No / There is a substantial body of evidence that prescribing for care home residents is suboptimal and requires improvement. Consequently, there is a need to identify effective interventions to optimise prescribing and resident outcomes in this context. OBJECTIVES: The objective of the review was to determine the effect of interventions to optimise prescribing for older people living in care homes. SEARCH METHODS: We searched the Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register; Cochrane Central Register of Controlled Trials (CENTRAL), The Cochrane Library (Issue 11, 2012); Cochrane Database of Systematic Reviews, The Cochrane Library (Issue 11, 2012); MEDLINE OvidSP (1980 on); EMBASE, OvidSP (1980 on); Ageline, EBSCO (1966 on); CINAHL, EBSCO (1980 on); International Pharmaceutical Abstracts, OvidSP (1980 on); PsycINFO, OvidSP (1980 on); conference proceedings in Web of Science, Conference Proceedings Citation Index - SSH & Science, ISI Web of Knowledge (1990 on); grey literature sources and trial registries; and contacted authors of relevant studies. We also reviewed the references lists of included studies and related reviews (search period November 2012). We included randomised controlled trials evaluating interventions aimed at optimising prescribing for older people (aged 65 years or older) living in institutionalised care facilities. Studies were included if they measured one or more of the following primary outcomes, adverse drug events; hospital admissions;mortality; or secondary outcomes, quality of life (using validated instrument); medication-related problems; medication appropriateness (using validated instrument); medicine costs. Two authors independently screened titles and abstracts, assessed studies for eligibility, assessed risk of bias and extracted data. A narrative summary of results was presented. The eight included studies involved 7653 residents in 262 (range 1 to 85) care homes in six countries. Six studies were cluster-randomised controlled trials and two studies were patient-randomised controlled trials. The interventions evaluated were diverse and often multifaceted. Medication review was a component of seven studies, three studies involved multidisciplinary case-conferencing, two studies involved an educational element for care home staff and one study evaluated the use of clinical decision support technology. Due to heterogeneity, results were not combined in a meta-analysis. There was no evidence of an effect of the interventions on any of the primary outcomes of the review (adverse drug events, hospital admissions and mortality). No studies measured quality of life. There was evidence that the interventions led to the identification and resolution of medication-related problems. There was evidence from two studies that medication appropriateness was improved. The evidence for an effect on medicine costs was equivocal. Robust conclusions could not be drawn from the evidence due to variability in design, interventions, outcomes and results. The interventions implemented in the studies in this review led to the identification and resolution of medication-related problems, however evidence of an effect on resident-related outcomes was not found. There is a need for high-quality cluster-randomised controlled trials testing clinical decision support systems and multidisciplinary interventions that measure well-defined, important resident-related outcomes.

Pau King-man. / Thesis submitted in: October 2001. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2002. / Includes bibliographical references (leaves 173-181). / Abstracts in English and Chinese. / Acknowledgements --- p.i / Abstract --- p.ii / Abstract (Chinese version) --- p.iii / Table of Contents --- p.iv / List of Figures --- p.xii / List of Tables --- p.xiii / List of Abbreviations --- p.xxiv / Chapter CHAPTER ONE: --- INTRODUCTION / Chapter 1.1 --- Women's Overweight and Obesity Prevalence and Trends --- p.1 / Chapter 1.2 --- Etiology of Overweight and Obesity --- p.2 / Chapter 1.3 --- Health Consequences of Obesity in Women --- p.4 / Chapter 1.4 --- Dietary and Physical Activity Recommendations for Good Health for Adults --- p.6 / Chapter 1.5 --- Health Behavior Change Theories --- p.8 / Chapter 1.6 --- Weight Control/Loss Interventions for Women --- p.10 / Chapter 1.7 --- Weight Loss Risks --- p.11 / Chapter 1.8 --- Health Promotion Programs for Women --- p.12 / Chapter 1.9 --- General Situation and Population Trends Among Hong Kong Middle- aged Women --- p.15 / Chapter 1.10 --- Nutrition-related Morbidity and Mortality Among Hong Kong Women --- p.16 / Chapter 1.11 --- Diet Composition of Hong Kong Middle-aged Women --- p.20 / Chapter 1.12 --- Physical Activity Patterns of Hong Kong Middle-aged Women --- p.21 / Chapter 1.13 --- Education and Health in Hong Kong Middle-aged Women --- p.23 / Chapter 1.14 --- Attitudes Toward and Beliefs About Diet and Health of Hong Kong Middle-aged Women --- p.24 / Chapter 1.15 --- Common Weight Loss Methods Among Hong Kong Middle-aged Women --- p.25 / Chapter 1.16 --- Sources of Health Information Among Hong Kong Middle-aged Women --- p.25 / Chapter 1.17 --- Summary --- p.26 / Chapter 1.18 --- Study Purpose and Objectives --- p.26 / Chapter CHAPTER TWO: --- METHODOLOGY / Chapter 2.1 --- Recruitment of Participants --- p.29 / Chapter 2.2 --- Focus Groups --- p.29 / Chapter 2.3 --- Survey Instrument --- p.30 / Chapter 2.3.1 --- Questionnaire --- p.30 / Chapter 2.3.2 --- Three-day Dietary Record --- p.35 / Chapter 2.3.3 --- Anthropometric and Cholesterol Measurements --- p.35 / Chapter 2.4 --- Intervention --- p.37 / Chapter 2.5 --- Evaluation --- p.39 / Chapter 2.5.1 --- Process Evaluation --- p.39 / Chapter 2.5.2 --- Outcome Evaluation --- p.40 / Chapter 2.6 --- Data Management --- p.40 / Chapter 2.7 --- Statistics --- p.40 / Chapter 2.8 --- Data Analysis --- p.41 / Chapter 2.8.1 --- Physical Activity Patterns --- p.41 / Chapter 2.8.2 --- Dietary Patterns --- p.44 / Chapter 2.8.3 --- Nutrition Knowledge Score --- p.45 / Chapter 2.8.4 --- Physical Activity Knowledge Score --- p.46 / Chapter 2.8.5 --- Blood Total Cholesterol --- p.46 / Chapter 2.8.6 --- Body Mass Index --- p.47 / Chapter 2.8.7 --- Percent Body Fat --- p.47 / Chapter 2.9 --- Ethics --- p.47 / Chapter CHAPTER THREE: --- RESULTS / Chapter 3.1 --- Focus Group Results --- p.43 / Chapter 3.1.1 --- General Description of Participants --- p.48 / Chapter 3.1.2 --- Perceived Values and Views on 'Health' --- p.50 / Chapter 3.1.3 --- Perceived Values and Views on 'Healthy Lifestyle' --- p.51 / Chapter 3.1.4 --- Perceived Values and Views on 'Healthy Eating' --- p.52 / Chapter 3.1.5 --- Perceived Values and Views on 'Physical Activity' --- p.53 / Chapter 3.1.6 --- The Factors Motivating the Women to Adopt a Healthy Lifestyle --- p.53 / Chapter 3.1.7 --- Sources of Information About Healthy Eating and Physical Activity --- p.55 / Chapter 3.1.8 --- Suggestions for the Type and Content of Activities in a Health Promotion Program --- p.55 / Chapter 3.2 --- Participation Rate in the Study --- p.56 / Chapter 3.3 --- Pretest --- p.57 / Chapter 3.3.1 --- General Participant Sociodemographic Description --- p.57 / Chapter 3.3.2 --- Anthropometry --- p.59 / Chapter 3.3.3 --- Health Conditions Reported --- p.60 / Chapter 3.3.4 --- Meal Patterns --- p.61 / Chapter 3.3.5 --- Nutrient Supplements Practices --- p.62 / Chapter 3.3.6 --- Cooking Practices --- p.63 / Chapter 3.3.7 --- Food Removal Behavior --- p.65 / Chapter 3.3.8 --- Food Label Reading --- p.65 / Chapter 3.3.9 --- Dietary Intake --- p.66 / Chapter a. --- From the Three-day Dietary Records --- p.66 / Chapter b. --- From the Food Frequency Questionnaire --- p.68 / Chapter 3.3.10 --- Nutrition Knowledge --- p.69 / Chapter 3.3.11 --- Physical Activity Habits --- p.72 / Chapter 3.3.12 --- Physical Activity Knowledge --- p.73 / Chapter 3.3.13 --- Intention and Confidence in Changing Behavior --- p.76 / Chapter 3.3.14 --- Perceived Difficulties in Changing Behavior --- p.77 / Chapter 3.3.15 --- Perceived Methods Facilitating Behavior Change --- p.79 / Chapter 3.3.16 --- Health Information Desired --- p.80 / Chapter 3.3.17 --- Areas of Health the Women Would Like to Improve --- p.81 / Chapter 3.3.18 --- Summary Profile of the Women at Pretest --- p.82 / Chapter 3.4 --- Outcome Evaluation --- p.85 / Chapter 3.5 --- Posttest --- p.85 / Chapter 3.5.1 --- General Participant Sociodemographic Description --- p.85 / Chapter 3.5.2 --- Anthropometry --- p.86 / Chapter 3.5.3 --- Health Conditions Reported --- p.87 / Chapter 3.5.4 --- Meal Patterns --- p.88 / Chapter 3.5.5 --- Nutrient Supplements Practices --- p.89 / Chapter 3.5.6 --- Cooking Practices --- p.90 / Chapter 3.5.7 --- Food Removal Behavior --- p.91 / Chapter 3.5.8 --- Food Label Reading --- p.91 / Chapter 3.5.9 --- Dietary Intake --- p.93 / Chapter a. --- From the Three-day Dietary Records --- p.93 / Chapter b. --- From the Food Frequency Questionnaire --- p.94 / Chapter 3.5.10 --- Nutrition Knowledge --- p.95 / Chapter 3.5.11 --- Physical Activity Habits --- p.98 / Chapter 3.5.12 --- Physical Activity Knowledge --- p.99 / Chapter 3.5.13 --- Analysis the Changes by Education Level --- p.102 / Chapter 3.5.14 --- Analysis the Changes by Age Group --- p.104 / Chapter 3.5.15 --- Intention and Confidence in Changing Behavior --- p.105 / Chapter 3.5.16 --- Perceived Difficulties in Changing Behavior --- p.107 / Chapter 3.5.17 --- Perceived Methods Facilitating Behavior Change --- p.109 / Chapter 3.5.18 --- Health Information Desired --- p.110 / Chapter 3.5.19 --- Areas of Health the Women Would Like to Improve --- p.111 / Chapter 3.5.20 --- Summary Profile of the Women at Posttest --- p.112 / Chapter 3.6 --- Participants' Evaluation of the Intervention Program --- p.113 / Chapter 3.7 --- Follow-up --- p.118 / Chapter 3.7.1 --- General Participant Sociodemographic Description --- p.118 / Chapter 3.7.2 --- Anthropometry --- p.118 / Chapter 3.7.3 --- Health Conditions Reported --- p.121 / Chapter 3.7.4 --- Meal Patterns --- p.121 / Chapter 3.7.5 --- Nutrient Supplements Practices --- p.122 / Chapter 3.7.6 --- Cooking Practices --- p.123 / Chapter 3.7.7 --- Food Removal Behavior --- p.125 / Chapter 3.7.8 --- Food Label Reading --- p.126 / Chapter 3.7.9 --- Dietary Intake --- p.127 / Chapter a. --- From the Three-day Dietary Records --- p.127 / Chapter b. --- From the Food Frequency Questionnaire --- p.129 / Chapter 3.7.10 --- Nutrition Knowledge --- p.131 / Chapter 3.7.11 --- Physical Activity Habits --- p.135 / Chapter 3.7.12 --- Physical Activity Knowledge --- p.136 / Chapter 3.7.13 --- Intention and Confidence in Changing Behavior --- p.140 / Chapter 3.7.14 --- Analysis the Changes by Education Level --- p.142 / Chapter 3.7.15 --- Analysis the Changes by Age Group --- p.143 / Chapter 3.7.16 --- Perceived Difficulties in Changing Behavior --- p.144 / Chapter 3.7.17 --- Perceived Methods Facilitating Behavior Change --- p.145 / Chapter 3.7.18 --- Health Information Desired --- p.148 / Chapter 3.7.19 --- Areas of Health the Women Would Like to Improve --- p.149 / Chapter 3.7.20 --- Summary Profile of the Women at Follow-up --- p.150 / Chapter CHAPTER FOUR: --- DISCUSSION / Chapter 4.1 --- Implications of Findings --- p.154 / Chapter 4.1.1 --- Current Situations in Diet and Physical Activity of Hong Kong Middle-aged Women --- p.154 / Chapter 4.1.2 --- Overall Effects of the Program --- p.161 / Chapter a. --- Changes in Knowledge --- p.161 / Chapter b. --- Changes in Awareness and Intention --- p.163 / Chapter c. --- Changes in Behavior --- p.164 / Chapter d. --- Changes in Anthropometery --- p.166 / Chapter 4.2 --- Strengths and Limitations of the Study --- p.167 / Chapter 4.3 --- Implications and Recommendations for Meeting the Challenges of Improving Hong Kong Middle-aged Women's Nutrition and Physical Activity Habits --- p.169 / Chapter 4.4 --- Suggestions for Future Research --- p.170 / Chapter CHAPTER FIVE: --- CONCLUSIONS --- p.172 / References --- p.173 / Appendices / Chapter A --- Consent form (Chinese version) --- p.182 / Chapter B --- Consent form (English version) --- p.183 / Chapter C --- Questionnaire (Chinese version) --- p.184 / Chapter D --- Questionnaire (English version) --- p.196 / Chapter E --- Photos for food amount quantities and household measures (Chinese version) --- p.210 / Chapter F --- Photos for food amount quantities and household measures (English version) --- p.213 / Chapter G --- Sample of dietary record (Chinese version) --- p.216 / Chapter H --- Sample of dietary record (English version) --- p.217 / Chapter I --- Three-day dietary record (Chinese version) --- p.218 / Chapter J --- Three-day dietary record (English version) --- p.221 / Chapter K --- Pamphlets for health talks (Chinese version) --- p.224 / Chapter L --- Pamphlets for health talks (English version) --- p.236 / Chapter M --- Pamphlets for physical activity demonstration (Chinese version) --- p.248 / Chapter N --- Pamphlets for physical activity demonstration (English version) --- p.253 / Chapter O --- Process evaluation questionnaire (Chinese version) --- p.258 / Chapter P --- Process evaluation questionnaire (English version) --- p.260 / Chapter Q --- Overall evaluation questionnaire (Chinese version) --- p.262 / Chapter R --- Overall evaluation questionnaire (English version) --- p.263 / Chapter S --- Focus group questionnaire (Chinese version) --- p.264 / Chapter T --- Focus group questionnaire (English version) --- p.265 / Chapter U --- Focus group question guides (Chinese version) --- p.266 / Chapter V --- Focus group question guides (English version) --- p.268 / Chapter W --- The food consumption patterns of women in the Education and Control Groups --- p.270

Doctor of Philosophy / Aim and significance: The aim of this research was to explore the phenomenon of Australian nursing home care from the perspective of those who provide and receive it. Its focus is on the processes of ‘quality care’ provision and the meanings and evaluations that care providers attach to their work. In other words, its purpose was to shed light on the practices based on a conceptualisation of care that is entwined with the mechanisms of ‘care’ production and identity creation, or what actually happens in the daily life of the complex social phenomenon that is a nursing home. A related aim was to add to understandings of clinical nursing competence and develop tools that will assist nurses to conceptualise and implement positive change in this setting. Background: The provision of care to our elderly has become a major concern with the ageing of the world population. This is occurring in the context of decline in the capacity of families to take on the responsibility of elder care, and of increasing commercialisation of medical care. Governments have responded by shifting their responsibilities from direct care provision to become auditors of the business of care provision that is supported by public funding. However poor care delivery has largely been hidden from the public gaze. Governments present themselves as having systems in place, creating the illusion of rational control; in reality, like the market economy, there is a ‘black box’ of unknown factors driven by human impulse. The aim of this study was to open up the black box of ‘quality care’ to direct observation, drawing insights from the literature on organisational culture and with a focus on the frontline worker and the construct of quality assurance. Specific research objectives were to: • Document the beliefs and attitudes of care providers towards elderly people in general and the needs of nursing home residents in particular • Elicit the range of meanings and evaluations that care providers attach to their work • Describe their constructions of ‘care’ and ‘quality of care’ and the organisational factors they believe to impact (positively and negatively) on their ability to provide it. • Through in-depth understanding of a particular setting, generate grounded theoretical insights into the phenomenon of quality of residential care that are more widely applicable Method: The study adopted a paradigmatic bricoleur approach, seeking to develop connections between a diverse range of methodologies. These included combinative ethnography, phenomenology, hermeneutics and traditional grounded theory. Conceptual insights were drawn from organisational studies, psychosocial nursing and coping theory. The research site was an Australian for-profit suburban nursing home. The student investigator conducted more than 500 hours of participant observation, recording extensive field notes which were analysed through the perspective of a hermeneutic middle way horizon that directed an augmented constant comparison traditional grounded theory approach. Additional data were collected through formal indepth interviews with six key stakeholders. Interviews were tape recorded, transcribed in full and analysed to reveal themes that were brought within a hermeneutic circle that spiralled recursively from the whole to the part and back to the whole. Findings: Eight key interrelated factors in the production of care within the nursing home were identified: internal and external accountability (the accreditation system); economic considerations; management and training; advocacy; characteristic of residents; care providers’ working conditions and environmental stressors; organisational culture; and the work/care styles of individual care providers. I have categorised the latter into two main types: ‘tortoises’ and ‘hares’. This typology is then used to generate a process-driven schematic diagram that tracks a hypothetical novice care provider through the process of learning how to produce ‘care’. Specifically, I found that nursing home ‘care’ is the outcome of a complex social process involving the interplay between resident, relative, care provider, proprietor, quality assessors and government within the phenomenon of the nursing home. Such care, indeed the phenomenon of the nursing home itself, is not a stable, controllable entity but is in a constant state of flux – what I refer to as a moral ecology. In their everyday practice, care providers devise a construction of ‘quality care’ that is more clearly grounded in their own worldviews and the development of the own identity than in the formal quality assurance system of standards, guidelines and evaluations. Conclusion: Understanding the ‘black box’ of processes that produce care is the key to identifying courses of action that will improve care outcomes. The study findings also question the validity, assumptions and significance of the accreditation system, which only identifies some of the component variables, disregarding both the complexity within the ‘black box’ and failing to acknowledge that the quality of care outcomes is overwhelmingly dependent on individual care providers.

We reviewed 13 cases of ultrasound-guided thrombin injection of femoral pseudoaneurysms. All cases occurred within a 17-month period from January 1998 through May 1999 and were complications of femoral artery puncture. Immediate total thrombosis occurred in nine of 13 patients. Twenty-four-hour follow-up ultrasound in seven patients revealed no recurrence of pseudoaneurysm. Two of 13 patients required operative repair. One pseudoaneurysm thrombosed with 15 minutes of compression after injection and one case required a second injection. No cases of arterial thrombosis were noted. Ultrasound-guided thrombin injection for femoral artery pseudoaneurysm represents a safe and effective alternative to operative repair.

No / To demonstrate the benefits of fluoroscopy-guided intra-articular steroid injection in the hip with varying degrees of disease severity, and to investigate the financial aspects of the procedure and impact on waiting time. MATERIALS AND METHODS: A prospective study was undertaken of patients who underwent fluoroscopic intra-articular steroid injection over the 9-month study period. Comparative analysis of the Oxford hip pain score pre- and 6-8 weeks post-intra-articular injection was performed. Hip radiographs of all patients were categorised as normal, mild, moderate, or severe disease (four categories) based on the modified Kellgren-Lawrence severity scale, and improvement on the Oxford hip pain score on each of these four severity categories were assessed. RESULTS: Within the study cohort of 100 patients, the mean increase in post-procedure hip score of 7.32 points confirms statistically significant benefits of the therapy (p<0.001, 95% confidence interval: 5.55-9.09). There was no significant difference in pre-injection hip score or change in score between the four severity categories (p=0.51). Significant improvement in hip score (p<0.05) was demonstrated in each of the four severity categories 6-8 weeks post-injection. No associated complications were observed. CONCLUSION: The present study confirms that fluoroscopy-guided intra-articular steroid injection is a highly effective therapeutic measure for hip osteoarthritis across all grades of disease severity with significant cost savings and the potential to reduce waiting times.

The purpose of this study was to explore the utilization patterns of elderly women in a nurse managed clinic (NMC). A convenience sample of 20 women, 65 and older, attending an NMC completed an questionnaire and an interview. A pilot study guided the development of the questionnaire. Interrater reliability was performed to enhance the reliability of the pattern categories developed from the interviews. The findings of this research were that elderly women utilized this NMC for: physical assessment and monitoring; health care information; evaluating a physical need; referral; emotional support; socialization; convenience; cost; familiarity/comfort; health care need; and reliability. Satisfaction was the main component of the clients' perception of their visit to the NMC. Conclusions reached were that utilization of this NMC was based mainly on perceptions of health care needs and that cost, convenience, and familiarity influenced clients in choosing this clinic in addition to their primary care provider.

"The purpose of this study is to examine the impact of the medicare law on a particular hospital: Flow Memorial Hospital, Denton, Texas. The scope of this study is limited to an analysis of changes in hospital car at Flow Memorial Hospital resulting from medicare. These changes are examined on the basis of 1. number of patients and days of care; 2. hospital services by department; 3. the means of payment; and 4. social characteristics of the aged patient group. A detailed examination of aged patient care was made for the fiscal years 1966 and 1967. The 1966 year was the year immediately preceding medicare. The 1967 year was the first year of medicare. Longer time periods were used where the data were available and pertinent."-- leaf 1.

Ao se considerar o aumento da expectativa de vida da população e a possibilidade da influência da idade na resposta ao cuidado intensivo, este estudo teve como objetivo: comparar as características e a evolução clínica de pacientes adultos, idosos e muito idosos admitidos em UTI, segundo comorbidades, insuficiências orgânicas, procedência, tempo de internação, condição de saída, unidade de destino e readmissão na UTI, além da gravidade e evolução, conforme o Simplified Acute Physiology Score (SAPS II) e o Logistic Organ Dysfunction Score (LODS). Prospectivamente foram analisados pacientes adultos internados em quatro UTI gerais de hospitais públicos e privados, localizados no Município de São Paulo. A casuística compôs-se de 279 pacientes categorizados como adultos (18 e < 60 anos), 216 idosos ( 60 e < 80 anos) e 105 muito idosos ( 80 anos), totalizando 600 indivíduos. Os dados coletados foram referentes as primeiras e últimas 24 horas de permanência na UTI e a evolução da gravidade, segundo o SAPS II e o LODS, foi analisada considerando a diferença do risco de morte calculado pelos índices entre o primeiro e último dia de internação do paciente na unidade. Os resultados mostraram maior frequência de indivíduos do sexo masculino (56,50%), procedentes do Centro Cirúrgico (36,06%) ou Pronto-Socorro/Atendimento (35,39%) e com antecedentes relacionados às doenças do aparelho circulatório (56,17%). A média do risco de morte do SAPS II e do LODS na admissão foi de 25,50 e 21,43 e, na alta, de 23,14 e 20,73, respectivamente e a taxa de mortalidade na UTI de 20%. Quanto à análise comparativa dos grupos, diferenças entre todos foram observadas nas variáveis procedência e comorbidades relacionadas às doenças do aparelho circulatório. Os adultos diferiram dos idosos e dos muito idosos em relação à presença das comorbidades associadas às doenças endócrinas, nutricionais e metabólicas e relacionadas aos aparelhos respiratório e geniturinário, quanto à insuficiência renal segundo LODS, unidade de destino, risco de morte calculado pelo SAPS II e LODS na admissão e alta da UTI, além da evolução, conforme o SAPS II no grupo dos sobreviventes. Houve diferença significativa entre adultos e idosos em relação ao antecedente de neoplasias, número de insuficiências orgânicas, segundo o LODS, e mortalidade. Entre adultos e muito idosos, só em relação à presença de doenças do sistema nervoso, como comorbidade, e evolução do SAPS II na amostra total. Como conclusão, os resultados apontaram para pouca diferença nas características clínicas e na evolução de idosos e muito idosos; o mesmo não foi observado em relação aos adultos que mostraram características clínicas e evolução em vários aspectos diferentes em relação aos outros dois grupos. / In view of the populations increased life expectancy and the possible influence of age on the intensive care response, this research aimed to: compare the characteristics and clinical evolution of adult, elderly and elder elderly patients admitted at an ICU according to comorbidities, organ failure, origin, hospitalization time, exit condition, destination unit and readmission at the ICU, besides severity and evolution, according to the Simplified Acute Physiology Score (SAPS II) and the Logistic Organ Dysfunction Score (LODS). Adult patients hospitalized at four general ICUs of public and private hospitals in São Paulo City were subject to prospective analysis. The sample comprised 279 patients categorized as adults (18 and < 60 years), 216 elderly ( 60 and < 80 years) and 105 elder elderly ( 80 years), totaling 600 individuals. The collected data referred to the first and last 24 hours of stay at the ICU and the severity evolution, according to SAPS II and LODS, was analyzed considering the difference in death risk calculated by the scores between the patients first and last day of hospitalization at the unit. The results showed higher frequencies of male patients (56.50%), coming from the Surgical Center (36.06%) or Emergency Care (35.39%) and with antecedents related to circulatory illnesses (56.17%). Average death risk according to SAPS II and LODS was 25.50 and 21.43 upon admission and 23.14 and 20.73 upon discharge, respectively, with a 20% mortality rate at the ICU. In the comparative analysis between the groups, differences between all groups were observed in terms of origin and comorbidities related to circulatory illnesses. Adults differed from elderly and elder elderly with regard to the presence of comorbidities associated with endocrine, nutritional and metabolic illnesses, respiratory illnesses and genitourinary illnesses regarding kidney failure according to LODS, destination unit, death risk calculated by SAPS II and LODS upon admission and discharge from the ICU, besides evolution according to SAPS II in the survival group. A significant difference was found between adults and elderly related to tumor antecedents, number of organ failures according to LODS and mortality. Differences between adults and elder elderly patients were only related to the presence of nervous system disorders as a comorbidity and SAPS II evolution in the total sample. In conclusion, the results indicate little difference between the clinical characteristics and evolution of elderly and elder elderly; the same was not observed regarding adults, who showed clinical characteristics and evolution that differed from the other two groups in various aspects.

INTRODUÇÃO: O envelhecimento é um processo contínuo e dinâmico que produz alterações biopsicossociais que culminam com a morte. Embora normais, tais alterações acabam por comprometer a Qualidade de Vida (QV) dos idosos. Dentre elas cabe citar: aposentadoria, viuvez, mudanças de papéis na família e na sociedade, falta de motivação e dificuldade de planejar o futuro, deficiências orgânicas, entre outras. Muitos idosos conseguem adaptar-se e conviver com essas alterações enquanto outros não as aceitam e se tornam vulneráveis ao surgimento de doenças tais como a insônia e a depressão. OBJETIVOS: identificar a presença de insônia em idosos institucionalizados; avaliar a presença de sinais e sintomas depressivos em idosos institucionalizados; verificar a percepção dos idosos institucionalizados em relação à sua QV; comparar a QV nos idosos institucionalizados insones e nãoinsones; comparar os idosos institucionalizados no que se refere à presença de sinais e sintomas depressivos entre insones e não- insones; correlacionar sinais e sintomas depressivos e QV no grupo de insones comparado ao de não-insones; comparar com grupo comparativo os itens citados acima. MÉTODOS: o estudo foi realizado no asilo \"São João Bosco\" e no centro de convivência dos idosos \"João Nogueira Vieira\", ambos situados em Campo Grande-MS; Utilizou-se o Mini-Exame do Estado Mental, o WHOQOL-breve, a Escala de Avaliação para Depressão de Hamilton e o Questionário de Sono do Adulto de Giglio. RESULTADOS: no que se refere aos idosos institucionalizados: 77,8% apresentou insônia inicial, 47,2% apresentou insônia intermediária e 16,7%, insônia final enquanto que no grupo comparativo 25,8% apresentou insônia inicial, 42,8% insônia intermediária e 18%, insônia final; em relação aos sinais e sintomas depressivos, 52,8% dos idosos institucionalizados e 18% do grupo comparativo apresentou-os; quanto à percepção da \"Qualidade de Vida\", 72,2% dos idosos institucionalizados referiu estar \"nem satisfeito/nem insatisfeito\" em relação ao \"domínio social\" assim como 91,6% em relação ao domínio \"psicológico\" e 50% quanto ao domínio \"físico\" enquanto 88,9% relatou estar \"insatisfeito\" quanto ao domínio \"ambiente\" enquanto 79,4% do grupo comparativo referiu estar \"satisfeito\" em relação ao domínio \"relações sociais\", 84,6% relatou estar \"insatisfeito\" em relação ao domínio \"ambiente\" e a maioria informou estar \"nem satisfeita/nem insatisfeita\" quanto ao domínio \"psicológico\" (61,5%) e \"físico\" (87,2%). CONCLUSÃO: houve maior ocorrência de insônia nos idosos institucionalizados; houve maior ocorrência de sinais e sintomas depressivos nos idosos institucionalizados; houve diferença na percepção da QV entre os idosos institucionalizados e o grupo comparativo; ocorreu diferença na percepção da QV entre os idosos institucionalizados insones e não-insones; os sinais e sintomas depressivos foram mais freqüentes nos idosos institucionalizados insones em relação aos não-insones; houve diferença na percepção negativa da QV entre os idosos institucionalizados insones e com sinais e sintomas depressivos em relação aos nãoinsones e com sinais e sintomas depressivos / INTRODUCTION: Growing old is a dynamic and continuous process, however biopsychosocial ordinary changes can compromise quality of life and also lead senior citizens to death. Several elderly citizens can adapt themselves to those changes and live longer, while others become vulnerable to the emergence of illnesses like insomnia and depression. OBJECTIVES: identify insomnia in institutionalized senior citizens; evaluate depressive signs and symptoms in institutionalized senior citizens; check institutionalized senior citizens\'s perceptions as to their quality of life; compare signs and citizens and quality of life in institutionalized senior citizens; compare depressive signs and symptoms and quality of life in senior citizens; correlate depressive signs and symptoms and quality of life between the insomniac and non-insomniac group of institutionalized senior citizens and compare the items above with comparative group; METHODOLOGY: the study was conducted at \"São João Bosco\" Asylum and with senior citizens who joined a contact center for the elderly called \"João Nogueira Vieira\" (composing the comparative group), both in the city of Campo Grande, MS. Data were obtained from Mini-Mental State, brief - WHOQOL test, Hamilton Depression Rating Scales and Giglio\'s Sleep Questionnaire. RESULTS: concerning occurrence of insomnia 77.8% of institutionalized senior citizens reported initial insomnia, 47.2% had intermediate insomnia and 16,7% had final insomnia while 25.8% presented initial insomnia, 42.8% intermediate insomnia and 18.0% final insomnia; as to depressive signs and symptoms 52.8% of institutionalized senior citizens showed those while the larger part of comparative group did not manifest either feature; the subjective perception of institutionalized senior citizens regarding \"quality of life\" pointed that 72.2% of them felt neither \"satisfied nor unsatisfied\" as to \"social relationship\", \"psychological\" (91.6%) and \"physical\" (50.0%) and 88.9% referred \"unsatisfied\" about \"environmental\" domain of WHOQOL-bref while comparative group members showed 79.5% being \"satisfied\" with \"social relationship\" domain, the large majority neither \"satisfied nor unsatisfied\" with \"physical\" (87.2%) and \"psychological\" domains and 84.6% were \"unsatisfied\" about \"environmental\" domain of WHOQOL-bref. CONCLUSIONS: greater occurrence of insomnia was found in institutionalized senior citizens than in comparative group; greater occurrence of depressive signs and symptoms in institutionalized senior citizens than in comparative group; significant difference was detected in perception of quality life among institutionalized senior citizens and comparative group; institutionalized senior citizens displayed worse quality of life in physical environmental and social relationship domains of WHOQOL, and global and subjective perception of quality of life, results showed and in health, more incidence of depressive signs and symptoms in insomniac institutionalized senior citizens; insomniac institutionalized senior citizens with depressive signs and symptoms referred being more affected in environmental and social relationship

A evolução do conhecimento acerca das funções dos meniscos e do tratamento das suas lesões, impulsionada pelo advento da cirurgia artroscópica, consagrou e popularizou a meniscectomia por esta via, por ser uma técnica menos invasiva, com menor morbidade e menores custos hospitalares, a ponto de torná-la, atualmente, a cirurgia ortopédica mais frequentemente realizada no mundo. Embora a maior parte dos pacientes submetidos a esta intervenção cirúrgica tenha resultados favoráveis e resolução rápida dos sintomas, percebe-se que parte considerável dos pacientes, especialmente os mais idosos, não apresenta uma evolução póscirúrgica satisfatória, apresentando piora dos sintomas e, eventualmente, necessitando de nova cirurgia. Partindo da hipótese que em determinados pacientes a meniscectomia, em vez de tratar, precipita e acentua um desequilíbrio biomecânico do joelho, o autor realizou estudo observacional prospectivo não-controlado com 86 pacientes de ambos os gêneros, com idade superior a 50 anos (média de 60,2 ± 7,1 anos), submetidos à meniscectomia artroscópica para tratamento de lesão do menisco medial de natureza degenerativa, com o objetivo de determinar variáveis demográficas, clínicas, anatômicas e cirúrgicas relacionadas aos resultados desfavoráveis. As avaliações funcionais pré e pós-operatórias foram realizadas utilizandose o Índice do KOOS (Knee Injury and Osteoarthritis Outcome Score), aplicado a todos os pacientes antes da cirurgia e 60 meses depois. Após análise estatística dos resultados obtidos, o autor verificou que 10 fatores podem ser considerados preditivos das meniscectomias mediais artroscópicas neste grupo etário, sendo quatro fatores fortemente associados aos resultados desfavoráveis: lesão da raiz posterior do menisco medial, dor pré-operatória intensa, claudicação antes da cirurgia e tempo decorrido entre o início dos sintomas e a cirurgia; dois fatores foram considerados moderadamente associados aos resultados desfavoráveis: presença de edema de medula óssea na ressonância magnética (RM) préoperatória e duração da cirurgia; quatro fatores foram considerados associados de modo fraco aos resultados desfavoráveis: Índice de Massa Corporal (IMC) >= 30 kg/m2 , varismo do joelho, presença de cisto poplíteo na RM pré-operatória e extensão da ressecção do menisco medial / The evolution of knowledge concerning meniscal functions and the treatment of their injuries, boosted by the development of arthroscopic surgery, has established and popularized arthroscopic meniscectomy due to its less invasiveness, less post-operative morbidity and lower hospital costs, to the point it has become, nowadays, the most frequently performed orthopedic procedure in the world. Although the majority of patients undergoing this operation is quite pleased with the outcomes and with the prompt resolution of their symptoms, it is noticeable that a considerable amount of patients with meniscal injuries, mainly the older, does not have a satisfactory postoperative outcome, with worsening of symptoms after being operated on and occasionally requiring another surgery. Based on observations of his medical practice and on the assumption that meniscectomy, rather than treat, can hasten and accentuate a biomechanical imbalance of the knee in those patients, the author conducted an observational prospective uncontrolled study with 86 patients of both genders, aged over 50 years old (average 60.2 ± 7.1 years), who underwent arthroscopic meniscectomy for the treatment of degenerative medial meniscal lesions, aiming to determine demographic, anatomical, clinical and surgical variables related to poor outcomes. The functional pre and post-operative evaluations were performed using the KOOS index (Knee Injury and Osteoarthritis Outcome Score) applied to all patients before surgery and 60 months later. After statistical analysis of the results, the author found that 10 factors can be considered predictors of arthroscopic medial meniscectomy in this age group: four factors were strongly associated with unfavorable results - posterior root lesion of the medial meniscus, intense pre-operative pain, claudication before surgery and time elapsed between onset of symptoms and surgery; two factors were moderately associated with unfavorable results - bone marrow edema in preoperative magnetic resonance imaging (MRI) and surgery time length; four factors that were weakly associated with poor results - bone mass index (BMI) >= 30 kg/m2, varus knee, poplyteal cyst in pre-operative MRI and extension of meniscal ressection