Neurology Ward Research Articles

The effects of neurologic assessment E-learning in nurses

BackgroundA firm understanding of the preliminary assessment of a patient with neurological disorders is needed for ensuring optimal patient outcomes. ObjectivesThe purpose of this study is to evaluate the effects of using e-learning on neurologic assessment knowledge, ability, and self-confidence among nurses. DesignThis study used a non-equivalent control group pretest-posttest design. SettingsNurses working in the neurology and neurosurgery wards, Republic of Korea ParticipantsA convenience sample of 50 nurses was assigned to either the experimental group (n=24) or the control group (n=26). MethodsThe experimental group participated in the self-directed e-learning program related to neurologic assessment, and control group underwent self-directed learning with handout. Knowledge, ability, and self-confidence were measured at pretest and posttest. ResultsThere were no significant differences in knowledge (U=270, p=0.399) and self-confidence (U=241.5, p=0.171) between the two groups. Nurses in the experimental group showed higher neurologic assessment ability compared with those in the control group (U=199, p=0.028). ConclusionsSelf-directed neurologic assessment e-learning induced improvement in the neurologic assessment ability among nurses. Self-directed e-learning can be applied for improving competencies in neurologic assessment.

DRUG UTILISATION STUDY OF STROKE AND OTHER PATIENTS ADMITTED TO GENERAL WARD OF NEUROLOGY UNIT AT QUATERNARY CARE PRIVATE HOSPITAL

Objective: To study the profile of the patient, the pattern of their illness and their drug use patterns attending to general ward of quaternary care hospital.Methods: Prospective observational study of 2 mo was performed at neurology unit of the quaternary care private hospital, India. Patients aged above 20 y with at least one neurological drug in prescription were included to observe their demographic profile, illness pattern and drug use. The data was analysed and summarised as frequency and percentage using microsoft excel and presented as tables.Results: Among 60 patient that were enrolled, more were males (N=33, 55%) than females (N=27, 45%) and within the age group of 60-70 y (N=22, 36.67%). The majority of patients were diagnosed with strokes (N= 48, 80%) where the cerebrovascular accident was most common (N=16, 26.66%). Males (N=29, 60.4%) were more prone to get stroke than females (N=19,39.6%). An average number of drugs per prescription was 5.7, the percentage of antibiotics, generic drugs and injections were 36.6%, 0.05% and 44.14% respectively. A total of 28 different drug classes with 61 different drugs was utilised. Fourteen drug classes had been accounted for 90% of drugs utilisation. Clopidegrol+Aspirin have frequently used the drug.Conclusion: Most people attending neurology unit were elderly. Stroke occupies 1st list for the burden. Average drugs for neurology visit remain high. Wide types of drug classes are utilised in neurological wards

Signalling a deeper understanding.

On placement on a neurological rehabilitation ward, I helped care for a patient receiving rehabilitation following a stroke.

Effectiveness of an Educational Program on Nurses’ Knowledge Concerning the Infection Control Guideline in Baghdad Teaching Hospital


 
 
 
 
 Objectives: the study aims to findout the effectiveness of educational program concerning infection control guideline on nurses, and to find out the relationship between effectiveness of program and types of hospital unit, age, level of education, and years of experience of nurses. Methodology: A quasi-experimental design study was carried out in Baghdad teaching hospital in the wards, for the period of December, 20th 2013 to September, 30th of July 2014, The study samples is composed of (60) nurses who have been actually working in the medical ward, blood disease, psychiatric ward, and neurological wards in Baghdad Teaching Hospital, those nurses are divided equally into the study and the control groups. The researcher constructed the educational program and instruments in order to reach the aims of this study, the program deals with (10) main domains related to infection control, and each domains consist of many items to assess the nurses knowledge, and the questionnaires consist of two parts; first is concerned with the demographic data for nurses; and the second part is concerned with the assessment of the nurses' knowledge about infection control methods. The data have been analyzed through the application of: descriptive frequency, percentages; mean of scores; and the inferential analysis that include: Analysis of variance, and the researcher used the SPSS version 20 to analysis of data. . Results: Most of the nurses 63.3% was females at age (20-29), in relation to marital status most of the samples was married, and graduated from nursing institute as educational level, (53.3%) of nurses have (1-9) years of experience and majority of nurses included with training course in Iraq but not related to infection control program , and the findings of present study revealed that there were statistical differences about the infection control knowledge of nurses between pre and post program and between the post study and post control group also there are statistical differences between level of education of nurses and infection control knowledge at P ≥0.05. Recommendation: The study recommends to application the world health organization (WHO) program of infection control program at all health centers and continuous medical educational program for all staff in the health center, and continuous follow up to applying the program to prevent spread of infection
 
 
 
 
 
 
 
 

Assessment of the Quality of Life in Patients Recovering after a Cerebral Stroke

Introduction. Quality of life (QOL) has been defined as a person’s perception of their social, cultural and self-worth position in the society and its effect on the person’s goals, expectations and apprehensions in life. It is a wide-ranging concept including physical health, mental state, level of independence and social relationships.Aim. The aim of the study was to asses the quality of life of patients after a cerebral stroke.Material and Methods. The study was carried out in a group of 106 patients after a cerebral stroke and hospitalized in the neurological ward. The age of the patients was ranged 32–90 years (mean age 59.12±13.04). Females constituted 56.00% of the studied group. The majority of patients were married (57.55%). The study material was obtained with the use of WHOQOL-Bref scale and Barthel scale.Results. The patients’ assessment of their general quality of life was at a mean level of 3.18±0.943 and their assessment of the state of health was 2.96±0.94. Distribution of the mean values in specific domains of life was as follows: social (55.00±21.61), environmental (54.23±16.67), somatic (53.89±18.17), psychological (46.53±17.23). Evaluation of the patients with Barthel scale classified the majority of them into Category II (51.90%), while Category I included 41.50% of patients; only 6.60% were in the worst state and qualified for Category III.Conclusions. Self-assessment of the patients recovering from a cerebral stroke was at a reduced level. The patients’ functional agility significantly affected their assessment of the quality of life. The type of stroke, education and place of living had a considerable effect on self-assessment of the quality of life in the patients recovering from a cerebral stroke. (JNNN 2017;6(4):163–169)

Factors Determining Night Rest and the Quality of Nursing Care for a Patient in a Neurological Ward

Introduction. The duration of hospitalization in a neurological ward depends on the medical diagnosis and the patient’s state of health. Because of the variety of symptoms from the nervous system, nurse practitioners provide 24 hours care for their patients, fulfilling their professional duties. The family is also included in the care of the patient during the day. At night, the patient is mainly under the care of a nurse, which on the one hand, is a period of sleep and rest, and on the other hand, the risk of health deficiencies is increased.Aim. The purpose of this paper is to present the patient’s opinion about the factors determining night rest in the ward and the quality of nursing care provided at night.Material and Methods. A diagnostic survey was the research method, and the survey was the technique applied. The tools applied consisted of: Author Survey Questionnaire and Care Satisfaction Scale (Newcastle). The study was performed in a group of 98 patients of the clinical neurological Clinic in Rzeszów. The study covered the factors negatively affecting the patient’s night time rest in hospital and the nurse’s assessment of nursing and therapeutic tasks performed during the night. Patients with the score exceeding 6 in the Hodgkinson test 6 were included in the study.Results. The factors hindering/disrupting the night rest were listed by the patients in the following order: snoring of other patients, pain, uncomfortable bed, morning temperature measurements, medical acts and others. The least disturbing factor was the staff’s talks. In assessing the quality of nursing care provided during the night, the highest scores were obtained by the following activities performed by nurses: satisfying needs to create a sense of security, providing medical care at scheduled time and satisfying the need for sleep and rest at night or the opportunity to talk to a nurse.Conclusions. 1) The discomfort caused by factors affecting the night rest in the assessment of the patient is on the average level. 2) Overall assessment of nursing care by patients in both aspects the “experience” of nursing care and “satisfaction” was high. (JNNN 2017;6(4):143–149)

Impact de la formation théorique et clinique sur les attitudes de stigmatisation des étudiants en médecine envers la psychiatrie et la pathologie psychiatrique

ObjectiveThe aim of the study was to explore whether a medical student education program and clinical posting in psychiatry had an impact on medical students’ stigmatizing attitudes towards psychiatry and psychiatric disorders. MethodsMedical students from the University of Bordeaux were recruited during their 4-year course at the beginning of the academic education program in psychiatry. Medical students who were concomitantly in a clinical posting in wards of psychiatry or neurology were invited to participate in the study. The medical student version of the scale Mental Illness: Clinicians’ Attitudes (MICA) was used to measure their attitudes towards psychiatry and persons with psychiatric disorder. This 16-item scale is designed to measure attitudes of health care professionals towards people with mental illness, a higher score indicating more stigmatizing attitudes. Items exploring history of psychiatric disorders in close persons were added at the end of the MICA scale. The questionnaire was completed twice by each student, at the beginning and the end of the 11-week clinical posting. All questionnaires were strictly anonymized. Multivariate linear regression analyses were used to identify the variables independently associated with MICA total score. ResultsAt the beginning of the education program and clinical posting, 174 students completed the MICA scale: the mean MICA total score was equal to 46.4 (SD 6.9) in students in clinical posting in psychiatry (n=72) and 45.1 (SD 7.01) in those in neurology (n=102). At the end of the academic and clinical training, 138 students again completed the questionnaire, with mean MICA total scores equal to 41.4 (SD 8.1) in students in clinical posting in psychiatry (n=51) and 43.5 (SD 7.3) in those in neurology (n=87). Multivariate analyses showed that lower total MICA scores were independently associated with the time of assessment (lower scores at the end of education program and clinical posting) (b=−2.8; P=0.001), female gender (b=−1.8; P=0.03) and history of a psychiatric disorder in a close person (b=−1.92; P=0.02). Type of clinical posting (psychiatry vs. neurology) was not independently associated with MICA total scores (b=−0.02; P=0.98). A significant interaction was found between the variables “time of assessment” and “type of clinical posting” (P=0.05): stratified analyses showed that MICA total scores decreased significantly only when the clinical posting was in psychiatry (b=−4.66; P=0.001), with no significant change in medical students in neurology wards (b=−1.45; P=0.16). ConclusionStigmatizing attitudes of medical students towards psychiatry and psychiatric disorders are reduced by an education program in psychiatry, with a positive impact more marked when the education program is concomitant to a clinical posting in psychiatry. As future health professionals in charge of persons with psychiatric disorders, medical students are key targets of actions aimed at reducing stigma towards mental health disorders. It is hence of great importance to promote clinical training in psychiatric wards during medical studies for all future practitioners, irrespective of their future specialty.

Managing Patient Admissions in a Neurology Ward

We study patient admission policies in a neurology ward where there are multiple types of patients with different medical characteristics. Patients receive specialized care inside the neurology ward and delays in admission to the ward will have negative impact on their health status. The level of this impact varies among patient types and depends on the severity of patients. Patients are also different in terms of arrival rate and length of stay at the ward. The patients normally wait in the emergency department until a ward bed is assigned to them. We formulate this problem as an infinite-horizon average cost dynamic program and propose an efficient approximation scheme to solve large-scale problem instances. The computational results from applying our model to a neurology ward show that dynamic policies generated by our approach can reduce the overall deterioration in patients’ health status compared to several alternative policies. The online appendix is available at https://doi.org/10.1287/opre.2016.1574 .

A Case of Isolated Central Nervous System Vasculitis in an Elderly Patient

A 83 year old Italian woman, with unremarkable family history, was admitted in 2013 to a Neurology Ward for lumbar pain and progressive motor impairment of right lower limb.

Nutritional Status of Hospitalized Stroke Patients: Assessment by Body Mass Index and Subjective Global Assessment Method

Background: Stroke is a disease with a high mortality rate and common cause of disability. Nutritional factors are strongly associated with this disease. Malnutrition in hospitalized patients increases the incidence of complications, prolonged the length of stay and also the cost of hospitalization. Furthermore, nutritional status of stroke patients can deteriorate during hospitalization. The prevalence of malnutrition in hospitalized stroke patients is about 6% to 62%. The objective of this study was to identify the nutritional status of hospitalized stroke patient. Methods: This was a descriptive cross-sectional study. Population of the study was hospitalized stroke patients at Neurology Ward, Kemuning Building Dr. Hasan Sadikin General Hospital Bandung, Indonesia from August until October 2014 who meet the inclusion criteria. Nutritional status was measured objectively using Body Mass Index (BMI) and subjectively using Subjective Global Assessment (SGA) method. The collected data were processed using frequency tabulation and percentage. Results: Twenty six hospitalized stroke patients were included in this study. The hospitalized patients with normal BMI were about 12 people (46.15%), 8 people were overweight (30.77%), 4 people were undernourished (15.39%) and 2 people (7.69%) were obese. According to SGA measurement, approximately 18 people (69.22%) were moderately malnourished, and as much as 4 people (15.39%) were in good nutrition, whereas 4 people (15.39%) were severely malnourished. Conclusions: Majority of the hospitalized stroke patients has normal BMI and moderately malnourished based on SGA. DOI: 10.15850/amj.v4n2.1090

Service provision for stroke: The Greek paradox

Stroke remains a leading cause of mortality, as well as of subsequent serious long-term physical and mental morbidity. This places special demands for updated clinical excellence and optimum organization of stroke care services. Stroke units have been shown to improve patient outcomes. Thus, many western countries have developed and implemented sophisticated stroke facilities and corresponding public awareness strategies. These cannot be easily "translated" in Greece due to special features on the hospital administration system such as a unique rotation system for acute admissions and long-standing austerity. Yet, despite adverse conditions, clinicians within the Greek health care system have been exceeding themselves in their attempt to provide optimum care outcomes. An example of such efforts is the improvisation of stroke bays (SBs) as part of a medical or neurology ward, providing sophisticated treatments. New centralized policy decisions are now needed in order to improve stroke services nationwide. These should be tailored to the country's geography and health care mapping especially as there is already considerable technical knowhow and local efforts in place. A pragmatic solution would be to create a "grid" of services for stroke, by providing a comprehensive stroke centers in each of the two major cities and SBs at a prefectural level. Once these are established, more efforts should be taken to educate the public on stroke recognition and subsequently on facilities available.

Clinico-epidemiological study of childhood stroke in Children Welfare Teaching Hospital/Baghdad

Background: The annual incidence of stroke in children after the newborn period is approximately 2.3 per 100000. Half are ischemic, and half are non-traumaticintracerebral and subarchnoidal hemorrhages.Objectives: To study the etiologic factors, clinical presentation andoutcome of stroke among children admitted to children welfare teaching hospital/Baghdad.Patient and methods: A prospective study was carried out in Children Welfare Teaching Hospital;Children age ranged between 1 month -13 years and was admitted to pediatric neurology ward between 1st of November 2013 and 1st of November 2014. After carful clinical history, physical and neurological examinations, the diagnosis of brain stroke was confirmed in all patients by computerized tomography (CT) and/or magnetic resonance imaging (MRI). Patients included in this study were those diagnosed as having ischemic stroke, hemorrhagic stroke.Results: The total number of cases were 61, 36 were male (59%). The age at onset ranged from 1-156 months. Ischemic stroke constituted 39 patients (63.9%). The most common etiologic factors for the ischemic stroke were protein C deficiency (9, 23.1%). The most common etiologic factor for hemorrhage was bleeding disorders in about 50% of patients. The most common presenting features were hemiplegia, seizure, alteration of consciousness; Cranial nerves palsy is mostly present in the ischemic stroke (14,35.9%) and only in one patient (4.5%) of hemorrhagic stroke.Conclusions: Ischemic stroke is more common than hemorrhagic stroke in pediatric age group. The significant risk factors for ischemic stroke are protein C deficiency, Congenital heart disease(CHD) and positive family history, while vitamin K deficiency, prolong Partial thromboplastin time (PTT) and trauma are significant for hemorrhagic stroke. The most common clinical features of both types of stroke are hemiparesis, siezure and alteration of consciousness.

الاسباب والانماط السريرية للجلطة الدماغية عند الاطفال في مستشفى حماية الاطفال/ بغداد.

Background: The annual incidence of stroke in children after the newborn period is approximately 2.3 per 100000. Half are ischemic, and half are non-traumaticintracerebral and subarchnoidal hemorrhages.Objectives: To study the etiologic factors, clinical presentation andoutcome of stroke among children admitted to children welfare teaching hospital/Baghdad.Patient and methods: A prospective study was carried out in Children Welfare Teaching Hospital;Children age ranged between 1 month -13 years and was admitted to pediatric neurology ward between 1st of November 2013 and 1st of November 2014. After carful clinical history, physical and neurological examinations, the diagnosis of brain stroke was confirmed in all patients by computerized tomography (CT) and/or magnetic resonance imaging (MRI). Patients included in this study were those diagnosed as having ischemic stroke, hemorrhagic stroke.Results: The total number of cases were 61, 36 were male (59%). The age at onset ranged from 1-156 months. Ischemic stroke constituted 39 patients (63.9%). The most common etiologic factors for the ischemic stroke were protein C deficiency (9, 23.1%). The most common etiologic factor for hemorrhage was bleeding disorders in about 50% of patients. The most common presenting features were hemiplegia, seizure, alteration of consciousness; Cranial nerves palsy is mostly present in the ischemic stroke (14,35.9%) and only in one patient (4.5%) of hemorrhagic stroke.Conclusions: Ischemic stroke is more common than hemorrhagic stroke in pediatric age group. The significant risk factors for ischemic stroke are protein C deficiency, Congenital heart disease(CHD) and positive family history, while vitamin K deficiency, prolong Partial thromboplastin time (PTT) and trauma are significant for hemorrhagic stroke. The most common clinical features of both types of stroke are hemiparesis, siezure and alteration of consciousness.

The International Dysphagia Diet Standardisation Initiative (IDDSI) framework: the Kempen pilot

One of the most common treatments for dysphagia is the provision of texture-modified food and thickened liquids. To improve patient safety, a standardised terminology has been advocated. In 2015, the International Dysphagia Diet Standardisation Initiative (IDDSI) framework was released. The IDDSI framework describes texture-modified food and thickened liquids for individuals of all ages, in all care settings and in all cultures. To put the IDDSI framework into operation, a pilot site in Kempen, Germany volunteered to conduct a quality assurance process to document IDDSI implementation. The process commenced on the neurology ward, with findings to inform roll-out to other wards and eventually other hospitals. Through wide stakeholder involvement using simultaneous top-down and bottom-up approaches and agreed timelines, the Kempen Pilot achieved implementation at ward level. Practical training, incorporating the IDDSI framework into a range of communication channels and inter-professional collaboration were key to successful implementation.

The impact of screening psychiatric comorbidity and high-risk feedback on liaison psychiatric consultation rates and clinicians’ attitudes on a neurology ward

IntroductionLifetime prevalence of psychiatric comorbidity in neurological patients is as high as 55%, but it remains often undetected and therefore untreated in hospital settings. Further, clinicians tend to make little use of the consultative and liaison psychiatric team for detection and treatment of anxiety and mood disorders in neurological patients. The current study aimed to investigate whether the implementation of a stepped screening protocol with high risk feedback to the clinician had an influence on the use of consultative and liaison psychiatric services.MethodAll patients admitted to the neurological ward were assessed using a stepped screening protocol for depression, anxiety and substance use during 15 months. Positive screening resulted in feedback to the clinicians depending on the study phase (e.g. feedback vs. no feedback).ResultsNo differences were found in the use of consultative and liaison psychiatric services during the non-feedback and feedback phase.ConclusionScreening and high risk feedback of psychiatric comorbidity in neurological patients does not increase psychiatric referral rates. It points to the necessity of a more integrated collaborative care model for detection and treatment of psychiatric comorbidity.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Potential values and risks of biomarker use in differential diagnosis of neurocognitive disorders

IntroductionNeurocognitive disorders are the only psychiatric disorders which underlying pathogeny can potentially be determined. This has important implications, for it makes possible the use of biomarkers in order to gain better diagnosis, and opens a door to more accurate treatments. Nonetheless, as biomarkers are not exclusive of a single disorder, the lengths of its utility are still unknown.Objectives and aimsTo understand the values and limitations of biomarkers in differential diagnosis of dementias.MethodsWe present three cases followed in the Neurology ward of our hospital, in which they were admitted for diagnosis and treatment of a subacute form of dementia. Medical history, core symptoms, screening tests for cognitive impairment, MRI, EEG and biomarkers in cerebrospinal fluid were used for diagnosis.ResultsTwo cases had consistent clinical features and complementary explorations, and they were respectively diagnosed as Creutzfeldt-Jakob Disease and Lewy Body Dementia; however, the last case showed contradictory results between clinic and complementary explorations, particularly 14-3-3 protein, which was positive and led to the initial diagnosis as Creutzfeldt-Jakob Disease, which was proven wrong once necropsy was practiced.ConclusionsAlthough complementary explorations, and biomarkers in particular, are of invaluable utility in the accurate diagnosis of multiple psychiatric diseases, they must always be considered within a context given by biography and clinical features, because, when failing to do so, they can lead to misdiagnosis and delay of correct treatment.

Lipid profile and carotid artery intima-media thickness in diabetic and non-diabetic ischaemic stroke

Background: Stroke is one of the leading reasons for mortality throughout the world. Measurement of carotid intima media thickness (CIMT) is a reliable marker for the development of atherosclerosis and ischemic stroke (IS). The aim was to study and correlate lipid profile and CIMT in diabetic and non-diabetic IS patients.Methods: An observational study was done including 120 IS patients divided into two groups- diabetes (n=60, diabetic stroke patients) and non-diabetes (n=60, non-diabetic stroke patients) having age >18 years, admitted in Medicine and Neurology wards of G. R. Medical College, Gwalior, Madhya Pradesh, India between August 2015 to August 2016. Detailed history along with investigations such as fasting blood sugar (FBS), post prandial blood sugar (PPBS) and fasting lipid profile including triglycerides (TG), high density lipoprotein (HDL), low density lipoprotein (LDL), very low density lipoprotein (VLDL) and total cholesterol (TC) was done. The common and the internal carotid arteries of both sides were evaluated ultrasonographically using a high frequency linear probe. All the data were analysed using IBM SPSS- ver.20 software. Data was expressed as percentage. Analysis was performed using two-way ANOVA and independent sample student t test. Pearson correlation was used to establish the relation between the data. P values <0.05 was considered to be significant.Results: Most common age group among diabetes and non-diabetes IS patients were 51-60 years (26.66%) and 61-70 years (28.33%) respectively with male predominance (75% and 66.67% respectively). Most of the diabetic IS patients had FBS >200 mg/dl (41.66%) and PPBS >250 mg/dl, (50%). Out of 120 IS patients, 55 (45.83%) had CIMT ≤0.8 mm and 65 (54.16%) patients had CIMT >0.8 mm. Lipid parameters including TC (p=0.034), TG (p=0.022), HDL (p=0.039), VLDL (p=0.043) and LDL (p=0.017) were significantly different between groups (p<0.05). Mean CIMT in patients with diabetes and non-diabetes was 1.03±0.255 mm and 0.83±0.54 mm respectively (p=0.006). A significant positive correlation was recorded between CIMT and TC (r=0.36, p=0.006), TG (r=0.48, p=0.0001) and VLDL (r=0.46, p=0.0001) among diabetes stroke patients. Among non-diabetes stroke patients, TC (r=-0.25, p=0.042), TG (r=-0.44, p=0.0003), HDL (r=-0.33, p=0.016) and LDL (r=-0.58, p=<0.001) were negatively correlated and VLDL (r=0.92, p=<0.0001) was positively correlated with CIMT.Conclusions: Lipid parameters including TC, TG, LDL and VLDL were significantly raised in diabetic stroke patients and had a positive correlation with the risk of stroke. CIMT was significantly high in diabetic stroke patients. Correlation of lipid parameters (TC, TG and VLDL) with CIMT in diabetic stroke patients were significantly positively correlated, in non-diabetic ischemic stroke patients’ lipid parameters (TC, TG, HDL and LDL) were negatively correlated.

Comorbidity, Polytherapy, and Drug Interactions in a Neurological Context: An Example of a Multidisciplinary Approach to Promote the Rational Use of Drugs

Purpose: A high number of adverse drug reactions (ADRs), mainly caused by drug–drug interactions (DDIs), occur in neurological wards and few data are available about incidence and prevalence of DDIs in this context. This study investigated—(1) the prevalence of drug–drug and drug–disease interactions in patients admitted to a neurological unit in Italy, (2) the risk factors for DDIs, and (3) the diseases and the drug classes mostly involved in drug–drug and drug–disease interactions. Methods: For 2 months, we performed a retrospective, observational study in the neurological unit of St Bassiano Hospital, enrolling 79 patients who received a drug prescription at discharge. Results: About half of the patients were discharged with 5 or more prescribed drugs, and 72% of patients showed potential, clinically relevant DDIs. Linear correlations were observed between age and number of prescribed drugs (P < .01) and between age and number of interactions (P < .01). The number of prescribed drugs was associated with the number of detected DDIs (P < .01). The application of drug interaction alerts and the use of medication inappropriateness criteria (ie, Beers criteria) were not satisfactory in choosing the best therapy for each patient. Therefore, multidisciplinary discussions of each clinical case was required. Conclusion: The study demonstrated that the neurological patient, especially if elderly, has a high risk of DDI and ADRs and that many of these can be avoided by case discussion in multidisciplinary team meetings, in which the presence of a dedicated clinical pharmacist is crucial.

Assessment of Neurogeriatric Patients by Means of the NOSGER

Introduction. One of the fundamental objectives of care of elderly patients is the detection of risk factors that impair their abilities to continue their independent lives. Thus, preventive and therapeutic measures are of considerable significance as they could prevent an increase in disabilities and seniors’ dependence on others.Aim. The aim of the study was to assess patients in neurological wards by means of the Nurses’ Observation Scale for Geriatric Patients (NOSGER).Material and Methods. The study sample comprised 113 elderly patients treated in neurological wards in hospitals in Lublin. The research material was collected applying the NOSGER.Results. Having assessed the patients with the NOSGER, the results for the entire group averaged out at 54.43±18.96 points. The surveyed patients functioned best in the domain of disturbing behaviour (8.12±2.92 points). They were assessed slightly worse in terms of memory (8.38±4.39 points), activities of daily living (ADL) (8.55±3.56 points) and mood (8.80±3.21 points). The greatest deficits were reported in social behaviour (10.17±4.54 points) as well as instrumental activities of daily living (IADL) (10.42±4.61 points).Conclusions. The researched group of elderly inpatients treated at neurology wards was characterised by a relatively good level of performance. The elderly presented the greatest deficits in the domain of instrumental activities of daily living (IADL) as well as social behaviour. Their age and marital status significantly affected biopsychosocial activity of the surveyed group of patients. (JNNN 2017;6(1):20–25)

Pharmacist-led admission medication reconciliation before and after the implementation of an electronic medication management system

AimsTo investigate the impact of the introduction of an electronic medication management system on the proportion of patients with a recorded medication reconciliation on admission, the time from admission to when medication reconciliation was performed, and the characteristics of patients receiving this intervention pre-and post-implementation. MethodsAn electronic medication management system was implemented in an Australian hospital from May to July 2015. A retrospective observational study was conducted in three wards across two phases; pre- (August 2014) and post- (August 2015) implementation. The study sample included every second patient admitted to these wards. ResultsA total of 370 patients were included, 179 pre- and 191 post-implementation. The proportion of recorded admission medication reconciliation significantly increased post-implementation in all study wards; coronary care unit (40 vs 68%, p=0.004), gastroenterology ward (39 vs 59%, p=0.015), and the neurology ward (19 vs 45%, p=0.002). The proportion of patients with recorded medication reconciliation within 24h of weekday admissions, or 48–72h of weekend admissions, increased from 47% pre- to 84% post-implementation. Admission medication reconciliation was recorded within a median of 1.0day for weekday admissions pre- and post-implementation (IQR 1.1 vs 0.2, respectively), and 3.5days (IQR 2.0) pre-implementation vs 1.5days (IQR 2.0) post-implementation for weekend admissions. Overall, across both phases pre-and post-implementation, admission medication reconciliation was recorded for patients who were significantly older (median 77 and 71 years, p<0.001), had a higher number of preadmission medications (median 6.5 and 5.0 medicines, p=0.001), and had a longer hospital stay (median 6.5 and 5.1days, p=0.003). A significantly higher proportion of patients with recorded medication reconciliation in the pre-implementation phase experienced polypharmacy (61%, p=0.002), hyperpolypharmacy (15%, p=0.001), and used a high-risk medication (44%, p=0.007). ConclusionsImplementing an electronic medication management system facilitates the medication reconciliation process leading to more high risk patients receiving this service on admission to hospital and in a more timely manner. The impact of electronic medication reconciliation on patient safety and clinical outcomes remains unknown.