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Jagdish C Sharma

Publications and source records attributed to Jagdish C Sharma.

12 recordsLinked to original sources
PubMed2006

Cascade of levodopa dose and weight-related dyskinesia in Parkinson's disease (LD-WD-PD cascade).

We have studied a cohort of 220 Parkinson's disease (PD) patients for risk factors of developing new dyskinesia. Twenty-nine patients were noticed to have developed new dyskinesia at the second assessment. The dyskinetic patients received significantly higher maximum level daily dose of levodopa. These patients had lost weight during the course of the disease from 72+/-15 to 66+/-17kg, p=0.002. The dyskinetic patients received significantly higher daily dose of levodopa per kilogram body weight, 8.4+/-3.5mg/kg vs. 6.0+/-3.9mg, p=0.003. Weight-losers PD patients developed significantly more dyskinesia than non-weight losers-p=0.002. Logistic regression analysis revealed weight loss and daily levodopa dose per kilogram body weight to be the only significant factors for dyskinesia in addition to disease duration. There was a "dose response to developing dyskinesia" according to the increasing levodopa dose per kilogram body weight.

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PubMed2005

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.

Accidental Falls↗
PubMed2004

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. DESIGN: A quasi-experimental study. SETTING: Three geriatric wards with a similar design, equipment, staffing levels, and skill mix. PARTICIPANTS: Eight hundred twenty-five consecutive patients. INTERVENTION: The patients' fall-risk status was assessed using the Downton Score. Current practice was maintained on the two control wards (n=550). On the experimental ward (n=275), a fall-prevention program was introduced. A multidisciplinary team met weekly specifically to discuss patients' fall risk and formulate a targeted plan. Patients at risk were identified using wristbands; risk factors were corrected or environmental changes made to enhance safety. MEASUREMENTS: Primary outcomes were number of fallers, recurrent fallers, total falls, patients sustaining injury, and falls per occupied bed days. Secondary outcomes were place of discharge and mortality. RESULTS: Patients were matched for age and risk status. Control wards had proportionally more fallers (20.2% vs 14.2%: P=.033), patients sustaining injury (8.2% vs 4%: P=.025), and total number of falls (170 vs 72: P=.045). These results did not remain significant after controlling for differing length of stay. There was no reduction in recurrent fallers (6.4% vs 4.7%: P=.43) and no effect on place of discharge (home discharges; 57.5% vs 60.7%: P=.41) or mortality (15.3% vs 13.8%: P=.60). CONCLUSION: This study shows that falls might be reduced in a multidisciplinary fall-prevention program, but the results are not definitive because of the borderline significance achieved and the variable length of stay. More research on fall prevention in hospital is required, particularly as to what interventions, if any, are effective at reducing falls in this group of patients.

Accident Prevention↗
PubMed2004

Predictors for falls among hospital inpatients with impaired mobility.

Gait and balance disturbances have been shown to predispose to falls in hospital. We aimed to investigate the patient characteristics associated with an unsafe gait and to determine what features predispose to falling in this group of hospital inpatients. In a prospective open observational study we studied 825 patients admitted for rehabilitation following acute medical illness or a surgical procedure. The patient's gait was assessed with the 'get up and go' test and classified into one of four categories-normal; abnormal but safe with or without mobility aids; unsafe; or unable. 72.6% of patients were assessed as having an unsafe gait. The factors independently associated with an unsafe gait were confusion, abnormal lower limbs, hearing defects and the use of tranquillizers. Patients with an unsafe gait who fell were more likely than the non-fallers within the group to have had falls in the past (85.3% versus 73.8%) and to be confused (66.2% versus 34.1%). Patients with both these characteristics had a 37.5% chance of falling compared with 15.4% in patients with one and 11.2% in patients with none of these characteristics. The presence of confusion and a history of falls identifies those patients who are at greatest risk of falls. Such patients might be the focus of special efforts at falls prevention.

Accidental Falls↗
PubMed2003

Characteristics of early fallers on elderly patient rehabilitation wards.

BACKGROUND: falls are one of the most frequent complications on rehabilitation wards for elderly patients. OBJECTIVE: to study the characteristics of early and late fallers. DESIGN: prospective observational study with blinded end-point evaluation. SETTING: a non-acute geriatric hospital. SUBJECTS: 1025 consecutive patients admitted for rehabilitation following treatment for an acute illness. MAIN OUTCOME MEASURES: early/late fallers and time to first fall from admission. RESULTS: we identified 824 non-fallers and 201 fallers. Seventy seven (38.3%) fell during the first week. The incidence decreased progressively in subsequent weeks. Early fallers were more likely to have a past history of falls (P=0.0009), an unsafe gait (P=0.001), confusion (P<0.0001) and be admitted from medical wards (P=0.03). Patients admitted from orthopaedic wards having sustained a lower limb fracture were significantly less likely to have an early fall compared to all other patients (P=0.027). When compared to later fallers, early fallers were more likely to have a past history of falls (P=0.045). They were less likely to be admitted from an orthopaedic ward (P=0.01) or to have sustained a fracture of the lower limbs (P=0.002). Logistic regression analysis showed that a past history of falls, confusion and an unsafe gait were independent risk factors predisposing to early falls. The Kaplan-Meier survival analysis showed a significantly higher cumulative risk of falling associated with these characteristics. CONCLUSION: the initial week of patients' rehabilitation is associated with the greatest risk of falling. Early fallers can be predicted by easily identifiable characteristics. This highlights the need for early fall risk assessment.

Accidental Falls↗
PubMed2003

Evaluation of a stroke family support organiser: a randomized controlled trial.

BACKGROUND AND PURPOSE: There is inconclusive evidence of the effectiveness of the Stroke Family Support Organiser (FSO) service. We report the results from a randomized controlled trial of the service. METHODS: Stroke patients admitted to hospital and their informal caregivers were randomly allocated to receive the FSO service (n=126) or standard care (n=124). Outcome assessments were undertaken 4 and 9 months after recruitment with the General Health Questionnaire 12, Carer Strain Index, Barthel Index, Extended Activities of Daily Living scale, and a specially designed questionnaire to determine knowledge of stroke and satisfaction with services. RESULTS: There were no significant differences between groups in patients' mood and independence in personal or instrumental activities of daily living or caregivers' mood, strain, or independence. Patients in the intervention group were significantly more knowledgeable about whom to contact for stroke information, reducing the risk of stroke, practical help, community services, and emotional support. Patients in the intervention group were also significantly more satisfied with the stroke information received. Caregivers in the intervention group were significantly more knowledgeable about whom to contact for information on stroke, reducing the risk of stroke, community services, and emotional support. Caregivers in the intervention group were also significantly more satisfied with stroke information. CONCLUSIONS: The FSO service had no significant effect on mood, independence in activities of daily living, or reduction in caregiver strain, but it did increase knowledge of stroke and satisfaction with that knowledge. The results may not be representative of all FSO services, and the sample was small relative to the heterogeneity of the participants. However, results suggest that the policies and training procedures of FSOs need to be evaluated to ensure that a cost-effective service is being provided to stroke patients and their caregivers.

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PubMedDate not supplied

Characteristics of single fallers and recurrent fallers among hospital in-patients.

BACKGROUND: Recurrent fallers constitute a minority of patients who fall but contribute considerably to the total number of falls recorded. OBJECTIVE: To study the characteristics of recurrent fallers in a hospital setting. METHODS: In a prospective observational study we investigated the characteristics of 1,025 patients admitted to a geriatric non-acute hospital. Patients were followed until discharge and were classified as non-fallers, single fallers or recurrent fallers. RESULTS: We identified 824 non-fallers, 136 single fallers and 65 recurrent fallers contributing 175 falls. Compared to non-fallers, recurrent fallers were more likely to have pre-admission falls (p = 0.004), confusion (p < 0.0001), an unsafe gait (p = 0.0001) and be on tranquillisers (p = 0.018) and antidepressants (p = 0.006). They had longer stays in hospital (p < 0.0001) and more nursing home discharges (p = 0.0001). There was considerable overlap with risk factors for single fallers but compared to this group they were more likely to be confused (p = 0.027), and on antidepressant medication (p = 0.009). They also had a longer length of stay (p < 0.001) and more nursing home discharges (p = 0.03). Confusion (p = 0.0001), unsafe gait (p = 0.0006) and antidepressants (p = 0.018) were independently associated with recurrent falls. CONCLUSIONS: It is important to recognise the risk factors that prospectively identify a recurrent faller because of the significant contribution to total falls by a relatively small number of patients. This may be useful not only in trying to reduce total falls but also in trying to reduce injury.

Accidental Falls↗
PubMedDate not supplied

Characteristics and mortality of acute stroke patients: are there any gender differences?

OBJECTIVE: To investigate gender-related differences in the characteristics and mortality of stroke patients admitted to the hospital. METHODS: Prospective study of 296 consecutive patients admitted with a stroke and studied for epidemiologic features, risk factors, prior morbidity, neurologic details, acute-phase characteristics, acute mortality, and 90-day mortality. Patients were divided into male and female groups for analysis. RESULTS: Male-to-female ratio was 163 (55%) males to 133 (45%) females. There were no differences in mean age (P = .10), risk factors, stroke syndromes, infarct size, acute-phase characteristics, or complications. Females were found to be less frequently on prior aspirin (P = .02) and had fewer lacunar strokes (P = .005). A trend was observed for higher acute-phase mortality in females (P = .065); mortality at 90 days was similar (P = .71). CONCLUSION: There are no gender-related differences in patients admitted with acute strokes. A minor trend for higher acute-phase mortality in females may be due to their less frequent lacunar strokes and less frequent use of aspirin prior to stroke. Men and women with acute strokes should have access to similar services.

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