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Meeting the needs of acute geriatric patients is often challenging, and although evidence shows that older patients need tailored care, it is still unclear which interventions are most appropriate. The objective of this study is to systematically evaluate the hospital-wide acute geriatric models compared with conventional pathways. The design of the study includes hospital-wide geriatric-specific models characterized by components including patient-centered care, frequent medical review, early rehabilitation, early discharge planning, prepared environment, and follow‐up after discharge. Primary and secondary outcomes were considered, including functional decline, activities of daily living (ADL), length-of-stay (LoS), discharge destination, mortality, costs, and readmission. A systematic review and meta-analysis were conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. A total of 20 studies reporting on 15 trials and acutely admitted patients with an average age of 79, complex conditions and comorbidities to acute geriatric-specific pathways (N = 13,595) were included. Geriatric-specific models were associated with lower costs (weighted mean difference, WMD = − $174.98, 95% CI = -$332.14 to − $17.82; P = 0.03), and shorter LoS (WMD = − 1.11, 95% CI = − 1.39 to − 0.83; P

BACKGROUND This multicentre cohort study investigates the effect of smoking on the outcome of rotator cuff repair (RCR), with attention to age at presentation for surgery, pre-operative and post-operative pain and function and intra-operative findings. METHODS Patient information was collected pre-operatively, including Flex Shoulder Function (Flex SF) and visual analogue scale pain, then at 6 months, 1, 2 and 5 years post-operatively. Intra-operative technical data were collected by the operating surgeon. Current smokers were classified by daily cigarette consumption. RESULTS A total of 1383 RCRs in as many patients were included with an 84% 5-year follow-up. Smokers were on average 6.7 years younger than non-smokers (51.8 vs. 58.5, P

Simulation modelling has been utilised as a decision-support tool for different production systems. However, simulation uptake in construction is lagging due to several challenges such as the exten...

BackgroundImpetigo is a common and contagious bacterial skin infection, affecting children worldwide but it is particularly prevalent in deprived communities. In New Zealand widespread prescribing of the topical antibiotic fusidic acid had led to an increase in antimicrobial resistance of Staphylococcus aureus. Alternative treatments are urgently being sought and as impetigo is a superficial infection, it has been suggested that topical antiseptics such as hydrogen peroxide or simple wound care alone may treat impetigo while avoiding the risk of increased antimicrobial resistance.MethodsThis protocol for a non-inferiority, single-blind randomised controlled trial compares topical fusidic acid with topical hydrogen peroxide and with simple wound care in the treatment of childhood impetigo. Participants are randomised to one of the three treatments for five days and the primary outcome is clinical improvement. This is assessed through paired photographs analysed by graders blinded to treatment arm. The trial is based in school health clinics in an urban centre in New Zealand. Comparison of antimicrobial resistance patterns pre- and post-treatment is also performed.DiscussionSpecial note is made of the need to involve the communities most affected by impetigo in the design and implementation of the clinical trial in order to recruit the children most in need of safe and effective treatments.Trial registration: Australian New Zealand Clinical Trials Registry (ANZCTR) 12616000356460

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: Main objective: To assess the effects of acute assessment services on patient flow following attendance at a hospital emergency department. Secondary objectives: To assess whether the effects of acute assessment services differ according to the specialty population they serve (medicine‐only versus surgery‐only versus combined services). To assess whether the effects of acute assessment services differ depending on access pathways for patients (direct access to the service at or before the point of triage versus access via ED provider referral).