The risk of rehospitalization within 30 days of discharge in older adults with malnutrition: A meta-analysis.

INTRODUCTION: Malnutrition is a global health problem associated with higher rehospitalization risk, subsequently increasing the risks of adverse complications, and mortality in older individuals. Nevertheless, studies investigating this are still scarce, and even fewer reviewed and aggregated. A number of studies have recently assessed the correlation of malnourishment with rehospitalization among older adults. OBJECTIVE/AIM: This systematic review and meta-analysis aimed to elaborate the correlation between malnutrition and 30-day rehospitalization in older adults. METHODS: Systematic review was conducted on literatures from Cochrane, ScienceDirect, SpringerLink, Oxford Academic, and MEDLINE according to PRISMA Guideline, investigating the correlation of malnutrition in older adults with rehospitalization, using Malnutrition, Older Adults, and Rehospitalization as keywords. Meta-analysis was done using RevMan, with random-effect analysis model. P values of ≤0.05 were considered statistically significant with results reported as risk ratios (RR), mean differences (MD), 95 % confidence intervals (CI) and I2 statistics. RESULTS: Seven literatures were analysed, consisting of 19,340 patients aged 65 or older undergoing hospitalization. Subjects were assessed with screening tools to identify malnutrition. Malnourished subjects are compared to others with normal nutrition; in cohort studies with follow-up period ranging from 3 to 16 months. Malnutrition significantly increased the risks of rehospitalization within 30 days (RR 1.73 [95 % CI 1.10-2.72], p = 0.02, I2 = 56 %), overall rehospitalization at all times (RR 1.33 [95 % CI 1.16-1.52], p < 0.0001, I2 = 75 %), and overall mortality (RR 2.66 [95 % CI 1.09-6.50], p = 0.03, I2 = 94 %). CONCLUSION: Malnutrition exhibited significant consequences in older patients regarding the rate of rehospitalization and mortality based on this meta-analysis. Further research is highly encouraged to verify this finding.

STOPP-START Medication Review: A Non-Randomized Trial in an Indonesian Tertiary Hospital to Improve Medication Appropriateness and to Reduce the Length of Stay of Older Adults.

Background: Inappropriate prescribing may lead to medication errors among older adults. Pharmacists can curb the occurrences of these errors by conducting medication reviews. Screening Tool of Older Person's Prescriptions (STOPP) or Screening Tool to Alert doctors to Right Treatments (START) may curb the incidence of adverse drug reactions and improve medication appropriateness by providing guides about when particular types of medications should be started or stopped. Objective: This study aimed to evaluate the use of STOPP/START to improve the Adapted Medication Appropriateness Index (MAI), to reduce the risk of ADRs (GerontoNet score), and length of stay (LOS). Setting: Geriatric Inpatient Ward, Sanglah General Hospital, Bali, Indonesia. Method: A non-randomized controlled trial was conducted in older adults (>60 years) who were selected consecutively from inpatient units in a tertiary hospital in Bali, Indonesia. The intervention group received medication reviews by pharmacists in collaboration with physicians to assess its appropriateness with STOPP/START criteria on admission and during their stay at the hospital. The control group obtained standard care. Main Outcome Measures: The outcomes were measured using the Adapted MAI, GerontoNet Score, and LOS. Results: Thirty patients in the intervention group and 33 patients in the control group were included in this study. The adapted MAI was 2.97 (2.25) and 9.94 (6.14) with P < .001. The GerontoNet score was 3.33 (2.28) and 5.18 (2.10) with P = .003, LOS was 7.63 (3.00) days and 14.18 (9.97) days with P = .011, respectively. Conclusion: The use of STOPP/START as a tool for medication review improved medication appropriateness and reduced ADR risk and LOS.

The therapeutic potential of RNA interference in controlling HIV-1 replication.

Human immunodeficiency virus type 1 (HIV-1) has long been a major problem to handle. Its existence is incurable (yet) and has reached pandemic proportions despite strictly-controlled epidemiological surveillance. The current treatment regimen involves the use of multiple antiretroviral agents (known as HAART) is very complex and may harm patients through its serious risk of toxicities. Moreover, the continuing emergence of drug resistance further threaten the future therapy, thereby necessitates another treatment strategy i.e. specific and efficient with low or minimal toxicity. RNAi is a potent candidate for the future treatment of HIV-1. It involves an immune-based silencing mechanism (post transcriptional gene silencing/PTGS) that uses small sequence of RNA (21-25 nucleotides in length) to inhibit almost every genes expression, including HIV-1 RNA and its mRNA byproducts. Since RNAi uses sequence of base pairs, it can be designed very specific and homologues to silence the genes in favor. RNAi works either through binding with HIV-1 to inhibit provirus integration into cellular genome or with mRNA products to inhibit certain genes expression (e.g. p24/Gag, Vif, Rev) that plays an important role in HIV-1 infectivity to knockdown its virulence capacity. Given the need for a treatment modality that are sequence-specific and able to overcome the highly mutation rate of virus like HIV-1, also by its enormous power to inhibit HIV-1 expression through various target sites, it is considered essential to discuss the molecular mechanism of RNAi, progresses that have been achieved, and future directions for its use in clinical settings.