Acute Care Medical Wards Research Articles

Written Mobility Communication in Acute Care Medical Wards: An Observational Study of Physical Therapists' and Nurses' Documentation Practice.

Low inpatient mobility is associated with poor hospital outcomes. Poor communication between clinicians has been identified as a barrier to improving mobility. Understanding how mobility is communicated within the multi-disciplinary team may help inform strategies to improve inpatient mobility. The aim of this study was to describe written mobility communication by physical therapists and nurses in acute care medical wards. This cross-sectional observational study was conducted across 4 hospitals in an Australian health service. A survey of physical therapists and nurses identified preferred sources and content of written mobility communication. An audit described and compared written mobility communication in the most strongly preferred documentation sources. Findings were described and compared graphically between discipline and site. Questionnaires were completed by 85 physical therapists and 150 nurses. Twenty-two sources of documentation about mobility were identified. Preferences for sources and content varied between disciplines. Physical therapists nominated several preferred information sources and sought and documented broader mobility content. Nurses often sought nursing documents which focused on current mobility assistance and aids, with limited communication of mobility level or mobility goals. Audits of 104 patient records found that content varied between sources and sites, and content was variably missing or inconsistent between sources. Written mobility communication focused on mobility assistance and aids, rather than mobility levels or mobility goals, with poor completion and inconsistency within documentation. More complete and consistent documentation might improve progressive mobilization of hospital inpatients. Physical therapists and nurses seek and document different content in a wide range of locations, leading to incomplete and inconsistent written documentation.Understanding and resolving these practice differences offers potential to improve mobility communication and practice.

A STUDY ON FASTING LIPID PROFILE IN NONADIABETIC STROKE PATIENTS

Objectives: To study serum fasting lipid profile in patients with acute ischaemic stroke & to determine the significant correlation between them. To assess the role of aggressive control of dyslipidemia on recovery of stroke. Design: Prospective study. Setting: Patients admitted with Ischemic stroke into the Acute Medical Care Unit and Medical Wards in the department of General Medicine, SAIMS Hospital Indore, from December 2019 to November 2021, were taken for the study. Patients were subjected to a Fasting lipid profile at presentation and followed- up at 12 weeks and rechecked the fasting lipid profile and correlated with the recovery of stroke. Participants: A total of 50 Ischaemic stroke patients- 33 males and 17 females, participated. All subjects were above 50 years. Patients with suspected emboli of cardiac origin, haemorrhagic stroke, diabetes and h/o of head injury/usage of anticoagulant drugs were excluded from the study. None of the patients was on diet (or) other modifications to lower plasma lipid levels. Results: S.T.C was abnormal in 11 patients at onset and 8 pts after three months of statin therapy. TG was abnormal in 34 patients at the beginning and 35 pts after three months of treatment. LDL was abnormal in 32 patients at the beginning and 20 pts after three months of statin therapy. HDL was abnormal in 38 patients at onset and 35 pts after three months of treatment. VLDL was abnormal in 34 pts at the beginning & 35 pts after three months of statin therapy. After three months, the MRS score of most of the patients was 0 -1(21 pts), followed by a score of 0 (15 pts). Correlation between mNIHSS score and lipid profile showed a significant clinical improvement with reduction in the LDL levels & the corresponding p- value is .000, which is highly effective. Correlation between MRS score and lipid profile showed a good clinical outcome with a reduction in LDL levels & the corresponding p-value is 0.26, which is substantial. Conclusion: This study shows that higher levels of S.T.C, TG, LDL, VLDL is not the only significant risk factor for the occurrence of ischaemic CVD. A decrease in LDL levels shows significant improvement in clinical outcomes.

Barriers and facilitators to mobility of patients hospitalised on an acute medical ward: a systematic review.

low patient mobility is common during hospitalisation and is associated with adverse outcomes. To change practice, interventions should address barriers and facilitators to mobility. Our aim was to systematically review the literature to provide a synthesised overview of patient-, health care professional (HCP)- and environment-/system-related barriers and facilitators to mobility of patients hospitalised on an acute care medical ward. we searched Medline, Embase, PsycInfo, Web of Science Core Collection, Cochrane CENTRAL, CINHAHL and Google Scholar (inception to 18 October 2021) to identify studies reporting barriers and/or facilitators to mobility of adults hospitalised on an acute medical ward. We applied a deductive and inductive thematic analysis to classify barriers and facilitators into themes and subthemes relevant for clinical practice. among 26 studies (16 qualitative, 7 quantitative and 3 mixed methods), barriers and facilitators were categorised into 10 themes: patient situation, knowledge, beliefs, experiences, intentions, emotions, social influences, role/identity, implementation/organisation and environment/resources. Barriers included patient characteristics (e.g. impaired cognitive/physical status) and symptoms, HCPs prioritising other tasks over mobility, HCPs labelling patients as 'too sick', fear of injury, lack of time, lack of clarity about responsibility, patient medical devices and non-encouraging environment. Facilitators included knowledge of mobility importance, HCP skills, interdisciplinarity, documentation and unit expectations, encouraging staff, goal individualisation, activity programme, family/visitor/volunteer support and availability of equipment. this synthesised overview of patient-, HCP- and environment-/system-related barriers and facilitators to mobility of adults hospitalised on an acute medical ward can help researchers and clinicians focus on what can realistically be influenced to improve mobility. PROSPERO, CRD42021285954.

A STUDY ON FASTING LIPID PROFILE IN NON-DIABETIC STROKE PATIENTS

Objectives: To study serum fasting lipid profile in patients with acute ischaemic stroke & to determine the significant correlation between them. To assess the role of aggressive control of dyslipidemia on recovery of stroke. Setting: Patients admitted with Ischemic stroke into the Acute Medical Care Unit and Medical Wards in the department of General Medicine, SAIMS Medical Indore, from December 2019 to November 2021, were taken for the study. Patients were subjected to a Fasting lipid profile at presentation and followed– up at 12 weeks and rechecked the fasting lipid profile and correlated with the recovery of stroke. Participants: A total of 50 Ischaemic stroke patients- 33 males and 17 females, participated. All subjects were above 50 years. Patients with suspected emboli of cardiac origin, haemorrhagic stroke, diabetes and h/o of head injury/usage of anticoagulant drugs were excluded from the study. None of the patients was on diet (or) other modifications to lower plasma lipid levels. Results: S.T.C was abnormal in 11 patients at onset and 8 pts after three months of statin therapy. TG was abnormal in 34 patients at the beginning and 35 pts after three months of treatment. LDL was abnormal in 32 patients at the beginning and 20 pts after three months of statin therapy. HDL was abnormal in 38 patients at onset and 35 pts after three months of treatment. VLDL was abnormal in 34 pts at the beginning & 35 pts after three months of statin therapy. After three months, the MRS score of most of the patients was 0 -1(21 pts), followed by a score of 0 (15 pts). Correlation between mNIHSS score and lipid profile showed a significant clinical improvement with reduction in the LDL levels & the corresponding p- value is .000, which is highly effective. Correlation between MRS score and lipid profile showed a good clinical outcome with a reduction in LDL levels & the corresponding p-value is 0.26, which is substantial. Conclusion: This study shows that higher levels of S.T.C, TG, LDL, VLDL is not the only significant risk factor for the occurrence of ischaemic CVD. A decrease in LDL levels shows significant improvement in clinical outcomes.

Prevalence of peripheral intravenous catheters and policy adherence: A point prevalence in a tertiary care university hospital.

To determine prevalence and policy adherence for peripheral intravenous catheters (PIVC) in adult inpatients at a tertiary care university hospital (with about 83,000 inpatient admissions annually). Up to 80% of hospitalised patients receive intravenous therapy, most commonly via PIVCs. However, these devices are not risk-free. Studies indicate that PIVC management standards in clinical practice are inadequate despite established policies promoting best practice. This leads to premature failure resulting in treatment delays, extended length of stay and potential compromised venous access for subsequent IV therapy. Observational point prevalence study. Study undertaken on all adult acute care medical, surgical and oncology wards. Data were collected by senior registered nurses working in pairs on a single day. Descriptive statistics used to analyse data. SQUIRE 2.0 checklist for quality improvement reporting used. There were 449 adult inpatients in 19 wards on survey day. One hundred and ninety-seven had one or more PIVCs in situ. The total number of PIVCs in-situ was 212. PIVC Prevalence was 47%. PIVCs were inserted in points of flexion such as antecubital fossa, back of hand or wrist in 52% of patients. Only 19% of cases had documented assessment of 8-hourly visual infusion phlebitis (VIP) score. Patients had local signs of phlebitis in 14.4% of cases. Patients were not aware of the reason/need for their PIVC in 44% of cases. Discrepancies between evidence-based guidelines and local policy in clinical practice were identified including high rates of PIVC insertion in points of flexion and poor documentation. These quality problems increase likelihood of adverse patient outcomes especially when associated with limited patient awareness of the reason for their PIVC. Poor adherence to best practice standards is 'accepted but unacceptable'. PIVC failure is costly to both patients and health systems. A strong focus on improvement in PIVC care and management is needed.

Systematic review of interventions targeting fundamental care to reduce hospital-associated decline in older patients.

To examine the effectiveness of targeted nursing interventions on mobilization, nutrition and cognitive engagement to reduce functional and hospital-associated decline (HAD) in older patients. Systematic review of experimental studies using randomized and quasi-experimental designs. We searched electronic databases CINAHL, MEDLINE, EMBASE, Cochrane library, google scholar and BMJ quality reports from January 2009 to February 2020. We reviewed intervention studies that targeted ward nursing teams to increase mobilization, nutrition or cognitive engagement of older adults. Inclusion criteria included older patients, acute care (medical, surgical and older adult wards) and reporting patient level outcomes. Quality appraisal included the Joanna Briggs Critical Appraisal Checklist for Quasi-Experimental Studies. From 1729 papers, 18 studies using quasi-experimental and pre-post designs were selected. Study heterogeneity necessitated a narrative synthesis. The quality of evidence was low to moderate. All studies used multicomponent strategies, and 10 studies used evidence translation frameworks to align interventions to local barriers. Overall, 74% (n=14) of studies reported a significant improvement in the stated primary outcome. Eight studies reported a significant increase in mobilization (e.g., sitting in a chair or walking), and four reported improved functional outcomes. Five studies improved nutrition outcomes (e.g., protein or energy intake), and three studies reported a significant reduction in delirium. Acknowledging methodological limitations, the evidence indicates that nursing teams using evidence-translation frameworks can improve mobilization, nutrition and cognitive engagement in acute care settings. Future research requires higher-quality pragmatic trial designs, standardized outcomes, staff co-designed interventions, evidence-translation frameworks and patient engagement to make more confident inference about effectiveness. Nursing teams with the support of hospital management have to address ward and system barriers to prioritize fundamental care to improve patient outcomes. There is sufficient evidence on multicomponent interventions and implementation strategies to inform nurse-led quality improvement.

Redeploying Residents and Fellows in Response to COVID-19: Tensions, Guiding Principles, and Lessons From the University of Washington.

Redeploying Residents and Fellows in Response to COVID-19: Tensions, Guiding Principles, and Lessons From the University of Washington.

Evaluation of drug-related problems and subsequent clinical pharmacists' interventions at a Swiss university hospital.

The evaluation of clinical pharmacy services is essential for their further development and establishment. We analysed drug-related problems (DRPs) and subsequent clinical pharmacists' interventions (PIs) at a Swiss university hospital. We conducted a retrospective analysis of DRPs and subsequent PIs that were identified and implemented during interdisciplinary ward rounds in internal medicine at the University Hospital Basel, Switzerland, between 2015 and 2017. We estimated the potential clinical and economic impact of PIs using a validated evaluation tool (CLEOde ). Based on medication reviews of 5441 patients, clinical pharmacists identified 5024 DRPs, of which 2892 DRPs (57.6%) were followed by a PI that was directly accepted and implemented by the physician in charge and included in the present analysis. The leading cause and type of PIs were inappropriate dose and dose adjustment, respectively. Overall, 97.8% of DRPs were followed by PIs with an expected clinical benefit for the patients (major: 11.1%; moderate: 27.6%; minor: 59.1%). The drugs most often involved in PIs of major clinical impact were antithrombotics, acid blockers and cardiovascular drugs. With regard to the economic impact, 40.7% of DRPs implied PIs resulting in an increase of immediate therapy costs, whereas 39.3% implied PIs resulting in a decrease of immediate therapy costs. The remaining PIs were cost-neutral. This study emphasizes that clinical pharmacists may help improve the effectiveness and safety of pharmacotherapy on acute care medical wards.

Falls Risk Prediction for Older Inpatients in Acute Care Medical Wards: Is There an Interest to Combine an Early Nurse Assessment and the Artificial Neural Network Analysis?

Identification of the risk of falls is important among older inpatients. This study aims to examine performance criteria (i.e.; sensitivity, specificity, positive predictive value, negative predictive value and accuracy) for fall prediction resulting from a nurse assessment and an artificial neural networks (ANNs) analysis in older inpatients hospitalized in acute care medical wards. A total of 848 older inpatients (mean age, 83.0±7.2 years; 41.8% female) admitted to acute care medical wards in Angers University hospital (France) were included in this study using an observational prospective cohort design. Within 24 hours after admission of older inpatients, nurses performed a bedside clinical assessment. Participants were separated into non-fallers and fallers (i.e.; ≥1 fall during hospitalization stay). The analysis was conducted using three feed forward ANNs (multilayer perceptron [MLP], averaged neural network, and neuroevolution of augmenting topologies [NEAT]). Seventy-three (8.6%) participants fell at least once during their hospital stay. ANNs showed a high specificity, regardless of which ANN was used, and the highest value reported was with MLP (99.8%). In contrast, sensitivity was lower, with values ranging between 98.4 to 14.8%. MLP had the highest accuracy (99.7). Performance criteria for fall prediction resulting from a bedside nursing assessment and an ANNs analysis was associated with a high specificity but a low sensitivity, suggesting that this combined approach should be used more as a diagnostic test than a screening test when considering older inpatients in acute care medical ward.

Cleaning the grey zones of hospitals: A prospective, crossover, interventional study.

Environmental cleaning is a fundamental principle of infection prevention in hospitals, but its role in reducing transmission of health care-acquired pathogens has been difficult to prove experimentally. In this study we analyze the influence of cleaning previously uncleaned patient care items, grey zones (GZ), on health care-acquired transmission rates. The intervention consisted of specific GZ cleaning by an extra cleaner (in addition to routine cleaning) on 2 structurally different acute care medical wards for a period of 6 months each, in a crossover design. Data on health care-acquired transmissions of vancomycin-resistant enterococci (VRE), methicillin-resistant Staphylococcus aureus, and Clostridium difficile were collected during both periods. Adjusted incidence rate ratios (IRRs) using Poisson regression were calculated to compare transmission of pathogens between both periods on both wards. During the intervention VRE transmission was significantly decreased (2-fold) on the ward where patients had fewer roommates; cleaning of GZ did not have any effect on the ward with multiple-occupancy rooms. There was no impact on methicillin-resistant S aureus transmission and only a nonsignificant decrease in transmission of C difficile. Our data provide evidence that targeted cleaning interventions can reduce VRE transmission when rooming conditions are optimized; such interventions can be cost-effective when the burden of VRE is significant. Enhanced cleaning interventions are less beneficial in the context of room sharing where many other factors contribute to transmission of pathogens.

Use of proton pump inhibitors in older subjects: Risk of adverse clinical outcomes and potential mechanisms

Background In the last 2 decades, it was observed a widely increased use of proton pump inhibitors (PPIs) especially in older populations. Despite the fact that PPIs are superior to histamine receptor antagonists in treating gastroesophageal reflux disease (GERD) and peptic ulcers, the chronic use of PPIs has been associated with adverse clinical outcomes including higher risk of fractures and Clostridium difficile infections. In vitro studies have shown that PPIs negatively modulate the bioactivity of insulin-like growth factor-1 (IGF-1), anabolic hormone and nutritional marker. However, whether or not PPIs use has negative influence on survival and independence of activities of daily living (ADL) and the mechanisms underlying these hypothesized associations are still poorly known. Aims of the study The aims of the study were to test the relationship between the use of PPIs and adverse clinical outcomes (mortality and rehospitalization, loss of ADL) and the association between use of PPIs and cortical and trabecular bone mineral density, IGF-1 bioactivity in older patients of 2 different populations. Methods In 491 patients (mean age 80.1 ± 5.9 years), categorized as PPI users and non users, discharged from 11 acute care medical wards and 3 long-term care/rehabilitation units, we tested the relationship between use of PPIs and 1- year mortality or combined end-point mortality and rehospitalization and incident dependency by using time-dependent Cox proportional hazard regression models and after propensity score matching. The association between use of PPIs, IGF-1 and bone mineral density was estimated by multivariate regression model adjusted for multiple confounders in 938 subjects (413 men and 525 women) aged ≥ 65 years, from the InCHIANTI Study, with complete information on tibial pQCT, IGF-1, IGF-binding protein-1 (IGFBP-1) and medications. Results In the hospitalized population the use of PPIs was independently associated with mortality (hazard ratio, 1.51 [95% CI, 1.03–2.77]) but not with the combined end point (1.49 [0.98–2.17]). An increased risk of mortality was observed among patients exposed to high-dose PPIs vs none (hazard ratio, 2.59 [95% CI, 1.22–7.16]). Use of PPIs was significantly associated with functional decline either before (OR = 1.75; 95% CI = 1.17–2.60) and after propensity score matching (OR = 2.44; 95% CI = 1.36–4.41). In the InCHIANTI population, PPI users showed age- and sex-adjusted lower vBMDt than nonusers (180.5 ± 54.8 vs. 207.9 ± 59.4, P = 0.001). The inverse association between PPI use and vBMDt remained almost unchanged after adjustment for multiple confounders. There was no statistically significant difference in vBMDc between PPI users and nonusers. PPI users had lower IGF-1 levels (81,9 [61,1-113,8]) than non-users (110 [77,8–148,6]), P = 0.02. After further adjustment for BMI, liver function, number of medications, caloric intake and IGFBP-1, the relationship between use of PPI and IGF-1 remained statistically significant (β ± SE = –18,09 ± 9,38, P = 0,05). Conclusions In older persons discharged from acute care hospitals, the chronic use of PPIs is associated with increased 1-year mortality and functional decline. The lower trabecular bone mineral density and IGF-1 levels found in PPI users are potential mechanisms explaining this association.

Migrant care workers and rehospitalization among older patients discharged from acute care hospitals

The relationship between support at home and rehospitalization has not been extensively studied until now. In particular, little is known about the impact of being assisted by migrant care workers (MCW) and rehospitalization. We aimed at investigating such a relationship in a population of older patients discharged from hospitals. Our series consisted of 506 patients aged 65 years or older consecutively enrolled in a prospective observational study involving 11 acute care medical wards throughout Italy. The outcome of the study was the occurrence of at least one rehospitalization during 1-year follow up. Information derived from comprehensive geriatric assessment, discharge diagnoses and prescribed drugs were collected during the index hospitalization. Data about formal and informal assistance (spouse, son, other relative, MCW, home nursing) were collected. The relationship between study variables and rehospitalization was assessed using logistic regression. Being assisted by MCW was independently associated with the outcome (OR 2.04, 95% CI 1.10-4.37), as were complete dependency (OR 2.49, 95% CI 1.28-5.79) and overall comorbidity (OR 1.23, 95% CI 1.10-1.43). Older age was associated with a lower likelihood of rehospitalization (age 75-84 vs <75 years OR 0.51, 95% CI 0.30-0.92; age≥85 vs <75 years OR 0.30, 95% CI 0.12-0.65). Being assisted by MCW could contribute to an increase in the rate of use of hospital resources for older complex patients. This finding raises the need for educational efforts targeting MCW.

Proton Pump Inhibitors and Risk of 1-Year Mortality and Rehospitalization in Older Patients Discharged From Acute Care Hospitals

The use of proton pump inhibitors (PPIs) has rapidly increased during the past several years. However, concern remains about risks associated with their long-term use in older populations. To investigate the relationship between the use of PPIs and the risk of death or the combined end point of death or rehospitalization in older patients discharged from acute care hospitals. We investigated the relationship between PPI use and study outcomes using time-dependent Cox proportional hazards regression in patients 65 years or older discharged from acute care medical wards from April 1 to June 30, 2007. Eleven acute care medical wards. Four hundred ninety-one patients (mean [SD] age, 80.0 [5.9] years). Mortality and the combined end point of death or rehospitalization. RESULTS The use of PPIs was independently associated with mortality (hazard ratio, 1.51 [95% CI, 1.03-2.77]) but not with the combined end point (1.49 [0.98-2.17]). An increased risk of mortality was observed among patients exposed to high-dose PPIs vs none (hazard ratio, 2.59 [95% CI, 1.22-7.16]). In older patients discharged from acute care hospitals, the use of high-dose PPIs is associated with increased 1-year mortality. Randomized controlled studies including older frail patients are needed. In the meantime, physicians need to use caution and balance benefits and harms in long-term prescription of high-dose PPIs.

RANDOMISED CONTROLLED TRIAL TO REDUCE IN-PATIENT FALLS IN HOSPITALISED OLDER PEOPLE

BackgroundOne million in-patient falls occur in the US annually with similar rates across higher income countries. More than half such falls occur at the bedside. Multifactorial interventions including bed/chair pressure...

Relationship between renal function and physical performance in elderly hospitalized patients.

Chronic kidney disease (CKD) is increasingly recognized as a cause of worsening physical functioning in older patients. The Short Physical Performance Battery (SPPB) is highly reliable in older populations, but no data on older hospitalized patients with different degrees of kidney function are available. We aimed at testing the association between estimated glomerular filtration rate (eGFR) and SPPB, either global score (range 0-12) or its individual components (muscle strength, balance, and walking speed, each ranging from 0 to 4), in a sample of older hospitalized patients. Our series consisted of 486 patients aged 65 or more consecutively enrolled in 11 acute care medical wards participating to a multicenter observational study. eGFR was obtained by the Chronic Kidney Disease Epidemiological Collaboration (CKD-EPI) equation. Physical performance was objectively measured by the SPPB. The relationship between eGFR and SPPB was investigated by multiple linear regression analysis. Physically impaired patients (SPPB total score<5) were older, had lower serum albumin and Mini-Mental State Examination (MMSE) scores as well as higher overall co-morbidity, prevalence of stroke, cancer, and anemia compared to those with intermediate (SPPB=5-8) and good physical performance (SPPB=9-12). Fully adjusted multivariate models showed that eGFR (modeled as 10 mL/min per 1.73 m(2) intervals) was independently associated with the SPPB total score (B=0.49; 95% confidence interval [CI]=0.18-0.66; p=0.003), balance (B=0.30; 95% CI=0.10-0.49; p=0.005), and muscle strength (B=0.06; 95% CI=0.01-0.10; p=0.043), but not with walking speed (B=-0.04; 95% CI=-0.09-0.11; p=0.107). In conclusion, reduced renal function is associated with poorer physical performance in older hospitalized patients. SPPB is worthy of testing to monitor changes in physical performance in elderly CKD patients.

The Prevalence of Health Care-Associated Infections and Risk Factors in a University Hospital

The aim of the study was to evaluate the prevalence of health care-associated infections, risk factors, and antimicrobial use. The study was carried out as a point-prevalence study in acute care wards, i.e., intensive care, surgical, and medical wards, at Vilnius University Hospital Santariškių Klinikos in April 2010. The study variables included the patient's general data, indwelling devices, surgery, infection and its microbiological investigation, and antimicrobial use. All the variables that were logically related or had a P value of <0.25 in the univariate analysis were included in the stepwise logistic regression in order to study the factors potentially associated with health care-associated infections. A total of 731 patients were surveyed. The overall prevalence rate of health care-associated infections was 3.8%. The prevalence of health care-associated infections differed by hospital wards (range 0.0%-19.2%). The lower respiratory tract (32.2%), urinary tract (28.5%), and surgical site infections (32.1%) were the most common health care-associated infections. Moreover, 89.3% of the cases of health care-associated infections were microbiologically investigated. Staphylococcus aureus (28.6%) and Escherichia coli (19.1%) were the most frequently isolated microorganisms. The use of one or more invasive devices was recorded in 332 patients (45.4%). Of the surveyed patients, 20.2% received antimicrobial agents. The most commonly prescribed antimicrobial agents were fluoroquinolones (21.1%), broad-spectrum penicillins (19.1%), and first- or second-generation cephalosporins (18.6%). The prevalence of health care-associated infections was found to be similar to the reported overall prevalence rate of health care-associated infections in acute care hospitals in Lithuania.

The Antimicrobial Efficacy of Copper Alloy Furnishing in the Clinical Environment: A Crossover Study

To determine whether copper incorporated into hospital ward furnishings and equipment can reduce their surface microbial load. A crossover study. Acute care medical ward with 19 beds at a large university hospital. Fourteen types of frequent-touch items made of copper alloy were installed in various locations on an acute care medical ward. These included door handles and push plates, toilet seats and flush handles, grab rails, light switches and pull cord toggles, sockets, overbed tables, dressing trolleys, commodes, taps, and sink fittings. Their surfaces and those of equivalent standard items on the same ward were sampled once weekly for 24 weeks. The copper and standard items were switched over after 12 weeks of sampling to reduce bias in usage patterns. The total aerobic microbial counts and the presence of indicator microorganisms were determined. Eight of the 14 copper item types had microbial counts on their surfaces that were significantly lower than counts on standard materials. The other 6 copper item types had reduced microbial numbers on their surfaces, compared with microbial counts on standard items, but the reduction did not reach statistical significance. Indicator microorganisms were recovered from both types of surfaces; however, significantly fewer copper surfaces were contaminated with vancomycin-resistant enterococci, methicillin-susceptible Staphylococcus aureus, and coliforms, compared with standard surfaces. Copper alloys (greater than or equal to 58% copper), when incorporated into various hospital furnishings and fittings, reduce the surface microorganisms. The use of copper in combination with optimal infection-prevention strategies may therefore further reduce the risk that patients will acquire infection in healthcare environments.

Geriatric Conditions and Adverse Drug Reactions in Elderly Hospitalized Patients

To investigate the relationship between clinical conditions typically observed in the geriatric patients (geriatric conditions) and adverse drug reactions in older patients admitted to acute care hospitals. Prospective observational study conducted in 11 acute care medical wards throughout Italy. Five hundred six patients aged 65 years or older consecutively admitted to participating wards. The outcome of the study was the occurrence of any adverse drug reactions during the hospital stay. Geriatric conditions considered in the analysis were basic activities of daily living, history of falls, slow walking speed, malnutrition, dementia, depression, 1 or more unplanned admissions in the previous 3 months, history of stroke, unintentional weight loss, and exhaustion. The relationship between risk factors and outcomes was assessed using logistic regression. Female gender (odds ratio [OR] 2.29; 95% confidence interval [CI] 1.18-4.45) and number of medications taken during hospitalization (OR 1.12; 95% CI 1.06-1.18), but not individual Geriatric conditions, were associated with the outcome after correction for potential confounders. However, the simultaneous presence of history of falls and dependency in at least 1 activities of daily living (OR 2.18; 95% CI 1.13-4.19) was associated with adverse drug reactions during stay. The simultaneous presence of history of falls and dependency in at least one activity of daily living defines a condition of particular vulnerability of elderly hospitalized patients to adverse drug reactions. Physicians should be aware of this high-risk condition when prescribing new drugs to disabled older people.

Chronic kidney disease and 1-year survival in elderly patients discharged from acute care hospitals: a comparison of three glomerular filtration rate equations

Glomerular filtration rate (GFR) is directly associated with survival. However, the prognostic significance of GFR might be different according to the formula used to estimate it. We aimed at comparing the association between GFR estimated using three different formulas and 1-year survival in elderly patients discharged from acute care hospitals. Our series consisted of 439 patients aged 65 and older admitted to 11 acute care medical wards enrolled in a multicentre prospective observational study. GFR was estimated by body surface area-adjusted Cockcroft-Gault (CG-BSA), Modification of Diet in Renal Disease study (MDRD) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formulas. The relative risk of mortality in patients with estimated GFR = 30-59.9 or < 30 mL/min/1.73 m(2) compared to people with estimated GFR ≥ 60 mL/min/1.73 m(2) was calculated using Cox regression analysis. Participants with reduced GFR showed an increased mortality, regardless of the equation used, and the highest one was associated with CG-BSA-estimated GFR < 30 mL/min/1.73 m(2). After adjusting for potential confounders, CKD-EPI-estimated GFR remained significantly associated with the outcome [30-59.9 mL/min/1.73 m(2), hazard ratio (HR) = 1.70, 95% confidence interval (95% CI) = 1.02-2.98; < 30 mL/min/1.73 m(2), HR = 2.60, 95% CI = 1.20-5.66], while the strength of the association was clearly reduced for MDRD (30-59.9 mL/min/1.73 m(2), HR = 1.47, 95% CI = 0.83-2.38; < 30 mL/min/1.73 m(2), HR = 2.07, 95% CI = 1.01-4.30) and CG-BSA (30-59.9 mL/min/1.73 m(2), HR = 1.79, 95% CI = 0.67-4.53; < 30 mL/min/1.73 m(2), HR = 2.68, 95% CI = 0.92-7.55). GFR adds to the list of prognostic indicators in elderly and frail people, and CKD-EPI-derived GFR, which outperforms to some extent MDRD and CG-BSA-derived GFR in a multivariable predictive model, seems worthy of testing in wider populations.

Does Concealed Chronic Kidney Disease Predict Survival of Older Patients Discharged from Acute Care Hospitals?

We aimed at verifying whether unrecognized chronic kidney disease (CKD) (i.e., reduced estimated glomerular filtration rate in spite of normal serum creatinine) has prognostic significance in an unselected population of older patients discharged from 11 acute care hospitals located throughout Italy. Our series consisted of 396 participants aged 70 and older. Estimated glomerular filtration rate (eGFR) was calculated by the Modification of Diet in Renal Disease (MDRD) study equation. We compared three groups: Normal renal function (normal serum creatinine levels and normal eGFR), concealed (normal serum creatinine levels and reduced eGFR), or overt (increased creatinine levels and reduced eGFR) renal failure. The relationship between renal function and 1-year mortality was evaluated using Kaplan-Meier curves and Cox regression analysis including potential confounders. Overall, 56 patients died over a cumulative follow-up time of 335 months, with an estimated incidence rate of 16.7/100 person-year (PY). The corresponding figures in patients with normal renal function, concealed CKD, and overt CKD were 9.8/100 PY (95% CI, 5.7-15.7), 28.3/100 PY (95% CI, 13.6-52.1), and 23.0 (95% CI, 15.4-33.0), respectively (log rank test p = 0.006). According to the fully adjusted model, both concealed (hazard ratio [HR], 2.35; 95% CI, 1.09-6.01) and overt CKD (HR, 2.09; 95% CI, 1.05-5.34) were significantly associated with the outcome. Concealed CKD contributes to profile the elderly patient at greater risk of death after being discharged from acute care medical wards. If confirmed in broader populations, this finding might have both clinical and epidemiological implications.