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Watkin L.,Camden and Islington NHS Foundation Trust | Blanchard M.R.,Camden and Islington NHS Foundation Trust | Blanchard M.R.,University College London | Tookman A.,Royal Free Hospital Hampstead | And 2 more authors.
International Journal of Geriatric Psychiatry | Year: 2012

Background Reported adverse events (RAEs) are relatively common in the acute hospital and are associated with significant mortality and morbidity. Dementia is increasing in hospital in-patients, however there have been few studies exploring risk factors for RAEs, in particular cognitive impairment and dementia. Our objective was to identify the prevalence of RAEs in older acute medical inpatients and associated demographic, clinical or cognitive risk factors. Method A longitudinal cohort study set on acute medical wards in a large general hospital. We recruited 710 people aged over 70 years undergoing emergency medical admission. Dementia was diagnosed using operationalised DSM-IV criteria. Patients were assessed using standardised tools including the Confusion Assessment Method, mini-mental state examination, the Functional Assessment Staging scale, the APACHE scale and Charlson co-morbidity index. Data on adverse events was supplied independently by the hospital clinical risk department. Results 8.6% (95% CI 6.4-10.6) of patients experienced an RAE; 5.9% (95% CI 4.2-7.6) were patient-related and 2.7% (95% CI 1.5-3.8) system-related (incidence rate for all RAEs was 2.1 (95% CI 1.7-2.8)) per person year of hospital admission. Median length of admission was 8 days (inter-quartile range 4-17 days). Patient-related RAEs were associated with male gender, delirium, mild/moderate cognitive impairment and a FAST score of 2-6. Overall, 11.1% died during the admission-this was not associated with experiencing an RAE. Staff comments on incident forms indicated an apparent lack of understanding of the impact of cognitive impairment. Conclusions RAEs were common and associated with risk factors identifiable at admission. © 2011 John Wiley & Sons, Ltd.

Pratt M.M.,U.S. National Cancer Institute | John K.,U.S. National Cancer Institute | Maclean A.B.,Royal Free Hospital Hampstead | Afework S.,Royal Free Hospital Hampstead | And 2 more authors.
International Journal of Environmental Research and Public Health | Year: 2011

Polycyclic aromatic hydrocarbons (PAHs) are combustion products of organic materials, mixtures of which contain multiple known and probable human carcinogens. PAHs occur in indoor and outdoor air, as well as in char-broiled meats and fish. Human exposure to PAHs occurs by inhalation, ingestion and topical absorption, and subsequently formed metabolites are either rendered hydrophilic and excreted, or bioactivated and bound to cellular macromolecules. The formation of PAH-DNA adducts (DNA binding products), considered a necessary step in PAH-initiated carcinogenesis, has been widely studied in experimental models and has been documented in human tissues. This review describes immunohistochemistry (IHC) studies, which reveal localization of PAH-DNA adducts in human tissues, and semi-quantify PAH-DNA adduct levels using the Automated Cellular Imaging System (ACIS). These studies have shown that PAH-DNA adducts concentrate in: basal and supra-basal epithelium of the esophagus, cervix and vulva; glandular epithelium of the prostate; and cytotrophoblast cells and syncitiotrophoblast knots of the placenta. The IHC photomicrographs reveal the ubiquitous nature of PAH-DNA adduct formation in human tissues as well as PAH-DNA adduct accumulation in specific, vulnerable, cell types. This semi-quantative method for PAH-DNA adduct measurement could potentially see widespread use in molecular epidemiology studies. © 2011 by the authors.

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