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Polypharmacy

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161. Concomitant medication polypharmacy, interactions and imperfect adherence are common in Australian adults on suppressive ART. Full Text available with Trip Pro

Concomitant medication polypharmacy, interactions and imperfect adherence are common in Australian adults on suppressive ART. We quantified concomitant medication polypharmacy, pharmacokinetic and pharmacodynamic interactions, adverse effects and adherence in Australian adults on effective antiretroviral therapy.Cross-sectional.Patients recruited into a nationwide cohort and assessed for prevalence and type of concomitant medication (including polypharmacy, defined as ≥5 concomitant medications (...) ), pharmacokinetic or pharmacodynamic interactions, potential concomitant medication adverse effects and concomitant medication adherence. Factors associated with concomitant medication polypharmacy and with imperfect adherence were identified using multivariable logistic regression.Of 522 participants, 392 (75%) took a concomitant medication (mostly cardiovascular, nonprescription or antidepressant). Overall, 280 participants (54%) had polypharmacy of concomitant medications and/or a drug interaction

2017 AIDS

162. Intervention to improve the appropriate use of polypharmacy for older patients with hip fractures: an observational study. Full Text available with Trip Pro

Intervention to improve the appropriate use of polypharmacy for older patients with hip fractures: an observational study. Polypharmacy is frequently observed in hip fracture patients. Although it is associated with an increased risk of hip fracture, polypharmacy often continues after hip fracture recovery. This study aimed to evaluate the effectiveness of an intervention to improve appropriate polypharmacy for elderly patients admitted to the hospital for hip fractures.We conducted (...) a retrospective observational study to compare the outcomes of patients receiving the intervention (n = 32) with those of patients who received usual care (n = 132). All hip fracture patients aged 65 years or older and prescribed 5 or more medications at admission from January 2015 to December 2016 were included in the study. The intervention consisted of an assessment by internal medicine physicians of the appropriateness of polypharmacy and the de-prescription of any unnecessary medications during

2017 BMC Geriatrics

163. German healthcare professionals' perspective on implementing recommendations about polypharmacy in general practice: a qualitative study. Full Text available with Trip Pro

German healthcare professionals' perspective on implementing recommendations about polypharmacy in general practice: a qualitative study. Key recommendations for the management of patients with polypharmacy are structured medication counselling (SMC), medication lists and systematic medication reviews.The aim of this study was to identify determinants (hindering and facilitating factors) for the implementation of the recommendations in general practice.This study was linked to a tailored (...) checklist including guideline factors, patient factors, individual healthcare professional factors, social, political and legal factors, incentives and resources, and capacity for organizational change.While many interventions to improve polypharmacy focus on the provision of pharmacological knowledge, a much wider range of domains need to be addressed, such as communication skills, patient involvement and practice organization.

2017 Family Practice

164. Prevalence and determinants of polypharmacy in Switzerland: data from the CoLaus study. Full Text available with Trip Pro

Prevalence and determinants of polypharmacy in Switzerland: data from the CoLaus study. Polypharmacy is a frequent condition, but its prevalence and determinants in the Swiss mid-aged population are unknown. We aimed to evaluate the prevalence and determinants of polypharmacy in a large Swiss mid-aged population-based sample.Data from 4938 participants of the CoLaus study (53% women, age range 40-81 years) were collected between 2009 and 2012. Polypharmacy was defined by the regular use of five (...) or more drugs.Polypharmacy was reported by 580 participants [11.8%, 95% confidence interval (10.9; 12.6)]. Participants on polypharmacy were significantly older (mean ± standard deviation: 66.0 ± 9.1 vs. 56.6 ± 10.1 years), more frequently obese (35.9% vs. 14.7%), of lower education (66.6% vs. 50.7%) and former smokers (46.7% vs. 36.4%) than participants not on polypharmacy. These findings were confirmed by multivariate analysis: odds ratio and (95% confidence interval) for age groups 50-64 and 65-81

2017 BMC health services research

165. Association between polypharmacy and falls in older adults: a longitudinal study from England. Full Text available with Trip Pro

Association between polypharmacy and falls in older adults: a longitudinal study from England. Assess the longitudinal association between polypharmacy and falls and examine the differences in this association by different thresholds for polypharmacy definitions in a nationally representative sample of adults aged over 60 years from England.Longitudinal cohort study.The English Longitudinal Study of Ageing waves 6 and 7.5213 adults aged 60 or older.Rates, incidence rate ratio (IRR) and 95% CI (...) for falls in people with and without polypharmacy.A total of 5213 participants contributed 10 502 person-years of follow-up, with a median follow-up of 2.02 years (IQR 1.9-2.1 years). Of the 1611 participants with polypharmacy, 569 reported at least one fall within the past 2 years (rate: 175 per 1000 person-years, 95% CI 161 to 190), and of the 3602 participants without polypharmacy 875 reported at least one fall (rate: 121 per 1000 person-years, 95% CI 113 to 129). The rate of falls was 21% higher

2017 BMJ open

166. Updates in nutrition and polypharmacy. (Abstract)

Updates in nutrition and polypharmacy. Medications have the potential to affect nutritional status in negative ways, especially as the number of medications increase. The inter-relation between polypharmacy and malnutrition is complex and not fully delineated in previous studies. More research has been done and compiled in the last year, which helps to clarify this relationship. This review brings together the most recent literature with the previous research to help healthcare providers (...) to better assess and manage medication therapy in older adults.Recent evidence confirms a synergistic negative effect of polypharmacy and malnutrition on outcomes of older adults. In addition, several drug classes, including common antihypertensive agents, acetylcholinesterase inhibitors, multivitamins, proton pump inhibitors, HMG-CoA reductase inhibitors (statins), antiplatelet agents and metformin, have been implicated in important drug-nutrient interactions. These are reviewed in detail here. Ongoing

2017 Current opinion in clinical nutrition and metabolic care

167. A Pharmacist-Led Program to Evaluate and Reduce Polypharmacy and Potentially Inappropriate Prescribing in Older, HIV-Positive Patients. (Abstract)

A Pharmacist-Led Program to Evaluate and Reduce Polypharmacy and Potentially Inappropriate Prescribing in Older, HIV-Positive Patients. The goal of this pharmacist-led study was to utilize two validated instruments, Beers Criteria and Screening Tool of Older Persons' Potentially Inappropriate Prescriptions (STOPP), to assess potentially inappropriate prescribing (PIP) in older patients infected with the human immunodeficiency virus (HIV) and evaluate pharmacist interventions.Prospective

2017 Pharmacotherapy Controlled trial quality: uncertain

168. Polypharmacy among children and adolescents with psychiatric disorders in a mental referral hospital in Botswana. Full Text available with Trip Pro

Polypharmacy among children and adolescents with psychiatric disorders in a mental referral hospital in Botswana. There is a dearth of data on polypharmacy in child and adolescent mental health in Africa, especially Botswana where children and adults are treated in the same facility by general adult psychiatrists. This study was therefore designed to assess the prevalence and the risk factors of psychiatric polypharmacy among children and adolescents treated at Sbrana Psychiatric Hospital (...) , Lobatse, Botswana.Data involving socio-demographics, diagnosis (using ICD-10 classification) and pharmacological treatment were retrieved from the records of 120 children and adolescents aged below 18 years, between 1 January 2012 and 31 July 2016, who presented with psychiatric disorders. They were analysed with univariate and multivariate models.The prevalence of psychiatric polypharmacy was 29.2%. Psychiatric co-morbidity (OR = 3.374, 95% CI: 1.177-9.9673) and psychotropic side effects (OR = 5.782

2017 BMC Psychiatry

169. Rewriting the script on polypharmacy. (Abstract)

Rewriting the script on polypharmacy. With a blood pressure consistently around 105/50 mm Hg, it was an easy decision to stop one of the patient's 3 antihypertensive medications.

2017 Journal of Family Practice

170. Deprescribing: A simple method for reducing polypharmacy. (Abstract)

Deprescribing: A simple method for reducing polypharmacy. Polypharmacy brings with it increased risks for adverse drug events and reduced functional capacity. This 4-step plan will help you safely deprescribe in older adults.

2017 Journal of Family Practice

171. Prevalence of Central Nervous System Polypharmacy and Associations with Overdose and Suicide-Related Behaviors in Iraq and Afghanistan War Veterans in VA Care 2010–2011 Full Text available with Trip Pro

Prevalence of Central Nervous System Polypharmacy and Associations with Overdose and Suicide-Related Behaviors in Iraq and Afghanistan War Veterans in VA Care 2010–2011 The increase in the quantities of central nervous system (CNS)-acting medications prescribed has coincided with increases in overdose mortality, suicide-related behaviors, and unintentional deaths in military personnel deployed in support of the wars in Iraq and Afghanistan. Data on the extent and impact of prescribing (...) multiple CNS drugs among Iraq and Afghanistan Veterans (IAVs) are sparse.We sought to identify the characteristics of IAVs with CNS polypharmacy and examine the association of CNS polypharmacy with drug overdose and suicide-related behaviors controlling for known risk factors.This cross-sectional cohort study examined national data of Iraq and Afghanistan Veterans (N = 311,400) who used the Veterans Health Administration (VHA) during the fiscal year 2011. CNS polypharmacy was defined as five or more

2016 Drugs - real world outcomes

172. Cytochrome P450‐mediated interaction between perazine and risperidone: implications for antipsychotic polypharmacy Full Text available with Trip Pro

Cytochrome P450‐mediated interaction between perazine and risperidone: implications for antipsychotic polypharmacy Although clinically widespread, scientific evidence for antipsychotic polypharmacy is still limited. Combining different drugs increases the potential for drug-drug interactions, enhancing the risk of adverse drug reactions. We aimed to unravel the potential pharmacokinetic interactions between risperidone (RIS) and perazine.Using a therapeutic drug monitoring database containing

2017 British journal of clinical pharmacology

173. Polypharmacy in Zoological Medicine Full Text available with Trip Pro

Polypharmacy in Zoological Medicine Polypharmacy is a term that describes the inappropriate, concurrent use of multiple drugs in an individual patient. Zoological medicine practitioners must take approved agents (veterinary or human) and extrapolate their use to non-approved species often with little species-specific pharmacological evidence to support their decisions. When considering polypharmacy, even less information exists concerning multi-drug pharmacokinetics, pharmacodynamics (...) , or potential drug-drug interactions in non-domestic species. Unfortunately, captive, zoological species are susceptible, just like their domestic counterparts, to chronic diseases and co-morbidities that may lead to the usage of multiple drugs. Polypharmacy is a recognized and important issue in human medicine, as well as an emerging issue for veterinarians; thus, this paper will discuss the novel, potential risks of polypharmacy in zoological medicine. Hopefully, this discussion will help bring

2017 Pharmaceutics

174. Assessing medication burden and polypharmacy: finding the perfect measure Full Text available with Trip Pro

Assessing medication burden and polypharmacy: finding the perfect measure 28271722 2018 05 28 2018 11 13 1751-2441 10 4 2017 04 Expert review of clinical pharmacology Expert Rev Clin Pharmacol Assessing medication burden and polypharmacy: finding the perfect measure. 345-347 10.1080/17512433.2017.1301206 Gnjidic Danijela D a Faculty of Pharmacy and Charles Perkins Centre , University of Sydney , Sydney , NSW , Australia. Tinetti Mary M b Department of Internal Medicine , Yale School of Medicine (...) Prescribing statistics & numerical data Polypharmacy Practice Patterns, Physicians' standards Polypharmacy deprescribing older adults 2017 3 9 6 0 2018 5 29 6 0 2017 3 9 6 0 ppublish 28271722 10.1080/17512433.2017.1301206 PMC5477055 NIHMS863644 Clin Pharmacol Ther. 2012 Mar;91(3):521-8 22297385 J Clin Epidemiol. 2012 Sep;65(9):989-95 22742913 J Gerontol A Biol Sci Med Sci. 2017 Feb;72 (2):259-265 27384327 BMJ. 2016 Jun 15;353:i2868 27306620 Cochrane Database Syst Rev. 2014 Oct 07;(10):CD008165 25288041 J

2017 Expert review of clinical pharmacology

175. Identifying, highlighting and reducing polypharmacy in a UK hospice inpatient unit using improvement Science methods Full Text available with Trip Pro

Identifying, highlighting and reducing polypharmacy in a UK hospice inpatient unit using improvement Science methods Polypharmacy, the concurrent use of multiple medications by one individual is a growing global issue driven by an ageing population and increasing prevalence of multi-morbidity[1]. Polypharmacy can be problematic: interactions between medications, reduced adherence to medication, burden of medication to patients, administration time, increased risk of errors and increased cost (...) . Quality improvement methods were applied to identify and highlight polypharmacy patients with the aim of reducing their average number of regular tablets/capsules per day by 25%. The project was delivered within a UK based 27 bedded hospice inpatient unit. A series of PDSA cycles studied interventions focusing on the identification of patients with polypharmacy, the highlighting of these patients to prescribers for review and the views of patients about their medication. For the purposes of the study

2017 BMJ Quality Improvement Reports

176. Successful withdrawal from high-dose benzodiazepine in a young patient through electronic monitoring of polypharmacy: a case report in an ambulatory setting Full Text available with Trip Pro

Successful withdrawal from high-dose benzodiazepine in a young patient through electronic monitoring of polypharmacy: a case report in an ambulatory setting Dependence on high-dose benzodiazepines (BZDs) is well known and discontinuation attempts are generally unsuccessful. A well established protocol for high-dose BZD withdrawal management is lacking. We present the case of withdrawal from high-dose lorazepam (>20 mg daily) in an unemployed 35-year-old male outpatient through agonist

2017 Therapeutic Advances in Psychopharmacology

177. Unresolved Issues for Utilization of Atypical Antipsychotics in Schizophrenia: Antipsychotic Polypharmacy and Metabolic Syndrome Full Text available with Trip Pro

Unresolved Issues for Utilization of Atypical Antipsychotics in Schizophrenia: Antipsychotic Polypharmacy and Metabolic Syndrome Atypical antipsychotics (AAP) are the prevailing form of schizophrenia treatment today due to their low side effects and superior efficacy. Nevertheless, some issues still need to be addressed. First, there are still a large number of patients with treatment-resistant schizophrenia (TRS), which has led to a growing trend to resort to AAP polypharmacy with few side (...) effects. Most clinical treatment guidelines recommend clozapine monotherapy in TRS, but around one third of schizophrenic patients fail to respond to clozapine. For these patients, with clozapine-resistant schizophrenia AAP polypharmacy is a common strategy with a continually growing evidence base. Second, AAP generally have great risks for developing metabolic syndrome, such as weight gain, abnormality in glucose, and lipid metabolism. These metabolic side effects have become huge stumbling blocks

2017 International journal of molecular sciences

178. Antipsychotic polypharmacy prescribing and risk of hospital readmission Full Text available with Trip Pro

Antipsychotic polypharmacy prescribing and risk of hospital readmission The aim of this study was to determine if there was an association between being discharged on antipsychotic polypharmacy (APP) and risk of readmission into secondary mental health care.Using data from the South London and Maudsley (SLAM) case register, service users with serious mental illness (SMI), discharged between 1st January 2007 and 31th December 2014, were followed up for 6 months. Patients were classified (...) as receiving either monotherapy or polypharmacy at index discharge. Multivariable Cox regression models were constructed, adjusting for sociodemographic, socioeconomic, clinical and service use factors.We identified 5523 adults who had been admitted at least once to SLAM, of whom 1355 (24.5%) were readmitted into secondary mental health care. In total, 15% (n = 826) of patients were discharged on APP and 85% (n = 4697) on monotherapy. Of these, 30.9% (n = 255) and 23.4% (n = 1100) were readmitted

2017 Psychopharmacology

179. Poly-de-prescribing to treat polypharmacy: efficacy and safety Full Text available with Trip Pro

Poly-de-prescribing to treat polypharmacy: efficacy and safety The aim of this study was to evaluate efficacy and safety of poly-de-prescribing (PDP) based on the Garfinkel method in older people with polypharmacy.A longitudinal, prospective, nonrandomized study in Israel was carried out between 2009 and 2016. Comprehensive geriatric assessments were performed at home in people age ⩾66 years consuming ⩾6 prescription drugs. Exclusion criteria were life expectancy <6 months and a seeming (...) reduced (p < 0.002 in all). The rate of hospitalizations and mortality was comparable. Health improvement occurred within 3 months after de-prescribing in 83%, and persisted for ⩾2 years in 68%.This self-selected sample longitudinal research strongly suggests that the negative, usually invisible effects of polypharmacy are reversible. PDP is well tolerated and associated with improved clinical outcomes, in comparison with outcomes of older people who adhere to all clinical guidelines and take all

2017 Therapeutic advances in drug safety

180. A dataset quantifying polypharmacy in the United States Full Text available with Trip Pro

A dataset quantifying polypharmacy in the United States Polypharmacy is increasingly common in the United States, and contributes to the substantial burden of drug-related morbidity. Yet real-world polypharmacy patterns remain poorly characterized. We have counted the incidence of multi-drug combinations observed in four billion patient-months of outpatient prescription drug claims from 2007-2014 in the Truven Health MarketScan® Databases. Prescriptions are grouped into discrete windows (...) of polypharmacy in a large US cohort, which can prioritize common drug combinations for future safety and efficacy studies.

2017 Scientific data

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