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Quaye AA, Foster M, Whitehead L, Hallström IK. Parents' experiences of their child's best interests during a hospital stay in Australia. J Child Health Care 2024:13674935241243101. [PMID: 38569118 DOI: 10.1177/13674935241243101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
Determining the child's best interests in a hospital setting will ideally involve the combined views of children, parents, and healthcare professionals. However, few studies have explored parents' experiences of their child's best interests when they engage with the healthcare system. Therefore, this study aimed to explore parents' experiences of their child's best interests during hospitalisation. A descriptive qualitative inductive design using face-to-face parent-child combined interviews, analysed by latent content analysis, was used. Sixteen parents recruited from a tertiary hospital in Western Australia were interviewed. Collaboration, development of trustworthy relationships, and effective communication were essential in shaping parents' experiences of their child's best interests during hospitalisation.
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Affiliation(s)
- Angela Afua Quaye
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Mandie Foster
- School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
- School of Nursing and Midwifery, Edith Cowan University, Perth, WA, Australia
| | - Lisa Whitehead
- School of Nursing and Midwifery, Edith Cowan University, Perth, WA, Australia
- Centre for Postgraduate Nursing Studies, University of Otago, Christchurch, New Zealand
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2
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Lekpeh G, Salie M, van den Heuvel LL, Seedat S. Neurological and neuropsychiatric manifestations in hospitalised patients with COVID-19. S Afr J Psychiatr 2023; 29:2112. [PMID: 38059198 PMCID: PMC10696520 DOI: 10.4102/sajpsychiatry.v29i0.2112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 09/20/2023] [Indexed: 12/08/2023] Open
Abstract
Background Although literature globally indicates varied neurological and/or neuropsychiatric manifestations (NNM) and complications associated with coronavirus disease 2019 (COVID-19), information about NNM in infected hospitalised patients on the African continent remains limited. Aim To describe the presentation of NNM and compare patients with and without NNM considering demographic and clinical profiles, treatment, and outcomes. Setting Tygerberg Hospital, Cape Town, South Africa. Methods Retrospective medical record review of the first 100 consecutively admitted COVID-19 patients (64 females, mean age 47.6 years) between March and June 2020. Results Of the 98 patients included in the analysis, 56.1% had at least one NNM. The most common NNM were myalgia (32.7%), headache (21.4%), loss of smell and/or taste (15.3%), and delirium (10.2%). Patients with and without NNM did not differ with respect to demographic characteristics. Patients with NNM had significantly more constitutional symptoms (p = 0.017) and were more likely to have neurological and/or neuropsychiatric comorbid conditions (10.9% vs. 0.0%, p = 0.033) than those without NNM. Patients without documented NNM were more likely to have abnormalities on chest X-ray (p = 0.009) than those with NNM. Coronavirus disease 2019 related treatment and mortality did not differ between the groups. Conclusion Neurological and/or neuropsychiatric manifestations were common in hospitalised patients with COVID-19. The results suggest that while COVID-19 patients with NNM may have less of a respiratory phenotype they nonetheless have equivalent mortality rates. Contribution This study highlights the common NNM in patients with COVID-19 admitted to Tygerberg Hospital early in the pandemic and adds to the growing evidence of COVID-19 NNM.
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Affiliation(s)
- Gondah Lekpeh
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Muneeb Salie
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Leigh L van den Heuvel
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Soraya Seedat
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Piotrowicz K, Perera I, Ryś M, Skalska A, Hope SV, Gryglewska B, Michel JP, Grodzicki T, Gąsowski J. Diminished Physical Activity in Older Hospitalised Patients with and without COVID-19. J Clin Med 2023; 12:6261. [PMID: 37834905 PMCID: PMC10573782 DOI: 10.3390/jcm12196261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 09/06/2023] [Accepted: 09/15/2023] [Indexed: 10/15/2023] Open
Abstract
Acute viral respiratory infections have proven to be a major health threat, even after the Corona Virus Disease 2019 (COVID-19) pandemic. We aimed to check whether the presence or absence of an acute respiratory infection such as COVID-19 can influence the physical activity of older hospitalised patients. We cross-sectionally studied patients aged ≥60 years, hospitalized during the pandemic in the non-COVID-19 and COVID-19 ward at the University Hospital, Kraków, Poland. Using activPAL3® technology, we assessed physical activity for 24 h upon admission and discharge. In addition, we applied the sarcopenia screening tool (SARC-F); measured the hand grip strength and calf circumference; and assessed the Modified Early Warning Score (MEWS), age-adjusted Charlson Index, SpO2%, and length of stay (LoS). Data were analysed using SAS 9.4. The mean (min, max) age of the 31 (58% women, eight with COVID-19) consecutive patients was 79.0 (62, 101, respectively) years. The daily time (activPAL3®, median [p5, p95], in hours) spent sitting or reclining was 23.7 [17.2, 24] upon admission and 23.5 [17.8, 24] at discharge. The time spent standing was 0.23 [0.0, 5.0] upon admission and 0.4 [0.0, 4.6] at discharge. The corresponding values for walking were 0.0 [0.0, 0.4] and 0.1 [0.0, 0.5]. SARC-F, admission hand grip strength, calf circumference, and LoS were correlated with physical activity upon admission and discharge (all p < 0.04). For every unit increase in SARC-F, there was a 0.07 h shorter walking time upon discharge. None of the above results differed between patients with and without COVID-19. The level of physical activity in older patients hospitalised during the pandemic was low, and was dependent on muscular function upon admission but not on COVID-19 status. This has ramifications for scenarios other than pandemic clinical scenarios.
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Affiliation(s)
- Karolina Piotrowicz
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, 30-688 Kraków, Poland
- University Hospital, 30-688 Kraków, Poland
| | - Ian Perera
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, 30-688 Kraków, Poland
- University Hospital, 30-688 Kraków, Poland
| | - Monika Ryś
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, 30-688 Kraków, Poland
- University Hospital, 30-688 Kraków, Poland
| | - Anna Skalska
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, 30-688 Kraków, Poland
- University Hospital, 30-688 Kraków, Poland
| | - Suzy V. Hope
- College of Medicine and Health, University of Exeter, and Royal Devon & Exeter NHS Foundation Trust, Exeter EX2 5DW, UK
| | - Barbara Gryglewska
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, 30-688 Kraków, Poland
- University Hospital, 30-688 Kraków, Poland
| | | | - Tomasz Grodzicki
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, 30-688 Kraków, Poland
- University Hospital, 30-688 Kraków, Poland
| | - Jerzy Gąsowski
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, 30-688 Kraków, Poland
- University Hospital, 30-688 Kraków, Poland
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Shimoni Z, Houdhoud N, Isaacs Y, Froom P. Observational study of peripheral intravenous catheter outcomes in an internal medicine department. Intern Med J 2023; 53:221-227. [PMID: 36346286 DOI: 10.1111/imj.15963] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 10/18/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND In elderly patients hospitalised in internal medicine departments, risk factors, preferable placement area and methods of securement of short peripheral venous catheters (SPVC) a unclear. AIM To determine the incidence and risk factors of adverse events using a transparent bordered dressing for securement in the dorsum of the hand or cubital fossa in consecutive patients hospitalised in an internal medicine department. METHODS In a prospective observational study of patients admitted to a regional hospital with a SPVC, the dependent variable was the need to replace the catheter because of an adverse event (phlebitis, accidental removal, infiltration/occlusion). The independent variables were age, gender, disorientation, placement area, intravenous antibiotic therapy and indwelling time. Risk factors were determined by Cox regression model analysis. RESULTS There were 709 catheters placed in 499 patients. Per catheter placed the mean age was 75 ± 17 years. Accidental removal, infiltration/obstruction and phlebitis occurred in 21.5, 16.2 and 15.0 events per 1000 days respectively. There was a significantly increased risk on Day 3 compared to Days 2 and 4. An older age, intravenous antibiotics and disorientation increased the hazard for accidental displacement, whereas phlebitis was associated only with intravenous antibiotics and occlusion/infiltration only with age. CONCLUSIONS The observed low rates of adverse events suggests that placement in the dorsum of the hand or cubital fossa secured by a transparent dressing is acceptable. It is important to consider the indwelling catheter time when studying adverse events, and elderly patients, disoriented patients and/or patients receiving intravenous antibiotics deserve special attention.
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Affiliation(s)
- Zvi Shimoni
- The Adelson School of Medicine, Ariel University, Ariel, Israel.,Medical Director, Laniado Hospital, Netanya, Israel.,Department of Internal Medicine B, Laniado Hospital, Netanya, Israel
| | - Nihad Houdhoud
- Department of Internal Medicine B, Laniado Hospital, Netanya, Israel
| | - Yehudit Isaacs
- Department of Emergency Medicine and Nursing, Laniado Hospital, Netanya, Israel
| | - Paul Froom
- Clinical Utility Department, Sanz Medical Center, Laniado Hospital, Netanya, Israel.,School of Public Health, University of Tel Aviv, Tel Aviv, Israel
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Kaswa R. Acute kidney injury among hospitalised patients who died due to COVID-19 in the Eastern Cape, South Africa. S Afr Fam Pract (2004) 2023; 65:e1-e5. [PMID: 36744486 PMCID: PMC9900244 DOI: 10.4102/safp.v65i1.5616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 10/29/2022] [Accepted: 10/31/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Acute kidney injury (AKI) commonly occurs in coronavirus disease 2019 (COVID-19) patients who have been hospitalised and is associated with a poor prognosis. This study aimed to determine the incidence of AKI among COVID-19 patients who died in a regional hospital in South Africa. METHODS This retrospective record review was conducted at the Mthatha Regional Hospital in South Africa's Eastern Cape province. Data were collected between 10 July 2020 and 31 January 2021. RESULTS The incidence of AKI was 38% among the hospitalised patients who died due to COVID-19. Most study participants were female, with a mean age of 63.3 ± 16 years. The most common symptom of COVID-19 at the time of hospitalisation was shortness of breath, followed by fever and cough. Half of the patients had hypertension, while diabetes, human immunodeficiency viruses (HIV) and tuberculosis (TB) were other comorbidities. At admission, the average oxygen saturation was 75.5% ± 17. CONCLUSION The study revealed a high incidence of AKI among hospitalised patients who died due to COVID-19. It also found that those received adequate crystalloid fluids at the time of admission had a lower incidence of AKI.Contribution: Acute kidney injury can be prevented by adequate fluid management during early stage of COVID-19. Majority of COVID-19 patients were referred from lower level of care and primary care providers have their first encounter with these patients. Adequate fluid resuscitation in primary care settings can improve the outcome of hospitalised COVID-19 patients.
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Affiliation(s)
- Ramprakash Kaswa
- Department of Family Medicine and Rural Health, Faculty of Health Sciences, Walter Sisulu University, Mthatha.
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Bin Adnan MAA, Bin Kassim MSA, Bt Sahril N, Bin Abd Razak MA. Prevalence and Predictors of Anxiety among Stable Hospitalized COVID-19 Patients in Malaysia. Int J Environ Res Public Health 2022; 20:ijerph20010586. [PMID: 36612905 PMCID: PMC9819532 DOI: 10.3390/ijerph20010586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 12/16/2022] [Accepted: 12/22/2022] [Indexed: 06/07/2023]
Abstract
The COVID-19 pandemic has created anxiety among hospitalized SARS-CoV-2 patients. Therefore, this study aimed to determine the prevalence of anxiety and its associated factors among stable inpatient COVID-19 patients in Malaysia. Method: A cross-sectional study was conducted using a web-based online survey involving 401 patients from Malaysia’s leading COVID-19 hospitals from 15th April until 30th June 2020, who were chosen using quota sampling. The General Anxiety Disorders 7 items (GAD-7) scale, the Coping Orientation to Problems Experienced Inventory (Brief-COPE) and a socio-demographic profile questionnaire were used. Descriptive analysis and multiple logistic regression were performed using SPSS v23 to determine the prevalence of anxiety and its associated factors. Result: The results showed that the prevalence of anxiety was 7.0%. Multiple logistic regression analysis revealed that female gender (p < 0.05), a fear of infection (p < 0.05), a lack of information (p < 0.05), a maladaptive coping mechanism of behavioral disengagement (p < 0.001) and self-blame (p < 0.001) were significantly associated with anxiety. Meanwhile, adaptive coping mechanisms via instrumental support (p < 0.001) were a significant protective predictor of anxiety. Conclusions: COVID-19 infection has had a significant influence on the mental health of patients. Findings in our study provide baseline data on the prevalence of anxiety among stabilized COVID-19 inpatients in Malaysia. Despite the relatively low prevalence, the data have the potential to improve the present mental health monitoring system and the deployment of suitable treatments in dealing with similar circumstances.
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Affiliation(s)
- Muhammad Azri Adam Bin Adnan
- Correspondence: (M.A.A.B.A.); (M.S.A.B.K.); Tel.: +60-126660695 (M.A.A.B.A.); +60-175607623 (M.S.A.B.K.); Fax: +60-333627801 (M.A.A.B.A. & M.S.A.B.K.)
| | - Mohd Shaiful Azlan Bin Kassim
- Correspondence: (M.A.A.B.A.); (M.S.A.B.K.); Tel.: +60-126660695 (M.A.A.B.A.); +60-175607623 (M.S.A.B.K.); Fax: +60-333627801 (M.A.A.B.A. & M.S.A.B.K.)
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Williams S, O’Riordan C, Steed F, Leahy A, Shanahan E, Peters C, O’Connor M, Galvin R, Morrissey AM. Early Supported Discharge for Older Adults Admitted to Hospital with Medical Complaints: A Qualitative Study Exploring the Views of Stakeholders. J Multidiscip Healthc 2022; 15:2861-2870. [PMID: 36561433 PMCID: PMC9766477 DOI: 10.2147/jmdh.s380572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 10/07/2022] [Indexed: 12/23/2022] Open
Abstract
Introduction Early supported discharge (ESD) is well established as a model of health service delivery for people with stroke. Emerging evidence indicates that ESD also reduces the length of stay for older medical inpatients. There is a dearth of evidence exploring the views of stakeholders on ESD as a model of care for older medical inpatients. The overall aim of this study is to explore the views and perceptions of older adults, family carers and healthcare professionals on the potential role of ESD for older adults admitted to hospital with medical complaints. Methods Purposeful sampling was used to recruit older adults and family carers for interview. For Healthcare Professionals (HCPs), snowball purposeful sampling was used. Phone interviews took place following a semi-structured interview guide. Focus groups were moderated by A-MM. Braun and Clarke's approach to thematic analysis was used. Ethical approval was granted by the HSE Mid-Western Area Regional Ethics Committee in November 2021 (REC Ref. 096/2021). Results Fifteen HCPs took part across three focus groups, with six older adults and two family members participating in one-to-one interviews. Three themes were identified: 1. Pre-ESD experiences of providing and receiving older adult inpatient care, 2. Navigating discharge procedures from acute hospital services, 3. A vision for more integrated model of care and a medical ESD team. Discussion This study provided insight into the current discharge experiences of older adult care in the acute setting, the potential role for ESD in this population and the key factors that would need to be considered for the running of an ESD service for older adults admitted to hospital with medical complaints. Conclusion This research highlights the barriers and facilitators to ESD for older medical inpatients from the perspectives of key stakeholders. Given the adverse outcomes associated with prolonged hospital stay, these findings will help inform the development of a feasibility trial, examining patient and process outcomes for older adults admitted to hospital with medical complaints who receive an ESD intervention.
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Affiliation(s)
- Susan Williams
- School of Allied Health, University of Limerick, Limerick, Ireland,Correspondence: Susan Williams, School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland, Email
| | - Clíona O’Riordan
- School of Allied Health, University of Limerick, Limerick, Ireland
| | - Fiona Steed
- Department of Medicine, University Hospital Limerick, Limerick, Ireland
| | - Aoife Leahy
- School of Allied Health, University of Limerick, Limerick, Ireland,Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland
| | - Elaine Shanahan
- Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland
| | - Catherine Peters
- Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland
| | - Margaret O’Connor
- Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland,School of Medicine, University of Limerick, Limerick, Ireland
| | - Rose Galvin
- School of Allied Health, University of Limerick, Limerick, Ireland
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Cox NJ, Howson F, Ibrahim K, Morrison L, Sayer AA, Roberts HC, Robinson SM. Mood and physical activity are associated with appetite in hospitalised older men and women. Age Ageing 2022; 51:6964929. [PMID: 36580556 DOI: 10.1093/ageing/afac297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The anorexia of ageing is important in the development of malnutrition, frailty and sarcopenia amongst the older population and is a particular problem for hospital inpatients. This study assessed appetite-related factors in a group of hospitalised older adults, to identify potential preventive strategies. DESIGN Cross sectional observational study. SETTING Eleven wards in one large hospital in England. SUBJECTS Older inpatients aged ≥70 years, admitted non-electively. METHODS Appetite was assessed using the four-item Simplified Nutritional Appetite Questionnaire (SNAQ). Associations between SNAQ score and appetite-related factors present in the dataset were assessed in continuous analyses, including habitual physical activity, mood, medication, cognition and living circumstances. RESULTS 200 participants, mean age of 80.7 years (SD 6.9); 40% were women. Prevalence of poor appetite was 43%. In univariate analyses, lower medication count, higher habitual physical activity and better mood were associated with higher SNAQ scores during admission. In a multivariate analysis, independent associations of higher habitual physical activity and better mood with higher SNAQ scores during hospital admission remained. CONCLUSION In this group of older adults, better mood and higher habitual physical activity were independently associated with better appetite during hospital admission. These are potentially modifiable factors and could be targets for future research into interventions for the anorexia of ageing in the hospitalised older population.
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Affiliation(s)
- Natalie J Cox
- Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Tremona Road, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Fiona Howson
- Medicine for Older People, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Kinda Ibrahim
- Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Tremona Road, Southampton, UK.,NIHR Applied Research Collaboration (ARC) Wessex, University of Southampton, Southampton, UK
| | - Leanne Morrison
- Department of Psychology, Faculty of Social, Human, and Mathematical Sciences, University of Southampton, Southampton, UK.,Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Avan A Sayer
- AGE Research Group, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.,NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust and Newcastle University, Newcastle upon Tyne, UK
| | - Helen C Roberts
- Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Tremona Road, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK.,NIHR Applied Research Collaboration (ARC) Wessex, University of Southampton, Southampton, UK
| | - Sian M Robinson
- AGE Research Group, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.,NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust and Newcastle University, Newcastle upon Tyne, UK
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Dolan H, Slebodnik M, Taylor-Piliae R. Older adults' perceptions of their fall risk in the hospital: An integrative review. J Clin Nurs 2021; 31:2418-2436. [PMID: 34786777 DOI: 10.1111/jocn.16125] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 09/18/2021] [Accepted: 10/29/2021] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES The objectives of this review are to determine what is currently known about older adults' perceptions of their own fall risk in the hospital and associated factors and explore how perceived fall risk in the hospital is assessed. BACKGROUND Every year, up to one million patients suffer an accidental fall in the hospital. Despite research efforts during the last decade, inpatient fall rates have not significantly decreased, and about one third of inpatient falls result in injuries. Limited evidence suggests that assessing hospitalised patients' perceptions of their fall risk and engaging them in their own fall prevention can reduce inpatient falls. DESIGN An integrative review. METHODS An electronic literature search was conducted in the Cumulative Index of Nursing and Allied Health Literature, Cochrane Database of Systematic Reviews, Embase, Google Scholar, OpenGrey, ProQuest Dissertations & Theses Global, PsycINFO and PubMed. Data extraction and quality assessments were independently performed by two reviewers. PRISMA guidelines were followed for reporting this review. RESULTS Twenty-two studies met the inclusion criteria. The findings suggest that hospitalised older adults inadequately estimate their own fall risk. Most participants did not perceive themselves as at risk for falling in the hospital. Educational and motivational interventions can change the patients' perceptions of their own fall risk in the hospital and engage them in fall prevention. The desire to remain independent and feeling vulnerable were associated with fall risk, and the relationship with nursing staff may affect how hospitalised patients perceive their own fall risk. CONCLUSIONS Hospitalised adults, and specifically older adults, do not adequately estimate their own fall risk. Factors associated with these perceptions must be further explored to develop assessment tools and interventions to decrease inpatient fall rates. RELEVANCE TO CLINICAL PRACTICE Nurses' understanding and assessment of hospitalised adults' perception of their own fall risk is important to consider for reducing inpatient falls.
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Affiliation(s)
- Hanne Dolan
- College of Nursing, The University of Arizona, Tucson, Arizona, USA
| | - Maribeth Slebodnik
- Arizona Health Sciences Library and College of Nursing, The University of Arizona, Tucson, Arizona, USA
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Hasim N, Bakar MAA, Islam MA. Efficacy and Safety of Isotonic and Hypotonic Intravenous Maintenance Fluids in Hospitalised Children: A Systematic Review and Meta-Analysis of Randomised Controlled Trials. Children (Basel) 2021; 8:children8090785. [PMID: 34572217 PMCID: PMC8471545 DOI: 10.3390/children8090785] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 09/03/2021] [Accepted: 09/07/2021] [Indexed: 01/21/2023]
Abstract
Hyponatraemia is a known complication in hospitalised children receiving maintenance intravenous fluid. Several studies have been published to investigate the efficacy and safety of intravenous fluids in children. However, there is still an ongoing debate regarding the ideal solution to be used in the paediatric population. Therefore, the aim of this meta-analysis was to investigate the safety and efficacy of administering isotonic versus hypotonic intravenous maintenance fluid in hospitalised children. An extensive search was undertaken on PubMed, Web of Science, Scopus, ScienceDirect, Google Scholar and Cochrane Library on 28 December 2020. Only randomised controlled trials (RCTs) were included. We used the random-effects model for all analyses. Risk ratio (RR) and mean difference with 95% confidence intervals (CIs) were used for dichotomous and continuous outcomes, respectively. The quality of each study was assessed using the Joanna Briggs Institute critical appraisal tool for RCTs. This study is registered with PROSPERO (CRD42021229067). Twenty-two RCTs with a total of 3795 participants were included. The studies encompassed surgical and medical patients admitted to intensive care unit as well as to general wards. We found that hypotonic fluid significantly increases the risk of hyponatremia at both ≤24 h (RR 0.34; 95% CI: 0.26–0.43, p < 0.00001) and >24 h (RR 0.48; 95% CI: 0.36–0.64, p < 0.00001). Isotonic fluid increases the risk of hypernatraemia at ≤24 h (RR 2.15; 95% CI: 1.24–3.73, p = 0.006). The prevalence of hyponatraemia was also higher in the hypotonic group at both ≤24 h (5.7% vs. 23.3%) and >24 h (6.0% vs. 26.3%). There was no statistically significant difference in the risk of developing adverse outcomes between the two groups. Mean serum and urine sodium as well as serum osmolality/osmolarity was lower in the hypotonic group. Isotonic solution is protective against the development of hyponatraemia while hypotonic solution increases the risk of hyponatraemia.
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Affiliation(s)
- Norfarahin Hasim
- Department of Emergency Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia;
- Hospital Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| | - Mimi Azliha Abu Bakar
- Department of Emergency Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia;
- Hospital Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
- Correspondence: (M.A.A.B.); or (M.A.I.)
| | - Md Asiful Islam
- Department of Haematology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
- Correspondence: (M.A.A.B.); or (M.A.I.)
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11
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Kaswa R, Yogeswaran P, Cawe B. Clinical outcomes of hospitalised COVID-19 patients at Mthatha Regional Hospital, Eastern Cape, South Africa: A retrospective study. S Afr Fam Pract (2004) 2021; 63:e1-e5. [PMID: 34212748 PMCID: PMC8252182 DOI: 10.4102/safp.v63i1.5253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 03/27/2021] [Accepted: 03/30/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) is a public health crisis that threatens the current health system. The sudden expansion in the need for inpatient and intensive care facilities raised concerns about optimal clinical management and resource allocation. Despite the pressing need for evidence to make context-specific decisions on COVID-19 management, evidence from South Africa remained limited. This study aimed to describe the clinical characteristics and outcomes of COVID-19 hospitalised patients. METHODS A retrospective cross-sectional study design was used to evaluate the clinical outcomes of hospitalised adult patients (≥ 18 years old) with laboratory-confirmed COVID-19 illness at Mthatha Regional Hospital (MRH), Eastern Cape. RESULTS Of the 1814 patients tested for COVID-19 between 20 March 2020 and 31 July 2020 at MRH, two-thirds (65.4%) were female. About two-thirds (242) of the 392 patients (21.6%) who tested positive for this disease were hospitalised and one-third (150) were quarantined at home. The mean age of the patients tested for COVID-19 was 42.6 years and there was no difference between males and females. The mean age of hospitalised patients was 55.5 years and the mean age of hospitalised patients who died (61.3 years) was much higher than recovered (49.5 years). Overall, 188 (77.6%) hospitalised patients had clinical comorbidity on admission. Diabetes (36.8%) and hypertension (33.1%) were the most common comorbidities amongst COVID-19 hospitalised patients. CONCLUSION The majority of the patients who were hospitalised for COVID-19 were elderly and had high baseline comorbidities. Advance age and underlying comorbidities (diabetes, hypertension and HIV) were associated with high mortality in hospitalised COVID-19 patients.
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Affiliation(s)
- Ramprakash Kaswa
- Department of Family Medicine and Rural Health, Faculty of Health Sciences, Walter Sisulu University, Mthatha.
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12
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Titmarsh HF, Woods GA, Cartwright JA, Kilpatrick S, Gaylor D, Berry J, Gow A, Bommer NX, Gunn-Moore D, Handel I, Mellanby RJ. Low vitamin D status is associated with anaemia in hospitalised cats. Vet Rec 2021; 187:e6. [PMID: 33638545 DOI: 10.1136/vr.105626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 01/03/2020] [Accepted: 01/13/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND The major physiological role of vitamin D has traditionally been considered to be the regulation of calcium homeostasis and maintenance of skeletal health. However, there is increasing evidence that vitamin D influences a wider range of physiological processes including erythropoiesis. Vitamin D (25-hydroxyvitamin D, 25(OH)D) deficiency concentrations have been associated with anaemia in human beings. In contrast, the relationship between vitamin D status and erythropoiesis has not been investigated in cats. METHODS Clinical records of cats consecutively presenting between November 2013 and February 2015 were reviewed. For each cat, data including sex, age, breed, serum albumin and creatinine concentrations, and appetite scores were extracted. A multivariable linear regression model was constructed to examine the relationship between 25(OH)D concentrations and these variables. RESULTS Cats with anaemia had significantly lower 25(OH)D concentrations (median 49.5 nmol/l, n=31) than cats with packed cell volume above the lower limit of the reference range (median 109.0 nmol/l, n=130) (P<0.001). A binary logistic regression found that red blood cell count and mean corpuscular volume were negatively correlated with serum 25(OH)D concentrations (P<0.001 and P=0.007, respectively). CONCLUSION Vitamin D (25(OH)D) concentration is positively associated with red blood cell count and mean corpuscular volume in cats with a wide range of different illnesses.
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Affiliation(s)
- Helen Faye Titmarsh
- Hospital for Small Animals, Royal Dick School of Veterinary Studies and The Roslin Institute, Edinburgh, UK
| | - Glynn Alan Woods
- Hospital for Small Animals, University of Edinburgh, Edinburgh, UK
| | - Jennifer A Cartwright
- Hospital for Small Animals, Royal Dick School of Veterinary Studies and The Roslin Institute, Edinburgh, UK.,Hospital for Small Animals, University of Edinburgh, Edinburgh, UK
| | - Scott Kilpatrick
- Division of Veterinary Clinical Studies, University of Edinburgh, Edinburgh, UK
| | - Donna Gaylor
- Division of Veterinary Clinical Studies, Royal (Dick) School of Veterinary Studies, Edinburgh, UK
| | - Jaqueline Berry
- Clinical Biochemistry, Manchester Royal Infirmary, Manchester, UK
| | - Adam Gow
- Internal Medicine, University of Edinburgh, Edinburgh, UK
| | - Nick X Bommer
- Division of Veterinary Clinical Studies, Royal (Dick) School of Veterinary Studies, Edinburgh, UK
| | - Danielle Gunn-Moore
- Easter Bush Veterinary Centre, Royal (Dick) School of Veterinary Studies, Edinburgh, UK
| | - Ian Handel
- Centre for Infectious Diseases, University of Edinburgh, Edinburgh, UK
| | - Richard J Mellanby
- Division of Veterinary Clinical Studies, University of Edinburgh, Edinburgh, UK
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13
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Sha J, Worsnop CJ, Leaver BA, Vagias C, Kinsella P, Rahman MA, McDonald CF. Hospitalised exacerbations of chronic obstructive pulmonary disease: adherence to guideline recommendations in an Australian teaching hospital. Intern Med J 2021; 50:453-459. [PMID: 31157943 DOI: 10.1111/imj.14378] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 05/15/2019] [Accepted: 05/18/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Optimal management of exacerbations of chronic obstructive pulmonary disease (COPD) reduces patient morbidity and healthcare system burden. COPD guidelines, including the Global Initiative for Chronic Obstructive Lung Disease (GOLD) and the COPD-X Plan, provide evidence-based recommendations, but adherence in hospital practice is variable. AIMS To examine current practice in management of COPD exacerbations at an Australian teaching hospital and to compare with COPD-X Plan recommendations. METHODS Data were collected retrospectively from electronic medical records for admissions occurring during 1 May to 31 August 2016, and compared with recommendations from the COPD-X Plan. RESULTS A total of 134 patients (n = 68 females) was admitted for a COPD exacerbation during the study period. Mean age was 75.4 ± 10.2 years and 33.6% were current smokers. Airflow obstruction on spirometry was confirmed in 67.2% (mean forced expiratory volume in 1 s was 53 ± 22% predicted (1.2 ± 0.5 L)). Excellent adherence to the COPD-X Plan was demonstrated in the ordering of chest radiographs (97%) and electrocardiograms (94%). Supplemental oxygen was appropriately provided to all patients with oxygen saturation of <88%. All patients with confirmed hypercapnic respiratory failure were managed with non-invasive ventilation. Corticosteroids and bronchodilators were prescribed for the majority of patients. Areas of suboptimal practice included inadequate usage of arterial blood gases, excess supplemental oxygen in the absence of hypoxaemia, over-prescription of intravenous antimicrobials, low referral rates to pulmonary rehabilitation and insufficient smoking cessation counselling. CONCLUSIONS Level of adherence to guideline recommendations in the management of COPD exacerbations is inadequate and further strategies are required to elevate standards of practice.
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Affiliation(s)
- Joy Sha
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Victoria, Australia.,Institute for Breathing and Sleep, Melbourne, Victoria, Australia
| | - Christopher J Worsnop
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Victoria, Australia.,Institute for Breathing and Sleep, Melbourne, Victoria, Australia
| | - Benjamin A Leaver
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Victoria, Australia
| | - Christopher Vagias
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Victoria, Australia
| | - Paul Kinsella
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Victoria, Australia
| | - Muhammad A Rahman
- La Trobe University/Austin Health Clinical School of Nursing and Midwifery, College of Science, Health and Engineering, Melbourne, Victoria, Australia
| | - Christine F McDonald
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Victoria, Australia.,Institute for Breathing and Sleep, Melbourne, Victoria, Australia.,Department of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
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14
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Ong T, Bin Syed Ali SA, Sahota O. The Presentation of Older People with Vertebral Fragility Fractures to a University Hospital: A Cross-sectional Analysis. Curr Rheumatol Rev 2021; 17:109-112. [PMID: 32867654 DOI: 10.2174/1573397116999200820170559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 06/26/2020] [Accepted: 07/02/2020] [Indexed: 11/22/2022]
Abstract
INTRODUCTION There is a lack of robust data on hospitalised acute vertebral fragility fractures. This analysis aimed to report on the number of hospitalised vertebral fragility fractures treated in a large UK teaching hospital. This information would support better design of hospital services and resource allocation to manage this group of patients. METHODS Patients aged 50 years and over hospitalised with a vertebral fragility fracture from 1/2/2016 to 31/1/2017 were identified from radiology and hospital records. Patients sustaining vertebral fractures due to either major trauma or malignancy were excluded. Data was collected on patient demographics, fracture details, hospitalisation details and health outcomes. RESULTS 208 patients with acute vertebral fragility fractures were hospitalised over a 12 month period. The mean (SD) age was 80.5 (11) years, of which 68% were female. 94% presented to the Emergency Department (ED) as their first point of contact, of which 70% were subsequently hospitalised. Two-thirds presented with a single level vertebral fracture predominantly around the thoracolumbar region. The majority (87%) were non-operatively managed by general physicians, of which most were under Geriatric Medicine. The median length of stay was 12 (IQR 6-20) days and inpatient mortality was 3%. 52% of patients went on to have a bone health assessment. CONCLUSION We have reported on the number of patients presenting to hospital with an acute vertebral fragility fracture over 12 months. This helps identify resources needed to design hospital services to manage them adequately.
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Affiliation(s)
- Terence Ong
- Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Syed Ajmal Bin Syed Ali
- Department for Healthcare of Older People, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham NG7 2UH, United Kingdom
| | - Opinder Sahota
- Department for Healthcare of Older People, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham NG7 2UH, United Kingdom
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15
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Itaka MB, Omole OB. Prevalence and factors associated with malnutrition among under 5-year-old children hospitalised in three public hospitals in South Africa. Afr J Prim Health Care Fam Med 2020; 12:e1-e7. [PMID: 33354983 PMCID: PMC7736651 DOI: 10.4102/phcfm.v12i1.2444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 09/02/2020] [Accepted: 09/14/2020] [Indexed: 11/21/2022] Open
Abstract
Background Malnutrition is a significant risk factor for ill health among children under 5 years of age and the consequences are significant. Aim The aim of this study was to determine the prevalence and factors associated with malnutrition among under-5-year-old hospitalised children. Setting This study was set at Sebokeng, Kopanong and Heidelberg hospitals, Sedibeng district, South Africa. Methods This was a cross-sectional study comprising 306 hospitalised under-5-year-old children. Information on socio-demography, feeding practices, immunisation and clinical problems was obtained from caregivers and medical records. Anthropometric measurements were also performed. Results Most participants were male (59.8%), had normal birth weights (80.0%), come from a household with a monthly income R2000 (about 150 US dollars) (50.3%), up-to-date immunisation (97.4%), breastfed for 6 months (57.4%) and were fed 3–4 meals/day (66.7%) and, at most, one snack/day (63.4%). Acute malnutrition accounted for 9.5% (n = 29) of admissions. Among these, 82.8% (n = 24) had severe acute malnutrition. On test of association, monthly household income (p = 0.01), mother’s and father’s employment status (p = 0.01; p = 0.01), breastfeeding history (p = 0.01) and having diarrhoea in index admission (p = 0.01) were significantly associated with malnutrition admission. In multivariate regression analyses, not being breastfed (odds ratio [OR] = 3.9; 95% confidence interval [CI]: 1.23–12.29; p = 0.02) and diarrhoea at index admission were independently associated with malnutrition (OR = 23.3; 95% CI: 6.85–79.43; p = 0.01). Conclusion A significant proportion of participants had malnutrition and were subjected to suboptimal feeding practices. Healthcare providers in primary care need to entrench dietary education and anthropometric screening in all clinic visits for children 5 years old, particularly when they present with diarrhoea or are not being breastfed.
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Affiliation(s)
- Makanda B Itaka
- Division of Family Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg.
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16
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Cox NJ, Er Lim S, Howson F, Moyses H, Ibrahim K, Sayer AA, Roberts HC, Robinson SM. Poor Appetite Is Associated with Six Month Mortality in Hospitalised Older Men and Women. J Nutr Health Aging 2020; 24:1107-1110. [PMID: 33244568 DOI: 10.1007/s12603-020-1442-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Appetite loss is common in hospitalised older individuals but not routinely assessed. Poor appetite in hospital has previously been identified as predictive of greater mortality in the six months following discharge in a single study of female patients. The present study aimed to assess this association in a larger sample including both hospitalised men and women. DESIGN Longitudinal observational study with six month follow up. SETTING Acute hospital wards in a single large hospital in England. PARTICIPANTS Older inpatients aged over 70 years. MEASUREMENTS Appetite was assessed using the Simplified Nutritional Appetite Questionnaire (SNAQ) during hospital stay. Deaths during six month follow-up period were recorded. Association between SNAQ score during hospital admission and death 6 months post-discharge was assessed using binary logistic regression in unadjusted and adjusted analysis. RESULTS 296 participants (43% female, mean age 83 years (SD 6.9)) were included in this study. Prevalence of poor appetite (SNAQ score <14) was 41%. In unadjusted analysis a SNAQ score of <14 was associated with a 2.47 increase in odds of mortality at six months (OR 2.47 (95% CI 1.27,4.82)). This association remained after adjusting for number of comorbidities (Charlson index), length of stay and gender (OR 2.62 (95% CI 1.30, 5.27)). In unadjusted continuous analysis, every one point decrease in SNAQ score led to a 1.20 fold increase in odds of mortality at six months (OR 1.20 (95% CI 1.06-1.36)). This association remained in adjusted analysis (OR 1.22 (95% CI 1.07-1.39)). CONCLUSION Poor appetite is common in hospitalised older people. We have confirmed the association, previously reported in older women, between poor appetite during hospital stay and greater mortality at six months post-discharge but in a larger study including older men and women. Further research is needed to understand the mechanisms of poor appetite, which lead to increased mortality.
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Affiliation(s)
- N J Cox
- NJ Cox, Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Tremona Road, Southampton, UK,
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17
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Beard K, Brendish N, Malachira A, Mills S, Chan C, Poole S, Clark T. Pragmatic multicentre randomised controlled trial evaluating the impact of a routine molecular point-of-care 'test-and-treat' strategy for influenza in adults hospitalised with acute respiratory illness (FluPOC): trial protocol. BMJ Open 2019; 9:e031674. [PMID: 31852699 PMCID: PMC6937093 DOI: 10.1136/bmjopen-2019-031674] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Influenza infections often remain undiagnosed in patients admitted to hospital due to lack of routine testing. When tested for, the diagnosis and treatment of influenza are often delayed due to the slow turnaround times of centralised laboratory PCR testing. Newer molecular systems, have comparable accuracy to laboratory PCR testing, and can generate a result in under 1 hour, making them potentially deployable as point-of-care tests (POCTs). High-quality evidence for the impact of routine POCT for influenza on clinical outcomes is, however, currently lacking. This large pragmatic multicentre randomised controlled trial aims to address this evidence gap. METHODS AND ANALYSIS The FluPOC trial is a pragmatic, multicentre, randomised controlled trial evaluating adults admitted to a large teaching hospital and a district general hospital with an acute respiratory illness, during influenza season and defined by Public Health England. Up to 840 patients will be recruited over up to three influenza seasons, and randomised (1:1) to receive either POCT using the FilmArray respiratory panel, or routine clinical care. Clinical and infection control teams will be informed of the results in real time and where influenza is detected clinical teams will be encouraged to offer neuraminidase inhibitor (NAI) treatment in accordance with national guidelines. Those allocated to standard clinical care will have a swab taken for later analysis to allow assessment of missed diagnoses. The outcomes assessment will be by retrospective case note analysis. The outcome measures include the proportion of influenza-positive patients detected and appropriately treated with NAIs, isolation facility use, antibiotic use, length of hospital stay, complications and mortality. ETHICS AND DISSEMINATION Prior to commencing the study, approval was obtained from the South Central Hampshire A Ethics Committee (reference 17/SC/0368, granted 7 September 2017). Results generated from this protocol will be published in peer-reviewed scientific journals and presented at national and international conferences. TRIAL REGISTRATION NUMBER ISRCTN17197293.
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Affiliation(s)
- Kate Beard
- Academic Unit of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Nathan Brendish
- Academic Unit of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Ahalya Malachira
- Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Samuel Mills
- Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Cathleen Chan
- Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Stephen Poole
- Academic Unit of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Tristan Clark
- Academic Unit of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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18
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Yip KF, Wong TH, Alhamid SM, Nadkarni N, Tan CKG, Pang A, Seow CCD. Integrating advance care planning as part of comprehensive geriatric assessment for hospitalised frail elderly patients: findings of a cross-sectional study. Singapore Med J 2019; 61:254-259. [PMID: 31423542 DOI: 10.11622/smedj.2019098] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The integration of advance care planning (ACP) as part of the comprehensive geriatric assessment (CGA) of hospitalised frail elderly patients, together with the clinical and demographic factors that determine successful ACP discussion, has not been previously explored. METHODS A cross-sectional study on patients and family caregivers admitted under the geriatric medicine department of a tertiary hospital was conducted from October 2015 to December 2016. RESULTS Among 311 eligible patients, 116 (37.3%) patients completed ACP discussion while 166 (53.4%) patients declined, with 62 (37.3%) of the decliners providing reasons for refusal. Univariate logistic regression analysis showed that older age, higher Charlson Comorbidity Index, poorer functional status and cognitive impairment had statistically significant associations with agreeing to ACP discussion (p < 0.05). On multivariate logistic regression analysis, only poorer functional status was significantly associated (odds ratio 2.22 [95% confidence interval 1.27-3.87]; p = 0.005). Among those who completed ACP discussion, a majority declined cardiopulmonary resuscitation (79.3%), preferred limited medical intervention or comfort care (82.8%), and opted for blood transfusion (62.9%), antibiotics (73.3%) and intravenous fluid (74.1%) but declined haemodialysis (50.9%). Decision-making was divided for enteral feeding. Among decliners, the main reasons for refusal were 'not keen' (33.9%), 'deferring to doctors' decision' (11.3%) and 'lack of ACP awareness' (11.3%). CONCLUSION The feasibility and utility of integrating ACP as part of CGA has been demonstrated. Poorer functional status is significantly associated with successful ACP discussion. Greater public education on end-of-life care choices (besides cardiopulmonary resuscitation) and follow-up with decliners are recommended.
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Affiliation(s)
- King Fan Yip
- Department of Geriatric Medicine, Singapore General Hospital, Singapore
| | - Ting Hway Wong
- Department of General Surgery, Singapore General Hospital, Singapore.,Duke-NUS Medical School, Singapore
| | | | - Nivedita Nadkarni
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore
| | | | - Amanda Pang
- Department of Reproductive Medicine, KK Women's and Children's Hospital, Singapore
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19
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Nagai T, Sundaram V, Rothnie K, Quint JK, Shoaib A, Shiraishi Y, Kohsaka S, Piper S, McDonagh TA, Hardman SMC, Goda A, Mizuno A, Kohno T, Rigby AS, Yoshikawa T, Clark AL, Anzai T, Cleland JGF. Mortality after admission for heart failure in the UK compared with Japan. Open Heart 2018; 5:e000811. [PMID: 30228905 PMCID: PMC6135420 DOI: 10.1136/openhrt-2018-000811] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 04/24/2018] [Indexed: 12/13/2022] Open
Abstract
Objective Mortality amongst patients hospitalised for heart failure (HHF) in Western and Asian countries may differ, but this has not been investigated using individual patient-level data (IPLD). We sought to remedy this through rigorous statistical analysis of HHF registries and variable selection from a systematic literature review. Methods and results IPLD from registries of HHF in Japan (n=3781) and the UK (n=894) were obtained. A systematic literature review identified 23 models for predicting outcome of HHF. Five variables appearing in 10 or more reports were strongly related to prognosis (systolic blood pressure, serum sodium concentration, age, blood urea nitrogen and creatinine). To compare mortality in the UK and Japan, variables were imputed in a propensity model using inverse probability of treatment weighting (IPTW) and IPTW with logistic regression (doubly robust IPTW). Overall, patients in the UK were sicker and in-patient and post-discharge mortalities were greater, suggesting that the threshold for hospital admission was higher. Covariate-adjusted in-hospital mortality was similar in the UK and Japan (IPTW OR: 1.14, 95% CI 0.70 to 1.86), but 180-day postdischarge mortality was substantially higher in the UK (doubly robust IPTW OR: 2.33, 95% CI 1.58 to 3.43). Conclusions Despite robust methods to adjust for differences in patient characteristics and disease severity, HHF patients in the UK have roughly twice the mortality at 180 days compared with those in Japan. Similar analyses should be done using other data sets and in other countries to determine the consistency of these findings and identify factors that might inform healthcare policy and improve outcomes.
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Affiliation(s)
- Toshiyuki Nagai
- National Heart & Lung Institute, Imperial College London, London, UK.,Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan.,Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Varun Sundaram
- National Heart & Lung Institute, Imperial College London, London, UK.,Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan.,Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA.,Royal Brompton and Harefield Hospitals, London, UK
| | - Kieran Rothnie
- National Heart & Lung Institute, Imperial College London, London, UK
| | | | - Ahmad Shoaib
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, University of Keele and Royal Stoke Hospital, Stoke-on-Trent, UK
| | - Yasuyuki Shiraishi
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Susan Piper
- Cardiology Department, King's College Hospital, London, UK
| | | | - Suzanna Marie C Hardman
- Clinical and Academic Department of Cardiovascular Medicine, Whittington Hospital, London, UK
| | - Ayumi Goda
- Division of Cardiology, Kyorin University School of Medicine, Tokyo, Japan
| | - Atsushi Mizuno
- Department of Cardiology, St Luke's International Hospital, Tokyo, Japan
| | - Takashi Kohno
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Alan S Rigby
- Department of Statistics, Hull York Medical School, University of Hull, Kingston-upon-Hull, UK
| | | | - Andrew L Clark
- Department of Cardiology, Hull York Medical School, Castle Hill Hospital, Kingston-upon-Hull, UK
| | - Toshihisa Anzai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan.,Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - John G F Cleland
- Department of Cardiology, Hull York Medical School, Castle Hill Hospital, Kingston-upon-Hull, UK.,Robertson Centre for Biostatistics and Clinical Trials, University of Glasgow and National Heart & Lung Institute, Royal Brompton & Harefield Hospitals, Imperial College London, London, UK
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20
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Brooks S, Eckerli-Wäspi I, Händler Schuster D. In hospital with a hearing impaired child - How parents experience communication between nurses and their child. Pflege 2018; 31:63-73. [PMID: 29350077 DOI: 10.1024/1012-5302/a000603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background: In daily communication, children with hearing impairment are restricted and dependent on their parents’ help. In case of a hospitalisation, the risk of insufficient information and resulting traumatisation for those children is high. The aim of this study is the investigation of the communicative needs of the children concerned in order to avoid negative consequences of a hospitalisation and of inappropriate communication by nursing staff. Aim: This study explores how parents of a child with hearing impairment experience the communication between the nursing staff and their hospitalised child. Method: The study was conducted together with an advisory centre for hearing-impaired children, where most of the parents could be recruited. Narrative, semi-structured interviews were conducted. The transcribed interviews were analysed according to the method of interpretative phenomenology. Results: The parents expressed their wish for affectionate verbal and nonverbal love and care for their child. They often experienced the nursing staff having little time, that there was no continuity and that the communicative needs of the child were not recognised. Since the parents did not think the nursing staff were capable of communicating with the child and because they wanted to protect him or her, they adopted a mediating role. Conclusions: Besides the sensitisation of the nursing staff, time resources, continuity, professional knowledge and benevolence in the nursing care of a child with hearing impairment play a fundamental role.
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Affiliation(s)
- Seraina Brooks
- 1 Kinder- und Jugendmedizin, Kantonsspital Graubünden, Chur, Schweiz
| | | | - Daniela Händler Schuster
- 3 Institut Pflege, Departement Gesundheit, Zürcher Hochschule für Angewandte Wissenschaften (ZHAW), Winterthur, Schweiz
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21
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Ní Cheallaigh C, Cullivan S, Sears J, Lawlee AM, Browne J, Kieran J, Segurado R, O’Carroll A, O’Reilly F, Creagh D, Bergin C, Kenny RA, Byrne D. Usage of unscheduled hospital care by homeless individuals in Dublin, Ireland: a cross-sectional study. BMJ Open 2017; 7:e016420. [PMID: 29196477 PMCID: PMC5719262 DOI: 10.1136/bmjopen-2017-016420] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Homeless people lack a secure, stable place to live and experience higher rates of serious illness than the housed population. Studies, mainly from the USA, have reported increased use of unscheduled healthcare by homeless individuals.We sought to compare the use of unscheduled emergency department (ED) and inpatient care between housed and homeless hospital patients in a high-income European setting in Dublin, Ireland. SETTING A large university teaching hospital serving the south inner city in Dublin, Ireland. Patient data are collected on an electronic patient record within the hospital. PARTICIPANTS We carried out an observational cross-sectional study using data on all ED visits (n=47 174) and all unscheduled admissions under the general medical take (n=7031) in 2015. PRIMARY AND SECONDARY OUTCOME MEASURES The address field of the hospital's electronic patient record was used to identify patients living in emergency accommodation or rough sleeping (hereafter referred to as homeless). Data on demographic details, length of stay and diagnoses were extracted. RESULTS In comparison with housed individuals in the hospital catchment area, homeless individuals had higher rates of ED attendance (0.16 attendances per person/annum vs 3.0 attendances per person/annum, respectively) and inpatient bed days (0.3 vs 4.4 bed days/person/annum). The rate of leaving ED before assessment was higher in homeless individuals (40% of ED attendances vs 15% of ED attendances in housed individuals). The mean age of homeless medical inpatients was 44.19 years (95% CI 42.98 to 45.40), whereas that of housed patients was 61.20 years (95% CI 60.72 to 61.68). Homeless patients were more likely to terminate an inpatient admission against medical advice (15% of admissions vs 2% of admissions in homeless individuals). CONCLUSION Homeless patients represent a significant proportion of ED attendees and medical inpatients. In contrast to housed patients, the bulk of usage of unscheduled care by homeless people occurs in individuals aged 25-65 years.
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Affiliation(s)
- Clíona Ní Cheallaigh
- St James’s Hospital, Dublin, Ireland
- Trinity College, Dublin, Ireland
- National SpR Academic Fellowship Programme, Dublin, Ireland
| | | | | | | | | | | | - Ricardo Segurado
- UCD School of Public Health, Physiotherapy and Sports Science, Dublin, Ireland
| | - Austin O’Carroll
- Partnership for Health Equity, Dublin, Ireland
- North Dublin City GP Training Programme, Dublin, Ireland
- Safetynet Dublin, Dublin, Ireland
| | | | - Donnacha Creagh
- St James’s Hospital, Dublin, Ireland
- Trinity College, Dublin, Ireland
| | | | - Rose Anne Kenny
- St James’s Hospital, Dublin, Ireland
- Trinity College, Dublin, Ireland
| | - Declan Byrne
- St James’s Hospital, Dublin, Ireland
- Trinity College, Dublin, Ireland
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22
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Kariuki M, Raudino A, Green MJ, Laurens KR, Dean K, Brinkman SA, Lenroot RK, Liu E, Harris F, Luo L, Carr VJ. Hospital admission for infection during early childhood influences developmental vulnerabilities at age 5 years. J Paediatr Child Health 2016; 52:882-8. [PMID: 27439883 DOI: 10.1111/jpc.13239] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/16/2016] [Indexed: 01/31/2023]
Abstract
AIM Childhood infectious diseases can be associated with later physical and psychological ill health, and the effects of this association may be evident during early childhood development. This study aimed to examine the effects of hospitalisation for early life infection on early childhood development. METHODS Hospital admission data for infection were obtained from the New South Wales Ministry of Health Admitted Patient Data Collection for 87 026 children, for whom the Australian Early Development Census (AEDC) was completed in their first year of formal schooling (age approximately 5 years). The AEDC provides estimates of each child's level of functioning on five domains of development spanning social and emotional skills, communication skills, numeracy and literacy and physical health. Multinomial logistic regressions were used to determine the relationship between exposure to hospital admissions for infectious disease prior to age 4 years and vulnerability on the AEDC. Models were adjusted for the effects of potential confounding factors related to the perinatal period, exposure to maltreatment and family characteristics. RESULTS Single and multiple hospitalisation(s) for infections were consistently associated with increased likelihood of being developmentally vulnerable on all AEDC domains, with odds ratios ranging from 1.02 to 1.28, after adjustment for confounding factors. CONCLUSIONS This study demonstrates a pervasive effect of early life infections that require hospital admission on multiple aspects of early child development, even after adjustment for potential confounding factors. Relatively, severe infection during early childhood constitutes a risk factor for developmental vulnerability by the time of entry to school.
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Affiliation(s)
- Maina Kariuki
- School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia.,Schizophrenia Research Institute, Sydney, New South Wales, Australia
| | - Alessandra Raudino
- School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia.,Schizophrenia Research Institute, Sydney, New South Wales, Australia
| | - Melissa J Green
- School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia.,Schizophrenia Research Institute, Sydney, New South Wales, Australia
| | - Kristin R Laurens
- School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia.,Schizophrenia Research Institute, Sydney, New South Wales, Australia
| | - Kimberlie Dean
- School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia.,Justice Health and Forensic Mental Health Network, Sydney, New South Wales, Australia
| | - Sally A Brinkman
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia.,School of Population Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Rhoshel K Lenroot
- School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia.,Schizophrenia Research Institute, Sydney, New South Wales, Australia.,Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - Enwu Liu
- School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia.,Schizophrenia Research Institute, Sydney, New South Wales, Australia
| | - Felicity Harris
- School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia.,Schizophrenia Research Institute, Sydney, New South Wales, Australia
| | - Luming Luo
- School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia.,Schizophrenia Research Institute, Sydney, New South Wales, Australia
| | - Vaughan J Carr
- School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia. .,Schizophrenia Research Institute, Sydney, New South Wales, Australia. .,Department of Psychiatry, School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia.
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23
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Chang AB, Smith-Vaughan H, Sloots TP, Valery PC, Whiley D, Beissbarth J, Torzillo PJ. Upper airway viruses and bacteria detection in clinical pneumonia in a population with high nasal colonisation do not relate to clinical signs. Pneumonia (Nathan) 2015; 6:48-56. [PMID: 31641578 PMCID: PMC5922338 DOI: 10.15172/pneu.2015.6/636] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 06/23/2015] [Indexed: 12/27/2022] Open
Abstract
Indigenous Australian children have high (up to 90%) rates of nasopharyngeal microbial colonisation and of hospitalisation for pneumonia. In Indigenous children hospitalised with pneumonia in Central Australia, we describe the nasopharyngeal detection of viruses and bacteria and assessed whether their presence related to signs of pneumonia (tachypnoea and/or chest in-drawing) on hospital admission and during subsequent days. Nasopharyngeal swabs (NPS) and data were prospectively collected from 145 children (median age = 23.5 months, interquartile range [IQR] 8.7–50) hospitalised with pneumonia at Alice Springs Hospital, Australia, between April 2001 and July 2002. The cohort was enrolled in a randomised controlled study using zinc and/or vitamin A supplementation. NPS were taken within 24 hours of hospitalisation and kept frozen at-80°C until analysed in 2014. Polymerase chain reaction (PCR) was used to detect Moraxella catarrhalis, Haemophilus influenzae, Streptococcus pneumoniae, Staphylococcus aureus, Chlamydophila pneumoniae, Mycoplasma pneumoniae, and 16 respiratory viruses. Uni- and multi-variate analyses were used to examine the relationships. One or more organisms were present in 137 (94.5%) NPS; 133 (91.7%) detected ≥ 1 bacterium, 34 (37.2%) for ≥ 1 virus and 50 (34.5%) were positive for both viruses and bacteria. C. pneumoniae (n = 3) and M. pneumoniae (n = 2) were rare. In multi-variate analyses, age < 12 months (odds ratio [OR] 6.6 [95% confidence interval {CI} 1.7–25.4]) and fever (OR 4.1 [95% CI 1.7–10.4]) were associated with tachypnoea and chest in-drawing. However the presence of bacteria and/or virus type was not associated with tachypnoea and/or chest in-drawing on admission or during recovery. In children with high nasopharyngeal microbial colonisation rates, the utility of NPS in determining the diagnosis of clinical pneumonia or duration of tachypnoea or in-drawing is likely limited. Larger cohort and case-control studies are required to confirm our findings.
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Affiliation(s)
- Anne B Chang
- 17Menzies School of Health Research, Charles Darwin University, Casuarina, Australia.,27Department of Respiratory and Sleep Medicine, Queensland Children's Health Services and Queensland Children's Medical Research Institute, Queensland University of Technology, Herston, Australia.,Department of Respiratory and Sleep Medicine, Queensland Children's Hospital and Health Service, South Brisbane, Queensland 4101 Australia
| | - Heidi Smith-Vaughan
- 17Menzies School of Health Research, Charles Darwin University, Casuarina, Australia.,37School of Medicine, Griffith University, Australia
| | - Theo P Sloots
- Queensland Paediatric Infectious Diseases Laboratory, Sir Albert Sakzewksi Virus Research Centre, Queensland Children's Health Services, Herston, Australia
| | - Patricia C Valery
- 17Menzies School of Health Research, Charles Darwin University, Casuarina, Australia
| | - David Whiley
- Queensland Paediatric Infectious Diseases Laboratory, Sir Albert Sakzewksi Virus Research Centre, Queensland Children's Health Services, Herston, Australia
| | - Jemima Beissbarth
- 17Menzies School of Health Research, Charles Darwin University, Casuarina, Australia
| | - Paul J Torzillo
- 47Sydney Medical School, University of Sydney, Sydney, Australia.,57Royal Prince Alfred Hospital, Sydney, Australia
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24
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Abstract
BACKGROUND delirium affects up to 40% of older hospitalised patients, but there has been no systematic review focussing on risk factors for incident delirium in older medical inpatients. We aimed to synthesise data on risk factors for incident delirium and where possible conduct meta-analysis of these. METHODS PubMed and Web of Science databases were searched (January 1987-August 2013). Studies were quality rated using the Newcastle-Ottawa Scale. We used the Mantel-Haenszel and inverse variance method to estimate the pooled odds ratio (OR) or mean difference for individual risk factors. RESULTS eleven articles met inclusion criteria and were included for review. Total study population 2338 (411 patients with delirium/1927 controls). The commonest factors significantly associated with delirium were dementia, older age, co-morbid illness, severity of medical illness, infection, 'high-risk' medication use, diminished activities of daily living, immobility, sensory impairment, urinary catheterisation, urea and electrolyte imbalance and malnutrition. In pooled analyses, dementia (OR 6.62; 95% CI (confidence interval) 4.30, 10.19), illness severity (APACHE II) (MD (mean difference) 3.91; 95% CI 2.22, 5.59), visual impairment (OR 1.89; 95% CI 1.03, 3.47), urinary catheterisation (OR 3.16; 95% CI 1.26, 7.92), low albumin level (MD -3.14; 95% CI -5.99, -0.29) and length of hospital stay (OR 4.85; 95% CI 2.20, 7.50) were statistically significantly associated with delirium. CONCLUSION we identified risk factors consistently associated with incident delirium following admission. These factors help to highlight older acute medical inpatients at risk of developing delirium during their hospital stay.
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Affiliation(s)
- Suman Ahmed
- Tees, Esk and Wear Valleys NHS Foundation Trust, Durham DL2 2TS, UK
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