A new model of multidimensional discharge planning: continuity of care for frail and complex inpatients.

OBJECTIVE: Delays in patient discharge can adversely affect hospital and emergency room productivity and increase healthcare costs. The discharge should be structured from the hospital admission towards the most appropriate environment. This study aims to investigate the efficacy of the Unit, named "Continuity of Care Center" (CCC), to guarantee a safest and fastest hospital discharge in frail patients and to test the effect of our team-approach on hospital outcomes (length of stay and hospital mortality). MATERIALS AND METHODS: This is a prospective cohort study carried out in an acute care hospital with 1,558 beds and is equipped with 41 operating theaters. We collected data from October 2016 to June 2019. RESULTS: The time of patient discharge had an important reduction: 15.5±30.8 in the first 3 months vs. 11.0±20.1 in the last 3 months considered. The median of the time of discharge in all 12 months considered was 12 day. The length of stay presented an important reduction from 33.3±47.5 during the first 3 months vs. 28.8±39.5 in the last 3 months of activity of CCC; and a significant reduction of hospital deaths was recorded from 20% during the first 3 months to 14% in the last 3 months of activity of CCC. CONCLUSIONS: Results indicate a constant decrease in patient discharge time and length of hospital stay, with a consequent significant reduction of healthcare costs. According to the estimates of Italian Health Ministry concerning Latium region, every hospitalization day has a mean cost of € 674.00. Thus, the CCC activity has contributed to a reduction of approximately 12,832 days of hospitalization, in the considered period, with an estimated hospital saving of € 8,648,761.

Physiotherapy and occupational therapy: a geriatric experience in the acute care hospital.

The continuously growing segment of the geriatric population with the high incidence and prevalence of comorbidity and disability suggests that enhanced preventive and rehabilitative programs will be mandatory. The early arrangement of comprehensive assessment and rehabilitation services is extremely important not only in preventing the decline of patients in the acute care settings and successive prolonged care before discharge, but also in improving functional status at discharge. We have considered the effectiveness of a rehabilitation program in acute medical care of the elderly. This article discusses a pilot project being carried out at Catholic University Hospital "A. Gemelli" of Rome.

Characteristics of chronic venous insufficiency in 895 patients followed in general practice.

BACKGROUND: This study was designed to describe the main semiological and etiological characteristics of chronic venous insufficiency (CVI) and to determine if there was a relationship between the extent of objective signs, severity of symptoms and aetiology. MATERIALS AND METHODS: 895 outpatients presenting CVI of the lower limbs over a period of at least one year, irrespective of grade of severity or aetiology, were included in this retrospective study. They were treated with 2 different pharmaceutical forms of the same venoactive medication (1000 mg of micronised flavonoid fraction) for 2 months. Organic CVI (OCVI) was classified, in stages of increasing severity, according to the Widmer and Porter classification. In the absence of anatomical lesions of the main veins or their valvular system, CVI was termed functional (FCVI). RESULTS: Analysis indicated that CVI was more frequent in women than in men (sex ratio 10:1). 26% were FCVI and 91% of OCVI were of varicose origin. The mean progression time of the disease was 13+/-11 years. Disease began earlier in women than in men (34+/-14 vs 41+/-14 years). Oedema was the first objective sign in 68% of patients and the only one in 20% of FCVI. Heaviness was more frequent in FCVI and its intensity was not related to the severity of CVI. Trophic complications were more frequent in the advanced stages. CONCLUSIONS: In order to avoid progression to more severe forms which are disabling or expensive to treat, a rational approach to the management of early CVI is essential.

[Major agitated-anxious versus blunted-retarded depression: differential effects of fluoxetine]. / Dépressions majeures agitées-anxieuses versus émoussées-ralenties: effets différentiels de la fluoxétine.

A multi-centre study was designed to evaluate the efficacy and tolerance of fluoxetine in two groups of major depression: "agitated-anxious" and "blunted-retarded". The study included 50 patients presenting a major depressive episode (following DSM III-R criteria and score > or = 20 on MADRS): 26 in "agitated-anxious" group (score > or = 15 on Hamilton anxiety scale and > or = 10 on Tyrer anxiety brief scale) and 24 in the "blunted-retarded" group (score > or = 15 on Widlöcher retardation scale and > or = 10 on Abrams-Taylor blunted affect scale). After one week period on placebo, all patients were treated in an open design with fluoxetine at a fixed daily dose of 20 mg and followed on a period of 6 weeks with active treatment. In spite of a significant antidepressant efficacy of fluoxetine in the two groups, better results were observed in the "agitated-anxious" depressed group: marked improvement on MADRS total score at day 42 (76% decrease vs 62% in the "blunted-retarded" group, p = 0.012), greater number of "responders" defined by a decrease > or = 50% on MADRS total score and a total score < or = 12 (95% vs 63%, p = 0.04), better patient's global impression on efficacy (54% of "excellent efficacy" vs 18%, p = 0.012), more improvement on HSCL-58 total score (mean decrease of 69% vs 39%, p = 0.016), higher improvement on "hostility/interpersonal hypersensitivity" score (mean decrease of 74% vs 37%, p = 0.001) and on "anger attacks/irritability" sub-score (mean decrease of 73% vs 30%, p = 0.0002).(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical safety and efficacy of tianeptine in 1,858 depressed patients treated in general practice.

1,927 outpatients were included by 392 general practitioners in an open study in order to evaluate the safety of tianeptine in the ambulatory treatment of depression. The results of 1,858 depressed patients without melancholia and psychotic features, fulfilling DSM III criteria of Major Depressive Episode or Dysthymic Disorder, could be analysed. 1,458 patients completed the 3-month treatment period. The group treated with 37.5 mg/day of tianeptine showed improvement on the Montgomery-Asberg Depression Rating Scale. With regard to the clinical tolerance of tianeptine, somatic complaints were rarely reported and adverse events necessitating premature termination of treatment (4.8% of included patients) were without clinical severity. Cardiovascular, haematologic, hepatic and biochemical safety were verified. No signs of dependence and no specific withdrawal symptoms were found after discontinuation of treatment.