Towards Safe Medication Use Among Geriatric Patients: A Combined Tool For Identification of Potential Drug-Related Problems

2021 ◽  
Author(s):  
Veera Bobrova ◽  
Daniela Fialová ◽  
Shane Desselle ◽  
Jyrki Heinämäki ◽  
Daisy Volmer
Keyword(s):  
High Risk ◽  
Anatomical Therapeutic Chemical ◽  
Potentially Inappropriate Medications ◽  
Drug Related Problems ◽  
Active Ingredients ◽  
Specific Patient ◽  
Patient Groups ◽  
Sodium Picosulfate ◽  
C And N ◽  
The Eu

Abstract Background: Drug-related problems (DRP), including potentially inappropriate medications (PIMs), are a common problem in older people with multi-morbidity and polypharmacy. It is important to identify appropriate tools, preferably adjusted to specific patient groups, to deal more effectively with potential or existing DRPs. Our hypothesis is that combining PIM identification tools enables to significantly enhance the determination of DRPs. The aim of this study was to develop a combined tool for identification of DRPs in geriatric multi-morbid and polypharmacy patients, using the EU(7)-PIM and EURO-FORTA lists, with a focus on high-risk medications. Methods: The combined PIM identification tool used the information on PIM active ingredients in both databases - the EU(7)-PIM and EURO-FORTA. PIMs were classified into four color groups based on risk profile: very significant PIMs (should be avoided in older patients) as red, significant PIMs (require dose and/or treatment duration adjustment) as yellow, non-significant PIMs/non-PIMs (low DRP risk) as green, and questionable PIMs (incomplete/missing information) as grey. Results: The summarized list of the red PIMs contains 34 active ingredients, including one combination of two medications and one medication class. According to the Anatomical Therapeutic Chemical classification, most of the red PIMs (n=27, 79.4%) belong to the A, C and N medication groups. Only 41.2% of the red PIMs have marketing authorization in Estonia. In 2019 more frequently used red PIMs in Estonia were sodium picosulfate, propafenone, ginkgo biloba, magnesium hydroxide, and dextromethorphan. The approximate number of the yellow and green PIMs is 248, but sub-classification of this category into one or another group depends mainly on an individual patient´s clinical characteristics. The complete list of the grey PIMs will be developed in the future Conclusions: The combined PIM tool based on the EU(7)-PIM and EURO-FORTA criteria was created to address the need for more efficient identification of DRP in geriatric multi-morbid patients. The combined PIM tool was developed with a focus on the high-risk medications for older adults and taking into consideration the availability of the PIMs in Estonia. The tool could potentially be applied as a screen to identify DRPs in different health care settings.

scholarly journals Non-medical risk factors associated with postponing elective surgery: a prospective observational study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Julia Becker ◽  
Gerald Huschak ◽  
Hannes-Caspar Petzold ◽  
Volker Thieme ◽  
Sebastian Stehr ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Low Socioeconomic Status ◽  
Elective Surgery ◽  
Nursing Home Residents ◽  
Hospital Staff ◽  
Data Management System ◽  
Electronic Patient Records ◽  
Specific Patient ◽  
Emergency Procedures ◽  
Patient Groups

Abstract Background Operation room (OR) planning is a complex process, especially in large hospitals with high rates of unplanned emergency procedures. Postponing elective surgery in order to provide capacity for emergency operations is inevitable at times. Elderly patients, residents of nursing homes, women, patients with low socioeconomic status and ethnic minorities are at risk for undertreatment in other contexts, as suggested by reports in the medical literature. We hypothesized that specific patient groups could be at higher risk for having their elective surgery rescheduled for non-medical reasons. Methods In this single center, prospective observational trial, we analysed 2519 patients undergoing elective surgery from October 2018 to May 2019. A 14-item questionnaire was handed out to illicit patient details. Additional characteristics were collected using electronic patient records. Information on the timely performance of the scheduled surgery was obtained using the OR’s patient data management system. 6.45% of all planned procedures analysed were postponed. Association of specific variables with postponement rates were analysed using the Mann–Whitney U test and Fisher's exact test/χ2-test. Results Significantly higher rates of postponing elective surgery were found in elderly patients. No significant differences in postponing rates were found for the variables gender, nationality (Germany, EU, non-EU), native language, professional medical background and level of education. Significantly lower rescheduling rates were found in patients with ties to hospital staff and in patients with a private health insurer. Conclusions Elderly patients, retirees and nursing home residents seem to be at higher risk for having their elective surgery rescheduled. However, owing to the study design, causality could not be proven. Our findings raise concern about possible undertreatment of these patient groups and provide data on short-term postponement of elective surgery. Trial registration DRKS00015836. Retrospectively registered.

scholarly journals Predictive Factors in Sacral Neuromodulation: A Systematic Review

2021 ◽  
pp. 1-21
Author(s):  
Ranjana Jairam ◽  
Jamie Drossaerts ◽  
Tom Marcelissen ◽  
Gommert van Koeveringe ◽  
Desiree Vrijens ◽  
...  
Keyword(s):  
Systematic Review ◽  
Predictive Factors ◽  
Sacral Neuromodulation ◽  
Level Of Evidence ◽  
Specific Patient ◽  
Detrusor Contractility ◽  
Affective Symptoms ◽  
Lower Success Rate ◽  
Patient Groups ◽  
Based Medicine

<b><i>Introduction:</i></b> Sacral neuromodulation (SNM) is an effective treatment in patients with overactive bladder syndrome or nonobstructive urinary retention when conservative treatment fails. Several factors that could impact outcome with SNM have been studied. This systematic review investigated these predictive factors and their relevance for clinical practice. <b><i>Methods:</i></b> Systematic review according to the PRISMA guidelines was conducted. This review is registered in the PROSPERO register (CRD42015016256). <b><i>Results:</i></b> Seventy-eight studies (of which 11 abstracts) were included. Females, younger patients, and a tined lead procedure tend to be predictive in successful SNM outcome. Factors that did not influence SNM outcome were prior back surgery, surgery for stress urinary incontinence, affective symptoms, and duration of complaints. Reduced detrusor contractility is associated with a lower success rate. The level of evidence of most studies (graded according to the Centre for Evidence-Based Medicine) was 3b. <b><i>Conclusion:</i></b> Even though this systematic review investigated predictive factors (gender, age, type of procedure, type of lead, and detrusor contractility), no general consensus on predictive factors could be made. Most studies are small, retrospective, and involve a heterogeneous population. Therefore, prospective research in larger specific patient groups remains necessary to find predictors of SNM outcome.

Development of an Emergency Revisit Score for Patients With Drug-Related Problems

2021 ◽  
pp. 875512252110117
Author(s):  
Jesus Ruiz Ramos ◽  
Laura Gras-Martin ◽  
Ana María Juanes Borrego ◽  
Marta Blazquez-Andion ◽  
Mireia Puig Campmany ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Receiver Operating Curve ◽  
Drug Related Problems ◽  
Derivation Cohort ◽  
Factors Associated ◽  
Final Score ◽  
Anticholinergic Burden ◽  
Risk Categories ◽  
Frequent Reason

Background: Drug-related problems (DRPs) are a frequent reason for emergency departments (EDs) visits. However, data about the risk factors associated with EDs revisits are limited. Objective: To develop and validate a predictive model indicating the risk factors associated with EDs revisit within 30 days of the first visit. Methods: A retrospective cohort study was conducted involving patients who attended an ED for DRPs related to cardiovascular drugs. A 30-day prediction model was created in a derivation cohort by logistic regression. An integer score proportional to the regression coefficient was assigned to the variables with P < .100 in the multivariate analysis. Results: 581 patients (mean age: 80.0 [12.6] years) were included, 133 (22.9%) revisited the ED within 30 days from discharge. Six factors (chronic kidney disease, chronic heart failure, visit to an ED in the preceding 3 months, high anticholinergic burden, DRPs associated with heparin, and safety-related DRPs) were identified as risk factors and combined into a final score, termed the DREAMER score. The model reached an area under the receiver operating curve values of 0.72 (95% confidence interval [CI] = 0.67-0.77) in the referral cohort and 0.71 (95% CI = 0.65-0.74) in the validation cohort ( P = .273). Three risk categories were generated, with the following scores and estimated risks: low risk (0-8 points): 11.6%; intermediate risk (9-14 points): 21.3%; and high risk (>14 points): 41.2%. Conclusion and Relevance: The DREAMER score identifies patients at high risk for ED revisit within 30 days from the first visit for a DRPs, being a useful tool to prioritize interventions on discharge.

scholarly journals Subgroup analyses to determine cardiovascular risk associated with nonsteroidal antiinflammatory drugs and coxibs in specific patient groups

2008 ◽  
Vol 59 (8) ◽  
pp. 1097-1104 ◽  
Author(s):  
Daniel H. Solomon ◽  
Robert J. Glynn ◽  
Kenneth J. Rothman ◽  
Sebastian Schneeweiss ◽  
Soko Setoguchi ◽  
...  
Keyword(s):  
Cardiovascular Risk ◽  
Nonsteroidal Antiinflammatory Drugs ◽  
Antiinflammatory Drugs ◽  
Specific Patient ◽  
Subgroup Analyses ◽  
Patient Groups

scholarly journals Pharmaceutical care in a school pharmacy: from consultation to resolution of drug-related problems

2019 ◽  
Vol 41 (1) ◽  
pp. 42470
Author(s):  
Amanda Thiemy Chiozzi Watanabe ◽  
Fernando Henrique Zonzini ◽  
Maurício Fumio Sybui ◽  
Angela Maria Campanha
Keyword(s):  
Pharmaceutical Care ◽  
Anatomical Therapeutic Chemical ◽  
Descriptive Analysis ◽  
State University ◽  
Drug Related Problems ◽  
Relevant Role ◽  
Professional Information ◽  
General Community

This study aimed to provide pharmaceutical care for the general community served by Pharmacy students from the Pharmacy School of the State University of Maringá [Universidade Estadual do Maringá] (UEM). Pharmacotherapeutic follow-up was performed with the identification, classification and resolution of drug-related problems (DRPs) through pharmaceutical consultations. A descriptive analysis was conducted. A total of 59 patients were interviewed; they were mostly women (75%) with average age of 63 years, and each of them was taking 8 medicines on average. The most frequently mentioned drugs were classified according to the Anatomical Therapeutic Chemical Code and related to cardiovascular system (28%), alimentary tract and metabolism (23%), and nervous system (20%). An average of 1.49 DRP per patient was detected (88), and treatment non-compliance was the most frequent DRPs found (45%). In view of this, 63 pharmaceutical interventions were carried out, with most of them (52%) being related to patient education on the treatment; approximately 20% of the patients were referred to another health professional. Information supplied by this study shows the relevant role of pharmacists face the lack of pharmacotherapeutic follow-up of polymedicated patients.

scholarly journals Minimally invasive aortic valve replacement in high risk patient groups

2017 ◽  
Vol 9 (6) ◽  
pp. 1672-1696 ◽  
Author(s):  
Daniel Fudulu ◽  
Harriet Lewis ◽  
Umberto Benedetto ◽  
Massimo Caputo ◽  
Gianni Angelini ◽  
...  
Keyword(s):  
High Risk ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Minimally Invasive ◽  
Valve Replacement ◽  
High Risk Patient ◽  
Risk Patient ◽  
Patient Groups

scholarly journals Catheter-Based Therapies and Other Management Strategies for Deep Vein Thrombosis and Post-Thrombotic Syndrome

2020 ◽  
Vol 9 (5) ◽  
pp. 1439 ◽  
Author(s):  
Siddhant Thukral ◽  
Suresh Vedantham
Keyword(s):  
Deep Vein Thrombosis ◽  
Management Strategies ◽  
Patient Centered ◽  
Specific Patient ◽  
Vein Thrombosis ◽  
Post Thrombotic Syndrome ◽  
Patient Morbidity ◽  
Patient Groups ◽  
Deep Vein

Acute deep vein thrombosis (DVT) causes substantial short-term and long-term patient morbidity. Medical, lifestyle, and compressive therapies have been investigated for the prevention of pulmonary embolism (PE) and recurrence of venous thromboembolism (VTE). However, patient-centered outcomes such as resolution of presenting DVT symptoms and late occurrence of post-thrombotic syndrome (PTS) have not been prioritized to the same degree. Imaging-guided, catheter-based endovascular therapy has been used in selected patients to alleviate these sequelae, but important questions remain about their optimal use. In this article, we review the available evidence and summarize the rationale for use of catheter-based therapy in specific patient groups.

Transfer medicine

2014 ◽  
Author(s):  
Jeremy Prout ◽  
Tanya Jones ◽  
Daniel Martin
Keyword(s):  
Spinal Injury ◽  
Legal Aspects ◽  
Patient Transfer ◽  
Specific Patient ◽  
Patient Groups

This chapter on transfer medicine includes transfer indications, decisions, general considerations and complications as well as legal aspects of patient transfer. Considerations for specific patient groups are described for neurosurgical, trauma, spinal injury, burns and obstetric patients. Complications and management are detailed in an ABCDE format. Transfer equipment including ventilators with modes of ventilation are also considered.

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