Early identification of frailty through targeted screening can facilitate the delivery of comprehensive geriatric assessment (CGA) and may improve outcomes for older inpatients. As several instruments are available, we aimed to investigate which is the most accurate and reliable in the Emergency Department (ED). We compared the ability of three validated, short, frailty screening instruments to identify frailty in a large University Hospital ED. Consecutive patients aged ≥70 attending ED were screened using the Clinical Frailty Scale (CFS), Identification of Seniors at Risk Tool (ISAR), and the Programme on Research for Integrating Services for the Maintenance of Autonomy 7 item questionnaire (PRISMA-7). An independent CGA using a battery of assessments determined each patient’s frailty status. Of the 280 patients screened, complete data were available for 265, with a median age of 79 (interquartile ±9); 54% were female. The median CFS score was 4/9 (±2), ISAR 3/6 (±2), and PRISMA-7 was 3/7 (±3). Based upon the CGA, 58% were frail and the most accurate instrument for separating frail from non-frail was the PRISMA-7 (AUC 0.88; 95% CI:0.83–0.93) followed by the CFS (AUC 0.83; 95% CI:0.77–0.88), and the ISAR (AUC 0.78; 95% CI:0.71–0.84). The PRISMA-7 was statistically significantly more accurate than the ISAR (p = 0.008) but not the CFS (p = 0.15). Screening for frailty in the ED with a selection of short screening instruments, but particularly the PRISMA-7, is reliable and accurate.

Hypothermic circulatory arrest did not reduce the incidence of deaths and morbidity to a rate comparable with our conventional methods. We recommend the judicious application of this method in rare instances when proximal control is not feasible or catastrophic intraoperative bleeding leave the surgeon with no other option.

Very Long Instruction Word (VLIW) architectures were promised to deliver far more than the factor of two or three that current architectures achieve from overlapped execution. Using a new type of compiler which compacts ordinary sequential code into long instruction words, a VLIW machine was expected to provide from ten to thirty times the performance of a more conventional machine built of the same implementation technology.Multiflow Computer, Inc., has now built a VLIW called the TRACE TM along with its companion Trace Scheduling TM compacting compiler. This new machine has fulfilled the performance promises that were made. Using many fast functional units in parallel, this machine extends some of the basic Reduced-Instruction-Set precepts: the architecture is load/store, the microarchitecture is exposed to the compiler, there is no microcode, and there is almost no hardware devoted to synchronization, arbitration, or interlocking of any kind (the compiler has sole responsibility for runtime resource usage).This paper discusses the design of this machine and presents some initial performance results.

Objective: To identify sustainable governance arrangements for health care organisations undertaking integrated health service delivery based on best available evidence. Method: Systematic review of the literature (1990–2006), supported by key informant interviews as an integrative process. Results: 16 studies met our selection criteria. All described enablers of and barriers to delivering integrated health services. We identified three models for integrated health care governance with a demonstrated ability to be sustained in the medium term. Common themes that emerged as the logical starting point for more ambitious integrated governance arrangements regionally were: the need for a clear separation between governance and operational management; and the need for local communities with the vision, leadership and commitment to extend health service integration. These themes were reinforced by interviews with key informants. Careful measurement of the process, impact and outcomes of such activities was often overlooked. Conclusion: State governments are increasingly attempting to work with non‐government organisations and the private sector to maximise scarce resources in the face of increasing health care demand. Ambitious integration agendas must be underpinned by effective governance mechanisms that are appropriate to the undertaking, the stakeholders involved and the scale of delivery.

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