Sustainability of a proactive geriatric trauma consultation service.

BACKGROUND: Proactive geriatric trauma consultation service (GTCS) models have been associated with better delivery of geriatric care and functional outcomes. Whether such collaborative models can be improved and sustained remains uncertain. We describe the sustainability and process improvements of an inpatient GTCS. METHODS: We assessed workflow using interviews and surveys to identify opportunities to optimize the referral process for the GTCS. Sustainability of the service was assessed via a prospective case series (July 2012-December 2013). Study data were derived from a review of the medical record and trauma registry database. Metrics to determine sustainability included volume of cases, staffing levels, rate of adherence to recommendations, geriatric-specific clinical outcomes, trauma quality indicators, consultation requests and discharge destination. RESULTS: Through process changes, we were able to ensure every eligible patient was referred for a comprehensive geriatric assessment. Compared with the implementation phase, volume of assessments increased and recommendation adherence rates were maintained. Delirium and/or dementia were the most common geriatric issue addressed. The rate of adherence to recommendations made by the GTCS team was 88.2%. Only 1.4% of patients were discharged to a nursing home. CONCLUSION: Workflow assessment is a useful means to optimize the referral process for comprehensive geriatric assessment. Sustainability of a GTCS was shown by volume, staffing and recommendation adherence.

Les modèles de services de consultation proactifs en traumatologie gériatrique ont été associés à une amélioration des soins gériatriques et des capacités fonctionnelles. Toutefois, on ignore toujours s'il est possible de perfectionner et de maintenir ces modèles collaboratifs. Nous décrivons donc ici la viabilité et l'amélioration des procédures d'un service de consultation en traumatologie gériatrique en milieu hospitalier.

High prevalence of abnormal menstruation among women living with HIV in Canada.

OBJECTIVES: To measure the prevalence and correlates of abnormal menstruation among women living with HIV (WLWH) in Canada. METHODS: We used cross-sectional questionnaire data from the community-based Canadian HIV Women's Sexual and Reproductive Health Cohort Study (CHIWOS), which enrolled WLWH aged ≥16 from British Columbia (BC), Ontario, and Quebec. For this analysis, we excluded women >45 years, who had primary amenorrhea, were pregnant, on hormonal contraception, or who reported history of endometrial cancer, last menstrual period >12 months ago, or premature ovarian failure. The primary outcome was abnormal menstruation (Yes vs No) based on responses to five questions about menstrual regularity, frequency, volume, duration, and intermenstrual bleeding in the six months prior to interview. An exploratory multivariable logistic regression analysis examined independent correlates of abnormal menstruation. RESULTS: Of 1422 women enrolled, 521 (37%) met eligibility criteria. Overall, 55.9% (95% CI:52%-60%) reported abnormal menstruation. In adjusted analyses, abnormal menstruation was associated with having a biologic sister/mother who entered menopause before age 40 (AOR 5.01, 95%CI 1.39-18.03), Hepatitis B co-infection (AOR 6.97, 95%CI 1.52-31.88), current smoking (AOR 1.69, 95%CI 1.55-3.41); and currently taking antiretroviral therapy (ART) (AOR 2.36, 95%CI 1.25-4.45) compared to being ART-naïve. Women in BC had higher adjusted odds of abnormal menstruation (AOR 2.95, 95%CI 1.61-5.39), relative to women in Ontario and Quebec. CONCLUSIONS: Over half of WLWH in this analysis had abnormal menstruation. Correlates of abnormal menstruation include genetic, socio-behavioural factors (province of residence, smoking), Hepatitis B co-infection, and current ART use.