With the acceleration of society’s aging process,the widespread phenomenon of polypharmacy among the elderly has become a significant concern.This research aimed to analyze potential inappropriate medication among 17...With the acceleration of society’s aging process,the widespread phenomenon of polypharmacy among the elderly has become a significant concern.This research aimed to analyze potential inappropriate medication among 178 inpatients in the geriatric general department of our hospital from January 2022 to September 2022.The participants were randomly assigned to an observation group and a control group.The observation group received pharmaceutical intervention,whereas the control group did not.The objective was to explore the impact of pharmaceutical intervention on polypharmacy in this population.The results revealed that after pharmaceutical intervention,there were no significant differences in medication adherence,medication appropriateness index(MAI),quantity of medicine,and potentially inappropriate medication(PIM)in the control group compared to before the intervention(P>0.05).However,the observation group showed significant improvement(P<0.05).The proportion of patients with good adherence increased from 57%to 78%,and the percentage of patients with MAI scores over 10 decreased from 60%to 40%.Moreover,there was a reduction in the number of medications prescribed,with only 47%of patients receiving more than five different types compared to the initial rate of 64%.Additionally,the occurrence of PIM declined from an initial rate of 64%to just 44%,surpassing that observed in the control group.Therefore,the implementation of pharmaceutical intervention can effectively enhance medication adherence and appropriateness among elderly patients,mitigate the risk of PIM,and promote rational medicine utilization.展开更多
Healthcare polypharmacy is routinely used to treat numerous conditions;however,it often leads to unanticipated bad consequences owing to complicated medication interactions.This paper provides a graph convolutional ne...Healthcare polypharmacy is routinely used to treat numerous conditions;however,it often leads to unanticipated bad consequences owing to complicated medication interactions.This paper provides a graph convolutional network(GCN)-based model for identifying adverse effects in polypharmacy by integrating pharmaceutical data from electronic health records(EHR).The GCN framework analyzes the complicated links between drugs to forecast the possibility of harmful drug interactions.Experimental assessments reveal that the proposed GCN model surpasses existing machine learning approaches,reaching an accuracy(ACC)of 91%,an area under the receiver operating characteristic curve(AUC)of 0.88,and an F1-score of 0.83.Furthermore,the overall accuracy of the model achieved 98.47%.These findings imply that the GCN model is helpful for monitoring individuals receiving polypharmacy.Future research should concentrate on improving the model and extending datasets for therapeutic applications.展开更多
Introduction: The increasing number of elderly, and drug use among the elderly, emphasizes the need for continuous monitoring of drug utilization. Chronic diseases are frequent among the older population;the rate of d...Introduction: The increasing number of elderly, and drug use among the elderly, emphasizes the need for continuous monitoring of drug utilization. Chronic diseases are frequent among the older population;the rate of drug related problems and drug-drug interactions (DDIs) with the medical and financial consequences are enormous. Polypharmacy (PP) is defined as the concomitant use of 5 or more medications. We studied PP among chronic elderly patients in Gaza Strip and its distri- bution among primary health care clinics in different areas. Materials and Methods: This study is a descriptive analytical study, analyzing prescription data from general practices during a 3-month time period, to measure the prevalence of PP and medication errors among chronic elderly pa- tients. Data were collected directly from the prescriptions and medical records, which contain per- sonal data for patients like patient age and gender, included the current illness, drug treatment for the current illness, chronic disease/s and drug treatment for chronic disease/s. SPSS software was used to analyze the obtained data. Results: Percent of major PP was the highest among patients aged 60 - 69 years when compared with other ages categories of study population but not reached to be statisticaly significant (0.012). Major PP was higher in female patients than that in male patients but difference wasn’t statistically significant (0.5). The average number of drug per prescription was 3.4 drug;and the minimum value per prescription was 1 meanwhile maximum value was 9 (SD + 1.7). Conclusion: PP (use of five drugs or more) is more prevalent among elderly patients with multiple diseases. Female patients consume more drugs than male do. There were some regional differences in drug utilization not explained by morbidity, suggesting some varia- tions in prescribing behaviors.展开更多
Objective: Little is known about the prescription pattern of psychotropic drugs for patients with schizophrenia in Pakistan. The purpose of this study was to evaluate the characteristic features of psychotropic drug p...Objective: Little is known about the prescription pattern of psychotropic drugs for patients with schizophrenia in Pakistan. The purpose of this study was to evaluate the characteristic features of psychotropic drug prescriptions for patients with schizophrenia in Pakistan. Methods: Three centers in Pakistan participated in a large scale collaborative study known as Research on Asian Prescription Pattern (REAP). The 2016 REAP survey included centers from 15 countries in Asia and used a unified research protocol. The design of the study was quantitative and of descriptive epidemiology. Analysis was made on the data collected from three centers i.e., Lahore, Karachi and Islamabad. The data collected in Pakistan were compared with those from other Asian countries. The details of REAP were presented on the homepage of REAP (http://www.REAP.Asia). Results: From Pakistan, 298 patients were included. Patients with schizophrenia in Pakistan received higher rate of antipsychotic polypharmacy and a higher rate of co-prescription of mood stabilizers and anxiolytics when compared with participants from other South Asian countries (India and Bangladesh). Conclusion: The main findings of the study were that a majority of the patients were prescribed antipsychotic polypharmacy drugs in Pakistan. Insufficient training on the use of psychotropic drugs and a lack of treatment guideline are considered to be the major contributing factors. Further education and training on the proper use of psychotropic drugs are recommended to psychiatrists in Pakistan. The guidelines on pharmacotherapy for patients with schizophrenia should also be developed and promoted in Pakistan.展开更多
Introduction:The definition of polypharmacy is not consensual,but all authors refer it as the simultaneous use and the chronic way,of several drugs by the same person.Polypharmacy affects mainly the elderly and it is ...Introduction:The definition of polypharmacy is not consensual,but all authors refer it as the simultaneous use and the chronic way,of several drugs by the same person.Polypharmacy affects mainly the elderly and it is due to the high number of chronic diseases in this population and consequent need to take medications to control them.Aims:Characterization and quantification of polypharmacy in a rural elderly population.Materials and Methods:It carried out an observational,retrospective,transversal and analytical study in Farmácia Popular(Pombal).Total of 230 individuals aged 65 years old or more were surveyed and the data collection was made through a questionnaire prepared for this purpose,in time between February and April 2017.Results:The elderly took,on mean,6.20 drugs daily.The prevalence of Major polypharmacy(≥5 medications)was 70.4%.The most prescribed pharmacotherapeutics groups were cardiovascular and central nervous system.There were statistically significant differences between age and number of medicaments taken,as well between number of drugs and the way to identify the medication,the knowledge of the therapeutics indications,the occurrence of mistakes or take outside advised time,and the self-perception of health state(p≤0.05).Conclusion:In view of the obtained results,it concludes that polypharmacy is very high in Portuguese population in study.It is the persons most aged who consume a greater number of drugs.The elderly with less academic qualifications are those who have more difficulty in identifying medication and respective therapeutics indications.It is necessary to adopt strategies in order to reduce polypharmacy,with the prescriber and the professionals of pharmacy a preponderant role in this task.展开更多
Addiction literacy equips older adults with the knowledge to navigate substance use risks amid unique challenges like polypharmacy and social isolation.With rising trends in cannabis use among this group,targeted educ...Addiction literacy equips older adults with the knowledge to navigate substance use risks amid unique challenges like polypharmacy and social isolation.With rising trends in cannabis use among this group,targeted education can promote safe practices and reduce preventable harms.By fostering open conversations and integrating addiction literacy into healthcare,providers can support informed decision-making.展开更多
Background: The irrational use of medicines remains a key health problem in many developing countries. The overuse of antibiotics is a key driver of antimicrobial resistance (AMR). This study surveyed antibiotic use a...Background: The irrational use of medicines remains a key health problem in many developing countries. The overuse of antibiotics is a key driver of antimicrobial resistance (AMR). This study surveyed antibiotic use and adherence to the World Health Organization (WHO) prescribing indicators at the Request Muntanga Hospital in the Kalomo District of Southern Province, Zambia. Materials and Methods: This cross-sectional study was conducted from July 2023 to September 2023 at Request Muntanga Hospital in Zambia and reviewed 600 medical record prescriptions which were issued from July 1, 2022 to June 30, 2023 using the WHO prescribing indicators. The collected data were analyzed using Statistical Package for Social Sciences version 23.0. Results: From the 600 prescriptions sampled, 1246 medicines were prescribed, with antibiotics making up 86.7% of the encounters. Additionally, the average number of drugs prescribed per encounter was 2.1 and the prevalence of polypharmacy was 61.3%. Further, 17.8% of medicines were prescribed as injectables. Furthermore, 76.7% of the drugs were prescribed from the Zambia Essential Medicines List and 38.9% by generic names. Conclusions: This study found a high use of antibiotics and deviations from the WHO/International Network of Rational Use of Drugs (INRUD) core prescribing indicators at the Request Muntanga Hospital indicating non-adherence to the prescribing indicators. There is a need to promote adherence to the WHO/INRUD core prescribing indicators to promote the rational use of antibiotics and prevent the emergence and spread of AMR.展开更多
Proton pump inhibitors(PPIs)are widely utilized in oncology to treat gastroeso-phageal reflux disease,peptic ulcer disease,and chemotherapy-induced mucosal injury.Emerging evidence has suggested that prolonged use of ...Proton pump inhibitors(PPIs)are widely utilized in oncology to treat gastroeso-phageal reflux disease,peptic ulcer disease,and chemotherapy-induced mucosal injury.Emerging evidence has suggested that prolonged use of PPIs is associated with increased mortality in patients with cancer.The findings of Krishnan et al are proof of this but need to be considered cautiously due to potential confounding factors.This letter raised important methodological concerns,including con-founding by indication,reverse causality,and polypharmacy that can influence the observed association.While PPIs are important in oncology,their advantages and disadvantages should be weighed judiciously by clinicians.Future prospective studies with robust analytical approaches will be required to ascertain more definite causality.展开更多
BACKGROUND Bradycardia,renal failure,atrioventricular nodal blockade,shock,and hyper-kalemia(BRASH)syndrome is an acronym used to describe a constellation of BRASH.It is an underrecognized phenomenon that can be deadl...BACKGROUND Bradycardia,renal failure,atrioventricular nodal blockade,shock,and hyper-kalemia(BRASH)syndrome is an acronym used to describe a constellation of BRASH.It is an underrecognized phenomenon that can be deadly if not appro-priately managed in a timely manner.This case highlights the importance of rapid diagnosis and reviews a multitude of treatment options in a uniquely severe case of BRASH syndrome.CASE SUMMARY We present a case of a 54-year-old male on a beta-blocker and angiotensin-con-verting enzyme inhibitor who presented with one day history of nausea,vomi-ting,and shortness of breath.Upon presentation,he was bradycardic and hypotensive,requiring transcutaneous pacing.Initial electrocardiogram showed atrial fibrillation with ventricular rate in 30’s.He was found to have acute kidney injury,hyperkalemia,and metabolic acidosis.He was successfully treated with multiple potassium lowering agents,continuous renal replacement therapy,four pressors,mechanical ventilation,and transvenous pacing with complete recovery prior to discharge.CONCLUSION Increased awareness of BRASH syndrome may improve outcomes through timely diagnosis and aggressive intervention.展开更多
The research paper investigates the intricate landscape of drug-drug interactions (DDIs) within the context of breast cancer treatment, with a particular focus on the elderly population and the use of complementary an...The research paper investigates the intricate landscape of drug-drug interactions (DDIs) within the context of breast cancer treatment, with a particular focus on the elderly population and the use of complementary and alternative medicine (CAM). The study underscores the heightened susceptibility of elderly patients to DDIs due to the prevalence of polypharmacy and the widespread utilization of CAM among breast cancer patients. The potential ramifications of DDIs, encompassing adverse drug events and diminished treatment efficacy, are elucidated. The paper accentuates the imperative for healthcare providers to comprehensively understand both conventional and CAM therapies, enabling them to provide patients with informed guidance regarding safe and efficacious treatment options, culminating in enhanced patient outcomes.展开更多
AIM： To evaluate the patterns of use of clarithromycin for gastrointestinal disease treatment and promote its rational use.METHODS： Using a structured pro forma, we conducted a two-month survey of the electronic pre...AIM： To evaluate the patterns of use of clarithromycin for gastrointestinal disease treatment and promote its rational use.METHODS： Using a structured pro forma, we conducted a two-month survey of the electronic prescriptions containing immediate-release （IR） or sustained-release （SR） product of clarithromycin for outpatients with gastrointestinal diseases in a 2200-bed general hospital. Suitability of the prescription was audited retrospectively. RESULTS： One hundred and sixty-four prescriptions of SR product and 110 prescriptions of IR product were prescribed for gastrointestinal disease treatment. Among prescriptions for anti-Helicobacter pylori （H pylori） therapy, triple therapy take the dominant position （91.8%）, followed by quadruple therapy （4.3%） and dual therapy （3.9%）. Amoxicillin was the most frequently co-prescribed antibiotic.Furazolidone and levofloxacin are used more widely than metronidazole or tinidazole. Clarithromycin SR was administered at inappropriate time points in all prescriptions. Fifty percent of all prescriptions of clarithromycin SR, and 6.4% of prescriptions of clarithromycin IR, were prescribed at inappropriate dosing intervals. Surprisingly, disconcordance between diagnoses and indications was observed in all prescriptions of clarithromycin SR which has not been approved for treating Hpy/ori infection although off-label use for this purpose was reported in literature. On the contrary, only one prescription （0.9%） of clarithromycin IR was prescribed for unapproved indication （i.e. gastro-oesophageal reflux disease）. 1.4% of prescriptions for chronic gastritis or peptic ulcer treatment were irrational in that clarithromycin was not co-prescribed with gastric acid inhibitors. Clinical significant CYP3A based drug interactions with clarithromycin were identified. CONCLUSION： There is a great scope to improve the quality of clarithromycin prescribing in patients with gastrointestinal disease, especially with regard to administration schedule, concordance between indications and diagnoses and management of drug interactions.展开更多
Human aging is a global issue with important implications for current and future incidence and prevalence of health conditions and disability. Cardiac arrhythmias, including atrial fibrillation, sudden cardiac death, ...Human aging is a global issue with important implications for current and future incidence and prevalence of health conditions and disability. Cardiac arrhythmias, including atrial fibrillation, sudden cardiac death, and bradycardia requiring pacemaker placement, all increase exponentially after the age of 60. It is important to distinguish between the normal, physiological consequences of aging on cardiac electrophysiology and the abnormal, pathological alterations. The age-related cardiac changes include ventricular hypertrophy, senile amyloidosis, cardiac valvular degenerative changes and annular calcification, fibrous infiltration of the conduction system, and loss of natural pacemaker cells and these changes could have a profound effect on the development of arrhythmias. The age-related cardiac electrophysiological changes include up- and down-regulation of specific ion channel expression and intmcellular Ca2＋ overload which promote the development of cardiac arrhythmias. As ion channels are the substrates of antiarrhythmic drugs, it follows that the pharmacokinetics and pharmacodynamics of these drugs will also change with age. Aging alters the absorption, distribution, metabolism, and elimination of antiarrhythmic drugs, so liver and kidney function must be monitored to avoid potential adverse drug effects, and antiarrhythmic dosing may need to be adjusted for age. Elderly patients are also more susceptible to the side effects of many antiarrhytbanics, including bradycardia, orthostatic hypotension, urinary retention, and falls. Moreover, the choice of antiarrhythmic drugs in the elderly patient is frequently complicated by the presence of co-morbid conditions and by polypharmacy, and the astute physician must pay careful attention to potential drug-drug interactions. Finally, it is important to remember that the use of antiarrhythmic drugs in elderly patients must be individualized and tailored to each patient＇s physiology, disease processes, and medication regimen.展开更多
Medications are beneficial for curing or managing acute and chronic illnesses. Medications typically have positive outcomes, although older people are prone to drug-related problems. Community-dwelling seniors are at ...Medications are beneficial for curing or managing acute and chronic illnesses. Medications typically have positive outcomes, although older people are prone to drug-related problems. Community-dwelling seniors are at particularly high risk of polypharmacy, as they tend to receive many prescriptions over time and from different care providers. Continuing-care facility admission presents an excellent opportunity for a comprehensive medication review. A research study was conducted to describe and compare medications taken by community-dwelling seniors prior to and following admission to a continuing-care facility. This pilot project involved data being gathered from the charts of deceased residents, as required by a University Health Research Ethics Board, who had been cared for at one large local continuing-care facility. The facility administrators also approved this study, in part to evaluate their policy to conduct a medication review for all new residents within six weeks of entry. This study revealed a slight but statistically significant reduction in the number of medications following this review. Other issues such as medication interactions and required dosage changes were addressed by this medication review. Although this study was confined to one continuing-care facility and a small number of residents, the findings suggest medication reviews would be beneficial upon admission to all continuing-care facilities, and annually perhaps through other means for older persons living in the community.展开更多
1 Introduction Although older adults are generally among the highest users of cardiovascular medications, they are typically underrepresented or excluded from most efficacy and safety trials. Drug developers are usual...1 Introduction Although older adults are generally among the highest users of cardiovascular medications, they are typically underrepresented or excluded from most efficacy and safety trials. Drug developers are usually reluctant to include many senior adults in randomized controlled clinical trials in part due to their high prevalence of multiple comorbidities, frailty, and polypharmacy; and to age-related pharmacokinetic and pharmacodynamic complexities. Consequently, there is often insufficient high quality evidence-based data to inform pharmacologic management of common cardiovascular conditions on older adults. In the absence of data, clinicians often rely on conceptual principles regarding metabolism and drug-drug interactions to minimize adverse drug events, but this is often not well-substantiated or standardized. A related challenge is poor cardiovascular medication adherence among older adults, and its detrimental impact on their health outcomes. In this brief review we highlight some aspects of these topics.展开更多
Objective: To analyze the use of all subsidized prescription drugs including their use of drug combination generally accepted as carrying a risk of severe interactions. Methodology: In a cross sectional study, we anal...Objective: To analyze the use of all subsidized prescription drugs including their use of drug combination generally accepted as carrying a risk of severe interactions. Methodology: In a cross sectional study, we analyzed all prescriptions (n = 1014) involving two or more drugs dispensed to the population (age range 4-85 years) from all pharmacies, clinics and hospitals. Data were stratified by age and sex, and frequency of common interacting drugs. Potential drug interactions were classified according to clinical relevance as significance of severity (types A: major, B: moderate, and C: minor) and documented evidence (types 1, 2, 3, and 4). Result and Discussion: The growing use of pharmacological agents means that drug interactions are of increasing interest for public health. Monitoring of potential drug interactions may improve the quality of drug prescribing and dispensing, and it might form a basis for education focused on appropriate prescribing. To make the manifestation of adverse interaction subside, management strategies must be exercised if two interacting drugs have to be taken with each other, involving: adjusting the dose of the object drug;spacing dosing times to avoid the interaction. The pharmacist, along with the prescriber has a duty to ensure that patients are aware of the risk of side effects and a suitable course of action they should take. Conclusion: It is unrealistic to expect clinicians to memorize the thousands of drug-drug interactions and their clinical significance, especially considering the rate of introduction of novel drugs and the escalating appreciation of the importance of pharmacogenomics. Reliable regularly updated decision support systems and information technology are necessary to help avert dangerous drug combinations.展开更多
Background: Older diabetic patients are more likely to be frail than those who do not have diabetes. Frailty is an important risk factor for both mortality and disability in older patients with type 2 diabetes. Howeve...Background: Older diabetic patients are more likely to be frail than those who do not have diabetes. Frailty is an important risk factor for both mortality and disability in older patients with type 2 diabetes. However, the mechanism of frailty in diabetes mellitus is not fully understood. Aims: The aim of this study was to identify the prevalence of frailty and associated factors in older patients with type 2 diabetes in Japan. Methods: A cross-sectional study was conducted with a total of 178 outpatients who were over 65 years old with type 2 diabetes. We used the Obu Study Health Promotion for the Elderly definition of frailty to divided subjects into a non-frail and a frail group. We investigated the association between frailty and various patient characteristics. Results: In the study, 21.4% of the older patients with type 2 diabetes were considered frail. There were no significant differences in the duration of diabetes, BMI, proportion of microvascular complications, or HbA1c values between the frail and non-frail group. However, serum albumin and IGF-1 levels were lower in the frail group than the non-frail group as were the Mini-Mental State Examination scores. The frail group had a higher number of medications than the non-frail group. In a multivariable analysis, frailty was positively associated with the number of medications and, lower levels of both serum albumin and IGF-1. Conclusion: Our study suggests that diabetes accelerates the aging process and frailty is associated with low albumin, polypharmacy and low levels of IGF-1.展开更多
We aimed to characterize, and analyze the presence of factors such as polypharmacy and personal medical history that predispose to Adverse Drug Reactions （ADRs） and potential preventability of these. The Civil Hospi...We aimed to characterize, and analyze the presence of factors such as polypharmacy and personal medical history that predispose to Adverse Drug Reactions （ADRs） and potential preventability of these. The Civil Hospital of Culiacan （HCC）, in Sinaloa, where the study was conducted has 80 beds in total, in which the Department of Internal Medicine with 24 beds： 12 lbr men and 12 for women, we found the part of the share to contribute to the 200,000 cases of ADRs that according with the WHO each of the countries members report ever）, year to the Uppsala Monitoring Centre. We have not only but also ordered frequency of drugs, pathologies, and analytical tests of the hospitalized patients.展开更多
1 Introduction For patients with complex diseases or co-existing conditions,polypharmacy-defined as the concurrent use of multiple medications-can be a promising strategy.However,this approach significantly increases ...1 Introduction For patients with complex diseases or co-existing conditions,polypharmacy-defined as the concurrent use of multiple medications-can be a promising strategy.However,this approach significantly increases the risk of side effects due to drug-drug interactions(DDIs).Adverse DDIs are a leading cause of morbidity and mortality,with drug-induced fatalities accounting for approximately 100,000 deaths annually in the U.S.,making them the fourth leading cause of death after lung disease[1,2].展开更多
Background： Polyphamlacy and potentially inappropriate medications （PIMs） are prominent prescribing issties in elderly patients. This study was to investigate the different prevalence of PIM use in elderly inpatien...Background： Polyphamlacy and potentially inappropriate medications （PIMs） are prominent prescribing issties in elderly patients. This study was to investigate the different prevalence of PIM use in elderly inpatients between 65-70 years of age and 80 years or older, who were discharged from Geriatric Depamnent in West China Hospital. Methods： A large-scale cohort of 1796 inpatients aged 65 years or over was recruited. Respectively. 618 patients were 65 79 years and 1178 patients were 80 years or older. Updated 2012 Beers Criteria by the Anaerican Geriatric Society was applied to assess the use of PIM among the investigated samples. Results： A review of the prescribed medications identified 686 patients aged 80 years or older constimed at least one PIM giving a rate of 58.2%. Conversely, 268 （43.4%） patients aged 65-79 years consumed at least one PIM （x^2=40.18, P 〈 0.001）. Patients aged 80 years or older had higher hospitalization expenses, length of stay, co-morbidities, medical prescription, and mortality than patients aged 65-79 years （all with P 〈 0.001 ）. Patients aged 80 years or older were prescribed with more benzodiazepines, drugs with strong anticholmergic properties, megestrol, antipsychotics, theophylline, and aspirin. In multiple regression analysis, PIM use was significantly associated with female gender, age, number of diagnostic disease, and number of prescribed medication. Conclusions： The finding from this study revealed that inpatients aged 80 years or older encountered more PIM use than those aged 65-79 years. Anticholinergic properties, megestrol. antipsychotics, theophylline, and aspirin are medications that often prescribed to inpatients aged 80 years or older. Doctors should carefully choose drugs for the elderly, especially the elderly aged 80 years or older.展开更多
基金Hospital Pharmacy Research Foundation of Guangdong(Grant No.2022A14)。
文摘With the acceleration of society’s aging process,the widespread phenomenon of polypharmacy among the elderly has become a significant concern.This research aimed to analyze potential inappropriate medication among 178 inpatients in the geriatric general department of our hospital from January 2022 to September 2022.The participants were randomly assigned to an observation group and a control group.The observation group received pharmaceutical intervention,whereas the control group did not.The objective was to explore the impact of pharmaceutical intervention on polypharmacy in this population.The results revealed that after pharmaceutical intervention,there were no significant differences in medication adherence,medication appropriateness index(MAI),quantity of medicine,and potentially inappropriate medication(PIM)in the control group compared to before the intervention(P>0.05).However,the observation group showed significant improvement(P<0.05).The proportion of patients with good adherence increased from 57%to 78%,and the percentage of patients with MAI scores over 10 decreased from 60%to 40%.Moreover,there was a reduction in the number of medications prescribed,with only 47%of patients receiving more than five different types compared to the initial rate of 64%.Additionally,the occurrence of PIM declined from an initial rate of 64%to just 44%,surpassing that observed in the control group.Therefore,the implementation of pharmaceutical intervention can effectively enhance medication adherence and appropriateness among elderly patients,mitigate the risk of PIM,and promote rational medicine utilization.
文摘Healthcare polypharmacy is routinely used to treat numerous conditions;however,it often leads to unanticipated bad consequences owing to complicated medication interactions.This paper provides a graph convolutional network(GCN)-based model for identifying adverse effects in polypharmacy by integrating pharmaceutical data from electronic health records(EHR).The GCN framework analyzes the complicated links between drugs to forecast the possibility of harmful drug interactions.Experimental assessments reveal that the proposed GCN model surpasses existing machine learning approaches,reaching an accuracy(ACC)of 91%,an area under the receiver operating characteristic curve(AUC)of 0.88,and an F1-score of 0.83.Furthermore,the overall accuracy of the model achieved 98.47%.These findings imply that the GCN model is helpful for monitoring individuals receiving polypharmacy.Future research should concentrate on improving the model and extending datasets for therapeutic applications.
文摘Introduction: The increasing number of elderly, and drug use among the elderly, emphasizes the need for continuous monitoring of drug utilization. Chronic diseases are frequent among the older population;the rate of drug related problems and drug-drug interactions (DDIs) with the medical and financial consequences are enormous. Polypharmacy (PP) is defined as the concomitant use of 5 or more medications. We studied PP among chronic elderly patients in Gaza Strip and its distri- bution among primary health care clinics in different areas. Materials and Methods: This study is a descriptive analytical study, analyzing prescription data from general practices during a 3-month time period, to measure the prevalence of PP and medication errors among chronic elderly pa- tients. Data were collected directly from the prescriptions and medical records, which contain per- sonal data for patients like patient age and gender, included the current illness, drug treatment for the current illness, chronic disease/s and drug treatment for chronic disease/s. SPSS software was used to analyze the obtained data. Results: Percent of major PP was the highest among patients aged 60 - 69 years when compared with other ages categories of study population but not reached to be statisticaly significant (0.012). Major PP was higher in female patients than that in male patients but difference wasn’t statistically significant (0.5). The average number of drug per prescription was 3.4 drug;and the minimum value per prescription was 1 meanwhile maximum value was 9 (SD + 1.7). Conclusion: PP (use of five drugs or more) is more prevalent among elderly patients with multiple diseases. Female patients consume more drugs than male do. There were some regional differences in drug utilization not explained by morbidity, suggesting some varia- tions in prescribing behaviors.
文摘Objective: Little is known about the prescription pattern of psychotropic drugs for patients with schizophrenia in Pakistan. The purpose of this study was to evaluate the characteristic features of psychotropic drug prescriptions for patients with schizophrenia in Pakistan. Methods: Three centers in Pakistan participated in a large scale collaborative study known as Research on Asian Prescription Pattern (REAP). The 2016 REAP survey included centers from 15 countries in Asia and used a unified research protocol. The design of the study was quantitative and of descriptive epidemiology. Analysis was made on the data collected from three centers i.e., Lahore, Karachi and Islamabad. The data collected in Pakistan were compared with those from other Asian countries. The details of REAP were presented on the homepage of REAP (http://www.REAP.Asia). Results: From Pakistan, 298 patients were included. Patients with schizophrenia in Pakistan received higher rate of antipsychotic polypharmacy and a higher rate of co-prescription of mood stabilizers and anxiolytics when compared with participants from other South Asian countries (India and Bangladesh). Conclusion: The main findings of the study were that a majority of the patients were prescribed antipsychotic polypharmacy drugs in Pakistan. Insufficient training on the use of psychotropic drugs and a lack of treatment guideline are considered to be the major contributing factors. Further education and training on the proper use of psychotropic drugs are recommended to psychiatrists in Pakistan. The guidelines on pharmacotherapy for patients with schizophrenia should also be developed and promoted in Pakistan.
文摘Introduction:The definition of polypharmacy is not consensual,but all authors refer it as the simultaneous use and the chronic way,of several drugs by the same person.Polypharmacy affects mainly the elderly and it is due to the high number of chronic diseases in this population and consequent need to take medications to control them.Aims:Characterization and quantification of polypharmacy in a rural elderly population.Materials and Methods:It carried out an observational,retrospective,transversal and analytical study in Farmácia Popular(Pombal).Total of 230 individuals aged 65 years old or more were surveyed and the data collection was made through a questionnaire prepared for this purpose,in time between February and April 2017.Results:The elderly took,on mean,6.20 drugs daily.The prevalence of Major polypharmacy(≥5 medications)was 70.4%.The most prescribed pharmacotherapeutics groups were cardiovascular and central nervous system.There were statistically significant differences between age and number of medicaments taken,as well between number of drugs and the way to identify the medication,the knowledge of the therapeutics indications,the occurrence of mistakes or take outside advised time,and the self-perception of health state(p≤0.05).Conclusion:In view of the obtained results,it concludes that polypharmacy is very high in Portuguese population in study.It is the persons most aged who consume a greater number of drugs.The elderly with less academic qualifications are those who have more difficulty in identifying medication and respective therapeutics indications.It is necessary to adopt strategies in order to reduce polypharmacy,with the prescriber and the professionals of pharmacy a preponderant role in this task.
基金Supported by FAPESP and Conselho Nacional de Desenvolvimento Cientifico e Tecnologico,No.2024/13209-0.
文摘Addiction literacy equips older adults with the knowledge to navigate substance use risks amid unique challenges like polypharmacy and social isolation.With rising trends in cannabis use among this group,targeted education can promote safe practices and reduce preventable harms.By fostering open conversations and integrating addiction literacy into healthcare,providers can support informed decision-making.
文摘Background: The irrational use of medicines remains a key health problem in many developing countries. The overuse of antibiotics is a key driver of antimicrobial resistance (AMR). This study surveyed antibiotic use and adherence to the World Health Organization (WHO) prescribing indicators at the Request Muntanga Hospital in the Kalomo District of Southern Province, Zambia. Materials and Methods: This cross-sectional study was conducted from July 2023 to September 2023 at Request Muntanga Hospital in Zambia and reviewed 600 medical record prescriptions which were issued from July 1, 2022 to June 30, 2023 using the WHO prescribing indicators. The collected data were analyzed using Statistical Package for Social Sciences version 23.0. Results: From the 600 prescriptions sampled, 1246 medicines were prescribed, with antibiotics making up 86.7% of the encounters. Additionally, the average number of drugs prescribed per encounter was 2.1 and the prevalence of polypharmacy was 61.3%. Further, 17.8% of medicines were prescribed as injectables. Furthermore, 76.7% of the drugs were prescribed from the Zambia Essential Medicines List and 38.9% by generic names. Conclusions: This study found a high use of antibiotics and deviations from the WHO/International Network of Rational Use of Drugs (INRUD) core prescribing indicators at the Request Muntanga Hospital indicating non-adherence to the prescribing indicators. There is a need to promote adherence to the WHO/INRUD core prescribing indicators to promote the rational use of antibiotics and prevent the emergence and spread of AMR.
文摘Proton pump inhibitors(PPIs)are widely utilized in oncology to treat gastroeso-phageal reflux disease,peptic ulcer disease,and chemotherapy-induced mucosal injury.Emerging evidence has suggested that prolonged use of PPIs is associated with increased mortality in patients with cancer.The findings of Krishnan et al are proof of this but need to be considered cautiously due to potential confounding factors.This letter raised important methodological concerns,including con-founding by indication,reverse causality,and polypharmacy that can influence the observed association.While PPIs are important in oncology,their advantages and disadvantages should be weighed judiciously by clinicians.Future prospective studies with robust analytical approaches will be required to ascertain more definite causality.
文摘BACKGROUND Bradycardia,renal failure,atrioventricular nodal blockade,shock,and hyper-kalemia(BRASH)syndrome is an acronym used to describe a constellation of BRASH.It is an underrecognized phenomenon that can be deadly if not appro-priately managed in a timely manner.This case highlights the importance of rapid diagnosis and reviews a multitude of treatment options in a uniquely severe case of BRASH syndrome.CASE SUMMARY We present a case of a 54-year-old male on a beta-blocker and angiotensin-con-verting enzyme inhibitor who presented with one day history of nausea,vomi-ting,and shortness of breath.Upon presentation,he was bradycardic and hypotensive,requiring transcutaneous pacing.Initial electrocardiogram showed atrial fibrillation with ventricular rate in 30’s.He was found to have acute kidney injury,hyperkalemia,and metabolic acidosis.He was successfully treated with multiple potassium lowering agents,continuous renal replacement therapy,four pressors,mechanical ventilation,and transvenous pacing with complete recovery prior to discharge.CONCLUSION Increased awareness of BRASH syndrome may improve outcomes through timely diagnosis and aggressive intervention.
文摘The research paper investigates the intricate landscape of drug-drug interactions (DDIs) within the context of breast cancer treatment, with a particular focus on the elderly population and the use of complementary and alternative medicine (CAM). The study underscores the heightened susceptibility of elderly patients to DDIs due to the prevalence of polypharmacy and the widespread utilization of CAM among breast cancer patients. The potential ramifications of DDIs, encompassing adverse drug events and diminished treatment efficacy, are elucidated. The paper accentuates the imperative for healthcare providers to comprehensively understand both conventional and CAM therapies, enabling them to provide patients with informed guidance regarding safe and efficacious treatment options, culminating in enhanced patient outcomes.
基金Zhejiang Provincial Bureau of Education,No.20070227Zhejiang Medical Association,No.2007ZYC18Association of Zhejiang Hospital Administration,No.2007AZHA-KEB312
文摘AIM： To evaluate the patterns of use of clarithromycin for gastrointestinal disease treatment and promote its rational use.METHODS： Using a structured pro forma, we conducted a two-month survey of the electronic prescriptions containing immediate-release （IR） or sustained-release （SR） product of clarithromycin for outpatients with gastrointestinal diseases in a 2200-bed general hospital. Suitability of the prescription was audited retrospectively. RESULTS： One hundred and sixty-four prescriptions of SR product and 110 prescriptions of IR product were prescribed for gastrointestinal disease treatment. Among prescriptions for anti-Helicobacter pylori （H pylori） therapy, triple therapy take the dominant position （91.8%）, followed by quadruple therapy （4.3%） and dual therapy （3.9%）. Amoxicillin was the most frequently co-prescribed antibiotic.Furazolidone and levofloxacin are used more widely than metronidazole or tinidazole. Clarithromycin SR was administered at inappropriate time points in all prescriptions. Fifty percent of all prescriptions of clarithromycin SR, and 6.4% of prescriptions of clarithromycin IR, were prescribed at inappropriate dosing intervals. Surprisingly, disconcordance between diagnoses and indications was observed in all prescriptions of clarithromycin SR which has not been approved for treating Hpy/ori infection although off-label use for this purpose was reported in literature. On the contrary, only one prescription （0.9%） of clarithromycin IR was prescribed for unapproved indication （i.e. gastro-oesophageal reflux disease）. 1.4% of prescriptions for chronic gastritis or peptic ulcer treatment were irrational in that clarithromycin was not co-prescribed with gastric acid inhibitors. Clinical significant CYP3A based drug interactions with clarithromycin were identified. CONCLUSION： There is a great scope to improve the quality of clarithromycin prescribing in patients with gastrointestinal disease, especially with regard to administration schedule, concordance between indications and diagnoses and management of drug interactions.
文摘Human aging is a global issue with important implications for current and future incidence and prevalence of health conditions and disability. Cardiac arrhythmias, including atrial fibrillation, sudden cardiac death, and bradycardia requiring pacemaker placement, all increase exponentially after the age of 60. It is important to distinguish between the normal, physiological consequences of aging on cardiac electrophysiology and the abnormal, pathological alterations. The age-related cardiac changes include ventricular hypertrophy, senile amyloidosis, cardiac valvular degenerative changes and annular calcification, fibrous infiltration of the conduction system, and loss of natural pacemaker cells and these changes could have a profound effect on the development of arrhythmias. The age-related cardiac electrophysiological changes include up- and down-regulation of specific ion channel expression and intmcellular Ca2＋ overload which promote the development of cardiac arrhythmias. As ion channels are the substrates of antiarrhythmic drugs, it follows that the pharmacokinetics and pharmacodynamics of these drugs will also change with age. Aging alters the absorption, distribution, metabolism, and elimination of antiarrhythmic drugs, so liver and kidney function must be monitored to avoid potential adverse drug effects, and antiarrhythmic dosing may need to be adjusted for age. Elderly patients are also more susceptible to the side effects of many antiarrhytbanics, including bradycardia, orthostatic hypotension, urinary retention, and falls. Moreover, the choice of antiarrhythmic drugs in the elderly patient is frequently complicated by the presence of co-morbid conditions and by polypharmacy, and the astute physician must pay careful attention to potential drug-drug interactions. Finally, it is important to remember that the use of antiarrhythmic drugs in elderly patients must be individualized and tailored to each patient＇s physiology, disease processes, and medication regimen.
文摘Medications are beneficial for curing or managing acute and chronic illnesses. Medications typically have positive outcomes, although older people are prone to drug-related problems. Community-dwelling seniors are at particularly high risk of polypharmacy, as they tend to receive many prescriptions over time and from different care providers. Continuing-care facility admission presents an excellent opportunity for a comprehensive medication review. A research study was conducted to describe and compare medications taken by community-dwelling seniors prior to and following admission to a continuing-care facility. This pilot project involved data being gathered from the charts of deceased residents, as required by a University Health Research Ethics Board, who had been cared for at one large local continuing-care facility. The facility administrators also approved this study, in part to evaluate their policy to conduct a medication review for all new residents within six weeks of entry. This study revealed a slight but statistically significant reduction in the number of medications following this review. Other issues such as medication interactions and required dosage changes were addressed by this medication review. Although this study was confined to one continuing-care facility and a small number of residents, the findings suggest medication reviews would be beneficial upon admission to all continuing-care facilities, and annually perhaps through other means for older persons living in the community.
文摘1 Introduction Although older adults are generally among the highest users of cardiovascular medications, they are typically underrepresented or excluded from most efficacy and safety trials. Drug developers are usually reluctant to include many senior adults in randomized controlled clinical trials in part due to their high prevalence of multiple comorbidities, frailty, and polypharmacy; and to age-related pharmacokinetic and pharmacodynamic complexities. Consequently, there is often insufficient high quality evidence-based data to inform pharmacologic management of common cardiovascular conditions on older adults. In the absence of data, clinicians often rely on conceptual principles regarding metabolism and drug-drug interactions to minimize adverse drug events, but this is often not well-substantiated or standardized. A related challenge is poor cardiovascular medication adherence among older adults, and its detrimental impact on their health outcomes. In this brief review we highlight some aspects of these topics.
文摘Objective: To analyze the use of all subsidized prescription drugs including their use of drug combination generally accepted as carrying a risk of severe interactions. Methodology: In a cross sectional study, we analyzed all prescriptions (n = 1014) involving two or more drugs dispensed to the population (age range 4-85 years) from all pharmacies, clinics and hospitals. Data were stratified by age and sex, and frequency of common interacting drugs. Potential drug interactions were classified according to clinical relevance as significance of severity (types A: major, B: moderate, and C: minor) and documented evidence (types 1, 2, 3, and 4). Result and Discussion: The growing use of pharmacological agents means that drug interactions are of increasing interest for public health. Monitoring of potential drug interactions may improve the quality of drug prescribing and dispensing, and it might form a basis for education focused on appropriate prescribing. To make the manifestation of adverse interaction subside, management strategies must be exercised if two interacting drugs have to be taken with each other, involving: adjusting the dose of the object drug;spacing dosing times to avoid the interaction. The pharmacist, along with the prescriber has a duty to ensure that patients are aware of the risk of side effects and a suitable course of action they should take. Conclusion: It is unrealistic to expect clinicians to memorize the thousands of drug-drug interactions and their clinical significance, especially considering the rate of introduction of novel drugs and the escalating appreciation of the importance of pharmacogenomics. Reliable regularly updated decision support systems and information technology are necessary to help avert dangerous drug combinations.
文摘Background: Older diabetic patients are more likely to be frail than those who do not have diabetes. Frailty is an important risk factor for both mortality and disability in older patients with type 2 diabetes. However, the mechanism of frailty in diabetes mellitus is not fully understood. Aims: The aim of this study was to identify the prevalence of frailty and associated factors in older patients with type 2 diabetes in Japan. Methods: A cross-sectional study was conducted with a total of 178 outpatients who were over 65 years old with type 2 diabetes. We used the Obu Study Health Promotion for the Elderly definition of frailty to divided subjects into a non-frail and a frail group. We investigated the association between frailty and various patient characteristics. Results: In the study, 21.4% of the older patients with type 2 diabetes were considered frail. There were no significant differences in the duration of diabetes, BMI, proportion of microvascular complications, or HbA1c values between the frail and non-frail group. However, serum albumin and IGF-1 levels were lower in the frail group than the non-frail group as were the Mini-Mental State Examination scores. The frail group had a higher number of medications than the non-frail group. In a multivariable analysis, frailty was positively associated with the number of medications and, lower levels of both serum albumin and IGF-1. Conclusion: Our study suggests that diabetes accelerates the aging process and frailty is associated with low albumin, polypharmacy and low levels of IGF-1.
文摘We aimed to characterize, and analyze the presence of factors such as polypharmacy and personal medical history that predispose to Adverse Drug Reactions （ADRs） and potential preventability of these. The Civil Hospital of Culiacan （HCC）, in Sinaloa, where the study was conducted has 80 beds in total, in which the Department of Internal Medicine with 24 beds： 12 lbr men and 12 for women, we found the part of the share to contribute to the 200,000 cases of ADRs that according with the WHO each of the countries members report ever）, year to the Uppsala Monitoring Centre. We have not only but also ordered frequency of drugs, pathologies, and analytical tests of the hospitalized patients.
基金supported by the Key Program of Jiangsu Science Foundation(BK20243012)the Fundamental Research Funds for the Central Universities(022114380023).
文摘1 Introduction For patients with complex diseases or co-existing conditions,polypharmacy-defined as the concurrent use of multiple medications-can be a promising strategy.However,this approach significantly increases the risk of side effects due to drug-drug interactions(DDIs).Adverse DDIs are a leading cause of morbidity and mortality,with drug-induced fatalities accounting for approximately 100,000 deaths annually in the U.S.,making them the fourth leading cause of death after lung disease[1,2].
基金This work was supported in part by grants from the National Natural Science Foundation of China，Outstanding Scholar Foundation of Sichuan University，Program of Health and Family Planning Commission of Sichuan Province，Program of Science and Technology Department of Sichuan Province
文摘Background： Polyphamlacy and potentially inappropriate medications （PIMs） are prominent prescribing issties in elderly patients. This study was to investigate the different prevalence of PIM use in elderly inpatients between 65-70 years of age and 80 years or older, who were discharged from Geriatric Depamnent in West China Hospital. Methods： A large-scale cohort of 1796 inpatients aged 65 years or over was recruited. Respectively. 618 patients were 65 79 years and 1178 patients were 80 years or older. Updated 2012 Beers Criteria by the Anaerican Geriatric Society was applied to assess the use of PIM among the investigated samples. Results： A review of the prescribed medications identified 686 patients aged 80 years or older constimed at least one PIM giving a rate of 58.2%. Conversely, 268 （43.4%） patients aged 65-79 years consumed at least one PIM （x^2=40.18, P 〈 0.001）. Patients aged 80 years or older had higher hospitalization expenses, length of stay, co-morbidities, medical prescription, and mortality than patients aged 65-79 years （all with P 〈 0.001 ）. Patients aged 80 years or older were prescribed with more benzodiazepines, drugs with strong anticholmergic properties, megestrol, antipsychotics, theophylline, and aspirin. In multiple regression analysis, PIM use was significantly associated with female gender, age, number of diagnostic disease, and number of prescribed medication. Conclusions： The finding from this study revealed that inpatients aged 80 years or older encountered more PIM use than those aged 65-79 years. Anticholinergic properties, megestrol. antipsychotics, theophylline, and aspirin are medications that often prescribed to inpatients aged 80 years or older. Doctors should carefully choose drugs for the elderly, especially the elderly aged 80 years or older.
