Physical and mental health of older people while cocooning during the COVID-19 pandemic.

BACKGROUND: Cocooning or shielding, i.e. staying at home and reducing face-to-face interaction with other people, was an important part of the response to the COVID-19 pandemic for older people. However, concerns exist regarding the long-term adverse effects cocooning may have on their physical and mental health. AIM: To examine health trajectories and healthcare utilization while cocooning in a cohort of community-dwelling people aged ≥70 years. DESIGN: Survey of 150 patients (55% female, mean age 80 years and mean Clinical Frailty Scale Score 4.8) attending ambulatory medical services in a large urban university hospital. METHODS: The survey covered four broad themes: access to healthcare services, mental health, physical health and attitudes to COVID-19 restrictions. Survey data were presented descriptively. RESULTS: Almost 40% (59/150) reported that their mental health was 'worse' or 'much worse' while cocooning, while over 40% (63/150) reported a decline in their physical health. Almost 70% (104/150) reported exercising less frequently or not exercising at all. Over 57% (86/150) of participants reported loneliness with 1 in 8 (19/150) reporting that they were lonely 'very often'. Half of participants (75/150) reported a decline in their quality of life. Over 60% (91/150) agreed with government advice for those ≥70 years but over 40% (61/150) reported that they disliked the term 'cocooning'. CONCLUSIONS: Given the likelihood of further restrictions in coming months, clear policies and advice for older people around strategies to maintain social engagement, manage loneliness and continue physical activity and access timely medical care and rehabilitation services should be a priority.

Impact of a specialist service in the Emergency Department on admission, length of stay and readmission of patients presenting with falls, syncope and dizziness.

BACKGROUND: Up to half of patients presenting with falls, syncope or dizziness are admitted to hospital. Many are discharged without a clear diagnosis for their index episode, however, and therefore a relatively high risk of readmission. AIM: To examine the impact of ED-FASS (Emergency Department Falls and Syncope Service) a dedicated specialist service embedded within an ED, seeing patients of all ages with falls, syncope and dizziness. DESIGN: Pre- and post-cohort study. METHODS: Admission rates, length of stay (LOS) and readmission at 3 months were examined for all patients presenting with a fall, syncope or dizziness from April to July 2018 (pre-ED-FASS) inclusive and compared to April to July 2019 inclusive (post-ED-FASS). RESULTS: There was a significantly lower admission rate for patients presenting in 2019 compared to 2018 [27% (453/1676) vs. 34% (548/1620); X2 = 18.0; P < 0.001], with a 20% reduction in admissions. The mean LOS for patients admitted in 2018 was 20.7 [95% confidence interval (CI) 17.4-24.0] days compared to 18.2 (95% CI 14.6-21.9) days in 2019 (t = 0.98; P = 0.3294). This accounts for 11 344 bed days in the 2018 study period, and 8299 bed days used after ED-FASS. There was also a significant reduction in readmission rates within 3 months of index presentation, from 21% (109/1620) to 16% (68/1676) (X2 = 4.68; P = 0.030). CONCLUSION: This study highlights the significant potential benefits of embedding dedicated multidisciplinary services at the hospital front door in terms of early specialist assessment and directing appropriate patients to effective ambulatory care pathways.

Adverse drug reactions as a cause of admission to a Dublin-based university teaching hospital.

BACKGROUND: A meta-analysis of 25 international studies suggests that 4.2-6.0% of medical admissions are the result of an adverse drug reaction (ADR). One Irish study has found that 8.8% of admissions to a university teaching hospital were attributable to ADRs. AIM: To develop and evaluate a process to detect ADR-related medical admissions to a university teaching hospital in North Dublin. METHODS: A screening process was developed to detect ADR-related admissions based on a previous Scottish study. Having evaluated the accuracy of the screening process in a large Dublin-based university teaching hospital, the same methodology was then applied to medical admissions occurring over a 9-day period. RESULTS: The sensitivity and specificity of the screening process were 100 and 97%, respectively. The incidence of ADR-related hospitalization from 137 admissions was 5.1% (95% CI 1.4-8.8%). Of the ADRs, six were type A (predictable and preventable) and one was a type B (uncommon ADRs) reaction. Of the seven ADRs, two were considered to be unavoidable while five were potentially avoidable. High-risk medications namely anticoagulants, antiplatelets and antihypertensives were identified as causative medications. CONCLUSIONS: This study outlines the feasibility of screening for ADR-related admission in the hospital setting. ADRs constitute an important and avoidable cause of hospital admission.

Monitoring Clostridium difficile infection in an acute hospital: prevalence or incidence studies?

BACKGROUND: Surveillance of Clostridium difficile infection (CDI) is an essential component of a CDI preventative programme. AIMS: The aim of this study was to evaluate two methods of CDI surveillance. METHODS: Prevalence of CDI, antibiotic use and associated co-morbidity was assessed weekly on two wards over 6 weeks. In addition, CDI incidence surveillance was performed on all new CDI cases over a 13-week period. Cases were assessed for CDI risk factors, disease severity, response to treatment and outcome at 6 months. RESULTS: Clostridium difficile infection prevalence was 3.5% (range 2.9-6.1%) on the medical ward and 1.1% (range 0-3.5%) on the surgical ward. Patients on the medical ward were older and more likely to be colonised with MRSA; however, recent antibiotic use was more prevalent among surgical patients. Sixty-one new CDI cases were audited. Patients were elderly (mean age 71 years) with significant co-morbidity (median age adjusted Charlson co-morbidity score 5). CDI ribotypes included 027 (29 cases) 078 (5) and 106 (4). Eight patients developed severe CDI, seven due to 027. Antibiotic use was common with 56% receiving three or more antibiotics in the preceding 8 weeks. Twenty-four patients had died at 6 months, five due to CDI. CONCLUSION: Clostridium difficile infection prevalence gives a broad overview of CDI and points to areas that require more detailed surveillance and requires little time. However, patient-based CDI incidence surveillance provides a more useful analysis of CDI risk factors, disease and outcome for planning preventative programmes and focusing antibiotic stewardship efforts.

The role of anions in pH regulation of Leishmania major promastigotes.

The pH regulation of Leishmania major promastigotes was studied as a function of the ionic composition of the medium and in response to acid and alkali load. Intracellular pH (pHi) was monitored by on-line ratio fluorescence using the fluorescence-dependent pH indicator 2',7'-bis-(carboxyethyl)-5,6-carboxyfluorescein (BCECF). In Cl(-)-based medium (pH 7.4, 30 degrees C), the steady state pHi was maintained at 6.75 +/- 0.01. Only a minor (< or = 0.07 +/- 0.02 unit) decrease in steady state pHi was observed when parasites were treated with H(+)-ATPase inhibitors such as vanadate, N-ethylmaleimide, or bafilomycin. After treatment with the impermeant anion transport blocker DIDS, or in the presence of the reduced analog H2DIDS, pHi decreased by > or = 0.2 unit. In gluconate-based medium, however, pHi gradually decreased to 6.53 +/- 0.05 and showed a swift but time-dependent recovery (alkalinization) when Cl- or other halides or nitrate were restored to the medium. That recovery was also inhibited by pretreating cells with DIDS or exposing them to H2DIDS. The findings provide evidence for Cl- transport mechanisms that support a pHi regulatory process which is operative in acidic-neutral cytoplasmic milieu. Under alkali load induced by weak base treatment, parasites undergo a rapid alkalinization which was followed first by a fast but limited acidification and subsequently by a slower but more robust acidification (recovery) to reach a pHi of 6.85 +/- 0.05. The recovery of pHi was markedly reduced in the presence of H2DIDS and/or in the absence of Cl- in the medium. Based on these results and on the fact that the natural parasite environment is both alkaline and rich in HCO3-/CO3(2-) ions, we propose (Cl-)o-(HCO3-)i or (Cl-)o-(OH-)i exchange as the major mechanism of regulatory cell acidification which is operative upon cell alkalinization. The possibility that similar pH regulatory mechanisms are operative in Leishmania promastigotes in both acidic and alkaline conditions is considered. The putative pH regulatory mechanisms might serve as potential targets for therapeutic intervention.