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Polypharmacy

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121. Using an Integrated Care Pathway for Late-Life Schizophrenia Improves Monitoring of Adverse Effects of Antipsychotics and Reduces Antipsychotic Polypharmacy. (Abstract)

Using an Integrated Care Pathway for Late-Life Schizophrenia Improves Monitoring of Adverse Effects of Antipsychotics and Reduces Antipsychotic Polypharmacy. Antipsychotic use in older patients is associated with many adverse effects, including tardive dyskinesia and extrapyramidal symptoms, which, in turn, increase the risk of falling. Antipsychotics are also associated with metabolic syndrome and cognitive impairment in older patients. Integrated care pathways (ICPs) are designed to manage (...) conditions.Monitoring rates were significantly higher in the ICP group than in the TAU group for all assessments: extrapyramidal symptoms (94% versus 5%), metabolic disturbances (91% versus 25%), fall risk (82% versus 35%), and cognitive impairment (72% versus 28%). Rates of antipsychotic polypharmacy were also six times higher in the TAU group.Older patients with schizophrenia treated with antipsychotics within an ICP experience higher rates of monitoring and less psychotropic polypharmacy than older patients

2018 The American Journal of Geriatric Psychiatry Controlled trial quality: uncertain

122. Conceptualising multiple drug use in patients with comorbidity and multimorbidity: proposal for standard definitions beyond the term polypharmacy. Full Text available with Trip Pro

Conceptualising multiple drug use in patients with comorbidity and multimorbidity: proposal for standard definitions beyond the term polypharmacy. With older and aging populations, patients experience multiple chronic diseases at the same time. Individual chronic disease guidelines often recommend pharmacological therapies as a key intervention, resulting in patients being prescribed multiple regular medications for their different diseases. Although the term "polypharmacy" has been applied (...) to the use of multiple medications, there is no consistent definition, and this term is now being used all inclusively. To improve both scientific rigor and optimal patient care, it is crucial that a standard terminology is used, which reclassifies the term "polypharmacy" into distinct phenotypes relating to the index chronic disease, additional conditions to the index (comorbidity), or the experience of multiple chronic conditions at the same time (multimorbidity). Using three exemplar index conditions

2018 Journal of Clinical Epidemiology

123. How general practitioners would deprescribe in frail oldest-old with polypharmacy - the LESS study. Full Text available with Trip Pro

How general practitioners would deprescribe in frail oldest-old with polypharmacy - the LESS study. Many oldest-old (> 80-years) with multimorbidity and polypharmacy are at high risk of inappropriate use of medication, but we know little about whether and how GPs would deprescribe, especially in the frail oldest-old. We aimed to determine whether, how, and why Swiss GPs deprescribe for this population.GPs took an online survey that presented case-vignettes of a frail oldest-old patient

2018 BMC Family Practice

124. Associations Between Polypharmacy and Cognitive and Physical Capability: A British Birth Cohort Study. Full Text available with Trip Pro

Associations Between Polypharmacy and Cognitive and Physical Capability: A British Birth Cohort Study. To investigate longitudinal associations between polypharmacy and cognitive and physical capability and to determine whether these associations differ with cumulative exposure to polypharmacy.Prospective birth cohort study.England, Scotland, and Wales.An eligible sample of men and women from the Medical Research Council National Survey of Health and Development with medication data at age 69 (...) (N=2,122, 79%).Cognitive capability was assessed using a word learning test, visual search speed task, and the Addenbrooke's Cognitive Examination, Third Edition (ACE-III). Physical capability was measured using chair rise speed, standing balance time, walking speed, and grip strength.Polypharmacy (5-8 prescribed medications) was present in 18.2% of participants at age 69 and excessive polypharmacy (≥9 prescribed medications) in 4.7%. Both were associated with poorer cognitive and physical

2018 Journal of the American Geriatrics Society

125. Frailty and Polypharmacy in Older Patients with Otolaryngologic Diseases. (Abstract)

Frailty and Polypharmacy in Older Patients with Otolaryngologic Diseases. Frailty and Polypharmacy commonly impact disease processes and treatment of patients with otolaryngologic disorders. Although well known to geriatricians, the 2 concepts often elude other physicians, including otolaryngologists. This article reviews the common manifestations likely to be encountered in otolaryngology patients, reviews frailty measures in surgical patients, and makes recommendations regarding education

2018 Clinics in Geriatric Medicine

126. Polypharmacy and patterns of prescription medication use among cancer survivors. Full Text available with Trip Pro

Polypharmacy and patterns of prescription medication use among cancer survivors. The population of cancer survivors is rapidly growing in the United States. Long-term and late effects of cancer, combined with the ongoing management of other chronic conditions, make survivors particularly vulnerable to polypharmacy and its adverse effects. In the current study, the authors examined patterns of prescription medication use and polypharmacy in a population-based sample of cancer survivors.Using (...) data from the Medical Expenditure Panel Survey (MEPS), the authors matched cancer survivors (5216 survivors) with noncancer controls (19,588 controls) by age, sex, and survey year. Polypharmacy was defined as ≥5 unique medications. The authors estimated the percentage of respondents prescribed medications within therapeutic classes and total prescription expenditures.A higher percentage of cancer survivors were prescribed ≥5 unique medications (64.0%; 95% confidence interval [95% CI], 62.3%-65.8

2018 Cancer

127. Complex Polypharmacy in Patients With Schizophrenia-Spectrum Disorders Before a Psychiatric Hospitalization: Prescribing Patterns and Associated Clinical Features. (Abstract)

Complex Polypharmacy in Patients With Schizophrenia-Spectrum Disorders Before a Psychiatric Hospitalization: Prescribing Patterns and Associated Clinical Features. Current evidence-based guidelines provide unclear support for many common polypharmacy practices in schizophrenia. Excessive or complex polypharmacy (≥4 psychotropics) has been studied in patients with bipolar disorder, but not in schizophrenia to date.We conducted a digital medical record data extraction of 829 patients (...) consecutively admitted to a psychiatric hospital and diagnosed as having schizophrenia-spectrum disorders.In those prescribed psychiatric medication preadmission, 28.1% (n = 169) met the criteria for complex polypharmacy. Complex polypharmacy patients were older, female, white, and disabled, and had more comorbidities compared with those without complex polypharmacy. In multivariable analysis, complex polypharmacy was specifically associated with being white and disabled, and having a comorbid anxiety

2018 Journal of Clinical Psychopharmacology

128. Development and Application of the GheOP<sup>3</sup>S-Tool Addendum on Potentially Inappropriate Prescribing (PIP) of Renally Excreted Active Drugs (READs) in Older Adults with Polypharmacy. (Abstract)

Development and Application of the GheOP3S-Tool Addendum on Potentially Inappropriate Prescribing (PIP) of Renally Excreted Active Drugs (READs) in Older Adults with Polypharmacy. Renal function progressively worsens with age. Potentially inappropriate prescribing (PIP) of renally excreted active drugs (READs) is common in older adults, leading to an increased rate of iatrogenic illness. The Ghent Older People's Prescription community Pharmacy Screening (GheOP3S-) tool (...) of individual and combined READs, (2) collection of dose-adjustment recommendations, and (3) expert panel evaluation. Consequently, the addendum was applied retrospectively on the medication list of 60 older adults with polypharmacy and with four renal function-estimating equations.The addendum includes 61 READs recommendations for dose/drug-adjustment alternatives, laboratory test follow-ups, and patients' referral to specialists' care. In the cross-sectional analysis, 35-78% of patients were diagnosed

2018 Drugs & Aging

129. Polypharmacy in the oldest old (≥80 years of age) patients in China: a cross-sectional study. Full Text available with Trip Pro

Polypharmacy in the oldest old (≥80 years of age) patients in China: a cross-sectional study. The oldest old generally have worse health and more comorbidities than the general population of older adults, and they are more likely to be exposed to polypharmacy. Reliable investigation of polypharmacy among the oldest old (≥80 years of age) in China are lacking. So this study aims to describe the polypharmacy status of oldest old patients ≥80 years of age and to assess the factors influencing (...) taken ranged from 8 to 60 drugs (median of 22.9). Patients taking 11-20 drugs accounted for 46.1% of the patients. Subjects with a history of adverse drug reactions accounted for 40.3%. The proportion of PIMs was 27.1%. Compliance was only 32.6% among the oldest old patients with polypharmacy. Age and medication classes were independently negatively associated with compliance, and medication knowledge was independently positively associated with compliance.Oldest old patients (≥ 80 years of age) had

2018 BMC Geriatrics

130. Pharmacist-Led Medication Assessment and Deprescribing Intervention for Older Adults with Cancer and Polypharmacy: a Pilot Study Full Text available with Trip Pro

Pharmacist-Led Medication Assessment and Deprescribing Intervention for Older Adults with Cancer and Polypharmacy: a Pilot Study The aims of this study were to compare the application of three geriatric medication screening tools to the Beers Criteria alone for potentially inappropriate medication quantification and to determine feasibility of a pharmacist-led polypharmacy assessment in a geriatric oncology clinic.Adult patients with cancer aged 65 and older underwent a comprehensive geriatric (...) assessment. A polypharmacy assessment was completed by a pharmacist and included a review of all drug therapies. Potentially inappropriate medications were screened using the Beers Criteria, Screening Tool to Alert doctors to Right Treatment/Screening Tool of Older Persons' Prescriptions, and the Medication Appropriateness Index. Deprescribing occurred after discussion with the pharmacist, geriatric oncologist, patient, and caregiver.Data were collected for 26 patients. The mean number of medications

2018 Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer

131. Team Approach to Polypharmacy Evaluation and Reduction (Pharmacy)

Team Approach to Polypharmacy Evaluation and Reduction (Pharmacy) Team Approach to Polypharmacy Evaluation and Reduction (Pharmacy) - 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. Team Approach (...) to Polypharmacy Evaluation and Reduction (Pharmacy) 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. of clinical studies and talk to your health care provider before participating. Read our for details. ClinicalTrials.gov Identifier: NCT03557944 Recruitment Status : Not yet recruiting First Posted : June 15, 2018 Last Update Posted : August 28, 2018 See Sponsor

2018 Clinical Trials

132. Risk Factors for Polypharmacy in Older Adults

Risk Factors for Polypharmacy in Older Adults Risk Factors for Polypharmacy in Older Adults - 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. Risk Factors for Polypharmacy in Older Adults The safety (...) . For categorical independent variables, t-tests were performed. Condition or disease Intervention/treatment Polypharmacy Other: Comprehensive geriatric assesment Detailed Description: 1000 patients who were 65 years old or older and applied to Melek Hatun family practice center either in person or through a relative between 01 December 2014 and 01 August 2017 were enrolled in the study. All patients were seen either in our center or in their homes, and informed consents were obtained. Comprehensive Geriatric

2018 Clinical Trials

133. Mechanisms Underpinning the Polypharmacy Effects of Medications in Psychiatry Full Text available with Trip Pro

Mechanisms Underpinning the Polypharmacy Effects of Medications in Psychiatry Bipolar disorder is a mental health condition with progressive social and cognitive function disturbances. Most patients' treatments are based on polypharmacy, but with no biological basis and little is known of the drugs' interactions. The aim of this study was to analyze the effects of lithium, valproate, quetiapine, and lamotrigine, and the interactions between them, on markers of inflammation, bioenergetics

2018 International Journal of Neuropsychopharmacology

134. Changes in medicine prescription following a medication review in older high-risk patients with polypharmacy Full Text available with Trip Pro

Changes in medicine prescription following a medication review in older high-risk patients with polypharmacy Background The more (inappropriate) drugs a patient uses, the higher the risk of drug related problems. To reduce these risks, medication reviews can be performed. Objective To report changes in the prescribed number of (potentially inappropriate) drugs before and after performing a medication review in high-risk polypharmacy patients. A secondary objective was to study reasons (...) for continuing potentially inappropriate drugs (PIDs). Setting Dutch community pharmacy and general medical practice. Methods A retrospective longitudinal intervention study with a pre-test/post-test design and follow-up of 1 week and 3 months was performed. The study population consisted of 126 patients with polypharmacy and with additional risk for drug related problems that underwent a medication review in five community pharmacies. The medication review was performed by the pharmacist in close

2018 International journal of clinical pharmacy

135. Developing a measure of polypharmacy appropriateness in primary care: systematic review and expert consensus study. Full Text available with Trip Pro

Developing a measure of polypharmacy appropriateness in primary care: systematic review and expert consensus study. Polypharmacy is an increasing challenge for primary care. Although sometimes clinically justified, polypharmacy can be inappropriate, leading to undesirable outcomes. Optimising care for polypharmacy necessitates effective targeting and monitoring of interventions. This requires a valid, reliable measure of polypharmacy, relevant for all patients, that considers clinical (...) appropriateness and generic prescribing issues applicable across all medications. Whilst there are several existing measures of potentially inappropriate prescribing, these are not specifically designed with polypharmacy in mind, can require extensive clinical input to complete, and often cover a limited number of drugs. The aim of this study was to identify what experts consider to be the key elements of a measure of prescribing appropriateness in the context of polypharmacy.Firstly, we conducted

2018 BMC Medicine

136. Leveraging new information technology to monitor medicine use in 71 residential aged care facilities: variation in polypharmacy and antipsychotic use. Full Text available with Trip Pro

Leveraging new information technology to monitor medicine use in 71 residential aged care facilities: variation in polypharmacy and antipsychotic use. The aim of this study was to use routinely collected electronic medicines administration (eMAR) data in residential aged care (RAC) to investigate the quality use of medicines.A cross-sectional analysis of eMAR data.71 RAC facilities in New South Wales and the Australian Capital Territory, Australia.Permanent residents living in a participating (...) facility on 1 October 2015.None.Variation in polypharmacy (≥5 medications), hyper-polypharmacy (≥10 medications) and antipsychotic use across facilities was examined using funnel plot analysis.The study dataset included 4775 long-term residents. The mean resident age was 85.3 years and 70.6% of residents were female. The median facility size was 60 residents and 74.3% were in metropolitan locations. 84.3% of residents had polypharmacy, 41.2% hyper-polypharmacy and 21.0% were using an antipsychotic

2018 International Journal for Quality in Health Care

137. Opioid Prescribing and Polypharmacy in Children with Chronic Musculoskeletal Pain. Full Text available with Trip Pro

Opioid Prescribing and Polypharmacy in Children with Chronic Musculoskeletal Pain. Thirty percent of adults with fibromyalgia receive an opioid, but the prevalence of opioid prescribing in pediatric chronic musculoskeletal pain is unknown. The aims of this study were to determine the prevalence of and factors associated with opioid exposure and polypharmacy among children with chronic musculoskeletal pain.In this retrospective cohort study using health care claims data from 2000 to 2013 (...) , the index date was the first ICD-9 code 729.1. Included subjects were ≥ 2 and < 18 years old at the index date with two or more codes within 12 months and 18 months of continuous enrollment. Subjects with burns, sickle cell disease, or malignancy were excluded. Opioid exposure was defined as one or more prescriptions within six months before or any time after the index date. Polypharmacy was considered minor (2-4 medications) or major (≥5 medications).Of 25,321 included subjects, 20% received an opioid

2018 Pain Medicine

138. Structured Polypharmacy Management Before Elective Non-cardiac Surgery in Frail and Elderly People

Structured Polypharmacy Management Before Elective Non-cardiac Surgery in Frail and Elderly People Structured Polypharmacy Management Before Elective Non-cardiac Surgery in Frail and Elderly People - 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. Structured Polypharmacy Management Before Elective Non-cardiac Surgery in Frail and Elderly People 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. of clinical studies and talk to your health care provider before participating. Read our for details. ClinicalTrials.gov Identifier: NCT03445767 Recruitment Status

2018 Clinical Trials

139. The increasing burden and complexity of multi-morbidity and polypharmacy in geriatric HIV patients: a cross sectional study of people aged 65 - 74 years and more than 75 years. Full Text available with Trip Pro

The increasing burden and complexity of multi-morbidity and polypharmacy in geriatric HIV patients: a cross sectional study of people aged 65 - 74 years and more than 75 years. Geriatric Patients Living with HIV/AIDS (GEPPO) is a new prospective observational multicentre cohort consisting of all the HIV-positive geriatric patients being treated at 10 clinics in Italy, and HIV-negative controls attending a single geriatric clinic. The aim of this analysis of the GEPPO cohort was to compare (...) prevalence and risk factors of individual non-communicable diseases (NCD), multi-morbidity (MM) and polypharmacy (PP) amongst HIV positive and HIV negative controls at enrolment into the GEPPO cohort.This cross-sectional study was conducted between June 2015 and May 2016. The duration of HIV infection was subdivided into three intervals: < 10, 10-20 and > 20 years. The NCD diagnoses were based on guidelines defined criteria, including cardiovascular disease, hypertension, type 2 diabetes, chronic kidney

2018 BMC Geriatrics

140. Economic outcomes of pharmacist-physician medication therapy management for polypharmacy elderly: A prospective, randomized, controlled trial. Full Text available with Trip Pro

Economic outcomes of pharmacist-physician medication therapy management for polypharmacy elderly: A prospective, randomized, controlled trial. With an increasing geriatric population, the need for effective management of chronic conditions and medication use in the elderly is growing. Medication use in the elderly presents significant challenges due to changes in pharmacodynamic and pharmacokinetic profiles. We aimed to examine the impact of a collaborative physician-pharmacist medication (...) therapy management (MTM) program for polypharmacy elderly patients.Elderly patients with multiple chronic conditions on polypharmacy were enrolled in this prospective, randomized, and controlled study over 16 months of implementation. The intervention group consisted of patients randomized to a collaborative pharmacist-physician MTM program. They were monitored continuously by a clinical pharmacist, while patients in the control group received only usual care with follow-up assessment. Primary outcome

2018 Journal of the Formosan Medical Association = Taiwan yi zhi Controlled trial quality: uncertain

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