Surgery and the elderly

@varelalaf

More and more elderly people are being seen in the operating room, especially for large joint replacement interventions, for colorectal cancer resections or for vascular pathologies, to cite the most frequent casuistry. Many of these actions are aggressive and generate risks of postoperative complications, which often require catheters, serum, transfusions, intubations, etc. Therefore, a lot of clinical circumstances are generated that induce immobilization, a situation that adds a new chain of risks, especially thromboembolism, bedsores, infections, disorientation, delusions, malnutrition and dehydration.

Cancer research: little science, big data or big science

Apparently, the duration and costs of clinical trials of new oncological drugs could be reduced if surrogate measures, such as tumour reduction or time to progression, were to be used instead of survival, but a meta-analysis of 146 clinical trials of colorectal cancer and 191 of lung cancer found that only 10-16% of survival was explained by these variables; obviously a poor correlation. On the other hand, there is the question of the methodology used. A review of 43 studies found that, in 81% of the cases, promising results from phase II (without a control group) failed to transfer to phase III (double-blind randomized trial). The latter is another finding unfavourable to the rush with which many oncological drugs are introduced in the market. Perhaps it’s for this reason that, in an observation of 94 articles on the subject, Abola and Prasad have discovered that in half of them, the editors had resorted to adjectives of the type: miraculous, revolutionary, innovative, wonderful, transformative, etc...

Chronic Elderly Patients: new evaluative proposals for community programs

Marco Inzitari

In recent years, we have witnessed the implementation of various community programs based on proactive monitoring and secondary prevention interventions aiming to improve the health of chronically ill patients and reduce costs to the system, such as avoiding unnecessary hospitalizations. But when studies have been conducted to evaluate the effectiveness and efficiency of these studies, the results have been rather poor.

Some of these disappointing results were presented during the Congress of the European Union Geriatric Medicine Society (EUGMS). The symposium called "Strategies in primary care to promote the autonomy of frail elderly people" presented the preliminary results of three large randomized cluster studies (cluster Randomized Clinical Trial) of the Netherlands: