Roger Briggs

A Comparative Study of the Use of Four Fall Risk Assessment Tools on Acute Medical Wards

Objectives: To compare the effectiveness of four falls risk assessment tools (STRATIFY, Downton, Tullamore, and Tinetti) by using them simultaneously in the same environment. Design: Prospective, open, observational study. Setting: Two acute medical wards admitting predominantly older patients. Participants: One hundred thirty-five patients, 86 female, mean age±standard deviation 83.8±8.01 (range 56–100). Measurements: A single clinician prospectively completed the four falls risk assessment tools. The extent of completion and time to complete each tool was recorded. Patients were followed until discharge, noting the occurrence of falls. The sensitivity, specificity, negative predictive accuracy, positive predictive accuracy, and total predictive accuracy were calculated. Results: The number of patients that the STRATIFY correctly identified (n=90) was significantly higher than the Downton (n=46; P<.001), Tullamore (n=66; P=.005), or Tinetti (n=52; P<.001) tools, but the STRATIFY had the poorest sensitivity (68.2%). The STRATIFY was also the only tool that could be fully completed in all patients (n=135), compared with the Downton (n=130; P=.06), Tullamore (n=130; P=.06), and Tinetti (n=17; P<.001). The time required to complete the STRATIFY tool (average 3.85 minutes) was significantly less than for the Downton (6.34 minutes; P<.001), Tinetti (7.4 minutes; P<.001), and Tullamore (6.25 minutes; P<.001). The Kaplan-Meier test showed that the STRATIFY (log rank P=.001) and Tullamore tools (log rank P<.001) were effective at predicting falls over the first week of admission. The Downton (log rank P=.46) and Tinetti tools (log rank P=.41) did not demonstrate this characteristic. Conclusion: Significant differences were identified in the performance and complexity between the four risk assessment tools studied. The STRATIFY tool was the shortest and easiest to complete and had the highest predictive value but the lowest sensitivity.Objectives: To compare the effectiveness of four falls risk assessment tools (STRATIFY, Downton, Tullamore, and Tinetti) by using them simultaneously in the same environment.

Regional distribution of pre- and postsynaptic glutamatergic function in Alzheimer's disease

Ca2+/Cl- -independent L-[3H]glutamate- and sodium-dependent D-[3H]aspartate binding assays were used to assess the integrity of N-methyl-D-aspartate (NMDA) receptors and glutamate uptake sites in a number of areas from control and Alzheimers diseased brain. NMDA receptor densities were unchanged in all areas tested. In contrast, significant reductions in the number of glutamate terminals were seen in the hippocampus of the Alzheimers samples. A smaller reduction was seen in the caudate nucleus but this failed to reach significance. No such reductions were seen in either the frontal or parietal cortices.

Presynaptic and postsynaptic glutamatergic function in Alzheimer's disease

Sodium dependent D-aspartate and Ca2+/Cl-independent L-glutamate binding assays were used to assess the integrity of glutamate uptake sites and postsynaptic NMDA receptor levels in control and Alzheimers disease temporal cortex. The number of glutamate uptake sites was significantly and substantially reduced in accordance with previous findings. However, NMDA receptor levels were unchanged. This finding suggests that glutamatergic presynaptic elements are severely reduced in Alzheimers disease, whilst postsynaptic elements remain intact.

The effect of changing practice on fall prevention in a rehabilitative hospital: the Hospital Injury Prevention Study.

Objectives: To determine whether a change in practice to introduce a multidisciplinary fall‐prevention program can reduce falls and injury in nonacute patients in a rehabilitation hospital.

Mobility and dementia: is physiotherapy treatment during respite care effective?

Mobility problems experienced by elderly people with a dementia are associated with falls, fractures and admission to long‐term care. A hospital respite care admission is therefore often seen as an opportunity to provide physiotherapy treatment.

Serum ovalbumin‐specific immunoglobulin G responses during pregnancy reflect maternal intake of dietary egg and relate to the development of allergy in early infancy

Background The value of allergen elimination diets during pregnancy for primary prevention of infant allergy has been questioned. However, dietary compliance may influence effectiveness.

Characterisation, density, and distribution of kainate receptors in normal and Alzheimer's diseased human brain

Abstract: The specific binding of [3H]kainic acid was investigated in membrane preparations from human parietal cortex obtained postmortem. Saturation studies revealed that binding occurred to a single population of sites with a KD of 15 nM and a Bmax of 110 fmol/mg of protein. The kinetically determined dissociation constant for these sites agreed well with that obtained from saturation analyses. Pharmacological characterisation of these sites gave a profile consistent with those reported for kainate receptor sites in animal brain. The integrity of kainate receptors was studied in several brain regions from six patients who had died of Alzheimers disease and from six closely matched control subjects. No change in either the affinity or the number of kainate receptors was seen in any of the regions studied, despite the loss of neo‐cortical and hippocampal glutamatergic terminals in the Alzheimers diseased brains, as previously reported.

Muscarinic agonist receptor subtypes in aging rat brain

Whole brain homogenates from rats aged 6 months (young) and 24 months (old) showed a decline with age of the pre-synaptic cholinergic marker, choline acetyltransferase, and also of total specific binding sites for the muscarinic antagonist L(-)quinuclidinyl benzilate (L-QNB). However, neither the proportion nor the inhibition constants of high and low affinity muscarinic agonist binding sites (defined by displacement of L-QNB binding with carbachol) changed with age. These findings may be relevant to the central cholinergic deficit reported to be associated with cognitive impairment in aging man.

Do all systems age together

Background: Aging changes in different body system are well described, but few studies have considered the relationship between them. Objective: The purpose of this study was, therefore, to investigate the interrelationships between markers of aging in different parts of the body. Methods: A cross-sectional study design was used. Structural and functional markers of aging were measured in a number of different body systems. Results: Conditional independence analysis demonstrated that the aging markers selected clustered into two groups, either related to chronological age or adult height. Visual acuity, lens opacity, hearing threshold, cognitive decline, and the number of teeth were associated with age, while systolic blood pressure and skin thickness were related to height. Grip strength was associated with both. Conclusions: The differential associations of the aging markers with chronological age and adult height suggest that different systems do not age together. This may have relevance for understanding what underlies aging, and these preliminary findings now require replication in other aging cohorts.

Heterogeneity of NMDA receptors labelled with [3H]3-((±)-2-carboxypiperazin-4-yl)propyl-1-phosphonic acid ([3H]CPP): receptor status in Alzheimer's disease brains

The binding of [3H]3-(2-carboxypiperazin-4-yl)propyl-1-phosphonic acid ([3H]CPP) was studied in rat and human brain synaptic membranes. Specific binding was saturable, reversible and inhibited by a range of compounds active at N-methyl-D-aspartate (NMDA) receptors such as 2-amino-5-phosphonopentanoate (AP5), 2-amino-7-phosphonoheptanoate (AP7), NMDA and cis-2,4-methanoglutamate. Binding was heterogeneous as evidenced by non-linear Scatchard plots and Hill coefficients for binding inhibitors significantly different from unity. LIGAND analysis of the binding data indicated the likely presence of two distinct binding components for CPP, one of high (Kd values approx. = 70 nM) and the other of low (Kd values approx. 5 microM) affinity. Possible alterations in the binding of [3H]CPP to either site were investigated in medial frontal and medial temporal cortex from Alzheimers disease brains and compared with control tissues, carefully matched for age and postmortem delay. While there were considerable inter-individual variations in binding, no significant differences were detected either between brain regions in either Alzheimer or control subjects, or between Alzheimers disease and control brains. These data suggest the presence of at least two components of [3H]CPP binding in both rat and human brain tissue. The integrity of neither of these components is altered in Alzheimers disease, consistent with a lack of gross alterations of NMDA receptors in this disorder.