Deprescribing in older people

2020 ◽  
Vol 81 (1) ◽  
pp. 1-9 ◽  
Author(s):  
M Sinead O'Mahony ◽  
Anita Parbhoo
Keyword(s):  
Decision Making ◽  
High Risk ◽  
Older People ◽  
Adverse Drug Events ◽  
Evidence Base ◽  
Adverse Outcomes ◽  
Evidence Based ◽  
Pharmacological Management ◽  
International Evidence ◽  
Evidence Based Guidelines

Polypharmacy and multimorbidity are both currently rising. The number of medicines taken is the single biggest predictor of adverse drug events. Deprescribing is an approach to managing polypharmacy and reducing adverse outcomes. Multiple international evidence-based guidelines are emerging to promote discontinuation of high-risk medications, and use of alternative medical and non-pharmacological management. This review outlines the evidence base behind deprescribing, and suggests some pragmatic approaches to decision making around medication review.

scholarly journals Incentives and Support Programs to Improve Adherence to Tuberculosis Treatment

2021 ◽  
Vol 1 (2) ◽  
Author(s):  
Charlotte Wells ◽  
Melissa Severn
Keyword(s):  
High Risk ◽  
Methodological Quality ◽  
Clinical Effectiveness ◽  
Conclusive Evidence ◽  
Active Tuberculosis ◽  
Tuberculosis Treatment ◽  
Support Programs ◽  
Evidence Based ◽  
Evidence Based Guidelines

Three overviews of reviews and 11 systematic reviews were identified regarding the clinical effectiveness of adherence incentives in those who require assistance to complete their tuberculosis treatment. Four evidence-based guidelines were identified that provided recommendations regarding the use of adherence incentives in those who require assistance completing their tuberculosis treatment. The reported clinical effectiveness of adherence incentives for patients with tuberculosis was mixed. There were no detrimental effects of providing incentives, but there was also no conclusive evidence pointing to a clinical benefit. The overall quality of the included reviews was moderate to high. The included guidelines recommended that incentives and enablers be included as a part of a patient-centred strategy for treatment and for patients with active tuberculosis or patients at high risk; however, the evidence formulating these recommendations was of low certainty or quality. Two of the included guidelines were of high methodological quality, and 2 were of lower methodological quality.

Integrating research and evidence-based guidance into prescribing practice

2021 ◽  
Vol 3 (3) ◽  
pp. 120-123
Author(s):  
Adam Bedson
Keyword(s):  
Decision Making ◽  
Critical Appraisal ◽  
Clinical Decision Making ◽  
Primary Source ◽  
Clinical Decision ◽  
Evidence Base ◽  
Evidence Based ◽  
Multiple Sources ◽  
Prescribing Practice ◽  
Critical Appraisal Skills

The College of Paramedics and the Royal Pharmaceutical Society are clear that they require advanced paramedics, as non-medical prescribers, to review and critically appraise the evidence base underpinning their prescribing practice. Evidence-based clinical guidance such as that published by the National Institute for Health and Care Excellence (NICE) is recommended as the primary source of evidence on which paramedics should base their prescribing decisions. NICE guidance reflects the best available evidence on which to base clinical decision-making. However, paramedics still need to critically appraise the evidence underpinning their prescribing, applying expertise and decision-making skills to inform their clinical reasoning. This is achieved by synthesising information from multiple sources to make appropriate, evidence-based judgments and diagnoses. This first article in the prescribing paramedic pharmacology series considers the importance of evidence-based paramedic prescribing, alongside a range of tools that can be used to develop and apply critical appraisal skills to support prescribing decision-making. These include critical appraisal check lists and research reporting tools

Anaesthetic considerations for emergency laparotomy

Nowa Medycyna ◽  
2020 ◽  
Vol 27 (3) ◽  
Author(s):  
Jacek Wadełek
Keyword(s):  
Risk Assessment ◽  
Decision Making ◽  
High Risk ◽  
Adverse Outcomes ◽  
Emergency Laparotomy ◽  
Life Threatening ◽  
The Right ◽  
Level Of Experience ◽  
Time Frames ◽  
Reduced Time

The majority of patients undergoing emergency laparotomy have potentially life?threatening conditions that require prompt intervention. The reduced time?frames available due to surgical urgency necessitate prompt and senior decision?making to minimise delays. The time taken to correct any anomalies needs to be balanced against the need for prompt surgery, particularly in time?sensitive situations involving sepsis or hypovolaemia. Therefore, corrective measures may be performed in parallel with surgery. Patients undergoing emergency laparotomy are at a high risk of adverse outcomes. Key elements of care for these patients include repeated risk assessment, early antibiotic therapy, as well as fluid resuscitation and appropriate timely interventions provided by clinicians with the right level of experience.

scholarly journals Re-energising the way we manage change in healthcare: the case for soft systems methodology and its application to evidence-based practice

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Hanna Augustsson ◽  
Kate Churruca ◽  
Jeffrey Braithwaite
Keyword(s):  
Real World ◽  
Soft Systems Methodology ◽  
Evidence Base ◽  
Learning Cycle ◽  
Evidence Based ◽  
Systems Methodology ◽  
Soft Systems ◽  
Implementation Effort ◽  
Evidence Based Guidelines ◽  
Taking Action

Abstract Background Updating, improving and spreading the evidence base for healthcare practices has proven to be a challenge of considerable magnitude – a wicked, multi-dimensional problem. There are many interlinked factors which determine how, why and whether any particular implementation effort or intervention succeeds. Soft Systems Methodology (SSM), strongly grounded in systems ideas and complexity science, offers a structured, yet flexible process for dealing with situations that are perceived as problematical and in need of improvement. The aim of this paper is to propose the use of SSM for managing change in healthcare by way of addressing some of the complexities. The aim is further to illustrate examples of how SSM has been used in healthcare and discuss the features of the methodology that we believe can be harnessed to improve healthcare. Discussion SSM is particularly suited for tackling real world problems that are difficult to define and where stakeholders may have divergent views on the situation and the objectives of change. SSM engages stakeholders in a learning cycle including: finding out about the problematical situation, i.e. the context in which the problem exists, by developing a rich picture of the situation; defining it by developing conceptual models and comparing these with the real world; taking action to improve it by deciding on desirable and feasible improvements; and implementing these in an iterative manner. Although SSM has been widely used in other sectors, it has not been extensively used in healthcare. We make the case for applying SSM to implementation and improvement endeavours in healthcare using the example of getting clinicians at the hospital level to use evidence-based guidelines. Conclusion Applying SSM means taking account of the multi-dimensional nature of care settings, and dealing with entrenched and unique contexts, cultures and socio-political ecosystems – precisely those that manifest in healthcare. There are gains to be made in appreciating complexity and facilitating contextualization of interventions, and by approaching improvements in an iterative learning cycle.

Integrating research and evidence-based guidance into prescribing practice

2021 ◽  
Vol 13 (1) ◽  
pp. 10-13
Author(s):  
Adam Bedson
Keyword(s):  
Decision Making ◽  
Critical Appraisal ◽  
Clinical Decision Making ◽  
Primary Source ◽  
Clinical Decision ◽  
Evidence Base ◽  
Evidence Based ◽  
Multiple Sources ◽  
Prescribing Practice ◽  
Critical Appraisal Skills

The College of Paramedics and the Royal Pharmaceutical Society are clear that they require advanced paramedics, as non-medical prescribers, to review and critically appraise the evidence base underpinning their prescribing practice. Evidence-based clinical guidance such as that published by the National Institute for Health and Care Excellence (NICE) is recommended as the primary source of evidence on which paramedics should base their prescribing decisions. NICE guidance reflects the best available evidence on which to base clinical decision-making. However, paramedics still need to critically appraise the evidence underpinning their prescribing, applying expertise and decision-making skills to inform their clinical reasoning. This is achieved by synthesising information from multiple sources to make appropriate, evidence-based judgments and diagnoses. This first article in the prescribing paramedic pharmacology series considers the importance of evidence-based paramedic prescribing, alongside a range of tools that can be used to develop and apply critical appraisal skills to support prescribing decision-making. These include critical appraisal checklists and research reporting tools.

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