Analyzing supply and demand on a general internal medicine ward: a cross-sectional study

ObjectivesFew studies have investigated the prevalence of adverse drug reactions (ADRs) leading to hospitalisation in Japan. The aim of this study was to determine the prevalence of ADRs leading to hospitalisation and to evaluate the preventability of these ADRs in Japan.DesignA single-centre cross-sectional study using electronic medical records.SettingAcute care hospital.ParticipantsAll 1545 consecutive hospital admissions to an internal medicine ward due to acute medical illnesses from April 2017 to May 2018. The median patient age was 79 years (IQR 66–87), and the proportion of women was 47.9%.Outcome measuresThe primary outcome was the proportion of hospitalisations caused by ADRs among all hospitalisations. All suspected cases of ADRs were independently evaluated by two reviewers, and disagreements were resolved by discussion. The causality assessment for ADRs was performed by using the WHO-Uppsala Monitoring Committee criteria. The contribution of ADRs to hospitalisation and their preventability were evaluated based on the Hallas criteria.ResultsOf the 1545 hospitalisations, 153 hospitalisations (9.9%, 95% CI 8.4% to 11.4%) were caused by 200 ADRs. Cardiovascular agents (n=46, 23.0%), antithrombic agents (n=33, 16.5%), psychotropic agents (n=29, 14.5%) and non-steroidal anti-inflammatory drugs (n=24, 12.0%) accounted for approximately two-thirds of all ADRs leading to hospitalisation. Of 153 hospitalisations caused by ADRs, 102 (66.7%) were judged to be preventable.ConclusionsSimilar to other countries, one in every ten hospitalisations is caused by ADRs according to data from an internal medicine ward of a Japanese hospital. Most of these hospitalisations are preventable. Some efforts to minimise hospitalisations caused by ADRs are needed.

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Life worth living: cross-sectional study on the prevalence and determinants of the wish to die in elderly patients hospitalized in an internal medicine ward

BMC Geriatrics ◽

10.1186/s12877-020-01762-x ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Marc-Antoine Bornet ◽

Eve Rubli Truchard ◽

Gérard Waeber ◽

Peter Vollenweider ◽

Mathieu Bernard ◽

...

Keyword(s):

Internal Medicine ◽

Quality Of Life ◽

Elderly Patients ◽

Cross Sectional Study ◽

Worth Living ◽

Sectional Study ◽

Internal Medicine Ward ◽

Cross Sectional ◽

Wish To Die

Abstract Background Elderly people frequently express the wish to die: this ranges from a simple wish for a natural death to a more explicit request for death. The frequency of the wish to die and its associated factors have not been assessed in acute hospitalization settings. This study aimed to investigate the prevalence and determinants of the wish to die in elderly (≥65 years) patients hospitalized in an internal medicine ward. Methods This cross-sectional study was conducted between 1 May, 2018, and 30 April, 2019, in an acute care internal medicine ward in a Swiss university hospital. Participants were a consecutive sample of 232 patients (44.8% women, 79.3 ± 8.1 years) with no cognitive impairment. Wish to die was assessed using the Schedule of Attitudes toward Hastened Death-senior and the Categories of Attitudes toward Death Occurrence scales. Results Prevalence of the wish to die was 8.6% (95% confidence interval [CI]: 5.3–13.0). Bivariate analysis showed that patients expressing the wish to die were older (P = .014), had a lower quality of life (P < .001), and showed more depressive symptoms (P = .044). Multivariable analysis showed that increased age was positively (odds ratio [OR] for a 5-year increase: 1.43, 95% CI 0.99–2.04, P = .048) and quality of life negatively (OR: 0.54, 95% CI 0.39–0.75, P < 0.001) associated with the likelihood of wishing to die. Participants did not experience stress during the interview. Conclusions Prevalence of the wish to die among elderly patients admitted to an acute hospital setting is low, but highly relevant for clinical practice. Older age increases and better quality of life decreases the likelihood of wishing to die. Discussion of death appears to be well tolerated by patients.

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