A study to evaluate the potential contribution of medication use to falls in elderly patients presenting to an acute hospital

Introduction: Falls in elderly patients is a growing burden on healthcare resources globally. 10-15% of presentations in those ≥65 years at acute hospital services is due to falls. Medicines and polypharmacy are modifiable risk factors for falls. Different classes of medicines increase the risk of falling to differing extents. Aims: The aim was to review the role of medicines in falls in elderly at Our Lady of Lourdes Hospital Drogheda (OLOL). The objectives were: 1: Examine polypharmacy. 2: Examine the implication of the top five classes of falls risk increasing drugs (FRIDs) as potential causative factors in falls. 3: Determine is there a difference in medicine profile between those residing at home and in Long Term Care Facilities (LTCFs). 4: Has the Clinical Pharmacist a role in reducing patients’ risk of future falls. Methods: Admission records in OLOL were checked daily for elderly patients admitted due to a fall. When consent was granted data was collected from their records. Results: 94 patients met the inclusion criteria. 53 were recruited, 41 were excluded. Only 1 LTCF resident was recruited for the study, therefore objective 3 could not be examined. The Falls Risk Odds Ratio (FROR) was reduced for benzodiazepines, ACEi’s, ARB’s and diuretics but it was not a statistically significant reduction in FROR (p=0.22). Polypharmacy: Patients on ≥ 5 medicines on admission (41) 77%; Patients on ≥ 5 medicines on review (44) 83%; Polypharmacy by Medicine Class : Antipsychotics 100%; Benzodiazepines 100% ; Sedatives 100% Antidepressants 94%; Antihypertensives 76%. No of patients on ≥1 FRID: 94.3%. FRID prescribing by class: Antihypertensives 79.2%; Antidepressants 30.2%; Benzodiazepines 13.2%; Sedatives 11.3% ; Antipsychotics 1.9%. Clinical Pharmacist Recommendations Actioned Overall 41.7%. Actioned per FRID class: Antihypertensives 57.9%; Benzodiazepines 28.7%. Conclusions: Pharmacists have a role to play in highlighting polypharmacy and the prescribing of FRIDs

Predicting amputation and multiple debridements in tooth knuckle injuries

Background: Tooth knuckle injuries can be expensive to treat and may necessitate amputation in some cases. Several limitations exist in the literature regarding our knowledge around the factors predicting amputation and the need for multiple debridements in treating this injury. Methods: A historic cohort study of 321 patients treated for tooth knuckle injuries was undertaken. Twenty-one demographic, clinical and laboratory variables were collected. Two outcome measurements were collected - the need for amputation and the need for more than one surgical debridement. A multivariate logistic regression was performed to determine the relationship between the predictor variables and the outcome measurements. Results: Of the 321 patients examined, 1.6% required amputations and 25% required multiple debridements. Osteomyelitis was found to be a major predictor for amputation in these patients (OR = 35). Delayed presentation (OR = 1.1) and diabetes (OR = 2.6) were found to significantly increase the risk of requiring multiple debridements. Conclusions: Our models were able to predict what patients were at the greatest risk for amputation and multiple debridement. Reducing rates of osteomyelitis and delays in presentation may help reduce the incidence of amputation and reoperation in this injury

Ultrafast dynamics in the power stroke of a molecular rotary motor

Light-driven molecular motors convert light into mechanical energy through excited-state reactions. Unidirectional rotary molecular motors based on chiral overcrowded alkenes operate through consecutive photochemical and thermal steps. The thermal (helix inverting) step has been optimized successfully through variations in molecular structure, but much less is known about the photochemical step, which provides power to the motor. Ultimately, controlling the efficiency of molecular motors requires a detailed picture of the molecular dynamics on the excited-state potential energy surface. Here, we characterize the primary events that follow photon absorption by a unidirectional molecular motor using ultrafast fluorescence up-conversion measurements with sub 50 fs time resolution. We observe an extraordinarily fast initial relaxation out of the Franck-Condon region that suggests a barrierless reaction coordinate. This fast molecular motion is shown to be accompanied by the excitation of coherent excited-state structural motion. The implications of these observations for manipulating motor efficiency are discussed

Core competencies in applied infectious disease epidemiology: a framework for countries in Europe

In 2009, the European Centre for Disease Prevention and Control (ECDC) developed a competency frame-work to support European Union countries and the European Commission in ensuring a competent public health workforce for Europe. The coronavirus disease (COVID-19) pandemic emphasised the importance of harmonised public health strategies and competen-cies across international boundaries, specifically for infectious diseases. This perspective presents the process to update the competency framework for applied infectious disease epidemiology, highlight-ing ECDC's efforts to support countries with using the framework. ECDC commissioned the Association of Schools of Public Health in the European Region (ASPHER) to update the framework through publica-tion and dissemination of a technical report and a self-assessment tool linked to training resources. A mixed methods approach to gather input from experts in rel-evant specialities included qualitative interviews with 42 experts, workshops with ECDC Technical Advisory Group and an online survey of 212 public health pro-fessionals across Europe and beyond. Modifications resulted in 157 core competencies in 23 domains, each mapping to one of six subject areas of importance in applied infectious disease epidemiology. The frame-work serves as a basis to update the curriculum of the ECDC Fellowship programme with two alternative paths: intervention epidemiology or public health microbiology