Doloplus-2, a valid tool for behavioural pain assessment?

Research articl

Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis with Antiepileptic Drugs: An Analysis of the Food and Drug Administration Adverse Event Reporting System (FAERS)

Objective Stevens‐Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare and potentially fatal adverse skin reactions that are most commonly triggered by certain medications. One class of medications that has been highly associated with SJS/TEN reactions is antiepileptic drugs (AEDs). We sought to quantify the risk of SJS/TEN associated with AEDs as a class, as well as individual AEDs, in the United States. Methods An analysis was performed of the US Food and Drug Administration Adverse Event Reporting System (FAERS) from July 2014 through December 2017. Rates of SJS/TEN were calculated for each AED compared with all other non‐AEDs. Reporting odds ratios (RORs), proportional reporting ratios (PRRs), and 95% confidence intervals (CIs) were calculated using OpenEpi. Results With 198 reports, AEDs had more reports of SJS/TEN than any other medication class. AEDs as a class had an ROR of 8.7 (95% CI 7.5‐10.2) and a PRR of 8.7 (95% CI 7.5‐10.2) compared with all other non‐AEDs. The AEDs with the highest risk estimates were zonisamide (ROR 70.2, 95% CI 33.1‐148.7; PRR 68.7, 95% CI 32.9‐143.5), rufinamide (ROR 60.0, 95% CI 8.3‐433.5; PRR 58.9, 95% CI 8.4‐411.5), clorazepate (ROR 56.0, 95% CI 7.8‐404.1; PRR 55.1, 95% CI 7.8‐385.0), lamotrigine (ROR 53.0, 95% CI 43.2‐64.9; PRR 52.2, 95% CI 42.7‐63.7), phenytoin (ROR 26.3, 95% CI 15.5‐44.7; PRR 26.1, 95% CI 15.4‐44.2), and carbamazepine (ROR 24.5, 95% CI 16.0‐37.5; PRR 24.3, 95% CI 16.0‐37.1). Significance Although AEDs as a class were associated with 9 times the risk of SJS/TEN compared with non‐AEDs, there were 6 AEDs with risk estimates greater than 20. Increased awareness of this risk among both prescribers and patients, particularly variations in risk among different AEDs, along with education on early recognition of SJS/TEN signs/symptoms, may help mitigate the number and severity of these adverse events

DEPRESSION AFTER HIP FRACTURE

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/66299/1/j.1532-5415.2006.01022.x.pd

EXercising with Computers in Later Life (EXCELL) - pilot and feasibility study of the acceptability of the Nintendo® WiiFit in community-dwelling fallers

Peer reviewedPublisher PD

Effects of exercise interventions on physical function, mobility, frailty status and strength in the pre-frail population: A review of the evidence base for practice

Background: Frailty is associated with reduced functional ability. Pre-frail individuals are at increased risk of becoming frail and are more likely to transition back to a robust state than frail individuals. Exercise has been reported to have beneficial effects on physical function in combined pre-frail and frail populations. This review identified the need to investigate the pre-frail population in isolation. Objectives: To investigate the effects of exercise interventions on physical function, mobility, frailty status and strength in the pre-frail population, and to support the role of physiotherapy in the management of pre-frailty. Data Sources: The electronic databases AMED, CINAHL Complete, MEDLINE with Full Text and PubMed were searched using terms related to pre-frailty, exercise, strength, mobility and function. Results: The search yielded 456 articles. Seven RCTs and two NRSs were eligible and methodological quality varied from good to poor. Interventions included combinations of strengthening, balance, functional, mobility, power and wii-fit exercises. Conclusions: Exercise is an effective intervention to improve physical outcomes and potentially delay or reverse frailty in the pre-frail population. Further high quality research is required to support the recommendations made by this review

Chinese Consensus on Diagnosis and Assessment of Sleep Apnea Syndrome in Older Adults

It is a necessary trend to improve the quality of life of rapidly increasing number of older adults. Sleep disorders are significantly associated with the quality of life in older adults, among which sleep apnea syndrome (SAS) is second only to insomnia, which is an inducer of multiple diseases, and directly associated with many chronic diseases, such as cardiovascular and cerebrovascular diseases, Alzheimer's disease, metabolic abnormalities, respiratory diseases, even leads to sudden death. So SAS in older adults should be given great attention by the whole society. With this in mind, the Chinese Association of Geriatric Sleep Medicine, Chinese Geriatrics Society invited Chinese sleep medicine experts to develop a consensus on the classification, risk factors, clinical symptoms, diagnosis and assessment methods, diagnostic procedures as well as complications of SAS in older adults based on a review of relevant clinical studies, aiming to provide a reference for the standardization of SAS diagnosis and assessment in China

An Effective Community–Academic Partnership to Extend the Reach of Screenings for Fall Risk

Older adults should be screened for fall risk annually. Community providers (people without formal medical training who work with older adults in senior centers or aging services) may be a viable group to expand the reach of screenings. Our community–academic partnership developed a program to increase and assess fall risk screenings by community providers. Community sites hosted training workshops and screening events. Community screenings were well attended and received by providers and older adults. With administrative support from the regional fall prevention coalition and technical support from academia, community providers screened 161 older adults from a broad geographic area. Twenty-one community providers completed the training. Knowledge and confidence surveys demonstrated improvements before and after training (P < .001). Skills assessments demonstrated mastery of most skills, but some providers required additional training. Provider feedback indicated screening procedures were complex. Future projects will examine this model using simplified screening procedures

How Different are VA Nursing Home Residents?

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/111110/1/j.1532-5415.1993.tb06458.x.pd

Characteristics of outdoor falls among older people: A qualitative study

Background Falls are a major threat to older people’s health and wellbeing. Approximately half of falls occur in outdoor environments but little is known about the circumstances in which they occur. We conducted a qualitative study to explore older people’s experiences of outdoor falls to develop understanding of how they may be prevented. Methods We conducted nine focus groups across the UK (England, Wales, and Scotland). Our sample was from urban and rural settings and different environmental landscapes. Participants were aged 65+ and had at least one outdoor fall in the past year. We analysed the data using framework and content analyses. Results Forty-four adults aged 65 – 92 took part and reported their experience of 88 outdoor falls. Outdoor falls occurred in a variety of contexts, though reports suggested the following scenarios may have been more frequent: when crossing a road, in a familiar area, when bystanders were around, and with an unreported or unknown attribution. Most frequently, falls resulted in either minor or moderate injury, feeling embarrassed at the time of the fall, and anxiety about falling again. Ten falls resulted in fracture, but no strong pattern emerged in regard to the contexts of these falls. Anxiety about falling again appeared more prevalent among those that fell in urban settings and who made more visits into their neighbourhood in a typical week. Conclusions This exploratory study has highlighted several aspects of the outdoor environment that may represent risk factors for outdoor falls and associated fear of falling. Health professionals are recommended to consider outdoor environments as well as the home setting when working to prevent falls and increase mobility among older people