Evaluation of Medication Risks for Falls on an Inpatient Medical/Surgical Unit

Purpose: Patient falls during hospitalization can delay discharge and decrease quality of life. Medications are one factor that can impact fall risk. This study examines patients who fell while admitted to a cardiac surgery unit to identify which high-risk medications are most prevalent to promote patient safety. Methods: This was a retrospective case control study. Adult patients over the age of 18 were included. Exclusion criteria included pediatric patients and those with an intentional fall event. A total of 39 falls and 78 controls were analyzed in the study. The primary outcome was a fall event during hospitalization. Other variables included medications, time of medication administration, and risk factors. Results: The medications significantly more common in patients who fell include morphine (31% vs. 6%, p=0.001), insulin glargine (28% vs. 12%, p=0.011), amlodipine (23% vs. 10%, p=0.0495), hydralazine (23% vs. 8%, p=0.036), isosorbide mononitrate (21% vs. 5%, p=0.02), lorazepam (21% vs. 1%, p Conclusion: Cardiac surgery patients are exposed to multiple high-risk medications. Benzodiazepines and potent analgesics may increase fall risk and should be closely monitored. Further work is warranted to examine the clinical impact of these results in larger patient populations

Does turmeric relieve inflammatory conditions?

Limited evidence suggests that turmeric and its active compound, curcumin, are effective for rheumatoid arthritis and other inflammatory conditions (strength of recommendation [SOR]: C, primarily low-quality cohort studies with small patient numbers). Curcumin has shown limited benefit for patients with psoriasis, inflammatory bowel disease (IBS), inflammatory eye diseases, familial adenomatous polyposis, and kidney transplantation (SOR: B, small, short randomized controlled trials [RCTs]). No evidence indicates that curcumin helps patients with human immunodeficiency virus (HIV) (SOR: B, single RCT)

What screening tests should you use to evaluate a man with low testosterone?

Obtain a repeat morning testosterone level, as well as levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), and prolactin to help understand the cause of low testosterone when there is a lack of adequate empiric evidence to guide evaluation, advise the experts. When low or normal FSH and LH levels accompany low testosterone, evaluation of the pituitary gland is recommended. Chromosomal studies are indicated in prepubertal males with low testosterone and elevated FSH and LH levels to assess for Klinefelter syndrome. Perform a semen analysis if fertility is an issue. Bone densitometry is indicated in men with chronic hypogonadism to identify increased risk of hip fracture (strength of all recommendations: C, consensus guidelines and disease-oriented evidence)

What is the best approach to the evaluation of resting tachycardia for an adult?

The best evidence about the diagnostic evaluation of resting tachycardias in adults is currently outlined by practice guidelines. 1 Initial evaluation includes clinical history, physical examination, and 12-lead electrocardiogram (ECG). If the initial evaluation suggests a sinus tachycardia with narrow QRS complexes and no identifiable secondary cause, a 24-hour Holter monitor is usually recommended (strength of recommendation: C, based on expert opinion)

Which tests are the most useful for diagnosing PID?

No single test has adequate sensitivity and specificity to reliably identify pelvic inflammatory disease (PID) and thus help to spare women serious sequelae, including infertility (strength of recommendation [SOR]: B, based on systematic reviews of cohort studies and individual cohort studies)

Narrative through texture: shaping sound through abstract painting in my practice of ambient music

In an aesthetic of ambient music, this research investigates the creation of musical narrative through texture. The author finds varying results by experimenting with two ways of shaping sound; shaping sound with the use of controllers and designing sound through the aid of abstract paintings. This research focuses on the collaboration with Dutch painter Martijn den Ouden. The author discovers meaningful similarities between den Ouden’s abstract paintings and his music and derives novel compositional ideas from strategies in musical mapping. These ideas are explored in the accompanying album Expired Sceneries, a collection of four pieces, each relating to one of the paintings. The strategies involved in the process of composing this album are discussed and evaluated in this submission with the help of audio examples

Angiotensin blockade for diabetes: Monitor microalbuminuria?

No studies address whether continued screening for microalbuminuria once a patient is taking an angiotensin-converting enzyme (ACE) inhibitor or angiotensin-2 receptor blocker (ARB) improves outcomes. Indirect evidence and expert opinion suggest that it may be beneficial to continue microalbuminuria surveillance to assess response to therapy and monitor disease progression (strength of recommendation: C, based on expert opinion)

What are contraindications to IUDs?

Based on limited evidence, use of intrauterine devices (IUDs) is not contraindicated for women with HIV/AIDS (strength of recommendation [SOR]: C), multiple sexual partners (SOR: C), previous actinomyces colonization (SOR: C), most types of fibroids (SOR: C), or previous ectopic pregnancy (SOR: C). The risk to IUD users of pelvic inflammatory disease (PID) is similar to women using no contraception (SOR: B). Nulliparous women may experience increased insertion discomfort and higher rates of expulsion (SOR: B). IUD use of <3.5 years is not associated with decreased fertility (SOR: B)

What is the appropriate evaluation and treatment of children who are "toe walkers"?

The evaluation of toe-walking focuses on differentiating normal children from those with mild cerebral palsy. Gait analysis may be a useful diagnostic tool, but further investigation is needed to confirm its reliability (strength of recommendation [SOR]: C, based on case series). Observation alone is generally as successful as serial casting and surgery in decreasing the frequency of toe-walking at follow-up (SOR: C, based on case series)

Are any alternative therapies effective in treating asthma?

Yes, some are. Acupuncture relieves subjective symptoms of asthma and reduces medication use in mild to moderate asthma (strength of recommendation [SOR]: A, based on systematic review of randomized controlled trials [RCTs] of variable quality). Herbal medications, such as Ginkgo biloba, appear to improve lung function, while herbs such as Tylophora indica and Tsumura saiboku-to may decrease asthma symptoms (SOR: B, based on systematic review of RCTs with poor methodology). No evidence, however, supports the use of room air ionizers, manual therapy, homeopathy, or mind-body therapy for treatment of asthma (SOR: A, based on systematic reviews and meta-analyses of RCTs and individual RCTs)