Swiss medical weekly
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Swiss medical weekly · Oct 1997
Review[Multidimensional geriatric assessment in the acute hospital and ambulatory practice].
Comprehensive geriatric assessment (CGA) is defined as a multidimensional medical, functional, psychosocial and environmental evaluation of an older person's problems and resources, linked with an overall plan for treatment and follow-up. It is well established that CGA implemented in specialized geriatric evaluation and management units improves function and survival in frail older patients. The results of new randomized controlled trials, however, show that the application of CGA does not only improve outcomes in selected older persons, but probably in most. ⋯ Annual comprehensive geriatric assessments with preventive home visits in older people living at home resulted in fewer nursing home admissions and delayed or prevented the onset of disability in the activities of daily living in persons of the intervention group as compared to controls. One of the roles of geriatricians is teaching CGA and conducting further research with a view to refining CGA methodology and its application. Practical application of the principles of geriatric assessment and management, however, should not remain in the hand of specialists alone, but should become an integrated part of primary care medicine in the ambulatory and hospital settings.
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When physicians encounter pregnant patients with respiratory complaints, they face a challenging set of clinical problems. To understand the clinical cardiopulmonary manifestations of diseases occurring during pregnancy, knowledge of the basic physiologic changes during pregnancy is necessary. ⋯ Clinical symptoms, diagnosis and treatment of most diseases do not differ from those in the nonpregnant state. However, pharmacotherapy presents unique aspects, since not only may pharmacokinetics differ, but the fetus must also be assumed to be a recipient of the drug.