Drug Use Evaluation Among Elderly Patients With History of Falling in Geriatric Assessment Clinic, Ramathibodi Hospital

2021 ◽  
Vol 44 (4) ◽  
pp. 32-43
Author(s):  
Muanjan Wannasitthichok ◽  
Chitima Boongird ◽  
Thunyarat Anothaisintawee ◽  
Kittiya Theangjit
Keyword(s):  
Drug Use ◽  
Elderly Patients ◽  
Geriatric Assessment ◽  
Related Problem ◽  
Assessment Clinic ◽  
Drug Related Problem ◽  
Drug Use Evaluation ◽  
Recurrent Falls ◽  
Increased Risk ◽  
History Of

Background: Drug use evaluation as an intervention approach for fall prevention has an effect on most drug-related outcomes. Geriatric assessment clinic provides comprehensive care in elderly patients. All prescribed or non-prescribed medications were evaluated by pharmacists. Objective: To study the drug and drug-related problem among elderly patients with history of falling. Methods: This is a cross-sectional study of elderly patients with history of fallings. Demographic data, health information, history of falls, and drugs use evaluation were obtained from their medical records in year 2010 to 2020. Linear regression model was used to examine the multivariate correlates to number of fallings. Results: A total of 183 patients with history of falling were studied. Of this, 97 had recurrent falls. Most patients (77%) had more than 5 underlying diseases and over half (55%) had dementia. Drug-related problem were found 69.4%, 4 in 5 of patients used 5 types of the medications or more. The diabetes drugs were found to increase risk of recurrent falls significantly (OR [95% CI], 2.11 [1.03 - 4.33]; P < .05). Conclusions: Most elderly patient with history of falling have drug-related problem (69.4%) and multiple morbidities including dementia. The diabetes drugs were 2 times significantly increased risk of recurrent falls. This study highlights the important of drugs management in this vulnerable group of elderly patients.  

scholarly journals Patients with infective endocarditis and history of injection drug use in a Swedish referral hospital during 10 years

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Anna Damlin ◽  
Katarina Westling
Keyword(s):  
Infective Endocarditis ◽  
Drug Use ◽  
Injection Drug Use ◽  
Clinical Characteristics ◽  
National Registry ◽  
Injection Drug ◽  
University Hospital ◽  
Prosthetic Heart Valves ◽  
Increased Risk ◽  
History Of

Abstract Background Patients with injection drug use (IDU) have increased risk of developing infective endocarditis (IE). Previous studies have reported recurrent IE, increased duration of hospital stay, poor adherence and compliance as well as higher mortality and worse outcomes after surgery in the IDU-IE patient group. Further studies are needed to provide a basis for optimized care and prevention of readmissions in this population. This study aims to describe the clinical characteristics and outcomes among patients with IDU-IE. Methods Data of adults with IDU-IE and non-IDU-IE, treated between 2008 and 2017 at the Karolinska University Hospital in Stockholm were obtained from the Swedish National Registry of Infective Endocarditis. Clinical characteristics, microbiological results, treatment durations, results from echocardiography and in-hospital mortality were compared between the groups. Results Of the total 522 patients, 165 (32%) had IDU-IE. Patients with IDU-IE were younger than the patients with non-IDU-IE (mean age IDU-IE: 41.6 years, SD 11.9 years; non-IDU-IE: 64.3 years, SD 16.4 years; P <  0.01). No difference in distribution of gender was observed, 33% were females in both the IDU-IE and the non-IDU-IE group. History of previous IE (IDU-IE: n = 49, 30%; non-IDU-IE: n = 34, 10%; P <  0.01) and vascular phenomena (IDU-IE: n = 101, 61%; non-IDU-IE: n = 120, 34%; P <  0.01) were more common among patients with IDU-IE while prosthetic heart valves (IDU-IE: n = 12, 7%; non-IDU-IE: n = 83, 23%; P <  0.01) and known valvular disease (IDU-IE: n = 3, 2%; non-IDU-IE: n = 78, 22%; P <  0.01) were more common among patients with non-IDU-IE. Aetiology of Staphylococcus aureus (IDU-IE: n = 123, 75%; non-IDU-IE: n = 118, 33%; P <  0.01) as well as tricuspid (IDU-IE: n = 91, 55%; non-IDU-IE: n = 23, 6%; P <  0.01) or pulmonary valve vegetations (IDU-IE: n = 7, 4%; non-IDU-IE: n = 2, 1%; P <  0.01) were more common in the IDU-IE group. The overall incidence of IDU-IE decreased during the study period, while the incidence of definite IE increased (P <  0.01). Conclusions This study presents that patients with IDU-IE were younger, less frequently treated with surgery and had higher prevalence of vascular phenomena and history of previous IE, aspects that are important for improved management of this population.

scholarly journals Surgical Management of Lumbar Spinal Stenosis in Patients Over 80 : Is There an Increased Risk ?

2021 ◽  
Author(s):  
frédérick rault ◽  
Anaïs R Briant ◽  
Thomas Gaberel ◽  
Hervé Kamga ◽  
Evelyne Emery
Keyword(s):  
Risk Factors ◽  
Elderly Patients ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Heart Diseases ◽  
The Elderly ◽  
Lumbar Spine Surgery ◽  
Increased Risk ◽  
History Of ◽  
Lumbar Spinal

Abstract Introduction:Management of lumbar spinal stenosis (LSS) represents the first cause of spinal surgery for the elderly and will increase with the aging population. Although the surgery improves quality of life, the procedure involves anaesthetic and operative risks. The aim of this study was to assess whether the postoperative complications rate was higher for elderly patients and to find confounding factors.Material and MethodsWe conducted a retrospective study including all LSS surgeries between 2012 and 2020 at the University Hospital of Caen. We compared two populations opposing patients aged over 80 with others. The primary endpoint was the occurrence of a severe complication (SC). Minor complications were the secondary endpoint. Comorbidities, history of lumbar spine surgery and surgical characteristics were recorded.Results996 patients undergoing surgery for degenerative LSS were identified. Patients over 80 were significantly affected by additional comorbidities: hypertension, heart diseases, higher age-adjusted comorbidity Charlson score, ASA score and use of anticoagulants. Knee-chest position was preferred for younger patients. Older patients underwent a more extensive decompression and had more incidental durotomies. 5.2% of patients presented SC. Age over 80 did not appear to be a significant risk factor for SC, but minor complications increased. Multivariate analysis showed that heart diseases, history of laminectomy, AA-CCI, and accidental durotomies were independent risk factors for SC.ConclusionSurgical management for lumbar spinal stenosis is not associated to a higher rate of severe complications for patients over 80 years of age. However, preoperative risk factors should be investigated to warn the elderly patients that the complications risk is increased although an optimal preparation is the way to avoid them.

HIV infection in psychiatric patients: An unlinked anonymous study

1997 ◽  
Vol 170 (2) ◽  
pp. 181-185 ◽  
Author(s):  
José L. Ayuso-Mateos ◽  
Francisco Montañés ◽  
Ismael Lastra ◽  
Juan J. Picazo De La Garza ◽  
José L. Ayuso-Gutiérrez
Keyword(s):  
Drug Use ◽  
Hiv Infection ◽  
Psychiatric Patients ◽  
Risk Behaviour ◽  
Injecting Drug Use ◽  
Antibody Testing ◽  
Increased Risk ◽  
The Us ◽  
History Of ◽  
Blood Specimens

BackgroundRecent surveys suggest that psychiatric patients are at increased risk of being infected with HIV, although very little information is available concerning the seroprevalence of HIV infection among this population outside the US. The aim of this study is to determine the seroprevalence of HIV-I among patients admitted to a psychiatric in-patient unit and to gather linked anonymous risk-factor information.MethodAn unlinked serosurvey was made, using HIV-1 antibody testing of remnant blood specimens collected for routine medical purposes, of patients consecutively admitted to an acute psychiatric unit in Madrid.ResultsBlood was obtained from 390 of the 477 eligible patients (81.8%). The prevalence of HIV was 5.1% (20/390). Patients aged between 18 and 39 accounted for 63.4% of the admissions and 75% of the positive results. Of the 29 patients who presented with injecting drug use, 14 were HIV-infected (48.3%; 95% CI 29.4 67.5). Of the 51 patients for whom any risk behaviour was noted on the admission chart, 18 were HIV-infected (35.3%; 95% CI 22.4 49.9).ConclusionsThis study demonstrates that there is a substantial prevalence of HIV infection in psychiatric patients admitted to an acute in-patient unit. History of injecting drug use was strongly associated with seropositivity. Clinicians recognised risk factors for HIV infection in the majority of the HIV-infected cases.

Promoting Appropriate Drug Use Through the Application of the Spanish Drug-Related Problem Classification System in the Primary Care Setting

2009 ◽  
Vol 43 (2) ◽  
pp. 339-346 ◽  
Author(s):  
Marciana Alodia Gómez ◽  
Antonio Villafaina ◽  
Jesús Hernández ◽  
Rosa María Salgado ◽  
Miguel Ángel González ◽  
...  
Keyword(s):  
Primary Care ◽  
Drug Use ◽  
Classification System ◽  
Related Problem ◽  
Care Setting ◽  
Primary Care Setting ◽  
Drug Related Problem

scholarly journals The Relationship between NAFLD and Sarcopenia in Elderly Patients

2018 ◽  
Vol 2018 ◽  
pp. 1-4 ◽  
Author(s):  
Yu Zhai ◽  
Qian Xiao ◽  
Jing Miao
Keyword(s):  
Elderly Patients ◽  
Alcohol Intake ◽  
Protective Factor ◽  
Dual Energy ◽  
Nonalcoholic Fatty Liver ◽  
X Ray ◽  
Increased Risk ◽  
History Of ◽  
The Relationship ◽  
Usual Gait Speed

Aim. Previous studies have shown that individuals with low muscle mass exhibit an increased risk of nonalcoholic fatty liver disease (NAFLD). In this study, we investigated the association between NAFLD and sarcopenia in elderly patients. Methods. We classified the participants into sarcopenia/nonsarcopenia groups based on dual-energy X-ray absorptiometry (DXA), muscle strength (grip strength), or/and physical performance (6 m usual gait speed). We diagnosed NAFLD by ultrasonography combined with the history of alcohol intake. Logistic regression analysis was used to assess the correlation between sarcopenia and NAFLD. Results. NAFLD was significantly less frequent in the sarcopenia group than in the nonsarcopenia group (P<0.01). However, NAFLD was neither an independent risk factor nor a protective factor for sarcopenia. Conclusions. NAFLD is not independently associated with sarcopenia.

scholarly journals Patients with infective endocarditis and history of injection drug use –a register-based study of a 10-year period

2020 ◽  
Author(s):  
Anna Damlin ◽  
Katarina Westling
Keyword(s):  
Infective Endocarditis ◽  
Drug Use ◽  
Injection Drug Use ◽  
Clinical Characteristics ◽  
National Registry ◽  
Injection Drug ◽  
University Hospital ◽  
Prosthetic Heart Valves ◽  
Increased Risk ◽  
History Of

Abstract Background: Patients with injection drug use (IDU) have increased risk of developing infective endocarditis (IE), however data of these patients are scarce and need to be explored further. This study aims to describe the clinical characteristics and outcomes among patients with IDU-IE.Methods: Data of adults with IDU-IE and non-IDU-IE, treated between 2008-2017 at the Karolinska University Hospital in Stockholm were obtained from the Swedish National Registry of Infective Endocarditis. Clinical characteristics, microbiological results, treatment durations, results from echocardiography and in-hospital mortality were compared between the groups. Results: In total, 165 (32%) of the included patients had IDU-IE. Patients with IDU-IE were younger than the patients with non-IDU-IE (mean age IDU-IE: 41.6 years; non-IDU-IE: 64.3 years; P<0.01). No difference in distribution of genders was observed, 33% women in both groups. History of previous IE (n=49, 30%) and vascular phenomena (n=101, 61%), were more common among patients with IDU-IE while prosthetic heart valves (n=83, 23%) and known valvular disease (n=78, 22%) were more common among patients with non-IDU-IE (P<0.05). Aetiology of Staphylococcus aureus (n=121, 73%) and tricuspid (n=91, 55%) or pulmonary valve (n=7, 4%) vegetations were more common among IDU-IE (P<0.05). The overall incidence of IDU-IE decreased during the study period, while the incidence of definite IE increased (P<0.01). Conclusions: Patients with IDU-IE were younger, frequently presenting with right-sided vegetations and S. aureus aetiology, and were less frequently treated with surgery. Patients with IDU-IE had higher prevalence of vascular phenomena and history of previous IE, aspects that are important for improved management of this population.

scholarly journals Evaluasi penggunaan obat dan identifikasi drug related problem (DRP) pada pasien pneumonia di ruang rawat inap rumah sakit umum pusat Fatmawati Jakarta (periode Desember 2014 – Februari 2015)

2020 ◽  
Vol 14 (1) ◽  
pp. 129-139
Author(s):  
Diar Gustianti Istita ◽  
Dian Ratih Laksmitawati ◽  
Magdalena Niken
Keyword(s):  
Drug Use ◽  
General Hospital ◽  
Related Problem ◽  
Public Health Problem ◽  
Therapeutic Drug ◽  
Dose Selection ◽  
Problem Identification ◽  
Cross Sectional ◽  
Drug Related Problem ◽  
Disease Study

Evaluation of drug use and drug related problem identification among patients with pneumoniaBackground : Pneumonia is still a public health problem cause in mortality of due to this disease in various countries. Based on the burden of the Global Disease Study in 2010 which reported 90% of pneumonia cases occurring at the age of 65 years and pneumonia became the greatest need after ischemic heart disease, stroke and chronic obstructive pulmonary disease (COPD) in European countries. The high incidence of pneumonia needs  treatment therapy as accurate  and rationally, to ensure that the drugs used are appropriate, safe, and efficient.Purpose:  To evaluation of drug use and drug related problem identification among patients with pneumonia at Fatmawati General Hospital, December 2014-February 2015Method: This study uses a cross sectional study design by observing samples and analyzing the data descriptively. The flow of data collection is prospective among patients with pneumoniaResults: 25 cases of DRP occurrences. From 30 patients found 18 patients who experienced DRP events with a total of 25 cases, in this case 1 patient could experience more than 1 case of DRP events. In this study the most cases occurred in the domain (P1.2), namely the effect of the drug is not optimal as many as 20 cases (80%) with causes of DRP associated with drug dose selection (C.3) include (C3.1) less than a number of doses \ / 2 cases (8%), (C3.4) the frequency of administration was 15 cases (60%), then (C3.2) overdose of 3 cases (12%).Cases that often arise are in the category of dose selection caused by (C3.4) the frequency of administration is lacking. There were 15 patients who received ranitidine injection at a dose of 50 mg every 12 hours per day, whereas the dose listed in the Drugs Information of Handbook library was 50 mg every 6-8 hours per day. The doctor's consideration in giving ranitidine dose 2x50 mg / day is as a prophylactic therapy for the use of several drugs that can increase stomach acid production such as corticosteroids, NSAIDs, NSAID drugs combined with aspirin, and anticoagulant drugs.Conclusion : Knowing that the 5 most therapeutic drug classes used in Fatmawati General Hospital are 30 patients (100%) antibiotics, 30 patients (100%) bronchodilators, 28 patients (93%) anti-peptic ulcer, anti-hypertension. 23 patients (77%) and mucolytic 22 patients (77%). The results showed that there were 18 Drug Related Problems (DRP) patients experiencing DRP events out of 25 total cases, the majority of DRP events were in the domainKeywords: Evaluation; Drug use; Drug Related Problem; Identification; Patients; PneumoniaPendahuluan : Pneumonia masih menjadi masalah kesehatan masyarakat menyebabkan kematian akibat penyakit ini di berbagai negara. Berdasarkan Global Burden of Disease Study pada 2010 yang melaporkan 90% kasus pneumonia terjadi pada usia 65 tahun dan pneumonia menjadi masalah terbesar setelah penyakit jantung iskemik, stroke dan penyakit paru obstruktif kronik (PPOK) di negara-negara Eropa. Tingginya insiden pneumonia dapat menimbulkan risiko kematian, sehingga terapi pengobatan harus dilakukan secara rasional, untuk memastikan bahwa obat yang digunakan sesuai, aman, dan efisien.Tujuan : Untuk mengevaluasi penggunaan obat dan mengetahui ada tidaknya permasalahan terkait obat (DRPs) pada pasien Pneumonia.Metode: Menggunakan desain cross sectional dengan mengamati sampel dan menganalisis data secara deskriptif. Pengumpulan data prospektif pada pasien dengan pneumonia di bangsal rumah sakit.Hasil: Diperoleh 25 kasus kejadian DRP. Dari 30 pasien ditemukan 18 pasien yang mengalami kejadian DRP dengan total kasus sejumlah 25, dalam hal ini 1 pasien dapat mengalami lebih dari 1 kasus kejadian DRP. Dalam penelitian ini kasus terbanyak terjadi pada domain (P1.2) yaitu efek obat tidak optimal sebanyak 20 kasus (80%) dengan penyebab DRP yang berkaitan dengan pemilihan dosis obat (C.3) meliputi (C3.1) dosis kurang sejum\/lah 2 kasus (8%), (C3.4) frekuensi pemberian kurang sejumlah 15 kasus (60%), kemudian (C3.2) dosis berlebih sebanyak 3 kasus (12%). Kasus yang sering muncul yaitu pada kategori pemilihan dosis yang disebabkan (C3.4) frekuensi pemberian kurang. Terdapat 15 pasien yang mendapatkan ranitidin injeksi dengan dosis 50 mg tiap 12 jam perhari, sedangkan dosis yang tercantum dalam pustaka Drugs Information of Handbooks yaitu 50 mg tiap 6-8 jam perhari. Pertimbangan dokter dalam memberikan dosis ranitidine 2x50 mg/hari yaitu sebagai terapi profilaksis terhadap penggunaan beberapa obat yang dapat meningkatkan produksi asam lambung  seperti  kortikosteroid,  NSAID,  Obat  NSAID  yang  dikombinasi dengan aspirin, dan obat antikoagulan.Simpulan: Diketahui bahwa 5 kelas terapi obat terbanyak yang digunakan di RSUP Fatmawati adalah antibiotik sebanyak 30 pasien (100%), bronkodilator sebanyak 30 pasien (100%), anti tukak lambung sebanyak 28 pasien (93%), anti hipertensi sebanyak 23 pasien (77%) dan mukolitik sebanyak 22 pasien (77%). Hasil penelitian menunjukkan bahwa Drug Related Problem (DRP) terdapat 18 pasien mengalami  kejadian  DRP  dari  25  jumlah  total  kasus,  mayoritas  kejadian  DRP terdapat pada domain

Inhaled Drug Use in Elderly Patients and Limitations in Association With Geriatric Assessment Scores

2008 ◽  
Vol 44 (10) ◽  
pp. 519-524 ◽  
Author(s):  
Ventura Rabell-Santacana ◽  
Esther Pastor-Ramon ◽  
Juan Pujol-Ribó ◽  
Juan Solà-Genovés ◽  
Montserrat Díaz-Egea ◽  
...  
Keyword(s):  
Drug Use ◽  
Elderly Patients ◽  
Geriatric Assessment ◽  
Assessment Scores

Drug Use in Prisoners

2018 ◽  
Keyword(s):  
Substance Use ◽  
Drug Use ◽  
Evidence Base ◽  
Future Research ◽  
People Who Use Drugs ◽  
Policy Reforms ◽  
Increased Risk ◽  
History Of ◽  
Key Policy

The majority of people who experience incarceration have a history of harmful alcohol, tobacco, and/or illicit drug use. Some discontinue use of these substances while in custody. Others—notably including some people who inject drugs—continue to use drugs in prison, typically in avoidably high-risk circumstances. Rapid relapse to risky substance use after release from prison is common and is associated with a range of health and social problems, and increased risk of both death and reincarceration. Effective measures to reduce the incarceration of people who use drugs, and to minimize drug-related harms both in prison and after release from custody, are urgently required. However, the evidence base to inform effective responses remains weak, and implementation of evidence-based responses remains patchy. Drawing on the expertise of 40 authors from 10 countries, this book reviews what is known about the epidemiology of substance use in people who experience incarceration. It presents what is known about the health, social, and criminal justice consequences of harmful substance use in this population and discusses key policy reforms that have the potential to achieve better health outcomes. In addition to reviewing what is known, the book identifies key knowledge gaps and makes recommendations for future research.

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