scholarly journals Prevalence of drug-drug interactions in older people before and after hospital admission: analysis from the OPERAM trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Lorène Zerah ◽  
Séverine Henrard ◽  
Ingeborg Wilting ◽  
Denis O’Mahony ◽  
Nicolas Rodondi ◽  
...  
Keyword(s):  
Older People ◽  
Hospital Admission ◽  
Drug Interactions ◽  
Medication Review ◽  
Hospital Admissions ◽  
Point Prevalence ◽  
Control Group ◽  
Clinically Significant ◽  
Potentially Clinically Significant ◽  
Over Time

Abstract (N = 351) Background Drug-drug interactions (DDIs) are highly prevalent in older patients but little is known about prevalence of DDIs over time. Our main objective was to assess changes in the prevalence and characteristics of drug-drug interactions (DDIs) during a one-year period after hospital admission in older people, and associated risk factors. Methods We conducted a sub-study of the European OPERAM trial (OPtimising thERapy to prevent Avoidable hospital admissions in Multimorbid older people), which assessed the effects of a structured medication review (experimental arm) compared to usual care (control arm) on reducing drug-related hospital readmissions. All OPERAM patients (≥70 years, with multimorbidity and polypharmacy, hospitalized in four centers in Bern, Brussels, Cork and Utrecht between December 2016 and October 2018, followed over 1 year) who were alive at hospital discharge and had full medication data during the index hospitalization (at baseline i.e., enrolment at admission, and at discharge) were included. DDIs were assessed using an international consensus list of potentially clinically significant DDIs in older people. The point-prevalence of DDIs was evaluated at baseline, discharge, and at 2, 6 and 12 months after hospitalization. Logistic regression models were performed to assess independent variables associated with changes in DDIs 2 months after baseline. Results Of the 1950 patients (median age 79 years) included, 1045 (54%) had at least one potentially clinically significant DDI at baseline; point-prevalence rates were 58, 57, 56 and 57% at discharge, and 2, 6 and 12 months, respectively. The prevalence increased significantly from baseline to discharge (P < .001 [significant only in the control group]), then remained stable over time (P for trend .31). The five most common DDIs –all pharmacodynamic in nature– accounted for 80% of all DDIs and involved drugs that affect potassium concentrations, centrally-acting drugs and antithrombotics. At 2 months, DDIs had increased in 459 (27%) patients and decreased in 331 (19%). The main factor predictive of a change in the prevalence of DDIs was hyperpolypharmacy (≥10 medications). Conclusions DDIs were very common; their prevalence increased during hospitalization and tended to remain stable thereafter. Medication review may help control this increase and minimize the risk of adverse drug events.

scholarly journals Polypharmacy is a risk factor for hospital admission due to a fall: evidence from the English Longitudinal Study of Ageing

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
P. Zaninotto ◽  
Y. T. Huang ◽  
G. Di Gessa ◽  
J. Abell ◽  
C. Lassale ◽  
...  
Keyword(s):  
Older Adults ◽  
Longitudinal Study ◽  
Older People ◽  
Hospital Admission ◽  
Prescription Drugs ◽  
Hospital Admissions ◽  
Competing Risk ◽  
Risk Of Falls ◽  
Nationally Representative ◽  
English Longitudinal Study

Abstract Background Falls amongst older people are common; however, around 40% of falls could be preventable. Medications are known to increase the risk of falls in older adults. The debate about reducing the number of prescribed medications remains controversial, and more evidence is needed to understand the relationship between polypharmacy and fall-related hospital admissions. We examined the effect of polypharmacy on hospitalization due to a fall, using a large nationally representative sample of older adults. Methods Data from the English Longitudinal Study of Ageing (ELSA) were used. We included 6220 participants aged 50+ with valid data collected between 2012 and 2018.The main outcome measure was hospital admission due to a fall. Polypharmacy -the number of long-term prescription drugs- was the main exposure coded as: no medications, 1–4 medications, 5–9 medications (polypharmacy) and 10+ medications (heightened polypharmacy). Competing-risk regression analysis was used (with death as a potential competing risk), adjusted for common confounders, including multi-morbidity and fall risk-increasing drugs. Results The prevalence of people admitted to hospital due to a fall increased according to the number of medications taken, from 1.5% of falls for people reporting no medications, to 4.7% of falls among those taking 1–4 medications, 7.9% of falls among those with polypharmacy and 14.8% among those reporting heightened polypharmacy. Fully adjusted SHRs for hospitalization due to a fall among people who reported taking 1–4 medications, polypharmacy and heightened polypharmacy were 1.79 (1.18; 2.71), 1.75 (1.04; 2.95), and 3.19 (1.61; 6.32) respectively, compared with people who were not taking medications. Conclusions The risk of hospitalization due to a fall increased with polypharmacy. It is suggested that prescriptions in older people should be revised on a regular basis, and that the number of medications prescribed be kept to a minimum, in order to reduce the risk of fall-related hospital admissions.

scholarly journals Efficacy of different prediabetes program models in improving clinical outcomes in people with prediabetes

2020 ◽  
Vol 79 (OCE2) ◽  
Author(s):  
Rasha Al-Hamdan ◽  
Fiona McCullough ◽  
Amanda Avery ◽  
Dara Al-Disi ◽  
Nasser Al-Daghri
Keyword(s):  
Social Media ◽  
Standard Care ◽  
Lifestyle Modification ◽  
Educational Programs ◽  
Control Group ◽  
Haemoglobin A1c ◽  
Cluster Randomised ◽  
Clinically Significant ◽  
Over Time ◽  
Group Comparisons

AbstractBackground:Educational programs in general seem to have a clinically significant beneficial effect among the T2DM population in terms of improved glycaemic control. However, few evaluations of interventions to delay or prevent type 2 diabetes mellitus (T2DM) in Saudi Arabia (SA) have been undertaken.Objective:The present study evaluates for the first time, the differences in the effectiveness of the different educational programs [intensive lifestyle modification (Group Education Program, GEP), supervised education through social media (WhatsApp Education Group, WEP) and standard care via PHCCs (Control Group, CG)], among Saudi females with pre-diabetes.Methods:This was a 6-month, multi-center, 3-arm cluster, randomised, controlled (1:1:1), multi-intervention study conducted from July 2018 until March of 2019 in Riyadh, SA. A total of 1140 females from SA were cluster randomised equally to three groups, out of which only 253 [N = 100 GEP, N = 84 WEP and N = 69 CG] received intervention. Participants completed questionnaires including demographic, dietary and physical activity data. Anthropometrics, blood samples and dietary intake were collected at baseline and 6 months. A total of 120 [37 CG (age 50.9 ± 7.1 years; body mass index (BMI) 31.6 ± 5.8kg/m2), 40 GEP (age 42.9 ± 12.2 years; BMI 34.8 ± 9.0kg/m2) and 43 WEP (age 43.7 ± 8.1 years; BMI 30 ± 5.1kg/m2)] participants completed the study.Results:Haemoglobin A1c (HbA1c; primary endpoint) significantly improved in all groups over time, with no difference in between-group comparisons. Between group comparisons adjusted for age revealed a clinically significant reduction in BMI in favour of GEP (p = 0.02) post-intervention. A clinically significant reduction was also observed in favour of GEP in terms of weight (p = 0.003), waist circumference (p = 0.017), systolic and diastolic blood pressure (p-values < 0.01), triglycerides (p < 0.001) and caloric intake (p < 0.005) over time.Conclusion:Prediabetes education programs of 6-month duration, whether delivered through an intensive lifestyle modification, social media or standard care, are equally efficacious in improving HbA1c levels among Saudi women with prediabetes, but intensive lifestyle is superior in terms of weight reduction and over-all cardiometabolic improvement.

scholarly journals Inpatient hypoglycaemia in older people is associated with a doubling in the increased length of stay compared with the younger population

2020 ◽  
Author(s):  
Yue Ruan ◽  
Zuzana Moysova ◽  
Garry D Tan ◽  
Alistair Lumb ◽  
Jim Davies ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Older People ◽  
Hospital Admission ◽  
Hospital Admissions ◽  
Age Groups ◽  
University Hospitals ◽  
Clinical Consequences ◽  
Level 1 ◽  
Poor Outcomes ◽  
Level 2

Abstract Background Hypoglycaemia during hospital admission is associated with poor outcomes including increased length of stay. In this study, we compared the incidence of inpatient hypoglycaemia and length of stays among people of three age groups: ≤65 years, 65–80 years and &gt;80 years old. Methods The study was conducted using a 4-year electronic patient record dataset from Oxford University Hospitals NHS Foundation Trust. The dataset contains hospital admission data for people with diabetes. We analysed the blood glucose (BG) measurements and identified all level 1 (BG &lt;4 mmol/l) and level 2 (BG &lt;3 mmol/l) hypoglycaemic episodes. We compared the length of stays between different age groups and with different levels of hypoglycaemia. Results We analysed data obtained from 17,658 inpatients with diabetes who underwent 32,758 hospital admissions. The length of stays for admissions with no hypoglycaemia were 3[1,6], 3[1,8] and 4[2,11] (median[interquartile range]) days for age groups ≤65 years, 65–80 years and &gt;80 years, respectively. These were statistically significantly lower (P &lt; 0.01 for all pairwise comparisons) than the length of stays for admissions with level 1 hypoglycaemia, which were 6[3,13], 10[5,20] and 12[6,22] days, and level 2 hypoglycaemia, which were 7[3,14], 11[5,24] and 13[6,24] days. Conclusions In all age groups, admissions with either level 1 or level 2 hypoglycaemia were associated with an increased length of stay. However, in both the older groups, the length of stay increments were much higher (double) than the younger counterparts. The clinical consequences of hypoglycaemia were more severe in older people compared with the younger population.

scholarly journals Does pharmacist-led medication review help to reduce hospital admissions and deaths in older people? A systematic review and meta-analysis

2008 ◽  
Vol 65 (3) ◽  
pp. 303-316 ◽  
Author(s):  
Richard Holland ◽  
James Desborough ◽  
Larry Goodyer ◽  
Sandra Hall ◽  
David Wright ◽  
...  
Keyword(s):  
Systematic Review ◽  
Older People ◽  
Medication Review ◽  
Hospital Admissions ◽  
Meta Analysis

Quality of Life in Long-Term Breast Cancer Survivors

2013 ◽  
Vol 31 (28) ◽  
pp. 3540-3548 ◽  
Author(s):  
Tina Hsu ◽  
Marguerite Ennis ◽  
Nicky Hood ◽  
Margaret Graham ◽  
Pamela J. Goodwin
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
Breast Cancer Survivors ◽  
Distant Recurrence ◽  
Longitudinal Change ◽  
Control Group ◽  
Clinically Significant ◽  
Over Time

Purpose There is considerable interest in the quality of life (QOL) of long-term breast cancer (BC) survivors. We studied changes in QOL from time of BC diagnosis to long-term survivorship and compared QOL in long-term survivors to that of age-matched women with no history of BC. Patients and Methods In all, 535 women with localized BC (T1-3N0-1M0) were recruited from 1989 to 1996 and followed prospectively, completing QOL questionnaires at diagnosis and 1 year postdiagnosis. Between 2005 and 2007, those alive without distant recurrence were recontacted to participate in a long-term follow-up (LTFU) study. A control group was recruited from women presenting for screening mammograms, and both groups completed LTFU QOL questionnaires. Longitudinal change in BC survivors and differences between BC survivors and controls were assessed in eight broad categories with clinically significant differences set at 5% and 10% of the breadth of each QOL scale. Results A total of 285 patients with BC were included in the study, on average 12.5 years postdiagnosis. Longitudinally, clinically significant improvements were observed in overall QOL by 1 year postdiagnosis with further improvements by LTFU. Some clinically significant improvements over time were seen in all categories. A total of 167 controls were recruited. Deficits were observed in self-reported cognitive functioning (5.3% difference) and financial impact (6.3% difference) in BC survivors at LTFU compared with controls. Conclusion Long-term BC survivors show improvement in many domains of QOL over time, and they appear to have similar QOL in most respects to age-matched noncancer controls, although small deficits in cognition and finances were identified.

scholarly journals Real-life protection provided by vaccination, booster doses and previous infection against covid-19 infection, hospitalisation or death over time in the Czech Republic: a whole country retrospective view

2021 ◽  
Author(s):  
Ludek Berec ◽  
Martin Smid ◽  
Lenka Pribylova ◽  
Ondrej Majek ◽  
Tomas Pavlik ◽  
...  
Keyword(s):  
Czech Republic ◽  
Hospital Admission ◽  
Booster Dose ◽  
Hospital Admissions ◽  
Real Life ◽  
Vaccine Effectiveness ◽  
The Czech Republic ◽  
Vaccine Type ◽  
Previous Infection ◽  
Over Time

Background. Evidence is accumulating that the effectiveness of covid-19 vaccines against infection wanes, reaching relatively low values after 6 months. Published studies demonstrating this effect based their findings on a limited range of vaccines or subset of populations, and did not include booster vaccine doses or immunity obtained due to covid-19 infection. Here we evaluate effectiveness of covid-19 vaccines, booster doses or previous infection against covid-19 infection, hospital admission or death for the whole population in the Czech Republic. Methods. Data used in this study cover the whole population of the Czech Republic reported as infected and/or vaccinated between the first detected case on March 1, 2020 and November 20, 2021 (for reinfections), or December 26, 2020 and November 20, 2021 (for vaccinations), including hospital admissions and deaths. Vaccinations by all vaccines approved in the EU were included in this study. Anonymous, individual-level data including dates of vaccination, infection, hospital admission and death were provided by the the Institute of Health Information and Statistics of the Czech Republic. The risks of reinfection, breakthrough infection after vaccination, hospital admission and death were calculated using hazard ratios from a Cox regression adjusted for sex, age, vaccine type and vaccination status. Findings. The vaccine effectiveness against any PCR-confirmed infection declined from 87% (95% CI 86-87) at 0-2 months after the second dose to 53% (95% CI 52-54) at 7-8 months for Comirnaty, from 90% (95% CI 89-91) at 0-2 monthsto 65% (95% CI 63-67) at 7-8 months for Spikevax, and from 83% (95% CI 80-85) at 0-2 months to 55% at (95% CI 54-56) 5-6 months for the Vaxzevria. For Janssen Covid-19 Vaccine we found no significant decline but the estimates are less certain. The vaccine effectiveness against hospital admissions and deaths decayed at a significantly lower rate with about 15%, resp. 10% decline during the first 6-8 months. The administration of a booster dose returns the protection to or above the estimates in the first two months after dose 2. In unvaccinated but previously SARS-CoV-2-positive individuals the protection against PCR-confirmed SARS-CoV-2 infection declined from close to 97% (95% CI 97-97) after 2 months through 90% at 6 months down to 72% (95% CI 65-78) at 18 months. Interpretation. Our results confirm the waning of vaccination-induced immunity against infection and a smaller decline in the protection against hospital admission and death. A booster dose is shown to restore the vaccine effectiveness back to the levels seen soon after the completion of the basic vaccination schedule. The post-infection immunity decreases over time, too. Funding. No external funding was used to conduct this study.

scholarly journals Revisiting Oral Fluoroquinolone and Multivalent Cation Drug-Drug Interactions: Are They Still Relevant?

Antibiotics ◽  
2019 ◽  
Vol 8 (3) ◽  
pp. 108 ◽  
Author(s):  
Pitman ◽  
Hoang ◽  
Wi ◽  
Alsheikh ◽  
Hiner ◽  
...  
Keyword(s):  
Drug Interactions ◽  
Management Strategies ◽  
Oral Drug ◽  
Systemic Absorption ◽  
Resistant Bacteria ◽  
Oral Formulations ◽  
Multivalent Cation ◽  
Clinically Significant ◽  
High Bioavailability ◽  
Potentially Clinically Significant

Fluoroquinolones are a widely-prescribed, broad-spectrum class of antibiotics with several oral formulations notable for their high bioavailability. For certain infections, fluoroquinolones are the first line or only treatment choice. When administered orally, fluoroquinolones require proper administration to ensure adequate systemic absorption and, thereby, protect patients from treatment failure. Oral drug preparations that contain multivalent cations are well known to chelate with fluoroquinolones in the gastrointestinal tract; co-administration may lead to clinically significant decreases in oral fluoroquinolone bioavailability and an overall increase in fluoroquinolone-resistant bacteria. Based on a search and evaluation of the literature, this focused review describes oral fluoroquinolone-multivalent cation drug-drug interactions and their magnitude and offers several clinical management strategies for these potentially clinically significant interactions.

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