Management and outcomes of delirious patients with hyperactive symptoms in a secured behavioral unit jointly used by geriatricians and pyschogeriatricians

To compare the clinical outcomes and length of stay (LOS) between delirious patients with hyperactive symptoms admitted directly and those admitted indirectly from Emergency Department into a secured, behavioral unit jointly used by geriatricians and pyschogeriatricians (the Unit). A retrospective study analyzing data from the medical records of 122 patients with an admission diagnosis of delirium with hyperactive symptoms and subsequently discharged from the Unit, including restraint, one-to-one nursing care, falls, absconding, duration of delirium, recovery from delirium, destination and LOS. Significantly fewer patients with direct admission (n= 68) required physical restraint or chemical restraint compared with those transferred (n= 54). Patients admitted directly showed a higher discharge rate back home, shorter LOS, shorter duration of delirium and a higher rate of recovery from delirium than transferred patients. Of the transferred patients, more received one-to-one nursing care before transfer than after transfer. Three (5.6%) absconded before transfer, but none absconded from the Unit. The falls rate reduced from 14.2 to 6.7 falls/1000 patient delirium days after transfer. Delirious patients with hyperactive symptoms admitted directly to the Unit fared better in clinical outcomes and LOS. They also required less restraint, less intensive nursing and were unlikely to abscond compared to those transferred

Hip protector compliance in an acute hospital setting

Objectives. To examine compliance for a newly designed hip protector and reasons for non-compliance among elderly participants with a moderate-to-high risk of falls. Methods. This was a descriptive observational study conducted in acute aged care wards at the Bankstown Hospital, Sydney, Australia. Seventeen in-patients aged between 71 and 95 years in the four aged care wards at the Bankstown Hospital were recruited to wear the protectors. Twelve (71%) patients had fallen at least once in the last year, whilst all of them were assessed as being at moderate-to-high risk of falling (according to the Falls Risk Assessment tool). Results. Seventeen participants completed the study. The compliance rate was 72%. Three major reasons for non-compliance were: deterioration in medical condition (n=6), issue with laundering of hip protectors (n=4), and discomfort (n=3). Conclusion. Hip protectors are well-tolerated by elderly patients at high risk of falls in a hospital setting. Targeting the reasons for noncompliance may improve compliance. Further robust studies are required to verify if the high compliance rate could be maintained in the long-term, and efficacy of hip protectors in fracture reduction

A Prospective Review of Hip Fracture Subtypes, Surgical Procedure, Cognitive Status, and Analgesia Use Across 4 Australian Hospitals

Objectives: To correlate analgesia use among patients with hip fracture requiring surgery with hip fracture subtype, cognitive status, and type of surgery in the postacute period. Design and Participants: Prospective review of patients with hip fractures requiring surgical intervention. A total of 415 patients (mean age: 81.2 ± 9.1 years, 74.3% women) presented with 195 subcapital fractures (39 undisplaced, 156 displaced) and 220 trochanteric fractures (136 stable, 84 unstable) requiring surgery. Setting: Inpatient orthopedic units in 4 Australian hospitals. Measurements: The primary outcome measures were mean analgesia usage (oral morphine equivalent) for 4 defined time intervals and total amount 36 hours following surgery. Results: Patients with subtrochanteric fractures required more analgesia compared with displaced-subcapital, undisplaced-subcapital, basicervical, stable-pertrochanteric, and unstable-pertrochanteric fractures in the 24 to 36 hours following operation (24.7 vs 11.3 vs 8.8 vs 12.1 vs 7.6 vs 9.7, P = .001). Total analgesia requirements were higher in patients treated with an intramedullary nail, increasing by 1.3- to 3.3-fold in the 36 hours postsurgery. Patients with cognitive impairment utilized markedly less analgesia at all time periods measured. At 24 to 36 hours, higher levels of analgesia were noted in patients with higher premorbid level of mobility ( P = .015) and activities of daily living function ( P = .007). Conclusion: Important differences in utilization of analgesia following hip fracture across readily defined clinical groups exist. Proactive pain management for those with cognitive impairment, certain hip fracture subtypes, and surgical procedures may enable early functional mobility and other activities

Dangerously empty? Hegemony and the construction of the Irish entrepreneur

In this paper we build on Jones and Spicer\u27s (2009) conceptualisation of the entrepreneur as an empty signifier. We explore the function of the signifier \u27entrepreneurship\u27 within a social context marked by crisis: Ireland 2007 to 2010. In doing so, we show how its articulation by government acted to legitimise the continuation of market logics and, relatedly, the existing political status quo. Theoretically, we demonstrate the usefulness of Laclau and Mouffe\u27s conception of hegemony, which shares a Lacanian legacy with Jones and Spicer. This helps us to understand the contradictory nature of the signifier of the entrepreneur in Irish political and social discourse, along with its relationship to the reproduction of political hegemony

Twelve-Month Outcomes of the AFFINITY Trial of Fluoxetine for Functional Recovery After Acute Stroke: AFFINITY Trial Steering Committee on Behalf of the AFFINITY Trial Collaboration

Background and Purpose: The AFFINITY trial (Assessment of Fluoxetine in Stroke Recovery) reported that oral fluoxetine 20 mg daily for 6 months after acute stroke did not improve functional outcome and increased the risk of falls, bone fractures, and seizures. After trial medication was ceased at 6 months, survivors were followed to 12 months post-randomization. This preplanned secondary analysis aimed to determine any sustained or delayed effects of fluoxetine at 12 months post-randomization. Methods: AFFINITY was a randomized, parallel-group, double-blind, placebo-controlled trial in adults (n=1280) with a clinical diagnosis of stroke in the previous 2 to 15 days and persisting neurological deficit who were recruited at 43 hospital stroke units in Australia (n=29), New Zealand (4), and Vietnam (10) between 2013 and 2019. Participants were randomized to oral fluoxetine 20 mg once daily (n=642) or matching placebo (n=638) for 6 months and followed until 12 months after randomization. The primary outcome was function, measured by the modified Rankin Scale, at 6 months. Secondary outcomes for these analyses included measures of the modified Rankin Scale, mood, cognition, overall health status, fatigue, health-related quality of life, and safety at 12 months. Results: Adherence to trial medication was for a mean 167 (SD 48) days and similar between randomized groups. At 12 months, the distribution of modified Rankin Scale categories was similar in the fluoxetine and placebo groups (adjusted common odds ratio, 0.93 [95% CI, 0.76–1.14]; P =0.46). Compared with placebo, patients allocated fluoxetine had fewer recurrent ischemic strokes (14 [2.18%] versus 29 [4.55%]; P =0.02), and no longer had significantly more falls (27 [4.21%] versus 15 [2.35%]; P =0.08), bone fractures (23 [3.58%] versus 11 [1.72%]; P =0.05), or seizures (11 [1.71%] versus 8 [1.25%]; P =0.64) at 12 months. Conclusions: Fluoxetine 20 mg daily for 6 months after acute stroke had no delayed or sustained effect on functional outcome, falls, bone fractures, or seizures at 12 months poststroke. The lower rate of recurrent ischemic stroke in the fluoxetine group is most likely a chance finding. REGISTRATION: URL: http://www.anzctr.org.au/ ; Unique identifier: ACTRN12611000774921