RESUMO
The benefits of specialist geriatric assessment in acute medical units are debated and it is unclear if there is a reduction in readmission rates for older patients with specialist geriatric care compared to general acute medical care. We examined readmission rates for 2414 older patients who had been discharged from the acute medical unit at the Norfolk and Norwich University Hospital, either by acute medicine or older people's medicine (OPM), both of which teams were consultant-led. We found no significant difference in readmission rates between patients discharged by the acute medical team as compared to the OPM team. This finding was robust to a variety of sensitivity analyses, including different lengths of stay, or readmissions at different time intervals. Hence, acute medical teams may be able to achieve similar levels of quality care for older patients to specialist geriatric teams.
RESUMO
The expression of a novel regenerating (reg) gene has been reported previously in the regenerating islets of a surgical model of diabetes in rats. We exposed collagenase-isolated rat islets for three days to nutrient and non-nutrient growth factors in minimally supplemented RPMI medium (2.7 mmol/l glucose, 2% fetal calf serum), and investigated the relationship between reg gene expression and islet cell replication. RNA was prepared from half of the islets by homogenisation in guanidinium isothiocyanate followed by phenol/chloroform extraction. Northern/dot blot analyses were used to semi-quantify reg mRNA. Islet cell replication was estimated by culturing the remaining islets in radiolabelled thymidine to determine de novo DNA synthesis. Thymidine uptake was stimulated by the following factors: 11 mmol/l glucose (50% increase); 10% amino acids (126% increase); 10% fetal calf serum (39% increase); 100 ng/ml insulin (45% increase); 250 ng/ml growth hormone (65% increase); 1.5 nmol/l aldosterone (29% increase); 2 U/ml platelet derived growth factor (116% increase). The results are expressed as a percentage of the thymidine incorporated into control islets cultured in minimal RPMI (1118 +/- 100 (SD) cpm/microgram protein, n = 15). Increased islet cell replication was paralleled in each case by a clear rise in reg mRNA expression compared to controls. Furthermore, the rank order for reg gene expression was the same as that for thymidine uptake (r = 0.90). The present findings suggest a clear association between reg gene expression and islet cell replication in vitro, and are the first to demonstrate reg gene expression in response to individual growth factors.
