Hospital Medical Wards Research Articles

Dementia in elderly inpatients admitted to medical wards in Brazil: diagnosis and comorbidity with other clinical diseases.

Specific comorbidities affect older patients with dementia admitted to general hospitals and may complicate the recognition of dementia. The aim of the present study was to estimate the prevalence of dementia among elderly inpatients admitted to hospital medical wards and to identify its distribution across clinical and sociodemographic conditions. From June 2011 to May 2012, a sample of elderly inpatients (≥60 years old) were screened for dementia with the Mini-Mental State Examination and the Bayer Activities of Daily Living Scale to identify cognitive and functional impairment (CFI). Subjects with CFI underwent a diagnostic procedure for dementia using the Cambridge Mental Disorders of the Elderly Examination and the Diagnostic and Statistical Manual of Mental Disorders, 4th edition. The elderly inpatients also completed a standard questionnaire to investigate sociodemographic and clinical variables and a screening procedure for depression and delirium. The data obtained were submitted to univariate and multivariate analyses. The sample of 224 subjects had a mean age of 71.5 years and was mostly men (62.2%), poorly educated (≤4 years of schooling: 74.6%), and married (53.4%). CFI was observed in 84 subjects (prevalence: 37.4%; 95% confidence interval: 31.1-43.7), and dementia was observed in 31 subjects (prevalence: 17.2%; 95% confidence interval: 12.3-22.1). Dementia was related to older age and the presence of delirium, stroke, and pneumonia. The prevalence of CFI and dementia was high among the elderly inpatients examined. The identification of medical and sociodemographic conditions associated with a dementia diagnosis in a general hospital may be useful in the development of preventative actions.

The use of a pocket-sized ultrasound device improves physical examination: results of an in- and outpatient cohort study.

BackgroundThe performance of pocket mobile ultrasound devices (PUDs) is comparable with that of standard ultrasonography, whereas the accuracy of a physical examination is often poor requiring further tests to assess diagnostic hypotheses. Adding the use of PUD to physical examination could lead to an incremental benefit.AimWe assessed whether the use of PUD in the context of physical examination can reduce the prescription of additional tests when used by physicians in different clinical settings.MethodsWe conducted a cohort impact study in four hospital medical wards, one gastroenterological outpatient clinic, and 90 general practices in the same geographical area. The study involved 135 physicians who used PUD, after a short predefined training course, to examine 1962 consecutive patients with one of 10 diagnostic hypotheses: ascites, pleural effusion, pericardial effusion, urinary retention, urinary stones, gallstones, biliary-duct dilation, splenomegaly, abdominal mass, abdominal aortic aneurysm. According to the physicians’ judgment, PUD examination could rule out or in the diagnostic hypothesis or require further testing; the concordance with the final diagnosis was assessed. The main outcome was the proportion of cases in which additional tests were required after PUD. The PUD diagnostic accuracy was assessed in patients submitted to further testing.FindingsThe 1962 patients included 37% in-patients, 26% gastroenterology outpatients, 37% from general practices. Further testing after PUD examination was deemed unnecessary in 63%. Only 5% of patients with negative PUD not referred for further testing were classified false negatives with respect to the final diagnosis. In patients undergoing further tests, the sensitivity was 91%, and the specificity 83%.ConclusionsAfter a simple and short training course, a PUD examination can be used in addition to a physical examination to improve the answer to ten common clinical questions concerning in- and outpatients, and can reduce the need for further testing.

Diagnostic accuracy of fine needle aspiration cytology in providing a diagnosis of cervical lymphadenopathy among HIV-infected patients.

Opportunistic infections and malignancies cause lymphadenopathy in HIV-infected patients. The use and accuracy of fine needle aspiration cytology in diagnosing of cervical lymphadenopathy among HIV-infected patients is not well studied in Uganda. The aim of this study was to determine the diagnostic accuracy of fine needle aspiration cytology in providing a diagnosis of cervical lymphadenopathy among HIV-infected patients in Uganda. We consecutively recruited adult HIV-infected patients with cervical lymphadenopathy admitted to Mulago Hospital medical wards. Clinical examination, fine needle aspiration and lymph node biopsy were performed. We estimated the sensitivity, specificity; negative and positive predictive values using histology as the gold standard. We enrolled 108 patients with a mean age of 33 years (range, 18-60), 59% were men and mean CD4 was 83(range, 22-375) cells/mm(3). The major causes of cervical lymphadenopathy were: tuberculosis (69.4%), Kaposi's sarcoma-KS (10.2%) and reactive adenitis (7.4%). Overall fine needle aspiration cytology accurately predicted the histological findings in 65 out of 73 cases (89%) and missed 7 cases (9.5%). With a sensitivity of 93.1%, specificity of 100%, positive predictive value of 100% and negative predictive value of 78.7% for tuberculosis and 80%; 98.4%;88.9% and 98.9% for KS respectively. No fine needle aspiration complications were noted. Fine needle aspiration cytology is safe and accurate in the diagnosis of tuberculosis and KS cervical lymphadenopathy among HIV-positive patients.

All-cause mortality among elderly patients admitted to the medical wards of hospitals in Africa: A systematic review

Geriatric medicine as a speciality is just evolving in Africa. There is scanty data on the mortality and associated factors among elderly patients admitted to the hospital medical wards in Africa. The objective of this review was to identify, describe, and analyze systematically the available studies on all-cause mortality and associated factors among elderly patients admitted to the medical wards of a hospital in Africa. Online and hand-based systematic searches were conducted for literature (primary and secondary) describing the mortality in elderly patients admitted to the medical wards of a hospital in Africa. These included original research, review articles, proceedings, and transactions from 1969 to 2014. All identified studies were screened using the Population, Intervention, Comparison, and Outcomes criteria. Five studies describing 3427 hospitalized elderly patients reported 773 deaths giving an unadjusted proportion of admissions which resulted in in-hospital deaths of 22.6% (range: 6.8–44.7%). This was higher among the males (38.8–48.0%) compared with the females (29.4–40.7%). There was no significant association between the age and mortality. Mortality was high among patients who had stroke, meningitis, septicaemia, renal failure, chronic liver disease, chronic obstructive pulmonary disease, severe asthma, and heart failure. High mortality was associated with high serum creatinine and urea, tachycardia, reduced length of stay from admission to death, and low serum protein. In conclusion, the few available data showed high unadjusted all-cause mortality among hospitalized elderly patients in Africa. More studies are needed in Africa to quantify this health burden and identify the major factors causing the high mortality in elderly patients.

Risk Factors, Clinical Pattern and Outcome of Stroke in a Referral Hospital, Northwest Ethiopia

Stroke is one of the commonest causes of morbidity and mortality among non-communicable diseases. Its occurrence has been significantly increasing in Sub Saharan Africa in the last couple of decades. Mortality has been shown to be higher in this area compared to developed countries. Yet, there is a big information gap about stroke in Ethiopia. This study aimed at describing the clinical pattern, risk factors and outcome of adult stroke patients admitted to university of Gondar hospital. Retrospective chart record analysis of adult patients with stroke who had Computerized tomography(CT) scan of the brain admitted to University of Gondar hospital medical wards from June 2010 to May 2013 was done. Relevant data including sociodemographics, risk factors, type of stroke and outcome were collected using a data extraction form. Data was entered and analyzed using Epi info7. Results: A total of 98 patients with a median age of 68 years (IQR: 60-76) and F:M ratio of 1.13:1 were analyzed. Ischemic stroke accounted for 69.4% of the cases. The median ages of patients with hemorrhagic and ischemic stroke were 60 and 70 years respectively (P=0.0027). Hypertension (55.9%), any type of structural heart disease (44.6%) and atrial fibrillation (28.7%) were the most commonly identified risk factors. Atrial fibrillation was more prevalent in ischemic stroke patients (34.3%) compared to hemorrhagic stroke (14.8%) (P= 0.049). In hospital mortality rate was 13% with median duration of hospital stay before death of 6 days. Respiratory failure secondary to aspiration pneumonia and increased intracranial pressure were the most common immediate causes of death. Conclusion: Even though ischemic stroke was the most common stroke subtype, the proportion of hemorrhagic stroke was higher compared to studies from the developed world. Appropriate screening and treatment of hypertension, structural heart disease and atrial fibrillation should be give due attention as they are the most commonly identified risk factors. Most deaths occurred early after admission due to stroke related acute complications with respiratory failure; as such an emergency stroke care unit capable of managing these complications can partially decrease the death rate.

A pathway care model allowing low-risk patients to gain direct admission to a hospital medical ward--a pilot study on ambulance nurses and Emergency Department physicians.

A pathway care model allowing low-risk patients to gain rapid admission to a hospital medical ward − a pilot study on ambulance nurses and Emergency Department physicians.BackgroundPatients with non-urgent medical symptoms who nonetheless require inpatient hospital treatment often have to wait for an unacceptably long time at the Emergency Department (ED). The purpose of this study is to evaluate the feasibility and effect on length of delay of a pathway care model for low-risk patients who have undergone prehospital assessment by an ambulance nurse and ED assessment by a physician within 10 minutes of arrival at the ED.MethodsThe pilot study comparing two low-risk groups took place in western Sweden from October 2011 until January 2012. The pathway model for low-risk patients was used prospectively in the rapid admission group (N = 51), who were admitted rapidly after being assessed by the nurse on scene and then assessed by the ED physician on ED admission. A retrospectively assembled control group (N = 51) received traditional care at the ED. All p-values are age-adjusted.ResultsPatients in the rapid admission group were older (mean age 80 years old) than patients in the control group (mean age 73 years old) (p = 0.02). The median delay from arrival at the patient’s side until arrival in a hospital medical ward was 57 minutes for the rapid admission group versus 4 hours 13 minutes for the control group (p < 0.0001). However, the median delay time from the ambulance’s arrival at the patient’s side until the nurse was free for a new assignment was 77 minutes for the rapid admission group versus 49 minutes for the control group (p < 0.0001). The 30-day mortality rate was 20% for the rapid admission group and only 4% for the control group (p = 0.16).ConclusionThe pathway care model for low-risk patients gaining rapid admission to a hospital medical ward shortened length of delay from the first assessment until arrival at the ward. However, the result was achieved at the cost of an increased workload for the ambulance nurse. Furthermore patients who were rapidly admitted to a hospital ward had a high age level and a high early mortality rate. Patient safety in this new model of fast-track assessment needs to be further evaluated.

P17.11 * COMBINED RADIOTHERAPY(RT) AND CHEMOTHERAPY(CT) WITH TEMOZOLOMIDE(TMZ) CONCOMITANT(CC) AND ADJUVANT(ADJ) IN GLIOBLASTOMA IN TUNISIA(TN): RETROSPECTIVE STUDY ABOUT 37 CASES

OBJECTIVE: To report the epidemiological and clinical characteristics of a TN serie of GBM treated recently by CC RT-CT then adjuvant with TMZ, according to Stupp protocol(NEJM 2005;352:987-996). PATIENTS AND METHODS: Our retrospective bicentric study included 37 cases of histologically confirmed GBM treated between 2006 and 2012 in Abderrahmen Mami hospital (medical oncology ward) and Taoufik Clinic of Tunis. We collected the following data: age, sex, symptoms, histology, investigations, treatment and evolution. RESULTS: We treated 25 males and 12 females (sex-ratio = 2.08) with a median age of 54 years (13-72). GBM was revealed mainly by deficit symptoms (41%). Surgery consisted in a wide resection in 89% of cases, reported as macroscopically complete in 78% of cases. All our patients received a CC CT-RT and 51% Adj TMZ, 22% receiving the 6 planned cycles. With a median follow-up of 12 months, medican survival was 12 months, 4 remained alive with evolutive disease. 1 and 2 year-actuarial survival were respectively of 77.6% and 38.4%. CONCLUSION: GBM patients in Tunisia have lioblastoma is a rare neoplasm with poor prognosis. Their lower median and overall survivals could be explained by the predominance of high risk cases according to neurofunctional VI-VI RPA classification.

Hypertensive Urgency: The Role of Clinical Pharmacist in Identifying and Managing Drug Therapy Problems: The Case of Ambo Hospital Medical Ward, Ethiopia

Hypertensive Urgency: The Role of Clinical Pharmacist in Identifying and Managing Drug Therapy Problems: The Case of Ambo Hospital Medical Ward, Ethiopia

When Pain Memories Are Lost: A Pilot Study of Semantic Knowledge of Pain in Dementia

It has been documented that pain in people with dementia is often under-reported and poorly detected. The reasons for this are not clearly defined. This project aimed to explore semantic concepts of pain in people with dementia and whether this is associated with clinical pain report. Cohort study with nested cross-sectional analysis. Acute general hospital medical wards for older people. People with dementia (N = 26) and control participants (N = 13). Two subtests of semantic memory for pain: (1) Identifying painful situations from a standardized range of pictures; (2) Describing the concept of pain. Participants also indicated whether they were in pain or not, were observed for pain (PAINAD scale) and completed the Wong-Baker FACES scale to indicate pain severity. Compared with the control group, people with dementia were less able to identify painful situations and used fewer categories to define their concept of pain. In turn, the performance on these two measures was related to the reported presence and, albeit less strongly, to the reported severity of pain, indicating that a reduction in semantic memory for pain is associated with a decline in reported pain. This study is the first to show that semantic memory for pain is diminished in dementia patients. When using clinical pain tools, clinicians should consider these effects which may bias clinical pain ratings when they evaluate and manage pain in these patients. This might improve the recognition and management of pain in people with dementia.

Hospital Acquired Infections Among Patients Admitted in the Medical and Surgical Wards of a Non-Teaching Secondary Care Hospital in Northern India

To investigate the incidence of Nosocomial Infection (NI) and type of bacteriological isolates among the patients admitted in the medical and surgical wards of a non-teaching secondary care hospital in north India. This was a cross-sectional hospital based study conducted in the Wards of General Medicine, General Surgery and Orthopaedic of the hospital. The patient were admitted in the department for various surgical procedures, without evidence of initial infection, were included in the study. A total of 176 patients were included in the study of which 82 were from Medical and 94 from Surgical ward. Overall incidence of NI was found to be 26.1% (Medical ward=28%, Surgical ward=24.5%., p=0.58). The isolation rate of Acinetobacter baumanii was (p=0.15) higher among the patients of medical ward (95.7%) than surgical ward (82.6). Escherichia coli was isolated in 89.1% and no significant difference was observed between medical and surgical wards. Klebsiella pneumoniae was isolated in 50% patients and was almost similar (p=0.37) in medical surgical wards. The isolation rate of Pseudomonos aeruginosa, Enterococcus faecalis, Staphylococcus aureus and Coagulase negative staphylococci were 43.5%, 73.9%, 34.8% and 17.4% respectively. A significant difference was observed in the isolation rate of Enterococcus faecalis (p=0.007) and Coagulase negative staphylococci (p=0.002) between medical and surgical wards. Overall, among the patients who developed NI, 27.2% patient's bacterial isolates were Gram positive (Surgical=64.1, Medical=80%). The incidence of NI is increasing in the hospitals, so extensive that more care has to be taken in cleaning the wards of the hospitals.

Why do patients develop severe pressure ulcers? A retrospective case study

ObjectivesThis study focuses on the ways in which the organisational context can influence the development of severe pressure ulcers. Severe pressure ulcers are important indicators of failures in the organisation...

The Current Practice of Hypertensive Crises Treatment and the Underestimated Role of Clinical Pharmacists in Ambo Hospital Medical Ward, Ethiopia

Background: Hypertension is an extremely common clinical problem, affecting approximately 1 billion individuals worldwide. An estimated 1% to 2% of patients with chronic hypertension will at some time develop hypertensive crises (Hypertensive urgency and emergency). Hypertensive urgency and emergency are differentiated by the absence or presence of acute end-organ damage, respectively. The blood pressure of patients with hypertensive emergencies should be reduced rapidly during the treatment. It should not be reduced to the normal value, but by approximately 20-30% of the baseline value. The reason for a stepwise reduction in blood pressure is the fact that patients with chronic hypertension have an altered auto regulation curve. Case presentation: A 60 year old male patient, who has been a known hypertensive patient admitted due to sudden onset of body weakness, difficulty of speech, diverted lips towards the left side, difficulties in eating, moving, coughing and inability to move right side of his extremities since one day. On P/E the pt. was severely sick looking, and unconscious. Conclusion: A number of both parenteral and oral antihypertensive drugs can be used in these patients. Treatment of hypertensive crises in patients with hypertensive encephalopathy, intracranial haemorrhage, subarachnoid haemorrhage, and thrombotic stroke has been recommended to be initiated with nicardipine, fenoldopam, nimodipine, flunarizine or labetalol.

Hypertensive Urgency: The Role of Clinical Pharmacist in Identifying and Managing Drug Therapy Problems: The Case of Ambo Hospital Medical Ward, Ethiopia

Worldwide the role of clinical pharmacists is becoming valuable and expanding in an alarming rate especially in developed countries. However, it is at its infancy stage in low income countries like Ethiopia. Therefore, this particular case is meant to show how much clinical pharmacists are important in the identification and management of drug therapy related problems among hospitalized patients. Accordingly, it was found that clinical pharmacists were able to diagnosis drug related problems during the management of hypertensive urgencies and provide evidence based recommendation to address the problems identified. We recommend the need for more number of clinical pharmacists in the area as well as devotion from the policy makers in upgrading their knowledge.

The Correlation of Head Nurses’ Time Management with Nurses’ Job Satisfaction in Medical & Surgical Wards of Hospitals in Arak Medical Sciences University

AbstractIntroduction:Control of time and prevention from wasting time can improve the ability of managing, retaining human resources, decreasing stress and increasing job satisfaction among personnel. Lack of time management in nursing profession may have effect on quality of care and declining efficiency and productivity which lead to feeling burnout and job dissatisfaction in nurses. The aim of this research is to determine the correlation of the head nurses’ time management behaviors with nurses’ job satisfaction.Materials and methods:This research is a descriptive – correlation study. In this research head nurses and nurses who have had inclusion criteria and were employed in medical & surgical wards of hospitals in Arak Medical Sciences University participated by census method. For data collection, two questionnaires about time management and job satisfaction have been designed according to research goals. Their validity were measured by face and content validity (time management: CVI= and job satisfaction: CVI= ) and their reliability by Kronbach - Alpha coefficient ( . and . ). Analyzing data has performed by SPSS software, version .Results:Analysis of data showed that there was not any correlation between time management behaviors of head nurses (from their view) with nurses’ job satisfaction(r = . , p > . ). But the correlation of time management behaviors of head nurses )from nurses’ view( with job satisfaction of nurses was significant (r= . , p< . ).Conclusion:The findings of this research reveal the importance of using time management skills by the nurse managers as a step to improve nursing effectiveness and nurse’ job satisfaction.Keywords: Time Management, Job Satisfaction, Nurse

Interventional trials with anticoagulants in acutely ill medical patients: a methodological pitfall?

Autopsy and retrospective studies [1–4] lead to believe that patients hospitalized for acute medical illness are at higher risk of deep venous thrombosis (DVT) and pulmonary embolism (PE) and that anticoagulant treatment was, therefore, necessary to prevent such vascular outcomes. Interventional trials consistently showed that prophylaxis with anticoagulants reduces the risk of composite endpoints of DVT, PE and DVT-related death in patients hospitalized for acute medical illness while no effect has been detected for total mortality [5]. These results prompted to recommend the use of anticoagulant prophylaxis in patients hospitalized for acute medical illness [6], but despite this, there is a large underuse of anticoagulant prophylaxis in the medical wards of hospitals [7, 8]. The scarce use of anticoagulants in acutely ill medical is almost evident in a multicenter clinical registry (The REPOSI study) performed by investigating patients hospitalized in Italian divisions of internal medicine [9]. Thus, Marcucci et al. [9] included 1,121 acutely ill medical patients and followed them up during the hospital stay and until 3 months after hospital discharge. Patients included were very old, with a mean age of 82 years; males and females were equally distributed. Among 1,121 patients, 171 (15.2 %) were treated with thromboprophylaxis (TP) including low molecular weight heparin (n = 158), unfractionated heparin (n = 4) and fondaparinux (n = 9). Administration of anticoagulants was unrelated to the current guidelines of this setting as only 14.9 % of treated patients met the criteria of ACCP 2004 guidelines [10]. Among the putative risk factors considered, impaired global performance, as assessed by Barthel index [11], length of hospital stay and acute respiratory failure were independent predictors of TP during the hospitalization. Because the rate of patients treated with TP was low, the study offers an interesting chance to appreciate the rate of DVT in a relatively large population of acutely ill medical patients. Figure 1 depicts the rate of DVT in patients treated or not with TP. During the hospital stay among 950 untreated patients, DVT was diagnosed in 5 (0.5 %) while 1 (0.6 %) DVT was observed in the 171 treated patients; in the 3-month follow-up only three untreated and one treated patients experienced DVT. Taking into account the entire follow-up, 8 (0.8 %) untreated and 2 (1.1) treated patients experienced DVT. Pulmonary embolism was detected in two patients with DVT (one treated and one untreated) only after hospital discharge. We have recently reviewed the incidence of DVT in the interventional trials with anticoagulants performed in acutely ill medical patients [12]. The rate of DVT was quite different if symptomatic or asymptomatic events were separately considered [12]. Thus, asymptomatic DVT was much more frequent compared to symptomatic ones with a large variation ranging as high as 28 % to as low as 2.3 % with an average of 4.7 % [12]. The rate of symptomatic DVT was much less with values from as high as 1.5 % to as low as 0.8 % and an average of 0.99 % [12]. Despite Marcucci et al. [9] reported the incidence of only symptomatic DVT, we believe that these data add important news on this topic. Thus, they found that during the hospital stay the rate of symptomatic DVT was a little bit less (0.5 %) compared to This comment refers to the article available at doi:10.1007/s11739-013-0944-8.

The Liverpool Care Pathway for cancer patients dying in hospital medical wards: A before–after cluster phase II trial of outcomes reported by family members

Background: Hospital is the most common place of cancer death but concerns regarding the quality of end-of-life care remain. Aim: Preliminary assessment of the effectiveness of the Liverpool Care Pathway on the quality of end-of-life care provided to adult cancer patients during their last week of life in hospital. Design: Uncontrolled before–after intervention cluster trial. Settings/participants: The trial was performed within four hospital wards participating in the pilot implementation of the Italian version of the Liverpool Care Pathway programme. All cancer patients who died in the hospital wards 2–4 months before and after the implementation of the Italian version of Liverpool Care Pathway were identified. A total of 2 months after the patient’s death, bereaved family members were interviewed using the Toolkit After-Death Family Interview (seven 0–100 scales assessing the quality of end-of-life care) and the Italian version of the Views of Informal Carers - Evaluation of Services (VOICES) (three items assessing pain, breathlessness and nausea-vomiting). Results: An interview was obtained for 79 family members, 46 (73.0%) before and 33 (68.8%) after implementation of the Italian version of Liverpool Care Pathway. Following Italian version of Liverpool Care Pathway implementation, there was a significant improvement in the mean scores of four Toolkit scales: respect, kindness and dignity (+16.8; 95% confidence interval = 3.6–30.0; p = 0.015); family emotional support (+20.9; 95% confidence interval = 9.6–32.3; p < 0.001); family self-efficacy (+14.3; 95% confidence interval = 0.3–28.2; p = 0.049) and coordination of care (+14.3; 95% confidence interval = 4.2–24.3; p = 0.007). No significant improvement in symptom’ control was observed. Conclusions: These results provide the first robust data collected from family members of a preliminary clinically significant improvement, in some aspects, of quality of care after the implementation of the Italian version of Liverpool Care Pathway programme. The poor effect for symptom control suggests areas for further innovation and development.

Revisiting the role of a palliative care psychiatrist.

I was hired 3 years ago to join a palliative care medical team at a Veterans Administration (VA) hospital. At the time, I speculated about what the work involved was likely to be. I wrote an article that appeared in the Companion titled “Roles and Goals of a Palliative Care Psychiatrist.”1 Now, after 3 years of actually doing the work, revisiting the description of the job seems reasonable. My work encompasses 12 hours of the week. One morning is spent on a VA nursing home inpatient unit. One morning is spent in an oncology clinic. One morning is spent in a geriatric clinic. In each place, I am tasked to represent palliative care. In addition, I join the medical team on inpatient rounds on the VA hospital medical wards twice weekly. My dual role there involves aiding the treatment of inpatients and augmenting the teaching of medical residents. Palliative care replaces curative intent with comfort care as the goal of treatment for these patients. Comfort care focuses on pain relief, sleep and appetite promotion, the reduction of fatigue, the elimination of diarrhea and constipation, and the minimization of anxiety and depression. I learned quickly that the adjustment to admission to a nursing home unit could be represented psychologically as “starting a new life stage.” The same was true of the impact on most outpatients of a diagnosis of cancer. I observed a similar phenomenon whenever a patient was diagnosed with a serious (often life-threatening) illness. For many, a signal that the “end of life” was approaching had a similar effect. Some patients told me that now little in life was engaging. Others saw life passing them by. People with differing personalities often had different needs and engaged in different activities. For many, painfully little of their previous life stage seemed applicable to this new one. A significant number of people seemed overwhelmed by their new circumstance and seemed to have given up. On the nursing home unit, this was often indicated by the phrase, “I am here to die.” With the passage of a brief amount of time, and with the benefit of regular meals and routine, the design of a plan to adapt to their new circumstance seemed to be a good prospect for many patients.

The missed opportunities to diagnose and treat iron deficiency in patients hospitalized with heart failure

Iron Deficiency (ID) is common in heart failure (HF), and is an independent contributor to mortality and morbidity. We examined whether patients with previously known HF who were recently hospitalized, had previous treatment for ID, were investigated for it at the time of hospitalization, and, if ID was found, were prescribed iron on discharge. We examined the records of 76 consecutive patients admitted to our hospital medical wards with a primary diagnosis of HF. Anemia (Hb<12 g/dl) was found in 42/76 patients (55.3%). In 55/76 patients (72.4%) there was no iron workup, in 6 (7.9%) an incomplete iron workup with serum iron, transferrin or ferritin lacking and in 15/76 (19.7%) a complete iron workup. If ID was defined as either a serum ferritin of <100 μg/l or a serum ferritin of 100-299 μg/l and a %Transferrin Saturation of <20% it was found in 12/15 (80%) of those with a complete workup; in 9 of 10 (90%) of the anemic patients and in 3 of 5 (60%) of those non-anemic patients. At discharge 11/15 (73.3%) of those with a complete iron workup were given iron, 10 orally and 1 IV. In those 6 with an incomplete workup 2 were started on oral iron (33.3%) and in those without any workup, 1 of 55 (1.8%) was given oral iron. ID is common in hospitalized HF patients but is usually not sought after by physicians at the time of admission. However if detected the physicians usually treated it.

Quality of Inpatient Diabetes Care on the Medical and Surgical Wards of a Teaching Hospital in Manitoba, Canada

Quality of Inpatient Diabetes Care on the Medical and Surgical Wards of a Teaching Hospital in Manitoba, Canada

Inappropriate prescribing in hospitalised Australian elderly as determined by the STOPP criteria

The elderly population is increasing worldwide. Due to age-related physiological changes that affect the pharmacokinetics and pharmacodynamics of drugs, the elderly are predisposed to adverse drug reactions. Prescribing of potentially inappropriate medications (PIMs) has been found to be prevalent among the elderly and PIM use has been associated with hospitalisations and mortality. This study aims to identify the prevalence and nature of pre-admission inappropriate prescribing by using the STOPP (screening tool of older people's prescriptions) criteria amongst a sample of hospitalised elderly inpatients in South Australia. Medical, surgical and rehabilitation wards of a public teaching hospital in Adelaide, South Australia. Pre-admission prevalence of PIM. Medication management plans of 100 patients of ≥65 years old were prospectively studied to determine the prevalence of pre-admission PIM use. Sixty-five criteria of STOPP were applied to identify PIMs. The total number of pre-admission medications screened during the study period was 949; the median number of medicines per patient was nine (range 2-28). Overall the STOPP criteria identified 138 PIMs in 60 % of patients. The most frequently encountered PIM was opiates prescribed in patients with recurrent falls (12.3 %), followed by benzodiazepines in fallers (10.1 %) and proton pump inhibitors when prescribed for peptic ulcer disease for long-term at maximum doses (9.4 %). The number of medications were found to have a positive correlation with pre-admission PIM use (r(s) = 0.49, P < 0.01). Pre-admission PIM use is highly prevalent among the studied population. Strategies to reduce PIM use should be undertaken by physicians and pharmacists. The use of the STOPP criteria in clinical practice to reduce prescriptions of inappropriate medications requires further investigation.