Comparison of Creatinine and Cystatin C to Estimate Renal Function in Geriatric and Frail Patients.

The aim of this study was to compare estimated glomerular filtration rate (eGFR) with creatinine (eGFRcrea) and cystatin C (eGFRcys) in geriatric and frail patients. A retrospective, cross-sectional study was performed at a geriatric clinic in Stockholm (n = 95). The revised Lund−Malmö equation was used to calculate eGFRcrea and the Caucasian-Asian-Pediatric-Adult (CAPA) equation was used for eGFRcys. The absolute mean percentage difference between eGFRcrea and eGFRcys was used as a surrogate measure for accuracy in eGFR. Other outcome measures were consistency expressed in Lin's concordance correlation coefficient and the proportion of consistent staging of renal failure. Subgroup analyses were performed with regard to frailty (according to Clinical Frailty Scale) and age. eGFRcys estimated lower GFR than eGFRcrea across the entire study population as well as in all subgroups (p < 0.05). Difference between the estimates increased with increasing frailty (r2 = 0.15, p < 0.01), but was not significantly affected by age (r2 = 0.004, p = 0.55). In conclusion, eGFRcys was significantly lower compared to eGFRcrea in geriatric and frail patients. Moreover, frailty had greater impact than age on the accuracy of eGFR. However, this study cannot determine if any of the estimates are preferable over the other in this patient group.

On-Scene and Final Assessments and Their Interrelationship Among Patients Who Use the EMS on Multiple Occasions.

Introduction The use of Emergency Medical Services (EMS) is increasing. A number of patients call repeatedly for EMS. Early studies of frequent callers show that they form a heterogenous group. Problem There is a lack of research on frequent EMS callers. There is furthermore a lack of knowledge about characteristics and the prehospital assessment of the patients who call for EMS on several occasions. Finally, there is a general lack of knowledge with regard to the association between the prehospital assessment by health care providers and the final diagnosis. METHOD: Patients in Skaraborg in Western Sweden, who used the EMS at least four times in 2014, were included, excluding transport between hospitals. Information on the prehospital assessment on-scene and the final diagnosis was collected from the EMS and hospital case records. RESULTS: In all, 339 individual patients who used the EMS on 1,855 occasions were included, accounting for five percent of all missions. Fifty percent were women. The age range was 10-98 years, but more than 50.0% were in the age range of 70-89 years. The most common emergency signs and symptoms (ESS) codes on the scene were dyspnea, chest pain, and abdominal pain. The most common final diagnosis was chronic obstructive pulmonary disease (eight percent). Thirteen percent of all cases had a final diagnosis defined as a potentially life-threatening condition. Among these, 22.0% of prehospital assessments were retrospectively judged as potentially inappropriate. Forty-nine percent had a defined final diagnosis not fulfilling the criteria for a potentially life-threatening condition. Among these cases, 30.0% of prehospital assessments were retrospectively judged as potentially inappropriate. CONCLUSION: Among patients who used EMS on multiple occasions, the most common symptoms on-scene were dyspnea, chest pain, and abdominal pain. The most common final diagnosis was chronic obstructive pulmonary disease. In 13.0%, the final diagnosis of a potentially life-threatening condition was indicated. In a minority of these cases, the assessment on-scene was judged as potentially inappropriate. Tärnqvist J , Dahlén E , Norberg G , Magnusson C , Herlitz J , Strömsöe A , Axelsson C , Andersson Hagiwara M . On-scene and final assessments and their interrelationship among patients who use the EMS on multiple occasions. Prehosp Disaster Med. 2017;32(5):528-535.

[The impact of an Anaesthesia and Intensive Care collaboration between Sweden and Tanzania]. / Samarbete Tanzania-Sverige för bättre anestesi och intensivvård - 22 anestesiologer på 47 miljoner tanzanier men nu börjar samarbetsprojektet ge resultat.

The impact of an Anaesthesia and Intensive Care collaboration between Sweden and Tanzania Anaesthesia and intensive care is a neglected specialty in low-income countries. Many countries have less than 1 anaesthesia provider per 100,000 population and few hospitals in Africa have the resources for managing critically ill patients. Health partnerships between institutions in high- and low-income countries have been proposed as an effective way to strengthen health systems. This article describes a partnership in anaesthesia and intensive care between institutions in Sweden and Tanzania and its impact at regional and national levels. The partnership, initiated in 2008 on the request of Muhimbili National Hospital in Dar es Salaam, conducts training, exchanges, research, equipment, routines and guidelines projects. Through the newly formed Life Support Foundation, the partnership has expanded to all hospitals in Dar es Salaam, has assisted in the reactivation of the Society of Anaesthesiologists of Tanzania and has seen a marked increase in the number of trainee doctors.