Benzodiazepine and Z-drug Prescribing for Elderly People in a General Hospital: A Complete Audit Cycle

2012 ◽  
Vol 29 (2) ◽  
pp. 128-131
Author(s):  
Catherine Dolan ◽  
Sami Omer ◽  
Deirdre Glynn ◽  
Michelle Corcoran ◽  
Geraldine McCarthy
Keyword(s):  
General Hospital ◽  
Adult Population ◽  
Hospital Setting ◽  
Adverse Outcomes ◽  
Drug Prescribing ◽  
Consensus Guidelines ◽  
Number Of Patients ◽  
Increased Risk ◽  
Prescribing Practice ◽  
Audit Cycle

AbstractBackground: Use of benzodiazepines and Z-drugs in the elderly is associated with adverse outcomes such as increased risk of falls and fractures and cognitive impairment. We aimed to assess the prescribing practice of benzodiazepine and Z-drugs in those aged over 65 years in a general hospital against evidence based standards and to examine the effects of multidisciplinary feedback, as well as determine the prevalence of usage.Methods: All case-notes and medication charts of patients over the age of sixty five on surgical and medical wards in Sligo General Hospital (SGH) were retrieved and analysed over a two-day period in 2008. Data was collected in relation to benzodiazepine and Z-drug prescribing. We followed up on this initial data collection by screening discharge summaries at six weeks to assess benzodiazepine and Z-drug prescribing on discharge. Audit results were disseminated together with consensus guidelines on the prescribing of these medications in older adult population to all general practitioners in County Sligo. Educational sessions were held for both doctors and nurses in SGH. The audit cycle was completed by a re-audit of benzodiazepine and Z-drug prescribing six months from original study using identical methods.Results: We found a high prevalence of benzodiazepine and Z-drug use in original audit, 54% (38/70) of the group audited. The prevalence fell to 46% (32/70) at the re-audit post intervention. This result was not statistically significant. The percentage of patients commenced on benzodiazepine and Z-drugs prior to admission fell from 36% (25/70) at the initial audit to 23% (16/70) at the re-audit.Conclusion: Prescribing practices were not in keeping with consensus guidelines as highlighted by this relatively basic audit cycle. Multidisciplinary feedback and letters to GPs resulted in some reduction in the number of patients prescribed benzodiazepines and Z-drugs. Ongoing educational strategies aimed at relevant health care workers with regular audit of medication use within the general hospital setting is pertinent to further improve prescribing practice.

Exploring the Association between Multimorbidity and Cognitive Impairment in Older Adults Living in the Community: A Review of the Literature

2021 ◽  
pp. 108482232110304
Author(s):  
Grace F. Wittenberg ◽  
Michelle A. McKay ◽  
Melissa O’Connor
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Assessment Tool ◽  
Adult Population ◽  
Home Health ◽  
Adverse Outcomes ◽  
Community Dwelling ◽  
Cognitive Screening ◽  
Review Of The Literature ◽  
Increased Risk

Two-thirds of older adults have multimorbidity (MM), or co-occurrence of two or more medical conditions. Mild cognitive impairment (CI) is found in almost 20% of older adults and can lead to further cognitive decline and increased mortality. Older adults with MM are the primary users of home health care services and are at high risk for CI development; however, there is no validated cognitive screening tool used to assess the level of CI in home health users. Given the prevalence of MM and CI in the home health setting, we conducted a review of the literature to understand this association. Due to the absence of literature on CI in home health users, the review focused on the association of MM and CI in community-dwelling older adults. Search terms included home health, older adults, cognitive impairment, and multimorbidity and were applied to the databases PubMed, CINAHL, and PsychInfo leading to eight studies eligible for review. Results show CI is associated with MM in older adults of increasing age, among minorities, and in older adults with lower levels of education. Heart disease was the most prevalent disease associated with increased CI. Sleep disorders, hypertension, arthritis, and hyperlipidemia were also significantly associated with increased CI. The presence of MM and CI was associated with increased risk for death among older adults. Further research and attention are needed regarding the use and development of a validated cognitive assessment tool for home health users to decrease adverse outcomes in the older adult population.

scholarly journals Coronary Stenting in Diabetic Patients: Evaluation of Immediate Procedural Success & Adverse Outcomes

1970 ◽  
Vol 6 (1) ◽  
pp. 3-8
Author(s):  
Md Harisul Hoque ◽  
Sufia Rahman ◽  
Md Abu Siddique ◽  
Syed Ali Ahsan ◽  
CM Ahmed ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Clinical Success ◽  
Adverse Outcomes ◽  
Diabetic Group ◽  
Coronary Stenting ◽  
P Value ◽  
Diabetic Patients ◽  
Number Of Patients ◽  
Increased Risk ◽  
Procedural Success

Diabetes mellitus (DM) itself increases the risk of Coronary Artery Disease (CAD) by 2-4 fold and in out country we are treating a good number of patients having CAD with DM. On the other hand several studies have reported increased risk of adverse outcomes following balloon angioplasty in diabetic cases. In this situation this study had been carried out at National Institute of Cardiovascular Diseases (NICVD) cath lab to determine the immediate procedural success & in-hospital adverse outcomes in this population. In our study 100 cases were enrolled. Out of which, 40 patients had type II DM & rest were non-diabetic.Diabetic patients were compared with non- diabetic and found no major difference between the two patient group except for a higher number of LCX (Left Circumflex) lesion in the non-diabetic (25% VS 35%, P value 0.038). The lone case of renal complication came from the diabetic group. No MACE (Major Adverse Cardiovascular or Cerebrovascular Events) or death was occur in this series. Angiographic, procedural and clinical success in diabetic was 97.5%, 97.5% & 95% respectively whereas 100% found in non-diabetic group at its all segment. But this results are statistically insignificant and P value is 0.4000 for angiographic success, 0.4000 for procedural success and 0.158 for clinical success. P value for hospital stays is also insignificant i.e. 0.250 (while p value of < 0.05 was considered significant). Therefore in the setting of diabetes mellitus the outcomes of the stenting procedure are quite encouraging. Key words: Coronary Stenting; Diabetic; Outcomes DOI: 10.3329/uhj.v6i1.7181University Heart Journal Vol.6(1) 2010 pp.3-8

The Role of the Mental Health Counselor in the Psychiatric Liaison Service of the General Hospital

1974 ◽  
Vol 5 (1) ◽  
pp. 1-16 ◽  
Author(s):  
Bernard R. Shochet
Keyword(s):  
Mental Health ◽  
General Hospital ◽  
Case Reports ◽  
Hospital Setting ◽  
Acute Illness ◽  
Supportive Psychotherapy ◽  
Psychosocial Services ◽  
Mental Health Counselor ◽  
Number Of Patients ◽  
Health Counselor

A substantial number of patients admitted to the medical and surgical services of the general hospital experience significant and obvious psychological difficulties associated with their acute illness. This is more likely to be recognized overtly on a medical than on a surgical service; on both, a significant number of patients need psychological services during their acute illness and convalescence. The mental health counselor serves an important function on the medical and surgical units: screening new admissions and identifying those patients in need of psychosocial services, providing supportive psychotherapy to selected patients and consulting with the nursing staff and house staff concerning day to day management. By participating in walking rounds with the medical staff, the counselor is also able to facilitate the request and use of formal psychiatric consultative services. As demonstrated through statistics and case reports, the mental health counselor, trained to operate in the general hospital setting, makes a valuable contribution in the care of medical and surgical patients in the general hospital.

scholarly journals Risk for Falls in Patients with Limb Amputations in the Clinical Institute for Rehabilitation and Orthopedic Aids of the University Hospital Centre Zagreb

2021 ◽  
Vol 5 (1) ◽  
pp. 67-73
Author(s):  
Danijela Golub ◽  
Slađana Režić
Keyword(s):  
Hospital Setting ◽  
Clinical Problem ◽  
Primary Diagnosis ◽  
University Hospital ◽  
Patient Falls ◽  
Number Of Patients ◽  
Increased Risk ◽  
Risk Of Falls ◽  
The Cost ◽  
The University

Introduction. Patient falls are a significant clinical problem, as the fall can result in disability and, in some cases, death. The fall affects the patients’ quality of life, prolongs hospitalization, and increases the cost of treatment. Falls are the result of interaction between various factors. In the hospital setting, falls are considered adverse events. Aim. To determine the number of patients’ falls at the Clinical Institute for Rehabilitation and Orthopedic Aids of the University Hospital Centre Zagreb (UHC Zagreb) between September 1, 2019, and February 29, 2020. Methods. The data was extracted after the event from the Hospital Information System (Nursing records) and then processed. The study included 212 patients with limb amputations (both sexes) who were hospitalized in the Clinical Institute for Rehabilitation and Orthopedic Aids. Results. The results showed that patients with limb amputations have a risk for falls when doing rehabilitation for their primary diagnosis. Of the 212 patients admitted, 209 were at risk of falling according to the Morse Falls Scale, but of the total number of patients, only 2 fell. Conclusion. Patients with limb amputations have a higher risk of falls. The retrospective study shows that despite the increased risk of falls, the actual number of falls is very small. This shows that the medical staff are doing excellent work.

The development of pathways for responding to patient complexity in a liaison psychiatry setting

2020 ◽  
pp. 103985622093764
Author(s):  
Lindsay Jane Carpenter ◽  
Alison Bautovich ◽  
Swapnil Sharma ◽  
Mike Gatsi ◽  
Anne Pamela Frances Wand
Keyword(s):  
General Hospital ◽  
Screening Method ◽  
Adverse Outcomes ◽  
Face Validity ◽  
Liaison Psychiatry ◽  
Increased Risk ◽  
The Face ◽  
Consultation Liaison Psychiatry ◽  
Patient Complexity ◽  
Hospital Inpatients

Objectives: The aims were to develop and operationalise a method of identifying patients at increased risk of adverse outcomes due to clinical and systems complexity within consultation-liaison psychiatry (CLP), and to formalise escalation processes for enhanced input with targeted clinical and organisational support. Methods: The literature pertaining to methods for identifying and responding to complexity in general hospital settings was reviewed. An Escalation Tool operationalising the identification of complexity and response pathways was devised and tested. Feedback on the face validity and utility guided refinement. Results: Two established tools that assess complexity, INTERMED and the Patient-Centred Accreditation method (PCAM) and a novel ‘episode complexity’ screening method, were identified and informed the development of a tool for identifying and responding to complexity, which was then piloted. The tool was deemed useful, notwithstanding variability in scoring. Conclusions: The Escalation Tool combined elements of existing measures to identify complexity in general hospital inpatients and guide pathways for action. It was well received and considered feasible for implementation, with local adaptation according to available resources.

Postoperative Fluid and Electrolyte Balance: Alarming Audit Results

2009 ◽  
Vol 19 (9) ◽  
pp. 291-294 ◽  
Author(s):  
Rebecca Johnson ◽  
Simon Monkhouse
Keyword(s):  
General Hospital ◽  
Hospital Setting ◽  
District General Hospital ◽  
Electrolyte Balance ◽  
Consensus Guidelines ◽  
Fluid Losses ◽  
Fluid And Electrolyte Management ◽  
Poor Management

Perioperative fluid and electrolyte management requires an understanding of physiology and fluid losses. Consequences of poor management in postoperative patients can be fatal. This audit assesses the latest consensus guidelines and applies them to a district general hospital setting. Results are concerning and demonstrate a global lack of application of knowledge and understanding. Recommendations are suggested in order to control this potentially devastating situation.

The Lithium Toxic Patient in the Medical Hospital: Diagnostic and Management Dilemmas

1993 ◽  
Vol 23 (1) ◽  
pp. 55-62 ◽  
Author(s):  
Dilip Ramchandani ◽  
Barbara A. Schindler
Keyword(s):  
Risk Factors ◽  
General Hospital ◽  
Clinical Picture ◽  
Hospital Setting ◽  
Signs And Symptoms ◽  
Lithium Toxicity ◽  
Psychiatric Consultation ◽  
Diagnostic Skills ◽  
Increased Risk ◽  
Toxic Reactions

Objective: Patients with lithium toxicity can pose difficulties in diagnosis and management in the general hospital setting. The authors examined patients who were referred to the Psychiatric Consultation-Liaison Service with suspicion of lithium overdose to delineate and characterize medical and psychiatric risk factors for toxicity and to follow the course and resolution of their toxicity. Method: The authors reviewed the charts of patients with lithium levels >1.5 mEq/L who were admitted consecutively to a general hospital over an 18-month period. Results: Of twelve patients, eight were found to have developed lithium toxicity due to incidental and iatrogenic factors. These patients presented with a variety of confusing signs and symptoms. Hypothyroidism and coexisting organic illness contributed to the lack of clarity in their clinical picture. Conclusion: The widening scope of indication for lithium therapy leads to increased risk of toxic reactions which challenge the diagnostic skills of the consulting psychiatrist in a general hospital setting.

scholarly journals How COVID-19 Pandemic Affected the Treatment and Rehabilitation of Distal Radius Fracture? Data from a Peripheral General Hospital in Crete

2021 ◽  
Vol 6 (09) ◽  
pp. 541-544
Author(s):  
Pantouvaki Anna ◽  
Kastanis Grigorios
Keyword(s):  
General Hospital ◽  
Distal Radius Fracture ◽  
Distal Radius ◽  
Treatment Plan ◽  
Adult Population ◽  
Rehabilitation Program ◽  
Radius Fracture ◽  
Rehabilitation Treatment ◽  
Number Of Patients ◽  
The Mean

Objectives: The purpose of this study is to evaluate the frequency of unstable distal radius fractures in adult population and the management performed in orthopaedic and physiotherapy department of the General Hospital” Venizeleio” in Heraklion-Crete re-organised due to pandemic period. In pandemic period, due to urgent needs of covid-19 patients, a lot of orthopaedic associations suggested some restrictions concerning the treatment of DRF. The aim of this study is to answer in two hypothetical questions. First, did patients with unstable DRF receive a conservative instead of surgical treatment and second is the protocol of rehabilitation program still the same or do the patients receive a modified rehabilitation program? Methods: Patients admitted in the emergency department of the hospital during pandemic period of 2020 with distal radius fracture surgically treated, were evaluated and data compared with those of pre-pandemic period. (2018-2019). Results: A number of 32, 35 and 42 patients with DRF were treated and hospitalized in 2018, 2019 (pre-pandemic period) and 2020 (pandemic period) respectively. The mean age of patients did not appear with any statistical difference. (p= .93) between periods and causes of DRF did not change dramatically. Additionally, there was a remarkable variation in number of patients between the 1st and 2nd semesters of quarantine period. (p=.68). Conclusion: Adaptations in management of distal radius fracture during lockdown did not affect patient’s surgical and rehabilitation treatment and functional outcomes. The mean age of patients treated, did not vary during pandemic period while the causes of DRF. But it was obligatory to adopt the rehabilitation treatment plan and the number of hospital visits due to Covid-19 precautions.

Comparative analysis of polymorphic variants of IL-17A and MMP-1 genes with the risk of developing chronic periodontitis in petrochemical workers

2020 ◽  
Vol 60 (10) ◽  
pp. 687-693
Author(s):  
Iskander I. Zaidullin ◽  
Denis O. Karimov ◽  
Lilija K. Karimova ◽  
Milyausha F. Kabirova ◽  
Rasima R. Galimova ◽  
...  
Keyword(s):  
Ethylene Oxide ◽  
Chronic Periodontitis ◽  
Periodontal Diseases ◽  
Clinical Manifestations ◽  
Control Group ◽  
Periodontal Tissues ◽  
Dental Examination ◽  
Number Of Patients ◽  
Increased Risk ◽  
Harmful Substances

The susceptibility to the development and progression of inflammatory periodontal diseases, which depends on genetic and external factors (smoking, stress, oral hygiene), varies widely. In the development of these diseases, an important role is played not only by the presence of periodontal pathogenic microorganisms, but also by the presence of congenital or acquired immunodeficiency, immunoregulatory defects. The immune system plays a key role in the physiological and pathological processes of periodontal tissues. In this regard, IL17, produced by CD4+ Th cells, which has both Pro-inflammatory and protective activity, is of particular interest in the pathogenesis of periodontitis. The aim of study was to identify the relationship between polymorphic loci of the IL-17A (rs2275913) and MMP-1 (rs1799750) genes and clinical manifestations of chronic periodontitis in petrochemical workers. Dental examination was performed in 92 ethylene oxide production workers with chronic periodontitis and 74 patients with chronic periodontitis who did not come into contact with chemical factors (control group). Genotyping of polymorphisms rs2275913 of the IL17A gene and rs1799750 of the MMP1 gene was performed by allele-specific real-time polymerase chain reaction (PCR). Hygienic assessment of the degree of air pollution of the working area with harmful substances was carried out by gas chromatography according to the guidelines for the determination of harmful substances in the air № 5098-89, № 3119-84. When comparing the results of studies of both groups, there were no statistically significant differences in the frequency distributions of allelic variants and genotypes of the IL-17A and MMP-1 genes. The AA/AG genotypes of the IL-17A gene were associated with an increased risk of severe disease compared to the GG genotype in workers in the main group (OR=6.1; 95% CI 1.33-28.5; p=0.021) and in the control group (OR=7.26; 95% CI 1.34-39.25; p=0.016). Carriers of the A allele in the control group increased the risk of severe chronic periodontitis by 2.4 times compared to carriers of the G allele (OR=2.41; 95% CI 1.19-4.87; p=0.014). During the dental examination of employees of the ethylene oxide plant, the clinical course of periodontal diseases was more severe in comparison with the control group, and the number of patients with severe periodontitis was twice as high. It was found that the AA/AG genotypes of the IL-17A gene and the carrier of the A allele are associated with increased susceptibility to the development of severe chronic periodontitis. The association between the MMP-1 gene polymorphism and the risk of severe forms of chronic periodontitis has not been established. A risk factor for the development of inflammatory periodontal diseases in employees of the petrochemical complex is a complex of harmful production factors.

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