Background  The rate of urinary tract infection (UTI) investigation and treatment in confused older emergency department (ED) patients has not been described in the literature. We aim to describe the pattern of practice in an academic tertiary care ED for this common presentation.  Methods  A health record review was conducted on 499 adults aged ≥65 presenting to academic EDs with confusion. Exclusion criteria: Glasgow Coma Scale < 13, current treatment for UTI, indwelling catheters, nephrostomy tubes, transfer from another hospital. Outcomes were the prevalence of UTI investigation, diagnosis and antibiotic treatment.  Results  64.9% received urine tests, 11.4% were diagnosed with UTI, and 35.2% were prescribed antibiotics. In the subgroup with no urinary symptoms, fever, or other obvious indication for antibiotics, these numbers were 58.2%, 7.6%, and 18.1%, respectively. Patients who had urine tests or received antibiotics were older than those who did not (p values < .01). Patients receiving antibiotics had higher admission rates and 30-day and six-month mortality (OR of 2.9 [2.0–4.3], 4.0 [1.6–11], and 2.8 [1.4–5.8], respectively).  Conclusion  Older patients presenting to ED with confusion were frequently investigated and treated for UTI, even in the absence of urinary symptoms. Antibiotic treatment was associated with higher hospitalization and mortality.

Background: We aimed to evaluate the perceived effectiveness of interventions implemented by Canadian neurology residency programs for the 2020–2021 iteration of the Canadian Resident Matching Service (CaRMS). Methods: A cross-sectional survey was distributed to Canadian neurology residency programs and final-year Canadian medical students who applied to at least one neurology program during the 2020–2021 match cycle. The surveys evaluated pre-interview and interview period interventions implemented by Canadian neurology residency programs and accessed by medical students. Results: Thirty-five medical students and 13 out of 15 institutions in Canada with neurology residency programs responded to the survey. Multiple adaptations were implemented, including social media advertisement, web-based platforms, pre-interview information sessions, and teaching sessions, with all surveyed programs implementing at least two virtual interventions. We found that all interventions were perceived as adequate by a majority (>60%) of medical students, with pre-interview period virtual information sessions perceived as effective by the largest proportion of respondents. All Canadian neurology residency programs held virtual interviews for the 2020–2021 cycle, and most programs utilized the same interview structure as prior years. There was discordance between residency program stakeholders and medical students on the most helpful interview period modality. Medical students found the hospital tours and information sessions most valuable, whereas program stakeholders perceived the virtual socials and interviews as most helpful. Conclusion: The COVID-19 pandemic has led to innovative adaptations implemented by Canadian neurology residency programs, which were seen as effective by both medical students and program stakeholders.

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has been said that hospitals are people, and no-onẽ can doubt that the quality of a hospital reflects more the quality of the staff than the buildings themselves, but it has also been said of some of the best known and finest large general hospitals in Great Britain that the staff, particularly the medical staff, became too remote from their patients. In these circumstances there could be a tendency for patients to be treated as 'diseases' or, at best, interesting cases rather than as persons with families, friends and a place in the community. A recent committee recommended the setting up of even larger hospitals in the form of a national network of larger District General Hospitals each providing comprehensive hospital care for populations of the order of two hundred thousand. These large district general hospitals would, it was recommended, be supported by smaller peripheral, or what are now being called, Community Hospitals. The majority of acutely ill patients will be treated, therefore, in district general hospitals and my observations from hereon refer largely to these hospitals. It is, therefore, open to question whether such institutions which have been developed largely as diagnostic curative and therapeutically orientated centres can effectively provide a positive answer to the question posed in the title of this paper.It is, however, submitted that district general hospitals can and must have a preventive role.