Understanding Everyday Homes of Urban Communities: The Case of Local Streets (Hawari) of Old Cairo

This paper aims at investigating architectural and urban heritage from the socio-cultural point of view, which stands on the human asset of traditional sites such as the hawari of old Cairo. It analyzes the social practice of everyday life in one of the oldest Cairene hawari, Haret al-Darb al-Asfar. The focus is on architectural and spatial organization of outdoor and indoor spaces that coordinate the spatial practices of local community. A daily monitoring of people’s activities and interviews was conducted in an investigation of how local people perceive their built environment between the house’s interior and the outdoor shared space. It emerges that people construct their own field of private spheres according to complex patterns of daily activities that are not in line with the classical segregation between private and public in Islamic cities. This paper reports that the harah is basically a construct of social spheres that are organized spatially by the flexible development of individual buildings over time and in response to changes in individuals’ needs and capabilities. In order to achieve sustainability in old urban quarters, the paper concludes, the focus should be directed towards the local organization of activities and a comprehensive upgrading of deteriorating buildings to match the changing needs of current population.

Effect of a pharmacist-led multicomponent intervention focussing on the medication monitoring phase to prevent potential adverse drug events in nursing homes

OBJECTIVES: To determine the extent to which the use of a clinical informatics tool that implements prospective monitoring plans reduces the incidence of potential delirium, falls, hospitalizations potentially due to adverse drug events, and mortality.

DESIGN: Randomized cluster trial.

SETTING: Twenty-five nursing homes serviced by two long-term care pharmacies.

PARTICIPANTS: Residents living in nursing homes during 2003 (1,711 in 12 intervention; 1,491 in 13 usual care) and 2004 (1,769 in 12 intervention; 1,552 in 13 usual care).

INTERVENTION: The pharmacy automatically generated Geriatric Risk Assessment MedGuide (GRAM) reports and automated monitoring plans for falls and delirium within 24 hours of admission or as part of the normal time frame of federally mandated drug regimen review.

MEASUREMENTS: Incidence of potential delirium, falls, hospitalizations potentially due to adverse drug events, and mortality.

RESULTS: GRAM triggered monitoring plans for 491 residents. Newly admitted residents in the intervention homes experienced a lower rate of potential delirium onset than those in usual care homes (adjusted hazard ratio (HR)=0.42, 95% confidence interval (CI)=0.35–0.52), overall hospitalization (adjusted HR=0.89, 95% CI=0.72–1.09), and mortality (adjusted HR=0.88, 95% CI=0.66–1.16). In longer stay residents, the effects of the intervention were attenuated, and all estimates included unity.

CONCLUSION: Using health information technology in long-term care pharmacies to identify residents who might benefit from the implementation of prospective medication monitoring care plans when complex medication regimens carry potential risks for falls and delirium may reduce adverse effects associated with appropriate medication use.