Experience of establishing an acute geriatric outreach service versus subacute service to nursing homes.

To share our experience of establishing an acute outreach service to nursing homes and to evaluate the impact of such service on emergency department presentations, data were drawn from a pre-existing database from 2013 to 2017. Of the 986 acute patients treated in 12 nursing homes over a 23-month period, the acute geriatric outreach service was shown to be safe, with few adverse events (one allergic reaction) and 5.3% of patients required transfer to hospital. The acute service decreased emergency department presentation of nursing home patients by 10% compared to the subacute service (incidence rate ratio = 0.90; 95% confidence interval: 0.84-0.96; P = 0.001). Cost-benefit analysis showed for every $1 spent, a saving of $5 was realised.

Endobronchial palliation using Nd:YAG laser is associated with improved survival when combined with multimodal adjuvant treatments.

BACKGROUND: Endobronchial neodymium:yttrium aluminum garnet (Nd:YAG) laser therapy has been shown to be safe and effective in palliating large airway malignancies. The role of multimodal therapy with stenting, brachytherapy, chemotherapy, and radiotherapy together with Nd:YAG laser therapy is unclear. AIM: This study aims to confirm the safety and effectiveness of Nd:YAG laser therapy in the contemporary setting and to investigate the effectiveness of multimodal therapy compared with laser alone. METHODS: One hundred fifty-three Nd:YAG laser treatments on 110 patients between 1999 and 2004 were reviewed retrospectively. Symptom scores for dyspnoea, hemoptysis, and cough before and after the procedure were compared. Survival and time to reintervention were analyzed using the Kaplan-Meier method. Multimodality treatment was compared with Nd:YAG laser therapy alone to determine differences in survival and time to reintervention. p values less than 0.05 were considered significant. RESULTS: There were no operative mortalities directly caused by laser intervention, although 30-day mortality was 6.5%. Deaths were attributable to progression of advanced neoplastic processes rather than laser intervention, and 6.5% of patients had some postoperative morbidity. After Nd:YAG laser intervention, 76% of patients reported improvement to dyspnoea, 94% for hemoptysis, and 75% for cough. Median survival after Nd:YAG laser treatment was 6.64 months; 21% of patients required repeated laser treatment. Compared with Nd:YAG laser treatment alone, multimodality treatments significantly prolonged median time to reintervention by 1.7 months (p = 0.002) and prolonged median survival by 4.9 months (p < 0.001) in patients with NSCLC. CONCLUSION: Nd:YAG laser intervention is safe and effective for palliation of endobronchial malignancies. In most cases, it only needs to be performed once. Compared with Nd:YAG laser therapy alone, multimodal treatment prolonged survival.