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1. Deprescribing cholinesterase inhibitors and memantine in dementia: guideline summary

Deprescribing cholinesterase inhibitors and memantine in dementia: guideline summary Deprescribing cholinesterase inhibitors and memantine in dementia: guideline summary | The Medical Journal of Australia mja-search search Use the for more specific terms. Title contains Body contains Date range from Date range to Article type Author's surname Volume First page doi: 10.5694/mja__.______ Search Reset  close Individual Login Purchase options Connect person_outline Login keyboard_arrow_down (...) Individual Login Purchase options menu search Advertisement close Deprescribing cholinesterase inhibitors and memantine in dementia: guideline summary Emily Reeve, Barbara Farrell, Wade Thompson, Nathan Herrmann, Ingrid Sketris, Parker J Magin, Lynn Chenoweth, Mary Gorman, Lyntara Quirke, Graeme Bethune and Sarah N Hilmer Med J Aust 2019; 210 (4): . || doi: 10.5694/mja2.50015 Published online: 4 March 2019 Topics Abstract Introduction: Cholinesterase inhibitors (ChEIs) and memantine are medications used

2019 MJA Clinical Guidelines

2. Deprescribing for Older Veterans: A Systematic Review

Deprescribing for Older Veterans: A Systematic Review Management Briefs eBrief-no170 -- Deprescribing for Older Veterans: A Systematic Review Talk to the Veterans Crisis Line now An official website of the United States government Here's how you know The .gov means it's official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site. The site is secure. The https:// ensures that you're connecting (...) to the official website and that any information you provide is encrypted and sent securely. Search Search the ORD website Button to search HSRD Contact us TTY: 711 × We're here anytime, day or night — 24/7 If you are a Veteran in crisis or concerned about one, connect with our caring, qualified responders for confidential help. Many of them are Veterans themselves. Get more resources at . » » » Management Briefs eBrief-no170 -- Deprescribing for Older Veterans: A Systematic Review Health Services Research

2020 Veterans Affairs - R&D

3. Deprescribing benzodiazepine receptor agonists

Deprescribing benzodiazepine receptor agonists Vol 64: JANUARY | JANVIER 2018 | Canadian Family Physician | Le Médecin de famille canadien 17 CLINICAL PRACTICE GUIDELINES Abstract Objective To develop an evidence-based guideline to help clinicians make decisions about when and how to safely taper and stop antipsychotics; to focus on the highest level of evidence available and seek input from primary care professionals in the guideline development, review, and endorsement processes. Methods (...) The overall team comprised 9 clinicians (1 family physician, 1 family physician specializing in long-term care, 1 geriatric psychiatrist, 2 geriatricians, 4 pharmacists) and a methodologist; members disclosed conflicts of interest. For guideline development, a systematic process was used, including the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. Evidence was generated from a Cochrane systematic review of antipsychotic deprescribing trials for the behavioural

2018 CPG Infobase

4. Deprescribing proton pump inhibitors

Deprescribing proton pump inhibitors 354 Canadian Family Physician • Le Médecin de famille canadien | Vol 63: may • mai 2017 Clinical Practice Guidelines Deprescribing proton pump inhibitors Evidence-based clinical practice guideline Barbara Farrell PharmD ACPR FCSHP Kevin Pottie MD CCFP MClSc FCFP Wade Thompson Taline Boghossian ACPR Lisa Pizzola MSc Farah Joy Rashid ACPR Carlos Rojas-Fernandez PharmD Kate Walsh ACPR Vivian Welch PhD Paul Moayyedi MB ChB PhD MPH Abstract Objective To develop (...) included the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach, with a detailed evidence review in in-person, telephone, and online meetings. Uniquely, the guideline development process included a systematic review of PPI deprescribing trials and examination of reviews of the harm of continued PPI use. Narrative syntheses of patient preferences and resource-implication literature informed recommendations. The team refined guideline content and recommendation wording

2017 CPG Infobase

5. Deprescribing versus continuation of chronic proton pump inhibitor use in adults. Full Text available with Trip Pro

Deprescribing versus continuation of chronic proton pump inhibitor use in adults. Proton pump inhibitors (PPIs) are a class of medications that reduce acid secretion and are used for treating many conditions such as gastroesophageal reflux disease (GERD), dyspepsia, reflux esophagitis, peptic ulcer disease, and hypersecretory conditions (e.g. Zollinger-Ellison syndrome), and as part of the eradication therapy for Helicobacter pylori bacteria. However, approximately 25% to 70% of people (...) are prescribed a PPI inappropriately. Chronic PPI use without reassessment contributes to polypharmacy and puts people at risk of experiencing drug interactions and adverse events (e.g. Clostridium difficile infection, pneumonia, hypomagnesaemia, and fractures).To determine the effects (benefits and harms) associated with deprescribing long-term PPI therapy in adults, compared to chronic daily use (28 days or greater).We searched the following databases: Cochrane Central Register of Controlled Trials

2017 Cochrane

6. Deprescribing Proton Pump Inhibitors

Deprescribing Proton Pump Inhibitors Deprescribing Proton Pump Inhibitors March - April 2018 Mailing Address: Therapeutics Initiative The University of British Columbia Department of Anesthesiology, Pharmacology & Therapeutics 2176 Health Sciences Mall Vancouver, BC Canada V6T 1Z3 Tel.: 604 822 0700 Fax: 604 822 0701 E-mail: info@ti.ubc.ca www.ti.ubc.ca 111 T he first PPI was approved in Canada in 1988. Pronounced and durable reduction of stomach acid production made omeprazole a “blockbuster (...) The apparent association with serious pneumonia may not be causative. 11 Y et strong acidity in the stomach has long evolutionary roots, and acid may function as an “ecological filter” against harmful ingested microbes. 12 An obligation to consider deprescribing? Studies in the US, Australia, and UK found that 40-65% of hospitalized people taking long-term PPIs, and 40-55% of primary care outpatients, had no documented reason for taking a PPI. 13 In BC, 34% of people in residential care did not have

2018 Therapeutics Letter

7. Evidence-based Clinical Practice Guideline for Deprescribing Cholinesterase Inhibitors and Memantine

Evidence-based Clinical Practice Guideline for Deprescribing Cholinesterase Inhibitors and Memantine Evidence-based Clinical Practice Guideline for Deprescribing Cholinesterase Inhibitors and Memantine Developing organisations: The University of Sydney NHMRC Partnership Centre: Dealing with Cognitive and Related Functional Decline in Older People (Cognitive Decline Partnership Centre) Bruyère Research Institute, Deprescribing Guidelines in the Elderly Project Evidence-based clinical practice (...) guideline for deprescribing cholinesterase inhibitors and memantine: 2018 2 © The University of Sydney ISBN Online: 978-0-6482658-0-1 ISBN Print: 978-0-6482658-1-8 Publication date: February 2018 Suggested citation: Reeve E, Farrell B, Thompson W, Herrmann N, Sketris I, Magin P, Chenoweth L, Gorman M, Quirke L, Bethune G, Forbes F, Hilmer S. Evidence-based Clinical Practice Guideline for Deprescribing Cholinesterase Inhibitors and Memantine. Sydney: The University of Sydney; 2018. The full guideline

2018 Clinical Practice Guidelines Portal

8. Primary care: Deprescribing cardiovascular drugs in low-risk patients increases the risk of uncontrolled blood pressure and LDL-cholesterol

Primary care: Deprescribing cardiovascular drugs in low-risk patients increases the risk of uncontrolled blood pressure and LDL-cholesterol Deprescribing cardiovascular drugs in low-risk patients increases the risk of uncontrolled blood pressure and LDL-cholesterol | BMJ Evidence-Based Medicine We use cookies to improve our service and to tailor our content and advertising to you. You can manage your cookie settings via your browser at any time. To learn more about how we use cookies, please (...) see our . Log in using your username and password For personal accounts OR managers of institutional accounts Username * Password * your user name or password? Search for this keyword Search for this keyword Main menu Log in using your username and password For personal accounts OR managers of institutional accounts Username * Password * your user name or password? You are here Deprescribing cardiovascular drugs in low-risk patients increases the risk of uncontrolled blood pressure and LDL

2018 Evidence-Based Medicine

9. Patients beliefs and attitudes towards deprescribing: can deprescribing success be predicted? (Abstract)

Patients beliefs and attitudes towards deprescribing: can deprescribing success be predicted? The ability of questionnaires such as the Patients' Attitudes Towards Deprescribing (PATD) or the Beliefs about Medicines Questionnaire (Specific section) (BMQ-Specific) to successfully identify patients who will deprescribe remains unknown.To determine if screening questionnaires assessing patients' attitudes and beliefs towards medications and deprescribing can predict deprescribing outcomes.This (...) is a post-hoc secondary analysis of the D-PRESCRIBE trial. 489 community-dwelling adults (≥65 years) who were chronic users (≥3 months) of a potentially inappropriate medication were randomized to a pharmacist-led educational intervention or usual care. Association between baseline responses to PATD and BMQ-Specific items and successful deprescribing was calculated. To determine predictive ability of questionnaire items, receiver operating characteristic curves (ROC) were constructed and area under

2019 Research in social & administrative pharmacy : RSAP Controlled trial quality: uncertain

10. Randomised controlled trial: Deprescribing in nursing homes is safe and should be pursued

Randomised controlled trial: Deprescribing in nursing homes is safe and should be pursued Deprescribing in nursing homes is safe and should be pursued | Evidence-Based Nursing We use cookies to improve our service and to tailor our content and advertising to you. You can manage your cookie settings via your browser at any time. To learn more about how we use cookies, please see our . Log in using your username and password For personal accounts OR managers of institutional accounts Username (...) * Password * your user name or password? Search for this keyword Search for this keyword Main menu Log in using your username and password For personal accounts OR managers of institutional accounts Username * Password * your user name or password? You are here Deprescribing in nursing homes is safe and should be pursued Article Text Care of the older person Randomised controlled trial Deprescribing in nursing homes is safe and should be pursued Eline Tommelein Statistics from Altmetric.com Commentary

2018 Evidence-Based Nursing

11. Opportunities and Limits to Deprescribing in Nursing Homes:Quality Circle Deprescribing Module

Opportunities and Limits to Deprescribing in Nursing Homes:Quality Circle Deprescribing Module Opportunities and Limits to Deprescribing in Nursing Homes:Quality Circle Deprescribing Module - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please remove one (...) or more studies before adding more. Opportunities and Limits to Deprescribing in Nursing Homes:Quality Circle Deprescribing Module (OLD-NH-QC-DeMo) The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our for details. ClinicalTrials.gov Identifier: NCT03688542 Recruitment Status : Enrolling by invitation First Posted : September 28, 2018 Last Update Posted

2018 Clinical Trials

12. Deprescribing in the Pharmacologic Management of Delirium: A Randomized Trial in the Intensive Care Unit (Abstract)

Deprescribing in the Pharmacologic Management of Delirium: A Randomized Trial in the Intensive Care Unit Benzodiazepines and anticholinergics are risk factors for delirium in the intensive care unit (ICU). We tested the impact of a deprescribing intervention on short-term delirium outcomes.Multisite randomized clinical trial.ICUs of three large hospitals.Two hundred adults aged 18 years or older and admitted to an ICU with delirium, according to the Richmond Agitation-Sedation Scale (...) and the Confusion Assessment Method for the ICU (CAM-ICU). Participants had a contraindication to haloperidol (seizure disorder or prolonged QT interval) or preference against haloperidol as a treatment for delirium, and were excluded for serious mental illness, stroke, pregnancy, or alcohol withdrawal. Participants were randomized to a deprescribing intervention or usual care. The intervention included electronic alerts combined with pharmacist support to deprescribe anticholinergics

2019 EvidenceUpdates

13. Effects of discontinuation of chronic medication in primary care: a systematic review of deprescribing trials Full Text available with Trip Pro

Effects of discontinuation of chronic medication in primary care: a systematic review of deprescribing trials Polypharmacy is becoming more prevalent and evaluation of appropriateness of medication use is increasingly important. The primary care physician often conducts the deprescribing process; however, there are several barriers to implementing this.To examine the feasibility and safety of discontinuation of medication, with a focus on studies that have been conducted in the community (...) studies show that deprescribing and cessation of long-term use seem safe; however, there is a risk of relapse of symptoms. More research is needed to advise physicians in making evidence-based decisions about deprescribing in primary care settings.© British Journal of General Practice 2018.

2018 EvidenceUpdates

14. Attitudinal predictors of older peoples' and caregivers' desire to deprescribe in hospital. Full Text available with Trip Pro

Attitudinal predictors of older peoples' and caregivers' desire to deprescribe in hospital. Deprescribing is a partnership between practitioners, patients and caregivers. External characteristics including age, comorbidities and polypharmacy are poor predictors of attitude towards deprescribing. This hospital-based study aimed to describe the desire of patients and caregivers to be involved in medicine decision-making, and identify attitudinal predictors of desire to try stopping (...) a medicine.Patients and caregivers recruited from seven Older People's Medicine wards across two UK hospitals completed the revised Patients'Attitudes Towards Deprescribing (rPATD) questionnaire. Patients prescribed polypharmacy and caregivers involved in medication decision-making of such patients were eligible. A target of 150 patients and caregivers provided a 95% confidence interval of ±11.0% or smaller around rPATD item agreement. Descriptive statistics characterised participants and rPATD responses

2019 BMC Geriatrics

15. Deprescribing in the context of multiple providers: understanding patient preferences. (Abstract)

Deprescribing in the context of multiple providers: understanding patient preferences. Deprescribing could reduce the risk of harm from inappropriate medications. We characterized patients' acceptance of deprescribing recommendations from pharmacists, primary care providers (PCPs), and specialists relative to the original prescriber's professional background.Secondary analysis of national Patient Perceptions of Discontinuation survey responses from Veterans Affairs (VA) primary care patients (...) with 5 or more prescriptions.We created 4 relative deprescribing authority (RDA) outcome groups from responses to 2 yes/no (Y/N) items: (1) "Imagine…a specialist…prescribed a medicine. Would you be comfortable if your PCP told you to stop...it?" and (2) "Imagine…your VA PCP prescribed a medicine. Would you be comfortable if a VA clinical pharmacist [Pharm] told you to stop…it?" Multinomial regression associated patient factors with RDA.Respondents (n = 803; adjusted response rate, 52%) were

2019 American Journal Of Managed Care

16. Assessing an Interprofessional Polypharmacy and Deprescribing Educational Intervention for Primary Care Post-graduate Trainees: a Quantitative and Qualitative Evaluation. (Abstract)

Assessing an Interprofessional Polypharmacy and Deprescribing Educational Intervention for Primary Care Post-graduate Trainees: a Quantitative and Qualitative Evaluation. Polypharmacy and potentially inappropriate medications (PIMs) are increasingly common and associated with adverse health effects. However, post-graduate education in polypharmacy and complex medication management for older adults remain limited.The Initiative to Minimize Pharmaceutical Risk in Older Veterans (IMPROVE (...) ) polypharmacy clinic was created to provide a platform for teaching internal medicine (IM) and nurse practitioner (NP) residents about outpatient medication management and deprescribing for older adults. We aimed to assess residents' knowledge of polypharmacy and perceptions of this interprofessional education intervention.A prospective cohort study with an internal comparison group.IM residents and NP residents; Veterans ≥ 65 years and taking ≥ 10 medications.IMPROVE consists of a pre-clinic conference

2019 Journal of General Internal Medicine

17. Exploration of home care nurse's experiences in deprescribing of medications: a qualitative descriptive study. Full Text available with Trip Pro

Exploration of home care nurse's experiences in deprescribing of medications: a qualitative descriptive study. The aim of this study is to explore the barriers and enablers of deprescribing from the perspectives of home care nurses, as well as to conduct a scalability assessment of an educational plan to address the learning needs of home care nurses about deprescribing.This study employed an exploratory qualitative descriptive research design, using scalability assessment from two focus groups (...) with a total of 11 home care nurses in Ontario, Canada. Thematic analysis was used to derive themes about home care nurse's perspectives about barriers and enablers of deprescribing, as well as learning needs in relation to deprescribing approaches.Home care nurse's identified challenges for managing polypharmacy in older adults in home care settings, including a lack of open communication and inconsistent medication reconciliation practices. Additionally, inadequate partnership and ineffective

2019 BMJ open

18. Barriers and enablers for deprescribing among older, multimorbid patients with polypharmacy: an explorative study from Switzerland. Full Text available with Trip Pro

Barriers and enablers for deprescribing among older, multimorbid patients with polypharmacy: an explorative study from Switzerland. Polypharmacy is an increasing problem, leading to increased morbidity and mortality, especially in older, multimorbid patients. Consequently, there is a need for reduction of polypharmacy. The aim of this study was to explore attitudes, beliefs, and concerns towards deprescribing among older, multimorbid patients with polypharmacy who chose not to pursue at least (...) one of their GP's offers to deprescribe.Exploratory study using telephone interviews among patients of a cluster-randomized study in Northern Switzerland. The interview included a qualitative part consisting of questions in five pre-defined key areas of attitudes, beliefs, and concerns about deprescribing and an open explorative question. The quantitative part consisted of a rating of pre-defined statements in these areas.Twenty-two of 87 older, multimorbid patients with polypharmacy, to whom

2019 BMC Family Practice Controlled trial quality: uncertain

19. The MedSafer Study: A Controlled Trial of an Electronic Decision Support Tool for Deprescribing in Acute Care. (Abstract)

The MedSafer Study: A Controlled Trial of an Electronic Decision Support Tool for Deprescribing in Acute Care. Polypharmacy is common, costly, and harmful for hospitalized older adults. Scalable strategies to reduce the burden of potentially inappropriate medications (PIMs) are needed. We sought to leverage medication reconciliation in hospitalized older adults by pairing with MedSafer, an electronic decision support tool for deprescribing.This was a nonrandomized controlled before-and-after (...) study.The study took place on four internal medicine clinical teaching units.Subjects were aged 65 years and older, had an expected prognosis of 3 or more months, and were taking five or more usual home medications.In the baseline phase, patients received usual care that was medication reconciliation. Patients in the intervention arm also had a "deprescribing opportunity report" generated by MedSafer and provided to their in-hospital treating team.The primary outcome was ascertained at the time

2019 Journal of the American Geriatrics Society Controlled trial quality: uncertain

20. Factors Associated With Deprescribing Acetylcholinesterase Inhibitors in Older Nursing Home Residents With Severe Dementia. (Abstract)

Factors Associated With Deprescribing Acetylcholinesterase Inhibitors in Older Nursing Home Residents With Severe Dementia. Uncertainty regarding benefits and risks associated with acetylcholinesterase inhibitors (AChEIs) in severe dementia means providers do not know if and when to deprescribe. We sought to identify which patient-, provider-, and system-level characteristics are associated with AChEI discontinuation.Analysis of 2015 to 2016 data from Medicare claims, Part D prescriptions (...) % at 1 year of follow-up. Our findings provide insight into potential drivers of deprescribing AChEIs, identify system-level barriers to deprescribing, and help to inform covariates that are needed to address potential confounding in studies evaluating the potential risks and benefits associated with deprescribing.© 2019 The American Geriatrics Society.

2019 Journal of the American Geriatrics Society

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