scholarly journals Combined Use of the Rationalization of Home Medication by an Adjusted STOPP in Older Patients (RASP) List and a Pharmacist-Led Medication Review in Very Old Inpatients: Impact on Quality of Prescribing and Clinical Outcome

Drugs & Aging ◽  
2016 ◽  
Vol 34 (2) ◽  
pp. 123-133 ◽  
Author(s):  
Lorenz Van der Linden ◽  
Liesbeth Decoutere ◽  
Karolien Walgraeve ◽  
Koen Milisen ◽  
Johan Flamaing ◽  
...  
2021 ◽  
Vol 36 (3) ◽  
pp. 159-170
Author(s):  
Wuqi Lin ◽  
Sabrina Haq ◽  
Samir Sinha ◽  
Chris Fan-Lun

Objective To describe the demographic and clinical characteristics of frail and homebound community-dwelling older patients receiving a home medication review (HMR) conducted by a home-visiting pharmacist; the types of drug therapy problems (DTPs) that were identified; the types of clinical interventions being recommended and their implementation rate. Design Retrospective, cross-sectional chart-review study using data from patient records. Setting Homes of patients receiving a HMR by a community pharmacy-based consulting home-visiting pharmacist. Patients 171 patients received a HMR between January 1, 2016, and May 31, 2018. Intervention Patients received a comprehensive HMR by a home-visiting pharmacist working as a member of an interprofessional geriatrics team. Main Outcome Measures Charlson Comorbidity Index (CCI) score, comorbidities, use of potentially inappropriate medications, DTPs identified, number and type of clinical interventions being recommended and successfully implemented. Results Patients had a mean age of 81 years (range: 54-100 years), majority were 65 years of age or older (95%), and female (59%). Fifty-three percent of patients had a CCI score of 1 to 2, and 93.6% were experiencing multi-morbidity and polypharmacy. Patients used an average of 13.0 medications, and 76.1% were found to be using at least 1 potentially inappropriate medication. In total, the home-visiting pharmacist identified 827 DTPs and made 1088 recommendations with a successful implementation rate of 74%. Conclusions Frail and homebound community-dwelling older adults referred for a HMR were observed to be using a high number of medications with a significant number of DTPs identified. Offering HMRs was an effective method for a community-based pharmacist to make acceptable recommendations to optimize medication therapy management for frail older patients.


2021 ◽  
Vol 36 (3) ◽  
pp. 159-170
Author(s):  
Wuqi Lin ◽  
Sabrina Haq ◽  
Samir Sinha ◽  
Chris Fan-Lun

OBJECTIVE: To describe the demographic and clinical characteristics of frail and homebound communitydwelling older patients receiving a home medication review (HMR) conducted by a home-visiting pharmacist; the types of drug therapy problems (DTPs) that were identified; the types of clinical interventions being recommended and their implementation rate. DESIGN: Retrospective, cross-sectional chart-review study using data from patient records. SETTING: Homes of patients receiving a HMR by a community pharmacy-based consulting home-visiting pharmacist. PATIENTS: 171 patients received a HMR between January 1, 2016, and May 31, 2018. INTERVENTiON: Patients received a comprehensive HMR by a home-visiting pharmacist working as a member of an interprofessional geriatrics team. MAIN OUTCOME MEASURES: Charlson Comorbidity Index (CCI) score, comorbidities, use of potentially inappropriate medications, DTPs identified, number and type of clinical interventions being recommended and successfully implemented. RESULTS: Patients had a mean age of 81 years (range: 54-100 years), majority were 65 years of age or older (95%), and female (59%). Fifty-three percent of patients had a CCI score of 1 to 2, and 93.6% were experiencing multi-morbidity and polypharmacy. Patients used an average of 13.0 medications, and 76.1% were found to be using at least 1 potentially inappropriate medication. In total, the home-visiting pharmacist identified 827 DTPs and made 1088 recommendations with a successful implementation rate of 74%. CONCLUSIONS: Frail and homebound communitydwelling older adults referred for a HMR were observed to be using a high number of medications with a significant number of DTPs identified. Offering HMRs was an effective method for a community-based pharmacist to make acceptable recommendations to optimize medication therapy management for frail older patients.


2005 ◽  
Vol 25 (3_suppl) ◽  
pp. 88-91 ◽  
Author(s):  
Edwina A. Brown

Many older patients do not cope well with hemodialysis, yet the proportion of older patients on peritoneal dialysis (PD) is considerably lower than for younger patients. This is despite the fact that clinical outcome studies show that older patients cope as well as, if not better than, younger patients on PD. Furthermore, the North Thames Dialysis Study, a prospective study of patients ≥70 years old, has shown that survival, hospitalization, and quality of life were identical for patients on hemodialysis and patients on PD.


2020 ◽  
pp. 26-28
Author(s):  
Н.Т. Чеботарев ◽  
Н.Н. Шергина

Пахотные угодья Республики Коми в основном представлены дерново-подзолистыми почвами с низким естественным плодородием, которые без применения удобрений быстро подвергаются деградационным процессам, что резко снижает их продуктивность. Цель исследований: оценка эффективности долговременного применения органических и минеральных удобрений при выращивании картофеля в кормовом севообороте в условиях Республики Коми. Методической основой выполнения работ были комплексные исследования дерново-подзолистых почв, клубней картофеля на участках многолетнего полевого эксперимента, заложенного на землях Института агробиотехнологий ФИЦ Коми НЦ УрО РАН в соответствии с «Методическими указаниями географической сети опытов с удобрениями». Длительный период исследований (более 40 лет) характеризовался различными климатическими условиями, которые отразились на количестве урожая и качестве клубней картофеля. Было проведено 7 ротаций (14 лет) с выращиванием картофеля. Вносили органические удобрения – торфонавозный компост (ТНК) в дозах 40 и 80 т/га (1 и 2 фон, соответственно) под картофель и минеральные удобрения – NPК в дозах 1/3; 1/2 и 1 для восполнения выноса растениями элементов питания. Установлено положительное влияние комплексного применения органических и минеральных удобрений на урожайность и качество картофеля, а также на плодородие дерново-подзолистой легкосуглинистой среднеокультуренной почвы в кормовом севообороте в почвенно-климатических условиях Республики Коми. В результате применения шестипольного севооборота и комплексного внесения удобрений с 1978 года к 2019 году в почвах снизилась обменная и гидролитическая кислотность; повысилось содержание гумуса на 0,5% (в контроле); на 0,2–0,5% (с тремя дозами минеральных удобрений); на 0,3–1,1% (с ТНК); на 0,2–1,6% (при совместном применении органических и минеральных удобрений). Наибольшие урожаи картофеля получены при совместном применении органических (80 т/га) и минеральных удобрений (1 NPК) и составили 37,1 т/га клубней (8,5 тыс/га кормовых единиц). При таком соотношении удобрений показано высокое качество клубней картофеля: содержание крахмала 15,5%, витамина С – 19,4 мг%, сырого протеина – 14,1%. Количество нитратного азота не превышало ПДК (ПДК 250 мг.с.м.). Экономические расчеты показали, что при внесении ТНК 40 т/га + 1 NPК в дерново-подзолистые почвы с.-х. использования в среднетаежной зоне Республики Коми при выращивании картофеля, условный чистый доход составит 68,4 тыс. р. с 1 га, себестоимость 1 т картофеля – 2,8 тыс. р., рентабельность 188,7%. The arable land of the Republic of Komi is mainly represented by dern-sub-ground soils with low natural fertility, which without the use of fertilizers are quickly subjected to degradation processes, which dramatically reduces their productivity. The aim of the research is to evaluate the efficiency of long-term use of organic and mineral fertilizers in the growing of potatoes in feed crop rotation in the conditions of the Komi Republic. The methodological basis for carrying out the works was comprehensive studies of dern-subhead soils, potato tubers on the sites of a multi-year field experiment laid on the lands of the Institute of Agrobiotechnology of the FRC Komi SC UB RAS in accordance with the «Methodological Instructions of the Geographical Network of Experiments with Fertilizers». A long period of research (more than 40 years) was characterized by different climatic conditions, which affected the number of crops and the quality of potato tubers. There were 7 rotations (14 years) with potato cultivation. Organic fertilizers – peat-avous compost (TNK) in doses of 40 and 80 t/ha (1 and 2 background, respectively) for potatoes and mineral fertilizers – NPK in doses of 1/3; 1/2 and 1 to replenish the carry-out of food elements by plants. The positive effect of the integrated use of organic and mineral fertilizers on the yield and quality of potatoes, as well as on the fertility of soddy-podzolic light loamy medium cultivated soil in fodder crop rotation in the soil and climatic conditions of the Komi Republic, has been established. As a result of the use of six-bed crop rotation and the integrated application of fertilizers, metabolic and hydrolytic acidity decreased in soils from 1978 to 2019; humus content increased by 0.5% (in control); 0.2–0.5% (with three doses of mineral fertilizers); 0.3–1.1% (with TNCs); 0.2–1.6% (with combined use of organic and mineral fertilizers). The largest potato yields were obtained from the combined use of organic (80 t/ha) and mineral fertilizers (1 NPK) and amounted to 37.1 t/ha tubers (8.5 thousand/ha feed units). The largest potato harvests were obtained with the combined use of organic (80 t/ha) and mineral fertilizers (1 NPK) and amounted to 37.1 t/ha of tubers (8.5 thousand/ha of feed units). With this ratio of fertilizers, the high quality of potato tubers was also determined: the starch content was 15.5%, vitamin C – 19.4 mg%, crude protein – 14.1%. The amount of nitrate nitrogen did not exceed the MPC (MPC 250 mg.s.m.). Economic calculations showed that if TNK is added 40 t/ha 1 NPK to the dern-sub-ground soils of agricultural use in the medium-sized zone of the Komi Republic when growing potatoes, the conditional net income will be 68.4 thousand rubles from 1 ha, the cost of 1 t of potatoes – 2.8 thousand rubles, profitability 188.7%.


2021 ◽  
Vol 9 (2) ◽  
pp. 31
Author(s):  
Christine E. Mc Carthy

Sleep complaints can be both common and complex in the older patient. Their consideration is an important aspect of holistic care, and may have an impact on quality of life, mortality, falls and disease risk. Sleep assessment should form part of the comprehensive geriatric assessment. If sleep disturbance is brought to light, consideration of sleep disorders, co-morbidity and medication management should form part of a multifaceted approach. Appreciation of the bi-directional relationship and complex interplay between co-morbidity and sleep in older patients is an important element of patient care. This article provides a brief overview of sleep disturbance and sleep disorders in older patients, in addition to their association with specific co-morbidities including depression, heart failure, respiratory disorders, gastro-oesophageal reflux disease, nocturia, pain, Parkinson’s disease, dementia, polypharmacy and falls. A potential systematic multidomain approach to assessment and management is outlined, with an emphasis on non-pharmacological treatment where possible.


Drugs & Aging ◽  
2021 ◽  
Author(s):  
Camille Debacq ◽  
Julie Bourgueil ◽  
Amal Aidoud ◽  
Joëlle Bleuet ◽  
Marc Mennecart ◽  
...  

2021 ◽  
Vol 11 (4) ◽  
pp. 416
Author(s):  
Carla Piano ◽  
Francesco Bove ◽  
Delia Mulas ◽  
Enrico Di Stasio ◽  
Alfonso Fasano ◽  
...  

Previous investigations have reported on the motor benefits and safety of chronic extradural motor cortex stimulation (EMCS) for patients with Parkinson’s disease (PD), but studies addressing the long-term clinical outcome are still lacking. In this study, nine consecutive PD patients who underwent EMCS were prospectively recruited, with a mean follow-up time of 5.1 ± 2.5 years. As compared to the preoperatory baseline, the Unified Parkinson’s Disease Rating Scale (UPDRS)-III in the off-medication condition significantly decreased by 13.8% at 12 months, 16.1% at 18 months, 18.4% at 24 months, 21% at 36 months, 15.6% at 60 months, and 8.6% at 72 months. The UPDRS-IV decreased by 30.8% at 12 months, 22.1% at 24 months, 25% at 60 months, and 36.5% at 72 months. Dopaminergic therapy showed a progressive reduction, significant at 60 months (11.8%). Quality of life improved by 18.0% at 12 months, and 22.4% at 60 months. No surgical complication, cognitive or behavioral change occurred. The only adverse event reported was an infection of the implantable pulse generator pocket. Even in the long-term follow-up, EMCS was shown to be a safe and effective treatment option in PD patients, resulting in improvements in motor symptoms and quality of life, and reductions in motor complications and dopaminergic therapy.


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