Impact of medication review, within a shared decision-making framework, on deprescribing in people living in care homes.

OBJECTIVES: The key objectives of this study were to quantify extent of prescribing, reasons for deprescribing, common therapeutic groups of medicines deprescribed and adverse events. METHODS: A retrospective analysis was carried out on a quality improvement project where 422 care home residents in 20 care homes received a medicines optimisation review with a pharmacist and other members of the healthcare team (general medical practitioner, care home nurse). Data on number, type and cost of medicines were collected. Statistical analysis was performed to test for differences between pharmacist-only review and the pharmacist plus general practitioner (GP), and to identify any correlation between the original number of medicines and the number of medicines stopped. RESULTS: Of the 422 patients reviewed, 298 (70.6%) had at least one medicine stopped with 704 medicines being stopped. This represented 19.5% of the medicines originally prescribed (3602 medicines). There was no statistically significant difference between pharmacist only and pharmacist plus GP in terms of stopping medicines. The main groups of medicines stopped were laxatives, skin products and bone protection. There was weak correlation between the original number of medicines prescribed and the number stopped. CONCLUSIONS: This study has shown that medicines optimisation reviews can lead to a reduction in polypharmacy for care home residents through a deprescribing process. Patients' medicine regimens were simplified and optimised while making financial significant savings for the National Health Service.

Reducing unacceptable missed doses: pharmacy assistant-supported medicine administration.

OBJECTIVES: The potential harm from omitted and delayed medicines for hospital inpatients was highlighted by the National Patient Safety Agency (NPSA). Despite evidence of omitted doses, few interventional studies have been reported on preventing the problem. This study aimed to assess the impact on omitted doses when medicine administration was supported by pharmacy assistants (PAs). METHODS: PAs were trained to support nurses on medicine administration rounds. Using stratified random sampling, two intervention and control wards were selected. Three study groups were defined: (A) intervention group (PA-supported medicine administration); (B) intra-ward control group; and (C) inter-ward control group. Primary outcome measure was number of patients with unacceptable omitted doses (UODs) in group A versus C. Secondary outcome measures were patients with critical UOD (cUOD), as defined by the NPSA, in groups A, B and C and UODs in group B versus A and C. Data were collected over 2 weeks (December 2011 and February 2012). KEY FINDINGS: Using aggregated data over 2 weeks, 778 patients were assessed; 308 were male (40%). The overall proportion of patients with ≥1 UOD was 12.4% (n = 96). The proportion of patients with ≥1 UOD was 1.1% (n = 2) in group A (intervention) and 18.5% (n = 68) in group C (control). There were significantly fewer patients with cUOD in group A (1.1%; n = 2) compared with group C (7.4%; n = 27). CONCLUSION: PA-supported medication rounds can significantly reduce the rate of omitted doses. This study provides evidence for a potential solution to the problem of omitted doses for hospital inpatients.

O2(b(1)Σ(+)(g), υ = 0, 1) relative yields in O((1)D) + O2 energy transfer.

Energy transfer from O((1)D) to O2 is the main source of O2(b(1)Σ(+)(g) in vibrational levels υ = 0 and 1 in the Earth's thermosphere. Knowledge of the relative yields for O2(b(1)Σ(+)(g) production in υ = 0 and 1 is essential for a reliable interpretation and modeling of the O2 atmospheric band emissions (b(1)Σ(+)(g) - X (3)Σ(-)(g) from these two vibrational levels. We report laboratory measurements of the relative yields at room temperature. In the experiments, O2(b(1)Σ(+)(g), υ = 0, 1) is generated by O((1)D) + O2 collisions following partial photodissociation of O2 at 157.6 nm. O2(b(1)Σ(+)(g), υ = 0, 1) emission detection is used to monitor the temporal evolution of the vibrational level populations. The measured fractional yield for υ = 1 is 0.8 ± 0.1, in contrast with the results of previous studies that indicated dominant O2(b(1)Σ(+)(g), υ = 0) production. A revision is warranted of the values used for these relative yields in atmospheric models.

A clinico-ethical framework for multidisciplinary review of medication in nursing homes.

Residents in care homes are more likely to be prescribed multiple medicines yet often have little involvement in these prescribing decisions. Reviewing and stopping inappropriate medicines is not currently adopted across the health economy. This Health Foundation funded Shine project developed a pragmatic approach to optimising medicines in care homes while involving all residents in decision making. The pharmacist undertook a detailed medication review using primary care records. The results were discussed at a multidisciplinary team (MDT) meeting involving the care home nurse and the resident's general practitioner (GP), with input from the local psychiatry of old age service (POAS) where appropriate. Suggestions for medicines which should be stopped, changed or started, and other interventions (eg monitoring) were discussed with the resident and/or their family. Over 12 months 422 residents were reviewed, and 1346 interventions were made in 91% of residents reviewed with 15 different types of interventions. The most common intervention (52.3%) was to stop medicines; 704 medicines stopped in 298 residents (70.6%). On average, 1.7 medicines were stopped for every resident reviewed (range zero to nine medicines; SD=1.7), with a 17.4% reduction in medicines prescribed (3602 medicines prescribed before and 2975 after review). The main reasons for stopping medicines were: no current indication (401 medicines; 57%), resident not wanting medicine after risks and benefits were explained (120 medicines; 17%), and safety concerns (42 medicines; 6%). The net annualised savings against the medicines budget were £77,703 or £184 per person reviewed. The cost of delivering the intervention was £32,670 (pharmacist, GP, POAS consultant, and care home nurse time) for 422 residents; for every £1 invested, £2.38 could be released from the medicines budget. This project demonstrated that a multidisciplinary medication review with a pharmacist, doctor, and care home nurse can safely reduce inappropriate medication in elderly care home residents.

Collisional relaxation of O2(X3Σg(-), υ = 1) and O2(a1Δg, υ = 1) by atmospherically relevant species.

Laboratory measurements are reported of the rate coefficient for collisional removal of O(2)(X(3)Σ(g)(-), υ = 1) by O((3)P), and the rate coefficients for removal of O(2)(a(1)Δ(g), υ = 1) by O(2), CO(2), and O((3)P). A two-laser method is employed, in which the pulsed output of the first laser at 285 nm photolyzes ozone to produce oxygen atoms and O(2)(a(1)Δ(g), υ = 1), and the output of the second laser detects O(2)(a(1)Δ(g), υ = 1) via resonance-enhanced multiphoton ionization. The kinetics of O(2)(X(3)Σ(g)(-), υ = 1) + O((3)P) relaxation is inferred from the temporal evolution of O(2)(a(1)Δ(g), υ = 1), an approach enabled by the rapid collision-induced equilibration of the O(2)(X(3)Σ(g)(-), υ = 1) and O(2)(a(1)Δ(g), υ = 1) populations in the system. The measured O(2)(X(3)Σ(g)(-), υ = 1) + O((3)P) rate coefficient is (2.9 ± 0.6) × 10(-12) cm(3) s(-1) at 295 K and (3.4 ± 0.6) × 10(-12) cm(3) s(-1) at 240 K. These values are consistent with the previously reported result of (3.2 ± 1.0) × 10(-12) cm(3) s(-1), which was obtained at 315 K using a different experimental approach [K. S. Kalogerakis, R. A. Copeland, and T. G. Slanger, J. Chem. Phys. 123, 194303 (2005)]. For removal of O(2)(a(1)Δ(g), υ = 1) by O((3)P), the upper limits for the rate coefficient are 4 × 10(-13) cm(3) s(-1) at 295 K and 6 × 10(-13) cm(3) s(-1) at 240 K. The rate coefficient for removal of O(2)(a(1)Δ(g), υ = 1) by O(2) is (5.6 ± 0.6) × 10(-11) cm(3) s(-1) at 295 K and (5.9 ± 0.5) × 10(-11) cm(3) s(-1) at 240 K. The O(2)(a(1)Δ(g), υ = 1) + CO(2) rate coefficient is (1.5 ± 0.2) × 10(-14) cm(3) s(-1) at 295 K and (1.2 ± 0.1) × 10(-14) cm(3) s(-1) at 240 K. The implications of the measured rate coefficients for modeling of atmospheric emissions are discussed.

Medication compliance aids: a qualitative study of users' views.

BACKGROUND: Despite the rapid rise in the use of multicompartmental compliance aids (MCAs), little is known about the role they play in self-management of medication. AIM: To explore the perceived benefits of MCAs for people using them to manage their own or a relative's medication. DESIGN OF STUDY: Qualitative study using in-depth interviews. SETTING: West Northumberland. METHOD: Recruitment was via posters and leaflets in general practices and community pharmacies. In-depth interviews were conducted using a topic guide. RESULTS: Nineteen people were interviewed. Three overarching themes emerged in relation to medicine taking: disruption, organisation, and adherence, which impacted on control. The medication regime had caused disruption to their lives and this had led to the purchase of an MCA. The MCA enabled them to organise their medication, which they believed had improved the efficiency of medicine taking and saved time. Although the MCA did not prompt them to take their medication, they could see whether they had actually taken it or not, which alleviated their anxiety. To meet their individual needs and lifestyles, some had developed broader systems of medication management, incorporating the MCA. For a small cost--the initial outlay for the MCA and time spent loading it--they gained control over the management of their medication and their condition. CONCLUSION: This group found the use of an MCA to be beneficial, but advice and support regarding how best to manage their medication and on the most appropriate design to suit their needs would be helpful.

Measurement of the rate coefficient for collisional removal of O2(X3Sigma- g, upsilon=1) by O(3P).

We report a laboratory measurement of the rate coefficient for the collisional removal of O(2)(X(3)Sigma(g) (-),upsilon=1) by O((3)P) atoms. In the experiments, 266-nm laser light photodissociates ozone in a mixture of molecular oxygen and ozone. The photolysis step produces vibrationally excited O(2)(a(1)Delta(g)) that is rapidly converted to O(2)(X(3)Sigma(g) (-),upsilon=1-3) in a near-resonant electronic energy-transfer process with ground-state O(2). In parallel, a large amount of O((1)D) atoms is generated that promptly relaxes to O((3)P). Under the conditions of the experiments, only collisions with the photolytically produced O((3)P) atoms control the lifetime of O(2)(X(3)Sigma(g) (-),upsilon=1), because its removal by molecular oxygen at room temperature is extremely slow. Tunable 193-nm laser light monitors the temporal evolution of the O(2)(X(3)Sigma(g) (-),upsilon=1) population by detection of laser-induced fluorescence near 360 nm. The removal rate coefficient for O(2)(X(3)Sigma(g) (-),upsilon=1) by O((3)P) atoms is (3.2+/-1.0)x10(-12) cm(3) s(-1) (2sigma) at a temperature of 315+/-15 K (2sigma). This result is essential for the analysis and correct interpretation of the 6.3-mum H(2)O(nu(2)) band emission in the Earth's mesosphere and indicates that the deactivation of O(2)(X (3)Sigma(g) (-),upsilon=1) by O((3)P) atoms is significantly faster than the nominal values recently used in atmospheric models.

Vibrational energy transfer in O2(X 3sigma(g)-, upsilon=2,3) + O2 collisions at 330 K.

Vibrational relaxation of O2(X 3sigma(g)-, upsilon=2,3) by O2 molecules is studied via a two-laser approach. Laser radiation at 266 nm photodissociates ozone in a mixture of molecular oxygen and ozone. The photolysis step produces vibrationally excited O2(a 1delta(g)) that is rapidly converted to O2(X 3sigma(g)-, upsilon=2,3) in a near-resonant adiabatic electronic energy-transfer process involving collisions with ground-state O2. The output of a tunable 193-nm ArF laser monitors the temporal evolution of the O2(X 3sigma(g)-, upsilon=2,3) population via laser-induced fluorescence detected near 360 nm. The rate coefficients for the vibrational relaxation of O2(X 3sigma(g)-, upsilon=2,3) in collision with O2 are 2.0(-0.4)(+0.6) x 10(-13) cm3 s(-1) and (2.6+/-0.4) x 10(-13) cm3 s(-1), respectively. These rate coefficients agree well with other experimental work but are significantly larger than those produced by various semiclassical theoretical calculations.