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The assessment of orthostatic blood pressure in an acute hospital

P. Kantachuvesiri


, T. Ong




Queens Medical Centre


University Hospitals NHS Trust, United Kingdom


Policies on falls management in hospital includes

assessment of orthostatic blood pressure (OBP). Accurate measure-

ment is paramount in falls assessment. A survey was conducted to

evaluate OBP assessment among healthcare staff according to our local

falls assessment policy.

Methods and sampling:

Multidisciplinary healthcare team(MDT)

working in geriatric medicine, acute medicine and orthopaedics were

asked to complete a self-reported questionnaire. These departments

were chosen as their patient cohort represents a significant proportion



. The survey focused on previous falls training, OBP

assessment in eight case scenarios, how staff measured OBP (5-key

points: 1. lying patient flat; 2. minimum5-min flat; 3. measure BP lying

down; 4. standing patient up; 5. take BP immediately and 3-min after

standing), and significant OBP findings.


54/100 responses were obtained (10 doctors, 28 nurses

(band 5

7), 11 health care assistants (HCA), and 5 student nurses. 15

(27.8%), 9(15.8%), 30(55.6%) responses were from the acute medicine,

orthopaedic wards and geriatric wards respectively. 44(81.3%) had

received in-hospital falls training and 25/44(56.8%) in the past 6

months. Only 12(21%) participants correctly identified all the clinical

scenarios where OBP assessment was needed with no difference

among the MDT(p = 0.12). Only 5(10.4%) participants were able to

identify all the 5-key points of measuring OBP. Most did not identify

the need to lie flat for a minimum 5-min (72.9%); and measure BP

immediately and after 3-min standing (75%). No difference was

detected between geriatric and non-geriatric wards (p = 0.05). 52

(96.3%) participants recognised a 20 mmHg systolic-drop as signifi-

cant but only 33(62.3%) acknowledged a 10 mmHg diastolic-drop as



Despite a significant majority received hospital falls

training, OBP is still inaccurately measured across different directo-

rates by different MDT members. Incorrect assessment of OBP affects

patient management and can be considered a marker of suboptimal

hospital falls training. A review of local training is needed to address



Clinical patterns of stroke in Lahore General Hospital, a Tertiary

Care center

M.I.H. Khan.



Stroke is a leading cause of disability and the second

principal cause of death in the world. Two-thirds of strokes occur in

developing countries. It is becoming major health issue due to

increasing burden. The aim of this study was to analyze different

characteristics in stroke patients in Medical Unit 1 of Lahore General

Hospital, which is biggest referral hospital for Neurology patients in

Punjab, to identify the risk factors and help in targeting prevention in

our patients.


This retrospective study was carried out in Lahore General

Hospital, Lahore in January 2016, including data from January to

November 2015. The demographic data, clinical manifestations, risk

factors, side of weakness, cranial nerves involved, neurological

weakness and Glasgow Coma Scale, duration of stay in hospital and

outcome were included in the data. SPSS software for Windows

(version 21, SPSS Inc., Chicago, IL, USA) was used for the statistical

analysis of the data. For the comparison between categorical variables

Chi-square test was used. For other variables, t-test was used.


A total of 235 patients with stroke, age 20 to 105 (mean ±

SD = 58 ± 14.6) were included. 127 (54%) had Ischemic stroke (IS) and

100 (42.6%) had hemorrhagic stroke (HS).127 (54%) were men and 108

(46%) were women. 17.9% of the patients with IS and 21.7% of the

patients with HS died (OR 0.65 95% CI 0.48

0.89). Hypertension,

diabetes and dyslipidemia were the most common risk factors.


Burden of stroke is high in Pakistan. Mean age of patients

with stroke is less. Hypertension, diabetes, dyslipidemia and smoking

are highly prevalent and hypertension is the most common. Ischemic

strokes are more common, mortality of intra-cerebral hemorrhage is


Key words:

Stroke, Hypertension, Clinical patterns, Lahore


Norton scale as a predictor for 30-day hospital readmission among

older acute medical patients

D. Kirshner


, T. Dwolatzky




Geriatric Unit, Rambam Health Care



The Ruth & Bruce Rappaport Faculty of Medicine at the

Technion-Israel Institute of Technology, Haifa, Israel


Older people are at risk for hospital readmissions, and

reducing readmissions may improve quality of care and reduce health

care costs. While the Norton scalewas devised to predict the likelihood

of pressure sore development, it is useful for predicting length of

hospital stay, in-hospital complications and mortality in older

patients. We aimed to determine the value of the total Norton scale

score and its domains as a simple tool for predicting readmission

within 30 days in older patients admitted to acute internal medicine



A 6-year retrospective study was performed based on the

electronic records of medical inpatients 65 years and older, with the

primary outcome being readmission within 30 days. Data collected

included Norton scale on admission, patient demographics, first ward

of admission, length of stay and laboratory parameters. Bivariate and

multivariate logistic regression analyses were used to predict the risk

for readmission.


We included 34,329 hospitalizations of which 18,044 (53%)

were women, mean age was 78.5 ± 7.8 years. Mean primary hospital-

ization length was 7.0 days. Overall, 30-day readmission ratewas 11.3%.

Based on multivariate logistic regression analysis, scores of 2/4 and 1/4

for the level of activity according to the Norton scale were associated

with increased risk for 30-day readmission (adjusted odds ratio [OR]:

1.33 and 1.64 respectively, 95% confidence interval [CI]: 1.22

1.45 and


1.8 respectively, P < 0.001).

Key conclusions:

The level of activity according to the Norton scale on

admission is useful for predicting the risk of 30-day readmission

among older patients.


Exploring how inflammation underlies adverse health outcomes

in acutely admitted older medical patients; associations between

different inflammatory patterns, and physical- and organ function

H.H. Klausen


, A.C. Bodilsen


, J. Petersen


, T. Bandholm



T. Haupt


, D.M. Sivertsen


, O. Andersen




Optimed, Clinical Research

Centre, Copenhagen University Hospital,


Physical Medicine &

Rehabilitation Research-Copenhagen (PMR-C), Department of Physical

and Occupational Therapy, Copenhagen University Hospital,


Section of

Biostatistics, Department of Public Health, University of Copenhagen,


Department of Orthopaedic Surgery, Copenhagen University Hospital,


The Emergency Department, Copenhagen University Hospital, Hvidovre,



In the general population, inflammation is associated

with age-related physical performance and organ function. This is

unknown in acutely admitted older medical patients.


Firstly, to investigate if systemic inflammation in acutely

admitted older medical patients is associated with physical perform-

ance, and organ dysfunction. Secondly, to investigate if the association

between organ dysfunction and physical performance is mediated by

systemic inflammation.


A cross sectional cohort study of medical patients (65+)

admitted to an Emergency Department. Physical performance was

assessed by four meter gait speed, handgrip strength and the de

Morton Mobility Index (DEMMI), and organ dysfunction by the

number of standard laboratory tests outside the reference range

Poster presentations / European Geriatric Medicine 7S1 (2016) S29