Objective To examine the effectiveness and safety of non-pharmacological interventions to reduce bone loss among post-stroke adult patients. Data sources Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Database for Systematic Reviews, MEDLINE, CINAHL, ScienceDirect, Scopus, PubMed and PeDRO databases were searched from inception up to 31st August 2021. Methods A systematic review of randomized controlled trials, experimental studies without randomization and prospective cohort studies with concurrent control of non-pharmacological interventions for adult stroke patients compared with placebo or other stroke care. The review outcomes were bone loss, fall and fracture. The Cochrane Risk of Bias Tools were used to assess methodological quality, and Grading of Recommendations, Assessment, Development and Evaluations Framework to assess outcome quality. Synthesis Without Meta-Analysis (SWiM) was used for result synthesis. Results Seven studies (n = 453) were included. The methodological and outcome qualities varied from low to moderate. There were statistically significant changes between the intervention and parallel/placebo group in bone mineral density, bone mineral content, cortical thickness and bone turnover markers with specific physical and vibration therapies (p<0.05). Falls were higher in the intervention group, but no fracture was reported. Conclusion There was low to moderate evidence that physical and vibration therapies significantly reduced bone loss in post-stroke patients at the expense of a higher falls rate. The sample size was small, and the interventions were highly heterogeneous with different duration, intensities and frequencies. Despite osteoporosis occurring with ageing and accelerated by stroke, there were no studies on vitamin D or protein supplementation to curb the ongoing loss. Effective, high-quality non-pharmacological intervention to improve post-stroke bone health is required.
Introduction Falls among hospital inpatients are common, generally ranging from 2.3 to 7 falls per 1000 patient bed days1. Around 30% of falls as inpatient are injurious2. Falls are associated with a longer length of stay in hospital and greater utilization of healthcare facilities3. Objective The goal of this study is to describe patient characteristics, circumstances of fall and clinical outcomes after inpatient fall Methodology This is a retrospective, descriptive study of all patients admitted to the Medical Department in year 2017 who sustained an inpatient fall. The data was obtained from the database of the Falls Team HKL. Results 162 patients, with an average age of (61.82±15.50) years were included in this study. Of these, 103(63.58%) were male and 74(45.68%) were ≥65 years. 120(74.1%) were walking unaided prior to admission. 146(90.1%) patients were admitted with an acute medical illness and 13(8.0%) with an acute fall. Median time to first fall was 5(IQR 3-8) days after admission. 160(98.77%) falls occurred in the ward. 79(48.77%) falls occurred between 9:00pm to 6:59am. 75(46.3%) patients fell near their bed and 56(34.6%) fell in the toilet. 47(29.01%) had an injurious fall; 32(19.7%) had minor injury, 9(5.6%) had moderate injury and 6(3.7%) had severe injury. Patients with injurious falls were more likely to have “Direct Impact to Head” during fall [OR; 12.73 (95%CI 5.62 – 28.82)]. They were also more likely to have a Head CT after fall [(OR; 6.41 (95%CI 3.02 – 13.62)]. 18(11.1%) patients died during hospitalisation. Median time to death was 9(IQR 4-16.25) days after fall. 144(88.9%) patients were discharged alive at median 6(IQR 3.75 – 9.25) days after fall. Upon discharge, only 49(30.2%) patients were walking unaided. Conclusion Inpatient falls affects patients of all age groups, regardless of gender. Our data shows that Inpatient falls can cause increased morbidity due to falls related injuries; however, there is no difference in age, gender, length of stay or death as inpatient between patients with injurious and non-injurious falls.
Introduction Inpatient falls are associated with serious and life–threatening injuries in 4-6% of cases1. This includes Intracranial Injury (ICI). Imaging of the Head is required to detect and manage patients with head injury2; however there are no specific guidelines to facilitate utilisation of Head CT after Inpatient Falls. Objective The goal of this study is to review the utilisation of Head CT to determine rates of intracranial injury (ICI) following inpatient falls. Methodology This is a retrospective study of all patients admitted to the Medical Department, HKL in year 2017 who sustained an inpatient fall. The data was obtained from the database of the Falls Team HKL and review of medical notes. Results 152 patients, with an average age of (61.65±15.51) years were included in this study. Of these 94 (61.8%) were male, 85 (55.9%) were ≥ 65 years. 45 (29.6%) patients had a Head CT after inpatient fall. Median time to request for Head CT was 130 (IQR 30–582.50) minutes from the time of fall. Head CT was more likely in patients with Direct impact to head during fall (Adj.OR;4.71(95%CI 1.39 – 15.85). Fifty-seven (37.5%) patients sustained Direct impact to head during fall, however only 32/57(71.1%) had a Head CT as inpatient. Patients who had Direct impact to head during fall, were more likely to develop Giddiness (Adj.OR;5.96(95%CI 1.94-18.30) and Hematoma (Adj.OR;6.186(95%CI 1.59 – 24.03) after fall. Intracranial injury (ICI) was identified in 5/45 (11.1%) patients who underwent a Head CT. Patients with (ICI) had an average age of (74.00 ±7.906) years. All 5 patients were reviewed by the Neurosurgical team. Of these, 1/5 (20%) patient died during hospitalisation and 1/5 (20%) patient was discharged in a terminally ill condition. Conclusion Intracranial injury (ICI) was identified in 5/45 (11.1%) patients who underwent a Head CT and they were more likely to be ≥ 65years. Head CT was more likely in patients with Direct impact to head, headache, hematoma and confusion after inpatient fall.
Introduction: Many tools have been developed to determine medication appropriateness in older persons including the 2015 American Geriatric Society (AGS) Beers criteria and the Screening Tool of Older People’s Prescriptions (STOPP) criteria. We aimed to determine and compare the prevalence of potentially inappropriate medications (PIMs) based on the Beers criteria 2015 and the STOPP criteria v2 among older persons admitted to a general hospital in Malaysia. Methods: A cross-sectional study comprising of 160 patients aged 65 years old and above admitted to the general medical wards of a tertiary teaching hospital were recruited. Beers criteria 2015 and the STOPP criteria v2 were used to evaluate participants’ medication list on admission, during hospitalisation and on discharge for PIMs. Prevalence of PIMs which was calculated as the total number of patients with one or more PIMs over the total number of patients. Results: The prevalence of PIMs identified by Beers criteria 2015 on admission, during hospitalisation and on discharge were 54.85%, 64.40% and 48.80% respectively. The prevalence of PIM based on STOPP criteria v2 were 33.08%, 47.50% and 42.50% respectively. The most prevalent PIMs according to Beers criteria 2015 and STOPP criteria v2 were diuretics, tramadol, ticlopidine, proton pump inhibitor, benzodiazepines and antipsychotics. Conclusion: The prevalence of PIMs use is high among hospitalised older persons in Malaysia. While it is not possible to avoid all PIMs listed in the Beers and STOPP criteria, clinicians should exercise caution in prescribing drugs such as benzodiazepines, antipsychotics and proton pump inhibitors for older persons weighing the risk versus benefit of the drugs.
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