Hospital transfers from nursing homes (NHs) are frequent, burdensome for residents, and often avoidable. The evidence regarding the effectiveness of interventions to reduce avoidable transfers is limited, and most projects focus on nurses’ knowledge and skills. In the present project, interventions focusing on nurses and physicians are integrated, elaborated, and implemented in 17 NHs. Results of the 6 months preintervention period are reported. Hospital transfer rates (N = 1,520) and basic data on all residents (N = 1,238) were collected prospectively. Nurses’ preintervention knowledge and self-efficacy were assessed using standardized questionnaires (N = 330). Many hospital transfers were initiated by nurses without physician involvement, polypharmacy was common, and a high potential for reducing transfers by increasing physician presence was observed. Nurses showed rather low knowledge but high self-efficacy. The results are discussed against the background of the interventions including enhancement of physician presence and geriatric quality circles.

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Summary.In order to estimate the degree of tubular lesions and to detect a possible glomerular involvement, proteinuria was studied in tubular and/ or interstitial nephropathies by determination of total protein and beta-2 microglobulin and by micro-gradientgel electrophoresis. The excretion of albumin, low molecular weight proteins (LMW) and high molecular weight (HMW) proteins was measured in addition. Other proximal tubulus functions such as glucose and phosphate reabsorption were also measured. The clinical entities studied were: chronic postinfectious nephritis, patients with nephropathy following analgesic abuse, tubular glucosuria in pregnancy and cis-platinum treated patients suffering from testicular tumor. The results were interpreted basing on the "selectivity" or urinary protein patterns, which means the relation between LMW and HMW proteins. Micro-gradientgel electrophoresis proved to be a fast and sensitive tool for quantitative as well as qualitative analysis of albumin, LMW and HMW proteins.All patients with advanced tubulo-interstitial disease excreted increased amounts of LMW proteins. The excretion of beta-2 microglobulin was also high and correlated with the LMW protein excretion. The albumin and HMW protein excretion showed no relation to LMW proteins. The disproportionate increase of LMW protein excretion on the one hand and albumin and HMW protein excretion on the other suggests different reabsorption mechanisms. The tubular patterns originate from a more easily disturbed reabsorption of LMW proteins and/or from a normally more active reabsorption of LMW proteins. Except in renal glucosuria phosphate and glucose excretion were not increased. This means that the capacity Offprint requests to: Dr. rer. nat. J. Alt (address see page 648) for the reabsorption of glucose and phosphate copes with a normal filtered load even in patients with highly increased proteinuria of a tubular type.

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