Functional changes during hospital stay in older patients admitted to an acute care ward : a multicenter observational study

Objectives: Changes in physical performance during hospital stay have rarely been evaluated. In this study, we examined functional changes during hospital stay by assessing both physical performance and activities of daily living. Additionally, we investigated characteristics of older patients associated with meaningful in-hospital improvement in physical performance. Methods: The CRiteria to assess appropriate Medication use among Elderly complex patients project recruited 1123 patients aged >= 65 years, consecutively admitted to geriatric or internal medicine acute care wards of seven Italian hospitals. We analyzed data from 639 participating participants with a Mini Mental State Examination score >= 18/30. Physical performance was assessed by walking speed and grip strength, and functional status by activities of daily living at hospital admission and at discharge. Meaningful improvement was defined as a measured change of at least 1 standard deviation. Multivariable logistic regression models predicting meaningful improvement, included age, gender, type of admission (through emergency room or elective), and physical performance at admission. Results: Mean age of the study participants was 79 years (range 65-98), 52% were female. Overall, mean walking speed and grip strength performance improved during hospital stay (walking speed improvement: 0.04 +/- 0.20 m/s, p<0.001; grip strength improvement: 0.43 +/- 5.66 kg, p = 0.001), no significant change was observed in activities of daily living. Patients with poor physical performance at admission had higher odds for in-hospital improvement. Conclusion: Overall, physical performance measurements show an improvement during hospital stay. The margin for meaningful functional improvement is larger in patients with poor physical function at admission. Nevertheless, most of these patients continue to have poor performance at discharge

Antipsychotics for the Treatment of Behavioral and Psychological Symptoms of Dementia (BPSD)

Behavioral and psychological symptoms of dementia (BPSD), i.e. verbal and physical aggression, agitation, psychotic symptoms (hallucinations and delusions), sleep disturbances, oppositional behavior, and wandering, are a common and potentially severe problem complicating dementia. Their prevalence is very high and it is estimated that up to 90% of patients with Alzheimer’s disease (AD) may present at least one BPSD. Beside the obvious impact on the quality of life of people with dementia, BPSD are responsible for increased risk of patient institutionalization and increased costs. Furthermore, they are associated with caregivers’ stress and depression. Drugs used include antipsychotics, antidepressants, anticonvulsivants, anxiolytics, cholinesterase inhibitors and N-methyl-D-aspartate receptor modulators. Among these, the most commonly used are anti-psychotics. These drugs have been used for many decades, but in the last years new compounds have been marketed with the promise of comparable efficacy but less frequent adverse effects (especially extra-pyramidal side effects). Their safety, however, has been challenged by data showing a potential increase in adverse cerebrovascular side effects and mortality. This review will summarize the pathophysiology and neuropharmacology of BPSD, it will describe the characteristics of the anti-psychotics most commonly used focusing on their efficacy and safety in BPSD

An embedded machine vision system for an in-line quality check of assembly processes

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A thrombotic snake in the thoracic aorta

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Deterioration of Kidney Function Is Affected by Central Arterial Stiffness in Late Life

Cardiovascular diseases affect kidney function. The aim of this study was to investigate the possible associations between hemodynamic parameters and change in kidney function in individuals aged 75 years and older. Data on hemodynamics and blood and urine samples were collected at baseline and during one-year visits. Hemodynamics were split into two groups based on median values. Changes in the estimated glomerular filtration rate (eGFR) were investigated between low and high groups for each hemodynamic parameter using analysis of variance. Changes in the albumin–creatinine ratio (ACR) were examined as binary outcomes (large increase vs. stable) using logistic regression. The population consisted of 252 participants. Participants in the high central systolic blood pressure (cSBP) group had a greater decline in eGFR than participants in the low cSBP group (−6.3% vs. −2.7%, p = 0.006). Participants in the high aortic pulse wave velocity (aPWV) group had a greater decline in eGFR than those in the low aPWV group (−6.8% vs. −2.5%, p = 0.001). Other hemodynamic parameters were not associated with eGFR changes. Hemodynamics were not associated with changes in the ACR; aPWV and cSBP appear to be predictors for eGFR decline in older age; monitoring and treatment of elevated stiffness might be helpful in order to prevent kidney function decline.</p

Approximate Down-Sampling Strategy for Power-Constrained Intelligent Systems

In modern power constrained applications, as with most of those belonging to the Internet-of-Things world, custom hardware supports are ever more commonly adopted to deploy artificial intelligence algorithms. In these operating environments, limiting the power dissipation as much as possible is mandatory, even at the expense of reduced computational accuracy. In this paper we propose a novel prediction method to identify potential predominant features in convolutional layers followed by down-sampling layers, thus reducing the overall number of convolution calculations. This approximation down-sampling strategy has been exploited to design a custom hardware architecture for the inference of Convolutional Neural Network (CNN) models. The proposed approach has been applied to several benchmark CNN models and we achieved an overall energy saving of up to 70% with an accuracy loss lower than 3%, with respect to baseline designs. Performed experiments demonstrate that, when adopted to infer the Visual Geometry Group-16 (VGG16) network model, the proposed architecture implemented on a Xilinx Z-7045 chip and on the STM 28nm process technology dissipates only 680 and 21.9 mJ/frame, respectively. In both cases, the novel design overcomes several state-of-the-art competitors in terms of energy-accuracy drop product

Does antipsychotic drug use increase the risk of long term mortality? A systematic review and meta-analysis of observational studies

Antipsychotics (AP) are widely used to treat schizophrenia and other psychiatric disorders. However, the association between the AP use and mortality risk is controversial. We searched PubMed, EMBASE, MEDLINE, PsycINFO, CINAHL, the Cochrane Library and four Chinese databases from inception to June 2016. All observational cohort or case–control studies reporting data on mortality outcomes in individuals exposed to AP drugs were included. This systematic review included 68 studies involving 4,812,370 participants. Sixty-seven studies reported confounding factors, the most common being age, sex, race, concomitant medications, and comorbidities. For all-cause mortality, current users of AP and conventional antipsychotics (CAP) had higher mortality risk than did non-AP users [AP users: RR, 1.50; 95% CI, 1.12 to 1.99; CAP users: RR, 1.53; 95% CI, 1.16 to 2.04]. However, the association between the current use of atypical antipsychotics (AAP) and the mortality was of borderline significance, and there was no significant difference for past users of AP. Mortality was higher in current CAP users than in current AAP users. For cardiac death and sudden death, current AP and CAP users also had higher mortality risk than non-AP users. A subgroup analysis showed a possible increased risk in patients with Parkinson’s, but not in those with dementia, Alzheimer’s disease, schizophrenia, delirium or stroke. An increased risk of all-cause mortality for patients ≧65 years may also exist. AP exposure is associated with an approximately 1.5-fold increased mortality risk. This increased risk may be particularly prominent in patients with Parkinson’s and those over 65 years old. Further studies are required to evaluate the mortality risk for individual AP drugs and diseases

Transient versus stable nature of fear of falling over 24 months in community-older persons with falls– data of the EU SCOPE project on Kidney function

BACKGROUND: Fear of falling (FoF) is an important risk factor for falls among older people. The objectives of our investigations were: a.) to present characteristics of older community-dwelling (CD) fallers with persistent or transient FoF (P-FoF or T-FoF) over 12 months, and b.) to investigate clinical predictors of P-FoF and T-FoF and c.) to explore differences between P-FoF and T-FoF. METHODS: Our series consisted of 389 older people reporting a fall or injurious fall at baseline and during 24 months follow-up participating in a multicenter prospective study. T-FoF was defined as participants reported “not at all” at baseline and “somewhat/fairly/very concerned” at follow-up, or “not at all” at follow-up, and “somewhat/fairly/very concerned” at baseline, and P-FoF was defined as participants answered “somewhat/fairly/very concerned” in both assessments at baseline and at follow-up. The association between risk factors and T-FoF or P-FoF was investigated by logistic regression analysis. RESULTS: The mean age of fallers in our sample was 79.0 years (SD 6.0), and 54.2% were females. Out of 389 older adults with a fall history at baseline, 83 participants (21.3%) did not report any FoF over time, P-FoF and T-FoF were observed in 42.7% and 35.9% of participants, respectively. After adjusting for potential confounders (e.g. age, gender), osteoporosis (OR = 2.04, 95%CI = 1.03–4.05) and impaired physical performance (OR = 2.38, 95%CI = 1.12–5.03) were significant predictors of T-FoF vs No-FoF. Osteoporosis (OR = 2.68, 95%CI = 1.31–5.48), depressive symptoms (OR = 3.54, 95%CI = 1.23–10.1) and living alone (OR = 2.44, 95%CI = 1.17–5.06) were significantly associated with P-FoF vs No-FoF. When comparing T-FoF and P-FoF, female gender (OR = 1.95, 95%CI = 1.16–3.27), BMI (OR = 1.08, 95%CI = 1.02–1.14), overall comorbidity (OR = 1.07, 95%CI = 1.02–1.13) and depression (OR = 2.55, 95%CI = 1.33–4.88) were significant predictors of P-FoF. CONCLUSIONS: T-FoF and P-FoF may be predicted by different sets of risk factors among older fallers. Thus, fallers should be screened for FoF especially when carrying specific risk factors, including female gender, osteoporosis, depression, living alone, impaired physical performance, BMI, comorbidity. These findings may be helpful in designing tailored intervention to blunt the risks related to consequence of FoF among older people experiencing falls. TRIAL REGISTRATION: The SCOPE study was registered prospectively at clinicaltrials.gov (NCT02691546; 25/02/2016). SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12877-022-03357-0