The Implementation of a Geriatrics Co-Management Model of Care Reduces Hospital Length of Stay.

(1) Background: Older adults comprise a large proportion of hospitalized patients. Many are frail and require complex care. Geriatrics has developed models of care specific to this inpatient population. Our objective was to demonstrate the effect of a geriatric co-management team on clinical administrative indicators of care in Clinical Teaching Units (CTUs) that have adopted the Age-friendly Hospital (AFH) principles in Brazilian hospitals. (2) Methods: Following 3 months of implementation of the AFH principles in CTUs, two periods of the same 6 months of two consecutive years were compared. (3) Results: The total number of participants in the study was 641 and 743 in 2015 and 2016, respectively. Average length of patient-stay (length of stay: 8.7 ± 2.7 vs. 5.4 ± 1.7 days) and number of monthly complaints (44.2 ± 6.5 vs. 13.5 ± 2.2) were significantly lower with the co-management model. Number of homecare service referrals/month was also significantly higher (2.5 ± 1 vs. 38.3 ± 6.3). The 30-day readmission rates and total hospital costs per patient remained unchanged. (4) Conclusion: The presence of a geriatric co-management team in CTUs is of added benefit to increase the efficiency of the AFH for vulnerable older inpatients with reduced LOS and increased referrals to homecare services without increasing hospital costs.

Electrocardiographic features at rest and during exercise in young adults born preterm below 30 weeks of gestation.

BACKGROUND: Preterm birth has adverse consequences on the cardiovascular system. Whether premature birth is associated with conduction and repolarisation abnormalities past childhood and into adulthood still needs to be demonstrated. METHODS: We analyzed the ECG of young adults (23.9 ± 3.1 years) born term (≥37 weeks, n = 53) and preterm (<30 weeks, n = 49) at rest, peak exercise and 3 min into recovery during an exercise test on a cycle ergometer. We measured PR, QRS and QT intervals, calculated the corrected QT (QTc), and determined blood calcium, magnesium, potassium and fasting glucose. RESULTS: Mean gestational age was 39.7 ± 1.1 and 27.3 ± 1.3 weeks for the term and the preterm groups, respectively. Apart from an increased heart rate at rest in individuals born preterm, no significant difference was found between both groups for any other ECG parameters at rest. None of the participants had a severely prolonged QTc (>500 ms) at rest; exercise revealed severely prolonged QTc in two participants including one in the preterm group. The use of QT-prolonging medications did not influence ECG parameters in either groups. CONCLUSIONS: We observed no significant difference in electrocardiographic measurements between young adults born preterm and term. Current results do not support avoidance of QT-prolonging medications in individuals born preterm. IMPACT: Preterm birth is associated with adverse cardiovascular consequences in early adulthood, but controversial evidence exists regarding differences in electrocardiographic features between young individuals born term and preterm.This study aims to assess the differences in electrocardiographic features between young adults born term and preterm, at rest and during exercise training.In contrast with previously published data, we observed no significant difference in electrocardiographic measurements between young adults born preterm and term.Our study does not support that preterm birth itself exposes young adults to a higher risk of QT prolongation.Current results do not support avoidance of QT-prolonging medications in individuals born preterm.