Managing "socially admitted" patients in hospital: a qualitative study of health care providers' perceptions.

Background: Emergency departments are a last resort for some socially vulnerable patients without an acute medical illness (colloquially known as "socially admitted" patients), resulting in their occupation of hospital beds typically designated for patients requiring acute medical care. In this study, we aimed to explore the perceptions of health care providers regarding patients admitted as "social admissions."

Methods: This qualitative study was informed by grounded theory and involved semistructured interviews at a Nova Scotia tertiary care centre.

Detection of Extended-Spectrum β-Lactamase (ESBL) at Different Processing Stages in Three Broiler Abattoirs.

The European Food Safety Authority (EFSA) identified extended-spectrum β-lactamase/AmpC β-lactamase (ESBL/AmpC)-producing as one of the main priority hazards for poultry. Different studies detected ESBL-producing at broiler fattening farms and in abattoirs, concluding that poultry meat is a potential source of human infection. Broiler breast skin samples taken in three abattoirs with different scalding techniques were examined for ESBL-producing (.

Adapting Geriatric Day Hospital Care From an In-House to Outreach Process.

Outpatient programs have been challenged to find ways to deliver services while adhering to coronavirus disease protocols. Our Geriatric Day Hospital (GDH) Falls Clinic changed from a 6-week in-house program to an outreach program incorporating telephone assessments and home visits. We evaluated whether the outreach program was effective in improving patient outcomes in 23 serially enrolled clients.

Multimodal Pain Management in Older Elective Arthroplasty Patients.

Background: Pain management after elective arthroplasty in older adults is complicated due to the risk of undertreatment of postoperative pain and potential adverse effects from analgesics, notably opioids. Using combinations of analgesics has been proposed as potentially beneficial to achieve pain control with lower opioid doses.

Objective: We compared a multimodal pain protocol with a traditional one, in older elective arthroplasty patients, measuring self-rated pain, incidence of postoperative delirium, quantity and cost of opioid analgesics consumed.

Translating Delirium Prevention Strategies for Elderly Adults with Hip Fracture into Routine Clinical Care: A Pragmatic Clinical Trial.

Objectives: To compare the feasibility (adherence) and effectiveness (prevalence of delirium, length of stay, mortality, discharge site) of delirium-friendly preprinted postoperative orders (PPOs) for individuals with hip fracture, administered by regular orthopedic nurses, with routine postoperative orders.

Design: Pragmatic clinical trial to evaluate a quality improvement intervention.

Setting: Tertiary care hospital.

Risk of Pre-and Post-Operative Delirium and the Delirium Elderly At Risk (DEAR) Tool in Hip Fracture Patients.

Background And Purpose: Delirium is common after hip fracture. Previous work has shown that a simple delirium risk factor tool, the Delirium Elderly At Risk instrument (DEAR), has a high inter-rater reliability in this population. Little research has looked at the ability of risk factor screening tools to identify patients at high risk of pre-operative delirium.

Prevalence and Characteristics of Pre-Operative Delirium in Hip Fracture Patients.

Background: Delirium is a common complication of hip fracture and is associated with negative outcomes. Previous studies document risk factors for post-operative delirium but have frequently excluded patients with pre-operative delirium.

Objective: This study endeavours to document prevalence and risk factors for pre-operative delirium in hip fracture patients and compares risk factor profiles and outcomes between pre- and post-operative delirium.

Cranial neural crest cells form corridors prefiguring sensory neuroblast migration.

The majority of cranial sensory neurons originate in placodes in the surface ectoderm, migrating to form ganglia that connect to the central nervous system (CNS). Interactions between inward-migrating sensory neuroblasts and emigrant cranial neural crest cells (NCCs) play a role in coordinating this process, but how the relationship between these two cell populations is established is not clear. Here, we demonstrate that NCCs generate corridors delineating the path of migratory neuroblasts between the placode and CNS in both chick and mouse.

Pax2 modulates proliferation during specification of the otic and epibranchial placodes.

Background: The inner ear and epibranchial ganglia of vertebrates arise from a shared progenitor domain that is induced by FGF signalling, the posterior placodal area (PPA), before being segregated by Wnt signalling. One of the first genes activated in the PPA is the transcription factor Pax2. Loss-of- and gain-of function studies have defined a role for Pax2 in placodal morphogenesis and later inner ear development, but have not addressed the role Pax2 plays during the formation and maintenance of the PPA.

Separating early sensory neuron and blood vessel patterning.

The anatomical association between sensory nerves and blood vessels is well recognised in the adult, and interactions between the two are important during development. Here we have examined the relationship between developing blood vessels and sensory neuronal cell bodies, which is less well understood. We show in the chick that the nascent dorsal root ganglia (DRG) lie dorsal to the longitudinal anastomosis, adjacent to the developing neural tube at the level of the sulcus limitans.

Progressive restriction of otic fate: the role of FGF and Wnt in resolving inner ear potential.

The development of the vertebrate inner ear is an emergent process. Its progression from a relatively simple disk of thickened epithelium within head ectoderm into a complex organ capable of sensing sound and balance is controlled by sequential molecular and cellular interactions. Fibroblast growth factor (FGF) and Wnt signals emanating from mesoderm and neural ectoderm have been shown to direct inner ear fate.

Development and Evaluation of a Mandatory Course in Geriatric Medicine for Fourth Year Medical Students.

Background And Objectives: As the population ages, older adults will make up an increasing proportion of the practices of most physicians. Because of this, education of medical students in Geriatric Medicine is essential, yet there is considerable variability in the amount, timing within the curriculum, and content of geriatric training in Medical Schools. Our goal was to develop and evaluate an integrated, mandatory 3-week geriatric medicine course for fourth year medical students with emphasis on knowledge acquisition.

Prevalence and outcomes of delirium in community and non-acute care settings in people without dementia: a report from the Canadian Study of Health and Aging.

Background: While delirium is common among older adults in acute care hospitals, its prevalence in other settings has been less well studied. We examined delirium prevalence and outcomes in a large cohort of older Canadians living outside of acute care.

Methods: In this secondary analysis of the Canadian Study of Health and Aging, the prevalence of clinically diagnosed delirium was estimated and five-year survival was compared with that of individuals with dementia of graded severity.

Incomplete functional recovery after delirium in elderly people: a prospective cohort study.

Background: Delirium often has a poor outcome, but why some people have incomplete recovery is not well understood. Our objective was to identify factors associated with short-term (by discharge) and long-term (by 6 month) incomplete recovery of function following delirium.

Methods: In a prospective cohort study of elderly patients with delirium seen by geriatric medicine services, function was assessed at baseline, at hospital discharge and at six months.

A 3 Week Geriatric Education Program for 4 Year Medical Students at Dalhousie University.

Purpose -Population demographics are shifting towards an increased average age. Yet, many medical schools still do not have mandatory comprehensive education in Geriatric Medicine. In 2001, the Division of Geriatric Medicine at Dalhousie University developed a required three-week geriatric course for fourth year medical students.

Office management of elderly hypertensive patients. Focusing on cognition and function.

Objective: To review office management of elderly hypertensive patients and to focus on cognition and function both as ways to stratify who gets treated and as end points for treatment.

Quality Of Evidence: Relevant papers were identified through a MEDLINE search from January 1994 to March 2000, using the MeSH terms hypertension, aged, aged 80 and over, cognition, activities of daily living, therapeutics, hypotension orthostatic, and dementia. Many well conducted randomized controlled trials were found and are included.

Recommendations of the Canadian Consensus Conference on Dementia--dissemination, implementation, and evaluation of impact.

Background: Subsequent to the development of consensus statements on a clinical topic, it is vital to establish a plan for dissemination, implementation and evaluation of impact. Consensus statements can be used for both guiding continuing medical education (CME) and producing clinical practice guidelines (CPGs). Insufficient attention to dissemination can lead to a failure to change physician behaviour and improve patient outcomes.

Relationship between timed 'up and go' and gait time in an elderly orthopaedic rehabilitation population.

Objective: To analyse the relationship between the timed 'up and go' (TUG) and gait time in an elderly orthopaedic population, in order to determine whether additional useful information is obtained by measuring both.

Design: Observational study.

Setting: Jewish Rehabilitation Hospital, Laval, Quebec.

Predictors of restful sleep in a rehabilitation hospital.

The effect of hypnotic use on self-rated quality of sleep and therapist-rated level of alertness was examined in an inpatient rehabilitation setting. We examined what other factors were predictive of a restful sleep in this population. Seventy-five inpatients at the Jewish Rehabilitation Hospital in Montreal were included.