Admission of elderly medical patients to fast track or standard hospitalisation: protocol for a randomised trial.

INTRODUCTION: Emergency department-based short stay units (SSUs) are increasingly being introduced to provide accelerated care. The effects of treatment in SSUs for elderly medical patients are not well-studied. METHODS: The ELDER trial is a single-blinded, randomised parallel trial with 1:1 allocation between hospitalisation in an SSU (intervention) and the Department of Internal Medicine (standard care). The study is conducted at Holbaek Hospital, Denmark. Elderly patients are screened for inclusion if an emergency physician assesses that treatment in an SSU is possible. Eligible participants are patients aged ≥ 75 years needing in-hospital treatment of an acute medical problem and who are stable upon admission. The primary outcome is 90-day all-cause mortality. Secondary outcomes include: length of stay in hospital, incidence of complications during hospitalisation, rate of unplanned readmissions and change in instrumental activities of daily living. We aim at recruiting 430 patients based on an estimated effects size of reducing mortality by 10%. All outcome measures will be assessed in an intention-to-treat analysis. Recruitment started on 5 January 2015. By 16 October 2015, we have enrolled 203 patients. An interim safety analysis is scheduled. CONCLUSION: In the ELDER trial, we explore benefits and harms related to treatment in an SSU for elderly medical patients compared with standard hospitalisation. FUNDING: Region Zealand's Forskningsfond, the Tryg Foundation and University of Copenhagen. TRIAL REGISTRATION: clinicaltrials.gov identifier: NCT02395718.

[What is the pedagogical development function of Region East, Denmark used for?]. / Hvad bruges Den Paedagogisk Udviklende Funktion i Region Øst til?

Implementing a reform of postgraduate medical education in Denmark (2004), a pedagogical development function (PDF) which employs clinical associate professors (CAP) was established. To evaluate the impact of the PDF and the CAP, 1,355 questionnaires were mailed to physicians in eastern Denmark: 687 (51%) replied, 114 (17%) expressed knowledge of the PDF and 75 (11%) reported a personal contact to the PDF. The rather low knowledge of the PDF may be due to the CAPs' involvement in several educational functions at the same time which may impede identification of the ''true" efforts of the CAP/PDF.

[Analysis of deaths during hospitalization and after discharge from hospital]. / Analyse af dødsfald under og efter hospitalsindlaeggelse.

INTRODUCTION: Analysis of deaths during and up to one month after discharge from hospital. MATERIALS AND METHODS: For 2006, all deaths during and up to one month after discharge were identified for patients admitted to hospital in Roskilde or Køge. Age, acute or planned hospitalisation, duration of in-hospital stay, department of discharge and main diagnose were registered. RESULTS: Out of 50,302 hospitalisations, 2.2% had a fatal outcome during hospitalisation, whereas 2.1% died within the following month. During hospitalisation, the proportion of deaths among patients with either planned or acute admission was 1.1% and 2.6%, respectively. For several diagnose groups the risk of death during the first month after discharge was higher than that of fatal outcome during hospitalisation. The diagnose groups most frequently related to fatal outcome were cancers, infectious diseases, cardiovascular diseases and respiratory diseases. Pneumonia was the most prevalent benign diagnosis for fatal cases during hospitalisation. Data are provided for mortality related to diagnose and age group. The incidence of fatal outcome increased with the length of in-patient stay. CONCLUSION: Analysis of fatality rates also during planned hospitalisations and within the first month after acute as well as planned hospitalisations should be in focus when planning quality improvement projects.

Does a distal forearm fracture lead to evaluation for osteoporosis? A retrospective cohort study in 147 Danish women.

In postmenopausal women, a low-trauma distal forearm fracture is a risk factor for osteoporosis and future fracture, which indicates osteoporosis follow-up according to prevailing guidelines. We decided to determine how often women over 45 yr presenting with a low-trauma distal forearm fracture to a Danish emergency department during a 1-yr period were followed up for osteoporosis. We performed a retrospective review of hospital records and we sent the women and their general practitioners (GPs) questionnaires regarding the follow-up undertaken in primary care. Finally, we invited the women for a densitometry to estimate the prevalence of osteoporosis. From May 1, 2001 to April 30, 2002, 147 women presented with a low-trauma distal forearm fractures. According to the review of hospital records, none of the women was referred for bone densitometry or spine X-rays. One woman had calcium and vitamin D supplementation (CVDS) prescribed and two were recommended to consult their GPs for osteoporosis follow-up. In primary care, 12 women were referred for densitometry or spine X-rays, and 11 women started CVDS after the fracture. Women with risk factors for osteoporosis in addition to the forearm fracture were not more likely to be referred for densitometry or spine X-rays (p = 0.10). The prevalence of osteoporosis was 24% among the 79 women who underwent densitometry. Our study demonstrates a low use of available measures to reduce the risk of future fracture in women with a low-trauma distal forearm fracture, and it emphasizes the need to decide on a local level how to provide osteoporosis follow-up for women with fragility fractures.

Body composition measured by dual-energy X-ray absorptiometry in patients who have undergone small-intestinal resection.

BACKGROUND: Patients who have undergone resection of the small intestine have lower body weight than do healthy persons. It remains unclear whether it is the body fat mass or the lean tissue mass that is reduced. OBJECTIVE: We compared body-composition values in patients who had undergone small-intestinal resection with reference values obtained in healthy volunteers, and we studied the relation between body-composition estimates and the net intestinal absorption of energy. DESIGN: In a cross-sectional study, we included 20 men and 24 women who had undergone small-intestinal resection and had malabsorption of energy > 2000 kJ/d. Diagnoses were Crohn disease (n = 37) and other conditions (n = 7). Body composition was estimated by dual-energy X-ray absorptiometry, and data were compared with those from a reference group of 173 healthy volunteers. Energy absorption was measured during 48-h balance studies by using bomb calorimetry, and individual values were expressed relative to the basal metabolic rate. RESULTS: Body weight and body mass index in patients were significantly (P < 0.05) lower than the reference values. Fat mass was 6.4 kg (30%) lower (95% CI: -8.8, -3.9 kg), but lean tissue mass was only slightly and insignificantly lower (1.5 kg, or 3.3%; 95% CI: -3.7, 0.60 kg). Weight, body mass index, and body-composition estimates by dual-energy X-ray absorptiometry did not correlate significantly with the net energy absorption relative to the basal metabolic rate, expressed as a percentage. CONCLUSIONS: Patients who had undergone small-intestinal resection had significantly lower body weights and body mass indexes than did healthy persons, and they had significant changes in body composition, mainly decreased body fat mass.