A longitudinal cohort study evaluating the impact of a geriatrician-led residential care outreach service on acute healthcare utilisation.

BACKGROUND: over the last decade, high demand for acute healthcare services by long-term residents of residential care facilities (RCFs) has stimulated interest in exploring alternative models of care. The Residential Care Intervention Program in the Elderly (RECIPE) service provides expert outreach services to RCFs residents, interventions include comprehensive care planning, management of inter-current illness and rapid access to acute care substitution services. OBJECTIVE: to evaluate whether the RECIPE service decreased acute healthcare utilisation. DESIGN: a retrospective cohort study using interrupted time series analysis to analyse change in acute healthcare utilisation before and after enrolment. SETTING: a 300-bed metropolitan teaching hospital in Australia and 73 RCFs within its catchment. SUBJECTS: there were 1,327 patients enrolled in the service with a median age of 84 years; 61% were female. METHODS: data were collected prospectively on all enrolled patients from 2004 to 2011 and linked to the acute health service administrative data set. Primary outcomes change in admission rates, length of stay and bed days per quarter. RESULTS: in the 2 years prior to enrolment, the mean number of acute care admissions per patient per year was 3.03 (SD 2.9) versus post 2.4 (SD 3.3), the service reducing admissions by 0.13 admissions per patient per quarter (P = 0.046). Prior to enrolment, the mean length of stay was 8.6 (SD 11.0) versus post 3.5 (SD 5.0), a reduction of 1.5 days per patient per quarter (P = 0.003). CONCLUSIONS: this study suggests that an outreach service comprising a geriatrician-led multidisciplinary team can reduce acute hospital utilisation rates.

The case for the rope-pump in Africa: a comparative performance analysis.

The conventional handpump is the most popular technology choice for improved potable water supplies in rural sub-Saharan Africa. To date, however, it has failed to deliver satisfactory levels of sustainability, largely due to inadequate maintenance capacity. An alternative option to standardised imported handpumps is the locally manufactured rope-pump, which is considerably cheaper and easier to maintain but has been rejected in the past due to fears of impaired water quality. This paper presents the key aspects of a study in northern Ghana which compared the performance of rope-pumps with that of conventional handpumps, to determine whether or not the rope-pump provides a viable alternative for community water supplies across the subcontinent. User interviews, sanitary surveys, water quality analyses and technical performance measurements were used to develop a comparative performance analysis for the two pump types. The findings of the study indicated that the rope-pump out-performed the conventional handpump on the majority of counts and that, contrary to widespread perceptions, there was no significant difference between pump types with respect to the impact on microbiological water quality. Consequently, the rope-pump provides a significant technological opportunity to improve water supply sustainability in Africa.

Implementing evidence-based guidelines:inpatient management of chronic obstructive pulmonary disease.

BACKGROUND: Evidence-based guidelines exist to guide inpatient management of chronic obstructive pulmonary disease (COPD) exacerbations, but we do not know how well these recommendations are adhered to. AIMS: The aims of this study were: (i) to examine concordance with evidence based guidelines for inpatient management of COPD and (ii)to address deficiencies in compliance with guidelines by feedback of audit results and distribution of an education package. METHODS: Retrospective chart reviews were performed using a data collection tool based on current guidelines. Forty-nine consecutive COPD admissions were audited, and results presented to medical staff. An education package was distributed directly after the presentation. One month later,35 consecutive separations were reviewed. Concordance with recommendations supported by the highest level of evidence was calculated. RESULTS: Data were complete for 84 cases. Concordance rates ranged from 0 to 100%. Apart from initiation of systemic steroids (80-83%)and avoidance of intravenous aminophylline (100%),concordance rates were less than 60%. The only significant improvement post-intervention was for steroid duration (10 vs 29%,95% confidence interval for difference (-36.2, -1.8)). CONCLUSION: Recommendations for steroid initiation and avoidance of aminophylline are well adhered to. Concordance rates for other recommendations were generally less than 60%. Concordance with recommendations for steroid duration was significantly improved by our intervention. The findings suggest that to facilitate evidence-based practice, alternative interventions should be evaluated.

Residential smoke alarms and fire escape plans.

OBJECTIVE: To estimate the proportion of U.S. homes with installed smoke alarms, smoke alarms on the same floor as occupants' bedrooms, and fire escape plans. METHODS: The authors analyzed data on smoke alarm use and fire escape planning from a 1994 stratified random telephone survey of 5238 U.S. households. RESULTS: Respondents from 91% of surveyed households reported the presence of at least one installed smoke alarm, and 94% of respondents reported having an alarm on the same level of the home as their sleeping area. The prevalence of installed smoke alarms varied by highest education level in the household and income level. Sixty percent of all households had designed or discussed a fire escape plan at least once; only 17% of these households had actually practiced one. CONCLUSIONS: Although overall use of smoke alarms was high, certain population subgroups were less likely to have smoke alarms or to have them installed on the same floor as bedrooms. Fire escape planning, another important safety measure, was somewhat less common, and very few respondents reported having practiced a fire escape plan with the members of their household.

Primary sebaceous carcinoma of lacrimal gland: a previously unreported primary neoplasm.

We describe a patient who presented with a rapidly growing neoplasm of the lacrimal gland which histologically was a sebaceous gland carcinoma. The eyelid was entirely normal on examination under anaesthesia. Sebaceous differentiation has been described on only three previous occasions, arising within pre-existing tumours of the lacrimal gland such as pleomorphic adenoma. In this case there is a single tumour cell line within normal lacrimal gland, and the eyelid is normal. This points to a previously unreported diagnosis of primary sebaceous carcinoma of the lacrimal gland.