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Inappropriate prescribing

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https://www.readbyqxmd.com/read/27915457/combined-use-of-the-rationalization-of-home-medication-by-an-adjusted-stopp-in-older-patients-rasp-list-and-a-pharmacist-led-medication-review-in-very-old-inpatients-impact-on-quality-of-prescribing-and-clinical-outcome
#1
Lorenz Van der Linden, Liesbeth Decoutere, Karolien Walgraeve, Koen Milisen, Johan Flamaing, Isabel Spriet, Jos Tournoy
BACKGROUND: Polypharmacy and potentially inappropriate drugs have been associated with negative outcomes in older adults which might be reduced by pharmacist interventions. OBJECTIVES: Our objective was to evaluate the effect of a pharmacist intervention, consisting of the application of the Rationalization of home medication by an Adjusted STOPP in older Patients (RASP) list and a pharmacist-led medication review on polypharmacy, the quality of prescribing, and clinical outcome in geriatric inpatients...
December 3, 2016: Drugs & Aging
https://www.readbyqxmd.com/read/27908334/antimicrobial-stewardship-in-the-management-of-sepsis
#2
REVIEW
Michael S Pulia, Robert Redwood, Brian Sharp
Sepsis represents a unique clinical dilemma with regard to antimicrobial stewardship. The standard approach to suspected sepsis in the emergency department centers on fluid resuscitation and timely broad-spectrum antimicrobials. The lack of gold standard diagnostics and evolving definitions for sepsis introduce a significant degree of diagnostic uncertainty that may raise the potential for inappropriate antimicrobial prescribing. Intervention bundles that combine traditional quality improvement strategies with emerging electronic health record-based clinical decision support tools and rapid molecular diagnostics represent the most promising approach to enhancing antimicrobial stewardship in the management of suspected sepsis in the emergency department...
February 2017: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/27907210/assessing-potentially-inappropriate-prescribing-in-community-dwelling-older-patients-using-the-updated-version-of-stopp-start-criteria-a-comparison-of-profiles-and-prevalences-with-respect-to-the-original-version
#3
Encarnación Blanco-Reina, Maria Rosa García-Merino, Ricardo Ocaña-Riola, Lorena Aguilar-Cano, Jennifer Valdellós, Inmaculada Bellido-Estévez, Gabriel Ariza-Zafra
Emerging and changing evidence made it necessary to update STOPP-START criteria, and version 2 was published recently. In this study the objectives were to determine the prevalence of potentially inappropriate medication prescribing (PIM) in primary care using STOPP versions 1 (v1) and 2 (v2), as well as 2012 AGS Beers criteria, and analyze the factors associated with inappropriate prescribing according to STOPP/START v2. A cross-sectional study was carried out including community-dwelling older adults over the age of 65...
2016: PloS One
https://www.readbyqxmd.com/read/27906601/association-between-pre-operative-cefazolin-dose-and-surgical-site-infection-in-obese-patients
#4
William J Peppard, David G Eberle, Nathan W Kugler, Danielle M Mabrey, John A Weigelt
BACKGROUND: A fixed dose of cefazolin results in serum concentrations that decrease as body mass increases. Current national guidelines suggest a pre-operative cefazolin dose of two grams may be insufficient for patients ≥120 kg; thus a three gram dose is recommended. These recommendations, however, are based on pharmacokinetic rather than outcome data. We evaluate the efficacy of pre-operative cefazolin two gram and three gram doses as measured by the rate of surgical site infection (SSI)...
December 1, 2016: Surgical Infections
https://www.readbyqxmd.com/read/27903209/incidence-and-cost-of-stress-ulcer-prophylaxis-after-discharge-from-the-intensive-care-unit-a-retrospective-study
#5
Benedict Tan, Richard Norman, Ed Litton, Chloe Heath, David J Hawkins, Ravi Krishnamurthy, Ravikiran Sonawane, Matthew H Anstey
OBJECTIVE: To describe current patterns in initiation and cessation of proton pump inhibitors (PPIs) for stress ulcer prophylaxis (SUP) in intensive care units, and to assess the costs associated with inappropriate (non-evidence-based) SUP. DESIGN, SETTING AND PARTICIPANTS: Retrospective observational study in five ICUs in Western Australia. We assessed the medical records of consecutive patients admitted to the ICUs between September 2013 and January 2015. Patients aged < 18 years were excluded...
December 2016: Critical Care and Resuscitation: Journal of the Australasian Academy of Critical Care Medicine
https://www.readbyqxmd.com/read/27902720/intervention-to-improve-appropriate-prescribing-and-reduce-polypharmacy-in-elderly-patients-admitted-to-an-internal-medicine-unit
#6
Milena Urfer, Luigia Elzi, Salome Dell-Kuster, Stefano Bassetti
BACKGROUND: Polypharmacy and inappropriate medication prescriptions are associated with increased morbidity and mortality. Most interventions proposed to improve appropriate prescribing are time and resource intensive and therefore hardly applicable in daily clinical practice. OBJECTIVE: To test the efficacy of an easy-to-use checklist aimed at supporting the therapeutic reasoning of physicians in order to reduce inappropriate prescribing and polypharmacy. METHODS: We assessed the efficacy and safety of a 5-point checklist to be used by all physicians on the internal medicine wards of a Swiss hospital by comparing outcomes in 450 consecutive patients aged ≥65 years hospitalized after the introduction of the checklist, and in 450 consecutive patients ≥65 years hospitalized before the introduction of the checklist...
2016: PloS One
https://www.readbyqxmd.com/read/27900070/potentially-inappropriate-medications-by-beers-criteria-in-older-outpatients-prevalence-and-risk-factors
#7
Yeon-Jung Lim, Ha-Yeon Kim, Jaekyung Choi, Ji Sun Lee, Ah-Leum Ahn, Eun-Jung Oh, Dong-Yung Cho, Hyuk-Jung Kweon
BACKGROUND: Prescription of inappropriate medicine to elderly patients is a major public health care concern. The Beers criteria have been commonly employed as a screening tool to identify the use of potentially inappropriate medications (PIMs). The present study investigated the prevalence of PIM use according to the Beers criteria as well as factors related to PIM use. METHODS: Data obtained from a retrospective survey included 25,810 outpatients aged ≥65 years from a university medical center in Seoul, Korea...
November 2016: Korean Journal of Family Medicine
https://www.readbyqxmd.com/read/27898526/uptake-of-hiv-pre-exposure-prophylaxis-prep-in-a-national-cohort-of-gay-and-bisexual-men-in-the-united-states-the-motivational-prep-cascade
#8
Jeffrey T Parsons, H Jonathon Rendina, Jonathan M Lassiter, Thomas H F Whitfield, Tyrel J Starks, Christian Grov
OBJECTIVES: The HIV care cascade provides milestones to track the progress of HIV-positive people from seroconversion through viral suppression. We propose a Motivational PrEP Cascade involving five stages based upon the Transtheoretical Model of Change. METHODS: We analyzed data from 995 men in One Thousand Strong, a longitudinal study of a national panel of HIV-negative gay and bisexual men in the United States. RESULTS: Nearly all (89%) participants were sexually active in the past 3 months, and 65% met CDC criteria for PrEP candidacy...
November 24, 2016: Journal of Acquired Immune Deficiency Syndromes: JAIDS
https://www.readbyqxmd.com/read/27896873/identifying-fallacious-arguments-in-a-qualitative-study-of-antipsychotic-prescribing-in-dementia
#9
Parastou Donyai
BACKGROUND: Dementia can result in cognitive, noncognitive and behavioural symptoms which are difficult to manage. Formal guidelines for the care and management of dementia in the UK state that antipsychotics should only be prescribed where fully justified. This is because inappropriate use, particularly problematic in care-home settings, can produce severe side effects including death. The aim of this study was to explore the use of fallacious arguments in professionals' deliberations about antipsychotic prescribing in dementia in care-home settings...
November 29, 2016: International Journal of Pharmacy Practice
https://www.readbyqxmd.com/read/27894225/agreement-between-the-2009-stopp-criteria-and-the-2003-beers-criteria-at-the-time-of-hospital-admission
#10
María Muñoz García, Eva Delgado Silveira, Sagrario Martín-Aragón Álvarez, Teresa Bermejo Vicedo, Alfonso José Cruz-Jentoft
: Potentially inappropriate prescription in elderly patients can be evaluated by different methods. The STOPP Criteria and Beers Criteria stand out among the explicit criteria most widely used. OBJECTIVE: The main objective of this study is to identify the agreement in the detection of potentially inappropriate prescribing between the STOPP criteria and the Beers Criteria, in elderly patients assessed at the time of hospital admission. METHOD: An observational retrospective study was designed in order to estimate the prevalence of potentially inappropriate prescription in the habitual treatment before admission, and to compare the agreement in detection capability between the 2003 Beers Criteria and the 2009 STOPP Criteria, in >70-yearold patients with an emergency hospital admission...
November 1, 2016: Farmacia Hospitalaria
https://www.readbyqxmd.com/read/27890352/residential-aged-care-medication-review-to-improve-the-quality-of%C3%A2-medication-use-a-systematic-review
#11
REVIEW
Kaeshaelya Thiruchelvam, Syed Shahzad Hasan, Pei Se Wong, Therese Kairuz
BACKGROUND: Aging is often associated with various underlying comorbidities that warrant the use of multiple medications. Various interventions, including medication reviews, to optimize pharmacotherapy in older people residing in aged care facilities have been described and evaluated. Previous systematic reviews support the positive impact of various medication-related interventions but are not conclusive because of several factors. OBJECTIVES: The current study aimed to assess the impact of medication reviews in aged care facilities, with additional focus on the types of medication reviews, using randomized controlled trials (RCTs) and observational studies...
November 24, 2016: Journal of the American Medical Directors Association
https://www.readbyqxmd.com/read/27890038/an-evaluation-of-antibiotic-prescribing-practices-upon-hospital-discharge
#12
Sarah J Scarpato, Daniel R Timko, Valerie C Cluzet, Jillian P Dougherty, Jonathan J Nunez, Neil O Fishman, Keith W Hamilton
We conducted a retrospective study of the appropriateness of antimicrobial agents prescribed on discharge from an acute care hospital. Seventy percent of discharge antibiotics were inappropriate in antibiotic drug choice, dose, or duration. Our findings suggest there is a significant need for antimicrobial stewardship at transitions in care. Infect Control Hosp Epidemiol 2016;1-3.
November 28, 2016: Infection Control and Hospital Epidemiology
https://www.readbyqxmd.com/read/27888478/examining-the-quality-of-medicines-at-kenyan-healthcare-facilities-a-validation-of-an-alternative-post-market-surveillance-model-that-uses-standardized-patients
#13
Francis Wafula, Amy Dolinger, Benjamin Daniels, Njeri Mwaura, Guadalupe Bedoya, Khama Rogo, Ana Goicoechea, Jishnu Das, Bernard Olayo
BACKGROUND: Promoting access to medicines requires concurrent efforts to strengthen quality assurance for sustained impact. Although problems of substandard and falsified medicines have been documented in low- and middle-income countries, reliable information on quality is rarely available. OBJECTIVE: The aim of this study was to validate an alternative post-market surveillance model to complement existing models. METHODS: The study used standardized patients or mystery clients (people recruited from the local community and trained to pose as real patients) to collect medicine samples after presenting a pre-specified condition...
November 25, 2016: Drugs—Real World Outcomes
https://www.readbyqxmd.com/read/27888429/inappropriateness-of-diagnostic-imaging-examinations-in-the-inpatient-setting-a-case-study-research
#14
Ettore Squillaci, Francesca Bolacchi, Jacopo Scaggiante, Francesca Ricci, Luca Pugliese, Alberto Bergamini, Francesco Garaci, Roberto Floris
OBJECTIVE: The purpose of our study was to audit the clinical appropriateness of the prescriptions of whole body CT (WB-CT), PET-CT and chest X-rays (CXRs) performed at Tor Vergata University Hospital in the inpatient setting. MATERIALS AND METHODS: WB-CT, PET-CT and CXRs examinations were retrospectively analysed in the period between January and December 2014. CXR examinations were divided into bedside CXRs and traditional CXRs. The appropriateness of the examinations was defined according the American College of Radiology Appropriateness Criteria...
November 25, 2016: La Radiologia Medica
https://www.readbyqxmd.com/read/27885844/guidance-to-manage-inappropriate-polypharmacy-in-older-people-systematic-review-and-future-developments
#15
Derek Stewart, Alpana Mair, Martin Wilson, Przemyslaw Kardas, Pawel Lewek, Albert Alonso, Jennifer McIntosh, Katie MacLure
Single disease state led evidence-based guidelines do not provide sufficient coverage of issues of multimorbidities, with the cumulative impact of recommendations often resulting in overwhelming medicines burden. Inappropriate polypharmacy increases the likelihood of adverse drug events, drug interactions and non-adherence. Areas covered: A detailed description of a pan-European initiative, 'Stimulating Innovation Management of Polypharmacy and Adherence in the Elderly, SIMPATHY', which is a project funded by the European Commission to support innovation across the European Union...
November 25, 2016: Expert Opinion on Drug Safety
https://www.readbyqxmd.com/read/27877048/utilization-of-gastroprotective-strategies-for-nonsteroidal-anti-inflammatory-drug-induced-gastrointestinal-events-in-a-major-teaching-hospital
#16
Hooi Leng Lee, Siew Siang Chua, Sanjiv Mahadeva
BACKGROUND AND PURPOSE: Clinical guidelines recommend the prescribing of gastroprotective strategies in nonsteroidal anti-inflammatory drug (NSAID) users with risk factors for gastrointestinal (GI) ulcer or ulcer complications. However, these guidelines are not often translated into clinical practice. Therefore, the aim of this study was to investigate the utilization of gastroprotective strategies for NSAID-induced upper GI events in at-risk users in a major teaching hospital. PATIENTS AND METHODS: A cross-sectional, observational, pharmacy-based study was conducted in a major Asian institution with both primary and secondary health care services...
2016: Therapeutics and Clinical Risk Management
https://www.readbyqxmd.com/read/27870547/prescribers-perceptions-of-medication-discontinuation-survey-instrument-development-and-validation
#17
Amy Linsky, Steven R Simon, Kelly Stolzmann, Barbara G Bokhour, Mark Meterko
OBJECTIVES: Primary care providers (PCPs) and clinical pharmacists have concerns about the adverse consequences of using medications inappropriately and generally support the notion of reducing unnecessary drugs. Despite this attitude, many factors impede clinicians' ability to discontinue medication in clinical settings. We sought to develop a survey instrument that assesses PCPs' and pharmacists' experiences, attitudes, and beliefs toward medication discontinuation. STUDY DESIGN: Survey development and psychometric assessment...
November 2016: American Journal of Managed Care
https://www.readbyqxmd.com/read/27870068/systematic-review-of-the-prevalence-of-medication-errors-resulting-in-hospitalization-and-death-of-nursing-home-residents
#18
Noha Ferrah, Janaka J Lovell, Joseph E Ibrahim
Medication errors (MEs) result in preventable harm to nursing home (NH) residents and pose a significant financial burden. Institutionalized older people are particularly vulnerable because of various organizational and individual factors. This systematic review reports the prevalence of MEs leading to hospitalization and death in NH residents and the factors associated with risk of death and hospitalization. A systematic search was conducted of the relevant peer-reviewed research published between January 1, 2000, and October 1, 2015, in English, French, German, or Spanish examining serious outcomes of MEs in NHs residents...
November 21, 2016: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/27852197/antimicrobial-use-in-australian-hospitals-how-much-and-how-appropriate
#19
John D Turnidge, Karin Thursky, Caroline S Chen, Vicki R McNeil, Irene J Wilkinson
Antimicrobial agents play a central role in modern health care, especially in the hospital setting. This article describes the currently available information on the volumes of antimicrobial use in Australian hospitals, the appropriateness of that use, and the levels of compliance with nationally or locally endorsed prescribing guidelines. The data presented here come from the 2014 National Antimicrobial Utilisation Surveillance Program report and the 2013 and 2014 National Antimicrobial Prescribing Survey reports and are based on voluntary participation in the two programs...
November 21, 2016: Medical Journal of Australia
https://www.readbyqxmd.com/read/27846837/prevalence-aetiology-treatment-and-outcomes-of-shock-in-children-admitted-to-kenyan-hospitals
#20
George Mbevi, Philip Ayieko, Grace Irimu, Samuel Akech, Mike English
BACKGROUND: Shock may complicate several acute childhood illnesses in hospitals within low-income countries and has a high case fatality. Hypovolemic shock secondary to diarrhoea/dehydration and septic shock are thought to be common, but there are few reliable data on prevalence or treatment that differ for the two major forms of shock. Examining prevalence and treatment practices has become important since reports suggest high risks from liberal use of fluid boluses in African children...
November 16, 2016: BMC Medicine
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