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See detailThe effectiveness of inpatient geriatric evaluation and management units: a systematic review and meta-analysis.
Van Craen, Katleen; Braes, Tom; Wellens, Nathalie et al

in Journal of the American Geriatrics Society (2010), 58(1), 83-92

OBJECTIVES: To examine how geriatric evaluation and management units (GEMUs) are organized and to examine the effectiveness of admission on a GEMU. DESIGN: Systematic review and meta-analysis based on ... [more ▼]

OBJECTIVES: To examine how geriatric evaluation and management units (GEMUs) are organized and to examine the effectiveness of admission on a GEMU. DESIGN: Systematic review and meta-analysis based on literature search of multiple databases and the references lists of all identified articles and by contacting authors. SETTING: GEMUs. PARTICIPANTS: Elderly people admitted to a GEMU. MEASUREMENTS: Quality of the studies was assessed on 10 criteria. The outcome parameters were mortality, institutionalization, functional decline, readmission, and length of stay at different follow-up points. A random-effects meta-analysis was performed using Hedges' gu and variance of relative risk (RR). RESULTS: GEMUs are organized in a heterogeneous way and the included studies gave no thorough description of comprehensive geriatric assessment (CGA). Involvement of a multidisciplinary team was a key element in all GEMUs. The individual trials showed that admission to a GEMU has one or more favorable effects on the outcomes of interest, with two significant effects in the meta-analysis: less functional decline at discharge from the GEMU (RR=0.87, 95% confidence interval (CI)=0.77-0.99; P=.04) and a lower rate of institutionalization 1 year after discharge (RR=0.78, CI=0.66-0.92; P=.003). For the other outcomes in the meta-analysis, a GEMU did not induce significantly different outcomes than usual care. CONCLUSION: This meta-analysis shows a significant effect in favor of the GEMU group on functional decline at discharge and on institutionalization after 1 year. There is heterogeneity between the studies, poor quality of some randomized controlled trials, and shortage of information about CGA. Multidisciplinary CGA offered in a GEMU may add value to the care for frail older persons admitted to the hospital, but the limitations confirm the need for well-designed studies using explicit CGA and more-structured and -coherent assessment instruments such as the Minimum Data Set Resident Assessment Instrument. [less ▲]

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See detailEffect of a collaborative approach on the quality of prescribing for geriatric inpatients: a randomized controlled trial
Spinewine, A.; Swine, C.; Dhillon, S. et al

in Journal of the American Geriatrics Society (2007), 55(5), 658-665

OBJECTIVES: To evaluate the effect of pharmaceutical care provided in addition to acute Geriatric Evaluation and Management (GEM) care on the appropriateness of prescribing. DESIGN: Randomized, controlled ... [more ▼]

OBJECTIVES: To evaluate the effect of pharmaceutical care provided in addition to acute Geriatric Evaluation and Management (GEM) care on the appropriateness of prescribing. DESIGN: Randomized, controlled trial, with the patient as unit of randomization. SETTING: Acute GEM unit. PARTICIPANTS: Two hundred three patients aged 70 and older. INTERVENTION: Pharmaceutical care provided from admission to discharge by a specialist clinical pharmacist who had direct contacts with the GEM team and patients. MEASUREMENTS: Appropriateness of prescribing on admission, at discharge, and 3 months after discharge, using the Medication Appropriateness Index (MAI), Beers criteria, and Assessing Care of Vulnerable Elders (ACOVE) underuse criteria and mortality, readmission, and emergency visits up to 12 months after discharge. RESULTS: Intervention patients were significantly more likely than control patients to have an improvement in the MAI and in the ACOVE underuse criteria from admission to discharge (odds ratio (OR)=9.1, 95% confidence interval (CI)=4.2-21.6 and OR=6.1, 95% CI=2.2-17.0, respectively). The control and intervention groups had comparable improvements in the Beers criteria. CONCLUSION: Pharmaceutical care provided in the context of acute GEM care improved the appropriate use of medicines during the hospital stay and after discharge. This is an important finding, because only limited data exist on the effect of various strategies to improve medication use in elderly inpatients. The present approach has the potential to minimize risk and improve patient outcomes. [less ▲]

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See detailExtensive scalp necrosis and subepicranial abscess in a patient with giant cell arteritis
Smitz, Simon ULg; HEINEN, Vincent ULg; Van Damme, Hendrik ULg

in Journal of the American Geriatrics Society (2004), 52(1), 165-166

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See detailComparison of rectal and infrared ear temperatures in older hospital inpatients.
Smitz, Simon ULg; Giagoultsis, T; Dewé, Walthère ULg et al

in Journal of the American Geriatrics Society (2000), 48(1), 63-6

OBJECTIVES: To assess the agreement between infrared emission detection (IRED) ear and rectal temperatures and to determine the validity of IRED ear thermometry in detecting rectal fever. DESIGN ... [more ▼]

OBJECTIVES: To assess the agreement between infrared emission detection (IRED) ear and rectal temperatures and to determine the validity of IRED ear thermometry in detecting rectal fever. DESIGN: Prospective, convenience sample, unblinded study. SETTING: An acute geriatric unit (teaching hospital) and a multidisciplinary intensive care unit. PARTICIPANTS: The study included 45 inpatients (26 women and 19 men), aged 78.3+/-6.9 years, admitted over a 4-month period. Twelve of the patients were definitely infected. MEASUREMENTS: Sequential rectal (RT) and ear temperature (ET) measurements were performed using mercury-in-glass and IRED ear thermometers, respectively. IRED ear temperatures were measured at both ears (unadjusted mode), with the highest of six ear temperatures considered the true value. RESULTS: Mean RT (37.39 degrees C +/- 0.52 degrees C) was significantly (P<.001) higher than mean ET (36.89 degrees C +/-0.59 degrees C). A highly significant positive correlation was found between RT and ET (slope = 0.69; 95% CI, 0.52-0.86; P<.001; r = 0.78). The mean bias (mean of the differences) between RT and ET was 0.50 degrees C +/-0.37 degrees C (95% CI, 0.41 degrees C-0.59 degrees C), and the 95% limits of agreement -0.22 degrees C and 1.23 degrees C (95% CI, -0.38 degrees C to 1.39 degrees C). According to the standard criterion (RT > or =37.6 degrees C), 14 patients were febrile. Using an optimum IRED ear fever threshold (37.2 degrees C), the sensitivity and specificity of IRED ear thermometry for predicting rectal fever were 86% and 89%, respectively (positive predictive value, 80%; negative predictive value, 93%). CONCLUSIONS: The degree of agreement between rectal temperature and the highest of six IRED ear temperatures was acceptable. Using an optimal IRED ear fever threshold of 37.2 degrees C (99 degrees F), IRED ear thermometry had acceptable sensitivity and specificity for predicting rectal fever. [less ▲]

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