Polypharmacy Management in the Older Adults: A Scoping Review of Available Interventions

Background: Polypharmacy paves the way for non-adherence, adverse drug reactions, negative health outcomes, increased use of healthcare services and rising costs. Since it is most prevalent in the older adults, there is an urgent need for introducing effective strategies to prevent and manage the problem in this age group.Purpose: To perform a scoping review critically analysing the available literature referring to the issue of polypharmacy management in the older adults and provide narrative summary.Data sources: Articles published between January 2010–March 2018 indexed in CINHAL, EMBASE and PubMed addressing polypharmacy management in the older adults.Results: Our search identified 49 papers. Among the identified interventions, the most often recommended ones involved various types of drug reviews based on either implicit or explicit criteria. Implicit criteria-based approaches are used infrequently due to their subjectivity, and limited implementability. Most of the publications advocate the use of explicit criteria, such as e.g. STOPP/START, Beers and Medication Appropriateness Index (MAI). However, their applicability is also limited due to long lists of potentially inappropriate medications covered. To overcome this obstacle, such instruments are often embedded in computerised clinical decision support systems.Conclusion: Multiple approaches towards polypharmacy management are advised in current literature. They vary in terms of their complexity, applicability and usability, and no “gold standard” is identifiable. For practical reasons, explicit criteria-based drug reviews seem to be advisable. Having in mind that in general, polypharmacy management in the older adults is underused, both individual stakeholders, as well as policymakers should strengthen their efforts to promote these activities more strongly.

Evaluating ELF Students’ Speaking Skill at Tertiary Level

This study was conducted at a Sudanese university in 2021 at the end of the semester to find out the areas caused problems of speech production. The research paper seeks to answer the question: What area/s of speaking is problematic to students? Fortysix undergraduate students in first year, who were majored in the English programme involved in the test. The total population was hundred students. Analytic rubrics were used for collecting data. Tuan (2014, p. 2) states that analytic rubric“… accesses the examinee’s specific strengths and weaknesses and identifies the particular components of speaking discourse that an examinee needs to develop”. Five explicit criteria were used to test participants; i.e.: grammar, vocabulary, pronunciation, cohesion and fluency. The test was conducted by two instructors who gave appropriate marks under each of five rubrics (Table 1 below). The test contents comprised some pictures and topics to speak about. Bar charts were utilized to compare and measure marks obtained by students in analytic rubrics, where each rubric was measured individually. The results revealed that students were weak in all five areas (grammar, vocabulary, punctuation, cohesion and fluency).The highest marks were gained in pronunciation, count 25%, while the lowest marks were obtained in vocabulary, 15% from the total mark allocated for this item. The results conveyed that, this group of participants was weak in all aspects that needed for speech production compared with their level (2nd year undergraduates).

98 Rationality of Hypnosedative Use in Seniors in Acute Care: Outputs of the Inomed and Euroageism Projects

Introduction Insomnia is a frequent problem in acutely hospitalized older adults, particularly in those suffering from polymorbidity and treated by polypharmacy. The aim of our study was to describe the prevalence of insomna and patterns of inappropriately prescribed hypnosedatives in acutely hospitalized older patients in the Czech Republic. Methods 438 patients (≥65 yrs) acutely hospitalized at 3 geriatric clinics (Brno, Hradec Králové, Praha) in the Czech Republic underwent a comprehensive geriatric assessment (CGA) using the EUROAGEISM H2020 assessment protocols. Descriptive statistics was used to determine the prevalence of insomnia and use of hypnosedatives. Explicit criteria of potentially inappropriate medications (PIMs), mainly 2019 Beers criteria and 2015 EU(7)-PIM list were applied to determine inappropriate patterns of hypnosedatives use. Results 16.9% (N = 74) seniors had diagnosed insomnia in their medical records, but 34,6% used hypnosedatives in the evening or at night (e/n). 13.8% reported e/n use of drugs aggravating insomnias (particularly beta-blockers- 6.4%, diuretics-2.5% and theophylline- 2.1%). Most frequent hypnosedatives used were: antipsychotics e/n (18.5%), Z-drugs (16,2%) and benzodiazepines e/n (BZD, 14,2%). Non-geriatric doses were determined in users of Z-drugs (10.5%) and sedative antidepressants e/n (1,8%), longer than recommended geriatric duration of therapy has been described for Z-drugs (5.9%,>1 month), BZDs e/n (5,3%,>1 month) and sedative antidepressants e/n (3,3%, >6 months). In total, 1PIM was prescribed to 7.5% of seniors (N = 33), 2PIMs to 2.5% and 3PIMs to 1,1% of seniors. Combination of hypnotics and other sedative drugs was documented in 5.9% of cases. Conclusion Inappropriate patterns of hypnosedative use in acutely hospitalized seniors in the Czech Republic at geriatric clinics were found particularly in excessive indication of antipsychotics e/n, inappropriate dosing of Z-drugs and long-term use of BZDs e/n. Supported by: InoMed project (reg. No: CZ.02.1.01/0.0/0.0/18_069/0010046, 2019–2022), EUROAGEISM H2020-MCSF-ITN-764632 project, PROGRESS Q42 Faculty of Pharmacy, Charles University, SVV 260417.

Assessment of Theses in Design Education

This article explores and proposes a design concept of a co-creative process that aims to support the assessment and grading of theses in design education through automated criteria evaluation. The research is based on a concept-driven design approach that theoretically anchored and empirically informed the design concept. The research was achieved by grounding the concept in theoretical resources concerning pedagogical principles and assessment, existing tools and models for examiners in assessment processes, and current design practices for assessment in higher education. The main contribution of this article, namely the concept of grading by automated criteria evaluation (GRACE), aims to provide support and structure for examiners and students to collectively advance the design, implementation, and evaluation of the concept through the co-creation and evaluation of criteria in higher education. GRACE could supplement existing assessment practices of theses in design education by focusing on both explicit criteria and the development of students' design thinking and abilities.

Who Is a Political Prisoner?

Who is a political prisoner? The classification of inmates as political prisoners has important real-world implications such as deciding over accession to international organizations or triggering international advocacy. However, the concept is ambiguously used in academic studies referring to both theoretically and empirically distinct groups of individuals. Building on a systematic review of the academic literature, I identify that definitions of political prisoners differ primarily with regard to (1) the source of politicization, (2) the timing of politicization, (3) the question of nonviolence, (4) the inclusion of identity prisoners, and (5) the criteria for biased state actions. In order to establish political prisoners as analytically consistent concept, I suggest to reserve it for victims of politically biased trials while remaining agnostic toward prisoners’ political motivations. I introduce explicit criteria grounded in international law to identify politically biased trials in practice. The new conceptualization allows to disentangle political imprisonments from other types of illegitimate and non-illegitimate imprisonments. A disaggregation of the concept further highlights that only a subset of political prisoners is entitled to demands for unconditional releases. Taken together, this article sheds light to the underlying meanings of different actors’ claims about political imprisonments and contributes to the systematic study of this type of human rights abuse.

Drug interactions for elderly with respiratory disorders and times of COVID-19: a systematic scoping review

Background: The elderly people have high morbimortality associated with respiratory disorders, in addition to the presence of other safety risk factors, such as the use of potentially inappropriate medication and the occurrence of drug interactions. Objective: Considering the current pandemic scenario, it was intended to identify explicit criteria-based tools that reported drug interactions between potentially inappropriate medication and respiratory system disorders and possibly worse prognosis of COVID-19 infection. Methods: A systematic scoping review was conducted until February 2020. Study characteristics of explicit criteria-based tools, and potentially inappropriate medication, drug interactions, and therapeutic management, were extracted. Results: Nineteen explicit criteria-based tools were included. Nineteen drug interactions and 17 potentially inappropriate medications with concerns for three respiratory disorders (asthma, chronic pulmonary obstructive disease, and respiratory failure) were identified. The most frequent pharmacological classes reported were benzodiazepines and beta-blockers. For clinical management, the tools recommend using cardioselective beta-blockers, calcium channel blockers, angiotensin-converting enzyme inhibitors, and angiotensin II type I receptor blockers, and benzodiazepines with a short or intermediate half-life. Conclusion: Considering the increased risk of COVID-19 infection in the elderly, drug interactions and the use of potentially inappropriate medication associated with the occurrence of adverse drug events in the respiratory system may also worsening COVID-19 infection in patients with uncontrolled respiratory disorders. Thus, it is essential to assess drug therapy in use, to identify safety risks, and monitor the elderly in general and those with a worse prognosis concerning COVID-19, promoting patient safety.