scholarly journals Antipsychotic prescribing patterns in care homes and relationship with dementia

2007 ◽  
Vol 31 (9) ◽  
pp. 329-332 ◽  
Author(s):  
David P. Alldred ◽  
Duncan R. Petty ◽  
Peter Bowie ◽  
Arnold G. Zermansky ◽  
David K. Raynor
Keyword(s):  
Medication Review ◽  
Controlled Trial ◽  
Intervention Group ◽  
The Elderly ◽  
Cross Sectional Study ◽  
Prescribing Patterns ◽  
Care Homes ◽  
Cross Sectional ◽  
Antipsychotic Prescribing ◽  
Randomised Controlled

Aims and MethodTo determine the prescribing patterns for antipsychotics in care homes for the elderly, a cross-sectional study was carried out using data from the intervention group of a randomised controlled trial of medication review in care homes.ResultsOf 331 residents studied, 67 (20%) were prescribed an antipsychotic (70% atypical); 57 of these (85%) did not have a diagnosis of a psychotic disorder. The antipsychotic prescribing rate was 32% (46 out of 146) for those with dementia and 10% (17 out of 174) for those without dementia. A quarter (82 out of 331) had received a medication review by the general practitioner in the preceding 12 months.Clinical ImplicationsOne-fifth of residents were prescribed an antipsychotic with little evidence of review. Systems should ensure residents' treatment is reviewed regularly.

scholarly journals Does occupational distress raise the risk of alcohol use, binge-eating, ill health and sleep problems among medical doctors? A UK cross-sectional study

BMJ Open ◽  
2019 ◽  
Vol 9 (5) ◽  
pp. e027362 ◽  
Author(s):  
Asta Medisauskaite ◽  
Caroline Kamau
Keyword(s):  
Binge Eating ◽  
Sleep Problems ◽  
Early Recognition ◽  
Controlled Trial ◽  
Psychiatric Morbidity ◽  
Cross Sectional Study ◽  
Health Problems ◽  
Coping With Stress ◽  
Cross Sectional ◽  
Randomised Controlled

ObjectivesThis study aims to assess the prevalence of health problems (eg, insomnia, binge-eating, substance use and ill health) among UK doctors and to investigate whether occupational distress increases the risk of health problems.DesignThis study reports the analysis of data collected at the baseline stage of a randomised controlled trial (protocol #NCT02838290).SettingDoctors were invited through medical Royal Colleges, the British Medical Association’s research panel and a random selection of NHS trusts across various UK regions.Participants417 UK doctors with an equivalent split of gender (48% males) and seniority (49% consultants).Main outcomes and measuresOutcomes were sleep problems (eg, insomnia), alcohol/drug use (eg, binge-drinking), ill health (eg, backache) and binge-eating (eg, uncontrollable eating). Predictor variables were occupational distress (psychiatric morbidity, burnout, job effort, work-life imbalance, coping with stress through self-blame or substances) and work factors (workplace and years practising medicine).Results44% of doctors binge-drank and 5% met the criteria for alcohol dependence; 24%–29% experienced negative emotions after overeating and 8% had a binge-eating disorder; 20%–61% had some type of sleep problem and 12% had severe/moderate insomnia; 69% had fatigue and 19%–29% experienced other types of ill health problems. The results show that occupational distress and job factors increase the odds of doctors using substances, having sleep problems, presenting with frequent symptoms of ill health and binge-eating. For example, burnout increased the risk of all types of sleep problems, eg, difficulty falling/staying asleep, insomnia (OR ≥1.344; p≤0.036). Even taking into consideration whether or not a doctor works in a hospital, the risk of health problems still rises when doctors have signs of occupational distress.ConclusionEarly recognition of occupational distress can prevent health problems among UK doctors that can reduce the quality of patient care because of sickness-related absence.

scholarly journals Professional medical writing support and the quality of randomised controlled trial reporting: a cross-sectional study

BMJ Open ◽  
2016 ◽  
Vol 6 (2) ◽  
pp. e010329 ◽  
Author(s):  
William T Gattrell ◽  
Sally Hopewell ◽  
Kate Young ◽  
Paul Farrow ◽  
Richard White ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
Controlled Trial ◽  
Cross Sectional Study ◽  
Medical Writing ◽  
Sectional Study ◽  
Cross Sectional ◽  
Randomised Controlled

Assessment of antipsychotic prescribing in Belgian nursing homes

2011 ◽  
Vol 23 (8) ◽  
pp. 1240-1248 ◽  
Author(s):  
Majda Azermai ◽  
Monique Elseviers ◽  
Mirko Petrovic ◽  
Luc van Bortel ◽  
Robert Vander Stichele
Keyword(s):  
Nursing Homes ◽  
Inappropriate Prescribing ◽  
The Elderly ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Prescribing Indicators ◽  
Prescribing Quality ◽  
Homes For The Elderly ◽  
Combined Use ◽  
Antipsychotic Prescribing

ABSTRACTBackground: Given the potential adverse effects of antipsychotics, high use in nursing homes creates concern. Our study goal was to explore the use of antipsychotics in relation to resident characteristics, and to assess the appropriateness of antipsychotic prescribing in Belgian nursing homes.Methods: Data were used from a cross-sectional study (Prescribing in Homes for the Elderly; PHEBE) conducted in 76 nursing homes in Belgium. Antipsychotics were classified into typical and atypical, using the anatomical therapeutic and chemical classification. Ten inappropriate antipsychotic prescribing indicators were selected from the updated Beers criteria (2003), Bergen District Nursing Home Study (BEDNURS) indicators, and Screening Tool of Older People's Prescriptions criteria (STOPP).Results: The residents' mean age was 84.8 years, 78.1% of whom were female. The prevalence of antipsychotic utilization was 32.9%. Antipsychotics were mainly indicated for dementia-related agitation, and psychosis with/without dementia. Higher use of antipsychotics was found for dementia (OR: 3.27; 95% CI: 2.61–4.09), insomnia (OR: 1.38; 95% CI: 1.10–1.73), depression (OR: 1.30; 95% CI: 1.03–1.65), and age <80 years (OR: 1.79; 95% CI: 1.38–2.33). Inappropriate antipsychotic prescribing indicators scoring the highest among users were: long-term use (92.6%), use despite risk of falling (45.6%), combined use with other psychotropics (31.8%), and duplicate use (15.1%). Inappropriate prescribing was associated with depression (OR: 3.41) and insomnia (OR: 2.17).Conclusion: The indicator-driven analysis of antipsychotic prescribing quality revealed a need for improvement, with the main prescribing problems relating to duration and combination of therapies. Risks/benefits of off-label use need to be evaluated more consciously at the start of therapy, and at periodic re-evaluations.

scholarly journals Development of a short-form Swedish version of the Montreal Cognitive Assessment (s-MoCA-SWE): protocol for a cross-sectional study

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e049035
Author(s):  
Tamar Abzhandadze ◽  
Erik Lundström ◽  
Dongni Buvarp ◽  
Marie Eriksson ◽  
Terence J Quinn ◽  
...  
Keyword(s):  
Cognitive Assessment ◽  
Short Form ◽  
Controlled Trial ◽  
Cross Sectional Study ◽  
Ethical Review ◽  
Swedish Version ◽  
Cross Sectional ◽  
Short Forms ◽  
Ethical Approval ◽  
Randomised Controlled

IntroductionShort forms of the Montreal Cognitive Assessment (MoCA) have allowed quick cognitive screening. However, none of the available short forms has been created or validated in a Swedish sample of patients with stroke.The aim is to develop a short-form Swedish version of the MoCA (s-MoCA-SWE) in a sample of patients with acute and subacute stroke. The specific objectives are: (1) to identify a subgroup of MoCA items that have the potential to form the s-MoCA-SWE; (2) to determine the optimal cut-off value of s-MoCA-SWE for predicting cognitive impairment and (3) and to compare the psychometric properties of s-MoCA-SWE with those of previously developed MoCA short forms.Methods and analysisThis is a statistical analysis protocol for a cross-sectional study. The study sample will comprise patients from Väststroke, a local stroke registry from Gothenburg, Sweden and Efficacy oF Fluoxetine—a randomisEd Controlled Trial in Stroke (EFFECTS), a randomised controlled trial in Sweden. The s-MoCA-SWE will be developed by using exploratory factor analysis and the boosted regression tree algorithm. The cut-off value of s-MoCA-SWE for impaired cognition will be determined based on binary logistic regression analysis. The psychometric properties of s-MoCA-SWE will be compared with those of other MoCA short forms by using cross-tabulation and area under the receiving operating characteristic curve analyses.Ethics and disseminationThe Väststroke study has received ethical approval from the Regional Ethical Review Board in Gothenburg (346–16) and the Swedish Ethical Review Authority (amendment 2019–04299). The handling of data generated within the framework of quality registers does not require written informed consent from patients. The EFFECTS study has received ethical approval from the Stockholm Ethics Committee (2013/1265-31/2 on 30 September 2013). All participants provided written consent. Results will be published in an international, peer-reviewed journal, presented at conferences and communicated to clinical practitioners in local meetings and seminars.

scholarly journals The level of functional dependency and independency among the elderly people of old care homes in Bangladesh

2017 ◽  
Vol 28 (2) ◽  
pp. 62-66
Author(s):  
Mir Hasan Shakil Mahmud ◽  
Nusrat Rahman ◽  
Shipra Mandal
Keyword(s):  
Elderly People ◽  
Sampling Technique ◽  
The Elderly ◽  
Cross Sectional Study ◽  
Functional Dependency ◽  
Care Homes ◽  
Functional Score ◽  
Age Group ◽  
Cross Sectional ◽  
Therapy Service

The level of functional dependency of elderly is increasing day by day. The old care homes have been markedly increased in recent years in Bangladesh. The purpose of the study was to identify the level of functional dependency and independency among activities of daily living for the elderly people of old care homes in Bangladesh. A cross sectional study was conducted with a structured and close ended interviewer administered questionnaire to collect information from 144 elderly people of five old care homes through convenient sampling technique. The results showed that, 38 participants were fully functional (score 6), 56 participants had score 4 and they had moderate impairment, 40 participants score was 2 or less which indicated severe functional impairment and 10 participants were totally dependent (score 0). The study also revealed that 58% of the elderly people in the age group 60-65 years were independent and 70% of the elderly people belonging to age group >70 were totally dependent. However, it has been evident that percentage of independency decreases with the increase of age. It was also found that respondents‘ at the age of 65 years and above were functionally dependent. This study also recommends for occupational therapy service in old care home.Bang J Psychiatry Dec 2014; 28(2): 62-66

scholarly journals Clinical medication review by a pharmacist of elderly people living in care homes—randomised controlled trial

2006 ◽  
Vol 35 (6) ◽  
pp. 586-591 ◽  
Author(s):  
Arnold Geoffrey Zermansky ◽  
David Phillip Alldred ◽  
Duncan Robert Petty ◽  
David K. Raynor ◽  
Nick Freemantle ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
Elderly People ◽  
Medication Review ◽  
Controlled Trial ◽  
Care Homes ◽  
Clinical Medication Review ◽  
Randomised Controlled

scholarly journals GP-delivered medication review of polypharmacy, deprescribing, and patient priorities in older people with multimorbidity in Irish primary care (SPPiRE Study): A cluster randomised controlled trial

PLoS Medicine ◽  
2022 ◽  
Vol 19 (1) ◽  
pp. e1003862
Author(s):  
Caroline McCarthy ◽  
Barbara Clyne ◽  
Fiona Boland ◽  
Frank Moriarty ◽  
Michelle Flood ◽  
...  
Keyword(s):  
Primary Care ◽  
Randomised Controlled Trial ◽  
Medication Review ◽  
Older Patients ◽  
Controlled Trial ◽  
Intervention Group ◽  
Cluster Randomised Controlled Trial ◽  
Community Dwelling ◽  
Cluster Randomised ◽  
Randomised Controlled

Background There is a rising prevalence of multimorbidity, particularly in older patients, and a need for evidence-based medicines management interventions for this population. The Supporting Prescribing in Older Adults with Multimorbidity in Irish Primary Care (SPPiRE) trial aimed to investigate the effect of a general practitioner (GP)-delivered, individualised medication review in reducing polypharmacy and potentially inappropriate prescriptions (PIPs) in community-dwelling older patients with multimorbidity in primary care. Methods and findings We conducted a cluster randomised controlled trial (RCT) set in 51 GP practices throughout the Republic of Ireland. A total of 404 patients, aged ≥65 years with complex multimorbidity, defined as being prescribed ≥15 regular medicines, were recruited from April 2017 and followed up until October 2020. Furthermore, 26 intervention GP practices received access to the SPPiRE website where they completed an educational module and used a template for an individualised patient medication review that identified PIP, opportunities for deprescribing, and patient priorities for care. A total of 25 control GP practices delivered usual care. An independent blinded pharmacist assessed primary outcome measures that were the number of medicines and the proportion of patients with any PIP (from a predefined list of 34 indicators based predominantly on the STOPP/START version 2 criteria). We performed an intention-to-treat analysis using multilevel modelling. Recruited participants had substantial disease and treatment burden at baseline with a mean of 17.37 (standard deviation [SD] 3.50) medicines. At 6-month follow-up, both intervention and control groups had reductions in the numbers of medicines with a small but significantly greater reduction in the intervention group (incidence rate ratio [IRR] 0.95, 95% confidence interval [CI]: 0.899 to 0.999, p = 0.045). There was no significant effect on the odds of having at least 1 PIP in the intervention versus control group (odds ratio [OR] 0.39, 95% CI: 0.140 to 1.064, p = 0.066). Adverse events recorded included mortality, emergency department (ED) presentations, and adverse drug withdrawal events (ADWEs), and there was no evidence of harm. Less than 2% of drug withdrawals in the intervention group led to a reported ADWE. Due to the inability to electronically extract data, primary outcomes were measured at just 2 time points, and this is the main limitation of this work. Conclusions The SPPiRE intervention resulted in a small but significant reduction in the number of medicines but no evidence of a clear effect on PIP. This reduction in significant polypharmacy may have more of an impact at a population rather than individual patient level. Trial registration ISRCTN Registry ISRCTN12752680.

scholarly journals Effects of stratified medication review in high-risk patients at admission to hospital: a randomised controlled trial

2020 ◽  
Vol 11 ◽  
pp. 204209862095714
Author(s):  
Dorthe Krogsgaard Bonnerup ◽  
Marianne Lisby ◽  
Eva Aggerholm Sædder ◽  
Birgitte Brock ◽  
Tania Truelshøj ◽  
...  
Keyword(s):  
At Risk ◽  
High Risk ◽  
Medication Errors ◽  
Medication Review ◽  
Controlled Trial ◽  
Intervention Group ◽  
Control Group ◽  
Prescribing Errors ◽  
Medication Reviews ◽  
Randomised Controlled

Background: Patients at high risk of medication errors will potentially benefit most from medication reviews. An algorithm, MERIS, can identify the patients who are at highest risk of medication errors. The aim of this study was to examine the effects of performing stratified medication reviews on patients who according to MERIS were at highest risk of medication errors. Methods: A randomised controlled trial was performed at the Acute Admissions Unit, Aarhus University Hospital, Denmark. Patients were included at admission to the hospital and were randomised to control or intervention. The intervention consisted of stratified medication review at admission on patients with a high MERIS score. Clinical pharmacists and clinical pharmacologists performed the medication reviews; the clinical pharmacologists performed the reviews on patients with the highest MERIS score. The primary outcome measure was the number of prescribing errors during the hospitalisation. Secondary outcomes included self-experienced quality of life, health-care utilisation and mortality measured at follow-up 90 days after discharge. Results: A total of 375 patients were included, of which medication reviews were performed in 64 patients. The medication reviews addressed 63 prescribing errors in 37 patients and 60 other drug-related problems. No difference in the number of prescribing errors during hospitalisation between the intervention group ( n = 165) and control group ( n = 153) was found, corresponding to 0.11 prescribing errors per drug (95% confidence interval (CI): 0.08–0.14) versus 0.13 per drug (95% CI: 0.09–0.16), respectively. No differences in secondary outcomes were observed. Conclusion: A stratified medication review approach based on the individual patient’s risk of medication errors did not show impact on the chosen outcomes. Plain language summary How does a medication review at admission affect patients who are in high risk of medication errors? Patients are at risk of medication errors at admission to hospital. Medication reviews aim to detect and solve these. Yet, due to limited resources in healthcare, it would be beneficial to detect the patients who are most at risk of medication errors and perform medication reviews on those patients. In this study we investigated whether an algorithm, MERIS, could detect patients who are at highest risk of medication errors; we also studied whether performing medication reviews on patients at highest risk of medication errors would have an effect on, for example, the number of medication errors during hospitalisation, qualify of life and number of readmissions. We included 375 patients in a Danish acute admission unit and they were divided into control group and intervention group. Patients in the intervention group received a medication review at admission if they were considered at high risk of medication errors, assessed with the aid of MERIS. In summary, 64 patients in the intervention group were most at risk of medication errors and therefore received a medication review. We conclude in the study that MERIS was useful in identifying relevant patients for medication reviews. Yet, the medication reviews performed at admission did not impact on the chosen outcomes.

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