How Accurate are Geriatricians’ Fall Predictions?

Background: Older patients are at increased risk of falling and of serious morbidity and mortality resulting from falls. The ability to accurately identify older patients at increased fall risk affords the opportunity to implement interventions to reduce morbidity and mortality. Geriatricians are trained to assess older patients for fall risk. If geriatricians can accurately predict fallers (as opposed to evaluating for individual risk factors for falling), more aggressive and earlier interventions could be employed to reduce falls in older adult fallers. However, there is paucity of knowledge regarding the accuracy of geriatrician fall risk predictions. This study aims to determine the accuracy of geriatricians in predicting falls. Methods: Between October 2018 and November 2019, a convenience sample of 100 subjects was recruited from an academic geriatric clinic population seeking routine medical care. Subjects performed a series of gait and balance assessments, answered the Stay Independent Brochure and were surveyed about fall incidence 6-12 months after study entry. Five geriatricians, blinded to subjects and fall outcomes, were provided the subjects’ data and asked to categorize each as a faller or non-faller. No requirements were imposed on the geriatricians’ use of the available data. These predictions were compared to predictions of an examining geriatrician who performed the assessments and to fall outcomes reported by subjects. Results: Kappa values for the 5 geriatricians who used all the available data to classify participants as fallers or non-fallers compared with the examining geriatrician were 0.42 to 0.59, indicating moderate agreement. Compared to screening tools’ mean accuracy of 66.6% (59.6-73.0%), the 5 geriatricians had a mean accuracy for fall prediction of 67.4% (57.3-71.9%).Conclusions: This study adds to the scant knowledge available in the medical literature regarding the abilities of geriatricians to accurately predict falls in older patients. Studies are needed to characterize how geriatrician assessments of fall risk compare to standardized assessment tools.

Difficulties faced by older Rohingya (forcibly displaced Myanmar nationals) adults in accessing medical services amid the COVID-19 pandemic in Bangladesh

BackgroundCOVID-19 has seriously disrupted health services in many countries including Bangladesh. This research aimed to explore whether Rohingya (forcefully displaced Myanmar nationals) older adults in Bangladesh faced difficulties accessing medicines and routine medical care services amid this pandemic.MethodsThis cross-sectional study was conducted among 416 Rohingya older adults aged 60 years and above residing in Rohingya refugee camps situated in the Cox’s Bazar district of Bangladesh and was conducted in October 2020. A purposive sampling technique was followed, and participants’ perceived difficulties in accessing medicines and routine medical care were noted through face-to-face interviews. Binary logistic regression models determined the association between outcome and explanatory variables.ResultsOverall, one-third of the participants reported difficulties in accessing medicines and routine medical care. Significant factors associated with facing difficulties accessing medicine included feelings of loneliness (adjusted OR (AOR) 3.54, 95% CI 1.93 to 6.48), perceptions that older adults were at the highest risk of COVID-19 (AOR 3.35, 95% CI 1.61 to 6.97) and required additional care during COVID-19 (AOR 6.89, 95% CI 3.62 to 13.13). Also, the notable factors associated with difficulties in receiving routine medical care included living more than 30 min walking distance from the health centre (AOR 3.57, 95% CI 1.95 to 6.56), feelings of loneliness (AOR 2.20, 95% CI 1.25 to 3.87), perception that older adults were at the highest risk of COVID-19 (AOR 2.85, 95% CI 1.36 to 5.99) and perception that they required additional care during the pandemic (AOR 4.55, 95% CI 2.48 to 8.35).ConclusionMany Rohingya older adults faced difficulties in accessing medicines and routine medical care during this pandemic. This call for policy-makers and relevant stakeholders to re-assess emergency preparedness plans including strategies to provide continuing care.

Nepali Older Adults With Pre-existing Conditions and Their Healthcare Access Amid COVID-19 Pandemic

COVID-19 has greatly impacted older adults with pre-existing non-communicable conditions (hereafter called pre-existing conditions) in terms of their access to essential healthcare services. Based on the theory of vertical health equity, this study investigated access to healthcare by Nepali older adults with pre-existing conditions during the COVID-19 pandemic. A cross-sectional study surveyed 847 randomly selected older adults (≥60 years) in three districts of eastern Nepal. Survey questionnaire, administered by trained community health workers, collected information on participants reported difficulty obtaining routine care and medications during the pandemic, in addition to questions on demographics, socioeconomic factors, and pre-existing conditions. Cumulative scores for pre-existing conditions were recoded as no pre-existing condition, single condition, and multimorbidity for the analyses. Chi-square tests and binary logistic regressions determined inferences. Nearly two-thirds of the participants had a pre-existing condition (43.8% single condition and 22.8% multimorbid) and reported experiencing difficulty obtaining routine care (52.8%) and medications (13.5%). Participants with single (OR: 3.06, 95%CI: 2.17-4.32) and multimorbid (OR: 5.62, 95%CI: 3.63-8.71) conditions had three and five-fold increased odds of experiencing difficulty accessing routine care. Findings were similar for difficulty obtaining medication (OR single: 3.12, 95%CI: 1.71-5.69; OR multimorbid: 3.98, 95%CI: 2.01-7.87) where odds were greater than three-folds. Older adults with pre-existing conditions in Nepal, who require routine medical care and medication, faced significant difficulties obtaining them during the pandemic, which may lead to deterioration in their pre-existing conditions. Public health emergency preparedness should incorporate plans for both managing the emergency and providing continuing care.

Analysis of the Assortability of Ophthalmologists Using a Therapy as Part of Routine Medical Care for Patients with Inflammatory Eye Diseases

The problem of diagnosis and treatment of inflammatory eye diseases takes a leading place in Russia and in the world, but the most important thing is the correct choice of treatment methods. Purpose of the work: collection and analysis of data on doctors’ preferences under prescribing therapy in patients with inflammatory eye pathology in routine clinical practice. As a result, 5960 clinical cases from 47 Russian cities were analyzed. This article compiles data from October to November 2020. 151 medical researchers were taken part in the participation of the recruitment. Doctors made different diagnoses for referring patients, but significantly more often diagnosis H10.3 was detected — 17.99 % (in 1072 patients). Ophthalmologists preferred to prescribe the following combination of drugs: 1 — antibacterial local, 2 — local antiseptics, 3 — non-steroidal anti-inflammatory local, a combination (antibiotic and glucocorticosteroid), antiallergic in the form of drops of local action. The choice of drugs for inflammatory eye disease is determined by their high efficiency of use for a given disease: antibiotic Signicef® (levofloxacin 0,5 %), nonsteroidal anti-inflammatory drug Broxinac® (bromphenac 0,09 %), fixed combination Kombinil® (ciprofloxacin 0,3 % + dexamethasone 0,1 %), Visallergol® (olopatadine 0,2 %) in the form of topical eye drops.

Unusual complications of a common disease in COVID times: a case series

Acute appendicitis is the most common abdominal surgical emergency worldwide. 20-30% of cases of appendicitis can complicate which is defined as perforation, purulent peritoneal collection, abscess formation and generalized peritonitis. The risk of perforated appendicitis increases when appropriate treatment for acute appendicitis is delayed. There has been an avoidance of both urgent or emergency and routine medical care because of Coronavirus disease 2019 (COVID-19) concerns all over the world. In our study, the delayed presentation of the patients with acute appendicitis to the hospital prevented appropriate management leading to a much more morbid disease course. Increasing accessibility of medical and telehealth services might help prevent delay of needed care. Even during the COVID-19 pandemic, persons experiencing a medical emergency should seek and be provided care without delay.

Persistent Fever and Rising CRP in a Patient With Pustular Psoriasis Deceived the Medical Team to Consider Her as a Case of COVID-19 During the Pandemic

Generalized pustular psoriasis is a rare variant of pustular psoriasis. During the pandemic of COVID-19, every patient referred to medical centers with fever or other flu-like symptoms would be first evaluated for COVID-19. Here, we report a case of pustular psoriasis who were under biologic immunosuppressive treatment (Infliximab) and was admitted to take her every eight weeks injection of infliximab. During evaluations before the injection, persistent fever and high CRP was detected. Due to these findings, she was suspected of having COVID-19, and this suspicion delayed routine medical care and infliximab infusion for her main disease, pustular psoriasis. After two negative results of the COVID-19 PCR test, Infliximab infusion was done, and surprisingly the fever disappeared, and CRP level decreased.

Smartphone-Based Tapping Frequency as a Surrogate for Perceived Fatigue

Fatigue is a common symptom in various diseases, including multiple sclerosis (MS). The current standard method to assess fatigue is through questionnaires, which has several shortcomings; questionnaires are subjective, prone to recall bias, and potentially confounded by other symptoms like stress and depression. Thus, there is an unmet medical need to develop objective and reliable methods to evaluate fatigue. Our study seeks to develop an objective and ubiquitous monitoring tool for assessing fatigue. Leveraging a smartphone-based rapid tapping task, we conducted a two-week in-the-wild study with 35 MS patients. We explore the association between tapping derived metrics and perceived fatigue assessed with two standard clinical scales: fatigue severity scale (FSS) and fatigue scale for motor and cognitive function (FSMC). Our novel smartphone-based fatigue metric, mean tapping frequency, objectively ranks perceived fatigue with a mean AUCROC = .76, CI = [.71, .81] according to the FSMC, and a mean AUCROC = .81, CI = [.76, .86] according to the FSS. These results demonstrate that our approach is feasible and valid in uncontrolled environments. In this work, we provide a promising tool for objective fatigue monitoring to be used in clinical trials and routine medical care.

Features of the Course of COVID-19 in Health Care Workers of a Non-infectious Hospital

Background: Health care workers (HCWs) are at high risk of SARS-COV-2 infection and COVID-19 disease, not only in the chain of care for COVID-19 patients but also in non-infectious health care organizations that provide routine medical care to the population. Objective: To analyze features of the course of COVID-19 in HCWs of a non-infectious hospital (non-IH). Materials: A retrospective analysis of COVID-19 cases of HCWs of a non-infectious hospital (non-IH) due to a local outbreak during the "second wave" of the pandemic, despite the use of PPE. Results: 7 HCWs out of 23 employees were infected and had a confirmed COVID-19 infection. All pointed to the presence of contact at work (patients, colleagues) as the main possible contamination factor. The development of COVID-pneumonia was observed in 4 persons; 2 of them were hospitalized. The most common symptoms were fever with a maximum temperature rise of 37.8-39 ° C, weakness, chest pain, cough, and loss of smell. The duration of the persistence of symptoms of the disease was up to 16 days. The elimination of coronavirus in most patients was noted after the 10th day. Conclusion: HCWs in non-IH providing routine medical care are at increased risk of contracting COVID-19 due to contact with infected patients or colleagues. The development of COVID-19 disease in HCWs leads to long-term disability, which creates tension in the work of non-IH. To reduce the risk of infection for non-IH HCWs, stated precautions are necessary: strict adherence to PPE use, mandatory testing of SARS-COV-2, and planning observational wards for unexamined patients hospitalized for medical care for other indications.

Treatment interruption is a risk factor for sickness presenteeism: a large-scale cross-sectional study during the COVID-19 pandemic

ObjectiveThis study examined the relationship between interruption to routine medical care during the coronavirus disease 2019 pandemic and sickness presenteeism in Japan.MethodsAn internet monitor questionnaire was conducted. Data from 27,036 people were analyzed. Interruption to medical care was defined based on the response “I have not been able to go to the hospital or receive treatment as scheduled.” The number of sickness presenteeism days in the past 30 days was employed as the primary outcome. A zero-inflated negative binomial model was used for analysis.ResultsThe incidence rate ratio was significantly higher among workers who experienced interrupted medical care (2.26; 95% confidence interval: 2.03–2.52) than those who did not require routine medical care.ConclusionsThis study suggests the importance of continuing necessary treatment during a pandemic to prevent presenteeism.

Tapentadol prolonged release in patients with chronic low back pain: real-world data from the German Pain eRegistry

Aim: Comparison of tapentadol prolonged release (PR) with other oral WHO-III PR opioid analgesics (morphine, oxycodone ± naloxone, hydromorphone) in routine medical care of chronic low back pain. Patients & methods: Noninterventional, retrospective 12-week study using anonymized clinical practice data from the German Pain eRegistry. Six effectiveness, tolerability, and safety criteria were aggregated in a primary composite end point (treatment responder). Propensity scoring matched 2331 datasets per treatment cohort. Results: All six single criteria showed significantly better outcomes for tapentadol PR (all parameters p < 0.001). There were significantly more treatment responders under tapentadol PR (65.7 vs 14.2%; p < 0.001). Conclusion: Tapentadol PR showed significantly better effectiveness and tolerability in severe chronic low back pain unsuccessfully treated with WHO-I/II analgesics compared with the other oral WHO-III PR opioids investigated.