Rapid emergency department intervention for older people reduces risk of functional decline: results of a multicenter randomized trial.

OBJECTIVES: To determine the effectiveness of a two-stage (screening and nursing assessment) intervention for older patients in the emergency department (ED) who are at increased risk of functional decline and other adverse outcomes. DESIGN: Controlled trial, randomized by day of ED visit, with follow-up at 1 and 4 months. SETTING: Four university-affiliated hospitals in Montreal. PARTICIPANTS: Patients age 65 and older expected to be released from the ED to the community with a score of 2 or more on the Identification of Seniors At Risk (ISAR) screening tool and their primary family caregivers. One hundred seventy-eight were randomized to the intervention, 210 to usual care. INTERVENTION: The intervention consisted of disclosure of results of the ISAR screen, a brief standardized nursing assessment in the ED, notification of the primary care physician and home care providers, and other referrals as needed. The control group received usual care, without disclosure of the screening result. MEASUREMENTS: Patient outcomes assessed at 4 months after enrollment included functional decline (increased dependence on the Older American Resources and Services activities of daily living scale or death) and depressive symptoms (as assessed by the short Geriatric Depression Scale). Caregiver outcomes, also assessed at baseline and 4 months, included the physical and mental summary scales of the Medical Outcomes Study Short Form-36. Patient and caregiver satisfaction with care were assessed 1 month after enrollment. RESULTS: The intervention increased the rate of referral to the primary care physician and to home care services. The intervention was associated with a significantly reduced rate of functional decline at 4 months, in both unadjusted (odds ratio (OR) = 0.60, 95% confidence interval (CI) = 0.36-0.99) and adjusted (OR = 0.53, 95% CI = 0.31-0.91) analyses. There was no intervention effect on patient depressive symptoms, caregiver outcomes, or satisfaction with care. CONCLUSION: A two-stage ED intervention, consisting of screening with the ISAR tool followed by a brief, standardized nursing assessment and referral to primary and home care services, significantly reduced the rate of subsequent functional decline.

Stress and residents' lifestyle. Survey of family medicine residents at McGill University.

To study the effects of training on quality of life and work satisfaction, we distributed questionnaires to all McGill family medicine residents. Residents lacked leisure time and were concerned that the heavy workload would affect subsequent quality of care. However, they adapted well to the stress of training. A spouse or partner was an important source of support.

[Not Available]. / La vaccination comme activité préventive dans une unité de médecine familiale.

Because we are concerned with the teaching of preventive medicine to residents in family medicine, we decided to implement a vaccination study to evaluate residents' efficacy in preventing infectious diseases. After collecting each patient's past history of infectious diseases and vaccination the residents completed the necessary vaccination according to protocol, over one year. We used the one-tail hypothesis test of proportion to verify significant differences in the proportion of patients not well immunized at the end of the study, compared with the beginning, for each vaccine studied. We found no statistically significant difference for vaccination against whooping cough, measles and mumps; there was a significant difference for vaccination against tetanus, diphtheria, polio and rubeola (P:0.01).

[Not Available]. / Travail d'équipe: omnipraticien, orthophoniste et audiologiste.

The Speech and Hearing Department of the University of Montréal, in conjunction with 'l'Unité de médecine familiale de Verdun' set up a pilot project grouping family doctors, audiologists and speech pathologists. Information was exchanged on speech and language problems in children, stuttering, voice disorders, aphasia and hearing problems in children and adults. We emphasized the importance of early detection of these problems, of adequate information to the patient and his family and referral to the speech pathologist or to the audiologist. The results of this experience showed the importance of close collaboration between family doctors and communication specialists.