Use of electronic adverse drug reaction check to identify inpatients with a high drug-associated risk of falling: a case-control study at the Department of Neurology.

Background: In hospital, falls are frequent adverse events. Certain drugs affect the fall risk, therefore studying prescriptions may reveal perilous combinations and support falls prevention. As neurologic diseases frequently increase fall risk, neurologic patients require special attention concerning fall prevention. Aim: To analyse the performance of the electronic adverse drug reaction check programmes VERIKO® and SCHOLZ Datenbank® in identifying neurologic patients with a high drug-associated fall risk. Method: Falls in the Department of Neurology in 2016 were matched to fall-free control patients of the same age, sex and principal diagnosis. Their estimated fall risk and other risk factors were compared using univariate and a multifactorial conditional logistic regression. Receiver operating characteristic curves visualised the performance of both programmes. R² for a model with and without software was calculated. Results: Eighty-seven matched pairs were analysed. In the univariate analyses, VERIKO risk estimations showed a significant correlation to fall events (OR=1.448, CI=1.061-1.975). Additionally, the number of comorbidities (OR=1.086, CI=1.013-1.164), the Hospital Frailty Risk Score (OR=1.085, CI=1.025-1.149), impaired balance (OR=3.6, CI=1.337-9.696), gait abnormality (OR=4.75, CI=1.616-13.962), presence of delirium (OR=3.4, CI=1.254-9.216) and previous falls (OR=8.0, CI=1.839-34.793) were related to high fall risk. Polypharmacy and the number of potentially inappropriate medications did not correlate with fall events. In the multivariate analysis, the Hospital Frailty Risk Score was associated to fall risk (OR=1.390, 95%-CI=1.049-1.842). Both programmes showed an area under the receiver operating characteristics curves < 0.6 and improved the model performance slightly (ΔR² ≤ 0.0006). Conclusion: VERIKO risk estimations correlated significantly to fall events. Nevertheless, both programmes showed little accuracy in identifying drug-associated fall risk.

[Standards in the use of fiberoptic endoscopic evaluation of swallowing in Germany : A questionnaire survey]. / Standards bei der Anwendung der fiberendoskopischen Schluckuntersuchung in Deutschland : Eine Fragebogenerhebung.

BACKGROUND: The fiberoptic endoscopic evaluation of swallowing (FEES) is considered to be an indispensable instrumental procedure in the management of patients with dysphagia. The aim of the implemented training curriculum is to raise the quality standards and to contribute to an upgrading of the procedure. OBJECTIVE: The study evaluated to what extent a standardized implementation, evaluation and documentation of FEES takes place in Germany after the introduction of the curriculum. MATERIAL AND METHODS: In this study 603 neurological and geriatric hospitals in Germany were interviewed by the use of an online questionnaire regarding structural features and the course of the investigation. RESULTS: A total of 190 institutions completed the survey. Of the institutions 43.31% had only implemented FEES since the publication of the curriculum. The practical application is increasingly carried out by physicians (59%), the clinical reports and cost recommendations are carried out by speech therapists (62% and 83%, respectively). The practical application by speech therapists increases with increasing level of training. Despite orientation towards the standard protocol according to Langmore, there are differences in the implementation of the anatomical physiological examination, the consistencies and foods administered and the scoring of swallowing-relevant parameters. DISCUSSION: The introduction of the curriculum has led to an upgrading of the FEES and to a strengthening of speech therapy as the implementing professional group. At the current state of the art there is a homogeneous course of the examination in essential aspects but it shows a need for further uniformity. The FEES curriculum could be used as a guiding instrument for further standardization.

[Geriatric Trauma Center DGU®: Evaluation of clinical and economic parameters : A pilot study in a german university hospital]. / AltersTraumaZentrum DGU®: Evaluation klinischer und ökonomischer Parameter : Eine Pilotstudie an einer deutschen Universitätsklinik.

BACKGROUND: Previous studies on orthogeriatric models of care suggest that there is substantial variability in how geriatric care is integrated in the patient management and the necessary intensity of geriatric involvement is questionable. OBJECTIVE: The aim of the current prospective cohort study was the clinical and economic evaluation of fragility fracture treatment pathways before and after the implementation of a geriatric trauma center in conformity with the guidelines of the German Trauma Society (DGU). METHODS: A comparison of three different treatment models (6 months each) was performed: A: Standard treatment in Orthopaedic Trauma; B: Special care pathways with improvement of the quality management system and implementation of standard operating procedures; C: Interdisciplinary treatment with care pathways and collaboration with geriatricians (ward round model). RESULTS: In the 151 examined patients (m/w 47/104; 83.5 (70-100) years; A: n = 64, B: n = 44, C: n = 43) pathways with orthogeriatric comanagement (C) improved frequency of postoperative mobilization (p = 0.021), frequency of osteoporosis prophylaxis (p = 0.001) and the discharge procedure (p = 0.024). In comparison to standard treatment (A), orthogeriatric comanagement (C) was associated with lower rates of mortality (9% vs. 2%; p = 0.147) and cardio-respiratory complications (39% vs. 28%; p = 0.235) by trend. In this context, there were low rates of myocardial infarction (6% vs. 0%), dehydration (6% vs. 0%), cardiac dysrhythmia (8% vs. 0%), pulmonary decompensation (28% vs. 16%), electrolyt dysbalance (34% vs. 19%) and pulmonary edema (11% vs. 2%). Duration of stay in an intensive care unit was 29 h (A) and 18 h (C) respectively (p = 0.205), with consecutive reduction in costs. A sole establishment of a special care pathway for older hip fracture patients (B) showed a lower rate of myocardial infarction (A: 11%, B: 0%, C: 0%; p = 0.035). CONCLUSION: There was a clear tendency to a better overall result in patients receiving multidisciplinary orthogeriatric treatment using a ward visit model of orthogeriatric comanagement, with lower rates of cardiorespiratory complications and mortality. While special care pathways could reduce the rate of myocardial infarction in hip fracture patients, costs and revenues showed no difference between all care models evaluated. However, patients with hip fracture or periprosthetic fracture represent cohorts at clinical and economic risk as well.

Improved visual [(123)I]FP-CIT SPECT interpretation for evaluation of parkinsonism by visual rating of parametric distribution volume ratio images.

AIM: Imaging of presynaptic dopamine transporters (DAT) by single-photon emission computed tomography (SPECT) and [(123)I]FP-CIT is an established method for differentiating between neurodegenerative and non-neurodegenerative parkinsonism. Whereas a region-of-interest (ROI) analysis is the method of choice for analyzing [(123)I]FP-CIT SPECT studies, visual image interpretations can also provide highly accurate results. The present study was undertaken to validate a visual reading system for parametric volume of distribution (DVR) [(123)I]FP-CIT SPECT images that combines the quantitative nature of ROI analyses and the simplicity of visual readings. METHODS: A 9-step linear visual rating template for semi-quantitative DVR ratings of caudate nucleus and putamen was developed (VRDVR). The conventional 4-step visual reading system that is mainly based on the [(123)I]FP-CIT uptake pattern was used for comparison (VRP method). Six independent observers retrospectively rated the [(123)I]FP-CIT scans of 30 consecutive parkinsonism and tremor patients (N.=16 neurodegenerative, N.=14 non-neurodegenerative) using VRDVR and VRP. In addition, a highly trained investigator performed manual ROI analyses. RESULTS: The ROI analysis provided complete separation of both patient groups by comparing the lower DAT binding of both putamina (i.e., putamen contralateral to clinically most affected side in neurodegenerative parkinsonism). Using VRP, the two most experienced observers correctly classified all patients while 20 false-positive ratings occurred in the less experienced observers (mean area under the receiver operating characteristic curve [AUCROC] of all observers 0.93±0.07). The VRDVR ratings of the two most experienced observers did not overlap between patient groups, although at different VRDVR score cut-offs. Using the same VRDVR score cut-off for all observers, only six false-negative and one false-positive ratings occurred in total (AUCROC 0.99±0.01). Inter-observer agreement was good for VRP and VRDVR. Moreover, semi-quantitative VRDVR and quantitative ROI analyses showed a strong correlation in all observers (Spearman's rho, 0.85-0.91). CONCLUSIONS: The proposed VRDVR method offers a very promising visual analysis method for [(123)I]FP-CIT SPECT studies in parkinsonism. The accuracy of VRDVR readings was found to be superior to conventional VRP, while it provided a diagnostic accuracy in less experienced observers that is comparable to manual ROI analyses by a highly trained investigator.

Lythrum hyssopifolia (lesser loosestrife) poisoning of sheep in Victoria.

OBJECTIVE: To document an ovine disease attributed to the consumption of Lythrum hyssopifolia (lesser loosestrife). PROCEDURES: Historical and histological review of field and experimental cases. RESULTS: 1-20% mortality occurred in sheep flocks grazing paddocks where L. hyssopifolia was the predominant green vegetation. Well-documented disease outbreaks occurred in summer on nine farms across Victoria between 1974 and 2002. Liver damage occurred in all nine outbreaks, with kidney damage in at least eight. Hepatocyte necrosis was usually zonal to midzonal (zone 2) in the liver samples from four farms and periacinar (zone 3) in those from three farms, but some livers showed only single-cell necrosis. Multinucleate hepatocytes near necrotic areas were a feature in six cases. Proximal tubular epithelium appeared to be the primary renal target and brown granules were often present in renal tubules. Biochemical and histological evidence of liver and kidney damage was obtained from two sheep experimentally pen-fed harvested L. hyssopifolia. CONCLUSION: Chemicals in L. hyssopifolia are toxic to ovine hepatocytes and renal tubular epithelial cells.