Inappropriate prescribing in hospitalized elderly patients

Inappropriate prescribing (IP) is a major healthcare problem in elderly patients. The risk of this problem increases during hospitalization. This is due to increase morbidity and thus increases the use of medications by the inpatients. This study will clarify the problem of IP for elderly people during hospitalization and will identify the different types of it. It also will highlight some tools that are used to assess the different types of IP and the prevalence of it in elderly patients during hospitalization. Finally, the study will address the consequences of IP in the elderly inpatients and the risks associated with the use of some potentially inappropriate medications (PIMs) in the elderly.

Spin-orbit coupling and phase-coherence in InAs nanowires

We investigated the magnetotransport of InAs nanowires grown by selective area metal-organic vapor phase epitaxy. In the temperature range between 0.5 and 30 K reproducible fluctuations in the conductance upon variation of the magnetic field or the back-gate voltage are observed, which are attributed to electron interference effects in small disordered conductors. From the correlation field of the magnetoconductance fluctuations the phase-coherence length l_phi is determined. At the lowest temperatures l_phi is found to be at least 300 nm, while for temperatures exceeding 2 K a monotonous decrease of l_phi with temperature is observed. A direct observation of the weak antilocalization effect indicating the presence of spin-orbit coupling is masked by the strong magnetoconductance fluctuations. However, by averaging the magnetoconductance over a range of gate voltages a clear peak in the magnetoconductance due to the weak antilocalization effect was resolved. By comparison of the experimental data to simulations based on a recursive two-dimensional Green's function approach a spin-orbit scattering length of approximately 70 nm was extracted, indicating the presence of strong spin-orbit coupling.Comment: 8 pages, 7 figure

Development of a new assessment tool for cervical myelopathy using hand-tracking sensor: Part 2: normative values

Purpose To set a baseline measurement of the number of hand flexion–extension cycles and analyse the degree of motion in young healthy individuals, measured by leap motion controller (LMC), besides describing gender and dominant hand differences. Methods Fifty healthy participants were asked to fully grip-and-release their dominant hand as rapidly as possible for a maximum of 3 min or until subjects fatigued, while wearing a non-metal wrist splint. Participants also performed a 15-s grip-and-release test. An assessor blindly counted the frequency of grip-and-release cycles and magnitude of motion from the LMC data. Results The mean number of the 15-s G–R cycles recorded by LMC was: 47.7 ± 6.5 (test 1, LMC); and 50.2 ± 6.5 (test 2, LMC). In the 3-min test, the total number of hand flexion–extension cycles and the degree of motion decreased as the person fatigued. However, the decline in frequency preceded that of motion’s magnitude. The mean frequency of cycles per 10-s interval decreased from 35.4 to 26.6 over the 3 min. Participants reached fatigue from 59.38 s; 43 participants were able to complete the 3-min test. Conclusions Normative values of the frequency of cycles and extent of motion for young healthy individuals, aged 18–35 years, are provided. Future work is needed to establish values in a wider age range and in a clinical setting

Complex and unexpected dynamics in simple genetic regulatory networks

Peer reviewedPublisher PD

Role of Caustic Addition in Bitumen-Clay Interactions

Coating of bitumen by clays, known as slime coating, is detrimental to bitumen recovery from oil sands using the warm slurry extn. process. Sodium hydroxide (caustic) is added to the extn. process to balance many competing processing challenges, which include undesirable slime coating. The current research aims at understanding the role of caustic addn. in controlling interactions of bitumen with various types of model clays. The interaction potential was studied by quartz crystal microbalance with dissipation monitoring (QCM-D). After confirming the slime coating potential of montmorillonite clays on bitumen in the presence of calcium ions, the interaction of kaolinite and illite with bitumen was studied. To represent more closely the industrial applications, tailings water from bitumen extn. tests at different caustic dosage was used. At caustic dosage up to 0.5 wt % oil sands ore, a negligible coating of kaolinite on the bitumen was detd. However, at a lower level of caustic addn., illite was shown to attach to the bitumen, with the interaction potential decreasing with increasing caustic dosage. Increasing concn. of humic acids as a result of increasing caustic dosage was identified to limit the interaction potential of illite with bitumen. This fundamental study clearly shows that the crit. role of caustics in modulating interactions of clays with bitumen depends upon the type of clays. Thus, clay type was identified as a key operational variable

Medication errors in the Middle East countries: a systematic review of the literature

Background: Medication errors are a significant global concern and can cause serious medical consequences for patients. Little is known about medication errors in Middle Eastern countries. The objectives of this systematic review were to review studies of the incidence and types of medication errors in Middle Eastern countries and to identify the main contributory factors involved. Methods: A systematic review of the literature related to medication errors in Middle Eastern countries was conducted in October 2011 using the following databases: Embase, Medline, Pubmed, the British Nursing Index and the Cumulative Index to Nursing & Allied Health Literature. The search strategy included all ages and languages. Inclusion criteria were that the studies assessed or discussed the incidence of medication errors and contributory factors to medication errors during the medication treatment process in adults or in children. Results: Forty-five studies from 10 of the 15 Middle Eastern countries met the inclusion criteria. Nine (20%) studies focused on medication errors in paediatric patients. Twenty-one focused on prescribing errors, 11 measured administration errors, 12 were interventional studies and one assessed transcribing errors. Dispensing and documentation errors were inadequately evaluated. Error rates varied from 7.1% to 90.5% for prescribing and from 9.4% to 80% for administration. The most common types of prescribing errors reported were incorrect dose (with an incidence rate from 0.15% to 34.8% of prescriptions), wrong frequency and wrong strength. Computerised physician rder entry and clinical pharmacist input were the main interventions evaluated. Poor knowledge of medicines was identified as a contributory factor for errors by both doctors (prescribers) and nurses (when administering drugs). Most studies did not assess the clinical severity of the medication errors. Conclusion: Studies related to medication errors in the Middle Eastern countries were relatively few in number and of poor quality. Educational programmes on drug therapy for doctors and nurses are urgently needed

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Pious Entertainment: Hizbullah's Islamic Cultural Sphere

Alagha’s chapter on Hezbollah’s Islamic cultural sphere is sure to generate some of the most interesting discussion. Lebanon and Hezbollah in particular are among the hottest topics in the studies of contemporary Islam, but few people actually have the appropriate levels of both access to and understanding of Hezbollah areas and personalities to do an adequate job of analyzing the ever growing body of cultural production the movement generates. As important is the demonstrable ease with which he can enter into the theological debates surrounding the lawfulness of music, bringing the expertise of an Islamologist to a discussion often dominated by cultural studies scholars who don’t have such a depth of knowledge. His discussion of the transition from al-hala al-Islamiyya [Islamic religio-political sphere] to al-saha al-Islamiyya [Islamic cultural sphere] are extremely important and exciting, particularly since his sources include the highest echelons of Hezbollah’s leadership… Finally, his discussion of how leading Shi‘i thinkers have declared that cultural production has to be central to the construction of revolution has far-reaching implications that most scholars in the field have yet to consider… If Alagha’s chapter shows how Shi‘i thinking is at the forefront of the changing Islamic attitude towards music… it points to the very different ways that Hezbollah conceives of both culture and the role of religion in public life