Challenges of Singapore’s First Acute Geriatric Isolation Facility During the COVID-19 Pandemic

Aim The COVID-19 pandemic has seen hospitals isolating suspect cases. Geriatric populations are at a risk of severe COVID-19 disease and often present with concomitant geriatric syndromes requiring holistic interdisciplinary care. However, isolation of older people poses challenges to care delivery. This study shares the experience of Singapore’s first acute geriatric isolation facility geriatric PARI (Pneumonia-Acute Respiratory Infection) ward and describes the geriatric-related outcomes and pitfalls in care delivery. Methods This is a retrospective cross-sectional study performed in 7 negative pressure isolation rooms in an acute care public hospital in Singapore. 100 patients admitted consecutively to the geriatric PARI ward were included. Patient demographics, presenting symptoms and geriatric-related adverse outcomes associated with hospitalisation were collected and analysed. Results Patients’ mean age was 86.4 years (standard deviation [SD]: 6.8) with significant comorbidities being hypertension (81%), hyperlipidaemia (74%) and renal disease (70%). 51% of patients had dementia and 24% had behaviour and psychological symptoms of dementia (BPSD). 27% of patients presented atypically with delirium and 15% presented with a fall. Delirium was associated with restraint use (OR: 3.88; p-value 0.01). Falls rate was 1.64 per 1000 occupied bed. 1 patient screened positive for COVID-19. Conclusions The geriatric PARI ward is essential for curbing nosocomial transmission of COVID-19. This is important in the older people with comorbidities who are more likely to develop morbidity and mortality. Our study reveals challenges in delivering person-centred care to the older patients in isolation rooms, especially in the management of delirium and falls prevention. Innovative strategies should be developed to minimise isolation-related adverse outcome.

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Frequency of Metabolic Abnormalities of Vesical Calculus in Children Younger than 10 Yrs of Age

10.53350/pjmhs211561243 ◽

2021 ◽

Vol 15 (6) ◽

pp. 1243-1245

Author(s):

H.U Rahman ◽

S. F. Shah ◽

A. J. Sheikh ◽

I. U. Memon ◽

W. S. Bhatti ◽

...

Keyword(s):

Cross Sectional Study ◽

P Value ◽

Metabolic Abnormalities ◽

Urine Ph ◽

College Hospital ◽

Cross Sectional ◽

Vesical Calculus ◽

Medical College ◽

Presenting Symptoms ◽

Calcium Magnesium

Aim: To assess the metabolic abnormalities in children younger than 10 years of age with vesical calculus. Study design: Retrospective cross-sectional study Place and duration of study: Department of Urology, Khairpur Medical College Hospital, Khairpur from 1st October 2014 to 30th September 2016. Methodology: Two hundred and six children age <10 years of age and either gender presented with vesical calculus were enrolled. Demographic information like age, gender, residence, serum electrolytes, calcium, magnesium, phosphate, uric acid, blood, and urine pH were recorded for the purpose of metabolic workup. Results: The mean age was 4.76±1.22 years and 157 (76.2%) were males and 49 (23.8%) were females. The frequency of metabolic abnormalities was observed in 153 (74.3%) of the patients. A significantly higher prevalence of metabolic abnormalities was observed with male gender (p-value 0.006), dark colored urine as presenting symptoms (p-value 0.022), frequent urination (p-value 0.045), and hematuria (p-value 0.016). Of 153 patients with metabolic abnormalities, hypercalciuria was observed in 45 (29.4%), hypocitraturia in 73 (47.7%), hyperoxaluria in 21 (13.7%), and hyperuricosuria in 14 (9.2%) patients. Conclusion: The frequency of metabolic abnormalities was high among children with vesical calculus. Moreover, hypocitraturia in these children was observed in majority followed by hypercalciuria, hyperoxaluria, and hyperuricosuria. Keywords: Metabolic abnormalities, Children, Vesical calculus

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Influence of Education Level of Older Patients on Polypharmacy, Potentially Inappropriate Medications Listed in Beer’s Criteria, and Unplanned Hospitalization: A Cross-Sectional Study in Lahore, Pakistan

Medicina ◽

10.3390/medicina54040057 ◽

2018 ◽

Vol 54 (4) ◽

pp. 57 ◽

Cited By ~ 5

Author(s):

Muhammad Sarwar ◽

Sadia Iftikhar ◽

Muhammad Sarfraz

Keyword(s):

Older People ◽

Older Patients ◽

Formal Education ◽

Cross Sectional Study ◽

Education Level ◽

P Value ◽

Potentially Inappropriate Medications ◽

Sectional Study ◽

Cross Sectional ◽

Inappropriate Medications

Objective: To evaluate influence of education level of older patients on polypharmacy, potentially inappropriate medications (PIMs) listed in Beer’s Criteria, and unplanned hospitalization. Methods: A cross-sectional study was conducted among older people aged ≥65 years between 1 December 2017 and 28 February 2018. For data analysis, descriptive statistics and logistic regression analysis were employed. Results: Among 385 older patients, 88.8% were prescribed PIMs and 56.4% underwent PIMs associated unplanned hospitalization. Older people were less exposed to polypharmacy or excessive polypharmacy as their education levels increased (no formal education vs. primary vs. secondary vs. tertiary, 74% vs. 69.8% vs. 60.5% vs. 58.1%). Patients having higher education were also accompanied by significantly lower prescription of PIMs (no formal education vs. primary vs. secondary vs. tertiary, 96% vs. 87.3% vs. 84.5% vs. 79.1%) as well as unplanned hospitalization (no formal education vs. primary vs. secondary vs. tertiary, 64.7% vs. 76.2% vs. 40.3% vs. 46.5%). Results of regression analysis revealed that no formal education (OR = 1.202, 95% CI = 1.032–2.146, p-value = 0.003) and primary education level (OR = 1.175, 95% CI = 1.014–1.538, p-value = 0.039) were significantly associated with the use of polypharmacy among older people. On the other hand, no formal education was significantly associated with the prescription of PIMs (OR = 1.898, 95% CI = 1.151–2.786, p-value = 0.007). Furthermore, older people with no formal education (OR = 1.402, 95% CI = 1.123–1.994, p-value = 0.010) and primary education level (OR = 1.775, 95% CI = 1.281–3.018, p-value = <0.001) were significantly more likely to undergo unplanned hospitalization. Conclusions: Patients having low literacy level are more likely to receive PIMs, polypharmacy, and undergo unplanned hospitalization in comparison to highly educated patients. Hence, promotion of health literacy for patients is crucial to overcome these problems.

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The Association Between Time in Range %, and Physical & Functional Indices Amongst Older People With Type 2 Diabetes: A Cross Sectional Study

Journal of the Endocrine Society ◽

10.1210/jendso/bvab048.976 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. A477-A478

Author(s):

Yamit Basson-Shleymovich ◽

Tali Cukierman-Yaffe ◽

Tal Yahalom-Peri ◽

Michal Azmon

Keyword(s):

Lower Extremity ◽

Older People ◽

Cross Sectional Study ◽

P Value ◽

Sectional Study ◽

Cross Sectional ◽

Lower Extremity Strength ◽

Increased Risk ◽

Time In Range

Abstract Diabetes is a major public health burden associated with high mortality, morbidity, hospitalization and health care services utilization rates. People with diabetes have an increased risk for mobility disability compared to those without diabetes, after controlling for age. People with diabetes also have a higher risk for falls and fractures. Data from the last several years suggests that this increased risk is not only due to diabetes co-morbidities but also due to an accelerated decline in physical capacity due to lower muscle quality and a more rapid decline in muscle mass (sarcopenia) and lower extremity strength over time. HBA1C is a measure of average glucose levels; however, it does not provide information about glycemic variability, or daily patterns of glycemia. In the last several years, several organizations have published consensus statements on the role of continuous glucose monitoring (CGM) in glucose control. The use of CGM has brought about the development of many glucose indices, amongst them is: Time In Range% (TIR) of 70–180 mg/dL (3.9–10 mmol/L). Less is known regarding the association between TIR and sarcopenia, muscle mass loss that leads to deterioration in mobility, disabilities and decline in physical indices in older people with diabetes. Aims: To assess among older people with diabetes type 2, the cross sectional association between: TIR and aerobic capacity, gait speed, strength, balance and frailty indices. Methods: A cross sectional study, conducted amongst people with diabetes over the age of 60. Participants were provided with a blinded CGM system- (I Pro2 carelink, Medtronic) for 1 week and underwent elaborate physical-functional assessment in the beginning and at the end of that week. The association between the % of time in range (Time in Range-TIR) and several physical indices was determined using linear regression. Results: This analysis pertains to 55 men and women who completed the evaluation. After adjustment for age and gender, we found that 1% increase in TIR was associated with a 0.341 higher score on the 30 second Sit to Stand score (a measure of lower extremity strength) (P-value=0.02), a 0.351 higher score on the BERG scale (a measure of balance) (P-value=0.01), a 0.271 lower score on the timed up and go score (a measure of fall risk and balance) (P-value=0.008), a 0.289 higher score on the 6-minute walk score (a measure of aerobic capacity and endurance) (P-value=0.02) and a 0.261 lower score on the 360 turn test (a measure of dynamic balance) (P-value=0.0004). The same was not observed for the relationship between HGA1C & physical indices.

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217 Investigating the Delivery of Falls Prevention Interventions to Older People Following Multi-Factorial Risk Assessment: A Cross-sectional Study

Age and Ageing ◽

10.1093/ageing/afz102.48 ◽

2019 ◽

Vol 48 (Supplement_3) ◽

pp. iii1-iii16

Author(s):

Rebecca Dennehy ◽

Patrick J Barry ◽

Kieran A O'Connor ◽

Finola Cronin ◽

Spencer Turvey ◽

...

Keyword(s):

Risk Assessment ◽

Older People ◽

Waiting Times ◽

Cross Sectional Study ◽

Service Planning ◽

Community Dwelling ◽

Falls Prevention ◽

Cross Sectional ◽

Falls Risk ◽

Prevention Interventions

Abstract Background Falls are one of the most common threats to older peoples’ independence. In Ireland, approximately one in three adults aged ≥65 years fall each year. Multifactorial interventions, which include an assessment of an individual's risk of falling followed by customised interventions or referral have been shown to reduce the rate of falls among community-dwelling older people. As part of an Integrated Falls Prevention Pathway initiated in 2016, six multidisciplinary risk assessment clinics were established in Cork city and county. The aim of this study is to examine whether recommended follow-on interventions were received following a falls risk assessment in the community. Methods Routinely collected administrative data for clients who attended a falls risk assessment clinic are being collated. Data include client demographics, onward referrals, waiting times and receipt of intervention. A process map of the patient pathway following a falls risk assessment is under development and will be refined based on the study findings. Results Preliminary analysis of a two-year implementation period (April 2016-2018) indicates that following assessment, clients received an average of 2.4 onward referrals. Most referrals were made to general practice (29%, n=315), community physiotherapy (25%, n=272), and community occupational therapy (15%, n=165). Other referrals were to public health nurses (n=104, 10%) and falls prevention classes (n=60, 6%). Further analysis will identify the percentage of individuals who receive interventions, the type of interventions received, the percentage of patients who do not attend and the waiting lists. Conclusion The Integrated Falls Prevention Service is the sole example of an operational integrated falls pathway in Ireland. This research will identify potential roadblocks for providers and clients along the pathway and will identify opportunities to. The results will also be used to inform service planning and resource allocation to ensure that this model of care is sustainable.

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Clinical validation of fall prevention behavior in a hospital environment

Revista Brasileira de Enfermagem ◽

10.1590/0034-7167-2017-0212 ◽

2018 ◽

Vol 71 (4) ◽

pp. 1841-1849 ◽

Cited By ~ 2

Author(s):

Jéssica Naiara de Medeiros Araújo ◽

Ana Paula Nunes de Lima Fernandes ◽

Amanda Barbosa da Silva ◽

Laísla Alves Moura ◽

Marcos Antonio Ferreira Júnior ◽

...

Keyword(s):

Fall Prevention ◽

Intraclass Correlation ◽

Cross Sectional Study ◽

Falls Prevention ◽

University Hospital ◽

Hospital Environment ◽

P Value ◽

Cross Sectional ◽

Prevention Behavior ◽

Study Population

ABSTRACT Objective: Clinically validate the Nursing Outcome Behavior of falls prevention in hospitalized patients. Method: This was a cross-sectional study developed at a public university hospital with a sample of 45 patients. The data collection was performed through the evaluation of four nurses, with a double used the instrument with the constitutive and operational definitions of the indicators and magnitudes of the Fall Prevention Behavior Result, while the other pair did not use such definitions. Results: When applying the non-parametric analysis of variance by the Friedman test, ten indicators showed statistical differences between the inferences made by the evaluators for each patient. In relation to the intraclass correlation coefficient, confidence interval and p value assigned to each indicator of the scale, most of the indicators were statistically significant. Conclusions: The instrument referring to the Fall Behavior Outcome Behavior was considered valid for the study population.

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HUBUNGAN PERILAKU CARING PERAWAT DENGAN KECEMASAN PASIEN PRA OPERASI DI RUANG BEDAH RSUD Dr. H. MOH. ANWAR SUMENEP

Jurnal Ilmu Kesehatan ◽

10.24929/jik.v2i1.390 ◽

2018 ◽

Vol 2 (1) ◽

pp. 17-22

Author(s):

Sugesti Aliftitah ◽

Emdat Suprayitno

Keyword(s):

Psychological Symptoms ◽

Sampling Technique ◽

Cross Sectional Study ◽

P Value ◽

Human Beings ◽

Patient Anxiety ◽

Cross Sectional ◽

Caring Behavior ◽

Nurse Caring ◽

Preoperative Patient

Nurse caring behavior as a moral commitment to protect, maintain and improve the dignity of patients as human beings. The problem of this study is the patient psychological symptoms of anxiety that arise when undergoing surgery, and many patients complain that the nurse is not good when providing services.This study purpose was to analyze the relation between nurse caring behavior with preoperative anxiety patient in bedah ward RSUD dr.H. Moh. Anwar Sumenep. The study design was Cross Sectional Study. The population all preoperative patients who treated in bedah ward as many as 13 nurses and preoperative patient. The sample sum a 13 nurses and 55 preoperative patients who had fill inclusion criteria by Quota Sampling technique. Independent variable is nurse caring behavior and preoperative patient anxiety as dependent variable. The results showed that most of the have good caring behavior as 7 nurses (53.8%) and most of the preoperative patients had low anxiety many as 34 patients (61.8%). The result of statistic test use Spearman rho befoud P value <α (0.002<0.05). The correlation strength r of 0.783 who has the direction that the strength of the relationship study between vareabel is sturdy. Conclusion in this study be found significant relationship between nurse caring behavior with anxiety preoperative patients in bedah ward RSUD dr. H. Moh. Anwar Sumenep 2017.

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THE VALIDITY OF THE SUNFRAIL TOOL: A CROSS-SECTIONAL STUDY AMONG DUTCH COMMUNITY-DWELLING OLDER PEOPLE

Journal of Frailty & Aging ◽

10.14283/jfa.2020.4 ◽

2020 ◽

pp. 1-7

Author(s):

R.J.J. Gobbens ◽

M. Maggio ◽

Y. Longobucco

Keyword(s):

Health Care ◽

Health Care Utilization ◽

Older People ◽

Health Care Professionals ◽

Cross Sectional Study ◽

Criterion Validity ◽

Adverse Outcomes ◽

Community Dwelling ◽

Care Utilization ◽

Cross Sectional

Background: Early detection of frail older people is important. Timely intervention may allow health care professionals to prevent or delay the occurrence of adverse outcomes such as disability, increases in health care utilization, and premature death. Objectives: We assessed the construct and criterion validity of the SUNFRAIL tool, a questionnaire for measuring frailty among older people. Design, Setting and Participants: This cross-sectional study was carried out in a sample of Dutch citizens. A total of 195 community-dwelling persons aged 71 years and older completed the questionnaire. Measurements: Construct validity was examined by determining the correlation between the SUNFRAIL tool and the Tilburg Frailty Indicator (TFI). Criterion validity for the SUNFRAIL tool was determined by establishing the correlations with chronic diseases and adverse outcomes of frailty (disability, falls, indicators of health care utilization). Disability was measured using the Groningen Activity Restriction Scale. Participants also answered questions regarding falls and health care utilization. Results: The construct validity of this tool was good and showed significant correlations with the TFI. The correlation between SUNFRAIL total and TFI total was 0.624. The criterion validity of the SUNFRAIL tool was good for chronic diseases and good-to-excellent for adverse outcomes disability, receiving nursing care, and falls. The area under the curve for these outcomes was 0.840 (95% CI 0.781–0.899), 0.782 (95% CI 0.696–0.868), and 0.769 (95% CI 0.686–0.859), respectively. Conclusions: The results of our study suggest that the SUNFRAIL tool is a valid instrument for assessing frailty in community-dwelling older people. It is an attractive instrument for use in practice because it takes little time for health care professionals and older people to complete the questionnaire, and it expresses the integral functioning of human beings.

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Frequency of Cervical Cancer in Women Attending Gynae OPD with Complaint of Abnormal Vaginal Bleeding

10.53350/pjmhs2115102641 ◽

2021 ◽

Vol 15 (10) ◽

pp. 2641-2642

Author(s):

Mahwish Shah ◽

Aruna Kumari Hira ◽

Urooj Naz ◽

Sheena . ◽

Sana Shahmir ◽

...

Keyword(s):

Cervical Cancer ◽

Vaginal Bleeding ◽

Cross Sectional Study ◽

Reproductive Age ◽

P Value ◽

Chi Square ◽

Cross Sectional ◽

Presenting Symptoms ◽

History Of ◽

Abnormal Vaginal Bleeding

Aim: Frequency of cervical cancer in women of reproductive age presenting with abnormal vaginal bleeding. Methodology: Descriptive cross sectional study, done at Department of Obs &Gynae, JPMC, Karachi Duration of study: Six months from 01-11-2014 to 30-04-2015 Total 73 patients of age 18-45 years, having history of abnormal vaginal bleeding > 3 menstrual cycles were selected. Pregnant woman, abortion within last 6 months, age >45 years, fibroid/ tumors/ polyps, PID, gonorrhea, or Chlamydia patients were excluded. Chi-square was used as test of significance with a P value <0.05 taken as significant. Results: Mean ± SD age was 38.12 ± 4.33 years. Mean ± SD parity was 2.21 ± 1.67 children (Range: 0-5). Mean ± SD duration of presenting symptoms was 7.45 ± 2.81 months (Range 3-11). About one fifth of patients (i.e. 19.2%) were of age between 18-25 years. a vast majority (i-e; 43.8%) were in 26-35 years age category while remaining (36.99%) patients were of age between 36-45 years. 12.3% women had no children, 35.6% had 1-2 children, 28.8% had 3-4 children while remaining 23.3% women had 5 children. 12 out of 73 (16.4%) women had cervical cancer confirmed through biopsy and histopathology of cervical tissue. Age was significant (P value = 0.003) while parity & duration of presenting symptoms were non-significant (P values = 0.110 & 0.405 respectively). Conclusion: The study found that almost every 6th women with abnormal vaginal bleeding is suffering from cervical cancer. Younger age women and those having lesser parity are less prone to this condition. Keywords: Abnormal vaginal bleeding, Cervical cancer, Postcoital bleeding

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Brief Overview and Experience of Visual Evoked Potential of First 67 cases at Referral Neuroscience Hospital in Bangladesh

Journal of National Institute of Neurosciences Bangladesh ◽

10.3329/jninb.v6i2.50744 ◽

2020 ◽

Vol 6 (2) ◽

pp. 74-77

Author(s):

Mohammad Enayet Hussain ◽

Bithi Debnath ◽

AFM Al Masum Khan ◽

Md Ferdous Mian ◽

Md Nahidul Islam ◽

...

Keyword(s):

Multiple Sclerosis ◽

Optic Neuritis ◽

Clinical Diagnosis ◽

Optic Neuropathy ◽

Cross Sectional Study ◽

P Value ◽

Pattern Reversal ◽

Cross Sectional ◽

The Mean ◽

Visual Evoked

Background: The visual evoked potentials (VEP) is a valuable tool to document occult lesions of the central visual channels especially within the optic nerve. Objectives: The purpose of the present study was to observe the findings of first few cases of VEP done in the neurophysiology department of the National Institute of Neurosciences (NINS), Dhaka, Bangladesh. Methodology: This cross-sectional study was conducted in the Department of Neurophysiology at the National Institute of Neurosciences and Hospital, Dhaka, Bangladesh from September 2017 to March 2020. All patients referred to the Neurophysiology Department of NINS for VEP were included. Pattern reversal VEPs were done using standard protocol set by International Federation of Clinical Neurophysiology (IFCN). Results: The mean age of the study population was 30.70 (±12.11) years (6-68 years) with 31 (46.3%) male and 36 (53.7%) female patients. The mean duration of illness was 8.71 (±1.78) months (3 days- 120 months). Most common presenting symptom was blurring of vision (37.3%) and dimness of vision (32.8%). Patterned VEP revealed mixed type (both demyelinating and axonal) of abnormality in most cases [29(43.35)]. The most common clinical diagnosis was multiple sclerosis (29.85%) and optic neuropathy (26.87%). In the clinically suspected cases of multiple sclerosis, optic neuropathy and optic neuritis most of the cases of VEP were abnormal and the p value is 0.04 in optic neuropathy and optic neuritis. Conclusion: The commonest presentation of the patients in this series were blurring of vision and dimness of vision. The most common clinical diagnosis for which VEP was asked for, was optic neuritis and multiple sclerosis. Most abnormalities were of mixed pattern (demyelinating and axonal). Journal of National Institute of Neurosciences Bangladesh, 2020;6(2): 74-77

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Relative risk of cardiovascular disease is higher in women with type 2 diabetes, but not in those with prediabetes, as compared with men

10.2337/figshare.12915272 ◽

2020 ◽

Author(s):

Elena Succurro ◽

Teresa Vanessa Fiorentino ◽

Sofia Miceli ◽

Maria Perticone ◽

Angela Sciacqua ◽

...

Keyword(s):

Type 2 Diabetes ◽

Cardiovascular Disease ◽

Longitudinal Study ◽

Relative Risk ◽

Hdl Cholesterol ◽

Cross Sectional Study ◽

Adverse Outcomes ◽

Cross Sectional ◽

Normal Glucose

Objective: Most, but not all studies suggested that women with type 2 diabetes have higher relative risk (RR) for cardiovascular disease (CVD) than men. More uncertainty exists on whether the RR for CVD is higher in prediabetic women compared to men. Research Design and Methods: In a cross-sectional study, in 3540 normal glucose tolerant (NGT), prediabetic, and diabetic adults, we compared the RR for prevalent non-fatal CVD between men and women. In a longitudinal study including 1658 NGT, prediabetic, and diabetic adults, we compared the RR for incident major adverse outcomes, including all-cause death, coronary heart disease, and cerebrovascular disease events after 5.6 years follow-up. Results: Women with prediabetes and diabetes exhibited greater relative differences in BMI, waist circumference, blood pressure, total, LDL and HDL cholesterol, triglycerides, fasting glucose, hsCRP, and white blood cell count than men with prediabetes and diabetes when compared with their NGT counterparts. We found a higher RR for prevalent CVD in diabetic women (RR 9.29; 95% CI 4.73-18.25; P<0.0001) than in men (RR 4.56; 95% CI 3.07-6.77; P<0.0001), but no difference in RR for CVD was observed comparing prediabetic women and men. In the longitudinal study, we found that diabetic, but not prediabetic women have higher RR (RR 5.25; 95% CI 3.22-8.56; P<0.0001) of incident major adverse outcomes than their male counterparts (RR 2.72; 95% CI 1.81-4.08; P<0.0001). Conclusions: This study suggests that diabetic, but not prediabetic, women have higher RR for prevalent and incident major adverse outcomes than men.

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