Unnecessary Medications Research Articles

Involving patients in medicines optimisation in general practice: a development study of the “PREparing Patients for Active Involvement in medication Review” (PREPAIR) tool

BackgroundMany patients have multiple health conditions and take multiple medications (polypharmacy). Active patient involvement may improve treatment outcomes and ensure patient-centred care. Yet, patient involvement remains a challenge in clinical practice. We aimed to develop and pilot test a questionnaire-based preparation and dialogue tool, the PREparing Patients for Active Involvement in medication Review (PREPAIR) tool, to encourage the involvement of patients with polypharmacy in medicines optimisation in general practice.MethodsWe conducted a literature review followed by a co-production process to develop the tool: a workshop with six GPs and pilot testing, including observations and interviews, with 22 patients, three GPs and three practice staff. During this process, we made continuous adaptations to the prototype. We analysed the qualitative data thematically, focusing on the development process and mechanisms of impact.FindingsThe final PREPAIR tool included five items concerning the patient’s experience of 1) adverse drug reactions, 2) excess medication, 3) unnecessary medication, 4) medication satisfaction and 5) medication-related topics to discuss with the GP (open-ended question). The applied workflow during testing was as follows; the patient completed the PREPAIR tool at home, to encourage reflection on the medication, and brought it to the GP consultation. During the consultation, the GP and the patient reviewed the patient’s responses and discussed potential medication-related problems. For some patients, the increased reflection led to worries about the medications. Still, the pilot testing showed that, when using the PREPAIR tool, the patients arrived at the clinic well prepared and empowered to speak. From the PREPAIR-supported dialogue, the GPs obtained a better understanding of patients’ perspectives and provided a more patient-centred consultation. For the patients, the PREPAIR-supported dialogue ultimately promoted an increased sense of security, satisfaction and insight into their medication, despite initial worries for some patients.ConclusionsWe developed a brief tool to support active patient involvement in medication review in general practice. The PREPAIR-tool was well received by both patients and GPs and fitted well into the existing clinical practice. Our findings suggest that the PREPAIR-tool can support patient involvement during consultations and facilitate patient-centred care.

A Season for PALTC: Improving Quality, Increasing Transparency, and Strengthening Our Workforce

A Season for PALTC: Improving Quality, Increasing Transparency, and Strengthening Our Workforce

MP30-11 COVID-19 VACCINATION IN AN INNER-CITY UROLOGY POPULATION FROM SEPTEMBER—OCTOBER 2021

You have accessJournal of UrologyCME1 May 2022MP30-11 COVID-19 VACCINATION IN AN INNER-CITY UROLOGY POPULATION FROM SEPTEMBER—OCTOBER 2021 Meher Pandher, Courtney Berg, Gabriel Fernandez, Chrystal Chang, Amjad Alwaal, and Robert Weiss Meher PandherMeher Pandher More articles by this author , Courtney BergCourtney Berg More articles by this author , Gabriel FernandezGabriel Fernandez More articles by this author , Chrystal ChangChrystal Chang More articles by this author , Amjad AlwaalAmjad Alwaal More articles by this author , and Robert WeissRobert Weiss More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002573.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: New Jersey has the fourth highest death rate due to COVID-19 in the United States over the past year and a half. As of October 2021, 66% of the New Jersey population has been fully vaccinated against COVID-19. The objective of this study is to examine the demographics and rate of vaccination of patients in an underserved, inner-city urology clinic population in Newark, New Jersey. METHODS: Anonymous surveys were distributed during urology clinics in Newark recording patient’s age, sex, race, insurance status, reason for clinic visit, other medical problems, previous COVID infection, infection of family members with COVID, COVID vaccination status and type, reasons for forgoing the vaccine, and likelihood of receiving the vaccine in the future. Data from 246 surveys administered from 9/27/2021 - 10/25/2021 was compiled and analyzed with descriptive statistics. RESULTS: 78% of the clinic patients were men of the average age of 60. The population was primarily patients of Hispanic (45.9%) and African American (41.9%) descent. 9.3% of patients were white, 1.5% asian, and 1.5% “other”. 55.2% of patients had managed medicaid, 15.4% had medicare, 16.7% were uninsured, 12.2% had charity care, and 0.4% were incarcerated. Many patients never had a COVID-19 infection (79.7%) and neither did any of their family members (79.3%). 78.5% of patients received a COVID vaccination, the most popular one being Moderna (47.4%) followed by Pfizer (44.9%), and Johnson & Johnson (7.7%). Of the 21.5% of patients who were not vaccinated, 55.8% did not plan to receive the vaccine, 30.8% were unsure, and 13.4% said they would in the future. When asked about their reasons for deferring the vaccine, 61.5% of unvaccinated patients expressed concern about the vaccine’s short term side effects, long term side effects or a combination of the two. The other 38.5% reported wanting to wait to see how others responded to the vaccine, reported lack of information about the vaccine, mentioned wanting to avoid unnecessary medication, believed they didn’t need the vaccine, or were unable to register for it. The unvaccinated patients were predominantly African American (48.1%), male (76.9%), and of the average age of 51. 80.8% of unvaccinated patients never had covid and for 82.7%, neither did any of their family members. CONCLUSIONS: COVID-19 vaccine reluctance continues to be a national issue. We were encouraged by the higher than expected vaccination rates in our clinic. Further measures should be taken to elucidate the perceived side effects of the COVID-19 vaccine to encourage vaccine use. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e482 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Meher Pandher More articles by this author Courtney Berg More articles by this author Gabriel Fernandez More articles by this author Chrystal Chang More articles by this author Amjad Alwaal More articles by this author Robert Weiss More articles by this author Expand All Advertisement PDF DownloadLoading ...

Possible misdiagnosis, inappropriate empiric treatment, and opportunities for increased diagnostic testing for patients with vulvovaginal candidiasis-United States, 2018.

Vulvovaginal candidiasis (VVC) is a common cause of vaginitis, but the national burden is unknown, and clinical diagnosis without diagnostic testing is often inaccurate. We aimed to calculate rates and evaluate diagnosis and treatment practices of VVC and recurrent vulvovaginal candidiasis (RVVC) in the United States. We used the 2018 IBM® MarketScan® Research Databases, which include health insurance claims data on outpatient visits and prescriptions for >28 million people. We used diagnosis and procedure codes to examine underlying conditions, vaginitis-related symptoms and conditions, diagnostic testing, and antibacterial and antifungal treatment among female patients with VVC. Among 12.3 million female patients in MarketScan, 149,934 (1.2%) had a diagnosis code for VVC; of those, 3.4% had RVVC. The VVC rate was highest in the South census region (14.3 per 1,000 female patients) and lowest in the West (9.9 per 1000). Over 60% of patients with VVC did not have codes for any diagnostic testing, and microscopy was the most common test type performed in 29.5%. Higher rates of diagnostic testing occurred among patients who visited an OB/GYN (53.4%) compared with a family practice or internal medicine provider (24.2%) or other healthcare provider types (31.9%); diagnostic testing rates were lowest in the South (34.0%) and highest in the Midwest (41.0%). Treatments on or in the 7 days after diagnosis included systemic fluconazole (70.0%), topical antifungal medications (19.4%), and systemic antibacterial medications (17.2%). The low frequencies of diagnostic testing for VVC and high rates of antifungal and antibacterial use suggest substantial empiric treatment, including likely overprescribing of antifungal medications and potentially unnecessary antibacterial medications. These findings support a need for improved clinical care for VVC to improve both patient outcomes and antimicrobial stewardship, particularly in the South and among non-OB/GYN providers.

Drug Therapy Problems Associated with Antibiotics Prescriptions in University of Uyo Health Centre, Uyo, Nigeria

Introduction: Antibiotic resistance has contributed as one of the greatest public health threats at present. This study aimed at identifying drug therapy problems (DTPs) associated with prescriptions of antibiotics to patients attending the University of Uyo Health Centre and presented a seminar as an intervention.
 Method: A prospective observational study was carried out. One hundred (100) patient folders with 147 antibiotics prescriptions were used for the survey for the first-month collation of antibiotics prescriptions while one hundred and sixty (160) patient folders with 160 antibiotics prescriptions were used at the second -month of the survey. The seminar presentation on drug therapy problems associated with antibiotics prescriptions was held after the first -month of the survey. Data obtained were analyzed by using descriptive statistical tools such as frequency, mean, standard deviation and bar chart. The statistical analytical tool such as student T- test was used and significance was considered at p ≤ 0.05.
 Result: The first survey involved 147 prescriptions of antibiotics. Prescriptions with DTPs were 77 (52.4%) while the most frequently occurring DTPs was drug interactions (37.1%), followed by inappropriate dosage frequency (23.7%) and unnecessary medication (22.7%). The follow up survey included 160 prescriptions of antibiotics, out of which 112 (70%) prescriptions of antibiotics contained 209 DTPs. The most frequent DTPs was drug interactions (49.3%), followed by inappropriate dosage duration (19.1%) and inappropriate dosage frequency (11.5%). The results also showed that antibiotics prescriptions with DTPs were significantly increased in the follow-up survey (p=0.00) of the study. Drug interaction (p=0.00), overdosing (p=0.00), underdosing (p=0.00) and Inappropriate dosage duration (p=0.00) were significantly increased in the follow-up survey.
 Conclusion: This study had indicated prevalence of DTPs associated with antibiotic prescriptions. Drug interaction, inappropriate dosage frequency and unnecessary medication were very common among antibiotic prescriptions.

Determine the impact of a structured pharmacist-led medication review - a controlled intervention study to optimise medication safety for residents in long-term care facilities

BackgroundMedication reviews contribute to protecting long-term care (LTC) residents from drug related problems (DRPs). However, few controlled studies have examined the impact on patient-relevant outcomes so far.ObjectiveWe examined the impact of a one-time, pharmacist-led medication review on medication changes (primary endpoint) including discontinued medication, the number of chronic medications, hospital admissions, falls, and deaths (secondary endpoints).MethodsA prospective, controlled intervention study was performed in three LTC facilities. In the intervention group (IG), after performing a medication review, a pharmacist gave recommendations for resolving DRPs to physicians, nurses and community pharmacists. The control group (CG) received usual care without a medication review. (i) We assessed the number of medication changes and the secondary endpoints in both groups before (t0) and after (t1, t2) the intervention. (ii) Additionally, the medication review was evaluated in the IG with regard to identified DRPs, the healthcare professional’s feedback on the forwarded pharmacist recommendations and whether DRPs were finally resolved.Results107 (IG) and 104 (CG) residents were enrolled. (i) More medication changes were identified in the IG than in the CG at t1 (p = 0.001). However, no significant difference was identified at t2 (p = 0.680). Mainly, medication was discontinued in those medication changes. Chronic medications increased in the CG (p = 0.005) at t2 while hospital admissions, falls, and deaths showed no differences. (ii) Overall, 1252 DRPs (median: 10; minimum-maximum: 2–39) were identified. Recommendations for 82% of relevant DRPs were forwarded to healthcare professionals, of which 61% were accepted or clarified. 22% were not accepted, 12% required further review and 6% remained without feedback. 51% of forwarded DRPs were finally resolved.ConclusionsWe found more medication changes in the IG compared to controls. Mostly, medication was discontinued. This suggests that our intervention was successful in discontinuing unnecessary medication. Other clinical outcomes such as falls, hospitalisations, and deaths were not improved due to the one-time intervention. The medication review further identified a high prevalence of DRPs in the IG, half of which were finally resolved.Trial registrationGerman Clinical Trials Register, DRKS00026120 (www.drks.de, retrospectively registered 07/09/2021).

The Effect of Clinical Pathway Socialization with Explicit Instruction Methods on Nurse Compliance in the Implementation of the COVID-19 Clinical Pathway

Introduction: Non-compliance with the established Clinical Pathway can reduce the quality of hospital services and risk harming patient safety. Clinical pathway is an integrated service planning concept in the form of a summary of every step given to patients and becomes a service guide so that patients avoid unnecessary care, medication errors or other safety incidents. Efforts to improve nurse compliance with clinical pathways require clinical pathway socialization. The purpose of this study was to determine the effect of the socialization of the explicit instruction method on nurse compliance in the implementation of the COVID-19 clinical pathway. Method: : this research method uses a pre-experimental research design with a one group pretest-posttest design. The sampling technique used total sampling with a sample of 24 respondents from September to November 2021. The dependent variable in this study was the socialization of the clinical pathway with the explicit instruction method, while the independent variable was nurse compliance in the implementation of the COVID-19 clinical pathway. Data was taken by means of observation using a clinical pathway checklist instrument which was then analyzed using the Wilcoxon Signed Ranks Test with sig p <0.05. Results: the results of this study prove that there is a significant effect of providing socialization with the explicit instruction method on nurse compliance in the implementation of the COVID-19 clinical pathway with a value (p = 0.008) with a compliance rate of 83%. Conclusions: hospital institutions, especially in the nursing field, can use this explicit instruction method in providing socialization of the COVID-19 clinical pathway.

Prescription of medicines for the management of childhood acute watery diarrhoea at a tertiary hospital in Ebonyi state, Nigeria

Background: The burden of childhood diarrhoea in Nigeria is huge and has been persistently high over the years with an estimated 205 under-fifives dying daily. Asimple combination of oral rehydration salts (ORS) and zinc tablets (ORS/Zinc) has been approved for its treatment by the WHO since it is benefificial for rehydration which is the goal of therapy. However, huge resources are spent on antibiotics and other medications which are not benefificial for rehydration, thereby exposing children to unnecessary medications and other drug therapy problems. This study was set to evaluate the prescription of medicines for acute watery diarrhea (AWD) in under-fifive children and to determine the appropriateness of these prescriptions. Method: This study was conducted in a tertiary hospital in Abakaliki, Ebonyi State. It was a retrospective review of prescriptions of medicines for AWD in under-fifives for a period of 28 months (January 2019 to April 2021). All available cases of AWD (338) were extracted from the prescription registers. Data were entered into SPSS version 24.0 and descriptive analysis was done. The guideline set by WHO for the management of AWD was followed for evaluating the prescriptions. Results: Out of the 338 cases of AWD, 190 (56.2%) occurred in male children and 265 (84.4%) in children under 24 months. Of the total cases, 291 (86.1%) received prescriptions containing ORS, zinc, and probiotics either alone or in difffferent combinations with only 154 (45.6%) containing ORS and zinc together. Of these prescriptions with ORS/Zinc, 47 (30.5%) also contained antibiotics, antimalarials and infusions. In total, there were 99(29.3%) and 48 (14.2%) prescriptions containing antibiotics and antimalarials respectively. The most frequently prescribed antibiotic classes were sulfonamides (41; 40.6%), cephalosporins (29; 28.7%) and flfluoroquinolones (13; 12.9%). Less prescribed antibiotic classes include macrolides, penicillins and nitroimidazoles. Other groups of medicines prescribed were analgesics, anthelmintics, oral potassium and antacids, and antihistamines. Overall, only 107 (36.8%) prescriptions were appropriate for the management of AWD. Conclusion: This study revealed that only 36.8% of AWD cases received appropriate prescriptions according to guideline. Therefore, there is urgent need for intervention in the study setting to improve appropriate treatment of AWD.

Deprescribing Education vs Usual Care for Patients With Cognitive Impairment and Primary Care Clinicians

Individuals with dementia or mild cognitive impairment frequently have multiple chronic conditions (defined as ≥2 chronic medical conditions) and take multiple medications, increasing their risk for adverse outcomes. Deprescribing (reducing or stopping medications for which potential harms outweigh potential benefits) may decrease their risk of adverse outcomes. To examine the effectiveness of increasing patient and clinician awareness about the potential to deprescribe unnecessary or risky medications among patients with dementia or mild cognitive impairment. This pragmatic, patient-centered, 12-month cluster randomized clinical trial was conducted from April 1, 2019, to March 31, 2020, at 18 primary care clinics in a not-for-profit integrated health care delivery system. The study included 3012 adults aged 65 years or older with dementia or mild cognitive impairment who had 1 or more additional chronic medical conditions and were taking 5 or more long-term medications. An educational brochure and a questionnaire on attitudes toward deprescribing were mailed to patients prior to a primary care visit, clinicians were notified about the mailing, and deprescribing tip sheets were distributed to clinicians at monthly clinic meetings. The number of prescribed long-term medications and the percentage of individuals prescribed 1 or more potentially inappropriate medications (PIMs). Analysis was performed on an intention-to-treat basis. This study comprised 1433 individuals (806 women [56.2%]; mean [SD] age, 80.1 [7.2] years) in 9 intervention clinics and 1579 individuals (874 women [55.4%]; mean [SD] age, 79.9 [7.5] years) in 9 control clinics who met the eligibility criteria. At baseline, both groups were prescribed a similar mean (SD) number of long-term medications (7.0 [2.1] in the intervention group and 7.0 [2.2] in the control group), and a similar proportion of individuals in both groups were taking 1 or more PIMs (437 of 1433 individuals [30.5%] in the intervention group and 467 of 1579 individuals [29.6%] in the control group). At 6 months, the adjusted mean number of long-term medications was similar in the intervention and control groups (6.4 [95% CI, 6.3-6.5] vs 6.5 [95% CI, 6.4-6.6]; P = .14). The estimated percentages of patients in the intervention and control groups taking 1 or more PIMs were similar (17.8% [95% CI, 15.4%-20.5%] vs 20.9% [95% CI, 18.4%-23.6%]; P = .08). In preplanned subgroup analyses, adjusted differences between the intervention and control groups were -0.16 (95% CI, -0.34 to 0.01) for individuals prescribed 7 or more long-term medications at baseline (n = 1434) and -0.03 (95% CI, -0.20 to 0.13) for those prescribed 5 to 6 medications (n = 1578) (P = .28 for interaction; P = .19 for subgroup interaction for PIMs). This large-scale educational deprescribing intervention for older adults with cognitive impairment taking 5 or more long-term medications and their primary care clinicians demonstrated small effect sizes and did not significantly reduce the number of long-term medications and PIMs. Such interventions should target older adults taking relatively more medications. ClinicalTrials.gov Identifier: NCT03984396.

Number-dependent association of potentially inappropriate medications with clinical outcomes and expenditures among community-dwelling older adults: A population-based cohort study.

The aim of this study was to investigate the prevalence of potentially inappropriate medication (PIM) prescribing and its number-dependent association (PIM = 1, 2, ≥3) with all-cause hospitalizations, emergency department (ED) visits, and medication expenditures in Beijing, China. A retrospective cohort analysis was conducted to analyse PIM prescribing in community-dwelling older adults aged ≥65 years within the Beijing Municipal Medical Insurance Database (data from July to September 2016). The prevalence of PIMs was estimated based on the 2015 Beers Criteria. Logistic models were utilized to investigate the associations between PIM use and all-cause hospitalizations and ED visits. Generalized linear models with the logic link and gamma distribution were used to analyse associations between PIM use and medication expenditures. Among the 506 214 older adults, the prevalence of PIM was 38.07%. After adjusting for covariables, prescribing two and three or more PIMs was associated with increased risks of hospitalizations (PIM = 2: odds ratio [OR] 1.34, 95% confidence interval [CI]: 1.22-1.47; PIM ≥ 3: OR = 1.47, 95% CI: 1.32-1.63) and ED visits (PIM = 2: OR = 1.29, 95% CI 1.12-1.48; PIM ≥ 3: OR = 1.23, 95% CI: 1.04-1.44). Exposures to two and three or more PIMs were associated with higher medication expenditures for inpatient visits (PIM = 2: incidence rate ratio [IRR] = 1.08, 95% CI 1.01-1.16; PIM ≥ 3: IRR = 1.18, 95% CI: 1.08-1.28). Vasodilators were the most frequent PIM prescribing group among patients who were hospitalized or had to visit the ED. PIMs were prescribed at a high rate among community-dwelling older adults in Beijing. Two or more PIMs were associated with increased risks of hospitalizations, ED visits, and increased inpatient medication expenditures. Effective interventions are needed to target unnecessary and inappropriate medications in older adults.

Over Half of Falls Were Associated with Psychotropic Medication Use in Four Nursing Homes in Japan: A Retrospective Cohort Study.

Medication use can increase the risk of falls and injuries in nursing homes, creating a significant risk for residents. We performed a retrospective cohort study over one year to identify the incidence of drug-related falls with and without injury among four Japanese nursing homes with 280 beds. We evaluated the relationship between potential risk factors for falls and fall-related injuries while considering well-known risks such as ADLs and chronic comorbidities. By collaboratively reviewing care records, we enrolled 459 residents (mean age, 87) and identified 645 falls, including 146 injurious falls and 16 severe injurious falls requiring inpatient care, incidence: 19.5, 4.4, 0.5 per 100 resident-months, respectively. Medication influenced around three-quarters of all falls, >80% of which were psychotropic drugs. Regularly taking ≥5 medications was a risk factor for the initial falls (HR 1.33: CI 1.00–1.77, p = 0.0048) and injuries after falls (OR 2.41: CI 1.30–4.50, p = 0.006). Our findings on the incidence of falls with and without injury were similar to those in Western countries, where the use of psychotropic medication influenced >50% of falls. Discontinuing unnecessary medication use while simultaneously assessing patient ADLs and comorbidities with physicians and pharmacists may help to avoid falls in nursing homes.

Detecting Suspected Prescribing Cascades by Prescription Sequence Symmetry Analysis of Nationwide Real-World Data

A prescription cascade is a subsequent event that occurs when an adverse drug event is misinterpreted as a new medical condition, resulting in the prescription of a potentially unnecessary medication to treat this new condition. This study was designed to test the hypothesis of whether prescribing cascades exist and their magnitude among older individuals by using prescription sequence symmetry analysis (PSSA). A retrospective population-based cohort study based on data from Taiwan's National Health Insurance Research Database (NHIRD), a nationwide claims-based database that covers 99% of the population in Taiwan. Patients receiving newly initiated index and marker drugs in the outpatient setting between 2014 and 2016 were included. Those who received index and marker drugs on the same date were excluded. PSSA measures the propensity for a marker drug (eg, thyroxine) to be prescribed after an index drug (eg, amiodarone) has been initiated, where the index drug is suspected of inducing a side effect (eg, hypothyroidism) and the marker drug is used to treat the side effect. We evaluated 14 PSSA sets as potential prescription cascade-related drug pairs (index and marker drug), including 2 confirmatory analyses (eg, amiodarone and thyroxin), to check the validity of the PSSA results and 12 exploratory analyses of cardiovascular medication-related prescribing cascades (eg, statins and antidepressants). The observation periods for sequences of incident marker drug use were 1year before and 1year after the use of the incident index drug, and the symmetry of prescriptions filled for the 2 periods was examined. The results of the PSSA were performed as the crude sequence ratio (SR), defined as the ratio of patients initiating the marker drug after the index drug (causal group) to those initiating the marker drug before the index drug (noncausal group), and the adjusted SR (aSR) with 95% confidence intervals (CIs). Among 12 potential prescription cascade-related drug pairs in exploratory analysis, 9 of them reached statistical significance, and aSR ranged from 1.02 to 1.46. Dihydropyridine calcium channel blocker-induced edema showed the highest aSR (1.46, 95% CI 1.45-1.48), and statin-induced muscle pain showed the lowest aSR (1.02, 95% CI 1.02-1.03). Our study supported the application of PSSA in detecting prescribing cascades using a nationwide claims database. Nevertheless, most previously reported prescribing cascades among cardiovascular medications were shown to have a low effect size of sequence ratios among older individuals.

Comprehensive medication management of kidney transplanted patients

Kidney transplant patients use several medications, which increases the risk of developing drug-related problems. This is a pre-post-intervention study, carried out in a transplant outpatient clinic in Belo Horizonte, Minas Gerais, Brazil, with post-transplant patients using tacrolimus. Pharmacy consultations were carried out in individual offices, and the initial and final status were measured between the first and the last consultation. Satisfaction with the pharmaceutical service was also assessed. Thirty-nine drug-related problems were identified, 64.3% of patients presenting at least one, of which 79.5% were resolved (p<0.001). The most frequent were “use of unnecessary medications” (26.5%), with omeprazole being the most prescribed medication for this situation. Polymedicated patients had more drug-related problems (p = 0.001). 49 interventions were performed, 51.02% were accepted. The most accepted interventions were recommendations for guidelines regarding the time of administration and reduction of adverse drug reactions (100%) and suspension of treatment (92.3%). In the end, the proportion of patients with stable clinical status increased from 35 .7% to 83.3% (p<0.001). Patients related the pharmaceutical service as very good, reporting the desire for its continuity. Comprehensive medication management positively impacted the patient's clinical situation, proved to be effective in solving drug-related problems, and was very well evaluated by the patients. It is recommended that polymedication is a priority criterion for this service.

Multidisciplinary Team Deprescribing Intervention for Polypharmacy in Elderly Orthopedic Inpatients: A Propensity Score-matched Analysis of a Retrospective Cohort Study.

Objective This study evaluated the effectiveness of a multidisciplinary team deprescribing intervention to reduce polypharmacy and potentially inappropriate medications (PIMs) in elderly orthopedic inpatients. Methods In this single-center retrospective observational study, orthopedic inpatients ≥75 years old and prescribed ≥6 different medications were enrolled as participants. Interventions comprised multidisciplinary team-led polypharmacy screening and suggestions regarding deprescribing any unnecessary medications during hospital stays. The primary outcome was reduction in the mean number of regular medicines and PIMs. Secondary outcomes included falls, delirium, and other adverse events during hospitalization as well as emergency department visits or unplanned hospital admissions within six months after discharge. Results After propensity score matching, 184 patients (intervention group, n=92; control group, n=92) were included in the analysis. The mean patient age was 83 years old. The mean number of prescribed medications and PIMs at admission were similar in both groups. The mean change in the number of regular medicines was -1.4 [standard deviation (SD), 2.3] in the intervention group and +0.2 (SD, 1.8) in the control group (p<0.001). The mean change in the number of PIMs was -0.5 (SD, 0.9) in the intervention group and +0.1 (SD, 0.8) in the control group (p<0.001). In-hospital adverse events other than falls and delirium were significantly less common in the deprescribing intervention group than in the control group. Conclusion Deprescribing intervention by our multidisciplinary team seems to have been effective in reducing the number of prescribed medicines and PIMs in elderly orthopedic inpatients, with some accompanying reduction in certain adverse events.

Lekovi i nefarmakološke mere za ublažavanje simptoma infekcija respiratornog trakta u pedijatrijskoj populaciji

In the pediatric population, acute respiratory tract infections (RTIs) are the most common reason for seeking professional help from a physician or a pharmacist. Alleviation of symptoms is the only therapeutic measure in viral RTIs and is an adjunct to antibiotic therapy in bacterial RTIs. This article discusses pharmacologic and nonpharmacologic options for treating nasal congestion, cough, fever and sore throat in RTIs and clinical evidence on their efficacy and safety in the pediatric population. In general, clinical studies conducted in children for most of these drug groups are few or nonexistent, making it difficult to create evidence-based recommendations. Nasal decongestants, cough suppressants, mucolytics, expectorants, antipyretics/analgesics and sore throat local preparations are available in suitable pharmaceutical forms and strengths for the certain age. As many of them are over-the-counter (OTC) preparations, it is necessary to strictly take into account the age of the child in whom they may be used and dose properly. Multicomponent preparations carry the risk of taking unnecessary medications and of their side effects. The use of multiple OTC medicines is associated with the risk of an overdose of a component that may be present in different preparations. Appropriate non-pharmacological measures (e.g. oral hydration, nasal saline application or irrigation, honey) may be helpful and should be used whenever possible due to their safety.

POSB235 Effectiveness and Cost-Effectiveness of a Collaborative Deprescribing Intervention of Proton-Pump Inhibitors on Community-Dwelling Elderly (C-SENIOR Trial): A Study Protocol

Medication safety for elderly people is an ongoing challenge. Older people are often exposed to unnecessary or inappropriate medications – medicines with a high risk of harm. There is evidence that inappropriate medications are overprescribed, accounting for a significant proportion of avoidable adverse drug events, emergency department visits and hospitalizations. This study aims to present the protocol of a study to investigate the effectiveness and cost-effectiveness of a community pharmacist-general practitioner collaborative deprescribing intervention of potential inappropriate class of medicines, focusing proton-pump inhibitors, among the community dwelling elderly.

POSB85 Deprescribing Interventions for Community-Dwelling Older Adults: A Systematic Review of Economic Evaluations

Older people are often exposed to unnecessary or inappropriate medications. Deprescribing is a method to reduce or withdrawal medication that might be causing harm or no longer be of benefit. This study aims to identify and synthetize the economic evidence of deprescribing interventions among community-dwelling elderly.

Abstract- Poster

INTRODUCTION:Conversion disorder has one or more symptoms that affect voluntary motor or sensory function suggesting a neurological or other medical condition, but they are inconsistent with known neurological or musculoskeletal pathologies. Individuals with conversion disorder do not intentionally produce or feign their symptoms. Instead, the symptoms are due to an unconscious expression of a psychological conflict or need. There might be associated primary and secondary gains which act as maintaining factors. The disorder is more common in adolescence than in childhood.CASE REPORT:A 17 years old male reported to the Emergency Department alleged history of fall from a 10 feet wall c/o neck pain, inability to move all 4 limbs, diminished sensation below the neck. Cervical immobilization was done and his vitals & routine blood investigations were found to be normal. No signs of any urinary retention or fecal incontinence. Routine neurological examination was performed which revealed hypotonia in all 4 limbs with flaccidity with a power of 0/5 and diminished sensation at the level of C3. Neuro imaging was done. MRI brain with cervical screening revealed no edema, cord compression. MRI CERVICAL SPINE – NORMAL. Stressor: He was convicted under POSCO act for 3 years, 2 days before the incident. Neurosurgeon ruled out the physical cause of the above presentation.Detailed history revealed he was being convicted for 3 years for a marrying a 17 years old girl with her consent under POSCO act 2 days prior to the incident. He was seen distressed after hearing the verdict, had sleep disturbances, remained aloof, not communicating with others. He attempted suicide by jumping from the wall. He had a history of occasional cannabis use for the past 2 years. Family history revealing possession attacks in his mother. He was raised by a single parent as his father left him and his mother when he was 5 years old. He had no episodes of similar illness in the past. His temperament revealed that he had difficulty in adjustment to the situations being impulsive and had self-injurious behavior. Mental status examination revealed that the patient was lying in supine position, not able to move his all 4 limbs with obvious psychomotor retardation decreased talks, sad mood.DISCUSSION:The clinical picture is indicative of Dissociative Motor Disorder F44.4 according to ICD 10. After taking a detailed history, it was clear that he was extremely distressed regarding his punishment under POSCO act as he willfully married a 17 years old girl with her consent which could not stand in the court of law. Patient was started on therapy sessions as well as low-dose diazepam. In the sessions, possible causes of these symptoms were discussed, his family members were also psycho-educated about the psychosomatic nature of the symptoms and advised to encourage him for a symptom-free lifestyle. They were also given an instruction not to pay attention to his complaints of physical nature. Psychotherapy sessions were started in which all her stressors were therapy discussed.CONCLUSION:Conversion disorder, somatoform disorder, and malingering always remain a diagnostic challenge for the clinicians. The prompt history taking, identification of stressors, use of appropriate and validated physical examination manoeuvres, and coordination of care and information exchange between all family members and medical team may facilitate the expeditious care of these patients in a cost-effective manner. Psychogenic symptoms should be treated using suggestions, patience, and reassurance. Early recognition of a conversion disorder will limit unnecessary tests and medications. The quality of doctor-patient relationship can influence outcome. The existing literature supports a multidisciplinary treatment approach, with specific interventions, such as cognitive behaviour therapy for cognitive restructuring and psychodynamic therapy for addressing symptom connections to trauma and dissociation.

Differentiation of the β-thalassemia Trait from Iron Deficiency Anaemia by Red Cell Indices among Pregnant Women in Southern Haryana, India: A Cross-sectional Study

Introduction: Due to similar red cell morphology, patients of beta Thalassemia Trait (β-TT) are often misdiagnosed as Iron Deficiency Anaemia (IDA) and given unnecessary iron medication. Facilities for diagnosing them are usually not available in underserved areas where health system and laboratory facilities are not strengthened. Aim: To differentiate β-TT from IDA by red cell indices among pregnant women in Southern Haryana, India. Materials and Methods: This hospital-based, cross-sectional study was conducted in the Department of Obstetrics and Gynaecology at Shaheed Hasan Khan Mewati Government Medical College, Haryana, India, from May 2020 to October 2020. Total 148 antenatal women were screened for presence of anaemia by their haemoglobin level at the time of admission. Types of anaemia were documented. After staining, it was examined for red cell morphology and various red cell indices were also noted. Data collected was entered in Microsoft excel 7, then data was analysed using Statistical Package for Social Sciences (SPSS) version 20.0 software package. Results: Of total 148 pregnant women, 104 were found to be anaemic thus the overall prevalence of anaemia was found to be 70.27% (104/148). Most of pregnant women were in the age group of 18-24 years (54.8%). Microcytic hypochromic picture (38.4%), followed by normocytic hypochromic to microcytic hypochromic (20.1%) was predominant on Peripheral Blood Film (PBF) examination followed by dimorphic anaemia. Red Blood Cell (RBC) count was found to be normal in 85.5% cases followed by decreased count in 14.4% cases. None of the case had increased RBC count. Mean Corpuscular Volume (MCV) was normal in 58.6% of cases followed by decreased below 80 fL in 28.8% of cases. Conclusion: Higher prevalence of anaemia in pregnant women indicates that anaemia still continues to be a major health problem in India. In resource constrained settings, where definitive diagnostic facilities do not exist, red cell indices may be used to differentiate β-TT from IDA among pregnant women.

Reflections on a Year as President

Reflections on a Year as President