Irish University Hospital Research Articles

Antimicrobial susceptibility patterns of anaerobic bacteria at an Irish University Hospital over a ten-year period (2010–2020)

ObjectivesIn recent years various clinical studies have demonstrated poor outcomes in infections caused by anaerobic bacteria due to inappropriate therapy, directly due to emergence of resistant strains. This is a concern given that many anaerobic infections are treated empirically with metronidazole or a beta-lactam/beta-lactamase inhibitor combinations (e.g., co-amoxiclav, piperacillin-tazobactam). To date there is a paucity of available data on antimicrobial resistance trends of anaerobic bacteria in Ireland, and our study aims to determine such patterns among isolates processed at our institution over the last ten years. MethodsSignificant anaerobic bacteria isolated from clinical specimens processed at our laboratory from January 2010 to January 2020 inclusive were reviewed. Bacteria were identified using MALDI-TOF, with E-tests used for antimicrobial susceptibility testing. Data was processed through WHONET. ResultsA total of 2098 clinically significant anaerobic bacterial isolates from blood cultures (31%), theatre/intraoperative specimens (30%), aspirates and drain fluid (22%) and wound swabs (17%) were reviewed during the study period; with the majority of isolates being Bacteroides spp (32.79%, n = 688) and Clostridium spp (18.68%, n = 392). With isolates demonstrating well-recognised or inherent resistances excluded, overall resistance to tested antimicrobials was 6.40% to penicillin, 1.71% to metronidazole, 1.43% to co-amoxiclav, 13.63% to clindamycin, 0.43% to piperacillin-tazobactam and 0% to meropenem. ConclusionMetronidazole and beta-lactam/beta-lactamase inhibitor combinations remain highly efficacious against the majority of anaerobic isolates reviewed, and can safely be used as empiric therapy in suspected anaerobic infections. However, periodic surveillance of resistance trends remains important.

Teamwork competence and readiness of emergency nurses in the care of trauma patients: A multicenter cross-sectional study

IntroductionEmergency nurse’s teamwork competency and readiness are crucial to improve the quality of care and patient outcome in trauma patients. This study aimed to determine teamwork competence and readiness of emergency nurses in the care of trauma patients. MethodsA cross-sectional study was conducted among 230 emergency nurses and nursing assistants in emergency departments of three university hospitals in Iran in 2020. Data were collected using a researcher-made questionnaire on nurses’ readiness and the nontechnical skills scale. ResultsThe mean score for nurses’ readiness was 3.55 ± 0.60 (maximum 5) and for nurses’ teamwork competence was 3.49 ± 0.77 (maximum 5). The significant variables related to teamwork competency were gender and type of hospital. Emergency nurses with master’s degrees, who had completed training courses of advanced trauma life support and triage, their source of information were from seminars’ participations and clinical experiences, and worked at trauma hospital reported a higher level of readiness. Older age and higher work experiences were positively associated with readiness in emergency nurses. ConclusionThe significant variables associated with the teamwork competence and readiness identified in this study may be used to improve the teamwork competence and readiness of emergency nurses in emergency settings.

Changing attitudes towards annual influenza vaccination amongst staff in a Tertiary Care Irish University Hospital

BackgroundHealthcare workers are encouraged annually to get vaccinated against influenza. This year in view of COVID-19 pandemic, attitudes of HCWs towards vaccination are particularly important. A cross-sectional study was completed to understand how to best encourage and facilitate the vaccination of HCWs based on the previous years’ findings.MethodsAn online survey was disseminated to all hospital staff via electronic channels. The clinical audit sphinx software was used for data collection and analysis.ResultsThe total number of responses was n = 728, almost double the rate from 2018 (N = 393). A total of 78% (N = 551) of participants were vaccinated last year. A total of 94% (N = 677) of participants reported their intention to be vaccinated this year. The main barriers listed were being unable to find time (32%, N = 36), side effects (30%, N = 33) and thinking that it does not work (21%, N = 23). The most popular suggestions for how to increase uptake were more mobile immunisation clinics (72%, N = 517) and more information on the vaccine (50%, N = 360). A total of 82% of participants (N = 590) agreed that healthcare workers should be vaccinated, with 56% (N = 405) agreeing that it should be mandatory. Of the participants who were not vaccinated last year (N = 159), 40% (N = 63) agreed that COVID-19 had changed their opinion on influenza immunisation with a further 11% (N = 18) strongly agreeing.DiscussionIn light of the increasing number of survey participants, more staff were interested in flu vaccination this year than ever before. The COVID-19 pandemic has had some influence on staff’s likelihood to be vaccinated. Feasibility of immunisation and education posed the largest barriers to HCW vaccination.

AB185. SOH21AS226. The management of Fournier’s Gangrene in an Irish university hospital: a case series

AB185. SOH21AS226. The management of Fournier’s Gangrene in an Irish university hospital: a case series

EFFECTS OF BENZODIAZEPINES ON ORTHOSTATIC BLOOD PRESSURE IN OLDER PEOPLE

Objective: Older people taking benzodiazepines (BDZs) have higher risk of falling, which is mainly attributed to unfavorable drug-related effects on cognition and psychomotor functioning. BDZs may also have hypotensive effects, but evidence concerning their consequences on orthostatic blood pressure (BP) behaviour is scarce. We investigated the association between BDZs and BP response to an active stand test in older people. Design and method: We performed a retrospective analysis of data from an outpatient research clinic in an Irish university hospital, where people aged 60 or older underwent a comprehensive geriatric assessment between August 2007 and May 2009. Non-invasive beat-to-beat orthostatic BP was measured during an active stand, with systolic BP assessed at each 10-second interval. Information on regular BDZs use was collected. Factors independently associated with orthostatic systolic BP were investigated using multiple linear regression. Results: Of 538 participants (67.7% female, mean age 72.7 ± 7.2), 33 (6.1%) reported regular use of BDZs. During active stand, participants taking BDZs showed a significantly greater systolic BP drop 10 seconds after the posture change (“immediate” BP drop), while no significant differences were detected in orthostatic systolic BP in the latter phases of standing. After adjusting for possible confounders, BDZs use was independently associated with a mean immediate systolic BP drop of 12 mmHg after standing. Conclusions: Older people taking BDZs may have higher risk of an immediate systolic BP drop after standing, adding to other BZD-related falls risks. BDZs should be avoided in older people at risk of falling.

Delirium occurrence in older Irish adults admitted to an acute medical hospital: a prospective cohort study.

Delirium, which is associated with adverse health outcomes, is poorly detected in hospital settings. This study aimed to determine delirium occurrence among older medical inpatients and to capture associated risk factors. This prospective cohort study was performed at an Irish University Hospital. Medical inpatients 70 years and over were included. Baseline assessments within 72 hours of admission included delirium status and severity as determined by the Revised Delirium Rating Scale (DRS-R-98), cognition, physical illness severity and physical functioning. Pre-existing cognitive impairment was determined with Short Informant Questionnaire on Cognitive Decline (IQCODE). Serial assessment of delirium status, cognition and the physical illness severity were undertaken every 3 (±1) days during participants' hospital admission. Of 198 study participants, 92 (46.5%) were women and mean age was 80.6 years (s.d. 6.81; range 70-97). Using DRS-R-98, 17.7% (n = 35) had delirium on admission and 11.6% (n = 23) had new-onset delirium during admission. In regression analysis, older age, impaired cognition and lower functional ability at admission were associated with a significant likelihood of delirium. In this study, almost one-third of older medical inpatients in an acute hospital had delirium during admission. Findings that increasing age, impaired cognition and lower functional ability at admission were associated with increased delirium risk suggest target groups for enhanced delirium detection and prevention strategies. This may improve clinical outcomes.

The Possible Role of Urinary Tract Infection in Urinary Stone Formation in Children

Background and Aim: The aim of this study was to evaluate urinary metabolic features as a risk factor in stone formation. Methods: In this case-control study, 222 children ranging from 6 months to 16 years old suffering from urolithiasis in our university hospitals in Iran in 2019-2020 were selected through random sampling and were subsequently evaluated. The research group were cchildren with urinary stones and urinary tract infection and the control group encompassed children with urinary stones and without urinary tract infection. Data was analyzed using statistical package for social sciences (SPSS) version 16 (SPSS Inc. Chicago, IL) for windows. Results: The ratio of average amounts of calcium, magnesium, oxalate, cystine, uric acid, and citrate to creatinine showed no significant differences between the two groups. Conclusion: Urinary tract infection cannot be considered as a factor for stone formation in the urinary tract due to changes in urinary biochemical characteristics.

Accuracy of magnetic resonance imaging in assessing knee cartilage changes over time in patients with osteoarthritis: A systematic review.

Magnetic resonance imaging (MRI) is a technique useful for the diagnosis of cartilage damage due to high sensitivity to identify subchondral bone abnormalities and full-thickness cartilage lesions. The lack of a study on knee cartilage changes over time in patients with osteoarthritis (OA) by MRI technique led us to investigate the accuracy of MRI in identifying knee cartilage changes over time in patients with OA in a systematic review. In the present systematic review, started from the beginning of 2020 in one of the University Hospitals in Iran, the databases of CINAHL, Ovid, Elsevier, Scopus, PubMed, Science Direct, and Web of Science were searched using the keywords MRI, OA, Cartilage Lesion, Imaging Techniques. A total of 169 articles were retrieved in the initial search, and after reviewing the titles, abstracts, and full-texts, finally, seven were enrolled in the systematic review. Review of the selected papers showed that a total of 1091 subjects were studied, of which 355 were males. The results of all the studies, except one, indicated the high accuracy of MRI to identify knee cartilage changes over time. MRI technique can show cartilage changes with high accuracy in patients with knee OA over time. We proved the potential of MRI to identify articular cartilage injuries in patients with OA and its importance to the evaluation of articular cartilage lesions along with other available techniques.

The Safety and Effectiveness of Pharmacotherapy for Opioid-Overdose Induced Aspiration Pneumonia in a Referral Poisoning Management University Hospital in Iran.

Objective:Opioid abuse is widespread throughout the world. Aspiration pneumonia is a serious problem following opioid overdose and poisoning. This study aimed to evaluate the safety and effectiveness of antimicrobial management of opioid-overdose induced aspiration pneumonia in a referral poisoning management university hospital in Iran.Methods:In an observational cross-sectional study (September–March 2019), opioid poisoned patients diagnosed with aspiration pneumonia within a maximum of 48 h of their overdose were evaluated regarding several variables, including the level of consciousness on admission, drug regimen used for the treatment of aspiration pneumonia, and its appropriateness, and the correctness of the used antibiotics dose and the therapeutic outcome.Findings:During the study, 53 eligible patients were identified and included in the study. The most frequently abused opioids were methadone (60.4%) and opium (17%). “Ceftriaxone + Clindamycin” (54.7%) and “Meropenem + Vancomycin” (9.5%) were the most frequently administered regimens. Regarding treatment outcome, most cases (n = 36, 67.9%) were discharged with a stable and satisfying medical status, while 3.8% of the cases (n = 2) died.Conclusion:The use of antibiotics in the treatment of aspiration pneumonia in hospitalized patients with opioid overdose in our referral university hospital is associated with notable antibiotic regimen choice issues. The implementation of strategies for improving the pattern of antibiotic prescribing for these patients is necessary.

Correlation of integrated ERG/PTEN assessment with biochemical recurrence in prostate cancer

IntroductionProstate cancer is a heterogeneous disease, with a complex molecular landscape that evolves throughout disease progression. Common alterations in genes such as ERG and PTEN have been attributed to worse prognosis. This study aimed to further examine the clinical relevance of PTEN and ERG expression in a cohort of patients with prostate cancer post radical prostatectomy. MethodsTissue microarrays were constructed from 132 patients with prostate cancer from the Irish Prostate Cancer Research Consortium and University Hospital of Orebro, Sweden. Patients were divided into three groups – Group 1: biochemical recurrence, Group 2: no biochemical recurrence and Group 3: immediate progression after surgery. PTEN and ERG immunohistochemical analysis was performed and the association between expression levels and clinical parameters were compared. ResultsPathological stage pT3 tumours were more common at borderline significantly higher levels amongst patients who biochemically recurred when compared to patients who did not recur after radical prostatectomy (p = 0.05). ERG and PTEN expression levels were compared separately and concurrently across all three patient groups. Lack of ERG expression was strongly associated with immediate progression after surgery (p = 0.029). Loss of/low PTEN trended towards an association with immediate progression, however this was not statistically significant (p = 0.066). ConclusionIn this study, negative ERG expression was strongly associated with immediate biochemical progression after radical prostatectomy. Moreover, a trend towards a relationship between aberrant PTEN expression and progression was observed. Additional studies with long-term follow up data may provide further clinical insight into the genomic heterogeneity in this population.

Sofosbuvir and daclatasvir compared with standard of care in the treatment of patients admitted to hospital with moderate or severe coronavirus infection (COVID-19): a randomized controlled trial

BackgroundCurrently no effective antiviral therapy has been found to treat COVID-19. The aim of this trial was to assess if the addition of sofosbuvir and daclatasvir improved clinical outcomes in patients with moderate or severe COVID-19.MethodsThis was an open-label, multicentre, randomized controlled clinical trial in adults with moderate or severe COVID-19 admitted to four university hospitals in Iran. Patients were randomized into a treatment arm receiving sofosbuvir and daclatasvir plus standard care, or a control arm receiving standard care alone. The primary endpoint was clinical recovery within 14 days of treatment. The study is registered with IRCT.ir under registration number IRCT20200128046294N2.ResultsBetween 26 March and 26 April 2020, 66 patients were recruited and allocated to either the treatment arm (n = 33) or the control arm (n = 33). Clinical recovery within 14 days was achieved by 29/33 (88%) in the treatment arm and 22/33 (67%) in the control arm (P = 0.076). The treatment arm had a significantly shorter median duration of hospitalization [6 days (IQR 4–8)] than the control group [8 days (IQR 5–13)]; P = 0.029. Cumulative incidence of hospital discharge was significantly higher in the treatment arm versus the control (Gray’s P = 0.041). Three patients died in the treatment arm and five in the control arm. No serious adverse events were reported.ConclusionsThe addition of sofosbuvir and daclatasvir to standard care significantly reduced the duration of hospital stay compared with standard care alone. Although fewer deaths were observed in the treatment arm, this was not statistically significant. Conducting larger scale trials seems prudent.

Self‐concept and health anxiety relate to psychological outcomes for BRCA1/2 carriers

Leventhal's common sense model of self-regulation highlights how specific beliefs about illness influence psychological outcomes. Little is known on how such beliefs relate to BRCA1/2 adjustment. Furthermore, beliefs about one's self-concept may be relevant to genetic conditions and may relate to psychological wellbeing. One-hundred and eighteen female BRCA1/2 carriers from an Irish University Hospital completed questionnaires for this cross-sectional study. Outcomes measured were state anxiety and physical and mental health-related quality of life (HRQOL). Explanatory variables included sociodemographics, health anxiety, illness perceptions, coping and self-concept. Hierarchical multiple regression analyses were conducted. Then, 44% of participants had clinically significant state anxiety and 12% had clinically significant health anxiety. Vulnerability, stigma, mastery and health anxiety explained 42% of the variance in state anxiety. Previous mental health difficulty, vulnerability, stigma, mastery and health anxiety explained 40% of the variance in mental HRQOL. Dysfunctional coping strategies were strongly related to the physical functioning aspect of quality of life. BRCA-specific beliefs related to self and health anxiety are important factors to consider in the adjustment to BRCA1/2 confirmation.

Challenges of implementing the accreditation model in military and university hospitals in Iran: a qualitative study

BackgroundThe aim of this study was to present challenges of implementing the accreditation model in university and military hospitals in Iran.MethodsIn this qualitative study, purposive sampling was used to select hospital managers and implementers of the model working in 3 hospitals affiliated to Kerman University of Medical Sciences and in 3 military hospitals in Kerman, Iran. A total of 39 participants were interviewed, and semi-structured questionnaires and thematic analysis were used for data collection and analysis, respectively.ResultsIn this study, 5 major codes and 17 subcodes were identified: (1) perspectives on accreditation model with 5 subcodes: a difficult and time-consuming model, less attention to the patient, accreditation as a way of money acquisition, not being cost-effective, and accreditation means incorrect documentation; (2) absence of appropriate executive policy, with 3 subcodes: lack of financial funds and personnel, disregarding local conditions in implementation and evaluation, and absence of the principle of unity of command; (3) training problems of the accreditation model, with 2 subcodes: absence of proper training and incoordination of training and evaluation; (4) human resources problems, with 3 subcodes: no profit for nonphysician personnel, heavy workload of the personnel, and physicians’ nonparticipation; (5) evaluation problems, with 4 subcodes: no precise and comprehensive evaluation, inconformity of authorities’ perspectives on evaluation, considerable change in evaluation criteria, and excessive reliance on certificates.ConclusionsThis study provided useful data on the challenges of implementing hospitals’ accreditation, which can be used by health policymakers to revise and modify accreditation procedures in Iran and other countries with similar conditions. The accreditation model is comprehensive and has been implemented to improve the quality of services and patients’ safety. The basic philosophy of hospital accreditation did not fully comply with the underlying conditions of the hospitals. The hospital staff considered accreditation as the ultimate goal rather than a means for achieving quality of service. The Ministry of Health and Medical Education performed accreditation hastily for all Iranian hospitals, while the hospitals were not prepared and equipped to implement the accreditation model.

Advanced psychometric testing on a clinical screening tool to evaluate insomnia: sleep condition indicator in patients with advanced cancer

PurposeTo examine the psychometric properties of the Sleep Condition Indicator (SCI) using different psychometric approaches [including classical test theory, Rasch models, and receiver operating characteristics (ROC) curve] among patients with advanced cancer.MethodsThrough convenience sampling, patients with cancer at stage III or IV (n = 859; 511 males; mean ± SD age = 67.4 ± 7.5 years) were recruited from several oncology units of university hospitals in Iran. All the participants completed the SCI, Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Hospital Anxiety and Depression Scale (HADS), General Health Questionnaire (GHQ), and Edmonton Symptom Assessment Scale (ESAS). In addition, 491 participants wore an actigraph device to capture objective sleep.ResultsClassical test theory [factor loadings from confirmatory factor analysis = 0.76–0.89; test–retest reliability = 0.80–0.93] and Rasch analysis [infit mean square (MnSq) = 0.63–1.31; outfit MnSq = 0.61–1.23] both support the construct validity of the SCI. The SCI had significant associations with ISI, PSQI, ESS, HADS, GHQ, and ESAS. In addition, the SCI has satisfactory area under ROC curve (0.92) when comparing a gold standard of insomnia diagnosis. Significant differences in the actigraphy measure were found between insomniacs and non-insomniacs based on the SCI score defined by ROC.ConclusionWith the promising psychometric properties shown in the SCI, healthcare providers can use this simple assessment tool to target the patients with advanced cancer who are at risk of insomnia and subsequently provide personalized care efficiently.

Evaluation of Service Quality From the Patients’ Viewpoint in the Oncology Setting of a University Hospital in Iran

Background: Hospitals are one of the most important units in providing healthcare services. The assessment of the quality of provided services is essential in these settings. Patient satisfaction is one of the key indicators of service quality in healthcare organizations. Objectives: This study aimed at investigating the gap between the perceptions and expectations of service recipients in Shohada-e-Tajrish Hospital (Tehran, Iran), using the SERVQUAL model in 2020. Methods: This cross-sectional study was conducted on patients with cancer, who were upon discharge from Shohada-e-Tajrish Hospital. Patients (> 18 years) with a cancer diagnosis, who were being discharged from the oncology ward of the hospital, were included in this study. The sample size was estimated at 118. The required information was collected, using the modified SERVQUAL questionnaire. Statistical analyses were performed in SPSS version 20, using a paired t test and one-sample t-test. Results: The results showed that the quality of the provided services from the patients’ perspective was significantly lower than their expectations. The mean gap between the expectations and perceptions of patients was significantly above zero (P < 0.001). The most influential factor in improving patient satisfaction with the quality of services was assurance, followed by reliability, while the least effective factor was empathy. The correlation coefficient between the general status of provided services from the patients’ point of view and loyalty was 0.740 (P < 0.001). Conclusions: The findings of the present study indicated that patient expectations were higher than their satisfaction. Therefore, hospital authorities should take major steps to improve the quality of services, especially reliability and responsiveness, through proper planning, prioritization of services, and review of processes contributing to patient expectations. The existing gaps can also be addressed by considering the perspectives of patients as the clients of healthcare organizations.

Morningness-Eveningness Chronotypes, Sleep Quality, and Sleepiness Among Nurses

Background:Poor sleep quality and sleepiness is a common problem in nurses. The morningness-eveningness preference of nurses may affect their sleep quality.Objective:The objectives of this study were (1) to describe the quality of sleep in a group of hospital nurses and (2) to analyze the effect of shift work and morningness-eveningness on the sleep quality of nurses.Methods:In this cross-sectional study, 120 nurses completed the survey in a university hospital in Iran. The study tools were Pittsburgh Sleep Quality Questionnaire (PSQI), Epworth Sleepiness Scale (ESS), and Morningness-Eveningness Questionnaire (MEQ). Nurses with PSQI>5 and ESS≥10 were considered having poor sleep quality and excessive daytime sleepiness. Nurses were subdivided into morning-, intermediate- and evening-types according to MEQ. Data were analyzed by chi-square, Mann–Whitney U-test, logistic regression, and analysis of covariance (ANCOVA) tests.Results:The mean (±SD) of PSQI and ESS was 6.88(2.18) and 9.5(±3.9), respectively. About 74% of nurses reported poor sleep quality, and near 40% of the nurses had excessive daytime sleepiness. Sixty percent of nurses were intermediate-type, and the remaining was morning (24.2%) and evening (15.8%) types. The sleep quality and daytime sleepiness had a significant relation with shift work. The mean PSQI was significantly different between shift work and non-shift work nurses. The mean PSQI of three main chronotypes was statistically different.Conclusion:Poor sleep quality was prevalent in the nurses and was significantly associated with shift work and chronotype. The sleep preference of nurses would be considered as an important factor in the assignment of shift work by hospital managers.

Forecasting the Amount of Blood Ordered in the Obstetrics and Gynaecology Ward with the Data Mining Approach.

Preoperative blood ordering is frequently used in the obstetrics and gynecology ward of university hospitals in Iran, even for surgeries that rarely require blood transfusions. This routine procedure is an inefficient use of resources and rising costs, wasting time and cause shortage for essential patients. So this study was carried out to propose a new optimal system based on data mining techniques for ordering blood. This cross-sectional study examined the number of units cross-matched and transfused during surgery in the obstetrics and gynecology ward from 2013 to 2015. Data was collected for 1097 patients. Statistical analyzing was applied on data to prove that; the current blood ordering was not optimal. So with use of blood indices, C/T ratio, the new blood ordering variable was introduced. Then decision tree was applied on data with use of Rapid miner. Decision tree evaluation measures were rMSE and accuracy. A total of 1097 patients were examined for which 9747 units of blood were ordered. There was a significant difference between the number of cross-matched and transfused units according to all variables. The new method reduced the cross-matched units about 71.50%. The accuracy of proposed decision tree based on new blood ordering variable (according to C/T index) was 96.10%. The effective variables of blood ordered were type of surgery, blood group and amount of hemoglobin. The recent blood ordering variable prevent blood shortages, reduce costs. Excessive blood ordering is common in the obstetrics and gynecology department. According to proper results of new ordering variable, we suggest to apply this procedure in all hospitals in order to reduce extra costs and the optimal management of blood ordering.

Predictors of Incident Fear of Falling in Community-Dwelling Older Adults

ObjectivesFear of falling (FoF) is common in older people and may lead to physical decline, disability, poor quality of life, and falls. Several risk factors for FoF have been identified in cross-sectional studies, but evidence on predictors of its incidence is scarce. We investigated the latter in community-dwelling older people undergoing a comprehensive geriatric assessment at baseline and after a 2-year follow-up. DesignLongitudinal study. Setting and ParticipantsConvenience sample of community-dwelling people aged ≥60 years evaluated in an Irish university hospital. MethodsParticipants were evaluated at baseline (August 2007–May 2009) and after a 2-year follow-up. FoF was measured using the Modified Falls Efficacy Scale. Predictors of incident FoF at 2 years were investigated. ResultsAt baseline, there were 563 participants (69% female, mean age 73 years). Among individuals that were not fearful at baseline, 105 (18.7%) developed FoF (incident FoF) after a median follow-up of 2.1 years. Individuals reporting incident FoF were older at baseline (P < .001), had worse performance in balance and physical function tests, and more frequently needed a walking aid (P < .001). Anxiety (P = .012) and depressive symptoms (P < .001) were more prevalent, as well as self-reported previous falls (P < .001). In multivariate analysis, older age, walking aid use, and a higher burden of depressive symptoms at baseline were predictors of incident FoF. Conclusions and ImplicationsAlmost a fifth of older adults using a walking aid and reporting depressive symptoms at baseline developed FoF after 2 years. These identifiable prodromal factors could help design FoF prevention strategies.

13 Effects of Benzodiazepines on Orthostatic Blood Pressure in Older People

Abstract Background Older people taking benzodiazepines (BDZs) have higher risk of falling, which is mainly attributed to unfavorable drug-related effects on cognition and psychomotor functioning. BDZs may also have hypotensive effects, but evidence concerning the relationship between BDZs and orthostatic blood pressure (BP) behaviour in older people is scarce. We investigated the effects of BDZs on BP response to an orthostatic active stand test. Methods We performed a retrospective analysis of data from an outpatient research clinic in an Irish university hospital, where people aged 60 or older underwent a comprehensive geriatric assessment between August 2007 and May 2009. Non-invasive beat-to-beat orthostatic BP was measured during active stand, with systolic BP assessed at each 10-second interval. Information on regular BDZs use was collected. Factors independently associated with orthostatic systolic BP were investigated using multiple linear regression. Results Of 624 community-dwelling people who underwent a clinic assessment, orthostatic active stand data was collected in 541. Information on regular BDZs use was available in 538 people. Of 538 participants, mean age was 72.7±7.2, 67.7% were female and 33 (6.1%) reported regular use of BDZs. History of falls (p=0.027) and fear of falling (p&lt;0.001) were more prevalent in this subgroup. During active stand, participants on BDZs showed a significantly greater systolic BP drop 10 seconds after the posture change (“immediate” BP drop). No significant differences were detected in orthostatic systolic BP in the latter phases of the active stand. After adjusting for possible confounders, BDZs use was independently associated with a mean immediate systolic BP drop of 12 mmHg after standing. Conclusion BDZs may confer higher risk of an immediate systolic BP drop after standing in older people, which may contribute to their known falls risk. BDZ should be avoided in older people at risk of falling.

Nutritional status of patients hospitalized in the intensive care unit: A comprehensive report from Iranian hospitals, 2018

Introduction and aimMalnutrition is a complication of hospitalization in critically ill patients. This event is occurred because of disease and therapeutic processes for curing the patients. Determination of nutritional status helps physicians and clinical nutritionists decide on the best regimen which should be prescribed for a patient. In the current study, we aimed to report the nutritional status ofpatientshospitalizedin the intensive care unit (ICU). Method of studyWe used three standard tolls, including Subjective global assessment (SGA), Nutrition Risk in the Critically Ill (NUTRIC) Score and nutrition risk screening (NRS) questionnaires via a multi-stage sampling for different ICU wards of 32 university hospitals in Iran. Frequencies and rates of nutritional scores, comparative studies, and determined agreement of scoring systems and nutritional status in any ward of hospitals were evaluated. ResultsThere were 771 males and 540 female Cancer and trauma patients had the best and worst nutritional scores, respectively. Using NRS and NUTRIC, the low-risk scores were more frequent than thehigh-riskscores among ICU patients. SGA showed that most patients were in grades A (well nutritional status) or B (moderate nutritional status), andfew caseswere in grade C (poor nutritional status).The high-risk nutritional score wasobtained for older patients. NUTRIC and NRS had better agreement for diagnosis and differentiation of malnutrition than NUTRIC-SGA or NRS-SGA pairs. However, there was no strong agreement between the mentioned pairs. ConclusionNutritional status of patients hospitalized in ICU wards in Iran wassomewhat better than other countries that this could be due to the highly observed guidelines of patient's care in Iran. Anyway,it is suggested that a more precise tool of nutritional scoresto be validated for patients hospitalized in ICU·In addition, better medical care needs a well evaluation of nutritional insufficiencies and what is necessary for compensation using complementary regimens.