No abstract

the interRAI-AC can be used to derive a single score that predicts multiple adverse outcomes in older inpatients. A score of ≤0.40 can well discriminate patients who are unlikely to die or experience a geriatric syndrome. Whether the FI-AC can result in management decisions that improve outcomes requires further study.

BackgroundA better understanding of the health status of older inpatients could underpin the delivery of more individualised, appropriate health care.Methods1418 patients aged ≥ 70 years admitted to 11 hospitals in Australia were evaluated at admission using the interRAI assessment system for Acute Care. This instrument surveys a large number of domains, including cognition, communication, mood and behaviour, activities of daily living, continence, nutrition, skin condition, falls, and medical diagnosis.ResultsVariables across multiple domains were selected as health deficits. Dichotomous data were coded as symptom absent (0 deficit) or present (1 deficit). Ordinal scales were recoded as 0, 0.5 or 1 deficit based on face validity and the distribution of data.Individual deficit scores were summed and divided by the total number considered (56) to yield a Frailty index (FI-AC) with theoretical range 0–1. The index was normally distributed, with a mean score of 0.32 (±0.14), interquartile range 0.22 to 0.41. The 99% limit to deficit accumulation was 0.69, below the theoretical maximum of 1.0.In logistic regression analysis including age, gender and FI-AC as covariates, each 0.1 increase in the FI-AC increased the likelihood of inpatient mortality twofold (OR: 2.05 [95% CI 1.70 – 2.48]).ConclusionsQuantification of frailty status at hospital admission can be incorporated into an existing assessment system, which serves other clinical and administrative purposes. This could optimise clinical utility and minimise costs.The variables used to derive the FI-AC are common to all interRAI instruments, and could be used to precisely measure frailty across the spectrum of health care.

Aims:To investigate the probability of developing type 2 diabetes mellitus (T2DM) at different body mass index levels compared to matched non-diabetic controls in a multi-ethnic population. Materials and methods:This was a case-control study of 90 367 patients with incident diabetes and 362 548 age-sex-ethnicity matched controls from UK primary care. The probability of developing T2DM was estimated. (29%) (all P < .01). Within the 18 to 70-year age range, South Asian males and females had a significantly higher probability of developing diabetes in the continuously measured BMI range of 18 to 30 kg/m 2 , compared to White Europeans and African-Caribbeans. Across all age groups <70 years, South Asians and African-Caribbeans had a significantly higher probability of developing T2DM in the normal weight and overweight categories, compared to White Europeans. However, this risk pattern of developing diabetes was reversed amongst the obese in all age groups. Conclusion:Risk patterns of developing diabetes at different levels of obesity varies among ethnic groups across all ages, while South Asians and African-Caribbeans carry the highest risk at a younger age and at lower adiposity burden. K E Y W O R D Sbody mass index, matched case-control study, multi-ethnic comparisons, probability of developing type 2 diabetes

Objectives. The aim of the present study was to describe trends in and age and gender distributions of presentations of older people to Australian emergency departments (EDs) from July 2006 to June 2011, and to develop ED utilisation projections to 2050.Methods. A retrospective analysis of data collected in the National Non-admitted Patient Emergency Department Care Database was undertaken to assess trends in ED presentations. Three standard Australian Bureau of Statistics population growth models, with and without adjustment for current trends in ED presentation growth and effects of climate change, were examined with projections of ED presentations across three age groups (0-64, 65-84 and 85 years) to 2050.Results. From 2006-07 to 2010-11, ED presentations increased by 12.63%, whereas the Australian population over this time increased by only 7.26%. Rates of presentation per head of population were greatest among those aged 85 years. Projections of ED presentations to 2050 revealed that overall ED presentations are forecast to increase markedly, with the rate of increase being most marked for older people.Conclusion. Growth in Australian ED presentations from 2006-07 to 2010-11 was greater than that expected from population growth alone. The predicted changes in demand for ED care will only be able to be optimally managed if Australian health policy, ED funding instruments and ED models of care are adjusted to take into account the specific care and resource needs of older people.What is known about the topic? Rapid population aging is anticipated over coming decades. International studies and specific local-level Australian studies have demonstrated significant growth in ED presentations. There have been no prior national-level Australian studies of ED presentation trends by age group. What does this paper add? The present study examined national ED presentation trends from July 2006 to June 2011, with specific emphasis on trends in presentation by age group. ED presentation growth was found to exceed population growth in all age groups. The rate of ED presentations per head of population was highest among those aged 85 years. What are the implications for practitioners? Growth in ED presentations exceeding population growth suggests that current models of acute health care delivery require review to ensure that optimal care is delivered in the most fiscally efficient manner. Trends in presentation of older people emphasise the imperative for ED workforce planning and education in care of this complex patient cohort, and the requirement to review funding models to incentivise investment in ED avoidance and substitutive care models targeting older people.

Students believed the course helped them to improve their knowledge regarding key aspects of e-health. It is important to design an e-health curriculum targeting competencies to provide necessary knowledge and skills to help students practice e-health in their professional careers.

Continuous blood glucose monitoring systems (CGMS) capture interstitial glucose levels at frequent intervals over time, and are used by people with diabetes and their health care professionals to assess glycaemic variability. This information helps to adjust treatment to achieve optimum glycaemic control, as well as potentially providing early warning of imminent and dangerous hypoglycaemia. Although a number of studies has reported the possibilities of predicting hypoglycaemia in insulin dependent type 1 diabetes (T1DM) patients, the prediction paradigm is still unreliable, as glucose fluctuations in people with diabetes are highly volatile and depend on many factors. Studies have proposed the use of linear auto-regressive (AR) and state space time series models to analyse the glucose profiles for predicting upcoming glucose levels. However, these modelling approaches have not adequately addressed the inherent dependencies and volatility aspects in the glucose profiles. We have investigated the utility of generalized autoregressive conditional heteroscedasticity (GARCH) models to explore glucose time-series trends and volatility, and possibility of reliable short-term forecasting of glucose levels. GARCH models were explored using CGMS profiles of young children (4 to <10 years) with T1DM. The prediction performances of GARCH approach were compared with other contemporary modelling approaches such as lower and higher order AR, and the state space models. The GARCH approach appears to be successful in both realizing the volatility in glucose profiles and offering potentially more reliable forecasting of upcoming glucose levels.

No abstract