Neurocognitive disorders: what are the prioritized caregiver needs? A consensus obtained by the Delphi method.

Background: The symptoms related to neurocognitive disorders (NCD) may lead to caregiver burden increase. Involving caregivers in research may be an effective way of improving the practicalities and relevance of interventions. The aim of this study was to gather opinion and gain consensus on the caregivers 'priorities, using a Delphi method and including aspects of needs in pharmaceutical dimension.

Severity of pain is associated with insufficient energy coverage in hospitalised patients: A cross-sectional study.

Background & Aims: The severity of pain is routinely assessed in hospitalised patients but the impact of pain and pain control on energy coverage has been poorly studied. This One-day cross-sectional observational study assessed the association between severity of pain and coverage of energy needs in hospitalised patients.

Methods: Foods provided and consumed were assessed on one day by dedicated dieticians for unselected hospitalised patients receiving three meals per day.

Integrated care at home reduces unnecessary hospitalizations of community-dwelling frail older adults: a prospective controlled trial.

Background: Care of frail and dependent older adults with multiple chronic conditions is a major challenge for health care systems. The study objective was to test the efficacy of providing integrated care at home to reduce unnecessary hospitalizations, emergency room visits, institutionalization, and mortality in community dwelling frail and dependent older adults.

Methods: A prospective controlled trial was conducted, in real-life clinical practice settings, in a suburban region in Geneva, Switzerland, served by two home visiting nursing service centers.

Reliability of the revised Swiss Emergency Triage Scale: a computer simulation study.

Background: The Swiss Emergency Triage Scale (SETS) is a four-level emergency scale that previously showed moderate reliability and high rates of undertriage due to a lack of standardization. It was revised to better standardize the measurement and interpretation of vital signs during the triage process.

Objective: The aim of this study was to explore the inter-rater and test-retest reliability, and the rate of correct triage of the revised SETS.

Identification and comparison of the predictors of maximal inspiratory force and handgrip in a healthy elderly population. The proof study.

Background: A severe weakness of peripheral muscles occurs in half of the persons aged 80 years or older. The common factors between muscle depletion and reduced respiratory strength have not yet been established.

Objective: In the subjects of the Proof cohort, we aimed to identify, among body composition, pulmonary function and energy expenditure parameters, the predictors of maximal inspiratory pressure (MIP) as an index of respiratory muscle strength and handgrip (HG) as an index of peripheral muscle strength.

Healthcare-associated infections are associated with insufficient dietary intake: an observational cross-sectional study.

Background: Indicators to predict healthcare-associated infections (HCAI) are scarce. Malnutrition is known to be associated with adverse outcomes in healthcare but its identification is time-consuming and rarely done in daily practice. This cross-sectional study assessed the association between dietary intake, nutritional risk, and the prevalence of HCAI, in a general hospital population.

Impaired baroreflex sensitivity and the risks of new-onset ambulatory hypertension, in an elderly population-based study.

Background: Impairment of the autonomic nervous system activity may be involved in the development of hypertension. Yet the prognostic values of heart rate variability and baroreflex sensitivity in the risk of new-onset ambulatory hypertension have not been investigated. We sought to assess the relationship between heart rate variability and baroreflex sensitivity parameters and ambulatory hypertension in a community-dwelling elderly cohort.

Primary attributions in women suffering fibromyalgia emphasize the perception of a disruptive onset for a long-lasting pain problem.

Objective: Fibromyalgia (FM) is a chronic musculoskeletal pain disorder characterized by widespread pain. This study focuses on patients' attributions of illness and of symptom onset.

Methods: Semi-structured interviews were conducted with 56 women to elicit patients' views on what triggered their FM.

Depressive symptoms and autonomic nervous system dysfunction in an elderly population-based study: the PROOF study.

Background: To assess the relationship between depressive symptoms, evaluated through self-reported history as well as current depressive symptoms, and impaired autonomic nervous system activity, evaluated by long-term heart rate variability and baroreflex sensitivity among elderly community residents, aged 65 years.

Methods: Subjects from the Proof cohort Study were evaluated for depressive symptoms and self-reported history of depression at inclusion. Autonomic nervous system activity was assessed through 24-h heart rate variability and baroreflex sensitivity.

Fondaparinux versus enoxaprin in the management of acute coronary syndromes in Switzerland: A cost comparison analysis.

Question Under Study: Anticoagulation therapy is routinely used in cases of non ST-segment elevation acute coronary syndromes (NSTE-ACS). The most commonly used drug in such events is enoxaparin, a low molecular weight heparin. Fondaparinux, a synthetic pentasaccharide, is as effective as enoxaparin in terms of survival or residual angina pectoris and significantly reduces bleeding complications.

Obstructive sleep apnea and the metabolic syndrome in an elderly healthy population: the SYNAPSE cohort.

Background: Obstructive sleep apnea syndrome (OSA) has been recently considered as a cause and a component of the metabolic syndrome (MetS), previous studies showing the presence of OSA in about half of middle-aged patients having MetS. To date, no study has considered the association of OSA and MetS in the elderly. In this study we examine the prevalence of MetS and its strength association among healthy elderly OSA subjects.

Increased waist circumference is the component of metabolic syndrome the most strongly associated with elevated C-reactive protein in elderly.

Background: Metabolic syndrome is associated with higher C-reactive protein (CRP) serum levels, a common biological marker of inflammation. However, the respective contribution of each component of metabolic syndrome to the inflammation has not been established. The aim of the present study was to assess the strength of the association between metabolic syndrome components and CRP in elderly subjects.

Body composition changes over 9 years in healthy elderly subjects and impact of physical activity.

Background & Aims: Age-related changes of body composition affect health status. This study aims at clarifying body composition changes in healthy elderly subjects, and evaluating the impact of physical activity on these changes.

Methods: In 1999, 213 subjects ≥ 65 years recruited through advertisements underwent assessment of health state, energy expenditure by physical activity, body composition by bioimpedance analysis and body cell mass by total body potassium.

Assessment of food intake in hospitalised patients: a 10-year comparative study of a prospective hospital survey.

Background & Aims: A food quality control and improvement permanent process was initiated in 1999. To evaluate the food service evolution, protein-energy needs coverage were compared in 1999 and 2008 with the same structure survey in all hospitalized patients receiving 3 meals/day.

Methods: Nutritional values of food provided, consumed and wasted over 24h including non-exclusive nutritional support were calculated individually.

Reduction of missed appointments at an urban primary care clinic: a randomised controlled study.

Background: Missed appointments are known to interfere with appropriate care and to misspend medical and administrative resources. The aim of this study was to test the effectiveness of a sequential intervention reminding patients of their upcoming appointment and to identify the profile of patients missing their appointments.

Methods: We conducted a randomised controlled study in an urban primary care clinic at the Geneva University Hospitals serving a majority of vulnerable patients.

Autonomic nervous system activity is independently associated with the risk of shift in the non-dipper blood pressure pattern.

An insufficient decrease in nocturnal blood pressure (BP) is a known factor in cardiovascular mortality. We aimed to determine whether autonomic nervous system (ANS) activity and its change over 2 years were associated with a shift to non-dipper status, independently of initial BP, in a general elderly population. From participants in the PROOF study, 600 subjects untreated for hypertension were selected (age at baseline: 65 years, men: 41.

Stairs instead of elevators at workplace: cardioprotective effects of a pragmatic intervention.

Background: Population strategies to increase physical activity are an essential part of cardiovascular disease prevention. However, little data exist on lifestyle interventions that are easy to integrate into everyday life such as using stairs instead of elevators at the workplace.

Design: Pre and postintervention study.

Plasma citrulline is a marker of absorptive small bowel length in patients with transient enterostomy and acute intestinal failure.

Background & Aims: Small bowel disruption is often complicated by acute intestinal failure and can be corrected by chyme reinfusion (CR). Plasma citrulline ([Cit]) is a biomarker of the enterocyte mass. Our aim was to determine whether [Cit] could be a marker of absorptive intestinal mass or function by assessing whether CR could affect intestinal absorptive function and [Cit].

C-reactive protein implications in new-onset hypertension in a healthy population initially aged 65 years: the Proof study.

Background: Because inflammation is known to be related with several cardiovascular diseases, we sought to determine whether C-reactive protein (CRP) might precede the onset of hypertension.

Methods: The study population was selected from the Proof study cohort including 1011 individuals initially aged 65 years at baseline and followed for 7 years. CRP, ambulatory blood pressure measurement (ABPM) and casual blood pressure were repeatedly measured during examination.

[Integrated care systems for elderly people].

The care of the frail elderly is characterised by fragmentation and discontinuity within and between sectors, resulting in frequent and inappropriate hospitalisations and premature nursing home placement. Integrated models of care in Europe, and North America have proven to be effective in improving health status, satisfaction and utilisation of resources in the frail elderly. The purpose of this article is to describe these programmes and the community geriatrics unit of Geneva, which provides health care to a frail elderly population in collaboration with other partners in the primary care sector.

Clinical relevance of parenteral nutrition prescription and administration in 200 hospitalized patients: a quality control study.

Background & Aims: Optimal implementation of parenteral nutrition (PN) is required to promote clinical outcome and costs control. This prospective quality control study examined if PN prescription was justified and PN administration was adequate to cover the nutritional needs of patients hospitalized in the Geneva University Hospital.

Methods: Two-hundred consecutive patients receiving PN were included from Medicine, Intensive Care or Surgery Units.

A predictive score to identify hospitalized patients' risk of discharge to a post-acute care facility.

Background: Early identification of patients who need post-acute care (PAC) may improve discharge planning. The purposes of the study were to develop and validate a score predicting discharge to a post-acute care (PAC) facility and to determine its best assessment time.

Methods: We conducted a prospective study including 349 (derivation cohort) and 161 (validation cohort) consecutive patients in a general internal medicine service of a teaching hospital.

Quality of care and survival of haemodialysed patients in western Switzerland.

Background: Many factors affect survival in haemodialysis (HD) patients. Our aim was to study whether quality of clinical care may affect survival in this population, when adjusted for demographic characteristics and co-morbidities.

Methods: We studied survival in 553 patients treated by chronic HD during March 2001 in 21 dialysis facilities in western Switzerland.

Patients' knowledge of drug treatments after hospitalisation: the key role of information.

Question Under Study: Patients often do not know the reasons for taking their medications after hospital discharge. We investigated whether lack of such knowledge was associated with patients' report of not having received information about their medications while hospitalised.

Methods: Patients with at least one long-term drug (ie, prescribed for more than 30 days) discharged from the wards of general internal medicine of a teaching hospital were included in the study.

Autonomic nervous system activity and decline as prognostic indicators of cardiovascular and cerebrovascular events: the 'PROOF' Study. Study design and population sample. Associations with sleep-related breathing disorders: the 'SYNAPSE' Study.

Background: Transversal studies have underlined the association between the decline in autonomic nervous system (ANS) activity and all-cause mortality. However, the predictive value of ANS has never been prospectively assessed in a general population-based cohort.

Method: The PROOF (PROgnostic indicator OF cardiovascular and cerebrovascular events) cohort study was designed to prospectively assess the predictive value of ANS activity level in the general population, with regard to cardiovascular and cerebrovascular events, and death.