles and responsibilities during disaster responses and provides specific plans, called annexes, for emergency support functions, other support functions, and specific types of incidents.

Purpose of review In the absence of an established critical pathway to evaluate patients with syncope presenting to the emergency department, this review is timely because of new clinical evidences supporting a specialized syncope management unit in the emergency department, and it is relevant because of the potential impact on a very large and heterogeneous population. Recent findings Three observational syncope studies from Italy showed a high degree of variability in practice patterns, diagnostic yields, and lengths of hospital stay. An appropriate and efficacious syncope management pathway in the emergency department remains far from established. In a randomized trial from a tertiary care hospital in the US, the SEEDS study demonstrated that a designated 'syncope unit' in the emergency department, with a multidisciplinary effort and appropriate resources, significantly improved diagnostic yield, reduced hospital admission and total length of hospital stay in intermediate-risk patients. Long-term follow-up showed that reduced hospital stay did not negatively affect survival and recurrent syncope. Summary Limited randomized trial data suggest a designated syncope unit in the emergency department holds promise to provide specialized and efficient care for patients with syncope. Additional data are needed to assess the general applicability of this critical pathway in community-based hospitals.

Objetivos: El objetivo general de este estudio es elaborar el Plan de Seguridad del Paciente en la Unidad de Gestión Clínica de Cirugía Torácica del Hospital Universitario Virgen de las Nieves de Granada para mejorar la Seguridad del Paciente, incluyendo posibles acciones preventivas que reduzcan la ocurrencia de efectos adversos en la población atendida y conseguir una mayor calidad asistencial. Métodos: Se realizó un análisis de la situación actual sobre Seguridad del Paciente de la Unidad de Gestión Clínica, asumiendo la coordinación de la actividad desde un punto de vista de trabajo en equipo multidisciplinar con un cronograma. Primeramente, se elaboró el proceso de Atención del paciente torácico y se diseñó su flujograma durante Mayo y Junio de 2013. Posteriormente, se desarrolló un catálogo de posibles eventos adversos, fallos y causas mediante metodología de análisis modal de fallos y efectos. Resultados: El DAFO desprende la falta de formación de los profesionales sobre seguridad del paciente, la infranotificación de eventos adversos y la falta de retroalimentación entre la unidad de registro de eventos y los profesionales; entre sus fortalezas, existen líderes implicados y referentes en calidad. El flujograma aporta conocer las actividades de cada profesional en cada fase del itinerario del paciente desde el comienzo de su proceso de enfermedad hasta que finaliza. El catálogo lista los 29 eventos adversos identificados en la Unidad de Gestión Clínica, clasificando sus fallos y causas, y detallando sus correspondientes medidas preventivas. Conclusiones: El Plan de Mejora de la Seguridad del Paciente Torácico permite conocer el mapa de riesgos, determinar el circuito del paciente torácico y elaborar un catálogo de eventos adversos por parte de un equipo multidisciplinar en la Unidad de Gestión Clínica de Cirugía Torácica con el fin de asegurar la calidad asistencial de este proceso., Aims: The main aim of this study is to develop the Patient Safety Plan in the Clinical Management Unit of Thoracic Surgery in the University Hospital Virgen de las Nieves of Granada in order to improve Patient Safety, including possible preventive actions to reduce the occurrence of adverse effects in this population and achieve a higher quality of care. Methods: An analysis of the current situation about patient safety on the Clinical Management Unit was performed. It was assumed the coordination of the activity from the point of view of a multidisciplinary team work within a time schedule. Firstly, the thoracic patient process of care was developed and its flowchart was designed for May and June of 2013. Subsequently, a catalog of possible adverse events, failures and sources was developed by failure mode and effects analysis in healthcare. Results: The SWOT analysis has lack of professional training on patient safety, underreporting of adverse events and lack of feedback between the clinical management leaders and professionals; among its strengths, there are involved leaders who are experts on quality assurance. The flow chart provides information on the activities of each professional at every stage of the patient process from the beginning of their disease until completion of the process. The catalog lists the 29 adverse events identified in the Clinical Management Unit, classifying its failures and causes, and corresponding preventive measures. Conclusions: The Plan to Improve Thoracic Surgery Patient Safety allows understanding the risk map, also determines the thoracic patient process and develops a catalog of adverse events by a multidisciplinary team in the Clinical Management Unit of Thoracic Surgery in order to ensure quality of this care process.

During the past 5–10 years, studies exploring small-scale structure of cod populations have provided accumulating evidence for the existence of local populations. In Iceland, all cod have been thought to belong to a single management unit. Recent studies on genetic and life history variation have, however, indicated the existence of local populations. The main objective of this study is to explore the potential existence of local populations by use of otolith shape to discriminate between spawning groups of Icelandic cod. Otoliths were sampled from mature and spawning cod at spawning locations around Iceland in 2002 and 2003, and otolith shape was described using variables correlated with size (otolith area, length, width, perimeter, and weight) as well as shape (rectangularity, circularity, and 10 Fourier coefficients). Only standardized otolith variables were used so as to remove the effect of otolith size on the shape variables. Cod were on average larger and older south of Iceland, where ambient temperature was higher than northwest, north, and east of Iceland. Otolith shape effectively discriminated between cod north and south of Iceland, and it was also possible to discriminate among cod spawning below and above 125 m at spawning locations south of Iceland. Recent genetic and tagging studies have indicated differences between cod at these two depths. Correct classification of groups of cod at the different spawning locations ranged between 0% and 44%. Incorrectly classified cod were in most cases classified to adjacent spawning locations, and a high percentage of cod south of Iceland was classified to other southern locations and cod north of Iceland to other northern locations. The temporal stability of otolith shape was studied at seven spawning locations in two consecutive years. Otolith shape differences were greater between locations than among years within a location. The spawning groups are therefore likely to have remained separate during much of their lifetime.

Background: In two previous publications, we have shown that treatment of acutely sick, frail elderly patients in a Geriatric Evaluation and Management Unit (GEMU) compared to treatment in the general Medical Wards (MW) reduced mortality and improved the chances of living at home in contrast to living in nursing homes or being dead. Objective: The aim of this presentation was to study the impact on function, symptoms of depression and general well-being of treatment in the GEMU as compared to treatment in MW. Methods: Acutely sick, frail patients aged ≧75 years, admitted as emergencies to the Department of Internal Medicine, were randomised either to treatment in the GEMU (n = 127) or the MW (n = 127). In the GEMU the treatment strategy emphasised comprehensive interdisciplinary assessment of all relevant disorders, prevention of complications and iatrogenic conditions, early mobilisation, rehabilitation and discharge planning. The control group received treatment as usual from the Department of Internal Medicine. After discharge neither group received specific follow-up. Activities of daily living (ADL), instrumental ADL, cognitive function, symptoms of depression and general well-being were assessed 3, 6 and 12 months after discharge from hospital. Results: There was no difference in function, depression or general well-being in the GEMU as compared to the MW group. If the dead were included in the analysis at the highest ADL dependency level, there was better function in the GEMU group at 3 months (p = 0.03). Conclusion: Treatment in the GEMU had no measurable beneficial impact on function, morale or symptoms of depression. Taken the previously shown mortality reduction into consideration an additional effect on function was less likely and the overall treatment effect was considered to be positive.

This study's objective was to determine whether patients treated in a geriatric evaluation and management unit (GEMU) had a more appropriate drug profile than patients treated in the general medical wards (MW).Frail elderly patients admitted as emergencies to the medical department were randomised to treatment in the GEMU (n=127) or MW (n=127). Drugs used at inclusion and discharge were registered retrospectively and analysed with regard to polypharmacy, number of drugs withdrawn or started, potential drug-drug interactions (DDIs), number of anticholinergic drugs prescribed, and the number of inappropriate drug prescriptions according to Beers' criteria. Utilisation of psychotropic and cardiovascular drugs was compared in detail according to prespecified hypotheses.The number of patients with polypharmacy did not differ significantly between the GEMU and MW. The median number of scheduled drugs withdrawn per patient was higher in the GEMU than in the MW (p=0.005). Drugs with anticholinergic effects (p=0.003); cardiovascular drugs (p0.001), particularly digitalis glycosides (p0.001); and antipsychotic drugs (p=0.009) were withdrawn more often in the GEMU. The median number of scheduled drugs started was higher in the GEMU than in the MW (p=0.03). In particular, antidepressants (p0.001) and estriol (p=0.001) were started more often in the GEMU than in the MW. Fewer GEMU than MW patients had potential DDIs at discharge (p=0.009).Drug treatment in the GEMU as compared with the MW was more appropriate in terms of prescription of fewer drugs with anticholinergic effects and fewer potential DDIs. There were distinct differences in treatment patterns of cardiovascular and psychotropic drugs.

Coronary atherosclerosis is the result of multiple complex metabolic disorders acting alone or in combination. Metabolic cardiology has advanced considerably in the past decade and now offers cardiologists a sophisticated approach to treating the underlying cause(s) of coronary artery disease in patients seen in invasive cardiology practices. Disorders which have now been powerfully linked to coronary artery disease include the small low-density lipoprotein trait, impaired reverse cholesterol transport, homocysteinemia, insulin resistance, aspects of inflammation, and infectious burden. These disorders are common and alone, or in combination, are found in over 90% of patients with coronary artery disease. Treatments for these disorders are well elucidated and have been associated with cardiovascular benefit. Incorporation of a sophisticated metabolic atherosclerosis management unit into existing invasive cardiology practices offers the cardiologist and patient many benefits. The cardiologist obtains a powerful tool that complements invasive cardiology, provides patients with access to cutting-edge diagnosis and treatment, and provides a forum that allows incorporation of clinically valid advances in metabolic cardiovascular care in a time frame far shorter than the traditional consensus recommendation approach. Incorporation of such a clinical service is consistent with the recent American College of Cardiology focus on the "CardioTeam."

Background. A geriatric evaluation and management unit (GEM) manages elderly inpatients with functional impairments. There is a paucity of literature on frailty and whether this impacts on rehabilitation outcomes.Objectives. To examine frailty score (FS) as a predictor of functional gain, resource utilisation, and destinations for GEM patients.Methods. A single centre prospective case study design. Participants (n=136) were ≥65 years old and admitted to a tertiary hospital GEM. Five patients were excluded by the preset exclusion criteria, that is, medically unstable, severe dementia or communication difficulties after stroke. Core data included demographics, frailty score (FS), and functional independence.Results. The mean functional improvement (FIM) from admission to discharge was 11.26 (95% CI 8.87, 13.66;P<0.001). Discharge FIM was positively correlated with admission FIM (β=0.748;P<0.001) and negatively correlated with frailty score (β=−1.151;P=0.014). The majority of the patients were in the “frail” group. “Frail” and “severely frail” subgroups improved more on mean FIM scores at discharge, relative to that experienced by the “pre-frail” group.Conclusion. All patients experienced functional improvement. Frailer patients improved more on their FIM and improved relatively more than their prefrail counterparts. Higher frailty correlated with reduced independence and greater resource utilisation. This study demonstrates that FS could be a prognostic indicator of physical independence and resource utilisation.

Changes in health systems are determining new hospital organization forms. The patient focused hospital suppose a new radical design of hospital processes from the patient's viewpoint. This paper defines the re-engineering process of the Cardiology and Cardiovascular Surgery Services of the Hospital Clinic of Barcelona in order to develop and Institute. The change consists fundamentally in a reorganization of the direction organs, creating a staff commission and director. The chief nursing and chief management report to the director. Also, a patients admission and management unit, that manage the beds infrastructure of both services has been developed. The first year results show a reduction of the length of stay and an increase in the in-hospital and external activity.

A number of studies have documented that there is an inadequate number of physicians trained in geriatrics in the United States. Over the last 15 years, we have developed a Geriatric Physician Fellowship Program directed at developing academic geriatric physicians. The first year of the program offers physicians experience in caring for older patients in unique settings such as continuing care retirement communities, long‐term care facilities, subspecialty clinics (e.g., those dealing with falls, metabolic bone disease, memory disorders, and gynecological bladder dysfunction), a geriatric evaluation and management unit, and an extended care rehabilitation center. During the second year of the fellowship, the majority of the time is spent on a research project under the supervision of a mentor. For fellows who wish to pursue this research experience, a third year of training is available. In addition to opportunities for geriatrics fellows, junior faculty have access to substantial resources through our Cl...

Objetivo: Apontar os fatores que interferem no gerenciamento do cuidado de enfermagem aos pacientes oncológicos internados em um hospital geral localizado ao sul do país. Método: Trata-se de uma pesquisa qualitativa que utilizou a Teoria Fundamentada nos Dados, com a abordagem Straussiana para a análise dos dados. Foram realizadas entrevistas semi-estruturadas com 14 participantes: seis enfermeiros, cinco técnicos de enfermagem, um nutricionista, uma psicóloga e um familiar, no período de agosto a outubro de 2010. Resultados: Como fatores intervenientes foram identificados o gerenciamento da unidade realizado pelo enfermeiro, a dor oncológica, a necessidade de capacitações, o vínculo com a família, o relacionamento interpessoal na equipe, a não-especificidade da clínica e o processo de morte. Considerações Finais: Os profissionais do hospital generalista apresentam dificuldade em ofertar uma assistência direcionada e adequada à complexidade do paciente oncológico, reiterando a importância do suporte da educação continuada, interdisciplinaridade e satisfação no trabalho.

BackgroundHeart failure is the leading cause of hospital admissions and economic burden. In accordance with guidelines, a dedicated heart failure unit has been created in Bordeaux (France) in May 2011.AimEvaluate the impact of a heart failure management unit with ambulatory sector on readmission rate and mortality; and identify prognosis parameters at diagnosis and 6 months after.MethodsDescriptive study of mortality and heart-failure-related readmission rates after a first admission for heart failure, from May 2011 to July 2014 (inclusion stopped in July 2013). Student’s test and Cox’s regression have been performed.ResultsSince the creation of this unit, its activity has been growing by 30% in the first year and 10%, in the second. 421 patients with less than 40% left ventricular ejection fraction (LVEF) have been included; 181 had been treated before May 2011 while 240 were news patients treated during the study. Average age was 57±14 years old and average LVEF was 28%±7%. Therapeutics drugs cover was good compared to previous studies: 98% of patients has been treated by beta blockers, 94% by an antagonist of reninangiotensin-aldosteron system and 82% by an antagonist of mineralocorticoid receptor. Survival after 3 years of treatment was 87.5%. Re-admission rate was less than one readmission per patient and per year. No diagnosis parameter was a prognosis factor. But after 6 months of treatment, univariate analysis found significant prognosis factors of survival: dyspnea I-II, 6minutes walking test>300m, BNP

The experience of conducting group therapy with different groups in a state prison's Special Management Unit (SMU) for the mentally and emotionally ill offenders has provided a definite challenge. The challenge comes from two sources: (1) the setting, and (2) the difficult, complex, and dual-diagnosed members of the groups. The latter aspect has been detailed in the body of this article. Although the results have been meager, on balance, there is a potential for this demanding and necessary type of professional task.

Drug is one of the essential elements in healthcare that should be effectively and efficiently managed. Following the decentralization in 2001 in Indonesia, drug management has changed in district drug management units and also in District General Hospitals. Certainly this condition influences the sustainability of drug access in primary health care such as in Community Health Center and District General Hospital, especially in drug financing policy. A cross sectional descriptive study to obtain information on drug management in public healthcare in district had been carried out between July and December 2006 in 10 District Public Drug Management Units from 10 district health offices and 9 district general hospitals as samples. Data were collected by interviewing heads of Drug Section in District Health Offices and heads of Hospital Pharmacies using structured questionnaires and observing drug storage in District Drug Management Units, Community Health Centers, and Hospital Pharmacies. Results of the study show that drug planning in District Health Offices and General Hospitals did not meet the basic real need in some districts nor District Hospitals. The minimum health service standards had not been achieved yet. Furthermore, drug procurement, storage and recording as well as reporting was not good enough either, such as shown by the existence of expired drugs. Lead time for drug delivery to community health centers in some districts was longer than the average of lead time in the past 3 years.

An ambitious programme to integrate TB and HIV services into single primary health care facilities and a R32 million European Union (EU)-funded treatment defaulter tracing project are among the chief mitigation weapons aimed at the TB pandemic this year. This emerged from an interview last month with the national director of the TB Control and Management Unit at the national health department, Dr Lindiwe Mvusi. With the HIV pandemic having multiplied South Africa’s TB prevalence three-fold over the past decade (Fig. 1) and the country now among the 10 worst performing in TB control internationally, Mvusi says more efficient awareness, prevention and monitoring campaigns are ‘crucial’.

Elderly patients who are hospitalized with acute illnesses frequently have adverse outcomes. To maintain functional independence, the geriatric evaluation and management unit (GEMU) was established to provide the opportunity for functional recovery (FR). This study's aim was to investigate potential prognostic factors for functional improvement in a GEMU of Taichung Veterans General Hospital, Taiwan. A total of 117 elderly patients (age, 80.0+/-6.3 years, 84.6% males) were enrolled. A comprehensive geriatric assessment and functional status evaluation, including the functional reach test (FRT) and the timed up-and-go (TUG) test, were performed. FR was defined by a greater than 10% improvement in the Barthel Index (BI) before GEMU discharge. Lower BI (44.7+/-25.2 vs. 68.7+/-34.5, p0.001), lower instrumental activities of daily living (IADL) scores (1.8+/-1.5 vs. 3.5+/-2.6, p0.001), impaired FRT (83.3% vs. 63.5%, p = 0.028), and impaired TUG test (94.4% vs. 74.6%, p = 0.008) were predictive factors for functional improvement. On multivariate logistic regression, an impaired TUG test (Odds ratio = OR = 6.18, 95% confidence interval = 95% C.I. = 1.69-22.6, p = 0.006) was an independent variable associated with FR. The results indicate that elderly hospitalized patients, even with poor physical function, could benefit from geriatric integrated care delivered by a GEMU.

A cancer pain management unit can benefit markedly from a well-planned documentation system for administrative and scientific purposes. This article presents the principles of such a computerized system based on relational data base programs. The described system has been used by the authors for the last seven years. The successful documentation of more than 1400 patients over treatment periods of up to 2 years has provided detailed administrative and scientific information.

In 2005, the Azienda Ospedaliero-Universitaria of Trieste (AOUT) activated the hospital-based post-acute geriatric evaluation and management unit (PAGEMU). The purpose of the study is to illustrate the activities of the PAGEMU, and to evaluate the effects of personalized and multidisciplinary care on geriatric inpatients. The evaluation for admission in PAGEMU included general admitting criteria, co-morbidity, autonomy, and assessment of the patient's pre-morbid functional status. During the stay, inpatients completed their treatment plan, comprehensive geriatric assessment was carried out, and rehabilitation and nutritional interventions were implemented. If necessary, a new diagnostic-therapeutic plan was provided. A number of 826 patients were evaluated for admission in PAGEMU (612 patients from surgical departments and 214 from medical wards). The mean length of stay was 19.55 days. Re-evaluation of patients at discharge showed a statistically significant improvement in co-morbidity and in self-sufficiency, not in cognitive or mood status. PAGEMU is a valid model both for patient-oriented and for management-oriented objectives, shortening the length of stay in acute care settings and increasing hospital turnover.