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Polypharmacy

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261. Complex psychotropic polypharmacy in bipolar disorder across varying mood polarities: A prospective cohort study of 2712 inpatients. (Abstract)

Complex psychotropic polypharmacy in bipolar disorder across varying mood polarities: A prospective cohort study of 2712 inpatients. It is common for patients with bipolar disorder (BP) to receive multiple psychotropics, but few studies have assessed demographic and clinical features associated with risk for receiving complex psychotropic polypharmacy.This longitudinal cohort study examined 2712 inpatients with a DSM-IV clinical diagnosis of BP to assess associations between complex (...) polypharmacy (defined as ≥4 psychotropics) and demographic and clinical features; associations with risk of rehospitalization were also examined. Logistic regressions were performed with the sample as a whole and with each of four DSM-IV BP subtypes individually.Complex polypharmacy was present in 21.0%. BP-I depressed patients were more likely to receive complex regimens than BP-I manic, BP-I mixed or BP-II patients. In the sample as a whole, variables significantly associated with complex polypharmacy

2017 Journal of Affective Disorders

262. A case of a four-year-old child adopted at eight months with unusual mood patterns and significant polypharmacy. Full Text available with Trip Pro

A case of a four-year-old child adopted at eight months with unusual mood patterns and significant polypharmacy. Long-term effects of neglect in early life are still widely unknown. Diversity of outcomes can be explained by differences in genetic risk, epigenetics, prenatal factors, exposure to stress and/or substances, and parent-child interactions. Very common sub-threshold presentations of children with history of early trauma are challenging not only to diagnose but also in treatment.A (...) initiated by primary care seemed to help with his symptoms of dyscontrol initially but later the dose had to be escalated to 6 mg total for the same result. After an episode of significant aggression, the patient was admitted to inpatient child psychiatric unit for stabilization and taper of the medicine.The case illustrates difficulties in management of children with early history of neglect. A particular danger in this patient population is polypharmacy, which is often used to manage transdiagnostic

2017 BMC Psychiatry

263. Co-morbidity and polypharmacy in Parkinson's disease: insights from a large Scottish primary care database. Full Text available with Trip Pro

Co-morbidity and polypharmacy in Parkinson's disease: insights from a large Scottish primary care database. Parkinson's disease is complicated by comorbidity and polypharmacy, but the extent and patterns of these are unclear. We describe comorbidity and polypharmacy in patients with and without Parkinson's disease across 31 other physical, and seven mental health conditions.We analysed primary health-care data on 510,502 adults aged 55 and over. We generated standardised prevalence rates by age (...) co-morbidity. Polypharmacy is also a significant issue due to the complex nature of the disease and associated treatments.

2017 BMC Neurology

264. Multimorbidity and polypharmacy in diabetic patients with NAFLD: Implications for disease severity and management. Full Text available with Trip Pro

Multimorbidity and polypharmacy in diabetic patients with NAFLD: Implications for disease severity and management. An observational study describing the number and type of chronic conditions and medications taken by diabetic patients with NAFLD and identifying characteristics that may impact liver disease severity or clinical management.Adults with type 2 diabetes have a high prevalence of nonalcoholic fatty liver disease (NAFLD) and increased risk of developing advanced liver disease (...) . NAFLD severity was classified by transient elastography and liver ultrasound into "no advanced disease" (LSM < 8.2 kPa) or "clinically significant liver disease" (LSM ≥ 8.2 kPa).The most common coexistent chronic conditions were metabolic syndrome (94%), self-reported "depression" (44%), ischaemic heart disease (32%), and obstructive sleep apnoea (32%). Polypharmacy or hyperpolypharmacy was present in 59% and 31% of patients respectively. Elevated LSM (≥ 8.2 kPa) suggesting significant liver disease

2017 Medicine

265. Opioids and Other Central Nervous System-Active Polypharmacy in Older Adults in the United States. Full Text available with Trip Pro

Opioids and Other Central Nervous System-Active Polypharmacy in Older Adults in the United States. To determine patterns of and trends in contributions to central nervous system (CNS) polypharmacy, defined by the Beers Criteria as three or more CNS-active medications of each medication class, of adults aged 65 and older seen in U.S. outpatient medical practices.National Ambulatory Medical Care Survey (2004-2013).U.S. outpatient medical care.Visits by older adults to outpatient physicians (N (...) = 97,910).Visits including three or more CNS medications including antipsychotics, benzodiazepines, nonbenzodiazepine benzodiazepine receptor agonist hypnotics (NBRAs), tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), and opioids. The proportion of CNS polypharmacy that each medication class contributed during 2011 to 2013 was determined, and then logistic regression was used to determine trends from 2004 to 2013 in the contribution of individual medication classes

2017 Journal of the American Geriatrics Society

266. Association between polypharmacy and death: A systematic review and meta-analysis. (Abstract)

Association between polypharmacy and death: A systematic review and meta-analysis. Polypharmacy has been linked to a myriad of adverse consequences, and escalating rates of polypharmacy present an emerging concern, particularly among older adults. This systematic review and meta-analysis summarizes the existing literature concerning the association between polypharmacy and mortality.A systematic literature review was done by searching the EMBASE, PubMed, Scopus, and International Pharmaceutical (...) Abstract databases to identify studies assessing the association between polypharmacy and death published until June 2016.Studies that investigated the association between polypharmacy and mortality were eligible for this systematic review and meta-analysis.Data were extracted by the first and second authors independently using a data extraction form. Disagreement was resolved by consensus. A meta-analysis was performed using random effect models. Heterogeneity was assessed using the I2 statistic.Forty

2017 Journal of the American Pharmacists Association : JAPhA

267. Supporting prescribing in older people with multimorbidity and significant polypharmacy in primary care (SPPiRE): a cluster randomised controlled trial protocol and pilot. Full Text available with Trip Pro

Supporting prescribing in older people with multimorbidity and significant polypharmacy in primary care (SPPiRE): a cluster randomised controlled trial protocol and pilot. Multimorbidity, defined as the presence of at least two chronic conditions, becomes increasingly common in older people and is associated with poorer health outcomes and significant polypharmacy. The National Institute for Clinical Excellence (NICE) recently published a multimorbidity guideline that advises providing (...) an individualised medication review for all people prescribed 15 or more repeat medicines. This study incorporates this guideline and aims to assess the effectiveness of a complex intervention designed to support general practitioners (GPs) to reduce potentially inappropriate prescribing and consider deprescribing in older people with multimorbidity and significant polypharmacy in Irish primary care.This study is a cluster randomised controlled trial, involving 30 general practices and 450 patients throughout

2017 Implementation Science Controlled trial quality: uncertain

268. Associations between polypharmacy and treatment intensity for hypertension and diabetes: a cross-sectional study of nursing home patients in British Columbia, Canada. Full Text available with Trip Pro

Associations between polypharmacy and treatment intensity for hypertension and diabetes: a cross-sectional study of nursing home patients in British Columbia, Canada. Describe nursing home polypharmacy prevalence in the context of prescribing for diabetes and hypertension and determine possible associations between lower surrogate markers for treated hypertension and diabetes (overtreatment) and polypharmacy.Cross-sectional study.6 nursing homes in British Columbia, Canada.214 patients residing (...) in one of the selected facilities during data collection period.Polypharmacy was defined as ≥9 regular medications. Overtreatment of diabetes was defined as being prescribed at least one hypoglycaemic medication and a glycosylated haemoglobin (HbA1c) ≤7.5%. Overtreatment of hypertension required being prescribed at least one hypertension medication and having a systolic blood pressure ≤128 mm Hg. Polypharmacy prescribing, independent of overtreatment, was calculated by subtracting condition-specific

2017 BMJ open

269. Polypharmacy Is Associated With Higher Frailty Risk in Older People: An 8-Year Longitudinal Cohort Study. Full Text available with Trip Pro

Polypharmacy Is Associated With Higher Frailty Risk in Older People: An 8-Year Longitudinal Cohort Study. To investigate whether polypharmacy is associated with a higher incidence of frailty in a large cohort of North Americans during 8 years of follow-up.Longitudinal study, follow-up of 8 years.A total of 4402 individuals at high risk or having knee osteoarthritis free from frailty at baseline.Details regarding medication prescription were captured and categorized as 0-3, 4-6, and ≥7. Frailty (...) increased the risk of frailty at the follow-up of 11% (HR = 1.11; 95% CI 1.07-1.15; P < .0001).Polypharmacy is associated with a higher incidence of frailty over 8-year follow-up period. Our data suggest evidence of a dose response relationship. Future research is required to confirm our findings and explore underlying mechanisms.Copyright © 2017 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

2017 Journal of the American Medical Directors Association

270. Comorbidity and polypharmacy in chronic heart failure: a large cross-sectional study in primary care. Full Text available with Trip Pro

Comorbidity and polypharmacy in chronic heart failure: a large cross-sectional study in primary care. Comorbidity is common in heart failure, but previous prevalence estimates have been based on a limited number of conditions using mainly non-primary care data sources.To compare prevalence rates of comorbidity and polypharmacy in those with and without chronic heart failure due to left ventricular systolic dysfunction (LVSD).A cross-sectional study of 1.4 million patients in primary care (...) found for seven or more conditions (odds ratio [OR] 4.10; 95% confidence interval (CI] = 3.90 to 4.32). Twenty-five physical conditions and six mental health conditions were significantly more prevalent in those with LVSD relative to standardised controls. Polypharmacy was higher in the LVSD group compared with controls, with the biggest difference found for ≥11 repeat prescriptions (OR 4.81; 95% CI = 4.60 to 5.04). However, these differences in polypharmacy were attenuated after controlling

2017 British Journal of General Practice

271. Targeted Deprescribing in an Outpatient Hemodialysis Unit: A Quality Improvement Study to Decrease Polypharmacy. (Abstract)

Targeted Deprescribing in an Outpatient Hemodialysis Unit: A Quality Improvement Study to Decrease Polypharmacy. Polypharmacy in hemodialysis patients can result in adverse patient outcomes. Deprescribing tools can reduce polypharmacy, yet no method exists for an outpatient hemodialysis population.Quality improvement study.240 patients in a tertiary-care outpatient hemodialysis unit.We aimed to: (1) develop a deprescribing tool for target medications with poor evidence for efficacy and safety (...) , (2) determine its effectiveness in decreasing polypharmacy, and (3) monitor patient safety and satisfaction.The primary outcome was the proportion of target medications completely deprescribed after 4 weeks. Secondary outcomes were the proportion of target medications completely deprescribed after 6 months, average number of medications per patient before and after deprescription, and proportion of successful deprescriptions for each target medication.Number of medications deprescribed at 4 weeks

2017 American Journal of Kidney Diseases

272. Deprescribing anticholinergic and sedative medicines: protocol for a Feasibility Trial (DEFEAT-polypharmacy) in residential aged care facilities. Full Text available with Trip Pro

Deprescribing anticholinergic and sedative medicines: protocol for a Feasibility Trial (DEFEAT-polypharmacy) in residential aged care facilities. Targeted deprescribing of anticholinergic and sedative medicines can lead to positive health outcomes in older people; as they have been associated with cognitive and physical functioning decline. This study will examine whether the proposed intervention is feasible at reducing the prescription of anticholinergic and sedative medicines in older

2017 BMJ open

273. Effectiveness of an intervention for improving drug prescription in primary care patients with multimorbidity and polypharmacy: study protocol of a cluster randomized clinical trial (Multi-PAP project). Full Text available with Trip Pro

Effectiveness of an intervention for improving drug prescription in primary care patients with multimorbidity and polypharmacy: study protocol of a cluster randomized clinical trial (Multi-PAP project). Multimorbidity is associated with negative effects both on people's health and on healthcare systems. A key problem linked to multimorbidity is polypharmacy, which in turn is associated with increased risk of partly preventable adverse effects, including mortality. The Ariadne principles (...) describe a model of care based on a thorough assessment of diseases, treatments (and potential interactions), clinical status, context and preferences of patients with multimorbidity, with the aim of prioritizing and sharing realistic treatment goals that guide an individualized management. The aim of this study is to evaluate the effectiveness of a complex intervention that implements the Ariadne principles in a population of young-old patients with multimorbidity and polypharmacy. The intervention

2017 Implementation Science Controlled trial quality: predicted high

274. Evaluation of the individual safe correction of antipsychotic agent polypharmacy in Japanese patients with chronic schizophrenia: validation of safe corrections for antipsychotic polypharmacy and the high-dose method. Full Text available with Trip Pro

Evaluation of the individual safe correction of antipsychotic agent polypharmacy in Japanese patients with chronic schizophrenia: validation of safe corrections for antipsychotic polypharmacy and the high-dose method. Polypharmacy for schizophrenia treatment is not justified by the available clinical evidence. We evaluated a treatment reduction approach that reduces the dose and number of antipsychotic medications simultaneously prescribed to patients.In a randomized open study of the Safe (...) Correction of Antipsychotic Polypharmacy and High-Dose Prescriptions program funded by the Japanese Ministry of Health, Labour, and Welfare, we evaluated a drug reduction method consisting of a dose reduction intervention performed on 163 patients with schizophrenia for twelve or 24 weeks. One antipsychotic medication was removed each week from each patient's treatment regimen by reducing the dose by 0 to 50 chlorpromazine equivalents. Data on health-related indices of quality of life, clinical symptoms

2015 The international journal of neuropsychopharmacology / official scientific journal of the Collegium Internationale Neuropsychopharmacologicum (CINP) Controlled trial quality: uncertain

275. Polypharmacy

Polypharmacy Polypharmacy Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Polypharmacy Polypharmacy Aka: Polypharmacy II. Definition (...) Polypharmacy Too many medications or use of unnecessary drugs Five or more medications used empirically III. Epidemiology Patients over age 65 years consume one third of all medications in the United States Average patient uses 4 perscribed medications and at least one OTC medication IV. Precautions Polypharmacy leads to increased adverse drug events (ADEs) including s See See See Patients on 2 drugs have a 35% risk of ADE, while those on >6 drugs have an 82% ADE risk Adverse drug events are among the top

2018 FP Notebook

276. Comorbidity-Polypharmacy Score as Predictor of Outcomes in Older Trauma Patients: A Retrospective Validation Study (Abstract)

Comorbidity-Polypharmacy Score as Predictor of Outcomes in Older Trauma Patients: A Retrospective Validation Study Traditional injury severity assessment is insufficient in estimating the morbidity and mortality risk for older (≥45 years) trauma patients. Commonly used tools involve complex calculations or tables, do not consider all comorbidities, and often rely on data that are not available early in the trauma patient's hospitalization. The comorbidity-polypharmacy score (CPS), a sum of all

2015 EvidenceUpdates

277. Top 10 most read in October: Physician-pharmaceutical industry interactions, systematic reviews and unpublished data, and polypharmacy and falls in older adults

Top 10 most read in October: Physician-pharmaceutical industry interactions, systematic reviews and unpublished data, and polypharmacy and falls in older adults Top 10 most read in October: Physician-pharmaceutical industry interactions, systematic reviews and unpublished data, and polypharmacy and falls in older adults | BMJ Open by Four new entries, and two re-entries, made it into BMJ Open’s top 10 most read articles in October. Climbing back into the top position is a longitudinal cohort (...) for it. Dhalwani et al. are new in at number eight. Using data from The English Longitudinal Study of Ageing the researchers examine the association between polypharmacy and falls in older adults. The rate of falls was found to be 21% higher in people with polypharmacy (five or more drugs) than those without. The final new entry for October is at number 9; Firmino-Machado et al. report the protocol for an ongoing population-based randomised controlled trial to improve Cervical Cancer Screening Adherence. Rank

2017 BMJ Open Blog

278. Intervention to Improve Appropriate Prescribing and Reduce Polypharmacy in Elderly Patients Admitted to an Internal Medicine Unit. Full Text available with Trip Pro

Intervention to Improve Appropriate Prescribing and Reduce Polypharmacy in Elderly Patients Admitted to an Internal Medicine Unit. Polypharmacy and inappropriate medication prescriptions are associated with increased morbidity and mortality. Most interventions proposed to improve appropriate prescribing are time and resource intensive and therefore hardly applicable in daily clinical practice.To test the efficacy of an easy-to-use checklist aimed at supporting the therapeutic reasoning (...) of potentially inappropriate medications (PIMs) at discharge, according to STOPP criteria, and the number of prescribed medications at discharge, before and after the introduction of the checklist. Secondary outcomes were the prevalence of polypharmacy (≥ 5 drugs) and hyperpolypharmacy (≥ 10 drugs), and the prevalence of potentially inappropriate prescribing omissions (PPOs) according to START criteria.At admission 59% of the 900 patients were taking > 5 drugs, 13% ≥ 10 drugs, 37% had ≥ 1 PIM and 25% ≥ 1 PPO

2016 PLoS ONE

279. [Antipsychotic polypharmacy in the treatment of schizophrenia]

[Antipsychotic polypharmacy in the treatment of schizophrenia] Antipsykotisk polyfarmaci i behandlingen af skizofreni [Antipsychotic polypharmacy in the treatment of schizophrenia] Antipsykotisk polyfarmaci i behandlingen af skizofreni [Antipsychotic polypharmacy in the treatment of schizophrenia] Baandrup L, Lublin H, Nordentoft M, Peacock L, Sorensen J, Andersen SE, Glenthoj B Record Status This is a bibliographic record of a published health technology assessment from a member of INAHTA (...) . No evaluation of the quality of this assessment has been made for the HTA database. Citation Baandrup L, Lublin H, Nordentoft M, Peacock L, Sorensen J, Andersen SE, Glenthoj B. Antipsykotisk polyfarmaci i behandlingen af skizofreni. [Antipsychotic polypharmacy in the treatment of schizophrenia] Copenhagen: Danish Centre for Evaluation and Health Technology Assessment (DACEHTA). Volume 11(1). 2011 Authors' objectives The aim of this health technology assessment is to explore how antipsychotic polypharmacy

2011 Health Technology Assessment (HTA) Database.

280. Developing and evaluating a measure of inappropriate polypharmacy in primary care

Developing and evaluating a measure of inappropriate polypharmacy in primary care Print | PDF PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. CRD bears no responsibility or liability for the content of this registration record, any associated files or external websites. Email salutation (e.g. "Dr Smith" or "Joanne") for correspondence: Organisation web address: Timing

2016 PROSPERO

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