Spread of ceftriaxone non-susceptible pneumococci in South Korea: Long-term care facilities as a potential reservoir.

Despite the availability of a pneumococcal National Immunization Program, which provides free PPSV23 vaccination for older adults aged ≥65 years in South Korea, pneumococcal pneumonia remains one of the most common respiratory infections, with increasing antimicrobial resistance. From January to December in 2015, all pneumococcal isolates were collected from a 1,050-bed teaching hospital in South Korea. All isolates were analyzed for serotype, genotype, and antimicrobial susceptibility. Demographic, clinical and microbiological data were compared between ceftriaxone susceptible and non-susceptible cases. Among 92 microbiologically identified pneumococcal isolates, ceftriaxone non-susceptible pneumococci (CNSP) accounted for 32 cases (34.8%). Some of these cases also showed levofloxacin resistance (25%, 8/32 isolates) and all CNSP cases were multidrug resistant. Compared to patients with ceftriaxone susceptible pneumococci (CSP), long-term care facility residents (odds ratio [OR] 7.0, 95% confidence interval [CI] 0.8-62.1) and patients with chronic lung (OR 4.1, 95% CI 1.1-15.0) and renal diseases (OR 9.1, 95% CI 1.2-70.5) were more common among those with CNSP on multivariate analysis. PPSV23-unique serotypes not included in PCV13 were more common in CNSP than in CSP (34.4% versus 13.3%, p = 0.02). Regarding genotypes, ST320 (10 cases), ST166 (7 cases) and ST8279 (3 cases) were dominant in CNSP, and ST8279 was only detected in previous long-term care facility residents. Clonal expansion and spread of CNSP strains should be monitored among patients with chronic lung/renal diseases and residents of long-term care facilities.

Falls and long-term care: a report from the care by design observational cohort study.

BACKGROUND: Falls and the resulting complications are common among frail older adults. We aimed to explore risk factors and potential prevention strategies for falls in elderly residents of Long-Term Care Facilities (LTCF). METHODS: This was a cross sectional study design using data from the Care by Design (CBD) study, within Nova Scotia's Capital District Health Authority. This observational time series cohort study collected data before, during and after the implementation of CBD, a new model of coordinated primary care in LTCF. Here, we analyzed data collected after the implementation of CBD (September 1, 2011- February 28, 2012). RESULTS: Falls were frequent; 56.2% of our sample of 395 residents fell at least once. In univariate analyses, male gender (p = 0.009), dementia (p = 0.005), and use of Selective Serotonin Reuptake Inhibitors or Selective Serotonin-Norepinepherine Reuptake Inhibitors (SSRI/SNRI) (p = 0.084) showed statistically significant associations with having fallen. Benzodiazepine use appeared to be protective for falls (p = 0.058). In a fully adjusted multivariable linear regression model, dementia (ß coefficient 0.96, 95% CI: 0.83,1.84; p = 0.032), visual impairment (ß 0.84, 95% CI: 0.13,1.56; p = 0.021), and use of any PIMs (ß 0.34, 95% CI: 0.037,0.65; p = 0.028) were associated with increased risk of having fallen. Benzodiazepine use remained associated with reduced numbers of falls (p = 0.009), and SSRI/SNRI use was associated with increased numbers of falls (p = 0.007). Male gender was associated with increased falls in the model which excluded frailty (p = 0.022), though gender lost statistical significance once frailty was added to the model (p = 0.06). CONCLUSIONS: In our sample of LTCF residents, falls were common. Cognitive impairment, male gender, visual impairment, PIM use and use of SSRI/SNRI medications were associated with increased risk of falls, while benzodiazepine use appeared to be associated with a decreased risk of having fallen. Falls remain an important problem among LTC residents. Screening for falls during patient encounters is recommended, along with further research to identify risk factors and target interventions.

Estudio Ebrictus. Resultados funcionales, supervivencia y años potenciales de vida perdidos después del primer episodio de ictus / Ebrictus study. Functional results, survival, and potential years of life lost after the first stroke

Objetivo: Conocer la mortalidad, el grado de dependencia, la supervivencia y los años potenciales de vida perdidos (APVP) después de un primer episodio de ictus. Diseño: Estudio de cohorte fija. Emplazamiento: Base comunitaria. Participantes: Entre el 1/4/2006 y el 31/3/2008 fueron incluidas 553 personas entre 15-90 años, con un primer episodio de ictus definitivo o transitorio. Mediciones principales: Grado de dependencia según la escala de Barthel (EB) al año, APVP (1-70 años) a partir de las medias de las esperanzas de vida al nacer, análisis de supervivencia por curvas de Kaplan-Meier, bivariante entre pacientes fallecidos y supervivientes, y multivariante de Cox. Resultados: Edad media, 73,3; DE: 11,6 años. El tiempo medio de seguimiento fue 29,7; DE:13,4 meses, en el que un 26,6% de los pacientes fallecieron. El valor medio EB descendió > 20%, especialmente entre las mujeres. El 41,5% (IC 95% 30,6-52,8%) tenía una dependencia moderada o más. La probabilidad de supervivencia global acumulada fue de 0,96 (IC 95% 0,94-0,97) el primer mes y 0,69 (IC 95% 0,65-0,72) al final. La fibrinólisis mejoró significativamente la curva de supervivencia a los 3 años post-episodio, en particular entre las mujeres. Los factores pronósticos independientes para la supervivencia global fueron la edad (riesgo relativo [RR] 1,08, IC 95% 1,001-1,179) y la incidencia de un nuevo episodio cardiovascular (RR 6,97, IC 95% 2,23-21,7). La tasa de APVP fue 11,5/104, DE 7,2, significativamente mayor en los hombres. Conclusiones: La evolución funcional, la mortalidad y la tasa de APVP son diferentes por género. La incidencia de un nuevo episodio cardiovascular es un factor pronóstico independiente de la supervivencia(AU)

Aim: To determine the mortality, degree of dependence, survival, and years of life lost (YLL) after first episode of stroke. Design: Cohort study. Location: Community based register. Participants: A total of 553 subjects between 15-90 years with a first episode of definitive or transitory stroke were recruited between 01/04/2006 and 31/03/2008.MeasurementsThe analyses were performed with the use of time-to-event methods, according to the intention-to-treat principle. The level of dependency was assessed according to the Barthel Scale one year after stroke; YLL (1-70 years) from the mean life expectancies at birth; survival analysis by Kaplan-Meier's curves, bivariate analysis comparing the variables between patients who had survived and those who died, and Cox's multivariate.: Results: The mean age was 73.3 (±11.6 years. The mean time of follow-up was 29.7±13,4 months, during which 26.6% of the patients died. The mean Barthel score fell by >20%, particularly among women. There was moderate or greater dependence in 41.5% (95%CI 30.6-52.8%) of the subjects. The overall accumulative probability of survival was 0.96 (95% CI 0.94-0.97) in the first month and 0.69 (95% CI 0.65-0.72) in the fourth year. The thrombolytic treatment showed a protective effect on mortality, particularly among the women. The main predictive variables were, history of recurrent cardiovascular event (RR 6.7, 95% CI 2.2-21.7) and aging (RR 1.08, 95% CI 1.01-1.2). The average YLL was 11.5/10000/year SD7.2, and higher among men. Conclusion: There are differences in functional outcome, mortality, and potential years of life lost by gender. A new cardiovascular event is an independent prognostic factor of survival(AU)

Measuring clinical outcomes of animal-assisted therapy: impact on resident medication usage.

OBJECTIVE: To measure changes in medication usage of as-needed, psychoactive medications and other select as-needed medication usage as a result of a therapy dog residing in the rehabilitation facility. Additional measures are participants' thoughts and feelings on quality-of-life factors. DESIGN: One group, pretest, post-test. SETTING: Residential rehabilitation facility. PARTICIPANTS: Convenience sample, N = 58 residents living at the facility. INTERVENTION: A certified, trained therapy dog. MAIN OUTCOME MEASURE(S): Changes in as-needed medication usage for the following categories: analgesics, psychoactive medications, and laxatives, as well as changes in vital sign measurements of blood pressure, pulse, respiration rate, and body weight. Additionally, changes in the residents' perception of quality-of-life factors. RESULTS: One of the three monitored drug classes, analgesia, revealed a decrease in medication usage (mean = 2.6, standard deviation [SD] +/- 6.90, P = 0.017), and one of four monitored vital signs, pulse, showed a decrease (mean = 5.8, SD +/-7.39, P = 0.000) in study participants exposed to the therapy dog. Positive changes were reported in study participants' quality of life. CONCLUSION: The benefits to human welfare as a result of the presence of a therapy dog have the potential to decrease medication usage for certain conditions in long-term care patients as well as decrease costs. Pharmacist involvement in animal-assisted therapy has the potential to make unique and measurable improvements to best patient care.