The use of opioids and laxatives, and incidence of constipation, in patients requiring neck-of-femur (NOF) surgery: a pilot study.

BACKGROUND AND OBJECTIVE: Constipation is one of the most frequent adverse drug reactions occurring in hospital inpatients. There is no evidence base for the use of laxatives in orthopaedic patients on opioids. The aim of the study was to determine the current nature of opioid and laxative prescribing, and the incidence of constipation in patients who require emergency neck-of-femur (NOF) surgery. METHODS: Patients admitted to the Royal Liverpool Hospital for emergency surgery for fractured NOF over an 8-week period in 2007 were included in the study. All opioid and laxative prescribing was recorded, alongside the incidence of constipation, nutritional status and mobility. RESULTS: During the study period, 46 patients were eligible for inclusion. All patients received opioid analgesics. Constipation occurred in 33 patients (71.7%). Prophylactic laxatives were prescribed in 20 (43%) patients, 12 of whom developed constipation. Of the 26 (57%) patients not prescribed prophylaxis, 21 developed constipation (chi(2) = 2.3, P < 0.1 NS). Constipated patients were older (86 years vs. 76 years) (U = 112.5, P < 0.05), and had poorer nutritional status (2/13 vs. 16/33) (chi(2) = 4.28, P < 0.05), than patients without constipation. CONCLUSIONS: This study demonstrates that age and nutritional status are significant factors influencing the occurrence of constipation, though the prophylactic use of laxatives did not alleviate the incidence of constipation. There is a clinical need to develop a robust evidence base surrounding the best management of constipation in this vulnerable group of orthopaedic patients.

Adverse drug reactions in hospital in-patients: a pilot study.

BACKGROUND: About 6.5% of admissions to hospital are related to an adverse drug reaction (ADR). There are no recent large studies, which explore the burden of ADRs on hospital in-patients. The aim of this pilot study was to assess the feasibility of, and establish the methodology for, conducting a large prospective study to fully assess the impact of ADRs on in-patients and the National Health Service (NHS). METHODS: Patients admitted to five wards in a university hospital over a 2-week period were assessed for ADRs through a daily ward visit by a pharmacist. Suspected ADRs were analysed for causality, severity and avoidability using appropriate scales. RESULTS: Twenty-four of 125 patients (19.2%, 95% CI 12-26%) were categorized as having suffered one or more ADRs. A total of 27 ADRs were identified. Patients with ADRs spent longer in hospital than those without ADRs. Causality assessment showed that 17 (63%) ADRs were possibly drug-related, whereas 10 (37%) were classified as probably or definitely related to the drug. Almost two-thirds of reactions were potentially avoidable. Intervention was required in all ADRs and reactions indirectly contributed to the death of two patients. CONCLUSIONS: Almost one-fifth of patients suffered an ADR as an inpatient. Methodology tested using this pilot will enable the design of a larger study, involving over 3000 patients, which will allow the ADR burden and vulnerable patient groups, to be more accurately characterized. This study will aid the development of interventions to reduce the impact of ADRs in hospital in-patients.

A study of factors which regulate the membrane appression of lettuce thylakoids in relation to irradiance.

Factors that may influence the extent of thylakoid membrane appression have been examined using lettuce (Lactuca sativa cv. Celtuce) grown under different irradiances. Electron microscopy and salt-induced chlorophyll fluorescence suggest that the percentage of membrane appression is increased in plants grown in low light (20 Wm(-2)) compared with those grown in high light (150 Wm(-2)). In high light plants surface charge, as measured by 9-aminoacridine, was found to be twice that measured in low light plants. There was a similar difference in ATPase activity of CF1 and in light saturated photophosphorylation. The chlorophyll content of LHC-2 as a proportion of the total chlorophyll was greatest in thylakoids of low light plants. Measurement of non-cyclic photophosphorylation rates suggested that membrane appression has a stimulatory role in the photophosphorylation process. The importance of these inter-related factors for the mechanism of thylakoid appression is discussed.