To determine which symptoms, signs, and characteristics that define the patient's functional status predict the survival time in terminally ill cancer patients, a prospective longitudinal study was conducted with terminally ill cancer patients followed by a Home Care Support Team. Patients were followed up with at least weekly visits until death, collecting variables at each visit. A Cox multivariate regression analysis took into account all the follow-ups in the same patient. Ninety-eight patients were studied, and 250 evaluations were done. The mean age was 72 years. The median survival was 32 days. In the multivariate analysis, three independent variables were identified: Palliative Performance Score of 50 or under, heart rate of 100/minute or more, and respiratory rate of 24/minute or more. The variables that were found to be prognostic in our study are objective, easy, and quick to measure, and do not require that the professional have special training or experience. The prediction of survival time may be improved by considering these variables.

Primary care doctors are aware of the need to estimate a global cardiovascular risk, recognize the usefulness of the tables but find problems in their practical application. In order to make their application feasible, tables should be simplified and unified, and their format should be improved.

Introduction and Objectives COPD is a major cause of mortality/ morbidity in high smoking prevalence Primary Care Trusts (PCTs). Our PCT expected COPD prevalence (3.7%) is therefore high but recorded prevalence (2009/2010) was 1.4%, suggesting large numbers of undiagnosed patients. COPD, as the 2nd commonest cause of emergency admission locally, is one of the most costly diseases for secondary care. Local research (Bastin et al, 2010 1 ) shows that, while most patients admitted for the first time with acute exacerbations of COPD have severe disease, there is no prior diagnosis in w1/3 cases. A COPD Local Enhanced Service (LES) was developed, to incentivise practices to proactively identify, diagnose and manage COPD patients using evidence-based interventions. Methods All GP practices in were invited to participate in the COPD LES. Key elements included number of case finding spirometries performed in smokers/ex-smokers ¼35 y, and provision of interventions (pulmonary rehabilitation (PR) referral, self-management, oxygen auditing) with regular reviews/assessments. Primary outcomes were the number of new COPD diagnoses, a change in the gap between recorded and estimated COPD prevalence and number of non-elective hospital admissions. Data were extracted from the PCT GP dataset, QMAS (diagnosed prevalence), APHO COPDprevalence model (expected prevalence) and Secondary Users Services (hospital admission data). Results 37/38 (97%) GP practices signed up to provide the LES. Between April 2010 and May 2011, 1807 case finding spirometries were performed resulting in an estimated 477 new COPD diagnoses, significantly reducing the undiagnosed COPD prevalence by 0.2% (p<0.05). Compared to the same period in 2009, referrals to PR increased from 78 to 119 (52%) in the first 6/12. Audits of oxygen therapy identified ongoing unnecessary payment in 52 patients (47 died/moved, five patients no longer required oxygen). Twenty-nine patients on LTOT had not been reviewed and were subsequently referred. The LES impact on the rate of emergency admissions for COPD remains unclear. Conclusions One year evaluation demonstrates the COPD-LES is an effective strategy to improve case finding and diagnosis of COPD, improve PR referrals and rationalise oxygen prescribing. Ongoing audit of COPD emergency admissions will determine whether the LES achieves its objective.

It is important to know what risk factors are associated with anxiety in order to detect it early and prevent its development to other serious mental disorders. In this study, higher levels of anxiety were found in immigrants, in girls, in drug users, in students in a worse socio-economic situation and in students who have had to repeat a year. This study corroborates the classic risk factors associated with anxiety, but shows that we should take into account a further one: immigration. It also suggests the importance of good family and personal relationships for psychological balance.