Do clinical guidelines improve management of sepsis in critically ill elderly patients? A before-and-after study of the implementation of a sepsis protocol.

Aim: Guidelines for the management of sepsis have been published but not validated for elderly patients, though a prompt work-up and initiation of appropriate therapy are crucial. This study assesses the impact of a sepsis protocol on timelines for therapy and mortality in standardized management.

Methods: Consecutive patients aged 70 years and older who were diagnosed with sepsis and admitted during the observation periods were included in this before-and-after study at a medical intensive care unit (ICU).

[Attitudes towards age-related rationing of medical supply: results of a cross-national analysis in Germany and Austria].

Background: Expenditure on health-care is increasing over the last years and the demographic shift leads to more elderly patients in the health-care system. Debates about the financial situation and solution about this topic are common. Direct, as well as hidden, rationing is verified by experts.

Economic evaluation of pay-for-performance in health care: a systematic review.

Background: Pay-for-performance (P4P) intents to stimulate both more effective and more efficient health care delivery. To date, evidence on whether P4P itself is an efficient method has not been systematically analyzed.

Objective: To identify and analyze the existing literature regarding economic evaluation of P4P.

[A health economics approach].

Frailty is a complex term and has a broad influence on the elderly patients. For evaluating the monetary impact of frailty it is necessary to approach in a differentiated way. It is of great interest to discover the relevance of multidisciplinary assessment and accordant preventive actions.

[Modern intensive care].

Frailty associated functional changes in the elderly lead to different problems treating geriatric patients in an intensive care unit. Patients suffering from frailty have less physiological reserves in acute illness, complications are more frequent and recovery is clearly delayed. Frailty is also an established and independent predictor for mortality.