scholarly journals Polypharmacy and drug misuse in elderly migrants: care practice and interprofessional collaboration

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
H Tezcan-Güntekin ◽  
R Bird ◽  
I Özer-Erdogdu
Keyword(s):  
Drug Therapy ◽  
Interprofessional Collaboration ◽  
Language Barriers ◽  
Chronically Ill ◽  
Drug Misuse ◽  
Care Practice ◽  
Interprofessional Communication ◽  
Increased Risk ◽  
Elderly Migrants ◽  
Health Application

Abstract Background Polypharmacy is associated with an increased risk of falls and adverse events in the elderly. Factors such as inappropriate infrastructure for resolving language barriers can make people with migration backgrounds more vulnerable to polypharmacy. This study aimed to assess barriers in the drug therapy of elderly migrants and to obtain input for an e-health application supporting medication management and interprofessional communication. Methods 10 expert interviews were conducted with health professionals working with chronically ill patients of Turkish descent. The sample included physicians, pharmacists, social workers and nursing professionals. The interviews were analyzed using structuring content analysis. Results Respondents perceived language barriers and discontinuities in medication prescription as key problems in the drug therapy of elderly migrants. Changes in the brand of medication prescribed were highlighted as particularly damaging to patient-provider relationships. Interprofessional communication was deemed important, with physicians and pharmacists expressing dissatisfaction in this area. Some respondents saw potential in the e-health application, while others cited concerns about data protection or the digital capabilities of elderly migrants. Conclusions Healthcare professionals may require support in providing information in a variety of languages. Additionally, more interprofessional collaboration is desired but it is necessary to first establish better channels of communication. An e-health application could help achieve clearer communication between stakeholders. However, it is necessary to work in close cooperation with professionals when designing the application to ensure that it can be implemented in practice. Key messages Language barriers and inconsistent prescription practices harm patient-provider relationships. Better channels of communication are needed to provide less fragmented care to elderly migrants.

scholarly journals Polypharmacy in elderly migrants: perspectives of chronically ill migrants on E-Health-Applications

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
H Tezcan-Güntekin ◽  
I Özer-Erdogdu
Keyword(s):  
Drug Therapy ◽  
Information Exchange ◽  
Inappropriate Medication ◽  
Medication Management ◽  
Chronically Ill ◽  
The Elderly ◽  
Accessible Information ◽  
Increased Risk ◽  
Elderly Migrants ◽  
Health Applications

Abstract Background Polypharmacy occurs frequently among the elderly and is associated with an increased risk of falls and medication-related adverse events. Especially people with migration backgrounds may receive inappropriate medication due to language barriers or experiences of discrimination in healthcare. This study aimed to assess barriers to drug therapy in elderly migrants and to generate user experience data for the development of an e-health application. Methods 10 interviews, respectively, with chronically ill individuals of Turkish descent and with family caregivers. The 20 interviews were analyzed qualitatively by means of structuring content analysis. Results Medication is connected to uncertainty for respondents and most are affected by polypharmacy. Medication is not always taken regularly, especially among respondents living transnationally. Adherence depends on trust and the quality of doctor-patient relationships. The number of medications required and their side effects are a source of dissatisfaction, but elderly migrants develop a variety of coping strategies. Smartphone use is common among respondents and they are open to using an application for medication prescription and intake management. Conclusions Interprofessional care teams are needed in order to reduce uncertainty regarding medication management, to improve health literacy and to strengthen alliances between stakeholders. Additionally, collaboration between diversity-sensitive nursing care specialists and physicians is needed to provide accessible information, thus improving continuity of intake and adherence. E-health applications have the potential to improve medication management and information exchange between all stakeholders, thus facilitating correct medication use. Key messages Diversity-sensitive care can improve drug therapy for elderly migrants by removing language, information and trust barriers. Elderly migrants are open to web-applications for medication management.

Dental Implant Placement in Patients with a History of Medications Related to Osteonecrosis of the Jaws: A Systematic Review

2020 ◽  
Author(s):  
Judd Sher ◽  
Kate Kirkham-Ali ◽  
Denny Luo ◽  
Catherine Miller ◽  
Dileep Sharma
Keyword(s):  
Systematic Review ◽  
At Risk ◽  
Drug Therapy ◽  
Dental Implant ◽  
Case Series ◽  
Cochrane Central Register ◽  
Bisphosphonate Treatment ◽  
Implant Placement ◽  
Increased Risk ◽  
History Of

The present systematic review evaluates the safety of placing dental implants in patients with a history of antiresorptive or antiangiogenic drug therapy. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed. PubMed, Cochrane Central Register of Controlled Trials, Scopus, Web of Science, and OpenGrey databases were used to search for clinical studies (English only) to July 16, 2019. Study quality was assessed regarding randomization, allocation sequence concealment, blinding, incomplete outcome data, selective outcome reporting, and other biases using a modified Newcastle-Ottawa scale and the Joanna Briggs Institute critical appraisal checklist for case series. A broad search strategy resulted in the identification of 7542 studies. There were 28 studies reporting on bisphosphonates (5 cohort, 6 case control, and 17 case series) and one study reporting on denosumab (case series) that met the inclusion criteria and were included in the qualitative synthesis. The quality assessment revealed an overall moderate quality of evidence among the studies. Results demonstrated that patients with a history of bisphosphonate treatment for osteoporosis are not at increased risk of implant failure in terms of osseointegration. However, all patients with a history of bisphosphonate treatment, whether taken orally for osteoporosis or intravenously for malignancy, appear to be at risk of ‘implant surgery-triggered’ MRONJ. In contrast, the risk of MRONJ in patients treated with denosumab for osteoporosis was found to be negligible. In conclusion, general and specialist dentists should exercise caution when planning dental implant therapy in patients with a history of bisphosphonate and denosumab drug therapy. Importantly, all patients with a history of bisphosphonates are at risk of MRONJ, necessitating this to be included in the informed consent obtained prior to implant placement. The James Cook University College of Medicine and Dentistry Honours program and the Australian Dental Research Foundation Colin Cormie Grant were the primary sources of funding for this systematic review.

scholarly journals Exploring Local Initiatives to Improve the Work Environment: A Qualitative Survey in Swedish Home Care Practice

2021 ◽  
pp. 108482232098693
Author(s):  
Christofer Rydenfält ◽  
Roger Persson ◽  
Inger Arvidsson ◽  
Charlotte Holgersson ◽  
Gerd Johansson ◽  
...  
Keyword(s):  
Home Care ◽  
Work Environment ◽  
Gender Equality ◽  
Musculoskeletal Disorders ◽  
Work Organization ◽  
The Elderly ◽  
Care Practice ◽  
Change Initiatives ◽  
Increased Risk ◽  
Local Initiatives

Home care for the elderly constitutes a large and growing part of the social welfare system. Though, home care work is associated with a number of work environment-related challenges, including an increased risk for injuries, musculoskeletal disorders, high levels of sick leave and staff turnover, as well as stress and high workload, research is sparse. The present study explores local initiatives to improve the work environment initiated by the home care organizations themselves, and asks whether or not these initiatives affected gender equality. A qualitative web survey was sent to Swedish home care organizations, with open questions about change initiatives intended to have a positive effect on the work environment. There is an impressive amount of local work environment-related change initiatives going on. 80 categories of change initiatives were identified in answers from 178 units. However, these change initiatives were seldom evaluated or made accessible to stakeholders outside the organization. Main themes were concerned with work organization, digitalization, and planning, which largely follows trends in society (ie, digitalization, teamwork), rather than the actual needs identified by research (eg, musculoskeletal disorders). Despite apparent gender-related challenges, little of the work was associated with gender equality. The results indicates that there is a huge learning potential as the identified initiatives can serve as inspiration for others. However, to fully take advantage of these type of initiatives, more systematic evaluations are required.

scholarly journals Relation of severe COVID-19 to polypharmacy and prescribing of psychotropic drugs: the REACT-SCOT case-control study

BMC Medicine ◽  
2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Paul M. McKeigue ◽  
◽  
Sharon Kennedy ◽  
Amanda Weir ◽  
Jen Bishop ◽  
...  
Keyword(s):  
Primary Care ◽  
Rate Ratio ◽  
Case Control Study ◽  
Fatal Outcome ◽  
Case Control ◽  
Care Practice ◽  
Drug Classes ◽  
Increased Risk ◽  
Co Morbidity ◽  
Control Study

Abstract Background The objective of this study was to investigate the relation of severe COVID-19 to prior drug prescribing. Methods Severe cases were defined by entry to critical care or fatal outcome. For this matched case-control study (REACT-SCOT), all 4251 cases of severe COVID-19 in Scotland since the start of the epidemic were matched for age, sex and primary care practice to 36,738 controls from the population register. Records were linked to hospital discharges since June 2015 and dispensed prescriptions issued in primary care during the last 240 days. Results Severe COVID-19 was strongly associated with the number of non-cardiovascular drug classes dispensed. This association was strongest in those not resident in a care home, in whom the rate ratio (95% CI) associated with dispensing of 12 or more drug classes versus none was 10.8 (8.8, 13.3), and in those without any of the conditions designated as conferring increased risk of COVID-19. Of 17 drug classes postulated at the start of the epidemic to be “medications compromising COVID”, all were associated with increased risk of severe COVID-19 and these associations were present in those without any of the designated risk conditions. The fraction of cases in the population attributable to exposure to these drug classes was 38%. The largest effect was for antipsychotic agents: rate ratio 4.18 (3.42, 5.11). Other drug classes with large effects included proton pump inhibitors (rate ratio 2.20 (1.72, 2.83) for = 2 defined daily doses/day), opioids (3.66 (2.68, 5.01) for = 50 mg morphine equivalent/day) and gabapentinoids. These associations persisted after adjusting for covariates and were stronger with recent than with non-recent exposure. Conclusions Severe COVID-19 is associated with polypharmacy and with drugs that cause sedation, respiratory depression, or dyskinesia; have anticholinergic effects; or affect the gastrointestinal system. These associations are not easily explained by co-morbidity. Measures to reduce the burden of mortality and morbidity from COVID-19 should include reinforcing existing guidance on reducing overprescribing of these drug classes and limiting inappropriate polypharmacy. Registration ENCEPP number https://EUPAS35558

Il vissuto di bambini e adolescenti con artrite idiopatica giovanile

2020 ◽  
Vol 39 (10) ◽  
pp. 638-641
Author(s):  
Lorenzoiara Mambelli ◽  
Agnese Menghi ◽  
Camilla Lama ◽  
Federico Marchetti
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Chronically Ill ◽  
Behavioural Problems ◽  
Psychological Care ◽  
Voluntary Withdrawal ◽  
Increased Risk ◽  
Rheumatology Unit ◽  
Chronically Ill Children ◽  
Important Drug

Chronically ill children show an increased risk of developing a psychological-psychiatric disorder, with an important impact on their quality of life. The paper describes all the cases of Juvenile Idiopathic Arthritis (JIA) in the Paediatric Rheumatology Unit in Ravenna with documented psychological-behavioural problems. 23% of juvenile idiopathic arthritis patients have psychological-behavioural problems and 9% have requested cognitivebehavioural therapy, with good results. One of the most significant aspects is the treatment with methotrexate (MTX), which is an important drug in the management of JIA cases and, as it is known, is burdened with side effects such as malaise and vomiting, even before its intake. Half of the patients on MTX therapy show this "intolerance", which sometimes also leads to the voluntary withdrawal of the drug. Therefore, an anticipatory approach to these issues and an adequate and timely psychological care are increasingly necessary.

scholarly journals Sinus node dysfunction due to psychotropic agents' combination

2012 ◽  
Vol 24 (4) ◽  
pp. 247-250
Author(s):  
József Simkó ◽  
Gabriella Nagy ◽  
Anikó Dózsa ◽  
István Lörincz
Keyword(s):  
Drug Therapy ◽  
Psychotropic Drug ◽  
Sinus Node ◽  
Bipolar Affective Disorder ◽  
Antipsychotic Agents ◽  
The Elderly ◽  
Sinus Node Dysfunction ◽  
Increased Risk ◽  
Psychotropic Agents ◽  
Pharmacologic Agents

Background: Although sinus node dysfunction is primarily related to degenerative fibrosis of nodal tissue in the elderly, it may occur at any age secondary to other cardiac abnormalities or extrinsic causes. Pharmacologic agents including psychotropic drug therapy may also play a role.Method: We present the case of a 53-year-old woman with bipolar affective disorder in whom antipsychotic agents were suspected of inducing sinus node dysfunction.Result: The combination of psychotropic agents including lithium, quetiapine and carbamazepine (first occasion) or escitalopram (second occasion) has been implicated as a cause for sinus node dysfunction.Conclusion: Patients with severe mental illness usually require long-term psychotropic drug therapy, often in combination. This may enhance efficacy but also involves an increased risk of adverse effects including cardiotoxicity.

scholarly journals Promoting positive interactions between midwives and obstetricians at the primary/secondary interface

2021 ◽  
Vol 57 ◽  
pp. 41-48
Author(s):  
Rachel Cassie ◽  
Christine Griffiths ◽  
George Parker
Keyword(s):  
New Zealand ◽  
Thematic Analysis ◽  
Maternity Care ◽  
Interprofessional Collaboration ◽  
Theoretical Perspective ◽  
Positive Interactions ◽  
Health Board ◽  
District Health ◽  
Interprofessional Communication ◽  
Aotearoa New Zealand

Background: Interprofessional communication is a critical component of safe maternity care. The literature reports circumstances in Aotearoa New Zealand and overseas when interprofessional collaboration works well between midwives and obstetricians, as well as descriptions of unsatisfactory communication between the two professions. Aim: To explore and define effective collaboration between midwives and obstetricians at the primary/secondary interface in maternity care, in order to generate suggestions to foster positive collaboration. Method: Eight primary care midwives, three obstetricians and two obstetric registrars from a single District Health Board in Aotearoa New Zealand were interviewed about their interactions at the primary/secondary interface and their understanding, and use, of the Referral Guidelines. The theoretical perspective was Appreciative Inquiry. Data were analysed using thematic analysis. Findings: Results indicate usually positive interprofessional interactions. Dominant emergent themes are the need to negotiate differing philosophies, to clarify blurred boundaries that sometimes lead to lack of clear lines of responsibility, and the importance of three-way conversations. Of the three themes, this article focuses on three-way communication between midwife, obstetrician/registrar and woman. Participants reported that, when effective three-way communication between woman, midwife and obstetrician occurred, philosophical difference could be negotiated, blurred boundaries clarified and understanding of the respective roles of the LMC midwife and the obstetric team promoted. Participants value the Referral Guidelines but report some limitations to their applicability. Conclusion: Effective three-way communication promotes good maternity care. This study has identified ways to support optimal communication.

Observation of interprofessional collaboration in primary care practice: A multiple case study

2016 ◽  
Vol 30 (6) ◽  
pp. 787-794 ◽  
Author(s):  
Susan Pullon ◽  
Sonya Morgan ◽  
Lindsay Macdonald ◽  
Eileen McKinlay ◽  
Ben Gray
Keyword(s):  
Primary Care ◽  
Primary Care Practice ◽  
Interprofessional Collaboration ◽  
Multiple Case Study ◽  
Care Practice ◽  
Multiple Case

Computerized Monitoring Protocols as a Pharmaceutical Care Practice Enhancement: A Conceptual Illustration Using Diabetes Mellitus

1993 ◽  
Vol 27 (7-8) ◽  
pp. 963-966
Author(s):  
Alan F. Boyd ◽  
Abraham G. Hartzema
Keyword(s):  
Diabetes Mellitus ◽  
Medical Care ◽  
Computer System ◽  
Patient Outcomes ◽  
Chronically Ill ◽  
Care Practice ◽  
Medline Search ◽  
Medical Interventions ◽  
Routine Medical Care ◽  
Monitoring Protocols

OBJECTIVE: To illustrate how a computer system used in an ambulatory care pharmacy setting might enhance care of patients with diabetes by prospectively monitoring and prompting them to seek routine medical care. DATA SOURCES: A MEDLINE search to identify existing works on informatics was conducted. An epidemiology and general medical literature review of diabetes mellitus was also performed via MEDLINE. Additionally, known textbooks on the disease were consulted. CONCLUSIONS: Programming a computer system to prompt pharmacists to remind their patients of necessary medical interventions could save medical resources by warning chronically ill patients not to ignore routine medical care. Also, this would allow the pharmacist to prospectively monitor patient outcomes. By knowing when medical interventions are due and obtaining feedback from patients on the results of the medical contact, pharmacists increase their knowledge about patient outcomes and the rationale behind changes in pharmacotherapy. It is expected that such a system would prevent the inconspicuous development of chronic complications.

scholarly journals Living on the Own Island? Aligned Collaboration Between Family Physicians, Nurses, Dieticians, and Patients With Diabetes Type 2 in an Outpatient Care Setting in Northern Italy: Findings From a Qualitative Study

2020 ◽  
Vol 9 ◽  
pp. 216495612094670 ◽  
Author(s):  
Heike Wieser ◽  
Giuliano Piccoliori ◽  
Marianne Siller ◽  
Evi Comploj ◽  
Harald Stummer
Keyword(s):  
Physical Activity ◽  
Health Care ◽  
Outpatient Care ◽  
Interprofessional Collaboration ◽  
Qualitative Content Analysis ◽  
Family Physicians ◽  
Diabetes Type 2 ◽  
Care Practice ◽  
Health Care Practice

Introduction: Diabetes mellitus type 2 (DM2), one of the four most important chronic diseases worldwide, is generally considered to be preventable. However, it is not yet sufficiently clear whether an aligned collaboration between different health professions could facilitate behavioral changes to be made by patients with DM2 regarding their eating and physical activity habits. Objective: To explore if and how far in current outpatient care for 3 health-care professions it is an objective to collaborate with each other supporting patients with DM2 in changing their eating and physical activity habits. Methods: We conducted 18 qualitative problem centered interviews with selected family physicians, nurses, dieticians working in outpatient setting and patients with DM2, transcribed verbatim, and analyzed with qualitative content analysis. Results: Issues identified ranged from description and reflection of current health-care practice, strategies, and hindrances to cope with changes of eating and physical activity behaviors as well as for health-care practice regarding interprofessional collaboration and patient-centered care up to considerations about collaboration and patient centricity (for health professionals and patients to achieve goals) and changes and ideas of “ideal care practice”. Discussion: The included professional groups work predominantly for themselves. Collaboration currently only takes place when individually triggered and neither structured nor organized.

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