Pharmacist intervention is associated with fewer serious falls over 3 months among older fallers at a day hospital: A quasi-experimental study.

OBJECTIVES: Some drugs increase the risk of falls, including serious falls. The objective of this quasi-experimental study was to determine whether the intervention of a clinical pharmacist among older outpatients receiving a multifactorial fall prevention program at a geriatric day hospital dedicated to older patients with a recent history of falls was effective in preventing serious falls over a 3-month follow-up, compared with usual care. STUDY DESIGN: Quasi-experimental study in 296 consecutive older outpatients, including 85 with pharmacist intervention (the intervention group) and 148 without (the control group). MAIN OUTCOME MEASURES: The main outcome was the occurrence of at least one serious fall within 3 months of follow-up. Covariates included age, sex, body mass index, grip strength, history of falls, Mini-Mental State Examination score, use of ≥3 drugs associated with risk of falls, frailty, and disability. RESULTS: Fewer participants in the intervention group experienced at least one serious fall than in the control group (5 (5.9 %) versus 23 (15.5 %), P = 0.029), which persisted after adjustment for potential confounding factors (OR = 0.30 [95CI:0.11-0.84], P = 0.022). No significant effect was found on the indicence of all falls. Pharmacist intervention allowed more frequent therapeutic optimizations of antithrombotics (OR = 3.69 [95CI: 1.66-8.20]), proton pump inhibitors (OR = 3.34 [95CI: 1.31-8.50]), benzodiazepines (OR = 3.15 [95CI: 1.06-9.36]) and antidepressants (OR = 3.87 [95CI: 1.21-12.35]). CONCLUSIONS: Among older fallers receiving a multifactorial fall prevention program at a day hospital, a clinical pharmacist intervention was associated with fewer incident serious falls over 3 months of follow-up.

[Enthalpies: Evidence and theory applied to sterilization practice]. / Base de données Enthalpies : évidence et théorie appliquée à la pratique en stérilisation.

OBJECTIVES: In order to share their knowledge, sterilization unit managers publish the results of their work in journals or at scientific conferences. The aim of Enthalpies is to list all such work in a single database. The work presented describes the construction of this database and the assessment of its feasibility for the washing step. METHODS: The first step was to carry out a literature review. Only articles published over 10years (2013-2023) in connection with the ten-year washing stage were included. Then, each publication was categorized, coded, graded and summarized by a pharmacist-internal pair. All this data was collated in an Excel® spreadsheet, and from the data categorization a tree structure was created, enabling the interface between the user and the platform hosting Enthalpies to be understood. RESULTS: Eighty-one publications were identified. These were categorized into 6 themes and 27 sub-themes. A reading grid was drawn up for each publication. Genially®, an online platform, was chosen to host our database. CONCLUSION: Enthalpies was not designed to issue recommendations for best practice. However, by collating published scientific data, this tool can be used to assist decision-making. It represents an innovative solution for providing a literature review in the field of hospital sterilization.

Preventable or potentially inappropriate psychotropics and adverse health outcomes in older adults: systematic review and meta-analysis.

OBJECTIVE: To systematically review and quantitatively synthetize evidence on the use of PIPs linked to adverse health outcomes in older adults. METHODS: A Medline, Embase® and Opengrey libraries search was conducted from 2004 to February 2021, using the PICO model: older people, psychotropic drugs, inappropriate prescribing, and adverse drug events. Fixed-effects and random-effects meta-analysis were performed from 3 eligible studies using an inverse-variance method. RESULTS: Of the 1943 originally identified abstracts, 106 met the inclusion criteria and 7 studies were included in this review. All were of good quality. The number of participants ranged from 318 to 383,150 older adults (54.5-74.4% women). Associations were found between PIPs use and decreased personal care activities of daily living (ADL), unplanned hospitalizations, falls and mortality. In the pooled analysis, association with falls was confirmed (1.23 [95%CI: 1.15;1.32]). CONCLUSIONS: Participants of 65 years and older treated with PIPs were more at risk of adverse health outcomes than those using no PIPs, including greater risks of falls, functional disabilities, unplanned hospitalizations, and mortality. Results of the present systematic review and meta-analysis provide additional evidence for an appropriate and safe use of psychotropics in older adults.

Identifying older inpatients at high risk of unintentional medication discrepancies: a classification tree analysis.

Unintentional medication discrepancies at admission are differences between the best possible medication history and the prescribed treatment at admission, and are associated with adverse outcomes, particularly in older people. This study aimed to identify the clinical profiles of geriatric inpatients with unintentional medication discrepancies at hospital admission. A classification tree Chi-square Automatic Interaction Detector (CHAID) analysis was conducted to assess those patients' profiles and characteristics that were associated with a higher risk of unintentional medication discrepancies. One-hundred and thirty consecutive older patients admitted to acute care (87 ± 5 years old; 61.8% women) were assessed. The CHAID analysis retrieved 5 clinical profiles of older inpatients with a risk of up to 94.4% for unintentional medication discrepancies. These profiles were determined based on combinations of three characteristics: use of eye drops, frequent falls (≥ 1/year), and admission due to urgent hospitalization. These easily measurable clinical characteristics may be helpful as a supportive measure to improve pharmacological care.

[How to optimise the use of psychotropic drugs in the elderly? Focus groups in a geriatric unit]. / Quelles optimisations envisager vis-à-vis du recours aux psychotropes chez la personne âgée ? Focus groups en gériatrie.

The elderly person (EP) treated with psychotropics is at risk of iatropathology. The guidelines for the proper use of these treatments are difficult to apply and the difficulties met by hospital teams are little described in the literature. Our objective was to investigate the problem of psychotropic management in EP among the medical and care teams. Three focus groups were run consecutively in 2021 with the geriatric team at Angers Hospital, France, to highlight the difficulties met daily and to bring innovative solutions. Following a thematic analysis of the content, 10 themes were described, including 4 emerging. These 4 themes are a greater precision of the conditional prescriptions of psychotropics, the choice of the moment of administration, the route of administration in case of agitation, and the revaluation during and after hospitalization management. Among the solutions mentioned, some will be gradually implemented according to a prioritization matrix as an awareness of teams to behavioral disorders and their management, or the development of teleconsultation to check the re-evaluation of prescriptions.

Therapeutic advice issued by a geriatric mobile team and 3-year mortality in older inpatients.

Our objective was to determine whether the provision of therapeutic advice (i.e., any recommendation for an increase or decrease in drug dosage, or for the addition, withdrawal or replacement of at least one drug) by hospital geriatric mobile teams (GMTs) was associated with long-term mortality among older inpatients. Data on therapeutic advice provided by the GMT of Angers University Hospital, France, were collected from 694 consecutive inpatients examined in 2012 (mean age 84.4 ± 6.3 years; 65.6% female), who were followed up after 3 years. We found no between-group differences regarding the 3-year mortality (P = 0.30) and no cumulative survival difference (log-rank P = 0.43). The provision of therapeutic advice by a GMT was not associated with better 3-year survival (HR = 1.18, P = 0.40) in these frail inpatients.

Understanding Breastfeeding Women's Behaviors Toward Medication: Healthcare Professionals' Viewpoint.

BACKGROUND:: Taking medication during breastfeeding is often a major concern for mothers. Knowledge, representations, and attitudes condition a mother's behavior in this situation. Healthcare professionals, whose medication advice for breastfeeding women is often described in scientific literature as inappropriate, play a major role in counseling mothers. Healthcare professionals' perceptions of mothers' behaviors regarding medication use during breastfeeding may influence mothers' behaviors. RESEARCH AIM:: The aim of this study was to identify healthcare professionals' perceptions of breastfeeding women's knowledge, representations, and attitudes and behaviors about medication use. METHOD:: A cross-sectional, prospective qualitative design was used. Semistructured interviews were conducted with a broad array of healthcare professionals ( N = 20) in different practice settings in the Angers area (France). Thematic analysis of the interview transcripts was carried out using the planned behavior theory of Ajzen. RESULTS:: Seventy themes concerning medication use while breastfeeding were identified and then combined into 8 categories. Healthcare professionals perceived that maternal behaviors regarding medication were mostly focused on the child's safety and were linked to poor knowledge and negative representations, attitudes, and feelings toward medication. Healthcare professionals also perceived significant negative influences from the mother's friends and family in regard to breastfeeding. Relationships between healthcare professionals and women were problematic when it came to drug use during breastfeeding. CONCLUSION:: Taking into account healthcare professionals' perceptions of maternal behavior will help improve education for these professionals. Indeed, knowing precisely what difficulties are met by healthcare professionals when they encounter medication use during breastfeeding can help educators improve training for these professionals.

A Retrospective Study on Infusion-Related Reactions to Rituximab in a Heterogeneous Pediatric Population.

OBJECTIVES: To assess risks and outcomes of infusion-related reactions to rituximab in a heterogeneous pediatric population. METHODS: All patients who received rituximab between July 2010 and July 2012 were retrieved from the pharmacy software and included for analysis. Data were collected according to 4 categories: demographic data, infusion data, infusion-related reactions, and biological data considered as risk factors (i.e., absolute lymphocyte count, lactate dehydrogenase levels). RESULTS: Sixty-seven patients treated for a total of 17 different indications were included. A total of 282 rituximab infusions were administered. Forty-three, mostly grade 1 or 2, infusion-related reactions occurred in 30 patients. Reactions occurred in 39.2% "first-dose" infusions, but this rate dropped drastically to 2.7% in subsequent doses. In multivariate analysis, high absolute lymphocyte count was the only risk factor for infusion-related reaction (OR = 1.03; 95% CI: 1.01-1.06; p = 0.014). CONCLUSIONS: Rituximab infusion-related reactions in a heterogeneous pediatric population were frequent on first infusion, but rare in subsequent ones. Overall, these reactions were mild and manageable through pharmacological treatment. Patients with an elevated absolute lymphocyte count before infusion were at greater risk for an infusion-related reaction.

Knowledge, Representations, Attitudes, and Behaviors of Women Faced With Taking Medications While Breastfeeding.

BACKGROUND: Breastfeeding is a major public health issue in terms of its benefits to both mothers and infants. Despite recommendations, breastfeeding initiation and duration are low in many industrialized countries. Although human milk is viewed as the most appropriate food for infants, when it is perceived as contaminated, doubts about its quality can lead to negative behaviors concerning breastfeeding. This is especially true when mothers are taking medication. Research aim: The aim of this review is to evaluate the data in the literature on the knowledge, representations, attitudes, and behaviors of women with regard to taking medication while breastfeeding. These elements should aid our understanding of how the mothers' behaviors are constructed in this situation. METHODS: The authors conducted a scoping review to map and analyze the available data from literature sources regarding breastfeeding mothers' knowledge, representations, attitudes, and behaviors about medicines. A staged approach to the scoping review was used. RESULTS: Eighteen studies met the selection criteria. They described safety behaviors like noninitiation, duration reduction, breastfeeding cessation, and refusal to take medication in order to breastfeed. Most showed a conflict between taking medication and breastfeeding. Because the knowledge, representations, and attitudes behind such behaviors have received very little study, it is difficult to explain how these behaviors are constructed. CONCLUSION: The results of this review confirm the need for a qualitative study to explore the knowledge, representations, and attitudes of breastfeeding women faced with taking medications, so that we can understand their connection with observed behaviors and take appropriate educational action.

Commentary on the article "Postpartum women's use of medicines and breastfeeding practices: a systematic review".

This commentary follows the article of Moni R. Saha and her co-authors, entitled "Postpartum women's use of medicines and breastfeeding practices: a systematic review." As highlighted in this systematic review, medication use is common during the postpartum period often creating difficulty for mothers. Several studies illustrate the negative impact medication has on breastfeeding, initiation and duration despite reassuring advice from health professionals. Current data only describe the use of medication and behavior adopted by mothers when medication is prescribed. The factors influencing maternal behaviors have not been studied. Behaviors depend on knowledge, representations and attitudes. To better understand the behaviors of mothers faced with medication, we conducted a qualitative study, utilizing semi-structured interviews to investigate knowledge, risk perception and difficulties women experienced. The study consisted of a description and comparison of the perceived needs of two populations: 19 breastfeeding mothers and 12 health professionals. Divergences between the two populations were highlighted, focusing specifically, on knowledge needed by the women. This commentary is intended to highlight the need for further research essential to explain the influences on maternal behavior when medication is a consideration, allowing health professionals to better help mothers deal with these situations frequently affecting their breastfeeding plans.

Drug related problems and pharmacist interventions in a geriatric unit employing electronic prescribing.

BACKGROUND: Computerised physician order entry (CPOE) and the integration of a pharmacist in clinical wards have been shown to prevent drug related problems (DRPs). OBJECTIVES: The primary objective was to make an inventory of the DRPs and resident pharmacist on-ward interventions (PIs) identified in a geriatric acute care unit using CPOE system. The secondary objective was to evaluate the physicians' acceptance of the proposed interventions. SETTING: A 26-bed geriatric ward of a 1,300-bed teaching hospital. METHOD: A 6-month descriptive study with prescription analysis and recommendations to physicians by a resident pharmacist during five half days a week. MAIN OUTCOME MEASURES: Patients' characteristics, number of prescribed drugs per patient, nature and frequency of DRPs and PIs, physicians' acceptance and drugs questioned. RESULTS: Resident pharmacist reviewed 311 patients and identified 241 DRPs. One hundred and fifty-two patients (49 %) had at least one DRP (mean ± SD age 87 ± 6 years, mean ± SD number of prescribed drugs 10.7 ± 3.4). Most frequent DRPs were: untreated indication (n = 58, 24.1 %), dose too high (n = 46, 19.1 %), improper administration (n = 31, 12.9 %) and drug interactions (n = 23, 9.5 %). The rate of physicians' acceptance was 90.0 % (7.5 % refusals, 2.5 % not assessable). DRPs related to CPOE system misuse (n = 35, 14.5 %) appeared as a worrying phenomenon (e.g., errors in selecting dosage or unit, or duplication of therapy). CONCLUSION: A resident pharmacist detected various DRPs. Most PIs were accepted. DRPs related to the misuse of the CPOE system appeared potentially dangerous and need particular attention by healthcare professionals. The description of the DRPs is an essential step for implementation of targeted clinical pharmacy services in order to optimize pharmacists' job time.