Development of a Comprehensive Approach for the Early Diagnosis of Geriatric Syndromes in General Practice.

According to demographic projections, a significant increase in the proportion of the elderly population is anticipated worldwide. This aging of the population will lead to an increase in the prevalence of chronic diseases and functional impairment. This expected increase will result in growing use of the health care system that societies are largely unprepared to address. General practitioners (GPs) are at the front line of this huge epidemiological challenge, but appropriate tools to diagnose and manage elderly patients in routine general practice are lacking. Indeed, while primary prevention and the management of common chronic diseases, such as hypertension, diabetes, or cardiac ischemic diseases, are routinely and mostly adequately performed in primary care, the management of geriatric syndromes is often incomplete. In order to address these shortcomings, this theoretical work aims to first develop, based on the best available evidence, a brief assessment tool (BAT) specifically designed for geriatric syndromes identification in general practice and, second, to propose a conceptual framework for the management of elderly patients in general practice that integrates the BAT instrument into the usual care of GPs. To avoid proposing unachievable goals for the care of elderly patients in general practice (for example, performing all the best screening tools for geriatric conditions identification and care), this work proposes an innovative way to combine geriatric assessment with the management of common chronic diseases

Two Gap State Density in MgB2_{2}: A True Bulk Property or A Proximity Effect?

We report on the temperature dependence of the quasiparticle density of states (DOS) in the simple binary compound MgB2 directly measured using scanning tunneling microscope (STM). To achieve high quality tunneling conditions, a small crystal of MgB2 is used as a tip in the STM experiment. The ``sample'' is chosen to be a 2H-NbSe2 single crystal presenting an atomically flat surface. At low temperature the tunneling conductance spectra show a gap at the Fermi energy followed by two well-pronounced conductance peaks on each side. They appear at voltages V$_{S}\simeq \pm 3.8$ mV and V$_{L}\simeq \pm 7.8$ mV. With rising temperature both peaks disappear at the Tc of the bulk MgB2, a behavior consistent with the model of two-gap superconductivity. The explanation of the double-peak structure in terms of a particular proximity effect is also discussed.Comment: 4 pages, 3 figure

Nonresonant microwave absorption in epitaxial La-Sr-Mn-O films and its relation to colossal magnetoresistance

We study magnetic-field-dependent nonresonant microwave absorption and dispersion in thin La$_{0.7}$Sr$_{0.3}$MnO$_{3}$ films and show that it originates from the colossal magnetoresistance. We develop the model for magnetoresistance of a thin ferromagnetic film in oblique magnetic field. The model accounts fairly well for our experimental findings, as well as for results of other researchers. We demonstrate that nonresonant microwave absorption is a powerful technique that allows contactless measurement of magnetic properties of thin films, including magnetoresistance, anisotropy field and coercive field.Comment: 20 pages, 11 figure

Intrinsic Low Temperature Paramagnetism in B-DNA

We present experimental study of magnetization in $\lambda$-DNA in conjunction with structural measurements. The results show the surprising interplay between the molecular structures and their magnetic property. In the B-DNA state, $\lambda$-DNA exhibits paramagnetic behaviour below 20 K that is non-linear in applied magnetic field whereas in the A-DNA state, remains diamagnetic down to 2 K. We propose orbital paramagnetism as the origin of the observed phenomena and discuss its relation to the existence of long range coherent transport in B-DNA at low temperature.Comment: 5 pages, 4 figures, submitted to Physical Review Letters October 200

A prospective study assessing agreement and reliability of a geriatric evaluation.

The present study takes place within a geriatric program, aiming at improving the diagnosis and management of geriatric syndromes in primary care. Within this program it was of prime importance to be able to rely on a robust and reproducible geriatric consultation to use as a gold standard for evaluating a primary care brief assessment tool. The specific objective of the present study was thus assessing the agreement and reliability of a comprehensive geriatric consultation. The study was conducted at the outpatient clinic of the Service of Geriatric Medicine, University of Lausanne, Switzerland. All community-dwelling older persons aged 70 years and above were eligible. Patients were excluded if they hadn't a primary care physician, they were unable to speak French, or they were already assessed by a geriatrician within the last 12 months. A set of 9 geriatricians evaluated 20 patients. Each patient was assessed twice within a 2-month delay. Geriatric consultations were based on a structured evaluation process, leading to rating the following geriatric conditions: functional, cognitive, visual, and hearing impairment, mood disorders, risk of fall, osteoporosis, malnutrition, and urinary incontinence. Reliability and agreement estimates on each of these items were obtained using a three-way Intraclass Correlation and a three-way Observed Disagreement index. The latter allowed a decomposition of overall disagreement into disagreements due to each source of error variability (visit, rater and random). Agreement ranged between 0.62 and 0.85. For most domains, geriatrician-related error variability explained an important proportion of disagreement. Reliability ranged between 0 and 0.8. It was poor/moderate for visual impairment, malnutrition and risk of fall, and good/excellent for functional/cognitive/hearing impairment, osteoporosis, incontinence and mood disorders. Six out of nine items of the geriatric consultation described in this study (functional/cognitive/hearing impairment, osteoporosis, incontinence and mood disorders) present a good to excellent reliability and can safely be used as a reference (gold standard) to evaluate the diagnostic performance of a primary care brief assessment tool. More objective/significant measures are needed to improve reliability of malnutrition, visual impairment, and risk of fall assessment before they can serve as a safe gold standard of a primary care tool

Emergency department use by oldest-old patients from 2005 to 2010 in a Swiss university hospital.

BACKGROUND: Aging of the population in all western countries will challenge Emergency Departments (ED) as old patients visit these health services more frequently and present with special needs. The aim of this study is to describe the trend in ED visits by patients aged 85 years and over between 2005 and 2010, and to compare their service use to that of patients aged 65-84 years during this period and to investigate the evolution of these comparisons over time. METHODS: Data considered were all ED visits to the University of Lausanne Medical Center (CHUV), a tertiary Swiss teaching hospital, between 2005 and 2010 by patients aged 65 years and over (65+ years). ED visit characteristics were described according to age group and year. Incidence rates of ED visits and length of ED stay were calculated. RESULTS: Between 2005 and 2010, ED visits by patients aged 65 years and over increased by 26% overall, and by 46% among those aged 85 years and over (85+ years). Estimated ED visit incidence rate for persons aged 85+ years old was twice as high as for persons aged 65-84 years. Compared to patients aged 65-84 years, those aged 85+ years were more likely to be hospitalized and have a longer ED stay. This latter difference increased over time between 2005 and 2010. CONCLUSIONS: Oldest-old patients are increasingly using ED services. These services need to adapt their care delivery processes to meet the needs of a rising number of these complex, multimorbid and vulnerable patients

Factors associated with quality of life in elderly hospitalised patients undergoing post-acute rehabilitation: a cross-sectional analytical study in Switzerland.

We investigated whether biopsychosocial and spiritual factors and satisfaction with care were associated with patients' perceived quality of life. This was a cross-sectional analytical study. Data were collected from inpatients at a postacute geriatric rehabilitation centre in a university hospital in Switzerland. Participants aged 65 years and over were consecutively recruited from October 2014 to January 2016. Exclusion criteria included significant cognitive disorder and terminal illness. Of 227 eligible participants, complete data were collected from 167. Perceived quality of life was measured using WHO Quality of Life Questionnaire-version for older people. Predictive factors were age, sex, functional status at admission, comorbidities, cognitive status, depressive symptoms, living conditions and satisfaction with care. A secondary focus was the association between spiritual needs and quality of life. Patients undergoing geriatric rehabilitation experienced a good quality of life. Greater quality of life was significantly associated with higher functional status (r <sub>s</sub> =0.204, p=0.011), better cognitive status (r <sub>s</sub> =0.175, p=0.029) and greater satisfaction with care (r <sub>s</sub> =0.264, p=0.003). Poorer quality of life was significantly associated with comorbidities (r <sub>s</sub> =-.226, p=0.033), greater depressive symptoms (r <sub>s</sub> =-.379, p<0.001) and unmet spiritual needs ( <i>r</i> <sub>s</sub> =-.211, p=0.049). Multivariate linear regression indicated that depressive symptoms (β=-0.961; 95% CIs -1.449 to 0.472; p<0.001) significantly predicted quality of life. Patient perceptions of quality of life were significantly associated with depression. More research is needed to assess whether considering quality of life could improve care plan creation