scholarly journals Searching for Success Factors in Deprescribing Proposals from Community Pharmacists

2021 ◽  
Author(s):  
Shin Osada
Keyword(s):  
Adverse Events ◽  
Success Rate ◽  
Elderly People ◽  
Success Factors ◽  
Community Pharmacists ◽  
Doctor Who ◽  
Study Success ◽  
Face To Face ◽  
Unused Medications ◽  
Critical Issues

Abstract BackgroundPolypharmacy is one of the most critical issues worldwide, especially in elderly people. In Japan, fees to support deprescription were established in 2018 which are calculated as the community pharmacists propose deprescribing in patients prescribed 6 or more medications regularly by submitting documents to the prescribing doctor, who may withdraw 2 or more medications. However, these are hardly calculated though many deprescribing proposals submitted.ObjectiveThe objective in this study, success factors in deprescribing proposals from the community pharmacists to prescribing doctors were searched for.MethodsTracing reports submitted from Aug 2017 to Mar 2020 were investigated retrospectively and factors that influenced the success of deprescribing were searched for.ResultsOne hundred and twenty-three tracing reports (67 reports of successful deprescribing and 56 reports of failure, success rate was 54.5%) were submitted to the prescribing doctors. Deprescribing proposals with existing unused medications or an assessment of possible adverse events significantly increased the deprescribing success rate. Whether the pharmacist experienced face-to-face communication with the prescribing doctors was not significant.ConclusionTracing reports with deprescribing proposals submitted by the community pharmacists may resolve polypharmacy. Mentioning unused medications or possible adverse events could increase the deprescribing success rate.

scholarly journals Examining Success Factors in Deprescribing Proposals from Community Pharmacists

2021 ◽  
Author(s):  
Shin Osada
Keyword(s):  
Adverse Events ◽  
Observational Study ◽  
Success Rate ◽  
Success Factors ◽  
Community Pharmacists ◽  
Critical Issue ◽  
Potentially Inappropriate Medications ◽  
Face To Face ◽  
Unused Medications ◽  
Inappropriate Medications

Abstract Background: Polypharmacy is a critical issue that affects elderly people in particular. In Japan, fees to support deprescription are calculated bycommunity pharmacists who propose deprescribing 2 or more medications for patients prescribed 6 or more. However, the fees are rarely calculated.The objective of this study is toexamine success factors in deprescribing proposals submitted bycommunity pharmacists to prescribing doctors.Methods: Tracing reports submitted from Aug 2017 to Mar 2020 were investigated retrospectively to uncover factors that influenced the success of deprescribing using statisticalanalyses.Results:One hundred and twenty-three unique tracing reports were submitted to the prescribing doctors. Of these, 67 reports were successful in deprescribing and 56 failed; the success rate was 54.5%. Deprescribing proposals with existingunused medications significantly increased the deprescribing success rate. Possible adverse events, potentially inappropriate medications, and overlapping medications with the same effecttended to increase the success rate, but not significantly. Whether the pharmacist experienced face-to-face communication with the prescribing doctors did not significantly influence the outcome.Conclusions:Tracing reports with deprescribing proposals submitted by community pharmacists may help resolve problems arising frompolypharmacy. Mentioning unused medications could increase the deprescribing success rate.Trial registration: This study did not registered due to purely observational study.

Physiotherapy via telehealth for acute respiratory exacerbations in paediatric cystic fibrosis

2021 ◽  
pp. 1357633X2199820
Author(s):  
Cloe Benz ◽  
Anna Middleton ◽  
Alison Elliott ◽  
Adrienne Harvey
Keyword(s):  
Cystic Fibrosis ◽  
Young People ◽  
Adverse Events ◽  
Travel Time ◽  
Standard Care ◽  
Limiting Factor ◽  
Specialist Care ◽  
Face To Face ◽  
Respiratory Exacerbations ◽  
Hybrid Group

Introduction The demand for Hospital in the Home has increased, especially as an avenue for treatment of respiratory exacerbations. However, a limiting factor of Hospital in the Home efficiency is excess travel. Telehealth can potentially increase in-home access to specialist care such as physiotherapy. This study examined clinical outcomes achieved with a hybrid telehealth model and assessed safety and efficiency. Method This study was an observational benchmarking study of Hospital in the Home physiotherapy episodes of care during respiratory exacerbations between January 2017–June 2019. The participants were young people aged 8–18 years, with cystic fibrosis receiving intravenous antibiotics and bi-daily physiotherapy. The intervention was physiotherapy via either a hybrid model (1× telehealth, 1× face-to-face session) or standard care (2× face-to-face sessions). The outcomes were frequency of return to at least 95% of baseline percentage predicted forced expiratory volume in the first second (ppFEV1), ppFEV1 change, adverse events, travel time and distance saved. Results There were 82 episodes of Hospital in the Home; 41 hybrid and 41 standard care. Return to at least 95% of baseline was achieved in 49% of the hybrid group and 32% of standard care. Median ppFEV1 change was +6% for the hybrid group and +2% standard care. There were no adverse events. Estimated travel time and distance saved was 16,520 min and 12,301.2 km. Conclusion Preliminary information supports a hybrid telehealth physiotherapy model as an alternative to standard care for young people with cystic fibrosis during an exacerbation. Safety of telehealth in conjunction with home visits favoured its use to improve efficiency and capacity without added risk.

Identifying key network characteristics for agricultural innovation: A multisectoral case study approach

2018 ◽  
Vol 47 (1) ◽  
pp. 19-26
Author(s):  
Evelien Lambrecht ◽  
Maarten Crivits ◽  
Ludwig Lauwers ◽  
Xavier Gellynck
Keyword(s):  
Success Factors ◽  
Knowledge Exchange ◽  
Group Discussions ◽  
Agricultural Innovation ◽  
Network Characteristics ◽  
Face To Face ◽  
Study Approach ◽  
Innovation Characteristics ◽  
Depth Interviews

This article identified network characteristics critical for successful agricutural innovations within networks, or a set of interrelated organizations aiming at knowledge exchange for innovations. To explore key success factors, the research questioned how networks cope with innovation characteristics and combined network characteristics with four innovation characteristics in four agricultural sub-sectors. Data were collected from in-depth interviews with farmers and network coordinators and from focus group discussions with farmers active in Flanders, the northern part of Belgium. Factors particularly helpful for success in agricultural innovation networks include numerous contacts, integration of knowledge providers in the network structure, face-to-face communication, a self-initiated coalition and surpassing innovation beyond the mere agricultural level, through collaboration with people from outside the sector. The findings are useful for academics, network coordinators and network members, possibly leading to a higher innovation performance via networking.

Barriers to self-care in elderly people with hypertension: a qualitative study

2018 ◽  
Vol 22 (4) ◽  
pp. 243-251
Author(s):  
Hanieh Gholamnejad ◽  
Ali Darvishpoor Kakhki ◽  
Fazlollah Ahmadi ◽  
Camelia Rohani
Keyword(s):  
Data Collection ◽  
Qualitative Study ◽  
Elderly People ◽  
Self Care ◽  
Content Type ◽  
Common Chronic Disease ◽  
Face To Face ◽  
Purposeful Sampling ◽  
Data Saturation ◽  
Conventional Content Analysis

Purpose Hypertension is the most common chronic disease throughout the world. Self-care is the key criteria in determining the final course of the disease. However, the majority of elderly people do not observe self-care behaviors. The purpose of this paper is to analyze the experiences of elderly people with hypertension in order to understand the barriers of their self-care behaviors. Design/methodology/approach This is a qualitative study with a conventional content analysis approach conducted in Tehran, Iran in 2017. Data collection was done among 23 participants – 14 elderly people; 6 cardiologists, geriatric physicians and nurses working in the cardiovascular ward; and 3 caregivers – who were selected by purposeful sampling. Using semi-structured, face-to-face interviews, data collection was continued until data saturation. Findings Three main categories, including attitude limitations, inefficient supportive network and desperation, all showed barriers to self-care by the experiences of elderly people with hypertension. Originality/value Lack of knowledge of the disease and its treatment process is one of the main barriers to self-care in elderly people with hypertension. Deficient supportive resources along with economic and family problems exacerbate the failure to do self-care behaviors.

scholarly journals Efficacy and Safety of Fospropofol Disodium for Injection in General Anesthesia Induction for Adult Patients: A Phase 3 Trial

2021 ◽  
Vol 12 ◽  
Author(s):  
Chao-Meng Wu ◽  
Wen-Sheng Zhang ◽  
Jin Liu ◽  
Wei-Yi Zhang ◽  
Bo-Wen Ke
Keyword(s):  
Adverse Events ◽  
General Anesthesia ◽  
Success Rate ◽  
Blood Pressure Reduction ◽  
Intervention Group ◽  
Adult Patients ◽  
Anesthesia Induction ◽  
Efficacy And Safety ◽  
Serious Adverse Events ◽  
Study Drug Administration

Background: Fospropofol disodium for injection (FospropofolFD) is a prodrug that is metabolized into propofol to produce a general anesthesia effect when administered intravenously.Objective: This study aimed to assess the efficacy and safety of FospropofolFD in comparison with propofol medium/long-chain fat emulsion injections (propofol-MCT/LCT) for general anesthesia induction in adult patients undergoing elective surgeries.Setting: Nine academic medical centers in China.Method: This multicenter, randomized, double-blind, double-simulated, controlled, and non-inferiority trial evaluated 540 eligible adult patients randomly assigned (2:1) to the intervention (20 mg/kg FospropofolFD) or control (2 mg/kg propofol-MCT/LCT) groups.Main Outcome Measure: The primary efficacy endpoint was the success rate, defined as a Modified Observer’s Assessment of Alertness/Sedation Scale score of 1 within 5 min after study drug administration. The safety endpoints consisted of adverse events (AEs) related to consciousness, cognitive function, hemodynamic status, liver and kidney function, and blood tests.Results: A total of 347 (96.3%) and 175 (97.2%) patients in the intervention and control groups, respectively, completed the study. The success rate for the primary outcome was 97.7% for both study drugs. The most frequent AEs in the intervention group were abnormal feeling (62.0%), blood pressure reduction (13.5%), and injection site pain (13.3%). No AEs related to consciousness and mental and cognitive functions or serious adverse events were reported.Conclusion: FospropofolFD (20 mg/kg) is not inferior to propofol-MCT/LCT (2 mg/kg) in general anesthesia induction for American Society of Anesthesiologists (ASA) physical status I-II adult patients undergoing elective surgeries. It is safe and effective for clinical use under anesthesiologist monitoring.Impact on Practice Statement: FospropofolFD can produce a general anesthesia effect and reduce the incidence of pain at the site of injection.

scholarly journals Impact of cytochrome P450 2C19 polymorphisms on the clinical efficacy and safety of voriconazole: an update systematic review and meta-analysis

2021 ◽  
Author(s):  
Ying Zhang ◽  
Xu Hao ◽  
Kelu Hou ◽  
Lei Hu ◽  
Jingyuan Shang ◽  
...  
Keyword(s):  
Cytochrome P450 ◽  
Adverse Events ◽  
Success Rate ◽  
Clinical Efficacy ◽  
Search Algorithm ◽  
Efficacy And Safety ◽  
Increased Risk ◽  
Significant Difference ◽  
The Impact ◽  
Cyp2c19 Polymorphisms

Aims: To assess the impact of cytochrome P450 (CYP) 2C19 polymorphisms on the clinical efficacy and safety of voriconazole. Methods: We systematically searched PubMed, EMBASE, CENTRAL, ClinicalTrials.gov, and three Chinese databases from their inception to March 18, 2021 using a predefined search algorithm to identify relevant studies. Studies that reported voriconazole-treated patients and information on CYP2C19 polymorphisms were included. The efficacy outcome was success rate. The safety outcomes included overall adverse events, hepatotoxicity and neurotoxicity. Results: A total of 20 studies were included. Intermediate metabolizers (IMs) and Poor metabolizers (PMs) were associated with increased success rates compared with normal metabolizers (NMs) (risk ratio (RR): 1.18, 95% confidence interval (CI): 1.03~1.34, I2=0%, p=0.02; RR: 1.28, 95%CI: 1.06~1.54, I2=0%, p=0.01). PMs were at increased risk of overall adverse events in comparison with NMs and IMs (RR: 2.18, 95%CI: 1.35~3.53, I2=0%, p=0.001; RR: 1.80, 95% CI: 1.23~2.64, I2=0%, p=0.003). PMs demonstrated a trend towards an increased incidence of hepatotoxicity when compared with NMs (RR: 1.60, 95%CI: 0.94~2.74, I2=27%, p=0.08), although there was no statistically significant difference. In addition, there was no significant association between CYP2C19 polymorphisms and neurotoxicity. Conclusions: IMs and PMs were at a significant higher success rate in comparison with NMs. PMs were significantly associated with an increased incidence of all adverse events compared with NMs and IMs. Researches are expected to further confirm these findings. Additionally, the relationship between hepatotoxicity and CYP2C19 polymorphisms deservers clinical attention.

scholarly journals A Systematic Literature Review of Total Productive Maintenance On Industries

2021 ◽  
Vol 20 (2) ◽  
pp. 97
Author(s):  
Setiawan San
Keyword(s):  
Literature Review ◽  
Success Rate ◽  
Systematic Literature Review ◽  
Success Factors ◽  
Engine Speed ◽  
Manufacturing Companies ◽  
Total Productive Maintenance ◽  
Variable Approach ◽  
The World ◽  
World Class

Attempts to achieve optimization of machine and equipment maintenance at manufacturing companies over the years have encountered a multitude of problems. Due to equipment losses such as setup and adjustment, minor stops and delays, defective products due to equipment, reduced engine speed, and reduced output has influenced their desire to reach world class manufacturing levels. This paper discusses a large part of the TPM approach in manufacturing companies and provides an overview of the various TPM implementation practices demonstrated by manufacturing companies in the world.. Based on review results of the 50 journals about TPM in industries It was found that most of the TPM implementations used the OEE parameter to see the success rate of implementing this TPM. This paper also highlights the variable approach that is most widely used by various practitioners and researchers and evaluates in detail the success factors of implementing TPM and the reasons behind the failure of implementing TPM are also discussed so as to ensure the implementation of TPM can run smoothly and effectively in manufacturing companies

Stent-over-sponge (SOS): a novel technique complementing endosponge therapy for foregut leaks and perforations

Endoscopy ◽  
2017 ◽  
Vol 50 (02) ◽  
pp. 148-153 ◽  
Author(s):  
Piero Valli ◽  
Joachim Mertens ◽  
Arne Kröger ◽  
Christoph Gubler ◽  
Christian Gutschow ◽  
...  
Keyword(s):  
Adverse Events ◽  
Success Rate ◽  
Vacuum Therapy ◽  
Line Treatment ◽  
Second Line ◽  
Metal Stent ◽  
First Line ◽  
Novel Technique ◽  
Upper Gastrointestinal ◽  
First Line Treatment

Abstract Background and study aims Endoluminal vacuum therapy (EVT) has evolved as a promising option for endoscopic treatment of foregut wall injuries in addition to the classic closure techniques using clips or stents. To improve vacuum force and maintain esophageal passage, we combined endosponge treatment with a partially covered self-expandable metal stent (stent-over-sponge; SOS). Patients and methods Twelve patients with infected upper gastrointestinal wall defects were treated with the SOS technique. Results Indications for SOS were anastomotic leakage after surgery (n = 11) and chronic foregut fistula (n = 1). SOS treatment was used as a first-line treatment in seven patients with a success rate of 71.4 % (5/7) and as a second-line treatment after failed previous EVT treatment in five patients (success rate 80 %; 4/5). Overall, SOS treatment was successful in 75 % of patients (9/12). No severe adverse events occurred. Conclusion SOS is an effective method to treat severely infected foregut wall defects in patients where EVT has failed, and also as a first-line treatment. Comparative prospective studies are needed to confirm our preliminary results.

Comparison between Ologen implant and Mitomycin C in trabeculectomy: A Systematic Review and Meta-Analysis

2019 ◽  
Author(s):  
Xiaoyan Liu ◽  
Yali Du ◽  
Min Lei ◽  
Leyi Zhuang ◽  
Peng Lv
Keyword(s):  
Adverse Events ◽  
Success Rate ◽  
Data Extraction ◽  
Meta Analysis ◽  
Collagen Matrix ◽  
Current Evidence ◽  
Cochrane Library ◽  
Significant Difference ◽  
Mean Differences ◽  
Alternative Choice

Abstract Objective To evaluate the effectiveness and safety of the biodegradable collagen matrix (Ologen) implant in trabeculectomy. Research design and methods We searched Pubmed, Cochrane library, Embase and Web of Science databases to find studies that met our pre-stated inclusion criteria. Reference lists of retrieved articles were also reviewed. The search was finished by February 2019. Study selection, data extraction, quality assessment, and data analyses were performed according to the Cochrane standards. Either a fixed or a random-effects model was used to calculate the overall combined risk estimates. The efficacy measures were the weighted mean differences (WMDs) for the intraocular pressure reduction (IOPR) and the glaucoma medications reduction, the odds ratio (OR) for the success rate and adverse events. Results Fifteen randomized controlled trials involved 682 eyes were included in the meta-analysis. There were no statistically differences between two groups in the IOPR at any time postoperatively. The MD of the IOPR was [MD= -0.45,95% Confidence Interval (CI), (-2.36,1.46), P=0.65] at one day, [MD= -0.82,95% CI, (-1.97, 0.33), P=0.16] at one week, [MD= -1.33, 95% CI,(-3.12, 0.47), P=0.15] at one month, [MD= 0.11,95% CI, (-1.87, 2.08), P=0.92] at three months, [MD= -0.60,95% CI, (-2.27, 1.06), P=0.48] at six months, [MD= -0.33,95% CI, (-1.99, 1.32), P=0.69] at one year, [MD= -0.13,95% CI, (-1.90, 1.65), P=0.89] at two years, [MD= 2.54,95% CI, (-2.83, 7.90), P=0.35] at three years, [MD= 3.04,95% CI, (-3.95, 10.03), P=0.39] at five years. There was no statistically significant difference between the Ologen groups and MMC groups concerned the complete success rate [OR=1.19, 95%CI, (0.83, 1.71), P=0.35]. With regard to the adverse events, no obvirously significance was observed. Seven studies reported the change of antiglaucoma medications. We found that the change of antiglaucoma medications is higher in MMC groups than that in Ologen groups [MD=-0.18, 95%CI, (-0.33, -0.03), P=0.02]. There is no significant difference in complications between the two groups. Conclusions From the current evidence, Ologen may be an alternative choice for trabeculectomy when considering the efficacy and safety. However, MMC might be the preferred choice concerned cost-effectiveness.

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