Introduction: A growing number of Canadian older adults are designated alternate level of care (ALC) and await placement into long-term care (LTC) while admitted to hospital. This creates infrastructural challenges by using resources allocated for acute care during disproportionately long hospital stays. For ALC patients, hospital environments maladapted to their needs impart risk of healthcare-associated adverse events. Methods: In this retrospective descriptive study, we examined healthcare-associated adverse events in 156 ALC patients, 65 years old and older, awaiting long-term care while admitted to two hospitals in London, Ontario in 2015–2018. We recorded incidence of infections and antimicrobial days prescribed. We recorded incidence of non-infectious adverse events including delirium, falls, venothrombotic events, and pressure ulcers. We used a restricted cubic spline model to characterize adverse events as a function of length of stay. Results: Patients waited an average of 56 ALC days (ranging from 6 to 333 days) before LTC placement, with seven deaths occurring prior to placement. We recorded 362 total adverse events accrued over 8668 ALC days: 94 infections and 268 non-infectious adverse events. The most common hospital-acquired infections were urinary-tract infections and respiratory infections. The most common non-infectious adverse events were delirium and falls. A total of 620 antimicrobial days were prescribed for infections. Conclusions: ALC patients incur a meaningful and predictable number of adverse events during their stay in acute care. The incidence of these adverse events should be used to educate stakeholders on risks of ALC stay and to advocate for strategies to minimize ALC days.
Background Low muscle radiodensity on computed tomography (CT) scan, indicative of myosteatosis, is commonly observed in cancer patients and can be associated with poor prognosis. Radiodensity is typically measured at the level of the third lumbar vertebra (L3). It is unknown whether features at L3 reflect a systemic state affecting peripheral muscle groups, whether images used at different levels can be used as a surrogate if L3 images are unavailable, and how radiodensity varies between cancer types. Methods Core and extremity muscle radiodensities were measured in whole body CT images from melanoma patients to evaluate the anatomical distribution of muscle radiodensity measurements. Core muscle radiodensity was measured in 891 patients with different cancer types to study malignancy-dependent patterns in muscle radiodensity. Results Low muscle radiodensity at L3 (<30 Hounsfield Unit) was associated with a corresponding lower muscle radiodensity in all muscle groups evaluated (P < 0.001). However, muscle radiodensities were lowest in the core muscle groups compared with muscles in the extremities. Muscle radiodensities at T12 closely correlated with measurements taken at L3 (r = 0.920, P < 0.001), but the correlation was weaker with mid-thigh measurements (r = 0.745, P < 0.001). The distribution of muscle radiodensities varied significantly with cancer type (P = 0.002). Conclusions The uniform distribution of low muscle radiodensity in cancer patients supports the hypothesis that the underlying mechanism for myosteatosis is systemic in nature. The most reliable measurements of muscle radiodensity are taken using images of core muscles. Variations in muscle radiodensity associated with cancer exist, suggesting that cancer-specific biological drivers are at play.
Background Proton pump inhibitors (PPIs) are one of the most frequently prescribed drug classes in the older person. Indications for PPI use are outlined in the NICE guidelines, however they are often prescribed without an appropriate indication resulting in increased healthcare costs and increased exposure to potential adverse clinical effects. Methods To determine the rate of inappropriate prescribing of PPI’s, an audit was carried out to assess the incidence of inappropriate prescribing in an Acute Rehabilitation facility pre and post Education to Hospital Doctors. An audit was carried out, pre and post intervention, on patients over the age of 65 years admitted to an acute rehabilitation hospital between 2018 and 2019. Patient’s medical charts were reviewed and data was collected on PPI prescribing. Results Cycle 1-Pre Education; 83 people included in the audit. Mean age was 80.8 years[SD ±9]. 43% of patients were on a PPI, all of which were prescribed the generic form. 83.4% of patients had no indication for PPI use. Of the 16.6%, indications included GORD, Barrett’s oesophagus, PUD and PPI prophylaxis against NSAID’s including aspirin. 77.7% were on therapeutic dose without any indication. 100% of patients were on PPI for longer than 6 weeks. Cycle 2, Post education: 86 patients were included in re-audit. Mean age was 81.5[SD ±10]. 60.4% of patients were on PPI. Of those, 55% had no indication for PPI. Of the 44% on PPI, indications were similar to those in Cycle 1. 83% of patients were on PPI longer than 6 weeks. 56.5% were on inappropriate dose of PPI. Conclusion This audit highlighted the inappropriate prescribing of PPI’s in the older person. By providing education to Doctors about NICE PPI prescribing guidelines, overall rate of inappropriate prescribing of PPI decreased by 28.4% and accurate dosing of PPI improved by 21.2%.
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