The effectiveness of intermediate care including transitional care interventions on function, healthcare utilisation and costs: a scoping review.

Background and aim Intermediate care describes services, including transitional care, that support the needs of middle-aged and older adults during care transitions and between different settings. This scoping review aimed to examine the effectiveness of intermediate care including transitional care interventions for middle-aged and older adults on function, healthcare utilisation, and costs. Design A scoping review of the literature was conducted including studies published between 2002 and 2019 with a transitional care and/or intermediate care intervention for adults aged ≥ 50. Searches were performed in CINAHL, Cochrane Library, EMBASE, Open Grey and PubMed databases. Qualitative and quantitative approaches were employed for data synthesis. Results In all, 133 studies were included. Interventions were grouped under four models of care: (a) Hospital-based transitional care (n = 8), (b) Transitional care delivered at discharge and up to 30 days after discharge (n = 70), (c) Intermediate care at home (n = 41), and (d) Intermediate care delivered in a community hospital, care home or post-acute facility (n = 14). While these models were associated with a reduced hospital stay, this was not universal. Intermediate including transitional care services combined with telephone follow-up and coaching support were reported to reduce short and long-term hospital re-admissions. Evidence for improved ADL function was strongest for intermediate care delivered by an interdisciplinary team with rehabilitation at home. Study design and types of interventions were markedly heterogenous, limiting comparability. Conclusions Although many studies report that intermediate care including transitional care models reduce hospital utilisation, results were mixed. There is limited evidence for the effectiveness of these services on function, institutionalisation, emergency department attendances, or on cost-effectiveness. Electronic supplementary material The online version of this article (10.1007/s41999-020-00365-4) contains supplementary material, which is available to authorized users

Diagnosis and risk stratification of chest pain patients in the emergency department: focus on acute coronary syndromes. A position paper of the Acute Cardiovascular Care Association.

This paper provides an update on the European Society of Cardiology task force report on the management of chest pain. Its main purpose is to provide an update on the decision algorithms and diagnostic pathways to be used in the emergency department for the assessment and triage of patients with chest pain symptoms suggestive of acute coronary syndromes

Hello

https://creativematter.skidmore.edu/lib_stu_art_spring2011/1015/thumbnail.jp

Twice

https://creativematter.skidmore.edu/lib_stu_art_spring2011/1032/thumbnail.jp

Development of a municipal solid waste management decision support tool for Naples, Italy

Naples has experienced serious waste mismanagement during the last several decades. Illegal waste trafficking, the lack of an appropriate municipal solid waste management plan, and the subsidizing of energy generation from indiscriminate waste incineration generated social unrest and an unremitting paralysis of waste services throughout much of the late 1990s and early 2000s. The waste situation in Naples is a “hot spot” that cannot be simply described or explained by theoretical and linear models or analyses based on conventional waste indicators. A novel approach for the assessment of urban solid waste management system performance is proposed to overcome the limitations of conventional methods. When dealing with the production and use of scientific information for governance, scientists, especially those used to just “crunch numbers” have a serious problems in providing a useful input to the process of decision making. This paper presents a method useful for organizing a process of production and use of scientific information in which both scientists and the other social actors can have a bidirectional and constructive exchange of information. The goal of this method is to guarantee the quality of the process of generation and use of quantitative science to generate informed deliberations about policies over Municipal Solid Waste Management. The proposed approach builds on metabolic network theory and multi-scale integrated analysis of societal and ecosystem metabolism (MuSIASEM). The current metabolic pattern of municipal solid waste in the Metropolitan Area of Naples is described and quantified across hierarchical scales and dimensions. The analysis shows that the current Neapolitan waste management system is characterized by an elevated share (60%) of waste treated outside of the metropolitan ambit, and a low rate of separate collection (37%). Simulation of (i) metropolitan self-sufficiency of urban waste final disposal, and (ii) increased recycling rate show, respectively (i) an increase in both financial burden and local environmental impact; (ii) a lessening of the local environmental impact and an increase of running costs and higher need of local waste processing capacity

Urinary arsenic methylation and porphyrin profile of C57B1/6J mice chronically exposed to sodium arsenate

Arsenic interferes with the function of enzymes responsible for haem biosynthesis leading to alteration in the porphyrin profile. In this study, young female C57B1/6J mice were given drinking water containing 0, 100, 250 and 500 mu g As-V/L as sodium arsenate ad libitum for 24 months. 24 It pooled urine samples were collected bimonthly for urinary arsenic methylation and porphyrin analyses by HPLC-ICP-MS and HPLC respectively. The levels of total arsenic were significantly dose related except for the 2nd month interval. No significant differences in the urinary arsenic methylation pattern between control and test groups were observed. Coproporphyrin I (Copro I) showed a significant dose-response relationship after 12, 14 and 20 months of exposure. Significant differences in the levels of coproporphyrin III (Copro III) were observed in the 8th month in 250 and 500 mu g/L treatment groups and the dose-response pattern was maintained after 10 and 12 months. Our results suggest that urinary arsenic is a useful biomarker for internal dose, and that urinary coproporphyrin can be used as an early warning biomarker of effects before the onset of cancer. Crown Copyright (c) 2006 Published by Elsevier B.V. All rights reserved

Ketogenic diet guidelines for infants with refractory epilepsy

Background The ketogenic diet (KD) is an established, effective non-pharmacologic treatment for drug resistant childhood epilepsy. For a long time, the KD was not recommended for use in infancy (under the age of 2 years) because this is such a crucial period in development and the perceived high risk of nutritional inadequacies. Indeed, infants are a vulnerable population with specific nutritional requirements. But current research shows that the KD is highly effective and well tolerated in infants with epilepsy. Seizure freedom is often achieved and maintained in this specific patient group. There is a need for standardised protocols and management recommendations for clinical use. Method In April 2015, a project group of 5 experts was established in order to create a consensus statement regarding the clinical management of the KD in infants. The manuscript was reviewed and amended by a larger group of 10 international experts in the KD field. Consensus was reached with regard to guidance on how the diet should be administered and in whom. Results The resulting recommendations include patient selection, pre-KD counseling and evaluation, specific nutritional requirements, preferred initiation, monitoring of adverse effects at initiation and follow-up, evaluation and KD discontinuation. Conclusion This paper highlights recommendations based on best evidence, combined with expert opinions and gives directions for future research