Database: EMBASE Classic+EMBASE <1947 to 2011 February 15>, Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations and Ovid MEDLINE(R) <1948 to Present> Search Strategy: -------------------------------------------------------------------------------- 1 medication review.ti,ab. (587) 2 remove duplicates from 1 (380) 3 1 not 2 (207) 4 from 1 keep 1-5,9-11,13-14,19,21,25,32-41,43,50,53-55,62-67,76-77,79-80,82-85,88-94,96,98-102,104-108,110,114-115,117-119,121-122,124-125,128,130-132,136,142-143,145,147-149,151,156,160-162,164,171-174,177,184-185,196,198-199,201-202,214,216,219,222-223,225-228,239,241,246-248,250-254,257-262,266,273-281,284,286-288,290,294-295,297-300,303-306,311,314-315,320-322,328,331-334,343,351,353,359-471,474-587 (390) 5 from 4 keep 1-30 (30) *************************** <1> DB - EMBASE Classic+EMBASE UI - 70340501 AU - Peters K. AU - Modreker M.K. AU - Golgert S. AU - Krause T. AU - Von Renteln Kruse W. IN - (Peters, Modreker, Golgert, Krause, Von Renteln Kruse) Geriatric Clinic, Albertinen-Haus, Centre of Geriatrics and Geronotology, University of Hamburg, Sellhopsweg 18-22, Hamburg 22459, Germany AD - K. Peters, Geriatric Clinic, Albertinen-Haus, Centre of Geriatrics and Geronotology, University of Hamburg, Sellhopsweg 18-22, Hamburg 22459, Germany OT - Medication and falls in older hospital inpatients - A case-control study. SO - British Journal of Clinical Pharmacology. Conference: 2009 Annual Meeting of the German Clinical Pharmacologists Heidelberg Germany. Conference Start: 20091021 Conference End: 20091024. Conference: 2009 Annual Meeting of the German Clinical Pharmacologists Heidelberg Germany. Conference Start: 20091021 Conference End: 20091024. Conference Publication: (var.pagings). 68 (pp 17), 2009. Date of Publication: October 2009. PB - Blackwell Publishing Ltd MH - *drug therapy MH - *case control study MH - *hospital MH - *hospital patient MH - patient MH - drug exposure MH - prevention MH - gender MH - competence MH - female MH - Barthel index MH - hospitalization MH - drug dose MH - drug combination MH - asthma MH - diagnosis MH - antihypertensive agent MH - antidepressant agent MH - neuroleptic agent MH - timonacic arginine AB - Introduction The role of medication in contributing to increased fallrisk, particularly in older patients, is equivocal. However, medication review is an essential part of multidimensional falls-prevention programs. The aim was to study differences in patterns, doses and number of drugs prescribed between older patients with and without inhospital falls. Methods and Materials Hundred patients who fell (152 total falls; 67 patients with single, 33 patients with >=2 falls) were matched to 100 patients without falls, according to age, gender, main diagnosis, and level of functional competence (66 females, mean age 78.5 years, mean total Barthel-Index score on admission 39.2 and 39.5, respectively). Total medication administered within the 24h interval before the first (index) fall event in fallers and matched patients (same day of in-hospital stay) was recorded and compared (ATC code, daily dose, drug combinations). Results Drug exposure was high in both patient groups (8.3 +/- 2.5 versus 7.9 +/- 2.9 medications). Antidepressants were prescribed more frequently to patients who fell, 32 versus 16 (P = 0.008), and there was a similar trend for anti-asthmatics (11 versus 4; P = 0.06) and neuroleptics (15 versus 7; P = 0.07). There were no significant differences regarding the number of single drugs, combination of antihypertensives, sedatives/hypnotics, psychotropics, and deviations from defined daily doses of antihypertensives, sedatives/hypnotics and antidepressants that were most frequently prescribed. Conclusion The level of total drug exposure, prescribing pattern, dosage and combination of drugs were not significantly associated with a first fall event (index fall) in older hospital in-patients. IS - 0306-5251 LG - English SL - English PT - Journal: Conference Abstract EM - 201107 DD - 20110214 YR - 2009 CR - Copyright 2011 Elsevier B.V., All rights reserved. XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=emedx&AN=70340501 <2> DB - EMBASE Classic+EMBASE UI - 70340503 AU - Modreker M.K. AU - Golgert S. AU - Von Renteln-Kruse W. IN - (Modreker, Golgert, Von Renteln-Kruse) Geriatric Clinic, Albertinen-Haus, Centre of Geriatrics and Geronotology, University of Hamburg, Sellhopsweg 18-22, Hamburg 22459, Germany AD - M.K. Modreker, Geriatric Clinic, Albertinen-Haus, Centre of Geriatrics and Geronotology, University of Hamburg, Sellhopsweg 18-22, Hamburg 22459, Germany OT - Orthostatic hypotension (OH) in geriatric inpatients-precipitating medication and clinical consequences. SO - British Journal of Clinical Pharmacology. Conference: 2009 Annual Meeting of the German Clinical Pharmacologists Heidelberg Germany. Conference Start: 20091021 Conference End: 20091024. Conference: 2009 Annual Meeting of the German Clinical Pharmacologists Heidelberg Germany. Conference Start: 20091021 Conference End: 20091024. Conference Publication: (var.pagings). 68 (pp 18), 2009. Date of Publication: October 2009. PB - Blackwell Publishing Ltd MH - *orthostatic hypotension MH - *drug therapy MH - *hospital patient MH - patient MH - postural orthostatic tachycardia syndrome MH - senescence MH - prevalence MH - adaptation MH - diuretic agent MH - cardiovascular agent AB - Introduction The prevalence of orthostatic hypotension (OH) is increasing with old age. Aim of the study was to screen for OH in geriatric inpatients and to evaluate underlying conditions and therapeutic consequences. Methods and Materials Consecutive patients were investigated by standard procedure, medication review, and history of falls (<=3 months). Results There were 102 out of 232 patients (f = 67, m = 35; age 80.2 +/- 7.2 years.) with systolic (9), diastolic (35) or combined OH (n = 55) and POTS (postural orthostatic tachycardia syndrome) (3). Symptomatic OH was present in 74 patients (75%). The average number of drugs used was 8.3 +/- 3.0, with >=5 drugs in 93 patients (91%). Drugs potentially precipitating OH were prescribed to 95 patients with cardiovascular medication most frequently incriminated (21/25). Symptomatic OH was associated with a history of recent falls (P < 0.001). Termination (14), adaptation of doses (11) and start of medication (6) was followed by clinical improvement in 18/74 (23%) patients. (Table presented) Conclusion OH was frequent in geriatric inpatients. Symptomatic OH was associated with a history of recent falls. Exclusion of orthostatic hypotension should be obligatory in older patients with a history of falls. Diuretics and cardiovascular drugs were most frequently incriminated with OH. IS - 0306-5251 LG - English SL - English PT - Journal: Conference Abstract EM - 201107 DD - 20110214 YR - 2009 CR - Copyright 2011 Elsevier B.V., All rights reserved. XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=emedx&AN=70340503 <3> DB - EMBASE Classic+EMBASE UI - 2010208791 AU - Niquille A. AU - Lattmann C. AU - Bugnon O. IN - (Niquille, Bugnon) Community Pharmacy Practice Unit, Pharmaceutical Sciences Section, Universities of Geneva, Lausanne, Switzerland (Lattmann) Pharmacy, Ambulatory Care and Community Medicine Department (PMU-Lausanne), University of Lausanne, Switzerland AD - A. Niquille, Community Pharmacy Practice Unit, Pharmaceutical Sciences Section, Universities of Geneva, Lausanne, Switzerland CP - Spain TI - Medication reviews led by community pharmacists in Switzerland: A qualitative survey to evaluate barriers and facilitators. SO - Pharmacy Practice. 8 (1) (pp 35-42), 2010. Date of Publication: January-March 2010. PB - Grupo de Investigacion en Atencion Farmaceutica (Campus de la Cartuja, Granada 18071, Spain) KW - Community pharmacy services KW - Qualitative research KW - Switzerland UR - http://www.pharmacypractice.org/vol08/pdf/035-042.pdf MH - access to information MH - article MH - communication skill MH - *drug monitoring MH - drug use MH - patient selection MH - *pharmacist MH - pharmacist attitude MH - physician attitude MH - prescription MH - professional practice MH - *support group MH - Switzerland MH - time AB - Objective: 1) To evaluate the participation rate and identify the practical barriers to implementing a community pharmacist-led medication review service in francophone Switzerland and, 2) To assess the effectiveness of external support. Methods: A qualitative survey was undertaken to identify barriers to patient inclusion and medication review delivery in daily practice among all contactable independent pharmacists working in francophone Switzerland (n=78) who were members of a virtual chain (pharmacieplus), regardless of their participation in a simultaneous cross-sectional study. This study analyzed the dissemination of a medication review service including a prescription and drug utilization review with access to clinical data, a patient interview and a pharmaceutical report to the physicians. In addition, we observed an exploratory and external coaching for pharmacists that we launched seven months after the beginning of the cross-sectional study. Results: Poor motivation on the part of pharmacists and difficulties communicating with physicians and patients were the primary obstacles identified. Lack of time and lack of self-confidence in administering the medication review process were the most commonly perceived practical barriers to the implementation of the new service. The main facilitators to overcome these issues may be well-planned workflow organization techniques, strengthened by an adequate remuneration scheme and a comprehensive and practice-based training course that includes skill-building in pharmacotherapy and communication. External support may partially compensate for a weak organizational framework. Conclusions: To facilitate the implementation of a medication review service, a strong local networking with physicians, an effective workflow management and a practice- and communications-focused training for pharmacists and their teams seem key elements required. External support can be useful to help some pharmacists improve their service management skills. Adequate remuneration seems necessary to encourage initial investments to provide such a service. Future research in this area may help improve the process and design of training programs, as well as the monitoring of implementation for each new pharmaceutical service. RF - 13 EC - Public Health, Social Medicine and Epidemiology [17] EN - 1886-3655 LG - English SL - English, Spanish PT - Journal: Article EM - 201021 DD - 20100525 YR - 2010 CR - Copyright 2010 Elsevier B.V., All rights reserved. XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=emed9&AN=2010208791 <4> DB - EMBASE Classic+EMBASE UI - 2010250302 AU - Sood J. IN - (Sood) Sainsbury's, New Barnet, United Kingdom AD - J. Sood, Sainsbury's, New Barnet, United Kingdom CP - United Kingdom TI - Focus on how best to carry out a medication review of heart failure. SO - Pharmacy in Practice. 19 (3) (pp 106-108), 2009. Date of Publication: September 2009. PB - Medicom Group (Thameside House, Hurst Road, Hampton Court, Surrey KT8 9AY, United Kingdom) UR - http://www.pharmacyinpractice.com/past-issues/2009-volume-19-issue-3/7-PIP-Cardiovascular-special-section-2-Sept09.pdf MH - angina pectoris/dt [Drug Therapy] MH - ankle edema/co [Complication] MH - article MH - atherosclerotic cardiovascular disease/dt [Drug Therapy] MH - blood pressure monitoring MH - bradycardia/si [Side Effect] MH - breathing disorder/co [Complication] MH - cold limb/si [Side Effect] MH - comorbidity MH - diarrhea/si [Side Effect] MH - disease severity MH - dizziness/si [Side Effect] MH - dose response MH - drug antagonism MH - drug blood level MH - drug contraindication MH - drug dose increase MH - drug dose titration MH - *drug information MH - drug mechanism MH - drug monitoring MH - drug safety MH - drug selectivity MH - drug transport MH - drug use MH - fatigue/si [Side Effect] MH - gout/dt [Drug Therapy] MH - gout/si [Side Effect] MH - gynecomastia/si [Side Effect] MH - health personnel attitude MH - heart atrium fibrillation/dt [Drug Therapy] MH - *heart failure/dt [Drug Therapy] MH - heart left ventricle failure/dt [Drug Therapy] MH - heart rate MH - human MH - Hypericum perforatum MH - hyperkalemia/si [Side Effect] MH - hypertension/dt [Drug Therapy] MH - hypotension/si [Side Effect] MH - hypovolemia/si [Side Effect] MH - impotence/si [Side Effect] MH - irritative coughing/si [Side Effect] MH - lifestyle modification MH - low drug dose MH - maximum tolerated dose MH - morning dosage MH - mortality MH - nausea/si [Side Effect] MH - patient education MH - patient information MH - prognosis MH - quality of life MH - self medication MH - sleep disorder/si [Side Effect] MH - vomiting/si [Side Effect] MH - weight change MH - aldosterone antagonist/ae [Adverse Drug Reaction] MH - aldosterone antagonist/dt [Drug Therapy] MH - allopurinol/dt [Drug Therapy] MH - amlodipine/dt [Drug Therapy] MH - angiotensin II antagonist/it [Drug Interaction] MH - antiarrhythmic agent/ae [Adverse Drug Reaction] MH - antiarrhythmic agent/it [Drug Interaction] MH - anticoagulant agent/dt [Drug Therapy] MH - beta adrenergic receptor blocking agent/do [Drug Dose] MH - beta adrenergic receptor blocking agent/it [Drug Interaction] MH - beta adrenergic receptor blocking agent/dt [Drug Therapy] MH - bisoprolol/ae [Adverse Drug Reaction] MH - bisoprolol/do [Drug Dose] MH - bisoprolol/dt [Drug Therapy] MH - bisoprolol/pd [Pharmacology] MH - candesartan/dt [Drug Therapy] MH - carvedilol/cr [Drug Concentration] MH - carvedilol/do [Drug Dose] MH - carvedilol/dt [Drug Therapy] MH - digoxin/it [Drug Interaction] MH - dipeptidyl carboxypeptidase inhibitor/ae [Adverse Drug Reaction] MH - dipeptidyl carboxypeptidase inhibitor/cb [Drug Combination] MH - dipeptidyl carboxypeptidase inhibitor/do [Drug Dose] MH - dipeptidyl carboxypeptidase inhibitor/it [Drug Interaction] MH - dipeptidyl carboxypeptidase inhibitor/dt [Drug Therapy] MH - diuretic agent/ae [Adverse Drug Reaction] MH - diuretic agent/cb [Drug Combination] MH - diuretic agent/it [Drug Interaction] MH - diuretic agent/dt [Drug Therapy] MH - eplerenone/ae [Adverse Drug Reaction] MH - loop diuretic agent/ae [Adverse Drug Reaction] MH - loop diuretic agent/cb [Drug Combination] MH - loop diuretic agent/dt [Drug Therapy] MH - losartan/dt [Drug Therapy] MH - nebivolol/dt [Drug Therapy] MH - neuroleptic agent/it [Drug Interaction] MH - nonsteroid antiinflammatory agent/it [Drug Interaction] MH - potassium sparing diuretic agent/ae [Adverse Drug Reaction] MH - potassium sparing diuretic agent/it [Drug Interaction] MH - sotalol/ae [Adverse Drug Reaction] MH - sotalol/it [Drug Interaction] MH - spironolactone/ae [Adverse Drug Reaction] MH - spironolactone/it [Drug Interaction] MH - spironolactone/dt [Drug Therapy] MH - statin/dt [Drug Therapy] MH - thiazide diuretic agent/cb [Drug Combination] MH - thiazide diuretic agent/dt [Drug Therapy] MH - tricyclic antidepressant agent/it [Drug Interaction] MH - warfarin/it [Drug Interaction] RF - 7 EC - Cardiovascular Diseases and Cardiovascular Surgery [18], Clinical and Experimental Pharmacology [30], Drug Literature Index [37], Adverse Reactions Titles [38] RN - 315-30-0 (allopurinol); 88150-42-9 (amlodipine); 66722-44-9 (bisoprolol); 139481-59-7 (candesartan); 72956-09-3 (carvedilol); 20830-75-5 (digoxin); 57285-89-9 (digoxin); 107724-20-9 (eplerenone); 114798-26-4 (losartan); 99200-09-6 (nebivolol); 3930-20-9 (sotalol); 80456-07-1 (sotalol); 959-24-0 (sotalol); 52-01-7 (spironolactone); 129-06-6 (warfarin); 2610-86-8 (warfarin); 3324-63-8 (warfarin); 5543-58-8 (warfarin); 81-81-2 (warfarin) IS - 1358-1538 CD - PHPRF LG - English PT - Journal: Article EM - 201021 DD - 20100526 YR - 2009 CR - Copyright 2010 Elsevier B.V., All rights reserved. XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=emed9&AN=2010250302 <5> DB - EMBASE Classic+EMBASE UI - 2010215686 AU - Galato D. AU - Galafassi L.D.M. AU - Alano G.M. AU - Trauthman S.C. IN - (Galato, Galafassi, Alano, Trauthman) University of South Santa Catarina, Brazil (Galato, Alano, Trauthman) Research Group on Pharmaceutical Care and Studies on Medication Use (NAFEUM), Pharmacy Undergraduate Program, University of South Santa Catarina, Brazil AD - D. Galato, Nucleo de Pesquisa em Atencao Farmaceutica e Estudos de Utilizacao de Medicamentos (NAFEUM), Curso de Farmacia, UNISUL, Av. Jose Acacio Moreira, 787, Bairro Dehon, 88704-900 - Tubarao, SC, Brazil. E-mail: dayani.galato@unisul.br CP - Brazil TI - Responsible self-medication: Review of the process of pharmaceutical attendance. SO - Revista Brasileira de Ciencias Farmaceuticas/Brazilian Journal of Pharmaceutical Sciences. 45 (4) (pp 625-633), 2009. Date of Publication: October-December 2009. PB - Faculdade de Ciencias Farmaceuticas (Biblioteca) (P.O. Box 66083, Sao Paulo 05389-970, Brazil) KW - Community pharmacy KW - Drugs/rational use KW - Minor illness KW - Pharmaceutical orientation KW - Responsible self-medication KW - Self-medication UR - http://www.scielo.br/pdf/bjps/v45n4/04.pdf MH - *caregiver MH - *clinical pharmacy MH - decision making MH - drug efficacy MH - drug safety MH - empathy MH - information MH - medical education MH - patient monitoring MH - *pharmacist MH - pharmacy MH - postgraduate education MH - qualitative research MH - review MH - *self medication MH - standardization MH - world health organization MH - non prescription drug AB - This article presents a review, based on a qualitative study, of pharmaceutical orientation in the management of minor illness. Action research methodology was used by a group of faculty members responsible for the community pharmacy internship and by postgraduates in clinical pharmacy, to carry out the study with the objective to present a standard service for this kind of procedure. The interaction with the individual starts with a welcoming reception, at which point the pharmacist should be receptive and show empathy. Subsequently, data from the history of the patient are collected to obtain relevant information. Based on this information, the pharmacist must develop a line of clinical reasoning and make a decision, taking the context of the patient into account. After this analysis, the most appropriate intervention is performed. This intervention could indicate the need for referral to another health professional, the use of a non-pharmacological therapy or the provision of sound advice on medicines available without prescription. The next step is monitoring the patient in order to identify the effectiveness and safety of treatment. The standardization process of pharmaceutical attendance in the management of minor disorders contributes to the rational use of medicines. RF - 34 EC - Public Health, Social Medicine and Epidemiology [17] IS - 1516-9332 DO - http://dx.doi.org/10.1590/S1984-82502009000400004 CD - RBCFF LG - English SL - English, Spanish PT - Journal: Review EM - 201020 DD - 20100518 YR - 2009 CR - Copyright 2010 Elsevier B.V., All rights reserved. XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=emed9&AN=2010215686 <6> DB - EMBASE Classic+EMBASE UI - 2010141357 AU - Clark A.M. AU - Davidson P. AU - Currie K. AU - Karimi M. AU - Duncan A.S. AU - Thompson D.R. IN - (Clark, Davidson, Currie, Karimi, Duncan, Thompson) Faculty of Nursing, Level 3 CSB, University of Alberta, Edmonton, AB T6R 2R6, Canada AD - A. M. Clark, Faculty of Nursing, Level 3 CSB, University of Alberta, Edmonton, AB T6R 2R6, Canada. E-mail: alex.clark@ualberta.ca CP - United Kingdom TI - Understanding and promoting effective self-care during heart failure. SO - Current Treatment Options in Cardiovascular Medicine. 12 (1) (pp 1-9), 2010. Date of Publication: January 2010. PB - Current Science Ltd (34-42 Cleveland Street, London W1P 6LB, United Kingdom) MH - aerobic exercise MH - alcohol consumption MH - behavior change MH - caregiver support MH - clinical protocol MH - cognitive therapy MH - cost effectiveness analysis MH - depression/di [Diagnosis] MH - depression/dt [Drug Therapy] MH - depression/th [Therapy] MH - disease association MH - drug dose titration MH - dyspnea/co [Complication] MH - fluid intake MH - health behavior MH - health belief MH - health care cost MH - health care utilization MH - health program MH - *heart failure/dm [Disease Management] MH - *heart failure/dt [Drug Therapy] MH - *heart failure/th [Therapy] MH - heart palpitation/co [Complication] MH - heart rehabilitation MH - help seeking behavior MH - high risk population MH - human MH - lifestyle modification MH - morbidity MH - mortality MH - patient compliance MH - patient decision making MH - patient education MH - prognosis MH - psychosocial care MH - quality of life MH - review MH - screening test MH - self care MH - smoking cessation MH - social interaction MH - sodium restriction MH - syncope/co [Complication] MH - thorax pain/co [Complication] MH - treatment response MH - weight reduction MH - aldosterone antagonist/dt [Drug Therapy] MH - angiotensin receptor antagonist/dt [Drug Therapy] MH - beta adrenergic receptor blocking agent/dt [Drug Therapy] MH - citalopram/dt [Drug Therapy] MH - dipeptidyl carboxypeptidase inhibitor/dt [Drug Therapy] MH - diuretic agent/dt [Drug Therapy] MH - serotonin uptake inhibitor/dt [Drug Therapy] MH - sertraline/dt [Drug Therapy] MH - sodium AB - Opinion statement: Heart failure (HF) self-care relates to the decisions made outside clinical settings by the individual with HF to maintain life, healthy functioning, and well-being. The people who help patients most (ie, caregivers/family members) should be involved in care, and general principles of health behavior change should be used to guide support. Medicines should be prescribed with once-daily dosing, with pharmacists providing medication review and support. Pill boxes should be provided and patients' health literacy levels assessed. Psychosocial interventions for smoking cessation should be undertaken. Regular aerobic exercise may benefit patients with mild to moderate HF and some with severe but stable HF; therefore, referral to cardiac rehabilitation should be considered. Exercise regimen must take into account patient-related factors, including functional status, comorbid conditions, and patient preferences. Intake of salt, alcohol, and fluid should be restricted, although these steps are supported by limited evidence. Patients should be educated on appropriate sources of help. They should seek help immediately for persistent chest pain, palpitations, syncope, breathlessness at rest, or a weight increase of >= 2 lb. Depression, if present, should be addressed with antidepressants (sertraline and citalopram), cognitive behavioral therapy, and regular exercise. HF disease management programs should be offered if available. 2010 Springer Science+Business Media, LLC. RF - 50 EC - Cardiovascular Diseases and Cardiovascular Surgery [18], Health Policy, Economics and Management [36], Drug Literature Index [37] RN - 59729-33-8 (citalopram); 79617-96-2 (sertraline); 7440-23-5 (sodium) IS - 1092-8464 DO - http://dx.doi.org/10.1007/s11936-009-0053-1 CD - CTOCC LG - English SL - English PT - Journal: Review EM - 201012 DD - 20100323 YR - 2010 CR - Copyright 2010 Elsevier B.V., All rights reserved. XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=emed9&AN=2010141357 <7> DB - EMBASE Classic+EMBASE UI - 2010089583 AU - Bojke C. AU - Philips Z. AU - Sculpher M. AU - Campion P. AU - Chrystyn H. AU - Coulton S. AU - Cross B. AU - Morton V. AU - Richmond S. AU - Farrin A. AU - Hill G. AU - Hilton A. AU - Miles J. AU - Russell I. AU - Chi Kei Wong I. IN - (Bojke, Philips, Sculpher) Centre for Health Economics, University of York, Heslington, York, YO10 5DD, United Kingdom (Campion) Department of Primary Care Medicine, Postgraduate Medical Institute, University of Hull, United Kingdom (Chrystyn) Department of Pharmacy, University of Huddersfield, United Kingdom (Coulton) Centre for Health Service Studies, University of Kent, United Kingdom (Cross, Morton, Richmond) Department of Health Sciences, University of York, United Kingdom (Farrin) Clinical Trials Research Unit, University of Leeds, United Kingdom (Hill) East Riding and Hull Local Pharmaceutical Committee, Hull, United Kingdom (Hilton) Faculty of Health and Social Care, University of Hull, United Kingdom (Miles) RAND Corporation, Santa Monica, CA, United States (Russell) School of Medicine, Swansea University (Chi Kei Wong) School of Pharmacy, University of London, United Kingdom AD - C. Bojke, Centre for Health Economics, University of York, Heslington, York, YO10 5DD, United Kingdom. E-mail: cb23@york.ac.uk CP - United Kingdom TI - Cost-effectiveness of shared pharmaceutical care for older patients: RESPECT trial findings. SO - British Journal of General Practice. 60 (570) (pp 21-27), 2010. Date of Publication: January 2010. PB - Royal College of General Practitioners (14 Princes Gate, London SW7 1PU, United Kingdom) KW - Cost-effectiveness KW - Health services for the aged KW - Medication therapy management KW - Pharmaceutical care MH - aged MH - article MH - clinical practice MH - clinical trial MH - controlled clinical trial MH - controlled study MH - cost benefit analysis MH - *cost effectiveness analysis MH - economic aspect MH - geriatric care MH - *geriatric patient MH - health care cost MH - health care organization MH - health service MH - human MH - medical record review MH - patient care MH - *pharmaceutical care MH - practice guideline MH - prescription MH - quality adjusted life year MH - randomized controlled trial MH - United Kingdom AB - Background: Pharmaceutical care serves as a collaborative model for medication review. Its use is advocated for older patients, although its cost-effectiveness is unknown. Although the accompanying article on clinical effectiveness from the RESPECT (Randomised Evaluation of Shared Prescribing for Elderly people in the Community over Time) trial finds no statistically significant impact on prescribing for older patients undergoing pharmaceutical care, economic evaluations are based on an estimation, rather than hypothesis testing. Aim: To evaluate the cost-effectiveness of pharmaceutical care for older people compared with usual care, according to National Institute for Health and Clinical Excellence (NICE) reference case standards. Method: An economic evaluation was undertaken in which NICE reference case standards were applied to data collected in the RESPECT trial. Results: On average, pharmaceutical care is estimated to cost an incremental 10 000 per additional quality-adjusted life year (QALY). If the NHS's cost-effectiveness threshold is between 20 000 and 30 000 per extra QALY, then the results indicate that pharmaceutical care is cost-effective despite a lack of statistical significance to this effect. However, the statistical uncertainty surrounding the estimates implies that the probability that pharmaceutical care is not cost-effective lies between 0.22 and 0.19. Although results are not sensitive to assumptions about costs, they differ between subgroups: in patients aged >75 years pharmaceutical care appears more cost-effective for those who are younger or on fewer repeat medications. Conclusion: Although pharmaceutical care is estimated to be cost-effective in the UK, the results are uncertain and further research into its long-term benefits may be worthwhile. British Journal of General Practice. RF - 19 EC - Public Health, Social Medicine and Epidemiology [17], Health Policy, Economics and Management [36] IS - 0960-1643 DO - http://dx.doi.org/10.3399/bjgp09X482312 CD - BJGPE LG - English SL - English PT - Journal: Article EM - 201011 DD - 20100315 YR - 2010 CR - Copyright 2010 Elsevier B.V., All rights reserved. XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=emed9&AN=2010089583 <8> DB - EMBASE Classic+EMBASE UI - 2010091414 AU - Richmond S. AU - Morton V. AU - Cross B. AU - Chi Kei Wong I. AU - Russell I. AU - Philips Z. AU - Miles J. AU - Hilton A. AU - Hill G. AU - Farrin A. AU - Coulton S. AU - Chrystyn H. AU - Campion P. IN - (Richmond, Morton, Cross) Department of Health Sciences, University of York, Heslington, York, YO10 5DD, United Kingdom (Chi Kei Wong) School of Pharmacy, University of London, United Kingdom (Russell) School of Medicine, Swansea University (Philips) Centre for Health Economics, University of York, United Kingdom (Miles) RAND Corporation, Santa Monica, CA, United States (Hilton) Faculty of Health and Social Care, University of Hull, United Kingdom (Hill) East Riding and Hull Local Pharmaceutical Committee, Hull, United Kingdom (Farrin) Clinical Trials Research Unit, University of Leeds, United Kingdom (Coulton) Centre Forhealth Service Studies, University of Kent, United Kingdom (Chrystyn) Department of Pharmacy, University of Huddersfield, United Kingdom (Campion) Department of Primary Care Medicine, Postgraduate Medical Institute, University of Hull, United Kingdom AD - S. Richmond, Department of Health Sciences, University of York, Heslington, York, YO10 5DD, United Kingdom. E-mail: sjr503@york.ac.uk CP - United Kingdom TI - Effectiveness of shared pharmaceutical care for older patients: RESPECT trial findings. SO - British Journal of General Practice. 60 (570) (pp 14-20), 2010. Date of Publication: January 2010. PB - Royal College of General Practitioners (14 Princes Gate, London SW7 1PU, United Kingdom) KW - Health services for the aged KW - Medication therapy management KW - Pharmaceutical care KW - Polypharmacy KW - Randomised controlled trial MH - aged MH - article MH - clinical trial MH - controlled clinical trial MH - controlled study MH - *cost effectiveness analysis MH - follow up MH - general practice MH - general practitioner MH - *geriatric patient MH - health care personnel MH - health care planning MH - hospital admission MH - human MH - interview MH - medical record review MH - outcome assessment MH - patient care MH - *pharmaceutical care MH - pharmacist MH - prescription MH - quality of life MH - randomized controlled trial MH - sample size MH - Short Form 36 MH - time series analysis MH - United Kingdom AB - Background: The pharmaceutical care approach serves as a model for medication review, involving collaboration between GPs, pharmacists, patients, and carers. Its use is advocated with older patients who are typically prescribed several drugs. However, it has yet to be thoroughly evaluated. Aim: To estimate the effectiveness of pharmaceutical care for older people, shared between GPs and community pharmacists in the UK, relative to usual care. Design of study: Multiple interrupted time-series design in five primary care trusts which implemented pharmaceutical care at 2-month intervals in random order. Patients acted as their own controls, and were followed over 3 years including their 12 months' participation in pharmaceutical care. Setting: In 2002, 760 patients, aged >=75 years, were recruited from 24 general practices in East and North Yorkshire. Sixty-two community pharmacies also took part. A total of 551 participants completed the study. Method: Pharmaceutical care was undertaken by community pharmacists who interviewed patients, developed and implemented pharmaceutical care plans together with patients' GPs, and thereafter undertook monthly medication reviews. Pharmacists and GPs attended training before the intervention. Outcome measures were the UK Medication Appropriateness Index, the Short Form-36 Health Survey (SF-36), and serious adverse events. Results: The intervention did not lead to any statistically significant change in the appropriateness of prescribing or health outcomes. Although the mental component of the SF-36 decreased as study participants become older, this trend was not affected by pharmaceutical care. Conclusion: The RESPECT model of pharmaceutical care (Randomised Evaluation of Shared Prescribing for Elderly people in the Community over Time) shared between community pharmacists and GPs did not significantly change the appropriateness of prescribing or quality of life in older patients. British Journal of General Practice. RF - 28 EC - Public Health, Social Medicine and Epidemiology [17], Health Policy, Economics and Management [36] IS - 0960-1643 DO - http://dx.doi.org/10.3399/bjgp09X473295 CD - BJGPE LG - English SL - English PT - Journal: Article EM - 201011 DD - 20100315 YR - 2010 CR - Copyright 2010 Elsevier B.V., All rights reserved. XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=emed9&AN=2010091414 <9> DB - EMBASE Classic+EMBASE UI - 19995493 CP - United Kingdom TI - Effectiveness of shared pharmaceutical care for older patients: RESPECT trial findings. SO - The British journal of general practice : the journal of the Royal College of General Practitioners. 60 (570) (pp e10-19), 2010. Date of Publication: Jan 2010. MH - aged MH - article MH - clinical trial MH - controlled clinical trial MH - controlled study MH - *drug therapy MH - *elderly care MH - female MH - *general practice MH - human MH - male MH - multicenter study MH - organization and management MH - *patient care planning MH - *pharmacy MH - prescription MH - public relations MH - *quality of life MH - randomized controlled trial MH - standard MH - United Kingdom AB - BACKGROUND: The pharmaceutical care approach serves as a model for medication review, involving collaboration between GPs, pharmacists, patients, and carers. Its use is advocated with older patients who are typically prescribed several drugs. However, it has yet to be thoroughly evaluated. AIM: To estimate the effectiveness of pharmaceutical care for older people, shared between GPs and community pharmacists in the UK, relative to usual care. DESIGN OF STUDY: Multiple interrupted time-series design in five primary care trusts which implemented pharmaceutical care at 2-month intervals in random order. Patients acted as their own controls, and were followed over 3 years including their 12 months' participation in pharmaceutical care. SETTING: In 2002, 760 patients, aged > or =75 years, were recruited from 24 general practices in East and North Yorkshire. Sixty-two community pharmacies also took part. A total of 551 participants completed the study. METHOD: Pharmaceutical care was undertaken by community pharmacists who interviewed patients, developed and implemented pharmaceutical care plans together with patients' GPs, and thereafter undertook monthly medication reviews. Pharmacists and GPs attended training before the intervention. Outcome measures were the UK Medication Appropriateness Index, the Short Form-36 Health Survey (SF-36), and serious adverse events. RESULTS: The intervention did not lead to any statistically significant change in the appropriateness of prescribing or health outcomes. Although the mental component of the SF-36 decreased as study participants become older, this trend was not affected by pharmaceutical care. CONCLUSION: The RESPECT model of pharmaceutical care (Randomised Evaluation of Shared Prescribing for Elderly people in the Community over Time) shared between community pharmacists and GPs did not significantly change the appropriateness of prescribing or quality of life in older patients. EN - 1478-5242 LG - English PT - Journal: Article EM - 201010 DD - 20100305 YR - 2010 CR - MEDLINE is the source for the citation and abstract of this record. XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=emed9&AN=19995493 <10> DB - EMBASE Classic+EMBASE UI - 20040164 CP - United Kingdom TI - Cost-effectiveness of shared pharmaceutical care for older patients: RESPECT trial findings. SO - The British journal of general practice : the journal of the Royal College of General Practitioners. 60 (570) (pp e20-27), 2010. Date of Publication: Jan 2010. MH - aged MH - article MH - clinical trial MH - controlled clinical trial MH - controlled study MH - cost benefit analysis MH - *drug therapy MH - economics MH - *elderly care MH - female MH - *general practice MH - human MH - male MH - multicenter study MH - organization and management MH - *patient care planning MH - *pharmacy MH - quality adjusted life year MH - randomized controlled trial MH - United Kingdom MH - prescription drug AB - BACKGROUND: Pharmaceutical care serves as a collaborative model for medication review. Its use is advocated for older patients, although its cost-effectiveness is unknown. Although the accompanying article on clinical effectiveness from the RESPECT (Randomised Evaluation of Shared Prescribing for Elderly people in the Community over Time) trial finds no statistically significant impact on prescribing for older patients undergoing pharmaceutical care, economic evaluations are based on an estimation, rather than hypothesis testing. AIM: To evaluate the cost-effectiveness of pharmaceutical care for older people compared with usual care, according to National Institute for Health and Clinical Excellence (NICE) reference case standards. METHODS: An economic evaluation was undertaken in which NICE reference case standards were applied to data collected in the RESPECT trial. RESULTS: On average, pharmaceutical care is estimated to cost an incremental 10 000 UK pounds per additional quality-adjusted life year (QALY). If the NHS's cost-effectiveness threshold is between 20 000 and 30 000 UK pounds per extra QALY, then the results indicate that pharmaceutical care is cost-effective despite a lack of statistical significance to this effect. However, the statistical uncertainty surrounding the estimates implies that the probability that pharmaceutical care is not cost-effective lies between 0.22 and 0.19. Although results are not sensitive to assumptions about costs, they differ between subgroups: in patients aged >75 years pharmaceutical care appears more cost-effective for those who are younger or on fewer repeat medications. CONCLUSION: Although pharmaceutical care is estimated to be cost-effective in the UK, the results are uncertain and further research into its long-term benefits may be worthwhile. EN - 1478-5242 LG - English PT - Journal: Article EM - 201010 DD - 20100305 YR - 2010 CR - MEDLINE is the source for the citation and abstract of this record. XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=emed9&AN=20040164 <11> DB - EMBASE Classic+EMBASE UI - 2010030739 AU - Locca J.-F. AU - Niquille A. AU - Krahenbuhl J.-M. AU - Figueiredo H. AU - Bugnon O. IN - (Locca, Niquille, Krahenbuhl, Figueiredo, Bugnon) Unite de Pharmacie Communautaire, Section des Sciences Pharmaceutiques, Universites de Geneve et de Lausanne, 1011 Lausanne AD - J.-F. Locca, Unite de Pharmacie Communautaire, Section des Sciences Pharmaceutiques, Universites de Geneve et de Lausanne, 1011 Lausanne. E-mail: jean-francois.locca@hospvd.ch CP - Switzerland TI - Physician-pharmacist collaborative care: A way to improve the quality of drug prescribing. [French] OT - Qualite de la prescription medicamenteuse: Des progres grace a la collaboration medecins-pharmaciens. SO - Revue Medicale Suisse. 5 (227) (pp 2382-2387), 2009. Date of Publication: 25 Nov 2009. PB - Editions Medecine et Hygiene (7, Avenue de la Roseraie, P.O. Box 456, Geneva 4 CH-1211, Switzerland) MH - health care cost MH - *health care quality MH - human MH - legal liability MH - medication error MH - patient care MH - *pharmacist MH - physician MH - *prescription MH - quality circle MH - review MH - Switzerland AB - The medical prescription is the end-result of a structured process. It is, in effect, a medico-legal document that binds the physician who writes it as well as the pharmacist who delivers it, with a civil duty of care that is protected by penal sanction. Moreover, prescriptions carry important costs, and can be the source of errors, especially where there are breakdowns in the continuity of patient care. These features underline the importance of the act of < >, and the need for ways to improve its quality through increased efficiency and safety. The Swiss experience of physicians-pharmacists Quality Circles for drug prescription in the community and in the nursing homes, represent with the medication review, one method of safeguarding quality prescribing. RF - 31 EC - Public Health, Social Medicine and Epidemiology [17], Health Policy, Economics and Management [36] IS - 1660-9379 LG - French SL - English, French PT - Journal: Review EM - 201007 DD - 20100214 YR - 2009 CR - Copyright 2010 Elsevier B.V., All rights reserved. XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=emed9&AN=2010030739 <12> DB - EMBASE Classic+EMBASE UI - 2009660662 AU - Farrell B. AU - Pottie K. AU - Woodend K. AU - Yao V. AU - Dolovich L. AU - Kennie N. AU - Sellors C. IN - (Farrell, Pottie, Yao) Elisabeth Bruyre Research Institute, CT Lamont Primary Health Care Centre, Ottawa, United States (Farrell, Pottie, Woodend, Yao) University of Ottawa, Ottawa, United States (Farrell) Bruyre Continuing Care, Ottawa, United States (Dolovich, Sellors) Centre for Evaluation of Medicines, McMaster University, Hamilton, United States (Kennie) St. Michael's Hospital, University of Toronto, Toronto, ON, Canada AD - B. Farrell, Pharmacy Department, Bruyre Continuing Care, Scientist, Elisabeth Bruyre Research Institute, 43 Bruyre Street, Ottawa, ON K1N 5C8, Canada. E-mail: bfarrell@bruyere.org CP - United Kingdom TI - Shifts in expectations: Evaluating physicians' perceptions as pharmacists become integrated into family practice. SO - Journal of Interprofessional Care. 24 (1) (pp 80-89), 2010. Date of Publication: January 2010. PB - Informa Healthcare (Telephone House, 69 - 77 Paul Street EC2A 4LQ, United Kingdom) KW - Family physician KW - Medication use process KW - Perception KW - Pharmacist KW - Primary care MH - analysis of variance MH - article MH - *general practice MH - medical documentation MH - medical education MH - *pharmacist MH - *physician attitude MH - primary medical care MH - Student t test AB - The objective of this study was to measure how primary care family physicians perceived their own and pharmacists' contributions to medication processes as pharmacists become integrated into primary care group family practices. The 22- item Family Medicine Medication Use Processes Matrix was mailed to physicians in seven sites at the 3rd, 12th and 19th month of pharmacist integration. Paired sample t-tests for the third month results were conducted to compare perceptions between pharmacist and physician contributions. One way repeated measure ANOVA test was conducted to determine significant changes over time. Physicians initially perceived their own contributions to be significantly higher than pharmacists in three subscales: Diagnosis & Prescribing, Monitoring and Administration/Documentation and their own contributions to be significantly lower than the pharmacists in the Education subscale. Over time, physicians perceived increases in the pharmacists' contribution to the Diagnosis & Prescribing, Monitoring and Medication Review subscales and decreases in their own contribution to the Diagnosis & Prescribing and Education subscales. Changes in family physicians' perceptions of pharmacists' contribution demonstrate an initial underestimate of pharmacists' role in primary care family practice and a gradual recognition of expertise and competence. This may have led to increased comfort in sharing aspects of contribution to medication use processes. RF - 17 EC - Public Health, Social Medicine and Epidemiology [17] IS - 1356-1820 EN - 1469-9567 DO - http://dx.doi.org/10.3109/13561820903011968 CD - JINCF LG - English SL - English PT - Journal: Article EM - 201004 DD - 20100122 YR - 2010 CR - Copyright 2010 Elsevier B.V., All rights reserved. XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=emed9&AN=2009660662 <13> DB - EMBASE Classic+EMBASE UI - 70088210 AU - Cornacchione M. IN - (Cornacchione) Commonwealth Medical College, United States AD - M. Cornacchione, Commonwealth Medical College, United States OT - Unintentional weight loss in long term care residents with Alzheimer's disease and weight response with the use of docosahexaenoic acid (DHA)/eicosapentaenoic acid (EPA) and bioflavinoids: A case series. SO - Journal of the American Medical Directors Association. Conference: Long Term Care Medicine 2010 Long Beach, CA United States. Conference Start: 20100311 Conference End: 20100314. Conference: Long Term Care Medicine 2010 Long Beach, CA United States. Conference Start: 20100311 Conference End: 20100314. Conference Publication: (var.pagings). 11 (3) (pp B26-B27), 2010. Date of Publication: March 2010. PB - Elsevier Inc. MH - *weight reduction MH - *weight MH - *long term care MH - *Alzheimer disease MH - *case study MH - dementia MH - appetite MH - drug therapy MH - cachexia MH - diagnosis MH - inflammation MH - oxidative stress MH - mini mental state examination MH - serum MH - physical examination MH - plasma MH - hospice care MH - laboratory MH - weight change MH - food MH - fruit MH - vegetable MH - health MH - dietary intake MH - tissue MH - cytokine production MH - weight gain MH - cause of death MH - nursing home patient MH - food intake MH - body weight MH - feeding MH - nutrient MH - anorexia MH - satiety MH - hypothalamus MH - patient MH - blood level MH - brain MH - synthesis MH - model MH - neoplasm MH - cerebrospinal fluid MH - diet supplementation MH - hunger MH - urinalysis MH - informed consent MH - citrus fruit MH - pine MH - bark MH - red wine MH - grape MH - plant seed MH - hypothyroidism MH - hypertension MH - diabetes mellitus MH - hyperlipidemia MH - nerve cell MH - *icosapentaenoic acid MH - *docosahexaenoic acid MH - cytokine MH - interleukin 1beta MH - bioflavonoid MH - multivitamin MH - memantine MH - antioxidant MH - reactive oxygen metabolite MH - C reactive protein MH - omega 3 fatty acid MH - 9 [(4 acetyl 3 hydroxy 2 propylphenoxy)methyl] 3 (1h tetrazol 5 yl) 4h pyrido[1,2 a]pyrimidin 4 one MH - tumor necrosis factor alpha MH - glucose MH - interleukin 6 MH - thyrotropin MH - pycnogenol MH - resveratrol MH - cholinesterase inhibitor MH - flavonoid MH - levothyroxine MH - citalopram MH - potassium chloride MH - donepezil MH - vitamin D MH - carbonic acid MH - mirtazapine AB - Introduction/Objective: Cachexia/dehydration may be the immediate cause of death in the end stage of dementia in as many as 35% of nursing home residents. Cachexia is associated with suppressed appetite, food intake and body weight while proinflammatory cytokines are increased. Proinflam-matory cytokines directly result in feeding suppression and lower intake of nutrients and cachexia is nearly always accompanied by anorexia. IL-1 beta and tumor necrosis factor alpha (TNFa) act on the glucose-sensitive neurons in the satiety and hunger sites in the hypothalamus. An association between high levels of circulating TNFa and unexplained weight loss in AD has been shown. Serum TNFa has been shown to be lower in mild-moderate Alzheimer's disease (AD) compared to severe AD.12 The levels of TNFa, IL-1beta, IL 6, and IL10 were elevated in the serum of patients with dementia. A minority of studies have shown no significant differences between AD subjects and controls in the mean serum levels of TNFa and other cytokines. Brain synthesis of cytokines has been shown in peripheral models of cancer, peripheral inflammation, and during peripheral cytokine administration and strikingly increased CSF levels of TNFa have been demonstrated in AD. Design/Methodology: Two residents in one facility, cared for by the investigator, in a moderate stage of dementia with 10% or greater weight loss over the previous six months despite the usual interventions at the facility (the addition of fortified foods, 2 cal supplement bid, offering snack tid, and 1 on 1 assistance with meals in a small dining room setting) were chosen. A TSH, CBC, complete metabolic profile, urinalysis, physical examination, medication review and Cornell Scale for Depression in Dementia (CSDD) were performed during the 6 month period. Both residents were on an acetylcholinesterase inhibitor (ACHE) and had a 10 day washout. After informed consent was obtained from the family of each resident, 570 mg DHA and 870 mg EPA plus 225 mg of bioflavonoid per day were administered. A proprietary formulation of bioflavonoids, OPC-3 was used. OPC-3 consists of an isotonic formulation of well studied flavonoids derived from extracts of bilberries, citrus fruit, French maritime pine bark (Pycnogenol), red wine (resveratrol), and grape seeds. The usual interventions were continued. Weights were followed over the 6 month period following the intervention. Results: Resident 1: 92 y.o, diagnoses: Alzheimer's disease, depression, hypothyroidism, hypertension, diabetes II, hyperlipidemia. Medications: done-pezil 10 mg, memantine 10 mg bid, levothyroxine, citalopram 10 mg., KCl, multivitamin. MMSE 14, 50-80% meals consumed, weight loss 1% over 1 month and 11% over 6 months immediately prior to intervention. Resident 2: 94 y.o., diagnoses: Alzheimer's disease, COPD, Oseteoarthritis. Medications: donepezil 10 mg, memantine 10 mg bid, vitamin D 800 IU, multivitamin, Ca carbonate 1000mg. Failed trial of mirtazapine 15 mg daily for weight loss. Hospice care during the last 3 months of weight loss prior to intervention and throughout the intervention period. MMSE 13, 0-50% meals consumed, weight loss 3.7% over 1 month and 10% over 6 months immediately prior to intervention. Laboratory work, CSDD, physical examination unremarkable and no change in appetite with the ACHE washout in both residents (ACHE was restarted). Post intervention percent weight change at I, 3 and 6 months respectively for resident 1 were +0.9%, +5.1%, +6.9% and for resident 2 were 0%, +1%, -1%. Both residents showed an improvement in appetite and general increase in percent of meals eaten. Conclusion/Discussion: The importance of ingesting foods and supplements high in antioxidants is becoming more valued as oxidative stress from reactive oxygen species is being uncovered as a common pathologic mechanism to inflammatory states by the induction of proinflammatory cytokines. 4 In recent years, the constituents in fruits and vegetables predominantly responsible for the health benefits have been identified as bioflavonoids which are anti-inflammatory. Reductions of plasma oxidative stress status by 10.1% and plasma C-reactive protein by 52.1% have been demonstrated with OPC-3 use. Adequate dietary intake of omega-3 polyunsaturated fatty acids increases tissue concentrations of EPA and DHA that reduce proinflammatory cytokine production and downregulate inflammation. Although this was an uncontrolled intervention, resident 1 showed clinically meaningful weight gain through the entire 6 month observation period and resident 2 showed stabilization of weight loss within 30 days of the intervention with continued weight maintenance throughout the 6 month observation period. Given the evidence in the literature supporting a mechanism for these nutritional interventions with our observed improvement in weight and appetite, further study in a controlled setting is warranted. IS - 1525-8610 DO - http://dx.doi.org/10.1016/j.jamda.2009.12.077 LG - English SL - English PT - Journal: Conference Abstract EM - 200900 DD - 20100331 YR - 2010 CR - Copyright 2010 Elsevier B.V., All rights reserved. XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=emed9&AN=70088210 <14> DB - EMBASE Classic+EMBASE UI - 70111476 AU - Masud T. IN - (Masud) Medicine, Nottingham University Hospital, Nottingham, United Kingdom AD - T. Masud, Medicine, Nottingham University Hospital, Nottingham, United Kingdom OT - Falls risk assessment and management. SO - Bone. Conference: 36th European Symposium on Calcified Tissues, ECTS 2009 Vienna Austria. Conference Start: 20090523 Conference End: 20090527 Sponsor: The Alliance for Better Bone Health (Procter and Gamble Pharm. and sanofi-aventis), Amgen Europe GmbH, Eli Lilly, Hologic Inc, MSD. Conference: 36th European Symposium on Calcified Tissues, ECTS 2009 Vienna Austria. Conference Start: 20090523 Conference End: 20090527 Sponsor: The Alliance for Better Bone Health (Procter and Gamble Pharm. and sanofi-aventis), Amgen Europe GmbH, Eli Lilly, Hologic Inc, MSD. Conference Publication: (var.pagings). 44 (pp S203-S204), 2009. Date of Publication: June 2009. PB - Elsevier Inc. UR - http://www.sciencedirect.com/science?_ob=MImg&_imagekey=B6T4Y-4WC0RMX-M-1&_cdi=4987&_user=8184434&_pii=S8756328209005535&_orig=browse&_coverDate=06%2F30%2F2009&_sk=999559999.8997&view=c&wchp=dGLbVlz-zSkWb&md5=6db2a98a9697a5504e0324adb1f6c0e2&ie=/sdarticle.pdf MH - *risk assessment MH - *tissue MH - risk MH - drug therapy MH - risk factor MH - community MH - population MH - gait MH - fracture MH - follow up MH - nutritional deficiency MH - emergency ward MH - occupational therapy MH - exercise MH - injury MH - United Kingdom MH - pathogenesis MH - hip fracture MH - bone fragility MH - health MH - anamnesis MH - examination MH - bone MH - environmental factor MH - daily life activity MH - skill MH - syncope MH - vitamin D AB - The two most important determinants in the pathogenesis of hip fractures are firstly, bone fragility and secondly the propensity to fall. Therefore measures to prevent fractures should focus on preventing falls as well as on optimising bone health. Comprehensive history taking and skilled examination as well as organising appropriate investigations are required in order to identify modifiable risk factors. Causes of falls can be classified broadly into the following categories: 1. Acute medical conditions; 2. Chronic medical conditions; 3. Medications deficiencies; 4. Nutritional deficiencies; and 5. Environmental factors Reducing the risk of falls requires dealing with any of the modifiable risk factors identified (as above). A multi-disciplinary approach is often essential particularly where gait, balance, environmental problems and impaired activities of daily living issues are contributory factors. Falls intervention strategies can be broadly divided into multifactorial and unifactorial: 1. Multifactorial approach.Risk factor modification (including medication review, balance and gait training and improvement in functional skills) led to a significant 31% reduction in falls [Tinetti et al.1994]. AUK study showedthat in the follow up of older people presenting to emergency department with a fall, a structured medical and occupational therapy home assessment produced a sustained and significant reduction in falls [Close et al. 1999]. Other studies have shown that the multi-factorial approaches can also reduce falls in care home populations [Jensen et al. 2002]. 2. Unifactorial approach. Individually targeted exercise programmes can reduce falls and injuries for community dwelling older people [Campbell et al. 1997]. Withdrawal of psychotropic medication can significantly reduce the individuals risk of falling; however permanent withdrawal can be difficult to achieve. Several studies have shown that Vitamin D can reduce the risk of falls in community dwelling and care home populations, although recent pragmatic trials in the UK have been negative [Bischoff-Ferrari et al., 2004]. A study of expeditedsignificant reduction in fall rates of 34% and a significant reduction in fractures of 77% [Harwood et al. 2005]. Those falls associated with syncope and those which remain unexplained after initial assessment require specialised investigations including tilt testing to identify cardiogenic causes. IS - 8756-3282 DO - http://dx.doi.org/10.1016/j.bone.2009.03.017 LG - English SL - English PT - Journal: Conference Abstract EM - 200900 DD - 20100427 YR - 2009 CR - Copyright 2010 Elsevier B.V., All rights reserved. XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=emed9&AN=70111476 <15> DB - EMBASE Classic+EMBASE UI - 70094458 AU - Gilani A. IN - (Gilani) Health Inequalities Pharmacist, United Kingdom AD - A. Gilani, Health Inequalities Pharmacist, United Kingdom. E-mail: alia.gilani@nhs.net OT - Evidence-based therapy in health inequalities. SO - Journal of Pharmacy and Pharmacology. Conference: British Pharmaceutical Conference Manchester United Kingdom. Conference Start: 20090906 Conference End: 20090909. Conference: British Pharmaceutical Conference Manchester United Kingdom. Conference Start: 20090906 Conference End: 20090909. Conference Publication: (var.pagings). 61 (pp A149), 2009. Date of Publication: September 2009. PB - Pharmaceutical Press UR - http://docserver.ingentaconnect.com/deliver/connect/rpsgb/00223573/v61n7x1/s11.pdf?expires=1267574654&id=55343426&titleid=1472&accname=Elsevier+Science&checksum=B484D6ACB1C952E87F592AA5F90DBC29 MH - *health MH - *evidence based practice MH - *therapy MH - hospital MH - community MH - population MH - diabetes mellitus MH - pharmacy MH - Asian MH - drug therapy MH - mortality MH - general practice MH - pharmacist MH - morbidity MH - patient MH - lifestyle MH - language MH - health service MH - aged MH - health care personnel MH - consultation MH - social care MH - vulnerable population MH - risk MH - cardiovascular disease MH - cultural factor MH - United Kingdom MH - autoregulation MH - model MH - national health service MH - speech MH - administrative personnel AB - Background: The south Asian population in the United Kingdom are up to six times more likely to get diabetes and are at a higher risk of cardiovascular disease, which accounts for higher morbidity and premature mortality. [1] South Asians have been described as a 'hard to reach' group. [2] Cultural factors can determine lifestyle behaviours, which are detrimental to their diabetes, and there is a higher level of deprivation among this group. [3,4] South Asian patients with diabetes are less likely to be prescribed key drugs. [5] There is evidence of self-regulation of diabetic drugs among this group with cultural beliefs having a role in this. [2] Changing the model of care: In Glasgow, a general practice-based pharmacist medication review service was established in 1997. It became apparent that it was not meeting the needs of south Asian individuals: attendance at these clinics was less than 50% compared with greater than 80% for the indigenous population. 1. Changing the National Health Service (NHS) invitation process: as a result of low attendance to pharmacy-led clinics, the following service was adapted: we targeted high south Asian-populated general practices and invited them to attend using an Urdu-speaking administrator to ensure the first point of contact being in Urdu; a language that most south Asians understand. This lead to an increase of greater than 80% attendance to pharmacy-led clinics. 2. Enabling access through community venues: access to health services is an inequality that exists in the south Asian population. To tackle this, clinics were set up in community venues. Examples of venues targeted were a mosque, elderly and voluntary centres. 3. Using community pharmacies: community pharmacies can be easily accessed by 99% of the population, even in the most deprived areas.[7] Regular and opportunistic customers were targeted to attend a diabetic medication review clinic, which was set up in a community pharmacy that was located in an area with a high population of south Asians. 4. Setup of a new access point: increased demand for the service has resulted in formation of minority ethnic long-term medicines service (MELTS). MELTS is an open referral service for any minority ethnic patient who wishes a medication review. Referral to the service can be made via self referral, a family member or any health care professional. Agreement has been gained from the local consultant diabetologists group who have agreed to refer individuals in from secondary care. Discussion: The processes described in steps 1-4 have enabled vulnerable individuals, including asylum seekers with long-term conditions, living in areas of socioeconomic deprivation to access an outreach pharmacist service. This has resulted in an increase in the prescribing of medicines, which will impact favourably on morbidity and mortality. There is onward referral to the wider primary health and social care team and an increase in the detection of conditions. This service has shown that pharmacyled clinics in a variety of settings can tackle access issues and health inequalities among a vulnerable population. IS - 0022-3573 LG - English SL - English PT - Journal: Conference Abstract EM - 200900 DD - 20100412 YR - 2009 CR - Copyright 2010 Elsevier B.V., All rights reserved. XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=emed9&AN=70094458 <16> DB - EMBASE Classic+EMBASE UI - 70079350 AU - Muramatsu R.S. AU - Goebert D. IN - (Muramatsu) University of Hawaii John A. Burns, School of Medicine, Deparment of Psychiatry, Honolulu, HI, United States (Goebert) University of Hawaii John A. Burns, School of Medicine, Department of Psychiatry, Honolulu, HI, United States AD - R.S. Muramatsu, University of Hawaii John A. Burns, School of Medicine, Deparment of Psychiatry, Honolulu, HI, United States OT - Psychiatric service needs and perceptions in Hawaii nursing facilities. SO - American Journal of Geriatric Psychiatry. Conference: AAGP Annual Meeting 2009 Honolulu, HI United States. Conference Start: 20090305 Conference End: 20090308. Conference: AAGP Annual Meeting 2009 Honolulu, HI United States. Conference Start: 20090305 Conference End: 20090308. Conference Publication: (var.pagings). 17 (pp A132), 2009. Date of Publication: March 2009. PB - Lippincott Williams and Wilkins MH - *nursing MH - *mental health service MH - *United States MH - mental health MH - long term care MH - aged MH - diagnosis MH - administrative personnel MH - personnel MH - training MH - community MH - aging MH - population MH - health care MH - policy MH - nursing home MH - mental disease MH - disabled person MH - social work MH - psychiatric treatment MH - dementia MH - suicide MH - employee MH - substance abuse MH - consultation MH - drug therapy MH - monitoring MH - professional standard MH - patient AB - With the aging of the population, mental health issues in long-term care settings are anticipated to become an ever more prominent focus of health care and public policy. Nursing homes have traditionally been recognized as having a great need for mental health services given that psychiatric illness and diagnoses are common in their clients. Despite this, many clients have gone untreated because of a lack of accessible psychiatric providers and available services. Hawaii nursing facilities face additional challenges with a more diverse ethnic and cultural mix, sicker and more disabled patients, facilities at near-maximum or maximum capacities, and higher costs of operations. The primary purpose of this study was to examine the characteristics of nursing facilities in the State of Hawaii and to assess their psychiatric services, needs and perceptions. We sent surveys to 188 multidisciplinary staff from 47 facilities and received 98 individual staff responses (52% response rate) from 42 facilities (89% response rate). In this first paper, we report the individual perceptions and needs of nursing facility administrators, medical directors, directors of nursing, and directors of social work. Overall, psychiatric treatment recommendations were considered effective and practical. Behavioral management of dementia (93.6%) was, by far, the most requested educational topic followed by depression and suicide (77.7%), basic mental health of the elderly (71.3%), and employee stress related to working with elderly (72.3%). Substance abuse (26.7%) and interviewing techniques (30.9%) were the lowest. Psychiatric consultant services deemed most helpful were pharmacologic treatment (88.4%), diagnostic evaluation (86.3%), and psychotropic medication review and monitoring (83.2%) while least helpful were nursing facility research (7.4%) and administrative support (18.9%). The magnitude of importance and ranking was significantly different by professional role. Understanding the overall needs and perceptions of key nursing facility personnel, as well as the differences between them and where they diverge from one another, is an important step not only in developing effective training programs but also in creating a sensitive and meaningful approach to working collaboratively with the whole group on the development of a comprehensive plan that addresses the mental health and psychiatric service needs of the long-term care community and its patients. IS - 1064-7481 DO - http://dx.doi.org/10.1097/01.JGP.0000346964.46544.ec LG - English SL - English PT - Journal: Conference Abstract EM - 200900 DD - 20100322 YR - 2009 CR - Copyright 2010 Elsevier B.V., All rights reserved. XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=emed9&AN=70079350 <17> DB - EMBASE Classic+EMBASE UI - 70070124 AU - Harren C. IN - (Harren) Specialized Outreach Services, Ontario Shores Centre for Mental Health Sciences, Toronto, ON, Canada AD - C. Harren, Specialized Outreach Services, Ontario Shores Centre for Mental Health Sciences, Toronto, ON, Canada OT - HD: The view from Ontario Shores. SO - Clinical Genetics. Conference: 2009 World Congress on Huntington's Disease Vancouver, BC Canada. Conference Start: 20090912 Conference End: 20090915. Conference: 2009 World Congress on Huntington's Disease Vancouver, BC Canada. Conference Start: 20090912 Conference End: 20090915. Conference Publication: (var.pagings). 76 (pp 22), 2009. Date of Publication: September 2009. PB - Blackwell Publishing Ltd MH - *Canada MH - *Huntington chorea MH - mental health MH - hospital MH - nursing MH - counseling MH - model MH - social welfare MH - case study MH - drug therapy MH - rehabilitation center MH - health science MH - community MH - neuropsychiatry MH - education MH - follow up MH - hospital patient MH - long term care MH - tertiary health care AB - This presentation will provide an overview of the mental health, cognitive, behavioural and physical concerns that can arise in clients who have Huntington Disease, and the role that the Neuropsychiatry Rehabilitation Service (NRS) of Ontario Shores Centre for Mental Health Sciences plays in the HD community in Ontario. Access to this tertiary care centre and common reasons referrals are made, along with the types of services that can be obtained, will also be discussed. The NRS Program offers outreach assessment and follow-up visits as well as inpatient services, to individuals who have HD and who reside at home, in a long-term care facility or who are in a Schedule 1 hospital. A comprehensive nursing and behavioural assessment is completed to assist in symptom management utilizing a variety of modalities including the development of a plan of care that is individualized and specific to that client's goals. This plan must also have the flexibility to address the client's changing needs and have an awareness of the contextual variables that may be instigating or reinforcing behaviours. Examples of such strategies include counseling and support, medication review and stabilization, environmental manipulation, adaptive equipment, and positive behavioural support strategies, all done within an evidencebased practice model. Working in conjunction with other community service providers, NRS staff also perform an education and advocacy role to increase awareness, enhance services and supports, and promote the need for ongoing research. Practical management strategies will be outlined in a case-study format with specific examples of successful interventions that participants can utilize. IS - 0009-9163 DO - http://dx.doi.org/10.1111/j.1399-0004.2009.01266.x LG - English SL - English PT - Journal: Conference Abstract EM - 200900 DD - 20100513 YR - 2009 CR - Copyright 2010 Elsevier B.V., All rights reserved. XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=emed9&AN=70070124 <18> DB - EMBASE Classic+EMBASE UI - 70069407 AU - Van Doormaal J. AU - Rommers M. AU - Kosterink J. AU - Teepe-Twiss I. AU - Haaijer-Ruskamp F. AU - Mol P. IN - (Van Doormaal, Kosterink) Hospital and Clinical Pharmacy, University Medical Center Groningen, Groningen, Netherlands (Rommers, Teepe-Twiss) Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, Netherlands (Haaijer-Ruskamp, Mol) Clinical Pharmacology, University Medical Center Groningen, Groningen, Netherlands AD - J. Van Doormaal, Hospital and Clinical Pharmacy, University Medical Center Groningen, Groningen, Netherlands OT - Comparing methods to identify patients at risk of medication related harm. SO - Pharmacoepidemiology and Drug Safety (PDS). Conference: 25th International Conference on Pharmacoepidemiology and Therapeutic Risk Management Providence, RI United States. Conference Start: 20090816 Conference End: 20090819. Conference: 25th International Conference on Pharmacoepidemiology and Therapeutic Risk Management Providence, RI United States. Conference Start: 20090816 Conference End: 20090819. Conference Publication: (var.pagings). 18 (S1) (pp S243), 2009. Date of Publication: August 2009. PB - John Wiley and Sons Ltd MH - *drug therapy MH - *patient MH - *risk management MH - *risk MH - *pharmacoepidemiology MH - computerized provider order entry MH - internal medicine MH - hospital care MH - ward MH - medication error MH - cross-sectional study MH - book MH - pharmacist MH - safety MH - intoxication MH - drug interaction MH - decision support system AB - Background: With the introduction of Computerised Physician Order Entry (CPOE) in routine hospital care much effort is put in refining Clinical Decision Support Systems (CDSS) to identify patients at risk of preventable medication related harm. Objectives: To compare to what extent patients at risk for medication related harm as identified by basic CDSS and clinical rules (more advanced CDSS) actually need a change in medication as indicated by a medication error (ME) identified by medication review. Methods: In this cross-sectional study dosing and prescribing MEs were identified through manual medication review of 313 patients admitted during 5 months to an internal medicine ward by a trained pharmacist. In a test setting the medication orders (MOs) of these patients were entered into a CPOE with basic CDSS and generated safety alerts were collected. A set of 16 clinical rules was applied to the patient and prescribing data in MS Access 2003. Overlap between CDSS and clinical rules was determined. Results: Medication review identified 2171 MEs of which 57 were classified as an overdose (OD) and 143 as prescribing errors (e.g. drug-drug interactions (DDI) or contra-indication). CDSS identified 297 ODs, with sensitivity 0.32, specificity 0.92 and positive predictive value (ppv) 0.06; and 365 DDIs, with sens. 0.96, spec 0.91 and ppv 0.12. The clinical rules identified 78 (39%) of the 200 OD and prescribing errors at which they were targeted. In 72 (23%) of 313 alerts generated a change of medication was actually indicated. When combined CDSS and rules identified 131 (66%) of the 200 errors. Conclusions: Clinical rules combined with basic CDSS hold promise for routine use to identify patients at risk of preventable harm, but still for a considerable number of alerts no subsequent change in medication is needed. IS - 1053-8569 DO - http://dx.doi.org/10.1002/pds.1806 LG - English SL - English PT - Journal: Conference Abstract EM - 200900 DD - 20100513 YR - 2009 CR - Copyright 2010 Elsevier B.V., All rights reserved. XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=emed9&AN=70069407 <19> DB - EMBASE Classic+EMBASE UI - 70052684 AU - Newall F.H. AU - Doan J. AU - Wallace T. AU - Ignjatovic V. AU - Monagle P. IN - (Newall, Doan, Monagle) Paediatrics, University of Melbourne, Parkville, Australia (Wallace) Clinical Haematology, Royal Childrens Hospital, Parkville, Australia (Ignjatovic) Murdoch Childrens Research Institute, University of Melbourne, Parkville, Australia AD - J. Doan, Paediatrics, University of Melbourne, Parkville, Australia OT - Compliance of antithrombotic management with paediatric guidelines. SO - Journal of Thrombosis and Haemostasis. Conference: 22nd Congress of the International Society of Thrombosis and Haemostasis Boston, MA United States. Conference Start: 20090711 Conference End: 20090716. Conference: 22nd Congress of the International Society of Thrombosis and Haemostasis Boston, MA United States. Conference Start: 20090711 Conference End: 20090716. Conference Publication: (var.pagings). 7 (S2) (pp 1080), 2009. Date of Publication: July 2009. PB - Blackwell Publishing Ltd MH - *hemostasis MH - *thrombosis MH - *society MH - drug therapy MH - therapy MH - patient MH - hospital patient MH - adult MH - child MH - pediatric hospital MH - physician MH - medical audit MH - ward MH - prevention MH - thromboembolism MH - college MH - thorax MH - monitoring MH - *anticoagulant agent MH - acetylsalicylic acid MH - clopidogrel MH - dipyridamole MH - tissue plasminogen activator MH - heparin MH - enoxaparin MH - warfarin AB - Paediatric guidelines for treatment and prevention of thromboembolism - including the American College of Chest Physicians (ACCP) guidelines (2008) - are challenged by a lack of high-grade evidence. Many recommendations are extrapolated from adult guidelines; this is problematic due to age-related differences between children and adults. No study has previously determined compliance of antithrombotic therapy with paediatric guidelines. A prospective 100-day chart audit was conducted at the Royal Children's Hospital: this report presents the initial results of the first 75 days. Eligible children were admitted to any of the inpatient wards (specified in table) and received at least one antithrombotic medication. Review of patient charts and notes was performed to assess compliance with recommendations. Medications assessed were: unfractionated heparin, enoxaparin, warfarin, aspirin, clopidogrel, dipyridamole and tissue plasminogen activator. Compliance of administration was defined as being consistent with indications listed in the ACCP guidelines. 383 inpatients from the selected units received antithrombotic medications during the study period, with 3008 medication administrations documented for these patients. Compliance with ACCP recommendations with regard to indication for therapy was 84.3%. Further analysis will assess compliance with dosage and monitoring guidelines. Given the lack of evidence behind many guidelines, most of them Grade 2C, this study suggests clinicians find the guidelines very useful as a starting point when considering therapy. Table represented. IS - 1538-7933 DO - http://dx.doi.org/10.1111/j.1538-7836.2009.03473-2.x LG - English SL - English PT - Journal: Conference Abstract EM - 200900 DD - 20100219 YR - 2009 CR - Copyright 2010 Elsevier B.V., All rights reserved. XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=emed9&AN=70052684 <20> DB - EMBASE Classic+EMBASE UI - 70052064 AU - DeSancho M.T. AU - Carlson K.S. AU - Mallik A. IN - (DeSancho, Carlson, Mallik) Medicine, Division of Hematology-Medical Oncology, Weill Cornell Medical College, New York, United States AD - M.T. DeSancho, Medicine, Division of Hematology-Medical Oncology, Weill Cornell Medical College, New York, United States OT - A case of spontaneous heparin induced thrombocytopenia and thrombosis. SO - Journal of Thrombosis and Haemostasis. Conference: 22nd Congress of the International Society of Thrombosis and Haemostasis Boston, MA United States. Conference Start: 20090711 Conference End: 20090716. Conference: 22nd Congress of the International Society of Thrombosis and Haemostasis Boston, MA United States. Conference Start: 20090711 Conference End: 20090716. Conference Publication: (var.pagings). 7 (S2) (pp 870-871), 2009. Date of Publication: July 2009. PB - Blackwell Publishing Ltd MH - *thrombosis MH - *hemostasis MH - *heparin induced thrombocytopenia MH - *society MH - thrombocyte count MH - surgery MH - exposure MH - anticoagulation MH - thrombocytopenia MH - knee arthroplasty MH - risk factor MH - case report MH - pathophysiology MH - deep vein thrombosis MH - drug therapy MH - enzyme immunoassay MH - diagnosis MH - serotonin release MH - assay MH - bone marrow biopsy MH - hyperplasia MH - thrombocyte MH - Doppler flowmetry MH - male MH - heparin MH - warfarin MH - prednisone MH - argatroban MH - chondroitin sulfate MH - autoantibody MH - antibody MH - chemokine MH - thrombocyte factor 4 MH - proteoglycan AB - Introduction: Platelet factor-4 (PF4) is a chemokine that binds hepa- rin and heparin-like molecules after release from platelet alpha-granules. Auto-antibodies produced against heparin: PF4 result in a syndrome called heparin-induced thrombocytopenia and thrombosis (HITT). Exogenous heparin exposure is the major risk factor for HITT with only 5 case reports of 'spontaneous' HITT reported in the literature to date. Methods: We report the case of a 60-year-old male who developed severe thrombocytopenia (15,000 per muL) and bilateral deep venous thrombosis 10 days after bilateral knee replacement. He received post-operative pharmacologic thromboprophylaxis with warfarin. The decline in platelet count was noted 8 days after surgery. Pre- and peri-operative medication review showed no evidence of heparin exposure. Enzyme immunoassay (PF4 Enhanced GTi Diagnostics) was positive (3.0 OD) and the serotonin release assay was reported positive. Bone marrow biopsy revealed megakaryocytic hyperplasia. Results: Anticoagulation was initiated with argatroban with a target aPTT of 50-60 s. Prednisone was initiated at 1 mg/kg/day with the addition of IVIg at 500 mg/kg x 4 doses on post-operative day 26. With 2 days of initiation of IVIg, his platelet count began to increase. He continued anticoagulation with argatroban and was bridged to warfarin when his platelet count reached 100 x 103/muL along with oral prednisone taper. Repeat heparin: PF4 antibodies were negative 3 months after the event at 0.386 OD. 6 months later, there was residual DVT noted on Doppler ultrasound. Conclusions: This case represents the third 'spontaneous' episode of HITT in the context of knee replacement surgery without heparin administration. As with the first reported case, warfarin thrombopro- phylaxis was given. It is unclear whether these cases are a result of exposure to a heparin-like proteoglycan such as chondroitin sulfate during surgery that binds PF4, or whether the peri-operative pro- inflammatory milieu is the inciting event. Further consideration of precipitating events in these individuals merits further investigation and may lead valuable insight into pathophysiology of heparin-inde- pendent PF4-related thrombocytopenia and thrombosis. IS - 1538-7933 DO - http://dx.doi.org/10.1111/j.1538-7836.2009.03473-2.x LG - English SL - English PT - Journal: Conference Abstract EM - 200900 DD - 20100219 YR - 2009 CR - Copyright 2010 Elsevier B.V., All rights reserved. XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=emed9&AN=70052064 <21> DB - EMBASE Classic+EMBASE UI - 70036590 AU - Nash J.D. AU - Tran H.T. AU - Bodenberg M. IN - (Nash, Tran, Bodenberg) Sullivan University College of Pharmacy, 2100 Gardiner Ln., Louisville, KY 40205, United States AD - J.D. Nash, Sullivan University College of Pharmacy, 2100 Gardiner Ln., Louisville, KY 40205, United States. E-mail: jnash@sullivan.edu OT - A current review of pharmacy school faculty providing Part D Medication Therapy Management (MTMP) services at primary practice sites. SO - Journal of Managed Care Pharmacy. Conference: AMCP's 2009 Educational Conference San Antonio, TX United States. Conference Start: 20091007 Conference End: 20091009. Conference: AMCP's 2009 Educational Conference San Antonio, TX United States. Conference Start: 20091007 Conference End: 20091009. Conference Publication: (var.pagings). 15 (7) (pp 572), 2009. Date of Publication: September 2009. PB - Academy of Managed Care Pharmacy (AMCP) MH - *medication therapy management MH - *school MH - certification MH - drug therapy MH - pharmacy MH - patient MH - pharmacist MH - hospital MH - community MH - documentation MH - reimbursement MH - resuscitation MH - health care MH - geriatric patient MH - computer program MH - solid MH - faculty practice MH - outpatient department MH - adult MH - college MH - oncology MH - immunization MH - asthma MH - education AB - BACKGROUND: Since the inception of Part D Medication Therapy Management Programs (MTMP) the number of pharmacists delivering MTMP services has varied. Some plans utilize in-house or existing network pharmacists to deliver MTMP services while creating options for members to opt-in or out of the program. College of Pharmacy faculty has struggled to receive reimbursement for MTMPs even though eligible members may already receive these services. OBJECTIVE: To review current faculty practice sites, qualifications, and documentation and billing standards with regards to providing MTMP services. Additionally, to determine if patients receiving MTMP services are provided a comprehensive medication review (CMR), medication action plan (MAP), and personal medication record (PMR). METHODS: Department of Clinical and Administrative Sciences faculty were administered a 23-question survey using Zoomerang. RESULTS: Eight out 12 faculty members completed the survey. Primary practice sites identified were mainly hospital and ambulatory clinic-based (62% and 25%, respectively) serving adult and geriatric patients while no faculty practiced within a community pharmacy setting. Fifty percent reported being Board of Pharmaceutical Specialties (BPS) certified, 75% in pharmacotherapy, and 25% in oncology. No faculty obtained certification through the Commission for Certification in Geriatric Pharmacy, while some highlighted immunization, asthma education, and Advanced Cardiac Life Support certifications. Two reported basic life support certification, while one member was trained and certified to deliver MTMP by the American Pharmacists Association. All faculty have obtained a National Provider Identifier (NPI) code but are currently not billing for services. Twenty-five percent have been trained through Outcomes Pharmaceutical Health Care and are currently providing MTMP services at sites. Sixty-seven percent of all services provided are being documented within the institution's software system. Out of those providing MTMP services, the following elements are being given to the patient: 33% PMR, 67% MAP, and 100% CMR. CONCLUSIONS: Results suggest many opportunities to develop practice sites within the community pharmacy setting and to enhance existing services provided within hospital or ambulatory-based sites. Faculty need to explore opportunities to provide, bill, and receive reimbursement for MTMP services. Documentation of MTMP services through a solid, reputable application will be necessary to show clinical outcomes and ensure that all elements are provided to patients. IS - 1083-4087 LG - English SL - English PT - Journal: Conference Abstract EM - 200900 DD - 20100118 YR - 2009 CR - Copyright 2009 Elsevier B.V., All rights reserved. XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=emed9&AN=70036590 <22> DB - EMBASE Classic+EMBASE UI - 70036504 AU - Johnson T. AU - Sabharwal S. AU - Velez K.A. IN - (Johnson, Sabharwal, Velez) VA Boston Healthcare System, West Roxbury, MA, United States (Johnson, Sabharwal) Harvard Medical School, Boston, MA, United States (Velez) Tufts Medical Center, Boston, MA, United States AD - T. Johnson, VA Boston Healthcare System, West Roxbury, MA, United States OT - Oral baclofen withdrawal and hyperthermia in SCI. SO - Journal of Spinal Cord Medicine. Conference: Congress on Spinal Cord Medicine and Rehabilitation Dallas, TX United States. Conference Start: 20090923 Conference End: 20090926. Conference: Congress on Spinal Cord Medicine and Rehabilitation Dallas, TX United States. Conference Start: 20090923 Conference End: 20090926. Conference Publication: (var.pagings). 32 (4) (pp 484), 2009. Date of Publication: 2009. PB - American Paraplegia Society MH - *hyperthermia MH - *rehabilitation MH - *spinal cord MH - critically ill patient MH - drug therapy MH - patient MH - liquid MH - bladder irrigation MH - bleeding MH - puncture MH - seizure MH - thrombocyte MH - drug megadose MH - thyroid gland MH - intrathecal drug administration MH - spinal cord injury MH - case report MH - human MH - community hospital MH - death MH - intensive care MH - acute respiratory failure MH - pneumonia MH - quadriplegia MH - rectum temperature MH - cooling MH - international normalized ratio MH - *baclofen MH - sodium chloride MH - vitamin K group MH - fresh frozen plasma MH - neuroleptic agent MH - antihypertensive agent MH - hypertensive factor MH - lorazepam AB - Objective: Reinforce the importance of continuing baclofen in critically ill patients with spinal cord injury (SCI) and considering oral baclofen withdrawal as a cause for hyperthermia in that setting. Design: Case report. Participants/Methods: A 57-year-old man with C5 ASIA B tetraplegia was transferred from a community hospital to a critical care unit secondary to acute respiratory failure. He had been diagnosed with pneumonia 2 days prior to admission. Four hours after transfer, he was found shaking uncontrollably and had a rectal temperature of 109degree F. Results: Ativan 2-mg IV was given due to seizure concern. Cooling blankets with ice packs were applied. Cold IV fluids and bladder irrigation with cold saline was also initiated. Significant blood loss occurred from puncture sites. He received fresh frozen plasma, platelets, and vitamin K for an INR of 4.0. Medication review did not reveal neuroleptic agents or other drugs commonly associated with hyperthermia. The patient had been on high doses of oral baclofen (210 mg) and retrospectively there was suspicion that he may have missed some doses during transfer. Thyroid panel was normal. The patient became hypotensive despite pressors. He was unresponsive and passed away the next morning. Conclusion: Baclofen withdrawal is known to cause hyperthermia which may lead to multi-organ failure and death. While it is more common in those receiving the intrathecal form, it is important to be aware that it can also occur with withdrawal from high intakes of the oral medication. Clinicians must be alert that sufficient baclofen doses are continued in critically ill patients to prevent this life-threatening condition. IS - 1079-0268 LG - English SL - English PT - Journal: Conference Abstract EM - 200900 DD - 20100118 YR - 2009 CR - Copyright 2009 Elsevier B.V., All rights reserved. XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=emed9&AN=70036504 <23> DB - EMBASE Classic+EMBASE UI - 70007977 AU - Dziehan M. AU - Cheat W.Y. AU - Thiruvanackan K.A.L. AU - Azmiah N. AU - Hui C.B. AU - Sariam N. AU - Syafinaz U. AU - Hassali A. AU - Ali S.M. IN - (Dziehan) KK Telok Panglima Garang, PKD Kuala Langat (Cheat) KK Ampang, PKD Hulu Langat (Thiruvanackan) KK Shah Alam, PKD Petaling (Azmiah) KK Anika, PKD Klang (Hui) KK Sg Pelek, PKD Sepang (Sariam) KK Bukit Kuda (Syafinaz, Ali) PKD Klang (Hassali) KK Pandamaran AD - M. Dziehan, KK Telok Panglima Garang, PKD Kuala Langat. E-mail: salmi85@yahoo.com OT - A prospective multicentre study of pharmacist initiated programme of 'Medication Therapy Management' (MTM) in government primary health clinic in the state of Selangor. SO - Pharmacy World and Science. Conference: PCNE 7th Working Conference. Conference: PCNE 7th Working Conference. Conference Publication: (var.pagings). 31 (4) (pp 498), 2009. Date of Publication: August 2009. PB - Kluwer Academic Publishers MH - *pharmacist MH - *health center MH - *government MH - *medication therapy management MH - patient MH - drug therapy MH - health care MH - treatment outcome MH - Student t test MH - cholesterol blood level MH - creatinine clearance MH - clinical pharmacy MH - hospital department MH - motivation MH - pharmacy MH - empowerment MH - hospital MH - emergency MH - disease course MH - quality of life MH - health MH - drug use MH - medical service MH - prospective study MH - outpatient department MH - diabetes mellitus MH - hypertension MH - physician MH - statistical analysis MH - Malaysia MH - hemoglobin A1c AB - Relevance of the work Besides improvement of treatment outcome, Home Medication Review (HMR) also can reduce incident of unscheduled appointment, reduce cost due to wastage of unused medication at home, and increase patient empowerment to manage their disease at home more effectively, reduce repeated admission to hospital emergency dept due to disease progression / complication, Improve patient's Quality Of Life, and reduce cost on treatment for disease complication in future, improve patient's perception towards the service provided by Ministry of health Malaysia (MoH) and HMR allowed pharmacists to contribute to some clinical activities at healthcare centre. Aim The aim of this study is to evaluate treatment outcome, enhanced patient understanding on drug use and reduce need for the costly medical services to treat complication in future from 'Medication Therapy Management' (MTM) program initiated by pharmacist at primary health clinic in Selangor. Methods This is a prospective study performed in five clinics examining the implications of pharmacist's interventions. Patient recruited (FMS/MO referred patient based on selection criteria) and the data collected are from August 2007 until May 2008. This program focuses on uncontrolled Diabetes Mellitus and or uncontrolled Hypertension patient which will be followed up by pharmacist at every doctor's appointment. Results There is a significant result after comparing monitored parameter before and after MTM program using statistical analysis Paired t-test (p = 0.001). There is a reduction on BP systolic p = 0.01, BP diastolic p = 0.0005, FBS p = 0.0005, HbA1C p = 0.0005, Total Cholesterol p = 0.01 and complexity of regimen p = 0.0005. Other interesting results are (1) improvement on patient medication knowledge by increase score DFIT p = 0.0005; (2) maintaining patient's renal condition from deteriorating when there is no significant result on reducing creatinine clearance (CrCL) and comparison mean CrCL before and after show result of CrCL above 50 ml/min. (3) There is no significant result in cost of medication prescribed for patient per month before and after MTM program. Discussion This study proves that MTM program is a good preventive program which can benefit in terms of; (1) saving cost of medication for treating complication of the disease and (2) cost of treatment complication of uncontrolled DM and or HPT in future. Conclusion The program promotes involvement of pharmacists at healthcare centres in Clinical Pharmacy activities which bring new image of pharmacy services at primary healthcare level. This could enhance recognition and motivation for pharmacy career and development. IS - 0928-1231 DO - http://dx.doi.org/10.1007/s11096-009-9298-8 LG - English SL - English PT - Journal: Conference Abstract EM - 200900 DD - 20091120 YR - 2009 CR - Copyright 2009 Elsevier B.V., All rights reserved. XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=emed9&AN=70007977 <24> DB - EMBASE Classic+EMBASE UI - 2009523151 AU - Leikola S.N.S. AU - Tuomainen L. AU - Ovaskainen H. AU - Peura S. AU - Sevon-Vilkman N. AU - Tanskanen P. AU - Airaksinen M.S.A. IN - (Leikola, Airaksinen) Faculty of Pharmacy, University of Helsinki, Finland (Tuomainen) Centre for Training and Development, University of Kuopio, Finland (Ovaskainen) Finnish Pharmacists' Association, Finland (Peura) Association of Finnish Pharmacies, Finland (Sevon-Vilkman) Pharmaceutical Learning Centre, Finland (Tanskanen) Department of Social Pharmacy, University Pharmacy, University of Kuopio, Finland (Leikola) Kohtolankatu 8D, 08100 Lohja, Finland AD - S. N. S. Leikola, Kohtolankatu 8D, 08100 Lohja, Finland. E-mail: saija.leikola@iki.fi CP - United States TI - Continuing education course to attain collaborative comprehensive medication review competencies. SO - American Journal of Pharmaceutical Education. 73 (6) , 2009. Article Number: 108. Date of Publication: 2009. PB - American Association of Colleges of Pharmacy (1426 Prince Street, Alexandria VA 22314-2815, United States) KW - Continuing education KW - Distance education KW - Experiential learning KW - Medication review UR - http://www.ajpe.org/aj7306/aj7306108/aj7306108.pdf MH - allied health education MH - article MH - *continuing education MH - curriculum MH - education program MH - experiential learning MH - Internet MH - learning MH - pharmacist MH - *professional competence MH - professional practice AB - Objective. To implement a long-term continuing education course for pharmacy practitioners to acquire competency in and accreditation for conducting collaborative comprehensive medication reviews (CMRs). Design. A 1 1/2- year curriculum for practicing pharmacists that combined distance learning (using e-learning tools) and face-to-face learning was created. The training consisted of 5 modules: (1) Multidisciplinary Collaboration; (2) Clinical Pharmacy and Pharmacotherapy; (3) Rational Pharmacotherapy; (4) CMR Tools; and (5) Optional Studies. Assessment. The curriculum and participants' learning were evaluated using essays and learning diaries. At the end of the course, students submitted portfolios and completed an Internet-based survey instrument. Almost all respondents (92%) indicated their educational needs had been met by the course and 68% indicated they would conduct CMRs in their practice. The most important factors facilitating learning were working with peers and in small groups. Factors preventing learning were mostly related to time constraints. Conclusion. Comprehensive medication review competencies were established by a 1 1/2- year continuing education curriculum that combined different teaching methods and experiential learning. Peer support was greatly appreciated as a facilitator of learning by course participants. RF - 39 EC - Public Health, Social Medicine and Epidemiology [17] IS - 0002-9459 EN - 1553-6467 LG - English SL - English PT - Journal: Article EM - 200900 DD - 20091119 YR - 2009 CR - Copyright 2009 Elsevier B.V., All rights reserved. XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=emed9&AN=2009523151 <25> DB - EMBASE Classic+EMBASE UI - 2009336789 AU - Lee E. AU - Braund R. AU - Tordoff J. IN - (Lee) Pharmacy are first, New Plymouth, New Zealand (Braund, Tordoff) School of Pharmacy, University of Otago, PO Box 913, Dunedin, New Zealand AD - J. Tordoff, School of Pharmacy, University of Otago, PO Box 913, Dunedin, New Zealand. E-mail: june.tordoff@otago.ac.nz CP - New Zealand TI - Examining the first year of medicines use review services provided by pharmacists in New Zealand: 2008. SO - New Zealand Medical Journal. 122 (1293) (pp 26-35), 2009. Date of Publication: 24 Apr 2009. PB - New Zealand Medical Association (26 The Terrace, P.O. Box 156, Wellington, New Zealand) UR - http://www.nzma.org.nz/journal/122-1293/3560/content.pdf MH - blister pack MH - cross-sectional study MH - *drug utilization MH - funding MH - health practitioner MH - health service MH - home MH - medical documentation MH - medical fee MH - *medication use review MH - New Zealand MH - patient assessment MH - patient information MH - patient referral MH - *pharmacist attitude MH - pharmacy MH - *professional practice MH - questionnaire MH - review AB - Aim: To determine where in New Zealand collaborative Medication Use Review and Adherence Support (MUR) services were provided by pharmacists, to identify the processes involved, and pharmacists' perceptions of the service. Methods: A questionnaire-based cross-sectional survey was undertaken of 68 of 71 MUR accredited pharmacists that were contactable in May 2008. Results: Fifty-four (79%) of the 68 accredited pharmacists completed the survey. Services were provided in 5/21 (24%) district health boards (DHBs) by 39 pharmacists from 33/897 (3.7%) pharmacies. The eligibility criteria for patients were highly consistent across the DHBs. The median time for pharmacists conducting their initial MUR consultation was 57 minutes. All pharmacists perceived this service to be highly (93%) or moderately valuable (7%) to patients. The main limitations to providing this service were identified as 'no current contract with funders', 'insufficient time', and 'personal circumstances'. Conclusion: By May 2008, collaborative medication review services (MURs) were provided in five DHBs by 39 pharmacists. Limited time since launch and the need for local contract negotiations may have contributed to current participation rates. Studies should be undertaken as the service grows to establish the stakeholders' perceptions of the service, and the impact of MURs on the health outcomes of patients. NZMA. RF - 20 EC - Public Health, Social Medicine and Epidemiology [17], Health Policy, Economics and Management [36] EN - 1175-8716 CD - NZMJA LG - English SL - English PT - Journal: Review EM - 200900 DD - 20090804 YR - 2009 CR - Copyright 2009 Elsevier B.V., All rights reserved. XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=emed9&AN=2009336789 <26> DB - EMBASE Classic+EMBASE UI - 2009296974 AU - Pavsar H. IN - (Pavsar) Mariborske Lekarne, Maribor, Slovenia AD - H. Pavsar, Mariborske Lekarne, Maribor, Slovenia CP - Slovenia TI - Cognitive services in community pharmacy: Pharmaceutical interventions and medication review. [Slovene] OT - Kognitivne storitve v lekarniski sluzbi: Farmacevtske intervencije in pregled terapije. SO - Farmacevtski Vestnik. 60 (2) (pp 127-134), 2009. Date of Publication: May 2009. PB - Slovenian Pharmaceutical Society (Dunajska 184 A, Ljubljana 1000, Slovenia) UR - http://www.sfd.si/modules/catalog/products/prodfile/fv_2_2009.pdf MH - *community care MH - computer program MH - health care cost MH - health economics MH - medical documentation MH - *medication error MH - outcome assessment MH - *pharmacist MH - pharmacy MH - review AB - In 2008 we started in JZZ Mariborske lekarne Maribor with the project Active preforming and documentation of pharmaceutical interventions by dispensing medicines. With active preforming of pharmaceutical interventions we wanted to prevent as many DRP as possible, to improve collaboration of patients in the medication use-process and to reduce presribing errors. With pharmacoeconomic analysis of by computer programe documented DRP , we proved that community pharmacists can make with identification and resolution of DRP by pharmaceutical interventions a substantial benefit to improvement in clinical outcomes of pharmacotherapy, diminish the occurance of DRP, accumulation of unused medication at patients home and related costs. RF - 9 EC - Public Health, Social Medicine and Epidemiology [17], Health Policy, Economics and Management [36], Pharmacy [39] IS - 0014-8229 CD - FMVTA LG - Slovene SL - English, Slovene PT - Journal: Review EM - 200900 DD - 20090721 YR - 2009 CR - Copyright 2009 Elsevier B.V., All rights reserved. XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=emed9&AN=2009296974 <27> DB - EMBASE Classic+EMBASE UI - 2009282544 AU - Barnett N. AU - Oboh L. IN - (Barnett) Older People Northwick Park Hospital, Harrow PCT, East and South East England Specialist Pharmacy Services (Oboh) Primary Care and Community, Lambeth Primary Care Trust, East and South East England Specialist Pharmacy Services AD - N. Barnett, Older People Northwick Park Hospital, Harrow PCT, East and South East England Specialist Pharmacy Services CP - United Kingdom TI - A new medication review guide from NPC Plus and the Medicines Partnership will benefit both pharmacists and patients. SO - Pharmacy in Practice. 19 (2) (pp 53-54), 2009. Date of Publication: March/April 2009. PB - Medicom Group (Thameside House, Hurst Road, Hampton Court, Surrey KT8 9AY, United Kingdom) MH - clinical evaluation MH - clinical medicine MH - clinical practice MH - decision making MH - drug quality MH - drug research MH - drug safety MH - health care personnel MH - *hospital organization MH - human MH - medical specialist MH - *medication review guide MH - *medicine MH - outcome assessment MH - patient MH - patient care MH - patient compliance MH - *pharmacist MH - *practice guideline MH - prescription MH - primary medical care MH - quality of life MH - short survey MH - United Kingdom RF - 2 EC - Public Health, Social Medicine and Epidemiology [17], Health Policy, Economics and Management [36], Pharmacy [39] IS - 1358-1538 CD - PHPRF LG - English PT - Journal: Short Survey EM - 200900 DD - 20090702 YR - 2009 CR - Copyright 2009 Elsevier B.V., All rights reserved. XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=emed9&AN=2009282544 <28> DB - EMBASE Classic+EMBASE UI - 2009236772 AU - Maeda K. IN - (Maeda) Osaka Medical Center for Health Science and Promotion, 1-3-2 Nakamichi, Higashinari-ku, Osaka 537-0025, Japan AD - K. Maeda, Osaka Medical Center for Health Science and Promotion, 1-3-2 Nakamichi, Higashinari-ku, Osaka 537-0025, Japan. E-mail: maeda@kenkoukagaku.jp CP - Japan TI - A systematic review of the effects of improvement of prescription to reduce the number of medications in the elderly with polypharmacy. [Japanese] SO - Yakugaku Zasshi. 129 (5) (pp 634-645), 2009. Date of Publication: May 2009. PB - Pharmaceutical Society of Japan (2-12-15-201, Shibuya, Shibuya-ku, Tokyo 150, Japan) KW - Medication review KW - Pharmacist KW - Polypharmacy UR - http://yakushi.pharm.or.jp/FULL_TEXT/129_5/pdf/631.pdf MH - article MH - *drug use MH - elderly care MH - frail elderly MH - human MH - medical profession MH - *polypharmacy MH - *prescription MH - systematic review AB - Polypharmacy, the use of multiple medications, is commonly prescribed in the elderly but leads to reduced compliance with drug treatment regimens and increased risk of adverse drug reactions. This study was performed to systematically review the results of previous studies to assess the effects of interventions to improve prescription quality on reduction of the number of medications in elderly patients with polypharmacy, and to determine the most effective types of intervention in such cases. Relevant articles in the English language literature were retrieved by keyword searches on MEDLINE, the Cochrane Library, and cited references. The criteria for inclusion in this review were as follows: 1) studies in elderly subjects taking multiple medications or frail elderly subjects assumed to be taking multiple medications; 2) study interventions were intended to improve quality of drug use; 3) changes in the number of medications prescribed during the intervention period were reported; 4) the study designs were controlled clinical studies. Twenty-seven articles, including 28 controlled studies, matched all the inclusion criteria. The interventions in the studies included in the review were categorized into two groups: a medication review by medical professionals (26 studies); and a request to prescribing physicians for re-evaluation of the drug use for their patients (2 studies). Medication reviews by medical professionals, mainly pharmacists, resulted in a significant reduction of prescribed drugs (median, 0.45 drugs; 95%CI, 0.11-0.76). The differences in effects among intervention methods could not be investigated because of a lack of diversity in the methods used. 2009 The Pharmaceutical Society of Japan. RF - 51 EC - Public Health, Social Medicine and Epidemiology [17] IS - 0031-6903 EN - 1347-5231 CD - YKKZA LG - Japanese SL - English PT - Journal: Article EM - 200900 DD - 20090602 YR - 2009 CR - Copyright 2009 Elsevier B.V., All rights reserved. XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=emed9&AN=2009236772 <29> DB - EMBASE Classic+EMBASE UI - 70215811 AU - Hewlett S. AU - Sanderson T. AU - May J. AU - Bingham C.O. AU - March L. AU - Alten R. AU - Pohl C. AU - Woodworth T. AU - Bartlett S. IN - (Hewlett, Sanderson) University of West of England, Bristol, United Kingdom (May) Patient Research Partner, Seattle, WA, United States (Bingham) Johns Hopkins School of Medicine, Baltimore, MD, United States (March) University of Sydney, Sydney, NSW, Australia (Alten, Pohl) University of Berlin, Berlin, Germany (Woodworth) Roche Products, Welwyn Garden City, United Kingdom (Bartlett) McGill University, Montreal, QC, Canada AD - S. Hewlett, University of West of England, Bristol, United Kingdom OT - Just shoot me: RA patients experience flare as more than painful, swollen joints. SO - Rheumatology. Conference: Rheumatology 2010 - British Society for Rheumatology, BSR and British Health Professionals in Rheumatology, BHPR Annual Meeting 2010 Birmingham United Kingdom. Conference Start: 20100420 Conference End: 20100423. Conference: Rheumatology 2010 - British Society for Rheumatology, BSR and British Health Professionals in Rheumatology, BHPR Annual Meeting 2010 Birmingham United Kingdom. Conference Start: 20100420 Conference End: 20100423. Conference Publication: (var.pagings). 49 (pp i141), 2010. Date of Publication: April 2010. PB - Oxford University Press MH - *patient MH - *rheumatology MH - *society MH - *health practitioner MH - self care MH - drug therapy MH - pain MH - fatigue MH - United Kingdom MH - child MH - disease activity MH - clinical trial MH - biological therapy MH - information processing MH - Australia MH - disease duration MH - influenza MH - synovitis MH - noise MH - skin MH - irritability MH - psychosocial withdrawal MH - planning MH - thematic analysis MH - prednisone AB - Background: Defining what is a flare or increase in disease activity in RA is crucial in clinical trials, informing treatment decisions and (in the UK) accessing biologic therapies. The literature only reflects the clinician's definition, yet it is often patients who initiate medication review by deciding they are in flare. This study explored the patient experience and definition of flare. Methods: 8 focus groups were held with RA patients, sampled for a range of characteristics (UK 3, Australia 3, USA 2). Taped discussions were analysed using inductive thematic analysis by a researcher and patient partner independently, reviewed by two further researchers. Results: 37 patients (32F, 5M) were aged from 35-82 yrs (mean 59.2), had a disease duration of 1-50 yrs (17.6), with 92% on DMARDs, 38% on biologics and global opinion VAS 0.4-9.0 (mean 3.96, high bad). Four main themes were identified, underpinned by themes of uncertainty and individual context. Warnings and symptoms: Patients often experience warning of impending flare, usually fatigue and feeling flu-like (I just start to feel tired and slightly unwell) or a single bad joint. Patients say pain is always present but synovitis is not and loss of function is common. Systemic features predominate, such as fatigue, pain all over, sensitivity to noise and light (Even my skin hurts), irritability, tearfulness, physical shut-down (You just can't keep going), cognitive shut-down (Mentally I can't function) and social withdrawal (I can't be around people when it gets really bad). Self-management: Patients try to divert or manage early flare by pacing and planning, hot/cold packs, rest and increasing medication (I increase the prednisone). Defining a flare: Patients define flare as clusters of unprovoked, persistent and unresolving symptoms that affect daily life and are dramatically intense, many voicing that they want to die (I hurt so bad I just wanted to shoot myself). Seeking help: Failure of self-management is the main tipping points for seeking help (When you've tried everything, then you reach for the phone), or inability to run their life (I've got 3 young children, I teach and it's where it gets to the point where I can't function). Individual context: underpinned clustering of symptoms, types of self-management, personal tipping points and delays seeking help. Uncertainty surrounded whether initial symptoms were the start of flare, seeking help too early or too late and remaining drug options/side-effects. Conclusions: Patients experience flare as early warnings, systemic features and intensely distressing symptoms, which differs from a traditional inflammatory paradigm of number of painful/swollen joints. These data suggest it may be necessary to re-define flare in a more patient-centred way. They offer the exciting therapeutic possibility that by paying attention to patient reports of early warning signs, we might intervene before flare is too strongly established. IS - 1462-0324 DO - http://dx.doi.org/10.1093/rheumatology/keq731 LG - English SL - English PT - Journal: Conference Abstract EM - 201030 DD - 20100726 YR - 2010 CR - Copyright 2010 Elsevier B.V., All rights reserved. XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=emed9&AN=70215811 <30> DB - EMBASE Classic+EMBASE UI - 70209559 AU - Terret C. AU - Droz J.P. IN - (Terret, Droz) Centre Leon Berard, Geriatric Oncology Program, Lyon, France AD - C. Terret, Centre Leon Berard, Geriatric Oncology Program, Lyon, France OT - Geriatric assessment in oncology: A tool to provide better cancer care in the elderly. SO - European Journal of Cancer, Supplement. Conference: Joint ECCO 15 - 34th ESMO Multidisciplinary Congress Berlin Germany. Conference Start: 20090920 Conference End: 20090924. Conference: Joint ECCO 15 - 34th ESMO Multidisciplinary Congress Berlin Germany. Conference Start: 20090920 Conference End: 20090924. Conference Publication: (var.pagings). 7 (2-3) (pp 40-41), 2009. Date of Publication: September 2009. PB - Elsevier Ltd MH - *geriatric assessment MH - *aged MH - *neoplasm MH - *oncology MH - patient MH - cancer therapy MH - screening MH - cancer patient MH - health status MH - decision making MH - health MH - mental health MH - population MH - nutritional assessment MH - life expectancy MH - tumor MH - senescence MH - groups by age MH - functional status MH - nurse MH - physiotherapist MH - dietitian MH - social worker MH - pharmacist MH - psychologist MH - general aspects of disease MH - rating scale MH - drug interaction MH - daily life activity MH - geriatrics MH - examination MH - Geriatric Depression Scale MH - drug therapy MH - skill MH - adult MH - national health organization MH - prospective study MH - pilot study MH - model MH - screening test MH - aging MH - social status MH - Lawton instrumental activities of daily living scale AB - The aging population is characterized by an extreme diversity in terms of clinical, functional and social status. As a consequence, life expectancy in older cancer patients is influenced not only by the tumor itself but also by the various comorbidities and geriatric problems associated with old age. The health status of each older individual should be evaluated in order to optimize cancer decision making in this age group. Oncologists are aware of a procedure for detecting older patients whose health problems may interfere with cancer treatment. Multidimensional geriatric assessment (MGA) addresses the major concerns of geriatric assessment (GA), i.e. patients' physical and mental status, their social, environmental and economic situation, their functional status, and geriatric syndromes. The MGA process involves a trained interdisciplinary team usually including a nurse and a geriatric-trained oncologist or a geriatrician, and sometimes a physical therapist, a dietician, a social worker, a pharmacist and a psychologist. Patients' health problems are detected through different validated screening tools: Katz's Activities of Daily Living and Lawton's Instrumental Activities of Daily Living scales; Cumulative Illness Rating Scale for Geriatrics; Timed Up & Go test or Performance-Oriented Assessment of Mobility instrument; Folstein's Mini Mental Status Examination; Geriatric Depression Scale; Mini Nutritional Assessment; medication review and appraisal of potential drug interactions. The findings from these tests provide a better picture of older patients' health status before cancer treatment decision making. Nevertheless, the MGA approach requires geriatric skills that are hardly available in conventional oncology units. Thus, specific screening tools are currently being developed to help oncologists differentiate healthy senior adults from patients whose problems might interfere with cancer treatment and who require more in-depth GA. These instruments must be easy to administer and quick to complete, and not require geriatric resources. The French National Cancer Institute has sponsored a prospective study, ONCODAGE, to validate an innovative geriatric screening tool designed to identify older cancer patients requiring GA before cancer treatment decision-making. The screening tool called G8 is composed of one question about the patient's age and 7 items from the Mini Nutritional Assessment instrument. Results of a pilot study have shown that a total score lower than 14 out of 17 indicates that the patient needs a full GA procedure. G8 will also be compared with the VES-13 instrument and a set of validated geriatric screening tools described earlier. A total population of 1650 newly diagnosed cancer patients will be included in around 15 centres over a 1-year period. Preliminary results are expected by the beginning of 2010. In conclusion, older cancer patients require both cancer and geriatric assessments. The more efficient model could be a two-step procedure including a preliminary screening test followed by a true GA for older patients identified as frail or vulnerable. This approach allows to characterize the patient's health status and to offer appropriate cancer treatment options. Consistent guidelines on cancer treatment in the elderly should be issued after the GA process is standardized. IS - 1359-6349 LG - English SL - English PT - Journal: Conference Abstract EM - 201030 DD - 20100726 YR - 2009 CR - Copyright 2010 Elsevier B.V., All rights reserved. XL - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=emed9&AN=70209559