Number Of Prescribed Medications Research Articles

Sarcopenia and risk factors among Japanese community-dwelling older adults during the COVID-19 pandemic: A cross-sectional study.

The COVID-19 pandemic exposed older adults to high risk of sarcopenia. This study aimed to investigate the prevalence of sarcopenia and its risk factors among Japanese community-dwelling older adults during the COVID-19 pandemic. We collected data through questionnaires and physical measurements among 242 older adults. Sarcopenia was assessed using the Asian Working Group for Sarcopenia 2019 criteria. The results revealed that 14.5% had sarcopenia, which was significantly associated with age, nutritional status, number of prescription medications, body mass index, and self-rated health. On multivariate analysis, the risk of malnutrition was independently significantly associated with sarcopenia. Approximately 70% of participants reported decreased social interaction and going outside, but with no significant association with sarcopenia. In addition, approximately 65% of the participants had an exercise habit and went outside at least once a week, thus maintaining a good level of activity. These findings suggest that prevention of sarcopenia during the pandemic required provision of opportunities for older adults to remain active and positive assessment of nutritional status and well-being.

Number of prescription medications and overall survival in veterans with metastatic hormone-sensitive prostate cancer.

68 Background: Robustassessment of comorbid conditions is essential to clinical care and the risk-stratification of patients for adverse events and death. Prescription medications may be a simple and readily available tool to estimate patient risk independent of established comorbidity indices, such as the Charlson Comorbidity Index (CCI). Clinicians have access to medication lists, facilitating assessment of comorbidities. We sought to examine the relationship between prescription medications and long-term outcomes in veterans treated for metastatic hormone-sensitive prostate cancer (mHSPC). Methods: We conducted a nationwide retrospective observational study of United States Veterans diagnosed with mHSPC in the Veterans Health Administration from 2010-2021. We determined the number of unique drugs and their respective Anatomic Therapeutic Chemical (ATC) Level One classes prescribed in the year prior to the initiation of treatment. Multivariable logistic regression and Cox proportional hazard modeling was used to assess the association between number of drugs with all-cause 90-day mortality and overall survival (OS) while accounting for covariates including age, CCI, body mass index, prostate specific antigen, and race. Results: Among 8,434 Veterans, a median (IQR) of 9 (5-14) unique medications and 5 (3-7) unique ATC medication classes were filled in the year prior to treatment. The mean age was 74.2 (SD 10.1) years, and 2,126 Veterans were black (25.2%). The median CCI was 3 (2.75-6). Increasing age was associated with increased CCI across age strata with mean CCI of 3.16 in age <60, 3.76 in 60-70, 4.43 in 70-80, and 5.25 in 80+ (p<0.001). Increasing age was associated with an increased number of unique medicines with mean 8.59 in age <60, 9.53 in 60-70, 10.1 in 70-80, and 10.4 in 80+ (p<0.001). There was no significant difference in the number of medications prescribed based on race. Veterans with 1-4 medicines had the longest average survival at 38.2 months compared to 5-9 medicines (33.1 months), 10-14 medicines (27.1 months), and 15+ medicines (22.0 months) (p<0.001). After adjusting for relevant patient, tumor, and treatment factors, the number of medications and drug classes were each independently associated with increased mortality with adjusted HR (95% CI) of 1.03 (1.02-1.03) and 1.05 (1.04-1.07), respectively. Veterans treated with 5-9, 10-14, and 15+ medicines had an increased risk of death compared to Veterans on 1-4 medicines [aHR 1.11 (1.03-1.19); 1.29 (1.19-1.39); and 1.51 (1.39-1.65) respectively]. Conclusions: The number of prescription medications and drug classes are independently associated with OS in patients diagnosed with mHSPC, even after accounting for important covariates including age and CCI. Assessment of patient medications may provide a simple, yet reliable tool to assess comorbidities, risk of adverse events, and death.

Predictors of Healthcare Utilization in Family Caregivers of Persons With a Primary Malignant Brain Tumor.

BACKGROUND: Negative physical health results from the emotional stress of providing care to a family member with a primary malignant brain tumor; however, the downstream effects on caregivers' healthcare utilization (HCU) are unknown. This analysis examined associations between caregivers' emotional health and markers of HCU during the 6 months after patients' diagnoses. METHODS: Caregivers' self-report HCU data from a longitudinal study with 116 neuro-oncology caregivers were analyzed. Healthcare utilization was operationalized as number of prescription medications, reporting visits to primary care providers (PCPs), nature of PCP visit, number of comorbid conditions, and change in comorbid conditions. Potential predictors were caregivers' depressive symptoms (Center for Epidemiologic Studies-Depression Scale), hours providing care per day, mastery (Pearlin and Schooler), and burden (Caregiver Reaction Assessment). Logistic mixed effects modeling were used. RESULTS : Caregivers with higher levels of depressive symptoms ( P < .01), anxiety ( P = .02), burden related to schedule ( P = .02), and abandonment ( P < .01) were more likely to report worsening comorbid conditions. Those with higher mastery ( P = .02) were less likely to report worsening comorbid conditions. Caregivers who had a PCP visit and reported higher burden related to feelings of self-esteem ( P = .03) were more likely to report an illness-related visit. CONCLUSION : Findings suggest a relationship between neuro-oncology caregivers' emotional health and their HCU. Data highlight the importance of caregivers' PCPs identifying caregivers at risk for deteriorating health and increased HCU and intervene to ensure caregivers' self-care.

Cross-sectional analysis of factors associated with medication adherence in western Kenya

ObjectivesPoor medication adherence in low-income and middle-income countries is a major cause of suboptimal hypertension and diabetes control. We aimed to identify key factors associated with medication adherence in western...

Sense of control and likelihood of prescription drug misuse 10-years later among middle-aged and older adults

Objectives: Sense of control (i.e. one’s beliefs about their ability to influence life circumstances) has been linked to various psychological outcomes. However, it is unknown if sense of control is protective against prescription drug misuse (PDM). The present study sought to evaluate if sense of control is associated with reduced odds of PDM 9 to 10 years later among a sample of middle-aged and older adults. Methods: Data were evaluated from participants (M = 54 years, SD = 10.86; N = 2,108) of the second and third waves of the Midlife in the United States study. Logistic regression models were used to assess whether baseline sense of control (Wave 2) predicted odds of PDM 9 to 10 years later (Wave 3). Results: Findings revealed that greater sense of control at baseline was related to reduced odds of subsequent PDM (OR = 0.78; 95% CI: 0.64, 0.95), adjusting for baseline PDM, sociodemographic characteristics, health behaviors, psychological factors, number of prescription medications, and health. When assessing the subscales of sense of control separately, constraints (OR = 1.19; 95% CI: 1.00, 1.42), but not mastery (OR = 0.96; 95% CI: 0.80, 1.12), was predictive of odds of subsequent PDM. Further, being female was associated with greater odds of PDM (OR = 1.46; 95% CI: 1.02, 2.09), but did not moderate the association between sense of control and PDM. Conclusions: Sense of control may be a novel and viable target for interventions (e.g. using mobile phone apps) aimed at mitigating prescription drug misuse.

Anticholinergic Drug Burden and Risk of Incident MCI and Dementia: A Population-based Study.

We investigated whether anticholinergic drug use was related to developing mild cognitive impairment (MCI) or dementia in older adults at the population level. We used an Anticholinergic Rating (ACR) scale, Clinical Dementia Rating, APOE genotype, and number of prescription medications. We examined time to incident MCI and incident dementia in a population-based cohort (n=1959). We assessed whether developing MCI or dementia was associated with (1) any anticholinergic drug use, (2) total ACR score, or (3) number of anticholinergic drugs taken. Taking any anticholinergic drug was significantly associated with higher risk of developing MCI; however, higher ACR score or higher number of anticholinergic drugs, compared with lower, were not associated with greater risk of developing MCI. We found no significant relationship between anticholinergic use and developing dementia. The relationship between anticholinergic use and cognitive outcome was not affected by APOE genotype. Among cognitively normal older adults in a population-based sample, anticholinergic drug use is independently associated with subsequently developing MCI, but not dementia. Thus, anticholinergic drug use may influence risk of MCI that is nonprogressive to dementia and potentially be a modifiable risk factor for MCI.

Tolerance for three commonly administered COVID-19 vaccines by healthcare professionals.

ImportanceMost healthcare institutions require employees to be vaccinated against SARS-CoV-2 and many also require at least one booster.ObjectiveWe determine the impact of vaccine type, demographics, and health conditions on COVID-19 vaccine side effects in healthcare professionals.DesignA COVID-19 immunity study was performed at the 2021 American Association for Clinical Chemistry Annual Scientific meeting. As part of this study, a REDCap survey with cascading questions was administered from September 9, 2021 to October 20, 2021. General questions included participant demographics, past and present health conditions, smoking, exercise, and medications. COVID-19 specific questions asked about SARS-CoV-2 vaccine status and type, vaccine-associated side effects after each dose including any boosters, previous infection with COVID-19, diagnostic testing performed, and type and severity symptoms of COVID-19.ResultsThere were 975 participants (47.1% male, median age of 50 years) who completed the survey. Pfizer was the most commonly administered vaccine (56.4%) followed by Moderna (32.0%) and Johnson & Johnson (7.1%). There were no significant differences in vaccine type received by age, health conditions, smoking, exercise, or type or number of prescription medications. Side effects were reported more frequently after second dose (e.g., Moderna or Pfizer) (54.1%) or single/only dose of Johnson & Johnson (47.8%). Males were significantly more likely to report no side effects (p < 0.001), while females were significantly more likely to report injection site reactions (p < 0.001), fatigue (p < 0.001), headache (p < 0.001), muscle pain (p < 0.001), chills (p = 0.001), fever (p = 0.007), and nausea (p < 0.001). There was a significant upward trend in participants reporting no side effects with increasing age (p < 0.001). There were no significant trends in side effects among different races, ethnicities, health conditions, medications, smoking status or exercise. In multivariate logistic regressions analyses, the second dose of Moderna was associated with a significantly higher risk of side effects than both the second dose of Pfizer and the single dose of Johnson & Johnson.Conclusions and relevanceYounger people, females, and those receiving the second dose of Moderna had more COVID-19 vaccine side effects that per self-report led to moderate to severe limitations. As reported in other studies, the increase in side effects from Moderna may be explained by higher viral mRNA concentrations but be associated with additional protective immunity.

Polypharmacy and premature aromatase inhibitor (AI) discontinuation in older women with breast cancer.

6568 Background: Treatment with AI therapy for at least five years is recommended to reduce risk of cancer recurrence in postmenopausal women with hormone-positive breast cancer, but up to 50% prematurely discontinue their AI. Prior studies have demonstrated higher rates of nonadherence in older patients. Higher rates of comorbidities are also present in older patients, many of which require treatment with prescription medications. However, in prior studies, the impact of polypharmacy on AI persistence in older women has been variable. We evaluated the relationship between use of prescription and over-the-counter (OTC) medications and AI discontinuation in older women in a randomized controlled trial of AI therapy. Methods: In the Exemestane and Letrozole Pharmacogenetics (ELPh) trial, postmenopausal women with stage 0-III hormone-positive breast cancer were randomized to receive exemestane or letrozole and followed for two years. Prescription medication and OTC supplement usage was prospectively collected. Only enrolled participants at least 65 years of age were included in this analysis. Univariate and multivariable Cox proportional hazards models evaluated the association between baseline prescription medications, OTC medications, initial assigned AI medication, and time to discontinuation of initial AI. Results: 131 women at least 65 years old with baseline medication and OTC supplement information were identified. The average age was 70.4 (SD 5). 58 participants (44%) were randomized to exemestane and 73 (56%) to letrozole. 21% had previously received tamoxifen and 18% received taxane-based chemotherapy. The average number of prescription medications at AI initiation was 4.95, and 127 patients reported taking at least one. The average number of OTC medications was 3.23, and 107 patients reported taking at least one. There was no difference in number of prescription medications or OTC medications by study arm. As previously reported, exemestane was associated with premature discontinuation (HR 1.92 [95%CI 1.06-3.50], p = 0.032). Controlling for AI, the risk of discontinuation decreased by 12% for every additional prescription medication (HR 0.88 [95%CI 0.78-0.99], p = 0.038). OTC medication use was not significantly associated with AI duration. Conclusions: Increased prescription medication usage at AI initiation was associated with decreased risk of premature discontinuation of AI. Further research is needed to evaluate this interaction and identify characteristics that impact AI persistence in older women with breast cancer. Clinical trial information: NCT00228956.

Patterns of Medication Prescription among Children and Adolescents with Attention-Deficit/Hyperactivity Disorder in the United States.

The objectives of this study are to: (1) quantify the difference in the annual number of prescription medications (total and unique) between children and adolescents with ADHD and those without ADHD; and (2) identify the most prescribed medication classes and unique medications among children and adolescents with ADHD. A retrospective cross-sectional study design was employed using data from the 2015 and 2017 Medical Expenditure Panel Survey. The study sample comprised children and adolescents (5–17 years). In the 5–12-year age group, those with ADHD were 2.4%, 17%, and 15% significantly more likely to have one, 2–4, and ≥5 prescription medications, respectively. Similarly, those in the 13–17-year age group were more likely to have one prescription medication (3%), 2–4 prescription medications (15%), and ≥5 prescription medications (12%) than those without ADHD. The most prescribed medications among children and adolescents with ADHD were methylphenidate and amphetamine-dextroamphetamine. ADHD was associated with both higher annual total and unique prescription medications. Additionally, concurrent use of prescription medications was more prevalent among children and adolescents with ADHD. High-quality randomized clinical trials on the safety and efficacy of combinations of multiple psychotherapeutics and stimulants’ agents are required to guide the evidence-based practices.

The relationship between 19-year trends in medication use and changes in physical function among women in the mid-life: A Study of Women's Health Across the Nation pharmacoepidemiology study.

Medication side effects are a major concern in aging adults who report using an increasing number of medications. The relationship between accumulating medication use and physical function has not been examined in a longitudinal cohort. We conducted a longitudinal cohort study using prospectively collected data from the Study of Women's Health Across the Nation (SWAN). Community-dwelling women from five US cities were followed for up to 20 years. The exposure of interest was the number of prescription medications. They were examined as a count variable and then for specific categories of medication. The outcome of interest was physical function measured repeatedly using the short form (SF)-36 physical function (PF) scale. Linear mixed models, using repeated measures of sociodemographics and comorbidities were assessed. 1452 participants qualified for the analyses with a median follow-up of 19.2 years. At baseline, the mean age was 46.5 years and 53.5% reported White race. Fully adjusted models demonstrated a reduction in the SF-36 PF of 0.99 for each additional prescription medication used or a 6.14-point reduction for women reporting more than five medications and an 8.92-point reduction among those reporting more than 10 medications. These results were similar across race and ethnicity. Specific medication categories with a significant and largely negative impact (at least a two-point reduction) on physical component score included beta-blockers, analgesics, glucocorticoids, anticonvulsants, anxiolytics, anticoagulants, and anti-depressants. There is a moderate association between increasing medication use and decreasing physical function among women transitioning through the mid-life.

Association between prevalence of obstructive lung disease and obesity: results from The Vermont Diabetes Information System

BackgroundThe association of obesity with the development of obstructive lung disease, namely asthma and/or chronic obstructive pulmonary disease, has been found to be significant in general population studies, and weight loss in the obese has proven beneficial in disease control. Obese patients seem to present with a specific obstructive lung disease phenotype including a reduced response to corticosteroids. Obesity is increasingly recognized as an important factor to document in obstructive lung disease patients and a critical comorbidity to report in diabetic patients, as it may influence disease management. This report presents data that contributes to establishing the relationship between obstructive lung disease in a diabetic cohort, a population highly susceptible to obesity.MethodsA total of 1003 subjects in community practice settings were interviewed at home at the time of enrolment into the Vermont Diabetes Information System, a clinical decision support program. Patients self-reported their personal and clinical characteristics, including any history of obstructive lung disease. Laboratory data were obtained directly from the clinical laboratory, and current medications were obtained by direct observation of medication containers. We performed a cross-sectional analysis of the interviewed subjects to assess a possible association between obstructive lung disease history and obesity.ResultsIn a multivariate logistic regression model, a history of obstructive lung disease was significantly associated with obesity (body mass index ≥30) even after correcting for potential confounders including gender, low income (<$30,000/year), number of comorbidities, number of prescription medications, cigarette smoking, and alcohol problems (adjusted odds ratio (OR) = 1.58, P = 0.03, 95% confidence interval (CI) = 1.05, 2.37). This association was particularly strong and significant among female patients (OR = 2.18, P = < 0.01, CI = 1.27, 3.72) but not in male patients (OR = 0.97, P = 0.93, CI = 0.51, 1.83).ConclusionThese data suggest an association between obesity and obstructive lung disease prevalence in patients with diabetes, with women exhibiting a stronger association. Future studies are needed to identify the mechanism by which women disproportionately develop obstructive lung disease in this population.

Correlation of physical, psychological, and functional factors with independent medication adherence in Korean older adults with chronic illness: Using the 2017 national survey of older Koreans

PurposeTo identify the differences in sight, hearing, cognitive function, depression, and activities of daily living and the relationships between the research variables according to the independent medication adherence of Korean older adults with chronic illness. MethodsData were taken from the 2017 National Survey of Older Koreans. The sample comprised 8333 household-dwelling participants aged 65 and older, who had one or more chronic diseases. ResultsKorean older adults were, on average, diagnosed with 3.21 chronic illnesses and taking 4.55 doctor-prescribed medications. There were significant differences in age, education level, living arrangement, perceived subjective health states, number of diagnosed chronic diseases, number of prescription medications being taken, level of discomfort with daily living due to decline in sight and hearing, cognitive function, depression, and levels of activities of daily living according to independent medication adherence. For Korean older adults with independent medication adherence, cognitive function had significant correlations with perceived subjective health states, depression, and daily living activities. For those with partially-dependent or dependent medication adherence, lower cognitive function was associated with greater discomfort due to hearing, and depression had significant correlations with perceived subjective health states, number of prescription medications being taken, and discomfort due to decline in sight and hearing, but significant correlation with level of cognitive function. ConclusionNursing intervention should be planned to enhance the medication adherence of Korean older adults. Specifically, cognitive function, depression, and activities of daily living must be considered along with the patient’s health.

The Relationship between Polypharmacy and Physical Activity in Those with or at Risk of Knee Osteoarthritis.

Physical activity is associated with improved pain, functional status, and less disability in persons with knee osteoarthritis (KOA). Because polypharmacy is related to several adverse health outcomes in older persons, we hypothesized that it might also be associated with decreased physical activity in those with KOA. This study evaluates the relationship between the number of prescription medications and weekly moderate to vigorous physical activity (MVPA). We used hierarchical median quantile regression analysis to examine the cross-sectional association between the number of prescription medications taken in the past 30 days and the median objectively measured MVPA minutes controlling for demographic and clinical variables. Four Osteoarthritis Initiative (OAI) recruitment centers in Providence, Rhode Island; Columbus, Ohio; Baltimore, Maryland; and Pittsburgh, Pennsylvania. Accelerometer monitoring occurred in 2,127 OAI participants. Of these, 1,889 participants had 4 or more days of valid physical activity monitoring data and complete medication/covariate data. Data were collected at the 48-month OAI follow-up visit (2008-2010). The outcome was weekly minutes of MVPA measured with an accelerometer. Number/type of prescribed medications and covariate data (age, sex, race/ethnicity, body mass index, presence of comorbidities, pain, depressive symptoms, and radiographic KOA severity) were taken from the public OAI database. Polypharmacy was defined as taking five or more prescribed medications. The prevalence of polypharmacy in the study population was 28.2%. Each additional prescription medication was related to a decrease of 3.6 minutes (95% confidence interval [CI] = -4.8 to -2.1) in median weekly MVPA minutes. Participants meeting the polypharmacy criterion exhibited a decrease of 12.6 minutes (95% CI = -21.2 to -4.7) in median weekly MVPA minutes compared with those not meeting the criterion. An increased number of prescription medications and polypharmacy are associated cross-sectionally with decreased MVPA in adults with KOA. Further study is necessary to establish the causal nature of this association.

Negative emotion differentiation and long-term physical health-The moderating role of neuroticism.

Negative emotion differentiation refers to the ability to make complex distinctions between specific negative emotions. However, little research has examined its associations with long-term physical health and its potential limitations. The present study aims to investigate whether negative emotion differentiation would predict long-term health outcomes and whether neuroticism would moderate this relationship. Adult participants (N = 1,010; 433 men, 577 women; Mage = 55.53) were studied in the present research. Negative emotion differentiation was computed based on a daily diary procedure, whereas neuroticism was measured using a validated 4-item scale. Physical health was assessed at baseline as well as an average of 7 years later using a combination of subjective (3-item self-report scale) and objective (number of chronic conditions and number of prescription medications) measures. Demographical variables (age, gender, income, education, household size, ethnicity) were controlled for. Negative emotion differentiation did not uniquely predict later health (β = .02) upon controlling for baseline health and demographical covariates. However, neuroticism significantly moderated this relationship, such that negative emotion differentiation significantly predicted better health (β = .12) an average of 7 years later after accounting for baseline health, but only for those low on neuroticism. For individuals low on neuroticism, negative emotion differentiation is a beneficial regulatory capacity that has substantial positive associations with later health outcomes. However, these health benefits did not generalize to individuals higher on neuroticism, suggesting that there are limits to the regulatory benefits afforded by negative emotion differentiation. Theoretical and practical implications are discussed. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

P444 The impact of azathioprine on inflammatory bowel disease patients’ overall health-related quality of life: a single-centre retrospective cohort study

Abstract Background The Ulcerative Colitis (UC) and Chron’s Disease (CD) are two debilitating Inflammatory Bowel Diseases (IBD) with an immense negative impact on patients’ health-related quality of life (HRQoL). Although several studies have examined the efficacy of different drugs in the management of IBD, none of these studies has assessed their impact on HRQoL among IBD patients in low incidence areas, such as Saudi Arabia. Therefore, the aim of this study was to examine the impact of Azathioprine, which is one of the commonly utilised immunosuppressive drugs, on HRQoL among a sample of IBD patients in Saudi Arabia. Methods This was a single-centre retrospective cohort study in which adult patients (≥18 years) with a confirmed diagnosis of UC or CD and no malignancies were identified in the hospital IBD registry. Patients’ HRQoL was assessed using the EuroQol five-dimensions- 3-level (EQ5D) at baseline as well as six months after initiation of therapy. The overall HRQoL was assessed using the Visual Analogue Scale (VAS) of the EQ5D. Multiple linear regression analysis was conducted to examine the impact of Azathioprine on patients’ EQ5D VAS scores at the six-month follow-up visit controlling for their baseline EQ5D VAS scores, duration of illness, sex, diagnosis (CD or UC), comorbidities, number of prescription medications, and the use of biologics (e.g., infliximab, adalimumab), 5-aminosalicylic acid (5-ASA), and steroids. Results Out of 220 IBD patients who were recruited, 160 patients met the inclusion criteria and were included in the study. About 56% of the patients had CD and 44% had UC. The mean age of the patients was 27 years and 54% of them were female. The majority of the patients (77%) did not have any comorbidities. Approximately 63% of the patients were on Azathioprine, and only 4% of them were on Azathioprine monotherapy. The majority of those on Azathioprine were on combination therapy with 5-ASA (78%), steroids (80%), and biologics (69%). Patients on Azathioprine were more likely to report higher overall HRQoL scores at the six-month follow-up visit compared with their counterparts on other therapies (β = 9.35; 95% CI: 0.486–18.22; p = 0.003). Conclusion The use of Azathioprine was associated with a positive impact on IBD patients’ HRQoL controlling for their baseline overall HRQoL scores as well as a myriad of covariates. Future studies should examine the cost-effectiveness of Azathioprine in comparison to other therapeutic agents in the management of IBD.

Frequency and risk factors of polypharmacy and drug interactions among patients in general intensive care unit of Golestan Hospital, Ahvaz, southwest of Iran

&lt;abstract&gt;&lt;sec&gt; &lt;title&gt;Objective&lt;/title&gt; &lt;p&gt;This study was aimed to evaluate polypharmacy and drug interactions in intensive care units.&lt;/p&gt; &lt;/sec&gt;&lt;sec&gt; &lt;title&gt;Materials and methods&lt;/title&gt; &lt;p&gt;This epidemiologic-descriptive study was performed on the records of 80 patients admitted to the intensive care unit with a duration of more than 48 hours from 2018-10-23 to 2019-01-21. The patients' records, including polypharmacy, type and number of drug interactions as well as factors such as age, gender, hospitalization duration, number of drug-prescribing physicians were investigated. To determine drug interactions, Free &lt;italic&gt;Lexi-Comp&lt;/italic&gt; &lt;italic&gt;iOS&lt;/italic&gt; software version 4.0.1 was used.&lt;/p&gt; &lt;/sec&gt;&lt;sec&gt; &lt;title&gt;Findings&lt;/title&gt; &lt;p&gt;Of 80 participants in this study, 58, and 22 patients (72.5%, and 27.5%) were respectively male and female, with a mean age of 39.9 years; besides, 46.2%, and 25.3% of patients were hospitalized due to trauma, and non-traumatic cerebral hemorrhage, respectively. The average hospitalization was six days. The average number of drug-prescribing physicians and medications received was 5 and 10, respectively. The majority of patients (91.2%) received over five drugs. The majority of drug interactions (70%) were in C-Class, and 1.2% were in X-Class. Also, 85% of the studied samples had at least one drug interaction.&lt;/p&gt; &lt;/sec&gt;&lt;sec&gt; &lt;title&gt;Conclusion&lt;/title&gt; &lt;p&gt;Polypharmacy and drug interactions were common in patients hospitalized in the intensive care unit ward. Risk factors for increasing drug interactions were the length of stay and number of medications prescribed, and for polypharmacy, length of stay, number of medications-prescribing physicians, and number of prescription medications.&lt;/p&gt; &lt;/sec&gt;&lt;/abstract&gt;

Prescription Medication Use and Phantom Odor Perception Among US Adults.

Prescription medication use may be associated with phantom odor perception. We evaluated associations between number of prescription medications and their therapeutic class and phantom odor perception among U.S. adults. Data were collected between 2011-2014 as part of the National Health and Nutrition Examination Survey (NHANES). A complex sampling design resulted in a nationally representative sample of 7,417 adults aged 40 years and older. During an in-home interview, participants were asked whether they had experienced an unpleasant, bad, or burning odor when nothing is there. Prescription medication use was assessed using validation with prescription bottles, when possible. Almost one quarter (23.3%) of adults uses ≥5 prescription medications. Use of five or more prescription medications is associated with 70% greater odds of phantom odor perception (OR 1.69 (1.09, 2.63)). Among adults 60 years and older, antidiabetic medications, antihyperlipidemic agents, and proton pump inhibitors are associated with 74-88% greater odds of report of phantom odor [OR=1.74 (1.09, 2.77), OR=1.85 (1.22. 2.80), and OR=1.88 (1.15, 3.07)], respectively. Phantom odor perception may be a side effect of antidiabetic or antihyperlipidemic agents. Among people taking proton pump inhibitors, phantom odors may also be a consequence of gastric gas reflux. Common prescription medications may be providing an olfactory stimulus.

Factors related to advance care planning among older African American women: Age, medication, and acute care visits.

Advance care planning (ACP) is linked with high-quality clinical outcomes at the end of life. However, ACP engagement is lower among African Americans than among Whites. In this study, we sought to identify correlates of ACP among African American women with multiple chronic conditions for two reasons: (1) African American women with multiple chronic conditions have high risks for serious illnesses, more intensive treatments, and circumstances that may require substitutes' decision-making and (2) identifying correlates of ACP among African American women can help us identify important characteristics to inform ACP outreach and interventions for this group. A cross-sectional survey was conducted with 116 African American women aged ≥50 years who were recruited from the central area of a mid-western city. On average, participants were 64 years old (SD = 9.42). The majority were not married (78%), had less than a college education (50%), and had an annual income of $15,000 (54%). Their mean numbers of chronic conditions and prescribed medications were 3.31 (SD = 1.25) and 8.75 (SD = 4.42), respectively. Fifty-nine per cent reported having talked with someone about their preferences (informal ACP); only 30% had completed a living will or a power of attorney for healthcare (formal ACP). Logistic regression showed that age, the number of hospitalizations or emergency department visits, and the number of prescription medications were significantly correlated with both informal and formal ACP; other demographic and psychosocial characteristics (the knowledge of ACP, self-efficacy, and trust in the medical system) were not. Results of this study suggest a need for targeted, culturally sensitive outpatient ACP education to promote ACP engagement in older African American women, taking into account age, the severity of chronic conditions, and levels of medication management.

The Risk Of Seizure-Related Hospitalization Among Older Adults On Levetiracetam Monotherapy: A Retrospective Comparative Cohort Study.

BackgroundAntiepileptic drug monotherapy is the mainstay of treatment for epilepsy; however, the efficacy of different antiepileptic drugs in reducing the incidence of seizure-related hospitalization among older adults, who are at higher risk of developing epilepsy compared to their younger counterparts, has not been examined.PurposeThe objective of the present study was to compare the rate of seizure-related hospitalization among older adults on levetiracetam compared to different antiepileptic drugs (AEDs).Patients and methodsThis was a retrospective cohort study of older adults (≥60 years) in two tertiary care hospitals. Patients who are 60 years of age and older, have a confirmed diagnosis of epilepsy, and are taking a single and the same antiepileptic drug for at least 36 months were included. The patients were followed up for 24 months after 12 months of treatment with no incidence of seizure-related hospitalization via their health records. Multiple Poisson regression with robust error variance was used to estimate the relative risk of hospitalization for patients on levetiracetam compared to different antiepileptic drugs controlling for age, gender, number of prescription medications, dosage strengths, and Charlson Comorbidity Index (CCI) score.ResultsOne hundred and thirty-six patients met the inclusion criteria and were included in the study. The recruited patients were on one of the following four antiepileptic drugs: carbamazepine (n=44), levetiracetam (n=39), phenytoin (n=31), and valproic acid (n=22). Patients on levetiracetam were more than twice as likely to be hospitalized due to seizures within the 24 months of follow-up compared to their counterparts on other AEDs (RR=2.76, 95% CI=1.16–6.53, P=0.021).ConclusionThis study suggests that older adults on old generation AEDs such as phenytoin, carbamazepine, and valproic acid appear to have a lower risk of seizure-related hospitalization compared to their counterparts on levetiracetam.

Development of a recommender system for dental care using machine learning

Resource mismanagement along with the underutilization of dental care has led to serious health and economic consequences. Artificial intelligence was applied to a national health database to develop recommendations for dental care. The data were obtained from the 2013–2014 National Health and Nutrition Examination Survey to perform machine learning. Feature selection was done using LASSO in R to determine the best regression model. Prediction models were developed using several supervised machine learning algorithms, including logistic regression, support vector machine, random forest, and classification and regression tree. Feature selection by LASSO along with the inclusion of additional clinically relevant variables identified 8 top features associated with recommendation for dental care. The top 3 features include gum health, number of prescription medications taken, and race. Gum health shows a significantly higher relative importance compared to other features. Demographics, healthcare access, and general health variables were identified as top features related to receiving additional dental care, consistent with prior research. Practicing dentists and other healthcare professionals can follow this model to enable precision dentistry through the incorporation of our algorithms into computerized screening tool or decision tree diagram to achieve more efficient and personalized preventive strategies and treatment protocols in dental care.