Adult Patients with Difficulty Swallowing Oral Dosage Forms: A Systematic Review of the Quantitative Literature

The aim of this systematic review was to identify and critically appraise the available evidence regarding solid oral dosage forms (SODFs), e.g., tablets, and challenges regarding the oral administration of medicine to inpatients in a variety of healthcare settings such as (1) hospitals, (2) nursing homes and (3) long-term stay units (LTSUs). A literature search was undertaken in September 2021 and repeated in June 2023 in the following databases: PubMed, EMBASE, CINAHL, Scopus, Web of Science, The Cochrane Library, PsycINFO and ProQuest. A Microsoft Excel® spreadsheet was devised to collate the following data from each eligible study: study author and year, country, number of participants, title, duration (follow-up period), study design, inclusion and exclusion criteria, method and data collection, relevant outcomes, and key findings. A total of 3023 records were identified, with 12 articles being included in the final systematic review. Seven of the twelve studies reported on the prevalence of difficulties swallowing SODFs, which varied from 10-34.2%. Nine of the twelve studies reported the methods used to manipulate SODFs, with the most reported method being tablet crushing. Given the prevalence of swallowing difficulties and the subsequent crushing of medicines in response to this, it is evident that concerns should be raised regarding the potential for a medication administration error to occur.

One year update following removal of high sugar sweetened beverages from a university campus

Key messages

Removal of high sugar sweetened drinks from a university campus is possible; advice must be provided to those who may feel negatively impacted by the change. Sales can grow despite health-related changes of the food environment.

Impact of Different Childhood Adversities on 1-Year Outcomes of Psychotic Disorder in the Genetics and Psychosis Study

While the role of childhood adversity in increasing the risk of psychosis has been extensively investigated, it is not clear what the impact of early adverse experiences is on the outcomes of psychotic disorders. Therefore, we investigated associations between childhood adversity and 1-year outcomes in 285 first-presentation psychosis patients. Exposure to childhood adversity prior to 17 years of age was assessed using the Childhood Experience of Care and Abuse Questionnaire. Data on illness course, symptom remission, length of psychiatric hospitalization, compliance with medication, employment, and relationship status were extracted from clinical records for the year following first contact with mental health services for psychosis. Seventy-one percent of patients reported exposure to at least 1 type of childhood adversity (physical abuse, sexual abuse, parental separation, parental death, disrupted family arrangements, or being taken into care). No robust associations were found between childhood adversity and illness course or remission. However, childhood physical abuse was associated with almost 3-fold increased odds of not being in a relationship at 1-year follow-up compared to patients who did not report such adverse experiences. There was also evidence of a significant association between parental separation in childhood and longer admissions to psychiatric wards during 1-year follow-up and 2-fold increased odds of noncompliance with medication compared to those not separated from their parents. Therefore, our findings suggest that there may be some specificity in the impact of childhood adversity on service use and social functioning among psychosis patients over the first year following presentation to mental health services.

Social disadvantage: cause or consequence of impending psychosis?

BACKGROUND

An association between social disadvantage and established psychosis is well documented in the literature, but there remains a lack of data on the social circumstances of patients before they became ill. We investigated whether social disadvantage at, and prior to, first contact with psychiatric services, is associated with psychosis.

METHOD

We collected information on social disadvantage in childhood and adulthood from 278 cases presenting with their first episode of psychosis to the South London and Maudsley National Health Service Foundation Trust and from 226 controls recruited from the local population. Three markers of childhood social disadvantage and 3 markers of disadvantage in adulthood were analyzed.

RESULTS

Long term separation from, and death of, a parent before the age of 17 years were both strongly associated with a 2- to 3-fold-increased odds of psychosis. Cases were also significantly more likely to report 2 or more markers of adult social disadvantage than healthy controls (OR = 9.03) at the time of the first presentation with psychosis, independent of a number of confounders. When we repeated these analyses for long-standing adult social disadvantage, we found that the strength of the association decreased but still remained significant for 1 year (OR = 5.67) and 5 years (OR = 2.57) prior to the first contact.

CONCLUSIONS

Social disadvantage indexes exposure to factors operating prior to onset that increase the risk of psychosis, both during childhood and adulthood.

Investigation and management of an outbreak of Salmonella Typhimurium DT8 associated with duck eggs, Ireland 2009 to 2011

>Salmonella Typhimurium DT8 was a very rare cause of human illness in Ireland between 2000 and 2008, with only four human isolates from three patients being identified. Over a 19-month period between August 2009 and February 2011, 34 confirmed cases and one probable case of Salmonella Typhimurium DT8 were detected, all of which had an MLVA pattern 2-10-NA-12-212 or a closely related pattern. The epidemiological investigations strongly supported a link between illness and exposure to duck eggs. Moreover, S. Typhimurium with an MLVA pattern indistinguishable (or closely related) to the isolates from human cases, was identified in 22 commercial and backyard duck flocks, twelve of which were linked with known human cases. A range of control measures were taken at farm level, and advice was provided to consumers on the hygienic handling and cooking of duck eggs. Although no definitive link was established with a concurrent duck egg-related outbreak of S. Typhimurium DT8 in the United Kingdom, it seems likely that the two events were related. It may be appropriate for other countries with a tradition of consuming duck eggs to consider the need for measures to reduce the risk of similar outbreaks.

Surgical salvage of pelvic recurrences from colorectal tumors

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Background: The morbidity of pelvic recurrences from colorectal tumors (PRCT) represents a challenge for the oncology multidisciplinary team. Surgical treatment is the best option for palliation and in several series it offers long term local control in 30% of the cases. Objective: To perform a retrospective analysis of patients (pts) surgically resected for PRCT in terms of: time to progression after surgical salvage (TP) and specific suvival (SS). Correlatives studies were performed with clinic and pathologic factors, surgical procedures (SP), and postoperative complications in terms of TP and SS. Methods: 64 pts treated (June 1994 - February 2005) were identified (women: 30), median age 63 years, site of the primary: rectum 48, sigmoid 16; Median number of resected nodes: 8 (r: 2 - 20) in pts with negative nodes and 15 (r: 6 - 42) in pts with positive nodes; primary treatment: surgery (S): 22 pts, S + chemotherapy (CT): 18, S + radiotherapy (RT): 4, S + CT/RT: 17, CT + S: 2 pts, QT/RT + CX: 1; in 7/64 a Miles procedure was performed as primary therapy, median disease free interval: 15 months; site of initial recurrence: locoregional 58 (90%), locoregional + systemic 10%. Pain and bleeding were the most frecuent symptoms. Results: The strategy in PRCT was: S: 29 pts, S + RT: 15, S + CT/RT: 9, CT/RT + S: 7, S + CT: 2, CT + S: 1, RT + S:1; IORT: 18/64; external beam RT: 17/64, 6 pts required Miles; type of resection: R0: 50/64 (78%), R1: 8/64 (12%), R2: 3/64 (5%) and 3 (5%) unknown. Median duration of surgery: 4 hours, abscesses and fistulas were the complications most frequently observed. Median time to progression (TP): 12 months, site of recurrence (56/64 pts) post salvage surgery: pelvic: 22 pts, extrapelvic: 6 pts, combined: 10 and unknown 18. Eleven pts are free of disease. In 16 pts more than one surgical salvage was perfomed. The specific survival was 21 months (IC 95% 37 - 61 m). Conclusions: In this serie surgical salvage of PRCT showed one year of local control disease, even in pts with R2 and with moderate morbidity. The surgical decision must be individualized and in the context of a trained surgical team.

No significant financial relationships to disclose.

Does arthritis progress in the retained compartments after ‘Oxford’ medial unicompartmental arthroplasty?

We determined the outcome of 56 ‘Oxford’ unicompartmental replacements performed for anteromedial osteoarthritis of the knee between 1982 and 1987. Of these, 24 were in patients who had died without revision, one was lost to follow-up and two had been revised. Of the remaining 29 knees, 26 were examined clinically and radiologically, two were only examined clinically and one patient was contacted by telephone. The mean age of the patients was 80.3 years.

At a mean follow-up of 11.4 years (10 to 14) the measurements of the knee score, range of movement and degree of deformity were not significantly different from those made one to two years after operation, except that the range of flexion had improved. Comparison of fluoroscopically-controlled radiographs at a similar interval of time showed no change in the appearance of the lateral compartments. The retained articular cartilage continued to function for ten or more years which suggests that anteromedial osteoarthritis may be considered as a focal disorder of the knee. This justifies continued efforts to develop methods of treatment which preserve intact joint structures.