Deprescribing Medications Among Older People to Reduce Polypharmacy at a Comprehensive Academic Medical Center

2021 ◽  
Vol 36 (4) ◽  
pp. 208-216
Author(s):  
Stella Ye ◽  
Sarah Boyko ◽  
Melissa Patel ◽  
Kruti Shah ◽  
Sara Turbow ◽  
...  
Keyword(s):  
Older People ◽  
Acute Care ◽  
Medical Center ◽  
Academic Medical Center ◽  
The Elderly ◽  
Control Group ◽  
Control Groups ◽  
Care For The Elderly ◽  
Academic Medical ◽  
And Control

OBJECTIVE: To evaluate deprescribing of select high-risk medications (HRMs) in an Acute Care for the Elderly (ACE) unit with pharmacist involvement compared with usual care in older people. DESIGN: Retrospective, single-center case-control study. SETTING: Medical-surgical units at an urban academic medical center. PARTICIPANTS: Patients 65 years of age and older admitted April-June 2019, with 1 or more of the following target HRMs prior to admission were included in the study: acid suppressants, antipsychotics, or insulin. Patients admitted to the ACE unit were included in the case group; all other patients were randomly matched by HRMs in a 2:1 ratio into the control group. INTERVENTIONS: The Acute Care for the Elderly pharmacist reviewed patients' medications to identify and deprescribe select HRMs. Deprescribing was defined as discontinuation, dose or frequency reduction. RESULTS: A total of 47 patients with 56 HRMs and 89 patients with 126 HRMs were included in the case and control groups, respectively. The primary outcome of HRMs deprescribed were similar between the case and control groups (21.4% and 25.4%; P = 0.56). Among the HRMs deprescribed (discontinued, dose or frequency reduced), 83.2% were complete discontinuations in case patients and 34.4% were complete discontinuations in control patients.

scholarly journals A Single Virtual Consult Reduces Severe Hyperglycemia in Patients Admitted with COVID19 Infection

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A335-A335
Author(s):  
Diana Athonvarangkul ◽  
Felona Gunawan ◽  
Kathryn Nagel ◽  
Leigh Bak ◽  
Kevan C Herold ◽  
...  
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Control Group ◽  
Post Intervention ◽  
Academic Medical ◽  
Treatment Plans ◽  
The Mean ◽  
Glucose Management ◽  
And Control ◽  
Glycemic Management

Abstract Diabetes and hyperglycemia are risk factors for morbidity and mortality in hospitalized patients with COVID19. Subspecialty consultative resources to help front-line clinicians treat these conditions is often limited. We implemented a “Virtual Hyperglycemia Surveillance Service (VHSS)” to guide glucose management in COVID19 patients admitted to our 1541-bed academic medical center. From April 22 to June 9, 2020, hospitalized adult patients with COVID19 and 2 or more blood glucose (BG) values greater than 250 mg/dl over 24-h were identified using a daily BG report. The VHSS reviewed BGs and treatment plans, then made recommendations for future glycemic management via a one-time note, visible to all providers. Some patients with re-admission or persistently elevated BG after 1 week received a second VHSS note. We compared BGs from 24-h pre- and 72-h post-intervention starting at 6AM on the day following VHSS review. We also evaluated for hypoglycemia, insulin infusion use and use of formal diabetes consults. A subgroup analysis was performed on patients in the intensive care unit (ICU). At the end of the intervention, we identified a retrospective control cohort admitted to the same hospital from March 21 to April 21, 2020 who met the inclusion criteria for a VHSS assessment. The VHSS group consisted of 100 patients with 126 individual VHSS encounters, and the control group comprised 50 patients. Baseline characteristics in the VHSS and control groups, respectively, were: mean age 62.5 vs 62.1 years, % male 58 vs 56, mean weight 91.4 vs 93.4 kg, BMI 31.8 vs 33.0 kg/m2, and HbA1c 9.1 vs 8.8 %. There were fewer patients in the ICU in the VHSS than control group (44% vs 66%). In the VHSS group, mean BG pre- vs. post-intervention was 260.3 ±21.7 and 227.4 ±25.3 mg/dl (p<0.001). In the control group, mean BG pre-and post- the day they met assessment criteria was 264.8 ± 6.5 mg/dl and 250.6 ± 8.6 mg/dl (p=0.18). There was no difference in the use of insulin infusions or diabetes consults between the two groups. More hypoglycemia (BG<70 mg/dl) occurred in the VHSS than control group (8.3% vs 0%, p=0.04). Within the VHSS group, the average change in BG was significantly greater in ICU than non-ICU patients (-51.8 ±8.7 vs -19.6 ±5.0 mg/dl, p<0.01) and the reduction in the % of BG over 250 mg/dl was also significantly greater in the ICU (-32.2% vs -16.8%, p=0.02). Implementation of a single virtual consult for severely hyperglycemic hospitalized COVID19 patients was associated with rapidly reduced BG concentrations, especially in the ICU. The mean reduction in BG with VHSS intervention was more than 2-fold greater than that observed in our control group. Glucose control remained suboptimal, however, suggesting the need for subsequent input from this specialty service.

scholarly journals The Effect of Positive Thinking Training on Anxiety and Happiness in the Elderly: a Quasi- Experimental Study

2021 ◽  
Author(s):  
Anis Pourdavarani ◽  
Jamileh Farokhzadian ◽  
Mansooreh Azizzadeh Forouz ◽  
Sedigheh Khodabandeh Shahraki
Keyword(s):  
Experimental Study ◽  
Skills Training ◽  
The Elderly ◽  
Anxiety And Depression ◽  
Control Group ◽  
Positive Thinking ◽  
Control Groups ◽  
Quasi Experimental ◽  
The Mean ◽  
And Control

Abstract Background: Anxiety and depression are the most common psychological disorders in the aging period. One of the ways to deal with anxiety and depression and increase happiness in the elderly is to train positive thinking. Therefore, the present study aimed to investigate positive thinking skills training on anxiety and happiness in the elderly.Methods: In this quasi-experimental study, 48 elderly people referred to two comprehensive health service centers in Kerman in southeastern Iran were selected by convenience sampling method and randomly assigned into intervention groups (n = 24) and control (n = 24). The data collection tools included the Beck Anxiety Inventory and the Oxford Happiness Inventory. Questionnaires were filled out before the intervention, then positive thinking training was held in eight sessions of 90 minutes. After training program, the was conducted one month after it, the follow-up tools.Results: The results showed that the mean score of anxiety before positive thinking training was (13.58 ± 8.61) and (19.25± 11.67) in the intervention and the control group, respectively. After positive thinking training, the mean scores were (4.50 ±4.07) and (15.54±9.04) in the intervention and control group, respectively. After the intervention, which significantly reduced anxiety the intervention, group (t= 8.10, P<0.001). The mean score of happiness before the test was (26.58±12.40) and (37.91 ± 5.57) in the intervention and control groups, respectively. However, the posttest happiness scores of the intervention and control groups were (62.91± 4.66) and (35.62 ±10.62), respectively. The results showed that implementing positive thinking training increased happiness significantly (t=-4.08, P<0.001).Conclusion: Since positive thinking training effect reducing anxiety and increasing happiness in the elderly. Due to the growing trend of the elderly population, the positive thinking training approach can be used as a suitable, cost-effective, and efficient method in reducing anxiety and increasing happiness in the elderly.

scholarly journals Effect of an aged wearing suit on nursing student’s knowledge and attitude

BMC Nursing ◽  
2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Zahra Mandegari Bamakan ◽  
Khadijeh Nasiriani ◽  
Farzan Madadizadeh ◽  
Fatemeh Keshmiri
Keyword(s):  
Nursing Students ◽  
The Elderly ◽  
Control Group ◽  
Control Groups ◽  
Significant Difference ◽  
Before And After ◽  
The Mean ◽  
Knowledge And Attitude ◽  
And Control ◽  
Experimental Group

Abstract Background The knowledge and attitude of health care providers are important and influential factors in providing care services to the elderly and need to be considered during the training course. Simulation in geriatric nursing education can be an opportunity for learners to experience the restrictions of the elderly. The present study was conducted to determine the effect of training through simulation on the attitude and knowledge of nursing students in elderly care. Methods This study was quasi-experimental with two experimental and control groups of pre and post-test, which was conducted on 70 nursing students of the 5th semester (two groups of 35 people). For the experimental group, the elderly simulation suit was worn for two hours, which was designed by the researcher and created sensory, physical, and motor restrictions similar to the elderly for students. Before and after the study, Kogan’s attitudes toward older people scale and Palmore’s “facts on aging quiz” were completed by students. The data were analyzed using an independent t-test and paired t-test using SPSS version 16 software. Results The mean scores of students’ knowledge in the experimental and control groups had no significant difference at the beginning of the study (p < 0.05). But the mean scores of knowledge in the experimental group before and after the intervention was (9.2 ± 2.6) and (15.3 ± 3.5), respectively, and in the control group before and after the intervention was (10.4 ± 2.9) and (11.3 ± 2.6), respectively, which had a statistically significant difference (p = 0.0001). The mean scores of students’ attitudes in the experimental and control groups had no significant difference at the beginning of the study (p < 0.05). The mean scores of attitude in the experimental group before and after the intervention was (114.69 ± 8.4) and (157.31 ± 10.7), respectively and in the control group before and after the intervention was (113.34 ± 13.6) and (108.5 ± 16.6), respectively, which was significantly different (p = 0.0001). Conclusions Based on the findings, the experience of aging restrictions through simulation has improved the knowledge and attitude of nursing students towards the elderly. Nursing education requires the growth of attitudinal skills, individuals’ beliefs, and creating empathy among them, so creating simulation opportunities can assist nursing students in the educational processes.

Acute Care Nurse Practitioners: Creating and Implementing a Model of Care for an Inpatient General Medical Service

2002 ◽  
Vol 11 (5) ◽  
pp. 448-458 ◽  
Author(s):  
Jill N. Howie ◽  
Mitchel Erickson
Keyword(s):  
Acute Care ◽  
Nurse Practitioners ◽  
Medical Service ◽  
Medical Center ◽  
Academic Medical Center ◽  
Public Funding ◽  
General Medical Service ◽  
Care Nurse ◽  
Insurance Reimbursement ◽  
Academic Medical

Changes in medical education and healthcare reimbursement are recent threats to most academic medical centers’ dual mission of patient care and education. Financial pressures stem from reduced insurance reimbursement, capitation, and changes in public funding for medical residency education. Pressures for innovation result from increasing numbers of patients, higher acuity of patients, an aging population of patients with complex problems, and restrictions on residency workloads. A framework for addressing the need for innovation in the medical service at a large academic medical center is presented. The framework enables acute care nurse practitioners to provide inpatient medical management in collaboration with a hospitalist. The model’s development, acceptance, successes, pitfalls, and evaluation are described. The literature describing the use of nurse practitioners in acute care settings is reviewed.

Microvascular Decompression for Trigeminal Neuralgia in the Elderly: A Review of the Safety and Efficacy

Neurosurgery ◽  
2004 ◽  
Vol 55 (4) ◽  
pp. 840-850 ◽  
Author(s):  
Keyoumars Ashkan ◽  
Henry Marsh
Keyword(s):  
Trigeminal Neuralgia ◽  
Microvascular Decompression ◽  
Older Patients ◽  
Treatment Options ◽  
Length Of Hospital Stay ◽  
The Elderly ◽  
Outcome Data ◽  
Control Group ◽  
Control Groups ◽  
And Control

Abstract OBJECTIVE: To critically examine the efficacy and safety of microvascular decompression (MVD) for trigeminal neuralgia (TN) in elderly patients. METHODS: We performed a retrospective review of medical records, followed by prospective follow-up. The outcome data from 44 MVD operations for TN performed in 40 consecutive patients with a mean age of 65 years (range, 60–75 yr) in the period 1991 to 2001 were compared with those from 40 younger control subjects (mean age, 46 yr; range, 20–59 yr) operated on during the same period. RESULTS: The median time from diagnosis of TN to MVD in the older patients was 7 years (range, 1–22 yr), compared with 3 years (range, 3 mo to 20 yr) in the younger group (P = 0.02). With the exception of one, all patients in this study were classified as American Society of Anesthesiologist Grade 1 or 2. Initial pain relief was achieved in 98 and 100% of the patients in the study and control groups, respectively. There were no operative mortalities or life-threatening morbidities. Transient facial numbness and diplopia occurred in both groups. Headaches, nausea, and vomiting were more frequent in the younger patients, whereas wound infection and confusion were more common in the older patients. The mean length of hospital stay was 5.4 days (range, 3–10 d) for the older patients, compared with 5.3 days (range, 3–9 d) for the control group (P = 0.4). After average follow-ups of 30 and 33 months, the pain recurred in 24 and 27% of the patients in the elderly and control groups, respectively. CONCLUSION: MVD is underused in the elderly despite being both safe and effective. Fitness and not age should be the key in deciding the treatment options. It is proposed that any patient with medically refractory TN who is fit for general anesthesia should be given the opportunity to choose MVD.

scholarly journals Effect of TRH on beta-gonadotropin subunits in patients with pituitary microincidentalomas

1999 ◽  
pp. 17-21 ◽  
Author(s):  
Y Greenman ◽  
Y Trostanetsky ◽  
D Somjen ◽  
K Tordjman ◽  
F Kohen ◽  
...  
Keyword(s):  
Medical Center ◽  
Adult Population ◽  
Control Group ◽  
Beta Subunits ◽  
Similar Response ◽  
Control Groups ◽  
Trh Stimulation ◽  
Pituitary Incidentaloma ◽  
Abnormal Increase ◽  
And Control

OBJECTIVE: To explore the hypothesis that most of the pituitary abnormalities compatible with the diagnosis of microadenoma, and detected in about 10% of the normal adult population, represent asymptomatic gonadotropinomas. DESIGN: Patients diagnosed with pituitary microincidentalomas at the Institute of Endocrinology of the Tel Aviv Medical Center were evaluated. Circulating beta-subunits of gonadotropin hormones were measured before and 30, 45, 60 and 90 min after the intravenous injection of 400 microgram TRH. PATIENTS: Twenty-two patients with pituitary incidentaloma and 16 normal volunteers were tested. RESULTS: In 16 of the 22 patients, an abnormal beta-subunit response was detected after the TRH challenge. Three patients had an abnormal increase in both beta-FSH and beta-LH after TRH administration. Isolated pathological beta-FSH or beta-LH responses were demonstrated in five and eight patients respectively. Six patients had normal basal and stimulated gonadotropin subunit values, raising the possibility that their lesions were not pituitary microadenomas. There was a significant overall difference between the response to TRH of the patient and control groups. In the gonadotropin positive group, comprising 16 patients, serum beta-FSH increased from 6.4+/-1.6 ng/ml to 9.2+/-1.3 ng/ml (P=0.042) 1 h after TRH stimulation, whereas no changes were detected in the control group after TRH injection (basal: 4.1+/-0.8 ng/ml, peak: 5.1+/-0.8 ng/ml; P=0.15). Serum beta-LH increased from 10.5+/-3.2 ng/ml to 23.4+/-4.9 ng/ml (P=0.0037) at this time, in contrast to a lack of response in controls (basal: 6.4+/-1.5 ng/ml, peak: 8.2+/-2.3 ng/ml; P=0.24). CONCLUSION: In about 73% of patients with pituitary incidentalomas smaller than 10 mm, TRH elicits an increase in gonadotropin beta-subunits. This observation raises the possibility that non-functioning pituitary micro- and macroadenomas, which share a similar response to TRH, originate in a common ancestor cell type, probably a pituitary gonadotrope.

scholarly journals Physician Workforce Response to the COVID-19 Pandemic at an Academic Medical Center

2020 ◽  
pp. 1-4
Author(s):  
Laurie G. Jacobs ◽  
Jason A. Korcak ◽  
Marygrace Zetkulic
Keyword(s):  
Acute Care ◽  
Medical Center ◽  
Academic Medical Center ◽  
Care Physician ◽  
Physician Workforce ◽  
Acute Hospital Care ◽  
Face To Face ◽  
Personal Risk ◽  
Academic Medical ◽  
Training Compensation

ABSTRACT Objectives: The aim of this study was to describe the planning, implementation, and outcome of an acute care physician supplemental workforce during the local coronavirus disease 2019 (COVID-19) surge at a 771-bed academic medical center, from March 25 to May 5, 2020, in New Jersey, United States. Methods: The Department of Medicine sought participation by “independent” and redeployed “employed” physicians to provide acute hospital care, as well as assistance with occupational health and family communication. Plans addressed training, compensation, clinical privileges, malpractice, and collaboration with the existing hospitalist service. Results: Redeployed employed physicians (81% internists) selected either acute care (n = 68; median age, 52 y [range, 32-72 y]; 28% female) or non-face-to-face supportive roles (n = 69; median age, 52 y [range, 32-84 y]; 28% female). The redeployed physician group totaled 474 twelve-h daytime shifts typically caring for 10 patients per day. Six employed physicians refused redeployment, and only 3 independent physicians participated (all acute care). Of note, COVID-19 infection occurred in 10 hospitalists and intensivists, and in several redeployed physicians. Conclusions: Successful physician workforce staffing for medical disasters, such as the COVID-19 pandemic, requires consideration of personal risk, as well as medicolegal, financial, and clinical competency issues.

scholarly journals “Brown Bag Clinic”: A Pharmacist-led Approach to Reduce Heart Failure Hospital Readmission

2021 ◽  
Vol 12 (4) ◽  
pp. 11
Author(s):  
Maggie N. Faraj ◽  
Ileana L. Piña ◽  
Candice Garwood
Keyword(s):  
Heart Failure ◽  
Medical Center ◽  
Academic Medical Center ◽  
Hospital Readmissions ◽  
Intervention Group ◽  
The United States ◽  
Control Group ◽  
Post Discharge ◽  
Academic Medical ◽  
The Impact

Objectives: Heart failure (HF) affects approximately 6 million in the United States and despite guideline-directed medical therapy (GDMT), still more than 20% of patients are readmitted within 30 days.1,2 This study evaluated the impact of a “pharmacist-led HF Brown Bag Clinic” (BBC) on HF patient outcomes including readmissions and mortality. Methods: This retrospective study, conducted at an academic medical center, included adult patients 18 to 89 years old with HF presenting to the BBC 7-14 days post HF hospitalization. Those failing to attend the BBC within 30 days of hospital discharge were in the control group. Our electronic medical records were used to capture patients’ baseline characteristics and describe pharmacists’ interventions. Thirty- and ninety-day post-discharge HF readmission and all-cause mortality were evaluated. Results: A total of 32 patients met the inclusion criteria; 15 receiving intervention and 17 controls. A total of 18 HF hospital readmissions occurred, 4 (22%) readmissions in the intervention group and 14 (78%) in the control group (p= 0.06). Hospital readmissions within 30 days and 90 days were greater in the control group compared with the intervention group (18% vs. 7% and 41% vs. 21% respectively). Conclusion: A pharmacist-led post-discharge clinic demonstrated numerically fewer HF hospital readmissions compared with a scheduled but “no show” control group.

scholarly journals PENGARUH TERAPI BEAPREASI (KOMBINASI SENAM OTAK DENGAN RELAKSASI BENSON) TERHADAP KUALITAS TIDUR PADA LANJUT USIA DENGAN INSOMNIA

2019 ◽  
Vol 3 (1) ◽  
pp. 8
Author(s):  
Wulansari Wulansari ◽  
Mukhamad Mustain ◽  
Fiktina Vifri Ismiriyam
Keyword(s):  
Sleep Quality ◽  
Pittsburgh Sleep Quality Index ◽  
The Elderly ◽  
Control Group ◽  
Control Groups ◽  
Post Test ◽  
The Mean ◽  
Improve Sleep Quality ◽  
And Control ◽  
Experimental Group

AbstrakKualitas tidur pada lansia yang mengalami insomnia sangat bervariasi  yaitu ada yang baik dan ada yang buruk.  Salah satu keluhan tidur lansia adalah Insomnia , dimana ini  merupakan suatu proses degenerasi pada lansia menyebabkan waktu tidur yang efektif semakin berkurang, dan menyebabkan tidak tercapainya kualitas tidur yang adekuat.  Intervensi yang diberikan dapat disisipkan dalan kegiatan Posbindu. Salah satu Intervensi yang dapat diberikan adalah terapi beapreasi. Penelitian ini bertujuan untuk mengetahui  ada atau tidaknya pengaruh terapi Beapreasi terhadap kualitas tidur pada lansia dengan insomnia di  Posbindu Kemuning Kelurahan Candirejo Ungaran. Design penelitian yang digunakan adalah quasi experiment pre-test post-test with control group dan dilakukan pada 128 responden yang terbagi kedalam kelompok eksperimen dan kelompok kontrol,  masing-masing kelompok terdiri dari 64 responden . Metode  yang digunakan untuk menentukan responden adalah teknik purposive sampling. Penilaian Kualitas tidur di ukur dengan kuesioner PSQI dan dilakukan 2 kali pengukuran yaitu sebelum dan sesudah diberikan terapi Beapreasi. Penelitian menunjukkan bahwa rerata nilai PSQI pada kelompok eksperimen sebelum dilakukan intervensi sebesar 6.27 dan rerata  nilai PSQI pada kelompok kontrol sebesar 5.15. Selanjutnya rerata nilai PSQI pada kelompok eksperimen setelah  dilakukan intervensi sebesar 3.67, sedangkan  rerata  nilai PSQI kelompok kontrol  sebesar  5,73. Terdapat perbedaan nilai PSQI pada kelompok eksperimen dan kontrol dengan nilai p 0.00, nilai p < 0.05 sehingga ada pengaruh yang bermakna dari pemberian terapi beapreasi terhadap peningkatan  kualitas tidur. Intervensi terapi Beapreasi dapat meningkatkan kualitas tidur pada lansia yang mengalami insomnia . Terapi Beapreasi dapat dijadikan salah satu intervensi mandiri perawat dalam  merawat lansia yang mengalami insomnia dalam upaya meningkatkan kualitas tidur pada lansia.  Kata kunci: Terapi beapreasi , kualitas tidur, PSQI (the pittsburgh sleep quality index), lansia insomnia, posbindu Abstract The Effect of Breapreasi  Therapy (combain for brain Gym and benson relaxation) on Sleep Quality in the Elderly with Insomnia. Sleep quality in the elderly who experience insomnia varies greatly, there are good and some are bad. One of the complaints of elderly sleep is Insomnia, which is a degeneration process in the elderly which causes effective sleep time to decrease, and causes inadequate quality sleep. The intervention provided can be inserted in the activities of Posbindu. One of the interventions that can be given is therapy of beapreasi. This study aims to determine whether or not there is an effect of beapreasi therapy on sleep quality in the elderly with insomnia at Posbindu Kemuning, Candirejo Village, Ungaran. The research design used was quasi experiment pre-test post-test with control group and carried out on 128 respondents divided into experimental groups and control groups, each group consisting of 64 respondents. The method used to determine respondents is purposive sampling technique. Assessment of sleep quality was measured by the PSQI questionnaire and carried out 2 measurements, namely before and after being given therapy Beapreasi. The study showed that the mean PSQI value in the experimental group before intervention was 6.27 and the mean PSQI value in the control group was 5.15. Then the mean PSQI value in the experimental group after intervention was 3.67, while the mean PSQI value of the control group was 5.73. There are differences in the PSQI values in the experimental and control groups with a value of p 0.00, the value of p <0.05 so that there is a significant effect of the provision of beapreasi therapy on improving sleep quality. Beapreasi therapy interventions can improve sleep quality in elderly who experience insomnia. Beapreasi therapy can be used as one of the nurse's independent interventions in treating elderly people who experience insomnia in an effort to improve sleep quality in the elderly. Keywords: Beapreasi therapy, sleep quality, psqi (the pittsburgh sleep quality index), elderly insomnia, posbindu

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