Background: Elderly patients are considered to be at risk of developing adverse drug events (ADEs) because they tend to receive a greater number of medications. The purpose of our study is to determine the prevalence of ADEs related to polypharmacy and causative admissions of patients in Japanese acute care hospitalization. Methods: In retrospective cohort study, we analyzed 700 consecutive elderly patients admitted to the department of medicine of a Japanese community hospital in 2011. ADEs were defined by World Health Organization–Uppsala Monitoring Centre criteria. Polypharmacy was defined as five or more medications. Results: The mean age was 79.5 years (men, 54%). The mean number of medications was 6.36 +/− 4.15 (maximum, 26). Polypharmacy was observed in 63% of cases. ADEs were identified in 4.9% (95% CI, 3.5–6.7%). The mean numbers of medications among patients with ADEs and those without ADEs were 9.3 +/− 3.4 and 6.2 +/− 4.1, respectively. A greater number of medications was significantly associated with ADEs (p < 0.001). Polypharmacy was identified in 91% of patients with ADEs, while it was noted in 62% of patients without ADEs (p = 0.001). Using logistic regression analysis, polypharmacy was significantly associated with ADEs (Odds ratio 5.89, 95% CI 1.74–19.9). The highest number of ADEs were identified among patients on antiplatelets or anticoagulants (n = 8), followed by benzodiazepines and NSAIDs (n = 4 for both). The most common ADEs were gastrointestinal bleeding, nausea and congestive heart failure. Conclusion: ADEs complicated to about 5% of acute care elderly hospitalizations in Japan. Polypharmacy was significantly associated with these ADEs.
Objective Dehydration is a common condition and frequent cause of hospitalization in older people, despite the caregiver's high attention in attempt to avoid its occurrence. In this study, various physical signs were examined as clinical signs of dehydration in elderly. Methods A prospective observational study was conducted in an acute care teaching hospital. Consecutive elderly patients who were admitted to the Department of Medicine were evaluated. Dehydration was defined as a calculated serum osmolality above 295 mOsm/L. The patients diagnosed as dehydrated or not dehydrated were observed for physical signs of dehydration. Data of blood and urine chemistry analysis were also compared between the two groups. Results A total of 27 elderly patients admitted with acute medical conditions were included in this study. For the physical signs, dry axilla had moderate sensitivity (44%) and excellent specificity (89%) to detect dehydration. Sunken eyes and delayed capillary refill time also showed relatively good specificity (83%). For laboratory data, the mean concentrations of serum sodium of the dehydrated group (146 mEq/L) was significantly higher (p<0.01) than those of the non-dehydrated group (134 mEq/L). Conclusion Physical signs of dehydration in elderly showed relatively good specificity but poor sensitivity. The evaluation of the axillary moisture could help assess dehydration as well as laboratory data analysis such as serum sodium concentration.
BackgroundBoth clinical workload and access to learning resource are important components of educational environment and may have effects on clinical knowledge of residents.MethodsWe conducted a survey with a clinical knowledge evaluation involving postgraduate year (PGY)-1 and -2 resident physicians at teaching hospitals offering 2-year postgraduate training programs required for residents in Japan, using the General Medicine In-Training Examination (GM-ITE). An individual-level analysis was conducted to examine the impact of the number of assigned patients and emergency department (ED) duty on the residents’ GM-ITE scores by fitting a multivariable generalized estimating equations. In hospital-level analysis, we evaluated the relationship between for the number of UpToDate reviews for each hospital and for the hospitals’ mean GM-ITE score.ResultsA total of 431 PGY-1 and 618 PGY-2 residents participated. Residents with four or five times per month of the ED duties exhibited the highest mean scores compared to those with greater or fewer ED duties. Those with largest number of inpatients in charge exhibited the highest mean scores compared to the residents with fewer inpatients in charge. Hospitals with the greater UpToDate topic viewing showed significantly greater mean score.ConclusionAppropriate ED workload and inpatient caseload, as well as use of evidence-based electronic resources, were associated with greater clinical knowledge of residents.
A 67-year-old man was admitted due to weakness, coughing, shortness of breath and fever. He had decreased breath sounds in the left lung and muscle weakness in the lower and upper extremities. Chest imaging showed a mass in the left lung, and a biopsy revealed small cell lung cancer. The nerve conduction velocity was decreased, and anti-GM1 IgG antibodies were positive. The patient showed a temporary neurologic recovery following the administration of cancer chemotherapy, although he eventually died of progression of lung cancer. As a result of the almost simultaneous symptomatic development of lung cancer and Guillain-Barré syndrome, this case may be considered to involve a paraneoplastic neurologic syndrome.
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