Proton Pump Inhibitors: Are We Still Prescribing Them Without Valid Indications?

BackgroundEvidence from several Western studies has shown an alarmingly high and inappropriate rate of prescription of proton pump inhibitors (PPIs), which may be associated with increased healthcare costs and adverse outcomes. PPI prescribing patterns remain largely unknown in well- developed healthcare systems in Southeast Asia.AimsWe aimed to determine the prevalence of inappropriate prescription of PPI among elderly patients without documentation of valid indications, in a tertiary teaching hospital in Singapore.MethodsWe carried out a retrospective clinical records review of 150 elderly patients aged ≥65 years that had been admitted to two internal medicine wards between 25 May 2011 and 28 June 2011 to determine the appropriateness of indications for PPIs prescribed at hospital discharge. PPI indications were categorised as “valid”, “likely invalid”, and “probable” based on current clinical literature. Pre-admission and discharge prescriptions were reviewed to determine continuation of pre-admission and new PPI prescriptions at discharge. Data on clinical characteristics and concurrent use of ulcerogenic medications were collected.ResultsFrom a total of 150 patients, 80 (53 per cent) received prescriptions for PPIs. Of these, 65 (81.2 per cent) had no valid documented indications (i.e., the indication was classed as “likely invalid”); 10 (12.5 per cent) had valid indications; and in five cases (6.2 per cent) the indication was “probable”. The most common “likely invalid” indication was primary gastrointestinal bleeding prophylaxis (GIP) among low-dose aspirin users in 28 patients (43 per cent) of invalid PPI prescriptions.ConclusionInappropriate prescribing of PPIs without documented valid indications was prevalent among elderly patients at our tertiary teaching hospital in Singapore, providing evidence that shows a similar trend to PPI prescribing to data from Western countries

A Pilot Study on Nurse-Led Rounds: Preliminary Data on Patient Contact Time

IMPORTANCE OF THE STUDY. Ward rounding has been a historical clinical method of inter-professional collaboration to support inpatient care through the sharing of mental models by exchanging information and discussing plans of care, treatment goals, and discharge plans for the patient. The extant literature reports that rounds are frequently led by doctors with infrequent nurse-physician collaboration and patients’ interactions with doctors during ward rounds tend to be brief. OBJECTIVE. To explore the effects of nurse-led morning ward rounds on patient contact time. DESIGN. An ethnographic prospective observational study comparing nurse-led and physician-led rounds. SETTING. A General Medicine ward at the National University Hospital in Singapore. INTERVENTION. A pilot intervention of nurse-led ward rounds for one week in June 2014. In the pilot intervention, nurses used the SPICES mnemonic to present their patients’ conditions to the clinical teams during morning rounds. MEASURES AND ANALYSES. Two observers shadowed the clinical teams for 57 patients. The amount of time that the clinical teams spent at the bedside of each patient was recorded. RESULTS. The results showed that the average time spent with patients at the bedside was significantly longer for nurse-led rounds compared to physician-led rounds. Also, the average time spent with patients at the bedside trended down toward the end of the 2-hour morning round time for resident-led ward rounds but it remained relatively consistent with an upward trend near the end of the 2-hour morning round for nurse-led rounds. CONCLUSION. The preliminary data suggests that quality time spent with patients at the bedside during morning rounds may be improved by nurse-led rounds

Impact of Inpatient Care in Emergency Department on Outcomes: A Quasi-Experimental Cohort Study

BACKGROUND: Hospitals around the world are faced with the issue of boarders in emergency department (ED), patients marked for admission but with no available inpatient bed. Boarder status is known to be associated with delayed inpatient care and suboptimal outcomes. A new care delivery system was developed in our institution where boarders received full inpatient care from a designated medical team, acute medical team (AMT), while still residing at ED. The current study examines the impact of this AMT intervention on patient outcomes. METHODS: We conducted a retrospective quasi-experimental cohort study to analyze outcomes between the AMT intervention and conventional care in a 1250-bed acute care tertiary academic hospital in Singapore. Study participants included patients who received care from the AMT, a matched cohort of patients admitted directly to inpatient wards (non-AMT) and a sample of patients prior to the intervention (pre-AMT group). Primary outcomes were length of hospital stay (LOS), early discharges (within 24 h) and bed placement. Secondary outcomes included unplanned readmissions within 3 months, and patient’s bill size. χ2- and Mann-Whitney U tests were used to test for differences between the cohorts on dichotomous and continuous variables respectively. RESULTS: The sample comprised of 2279 patients (1092 in AMT, 1027 in non-AMT, and 160 in pre-AMT groups). Higher rates of early discharge (without significant differences in the readmission rates) and shorter LOS were noted for the AMT patients. They were also more likely to be admitted into a ward allocated to their discipline and had lower bill size compared to non AMT patients. CONCLUSIONS: The AMT intervention improved patient outcomes and resource utilization. This model was noted to be sustainable and provides a potential solution for hospitals’ ED boarders who face a gap in inpatient care during their crucial first few hours of admissions while waiting for an inpatient bed

Validation of the care transition measure in multi-ethnic South-East Asia in Singapore

10.1186/1472-6963-12-256BMC Health Services Research121

Covid-19 and Virtual Geriatric Care

10.1007/s12603-022-1755-2JOURNAL OF NUTRITION HEALTH & AGING263213-21

Slow Gait, Subjective Cognitive Decline and Motoric Cognitive Risk Syndrome: Prevalence and Associated Factors in Community Dwelling Older Adults

10.1007/s12603-020-1525-yJOURNAL OF NUTRITION HEALTH & AGING25148-5

The utility of brief cognitive tests for patients with type 2 diabetes mellitus: a systematic review

Background Type 2 diabetes mellitus (T2DM) is associated with an increased risk for mild cognitive impairment and dementia in both middle-aged and older individuals. Brief cognitive tests can potentially serve as a reliable and cost effective approach to detect for cognitive decrements in clinical practice. Objective This systematic review examined the utility of brief cognitive tests in studies with patients with T2DM. Method This systematic review was conducted according to guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. “PubMed,” “PsychINFO,” “ScienceDirect,” and “ProQuest” electronic databases were searched to identify articles published from January 1, 2005 to December 31, 2015. Results The search yielded 22 studies, with only 8 using brief tests as a cognitive screening tool, whereas the majority using these tests as a measure of global cognitive functions. In regard to cognitive screening studies, most had failed to fulfil the standard reporting of diagnostic test accuracy criteria such as Standards for Reporting of Diagnostic Accuracy for dementia and cognitive impairment. Moreover, few studies reported discriminant indices such as sensitivity, specificity, and positive and negative predictive values of brief cognitive tests in detecting cognitive impairment in patients with T2DM. Among studies which used brief cognitive tests as a measure of global cognitive function, patients with diabetes tended to perform worse than patients without diabetes. Processing speed appeared to be particularly impaired among patients with diabetes, therefore, measures of processing speed such as the Digit Symbol Substitution Test may add value to brief cognitive tests such as the Montreal Cognitive Assessment. Conclusions The Montreal Cognitive Assessment supplemented by the Digit Symbol Substitution Test indicate initial promise in screening for cognitive impairment in T2DM

The Montreal Cognitive Assessment is superior to the MiniMental State Examination in detecting patients at higher risk of dementia

10.1017/S1041610212001068International Psychogeriatrics24111749-1755INPS

Effect of a new longitudinal interprofessional geriatric medicine educational track on knowledge and attitude of medical students: A controlled cohort study

10.1111/jgs.13295Journal of the American Geriatrics Society633558-56

Evidence for inefficient contraction and abnormal mitochondrial activity in sarcopenia using magnetic resonance spectroscopy

Abstract Background Mitochondrial dysfunction has been implicated in sarcopenia. 31P magnetic resonance spectroscopy (MRS) enables non‐invasive measurement of adenosine triphosphate (ATP) synthesis rates to probe mitochondrial function. Here, we assessed muscle energetics in older sarcopenic and non‐sarcopenic men and compared with muscle biopsy‐derived markers of mitochondrial function. Methods Twenty Chinese men with sarcopenia (SARC, age = 73.1 ± 4.1 years) and 19 healthy aged and sex‐matched controls (CON, age = 70.3 ± 4.2 years) underwent assessment of strength, physical performance, and magnetic resonance imaging. Concentrations of phosphocreatine (PCr), ATP and inorganic phosphate (Pi) as well as muscle pH were measured at rest and during an interleaved rest–exercise protocol to probe muscle mitochondrial function. Results were compared to biopsy‐derived mitochondrial complex activity and expression to understand underlying metabolic perturbations. Results Despite matched muscle contractile power (strength/cross‐sectional area), the ATP contractile cost was higher in SARC compared with CON (low‐intensity exercise: 1.06 ± 0.59 vs. 0.57 ± 0.22, moderate: 0.93 ± 0.43 vs. 0.58 ± 0.68, high: 0.70 ± 0.57 vs. 0.43 ± 0.51 mmol L−1 min−1 bar−1 cm−2, P = 0.003, <0.0001 and <0.0001, respectively). Post‐exercise mitochondrial oxidative synthesis rates (a marker of mitochondrial function) tended to be longer in SARC but did not reach significance (17.3 ± 6.4 vs. 14.6 ± 6.5 mmol L−1 min−1, P = 0.2). However, relative increases in end‐exercise ADP in SARC (31.8 ± 9.9 vs. 24.0 ± 7.3 mmol L−1, P = 0.008) may have been a compensatory mechanism. Mitochondrial complex activity was found to be associated with exercise‐induced drops in PCr [citrate synthetase activity (CS), Spearman correlation rho = −0.42, P = 0.03] and end‐exercise ADP (complex III, rho = −0.52, P = 0.01; CS rho = −0.45, P = 0.02; SDH rho = −0.45, P = 0.03), with CS also being strongly associated with the PCr recovery rate following low intensity exercise (rho = −0.47, P = 0.02), and the cost of contraction at high intensity (rho = −0.54, P = 0.02). Interestingly, at high intensity, the fractional contribution of oxidative phosphorylation to exercise was correlated with activity in complex II (rho = 0.5, P = 0.03), CS (rho = 0.47, P = 0.02) and SDH (rho = 0.46, P = 0.03), linking increased mitochondrial complex activity with increased ability to generate energy through oxidative pathways. Conclusions This study used 31P MRS to assess ATP utilization and resynthesis in sarcopenic muscle and demonstrated abnormal increases in the energy cost during exercise and perturbed mitochondrial energetics in recovery. Associations between mitochondrial complex activity and the fractional contribution to energy requirement during exercise indicate increased ability to generate energy oxidatively in those with better mitochondrial complex activity