Increasing frailty is associated with higher prevalence and reduced recognition of delirium in older hospitalised inpatients: results of a multi-centre study

Purpose: Delirium is a neuropsychiatric disorder delineated by an acute change in cognition, attention, and consciousness. It is common, particularly in older adults, but poorly recognised. Frailty is the accumulation of deficits conferring an increased risk of adverse outcomes. We set out to determine how severity of frailty, as measured using the CFS, affected delirium rates, and recognition in hospitalised older people in the United Kingdom. Methods: Adults over 65 years were included in an observational multi-centre audit across UK hospitals, two prospective rounds, and one retrospective note review. Clinical Frailty Scale (CFS), delirium status, and 30-day outcomes were recorded. Results: The overall prevalence of delirium was 16.3% (483). Patients with delirium were more frail than patients without delirium (median CFS 6 vs 4). The risk of delirium was greater with increasing frailty [OR 2.9 (1.8–4.6) in CFS 4 vs 1–3; OR 12.4 (6.2–24.5) in CFS 8 vs 1–3]. Higher CFS was associated with reduced recognition of delirium (OR of 0.7 (0.3–1.9) in CFS 4 compared to 0.2 (0.1–0.7) in CFS 8). These risks were both independent of age and dementia. Conclusion: We have demonstrated an incremental increase in risk of delirium with increasing frailty. This has important clinical implications, suggesting that frailty may provide a more nuanced measure of vulnerability to delirium and poor outcomes. However, the most frail patients are least likely to have their delirium diagnosed and there is a significant lack of research into the underlying pathophysiology of both of these common geriatric syndromes

Frailty in stroke

Stroke is predominantly a condition of older age. So, it seems sensible that specialists working in stroke services should understand the primary clinical syndrome of ageing—frailty. Recent studies have highlighted the prevalence of frailty in stroke and its associated poor outcomes, yet frailty does not feature prominently in stroke research, practice or policy. Frailty-informed stroke care may differ from the interventional management that dominates contemporary practice. However, this is not therapeutic nihilism. A person-centred approach ensures that every care decision is appropriate and based on a shared understanding of the person’s goals and likely prognosis. We present a primer on frailty in stroke, describing definition(s), epidemiology and prognostic implications. We discuss the challenges surrounding assessment and management of frailty in stroke units and offer practical guidance suitable for the stroke clinician

Stroke Literature Synopsis (Clinical)

No abstract available

An Exploratory Study of Learning Outcomes Literacy Regarding University Teachers: A Case Study of University of Education

Learning Outcome Literacy (LOL) is not only an imperative skill but a prime need to acquire competency in teaching. To make teaching effective and make its flow in the correct direction, LOs competency is indispensable as the whole teaching-learning process is dependent on LOs. The aim of this single “qualitative case study” was to investigate the ambiguity regarding LOs in the “institutions of higher education” and the “University of Education” was selected as a single case for the exploration. Objectives of the study were: to find out the perception of university teachers regarding their knowledge about learning outcomes and to find out the perception of university teachers regarding their understanding of learning outcomes to enable students to attain these LOs. The sample of the study comprised of content teachers of the University of Education, Township Campus, Lahore. Through a purposive sampling method, 12 teachers were carefully chosen. The data of the study was collected through “semi-structured interviews”. The thematic analysis technique was used to analyze the qualitative data. The findings of the study revealed that the University of Education Content Teachers had insufficient knowledge of Learning Outcomes (LO) and were misapprehending Learning Outcomes to enable learners to attain these LOs. In light of the study results, it was concluded that content teachers of the University of Education did not possess the Learning Outcomes Literacy (LOL). Both objectives were interconnected in a way that if someone didn’t have knowledge of LOs he/she could not have an understanding of LOs for students’ attainment. So, the case study concluded that the teachers were not sufficiently literate about LOs

Untapped potential of food waste derived biochar for the removal of heavy metals from wastewater

: The presence of heavy metals in water pose a serious threat to both public and environmental health. However, the advances in the application of low cost biochar based adsorbent synthesize from various feedstocks plays an effective role in the of removal heavy metals from water. This study implies the introduction of novel method of converting food waste (FW) to biochar through pyrolysis, examine its physiochemical characteristics, and investigate its adsorption potential for the removal of heavy metals from water. The results revealed that biochar yield decreased from 18.4 % to 14.31 % with increase in pyrolysis temperature from 350 to 550 °C. Likewise, increase in the pyrolysis temperature also resulted in the increase in the ash content from 39.87 % to 42.05 % thus transforming the biochar into alkaline nature (pH 10.17). The structural and chemical compositions of biochar produced at various temperatures (350, 450, and 550 °C) showed a wide range of mineralogical composition, and changes in the concentration of surface functional groups. Similarly, the adsorption potential showed that all the produced biochar effectively removed the selected heavy metals from wastewater. However a slightly high removal capacity was observed for biochar produced at 550 °C that was credited to the alkaline nature, negatively charged biochar active sites due to O-containing functional groups and swelling behavior. The results also showed that the maximum adsorption was recorded at pH 8 at adsorbent dose of 2.5 g L-1 with the contact time of 120 min. To express the adsorption equilibrium, the results were subjected to Langmuir and Freundlich isotherms and correlation coefficient implies that the adsorption process follows the Freundlich adsorption isotherm. The findings of this study suggest the suitability of the novel FW derived biochar as an effective and low cost adsorbent for the removal of heavy metals form wastewater

Phenotypic and genotypic characterization of enteroaggregative Escherichia coli isolates from pediatric population in Pakistan.

Enteroaggregative Escherichia coli (EAEC) are a leading cause of diarrhea among children. The objective of this study was to define the frequency of EAEC among diarrheal children from flood-affected areas as well as sporadic cases, determine multidrug resistance, and evaluation of virulence using an in vivo model of pathogenesis. Stool samples were collected from 225 diarrheal children from 2010 to 2011 from flood-affected areas as well as from sporadic cases in Pakistan. Identified EAEC isolates were characterized by phylogrouping, antibiotic resistance patterns including the extended-spectrum beta lactamase spectrum, single nucleotide polymorphism detection in gyrA and parC, and virulence potential using wax worm, G. mellonella. A total of 35 (12.5%) confirmed EAEC isolates were identified among 225 E. coli isolates. EAEC isolates displayed high resistance to tetracycline, ampicillin, and cefaclor. A total of 34.28% were ESBL positive. Single nucleotide polymorphism detection revealed 37.14% and 68.57% isolates were positive for SNPs in gyrA (A660 -T660 ) and parC (C330 -T330 ), respectively. Phylogrouping revealed that B2 phylogroup was more prevalent among all EAEC isolates tested followed by D, A, B1, and non-typeable (NT). Infection of G. mellonella with EAEC showed that killing infective dose was 100% higher than E. coli DH5 alpha control. EAEC are prevalent among Pakistani children with diarrhea, they are highly resistant to antibiotics, and predominantly fall into B2 phylogroup. Epidemiologic surveillance of EAEC and other E. coli pathotypes is critical to assess not only the role of these pathogens in diarrheal disease but also to determine the extent of multidrug resistance among the population

Pharmacological interventions for sialorrhoea in people with Parkinson's disease: a systematic review and meta-analysis

Background/objectives: Sialorrhoea is a common non motor complication experienced by people with Parkinson's disease (PD). Despite its prevalence there is conflicting evidence on how to effectively treat it. Our aim was to establish the efficacy and safety outcomes of pharmacological interventions used to treat sialorrhoea in people with idiopathic PD. Methods: We registered and conducted a systematic review and meta-analysis (PROSPERO: CRD42016042470). We searched seven electronic databases from inception until July 2022. Quantitative synthesis was performed where data allowed using random effects models. Results: From 1374 records we included 13 studies (n = 405 participants). Studies were conducted in Europe, North America and China. There was marked heterogeneity in the interventions used, follow up times and outcome measures investigated. The main source of risk of bias identified was reporting bias. Five studies were included in the quantitative synthesis. Summary estimates showed administration of botulinum toxin significantly reduced saliva production, improved patient reported functional outcomes and was associated with an increase in adverse events. Conclusion: Sialorrhoea in PD is an important condition, but current data does not allow for strong recommendations on optimal pharmacological treatments. There is significant heterogeneity in outcomes measures used to evaluate the burden of sialorrhoea with lack of consensus on what constitutes clinically meaningful change. More research is required to better understand the underlying mechanism and potential treatments of sialorrhoea in idiopathic PD