In-hospital adverse drug reactions in older adults; prevalence, presentation and associated drugs-a systematic review and meta-analysis
AGE AND AGEING
Authors: Jennings, Emma L. M.; Murphy, Kevin D.; Gallagher, Paul; O'Mahony, Denis
Abstract
Background: the prevalence of adverse drug reactions (ADRs) in hospitalised older patients, their clinical presentations, causative drugs, severity, preventability and measurable outcomes are unclear, ADRs being an increasing challenge to older patient safety. Methods: we systematically searched PubMed, Embase, EBSCO-CINAHL, the Cochrane Library, 'rey' literature and relevant systematic review bibliographies, published from database inception to March 2020. We included any study reporting occurrence of in-hospital ADRs as primary or secondary outcomes in hospitalised older adults (mean age >= 65 years). Two authors independently extracted relevant information and appraised studies for bias. Study characteristics, ADR clinical presentations, causative drugs, severity, preventability and clinical outcomes were analysed. Study estimates were pooled using random-effects meta-analytic models. Results: from 2,399 abstracts, we undertook full-text screening in 286, identifying 27 studies (29 papers). Final analysis yielded a pooled ADR prevalence of 16% (95%CI 12-22%, I-2 98%,tau(2) 0.8585), in a population of 20,153 hospitalised patients aged >= 65 years of whom 2,479 patients experienced >= one ADR. ADR ascertainment was highly heterogeneous. Almost 48.3% of all ADRs involved five presentations: fluid/electrolyte disturbances (17.3%), gastrointestinal motility/defaecation disorders (13.3%), renal disorders (8.2%), hypotension/blood pressure dysregulation disorders/shock (5.5%) and delirium (4.1%). Four drug classes accounted for 57.8% of causative medications i.e. diuretics (19.8%), anti-bacterials (14.8%), antithrombotic agents (12.2%) and analgesics (10.9%). Pooled analysis of severity was not feasible. Four studies reported the majority of ADRs as preventable (55-95%). Conclusions: on average, 16% of hospitalised older patients experience significant ADRs, varying in severity and mostly preventable, with commonly prescribed drug classes accounting for most ADRs.
Further studies on the physics potential of an experiment using LHC neutrinos
JOURNAL OF PHYSICS G-NUCLEAR AND PARTICLE PHYSICS
Authors: Beni, N.; Brucoli, M.; Cafaro, V; Camporesi, T.; Cerutti, F.; Dallavalle, G. M.; Danzeca, S.; De Roeck, A.; De Rujula, A.; Fasanella, D.; Giordano, V; Guandalini, C.; Ioannisyan, A.; Lazic, D.; Margotti, A.; Lo Meo, S.; Navarria, F. L.; Patrizii, L.; Rovelli, T.; Sabate-Gilarte, M.; Sanchez Galan, F.; Santos Diaz, P.; Sirri, G.; Szillasi, Z.; Wulz, C-E
Abstract
We discuss an experiment to investigate neutrino physics at the LHC, with emphasis on tau flavour. As described in our previous paper Beni et al (2019 J. Phys. G: Nucl. Part. Phys. 46 115008), the detector can be installed in the decommissioned TI18 tunnel, approximate to 480 m downstream the ATLAS cavern, after the first bending dipoles of the LHC arc. The detector intercepts the intense neutrino flux, generated by the LHC beams colliding in IP1, at large pseudorapidity eta, where neutrino energies can exceed a TeV. This paper focuses on exploring the neutrino pseudorapity versus energy phase space available in TI18 in order to optimize the detector location and acceptance for neutrinos originating at the pp interaction point, in contrast to neutrinos from pion and kaon decays. The studies are based on the comparison of simulated pp collisions at root s = 13 TeV: PYTHIA events of heavy quark (c and b) production, compared to DPMJET minimum bias events (including charm) with produced particles traced through realistic LHC optics with FLUKA. Our studies favour a configuration where the detector is positioned off the beam axis, slightly above the ideal prolongation of the LHC beam from the straight section, covering 7.4 < eta < 9.2. In this configuration, the flux at high energies (0.5-1.5 TeV and beyond) is found to be dominated by neutrinos originating directly from IP1, mostly from charm decays, of which approximate to 50% are electron neutrinos and approximate to 5% are tau neutrinos. The contribution of pion and kaon decays to the muon neutrino flux is found small at those high energies. With 150 fb(-1) of delivered LHC luminosity in Run 3 the experiment can record a few thousand very high energy neutrino charged current (CC) interactions and over 50 tau neutrino CC events. These events provide useful information in view of a high statistics experiment at HL-LHC. The electron and muon neutrino samples can extend the knowledge of the charm PDF to a new region of x, which is dominated by theory uncertainties. The tau neutrino sample can provide first experience on reconstruction of tau neutrino events in a very boosted regime.