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to examine the relationship between seven predictor variables (recorded on Day 3 of hospital admission) and discharge destination in non-elective medical patients aged 65+ years.prospective cohort.eight centres in six European countries.age, gender, living alone, physical function (three categories based on Barthel Index), cognition (Katzman's orientation-memory-concentration test), main body system affected (based on International Classification of Diseases), number of geriatric giants (GGs) involved in the referral (a GG being a problem with falling, mobility, continence or cognition).discharge destination (by Day 90) in three categories: 'HOMESAME' (return to previous residence), 'INSTIN90' (discharge to alternative residence or still in hospital at 90 days), 'DEADINHO' (death in hospital),in 1,626 patients, discharge destination was HOMESAME in 84.7%, DEADINHO in 8.9% and INSTIN90 in 6.4%. Mean duration of stay was 17.7 days, median 12. Univariate analyses showed a statistically significant relationship between all seven predictor variables and discharge destination. Physical function was the best single predictor with a seven-fold difference in adverse outcome rates between the best and worst categories. On multiple logistic regression, significant predictor variables were as follows. (i) For DEADINHO: physical function, cognition, gender; (ii) for INSTIN90: physical function, living alone, GGs, age, gender. Multiple linear regression identified physical function, GGs and living alone as predictors of loge length of stay.case-mix systems to compare risk-adjusted hospital outcome in older medical patients need to incorporate information about physical function, cognition and presenting problems in addition to diagnosis.

Patients with proximal femoral fracture occupy 20% of all orthopaedic beds at any one time [1]. In postmenopausal women, proximal femoral fracture accounts for more bed days annually than breast cancer, acute myocardial infarction, diabetes mellitus or chronic obstructive pulmonary disease. Most people with a proximal femoral fracture are old: 90% are older than 65 and 75% are older than 75. Most are women: one in six women who reach the age of 80 years will suffer a hip fracture [2, 3]The incidence is rising, partly because of the ageing population, but the agerelated fracture rate is also increasing [4], which may be related to smoking and a more sedentary lifestyle. Although treated on orthopaedic wards, patients with proximal femoral fracture frequently have complex problems. Eighty percent have hypertension, diabetes mellitus, Parkinson's disease or dementia [5].

Objective: to audit the success of a decision protocol to select patients for cardioversion from atrial fibrillation or flutter by recording the success of cardioversion and the maintenance of sinus rhythm over a 2-year period. Design: retrospective case notes review. Setting: a teaching hospital coronary care unit and cardiology department. Patients: 227 consecutive patients were considered for cardioversion from atrial fibrillation or flutter from 1989 to 1992; 128 fulfilled the selection criteria. Main outcome measures: successful cardioversion and maintenance of sinus rhythm after cardioversion. Results: 116 (91%) patients selected by application of the guidelines were successfully cardioverted. The probabilities of maintaining sinus rhythm at 6, 12 and 24 months were 0.92, 0.88 and 0.73 respectively. Conclusion: careful selection of patients in atrial fibrillation identifies a group in whom cardioversion is likely to be safe and successful regardless of age.