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Polypharmacy is an increasing problem in the care of multimorbide patients, and increases morbidity, mortality, hospitalization rates and costs. A promising intervention against polypharmacy is the systematic listing of all drugs taken by the patient with critical appraisal of indication, side effects, dosage and alternatives of every single drug. It is necessary to consider and to discuss priorities and preferences of patients in regard to treatment goals. A clear medication plan is needed after shared decision making with the patient. We present some helpful tools for this purpose. Further challenges besides an empathic communication with the patient are finding enough time in the clinical encounter, the integration of other health professionals and computer-assisted solutions in primary care practices and hospitals.

This document is part of a series of documents designed by the French Physical and Rehabilitation Medicine Society (Sofmer) and the French Federation of PRM (Fedmer). These documents describe the needs for or a specific type of patients; PRM care objectives, human and material resources to be implemented, chronology as well as expected outcomes. "Care pathways in PRM" is a short document designed to enable the reader (physicians, decision-maker, administrator, lawyer or finance manager) to quickly apprehend the needs of these patients and the available therapeutic care structures for proper organization and pricing of these activities. Patients after rotator cuff tear surgery are classified into four care sequences and two clinical categories, taking into account personal and environmental factors that could influence patients' needs, in accordance with the International Classification of Functioning (ICF) (WHO)., (2011 Elsevier Masson SAS. All rights reserved.)

Less money spent on health services, cost-effectiveness, better productivity and more efficiency are some of the driving forces of contemporary "neo-liberalism" and political trends. How can nursing services and the profession's human values adapt in this difficult context? The authors describe the newest modality of patient care delivery system: nursing case management. They examine the factors and assumptions that led up to its development and point out the validity of asking some serious questions before embarking on the euphoria of case management.

The new treatment of myocardial infarction in the acute phase is effective if it is applied as early as possible after the onset of ischemia. The concept of extreme emergency implies a change in the overall management of the patients, a reorganization of medical care and major increase in expenditures. Price disparities of thrombolytic agents and variability in complementary reperfusion therapies have a impact on hospital cost of thrombolysis. While individual patients unquestionably benefit from this new methods, further studies are needed to evaluate the increase in health expenditures involved and the economic repercussions of avoidance or limitation of myocardial infarctions.