Revue médicale suisse
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Age-related physiological changes and comorbidities affect older patients' tolerance to surgery. Pre-operative assessment in these patients requires, beside the usual physical evaluation, the systematic screening of common geriatric syndromes. Cognitive, gait and balance, nutritional, and functional impairments, all flag patients at higher risk for per- and postoperative complications. Preoperative assessment is an opportunity to detect these syndromes and propose preventative interventions (physical therapy, nutritional and cognitive support measures) likely to reduce the incidence of postoperative morbidity.
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Hip fracture management by the geriatrician demands a close cooperation with orthopedic surgeons and a interdisciplinary approach with the implementation of protocole-driven care to standardize the care of most patients. From admission to discharge this orthogeriatric management is based on the comprehensive geriatric assessment to reduce the delays in surgery, the occurence of delirium or the most postoperative complications. This collaborative model of care seems to have the potential to improve function, admissions to nursing homes and mortality outcomes compared with usual care of geriatric patient with hip fracture.
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Revue médicale suisse · Nov 2014
Review[Electives during preclinical medical curriculum: the Geneva experience ].
Electives have come of age in Medical Schools throughout Europe since the Bologna Guidelines were issued. At the Faculty of Medicine of Geneva its importance was recognized early to satisfy the students' curiosity, enlarge their visions, or deepen their knowledge in certain aspects of their curriculum. ⋯ The experience has so far been a success, with high satisfaction as well of the student as of the teacher body. A major challenge for the future will be opening further these Electives to other Faculties and other professions.