Predictors of Repeat Emergency Department Visits by Elders

Objective: To determine which characteristics of older patients who use a hospital ED are associated with repeat visits during the 90 days following the index visit.
Methods: The study was conducted in the ED of a 400-bed university-affiliated acute care community hospital in Montreal. Patients aged ≥75 years who visited the ED between 08:00 and and 16:00 on a convenience sample of days over an 8-week period (July and August 1994) were assessed using a questionnaire, physical and cognitive status instruments, and a functional problem checklist. The hospital's administrative database was used to identify repeat visits during the 90 days following the ED visit. The representativeness of the sample was assessed by analyses of ED visits made by 4,466 persons aged ≥65 years during a 12-month period (September 1993 to August 1994) using the hospital's administrative database.
Results: 256 patients aged ≥75 years visited the ED during the study period and 167 were assessed. Of these, 54 (32%) were admitted to the hospital. Among the 113 patients released from the ED, 27 (24%) made repeat visits during the next 90 days. In univariate analyses, repeat visits were significantly associated with the number of functional problems, cognitive impairment, and previous ED visits. In multiple logistic regression, male gender, living alone, and number of functional problems were independent predictors of repeat visits. In the administrative data analyses, nighttime arrival to the ED for the index visit was significantly associated with repeat visits.
Conclusions: Self-reported risk factors can help to identify a group of elders likely to make repeated ED visits; the development of a screening instrument incorporating questions on these problems and implementation of appropriate interventions might improve these patients' quality of life and reduce the demand for further ED care in this age group.     

NIFEDIPINE BLOCKS ACTH AND CORTISOL RELEASE IN MAN

1. The present study investigated the effect of prior administration of nifedipine on AVP-induced ACTH release in seven normal volunteers. Three protocols were used: 20 mg oral nifedipine; 0.14 pressor units intramuscular (i.m.) per kg bodyweight aqueous AVP; oral nifedipine plus i.m. AVP 90 min later. Plasma ACTH and cortisol were measured at intervals for 2.5 h during each test. 2. The mean peak plasma ACTH and cortisol levels and the mean peak changes from basal in these levels were significantly lower in the nifedipine/AVP test than in the AVP alone test. The integrated area under the cortisol time curve was significantly lower for the nifedipine/AVP test than that for the AVP test alone. Nifedipine alone caused no changes in ACTH or cortisol. 3. Acute administration of oral nifedipine caused an inhibition of AVP-stimulated ACTH and cortisol release in normal humans. This effect may be due to blockade of plasma membrane calcium channels normally activated during AVP stimulation of pituitary corticotrophs.     

Profession and Professionalisation: Part 1: Role and identity of undergraduate physiotherapy educators

The first part of this paper addresses the issues of profession and professionalisation which affect educators in physiotherapy undergraduate studies. It introduces ‘profession’ and ‘professionalisation’ in isolation, although it is not the intention to simplify discussion, but instead to explore the concepts as they stand from a wider perspective before applying them to physiotherapy education. This is followed by a consideration of the complex issues of physiotherapy itself as an aspiring profession, based upon the elements of a profession previously identified, before introducing the role of physiotherapy education and research within the professionalisation process. Part 2 continues this theme by offering a critical analysis of the overlap between education, research and professional status.The second and concluding part of this article continues the theme of professionalisation within physiotherapy, yet more specifically addresses the issues of professionalisation within academia. It provocatively considers physiotherapy academic educators themselves as jugglers of two values – the producers of future professionals and the aspirational creators of a profession. This theme is then expanded by an analysis of the demands placed upon physiotherapy educators, from the perspective both of promoting the profession, and of identifying physiotherapy educators' values. A summary of the discussion follows, outlining emerging points for future development.This paper finally proposes how physiotherapy educators need to revisit the values that underpin their role, and how the professionalisation of future physiotherapists depends upon both a sound understanding and respect of educational philosophy and educational research. The creation and support of a ‘profession’ of physiotherapy educators is offered as a medium through which they can reflect upon and evaluate their own practice within the discipline of education.     

Effect of dietary restriction upon the age-associated decline of lymphocyte DNA repair activity in mice

Effects of dietary restriction (DR) on DNA repair capacity of mouse splenocytes after ultraviolet (UV)-induced damage were assessed. Two mouse cohorts received restricted amounts of purified hypocaloric diets; one was minimally restricted (∼75% of the caloric intake of mice fed a commercial diet ad libitum), the other was severely restricted (∼50% caloric restriction). An inverse correlation between age and DNA repair was present in the two cohorts; however, the regression lines of the two cohorts showed different slopes. DR appears to decelerate the age-associated decline of DNA repair capacity, and this delay might account in part for the improved immune function shown by old mice on DR.