[Hospital case management].

Due to demographic changes, rising health expenditures, and the reimbursement mechanisms of insurers in the past 30 years, physicians and nurses have had to change the way services are delivered. Concepts such as cost effectiveness and patient safety have also led to the emergence of case management. Case management, usually led by nurses, is responsible for early recognition of patients at high risk for prolonged hospitalization, readmission, a high level of consumption of healthcare resources, and mobilizing strategies to discharge patients as soon as possible in a safe manner with appropriate medical follow-up.

Perioperative management of the elderly undergoing eye surgery.

Eye procedures are considered to be low risk; however, many ophthalmic surgery patients are elderly and are a unique vulnerable group with a myriad of concomitant health issues that put them at greater risk for perioperative medical complications. A trend to shift operative venues from hospitals to ambulatory facilities and more recently to specialty eye-care surgery centers limits the resources available to manage major, and even minor, medical issues that arise on the day of surgery. The role of the internist in the preoperative evaluation and optimization of medical issues before surgery and availability for perioperative consultation and intercession is increasingly essential.

Differences in presentation and outcome of invasive pneumococcal disease among patients with and without HIV infection in the pre-HAART era.

Invasive pneumococcal disease (PD) occurs frequently among HIV-infected patients, but it is unclear whether its manifestations and outcome are different compared to those observed among patients without HIV-1 infection. Because the immune reconstitution that accompanies antiretroviral therapy may change some of these features and because most cases of HIV- 1 infection occur in resource-poor settings of the world where access to antiretroviral agents is limited, we compared PD among patients with and without HIV-1 infection in a North American population before the introduction of highly active antiretroviral therapy (HAART). The records of all pneumococcal cultures processed at this medical center over a period of 20 months were used to identify patients with invasive PD.