European journal of internal medicine
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Eur. J. Intern. Med. · Mar 2016
Randomized Controlled TrialEffectiveness of a Geriatric Care Model for frail older adults in primary care: Results from a stepped wedge cluster randomized trial.
Primary care-based comprehensive care programs have the potential to improve outcomes in frail older adults. We evaluated the impact of the Geriatric Care Model (GCM) on the quality of life of community-dwelling frail older adults. ⋯ The GCM did not show beneficial effects on quality of life in frail older adults in primary care, compared to usual care. This study strengthens the idea that comprehensive care programs add very little to usual primary care for this population.
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Eur. J. Intern. Med. · Mar 2016
The alertness, gait and mortality of severely ill patients at two months after admission to a resource poor sub-Saharan hospital--Why is post-discharge surveillance not routine everywhere?
Mortality, the first level of the first tier of the Outcomes Measures Hierarchy used to assess the value of health care, is the only hospital outcome usually measured. Gait and alertness after discharge are important to patients; they capture much of the second level of the first tier of the hierarchy, and are required to more fully assess the benefits, value and quality of care. ⋯ In a resource poor setting gait and alertness assessments are of prognostic value, and practical and informative methods of patient follow-up.
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Eur. J. Intern. Med. · Mar 2016
Comparative StudyClinical findings of bacteremic septic arthritis according to the site of acquisition: The overlap between health care-related and community- and nosocomial-acquired cases.
The site of acquisition of infection may have a major impact on outcome. The health care-related (HCR) environment has recently come under scrutiny. In a group of patients with bacteremic septic arthritis (SA), we compared their characteristics, type of SA, microbiology and prognosis according to the site of acquisition: community-acquired (CA), nosocomial-acquired (NA), and HCR. ⋯ The characteristics of HCR-SA overlapped with those of the CA or NA-SA cases. The HCR and NA cases presented more advanced age, greater fragility, and the predominance of difficult-to-treat microorganisms, while the HCR and CA cases presented an involvement of the axial skeleton, streptococcal etiology, and a lower number of prosthetic joint infections. Our data show that the site of acquisition should be considered when planning diagnostic and therapeutic management for SA.