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Malnutrition is an important clinical condition leading to increased morbidity and mortality. This report describes an aggressive oral refeeding program of high-caloric foods, which was instituted in severely anorectic patients because of their refusal to eat meals or supplements. After ascertaining a patient's favorite sweet, hospital personnel and family collaborated in providing the food. Frequently, sweets were the patient's only intake for weeks. We saw a gradual return of appetite, inclusion of other foods in the diet, and overall clinical improvement in comorbid conditions. These cases suggest that aggressive oral refeeding with high-caloric foods is an underutilized therapy for multiply impaired elderly patients.

Discharge of homeless individuals from the hospital setting “into the community” often results in poor health outcomes, frequent re‐hospitalization, and increased costs. Through appropriate collaboration involving hospital staff, shelter operators, and primary care providers, and with ongoing nurse case management engagement to maintain linkage among all parties, individuals who have experienced homelessness can recover successfully following hospitalization with fewer negative consequences. Nurse case managers are key, by ensuring that homeless patients receive necessary support upon release from the inpatient setting, assisting hospital staff in determining appropriate housing arrangements for homeless patients being discharged, and preparing shelter providers with the information and tools to support homeless patients posthospitalization. This collaboration may lead to significant improvement in housing stability for homeless patients and a reduction in hospital re‐entry following discharge. This practice has implications for communities nationwide that are seeking to improve housing stability and reduce health‐care costs.

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best of all, the dam at Cascara had given way so that traffic was moving along as sweet as a rose."from Through the Alimenta y Canal with Gun and Camera, George S. Chappell ary Goldstein, M D In this Grand Rounds we present a case of fecal incontinence, followed by a discussion of the pathophys-M iology, evaluation, and management of the condition and by a discussion of the psychosocial aspects of management. This case and the ensuing discussion will highlight key information needed by the geriatrician or primary care physician to manage patients with this complaint. CASE HISTORYPeter Holt, MD: The patient, Colonel A., was a 90year-old white male retired Army Colonel under evaluation in an outpatient geriatric clinic. His problems included mild hypertension, glaucoma, chronic renal insufficiency, degenerative joint disease, and a remote history of cerebrovascular accident 45 years before admission, without residual deficit. It was also noted that he had a history of urinary and fecal incontinence. He reported a sense of urgency and occasional leakage of urine, just before his ability to get to the bathroom. This occurred several times a week. He was incontinent of stool, roughly once a month, again sensing the need to go, but unable to get to the bathroom in time. This continued to be a problem at the time of his hospitalization.