ABSTRACT
Transfer of care is a critical point for patient safety and requires an optimal care transfer model in order to ensure safe pharmacotherapy transfer. Polypharmacy among elderly is associated with adverse health consequences such as hospital readmissions. Hospital readmissions represent priorities in health care research and are one of the measures for assessing patient safety. Medication-related problems among elderly are associated with polypharmacy. The aim of the study was to show the impact of a developed model of care transfer led by a hospital clinical pharmacist on the number of hospital readmissions in the 12-months period in the elderly. A randomized controlled study of patients aged 65 or more was conducted at Dubrava University Hospital, Community Health Centre Zagreb - East and community pharmacies in the City of Zagreb and Zagreb County, Croatia. An intervention group received specially designed care transfer led by the hospital clinical pharmacist. Model included high-intensity pharmacotherapy interventions delivered at admission, during hospital stay and discharge, transition to primary care and post-discharge and cooperation between all healthcare professionals. In all, 182 patients in the intervention and 171 in the control group were analysed. The total number of hospital readmissions and emergency readmissions, within one year from the hospital discharge, was lower in the intervention group than in the control group (41.7% vs. 58.3%, p=0.005; 40.8% vs. 59.2%, p=0.008). The model of the health care transfer applied in this research thus significantly reduced hospital readmissions in the 1-year period in elderly patients. Therefore, the hospital clinical pharmacists should design and coordinate the transfer between hospital and primary care.
Subject(s)
Patient Readmission , Pharmacists , Pharmacy Service, Hospital , Humans , Patient Readmission/statistics & numerical data , Aged , Male , Female , Pharmacy Service, Hospital/organization & administration , Aged, 80 and over , Patient Transfer , Croatia , Polypharmacy , Patient DischargeABSTRACT
A systematic clinical examination of the shoulder joint, including a structured medical history, is essential for the diagnosis of shoulder pathologies. Complex clinical situations that are accompanied by pain, restriction of movement, loss of strength, or instability have to be considered in accordance with the functional interaction between the cervical spine, the shoulder girdle, and the glenohumeral joint. Only accurate diagnosis allows us to apply successful therapeutic interventions. In order to achieve this, the physician needs to use standardized clinical tests and signs combined with a profound knowledge of the anatomy and the possible underlying pathologies. To ensure a structured approach as well as a complete documentation of results, a shoulder assessment form should be used. The information obtained from the history, examination, and collected data form the basis for further diagnostic imaging.
Subject(s)
Joint Diseases/diagnosis , Physical Examination/methods , Shoulder Dislocation/diagnosis , Shoulder Fractures/diagnosis , Shoulder Pain/diagnosis , Diagnosis, Differential , HumansABSTRACT
During the acute training response, peripheral cellular mechanisms are mainly metabolostatic to achieve energy supply. During prolonged training, glycogen deficiency occurs; this is associated with increased expression of local cytokines, and decreased insulin secretion and beta-adrenergic stimulation and lipolysis in adipose tissue which looses energy. This is indicated by decrease of adipocyte hormone leptin, which has inhibitory effects on excitatory hypothalamic neurons. Leptin, insulin, and cytokines such as interleukin 6 (IL-6) contribute to the metabolic error signal to the hypothalamus which result in decrease of hypothalamic release hormones and sympathoadrenergic stimulation. Thyroid stimulating hormone (TSH) is correlated to the metabolic hormones leptin and insulin, and may be used as indicator of metabolic control. Because the hypothalamus integrates various error signals (metabolic, hormonal, sensory afferents, and central stimuli), the pituitary's releasing hormones represent the functional status of an athlete. Long-term overtraining will lead to downregulation of hypothalamic hormonal and sympathoadrenergic responses, catabolism, and fatigue. These changes contribute to myopathy with predominant expression of slow muscle fiber type and inadequacy in performance. Thyroid hormones are closely involved in the training response and metabolic control.
