scholarly journals Barriers to Effective Prescribing in the Elderly: Applying the Theoretical Domains Framework in the Ambulatory Setting

2020 ◽  
Author(s):  
Sabrina Lau ◽  
Penny Lun ◽  
Wendy Ang ◽  
Keng Teng Tan ◽  
Yew Yoong Ding
Keyword(s):  
Delphi Study ◽  
Grey Literature ◽  
Inappropriate Prescribing ◽  
Theoretical Domains Framework ◽  
The Elderly ◽  
Ambulatory Setting ◽  
Eligibility Criteria ◽  
Related Factors ◽  
Prescribing Behaviour ◽  
The Impact

Abstract Aims: As the population ages, potentially inappropriate prescribing (PIP) in the elderly may become increasingly prevalent. This undermines patient safety and creates a potential source of major morbidity and mortality. Understanding the factors that influence prescribing behaviour may allow development of interventions to reduce PIP. The aim of this study is to apply the Theoretical Domains Framework (TDF) to explore barriers to effective prescribing in the elderly in the ambulatory setting.Methods: A scoping review was performed based on the five-stage methodological framework developed by Arksey and O’Malley. Our search strategy included PubMed, CINAHL, EMBASE, the Cochrane Database of Systematic Reviews, and Web of Science. We also searched five electronic journals, Google and Google Scholar to identify additional sources and grey literature. Two reviewers applied eligibility criteria to the title and abstract screening, followed by full text screening, before systematically charting the data. Results: 5,731 articles were screened. 29 studies met the selection criteria for qualitative analysis. Using TDF, 14 domains for barriers to effective prescribing were identified. Significant domains include physician-related factors such as “Knowledge”, “Skills”, and “Social/Professional Role and Identity”; issues with “Environmental Context and Resources”; and the impact of “Social Influences” and “Emotion” on prescribing behaviour.Conclusion: The TDF elicited multiple domains which both independently and collectively lead to barriers to effective prescribing in elderly patients in the ambulatory setting. Changing the prescribing climate will thus require interventions targeting multiple stakeholders, including physicians, patients and hospital/clinic systems. Moving forward, we will perform a Delphi study to explore individual domains and ultimately develop a physician-pharmacist collaborative care intervention to guide prescribing for the elderly in the ambulatory setting.

scholarly journals Barriers to effective prescribing in older adults: applying the theoretical domains framework in the ambulatory setting – a scoping review

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Sabrina Lau ◽  
Penny Lun ◽  
Wendy Ang ◽  
Keng Teng Tan ◽  
Yew Yoong Ding
Keyword(s):  
Older Adults ◽  
Scoping Review ◽  
Grey Literature ◽  
Inappropriate Prescribing ◽  
Theoretical Domains Framework ◽  
Ambulatory Setting ◽  
Eligibility Criteria ◽  
Related Factors ◽  
Prescribing Behaviour ◽  
The Impact

Abstract Background As the population ages, potentially inappropriate prescribing (PIP) in the older adults may become increasingly prevalent. This undermines patient safety and creates a potential source of major morbidity and mortality. Understanding the factors that influence prescribing behaviour may allow development of interventions to reduce PIP. The aim of this study is to apply the Theoretical Domains Framework (TDF) to explore barriers to effective prescribing for older adults in the ambulatory setting. Methods A scoping review was performed based on the five-stage methodological framework developed by Arksey and O’Malley. From 30 Aug 2018 to 5 Sep 2018, we conducted our search on PubMed, CINAHL, EMBASE, the Cochrane Database of Systematic Reviews, and Web of Science. We also searched five electronic journals, Google and Google Scholar to identify additional sources and grey literature. Two reviewers applied eligibility criteria to the title and abstract screening, followed by full text screening, before systematically charting the data. Results A total of 5731 articles were screened. Twenty-nine studies met the selection criteria for qualitative analysis. We mapped our results using the 14-domain TDF, eventually identifying 10 domains of interest for barriers to effective prescribing. Of these, significant domains include physician-related factors such as “Knowledge”, “Skills”, and “Social/Professional Role and Identity”; issues with “Environmental Context and Resources”; and the impact of “Social Influences” and “Emotion” on prescribing behaviour. Conclusion The TDF elicited multiple domains which both independently and collectively lead to barriers to effective prescribing for older adults in the ambulatory setting. Changing the prescribing climate will thus require interventions targeting multiple stakeholders, including physicians, patients and hospital/clinic systems. Further work is needed to explore individual domains and guide development of frameworks to aid guide prescribing for older adults in the ambulatory setting.

scholarly journals Barriers to Effective Prescribing in Older Adults: Applying the Theoretical Domains Framework in the Ambulatory Setting – A Scoping Review

2020 ◽  
Author(s):  
Sabrina Lau ◽  
Penny Lun ◽  
Wendy Ang ◽  
Keng Teng Tan ◽  
Yew Yoong Ding
Keyword(s):  
Older Adults ◽  
Scoping Review ◽  
Grey Literature ◽  
Inappropriate Prescribing ◽  
Theoretical Domains Framework ◽  
Ambulatory Setting ◽  
Eligibility Criteria ◽  
Related Factors ◽  
Prescribing Behaviour ◽  
The Impact

Abstract Background: As the population ages, potentially inappropriate prescribing (PIP) in the older adults may become increasingly prevalent. This undermines patient safety and creates a potential source of major morbidity and mortality. Understanding the factors that influence prescribing behaviour may allow development of interventions to reduce PIP. The aim of this study is to apply the Theoretical Domains Framework (TDF) to explore barriers to effective prescribing for older adults in the ambulatory setting. Methods: A scoping review was performed based on the five-stage methodological framework developed by Arksey and O’Malley. From 30 Aug 2018 to 5 Sep 2018, we conducted our search on PubMed, CINAHL, EMBASE, the Cochrane Database of Systematic Reviews, and Web of Science. We also searched five electronic journals, Google and Google Scholar to identify additional sources and grey literature. Two reviewers applied eligibility criteria to the title and abstract screening, followed by full text screening, before systematically charting the data. Results: A total of 5,731 articles were screened. 29 studies met the selection criteria for qualitative analysis. We mapped our results using the 14-domain TDF, eventually identifying 10 domains of interest for barriers to effective prescribing. Of these, significant domains include physician-related factors such as “Knowledge”, “Skills”, and “Social/Professional Role and Identity”; issues with “Environmental Context and Resources”; and the impact of “Social Influences” and “Emotion” on prescribing behaviour. Conclusion: The TDF elicited multiple domains which both independently and collectively lead to barriers to effective prescribing for older adults in the ambulatory setting. Changing the prescribing climate will thus require interventions targeting multiple stakeholders, including physicians, patients and hospital/clinic systems. Further work is needed to explore individual domains and guide development of frameworks to aid guide prescribing for older adults in the ambulatory setting.

scholarly journals Barriers to Effective Prescribing in Older Adults: Applying the Theoretical Domains Framework in the Ambulatory Setting

2020 ◽  
Author(s):  
Sabrina Lau ◽  
Penny Lun ◽  
Wendy Ang ◽  
Keng Teng Tan ◽  
Yew Yoong Ding
Keyword(s):  
Older Adults ◽  
Grey Literature ◽  
Inappropriate Prescribing ◽  
Theoretical Domains Framework ◽  
Ambulatory Setting ◽  
Eligibility Criteria ◽  
Related Factors ◽  
Cochrane Database ◽  
Prescribing Behaviour ◽  
The Impact

Abstract Background: As the population ages, potentially inappropriate prescribing (PIP) in the older adults may become increasingly prevalent. This undermines patient safety and creates a potential source of major morbidity and mortality. Understanding the factors that influence prescribing behaviour may allow development of interventions to reduce PIP. The aim of this study is to apply the Theoretical Domains Framework (TDF) to explore barriers to effective prescribing for older adults in the ambulatory setting. Methods: A scoping review was performed based on the five-stage methodological framework developed by Arksey and O’Malley. From 30 Aug 2018 to 5 Sep 2018, we conducted our search on PubMed, CINAHL, EMBASE, the Cochrane Database of Systematic Reviews, and Web of Science. We also searched five electronic journals, Google and Google Scholar to identify additional sources and grey literature. Two reviewers applied eligibility criteria to the title and abstract screening, followed by full text screening, before systematically charting the data. Results: A total of 5,731 articles were screened. 29 studies met the selection criteria for qualitative analysis. We mapped our results using the 14-domain TDF, eventually identifying 10 domains of interest for barriers to effective prescribing. Of these, significant domains include physician-related factors such as “Knowledge”, “Skills”, and “Social/Professional Role and Identity”; issues with “Environmental Context and Resources”; and the impact of “Social Influences” and “Emotion” on prescribing behaviour.Conclusion: The TDF elicited multiple domains which both independently and collectively lead to barriers to effective prescribing for older adults in the ambulatory setting. Changing the prescribing climate will thus require interventions targeting multiple stakeholders, including physicians, patients and hospital/clinic systems. Further work is needed to explore individual domains and guide development of frameworks to aid guide prescribing for older adults in the ambulatory setting.

scholarly journals Measuring frailty in younger populations: a rapid review of evidence

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e047051
Author(s):  
Gemma F Spiers ◽  
Tafadzwa Patience Kunonga ◽  
Alex Hall ◽  
Fiona Beyer ◽  
Elisabeth Boulton ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
Predictive Validity ◽  
Data Extraction ◽  
Grey Literature ◽  
Frailty Index ◽  
Study Data ◽  
Rapid Review ◽  
Eligibility Criteria ◽  
Adult Age ◽  
The Impact

ObjectivesFrailty is typically assessed in older populations. Identifying frailty in adults aged under 60 years may also have value, if it supports the delivery of timely care. We sought to identify how frailty is measured in younger populations, including evidence of the impact on patient outcomes and care.DesignA rapid review of primary studies was conducted.Data sourcesFour databases, three sources of grey literature and reference lists of systematic reviews were searched in March 2020.Eligibility criteriaEligible studies measured frailty in populations aged under 60 years using experimental or observational designs, published after 2000 in English.Data extraction and synthesisRecords were screened against review criteria. Study data were extracted with 20% of records checked for accuracy by a second researcher. Data were synthesised using a narrative approach.ResultsWe identified 268 studies that measured frailty in samples that included people aged under 60 years. Of these, 85 studies reported evidence about measure validity. No measures were identified that were designed and validated to identify frailty exclusively in younger groups. However, in populations that included people aged over and under 60 years, cumulative deficit frailty indices, phenotype measures, the FRAIL Scale, the Liver Frailty Index and the Short Physical Performance Battery all demonstrated predictive validity for mortality and/or hospital admission. Evidence of criterion validity was rare. The extent to which measures possess validity across the younger adult age (18–59 years) spectrum was unclear. There was no evidence about the impact of measuring frailty in younger populations on patient outcomes and care.ConclusionsLimited evidence suggests that frailty measures have predictive validity in younger populations. Further research is needed to clarify the validity of measures across the adult age spectrum, and explore the utility of measuring frailty in younger groups.

scholarly journals Scoping review of mental health in prisons through the COVID-19 pandemic

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e046547
Author(s):  
Luke Johnson ◽  
Kerry Gutridge ◽  
Julie Parkes ◽  
Anjana Roy ◽  
Emma Plugge
Keyword(s):  
Mental Health ◽  
Scoping Review ◽  
Grey Literature ◽  
Well Being ◽  
Health Impact ◽  
Poor Quality ◽  
Eligibility Criteria ◽  
Prison Staff ◽  
The Impact

ObjectiveTo examine the extent, nature and quality of literature on the impact of the COVID-19 pandemic on the mental health of imprisoned people and prison staff.DesignScoping review.Data sourcesPubMed, Embase, CINAHL, Global Health, Cochrane, PsycINFO, PsychExtra, Web of Science and Scopus were searched for any paper from 2019 onwards that focused on the mental health impact of COVID-19 on imprisoned people and prison staff. A grey literature search focused on international and government sources and professional bodies representing healthcare, public health and prison staff was also performed. We also performed hand searching of the reference lists of included studies.Eligibility criteria for selection of studiesAll papers, regardless of study design, were included if they examined the mental health of imprisoned people or prison staff specifically during the COVID-19 pandemic. Imprisoned people could be of any age and from any countries. All languages were included. Two independent reviewers quality assessed appropriate papers.ResultsOf 647 articles found, 83 were eligible for inclusion, the majority (58%) of which were opinion pieces. The articles focused on the challenges to prisoner mental health. Fear of COVID-19, the impact of isolation, discontinuation of prison visits and reduced mental health services were all likely to have an adverse effect on the mental well-being of imprisoned people. The limited research and poor quality of articles included mean that the findings are not conclusive. However, they suggest a significant adverse impact on the mental health and well-being of those who live and work in prisons.ConclusionsIt is key to address the mental health impacts of the pandemic on people who live and work in prisons. These findings are discussed in terms of implications for getting the balance between infection control imperatives and the fundamental human rights of prison populations.

scholarly journals Measuring gender-based violence risk mitigation in humanitarian settings: results from a comprehensive desk review and systematic mapping

BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e050887
Author(s):  
Jocelyn TD Kelly ◽  
Emily Ausubel ◽  
Emma Kenny ◽  
Meredith Blake ◽  
Christine Heckman ◽  
...  
Keyword(s):  
Risk Mitigation ◽  
Grey Literature ◽  
Monitoring And Evaluation ◽  
Sufficient Information ◽  
Gender Based Violence ◽  
Systematic Mapping ◽  
Eligibility Criteria ◽  
Humanitarian Response ◽  
Gender Based ◽  
The Impact

ObjectivesTo systematically document measurement approaches used in the monitoring and evaluation of gender-based violence (GBV) risk mitigation activities, categorise the types of available literature produced by sector, identify existing tools and measures and identify knowledge gaps within the humanitarian sector.DesignSystematic mapping and in-depth review.Data sources: Pubmed, Global Health, PsychInfo, ReliefWeb, OpenGrey (grey literature), Google Scholar, Web of Science (Social Science Index)Eligibility criteria: a structured search strategy was systematically applied to 17 databases as well as registers, websites and other resources to identify materials published between 1 January 2005 and 15 May 2019.Data extraction and synthesis: Those resources that met the inclusion criteria underwent a comprehensive full-text review. A detailed matrix was developed and key data from each resource were extracted to allow for the assessment of patterns in thematic areas.ResultsA total of 2108 documents were screened. Overall, 145 documents and 112 tools were reviewed, representing 10 different humanitarian sectors. While numerous resources exist, many lack sufficient information on how to monitor outputs or outcomes of GBV risk mitigation activities. There is also limited guidance on how to integrate the measurement of GBV risk mitigation into existing monitoring and evaluation frameworks. Those reports that aimed to measure GBV risk mitigation activities mostly employed qualitative methods and few measured the impact of a GBV risk mitigation with robust research designs.ConclusionsRecent efforts to adapt humanitarian response to COVID-19 have highlighted new and existing challenges for GBV risk mitigation. There is a significant gap in the evidence base around the effectiveness of GBV risk mitigation across all sectors. Understanding and strengthening measurement approaches in GBV risk mitigation remains a critical task for humanitarian response.

scholarly journals Mesenchymal stromal cells for COVID-19: A living systematic review protocol

2020 ◽  
Author(s):  
Gabriel Rada ◽  
Javiera Corbalán ◽  
Patricio Rojas ◽  
Keyword(s):  
Systematic Review ◽  
Mesenchymal Stromal Cells ◽  
Stromal Cells ◽  
Direct Evidence ◽  
Meta Analysis ◽  
Grey Literature ◽  
Cochrane Central Register ◽  
Randomised Trials ◽  
Eligibility Criteria ◽  
The Impact

ABSTRACTObjectiveTo determine the impact of mesenchymal stromal cells outcomes important to patients with COVID-19.DesignThis is the protocol of a living systematic review.Data sourcesWe will conduct searches in PubMed/Medline, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), grey literature and in a centralised repository in L·OVE (Living OVerview of Evidence). L·OVE is a platform that maps PICO questions to evidence from Epistemonikos database. In response to the COVID-19 emergency, L·OVE was adapted to expand the range of evidence it covers and customised to group all COVID-19 evidence in one place. The search will cover the period until the day before submission to a journal.Eligibility criteria for selecting studies and methodsWe adapted an already published common protocol for multiple parallel systematic reviews to the specificities of this question.We will include randomised trials evaluating the effect of mesenchymal stromal cells versus placebo or no treatment in patients with COVID-19. Randomised trials evaluating other coronavirus infections, such as MERS-CoV and SARS-CoV, and non-randomised studies in COVID-19 will be searched in case we find no direct evidence from randomised trials, or if the direct evidence provides low- or very low-certainty for critical outcomes.Two reviewers will independently screen each study for eligibility, extract data, and assess the risk of bias. We will pool the results using meta-analysis and will apply the GRADE system to assess the certainty of the evidence for each outcome.A living, web-based version of this review will be openly available during the COVID-19 pandemic. We will resubmit it every time the conclusions change or whenever there are substantial updates.Ethics and disseminationNo ethics approval is considered necessary. The results of this review will be widely disseminated via peer-reviewed publications, social networks and traditional media.PROSPERO RegistrationSubmitted to PROSPERO (awaiting ID allocation).

scholarly journals Survival Analysis of Hospitalized Elderly People with Fractures in Brazil Over One Year

Geriatrics ◽  
2020 ◽  
Vol 5 (1) ◽  
pp. 10
Author(s):  
Brenda Kelly Gonçalves Nunes ◽  
Brunna Rodrigues de Lima ◽  
Lara Cristina da Cunha Guimarães ◽  
Rafael Alves Guimarães ◽  
Claci Fátima Weirich Rosso ◽  
...  
Keyword(s):  
Elderly People ◽  
Cox Regression ◽  
Age Groups ◽  
The Elderly ◽  
Diabetic Patients ◽  
Related Factors ◽  
Hospitalized Elderly ◽  
Study Results ◽  
One Year ◽  
The Impact

Objective: This study analyzes the causes of death, survival, and other related factors in hospitalized elderly people with fractures over the course of one year. Methods: We followed 376 fracture patients for one year in a prospective cohort study to a reference hospital in central Brazil. The Cox regression model was used to analyze factors associated with survival. Results: The results indicate that the one-year mortality rate was high (22.9%). The independent factors linked to lower overall survival were as follows: patients aged ≥80 years with previous intensive care unit (ICU) admission and presence of comorbidities (diabetes mellitus [DM] and dementia). Conclusion: Our study results may contribute to a better understanding of the impact of fractures on the elderly population and reinforce the need to oversee age-groups, diabetic patients, and patients with complications during hospitalization.

Evaluation of the impact of patient involvement in health technology assessments: A scoping review

2020 ◽  
Vol 36 (3) ◽  
pp. 217-223
Author(s):  
Robert J. Mason ◽  
Karlee M. Searle ◽  
Yvonne Bombard ◽  
Amanda Rahmadian ◽  
Alexandra Chambers ◽  
...  
Keyword(s):  
Scoping Review ◽  
Literature Search ◽  
Qualitative Interviews ◽  
Grey Literature ◽  
Health Technology ◽  
Eligibility Criteria ◽  
Health Technologies ◽  
Methods Of Evaluation ◽  
Patient Groups ◽  
The Impact

ObjectivesWhile involving patients in health technology assessment (HTA) has become increasingly common and important around the world, little is known about the optimal methods of evaluating patients’ involvement (PI) in HTA. This scoping review was undertaken to provide an overview of currently available methods for the evaluation of PI, specifically the impact of PI on HTA recommendations.MethodsA literature search was conducted using nine databases as well as a grey literature search of the websites of 26 organizations related to the conduct, practice or research of HTA to identify articles, reports and abstracts related to the evaluation of PI impact in HTA.ResultsWe identified 1,248 unique citations, six of which met our eligibility criteria. These six records (five articles, and one report) were all published after 2012. Four assessed the impact of patient experience submissions on final HTA recommendations; one evaluated the impact of direct involvement on HTA committees, and one assessed impact of multiple forms of involvement. Methods of evaluation included quantitative analyses of reimbursement decisions, qualitative interviews with those directly involved in an assessment, surveys of patient groups and committee members, and the review of HTA reports.ConclusionsQuantitative evaluation of PI based on associations with funding decisions may not be feasible or fully capture the relevant impact of PI in the assessment of health technologies. Rather, a combination of both qualitative and quantitative strategies may allow for the most comprehensive assessment of the impact of PI on HTA recommendations when possible.

Getting the cues of elder abuse: an identification through dependency and modernization

2020 ◽  
Vol 22 (3) ◽  
pp. 119-139
Author(s):  
Naval Bajpai ◽  
Kushagra Kulshreshtha ◽  
Prince Dubey ◽  
Gunjan Sharma
Keyword(s):  
Factor Analysis ◽  
Elder Abuse ◽  
Family Relationship ◽  
The Elderly ◽  
Related Factors ◽  
Content Type ◽  
Means And Ends ◽  
The Social ◽  
The Difference ◽  
The Impact

Purpose In the present era of modernization, the social group members interact with each other with selfish and unselfish intents. However, the unselfish means and ends build a long term relationship among people. On the other hand, selfish ends bud out unethical means such as abuses, violence and fights. The situation becomes tough when the same becomes evident among the family relationship and as a consequence the elderly are being treated unfairly. Out of such cases, some are reported and the majority of them remain unreported, which eventually becomes the cause of concern for the social welfare agencies. Thus, this paper aims to examine the elder abuse (EA) tendency in metro, non-metro and religious cities. Design/methodology/approach For this study, a mixed-method approach is used to develop survey instruments, validate findings using qualitative and quantitative data sources for better generalization of results. The present study explored and confirmed the related factors using exploratory factor analysis and confirmatory factor analysis for the establishment of a valid scale of EA. Further, the difference of perceptions among the elders for abuse across the metro, non-metro and religious cities was statistically checked using the ANOVA and post hoc techniques. Findings The present study identified the traces of EA and created a comprehensive understanding of it. The present study manifests the prevailing practices of EA in society by discussing the demerits of dependency and modernization. Moreover, the present study assesses the pervasiveness and the repercussion of dependency and the impact of modernization on EA followed by a discussion on how the victim elders may handle the situation. In the present study, a scale is developed to identify EA because of the dependency of the elderly and the modernization of society. Originality/value Some exclaiming thoughts such as the dependency of elders elevate the chances of EA on one side, while modernization of society hampers the social/family bonding leading to EA. The inconsistent development across the region has created modernization as a significant factor for EA. The level and depth of modernization across locations such as metro, non-metro and religious cities are the cause for varying degrees of EA. Based on the literature review, the present study has sensed the presence of EA in society at large by developing a scale for the aforesaid purpose.

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