Polypharmacy in atrial fibrillation: A prospective analysis of mortality and ischemic stroke using the Clinical Practice Research Datalink.

Background: Observational studies of polypharmacy and the risk of death or stroke in individuals with atrial fibrillation (AF) have produced inconsistent findings. By using propensity score matching (PSM) and Cox regression, this study aimed to determine whether polypharmacy (five to nine medicines) in the 3 months following AF diagnosis, is associated with an increased risk of death or ischemic stroke, compared to non-polypharmacy (one to four medicines). Methods: A prospective cohort study using data from the Clinical Practice Research Datalink (2006-2019). Data from 23 629 individuals with AF were analyzed. Cox regression models were adjusted for age, gender, morbidities, obesity, alcohol, smoking, and wealth. In the PSM models, cases and controls with near identical health profiles were selected from the study pool. The risk of death and stroke were presented as hazard ratios (HRs) with 95% confidence intervals (CIs). Results: 68.9% (n = 16 271) of the participants had polypharmacy. PSM showed that polypharmacy was associated with an increased risk of death during follow-up (HR 1.32; 95% CI: 1.19-1.47, p < .01), but not ischemic stroke (HR 0.84; 95% CI: 0.69-1.02, p = .08). Conclusion: Polypharmacy was associated with an increased risk of death during follow-up, but not ischemic stroke, in individuals with AF. The effects of comorbidity and other confounding factors were reduced by using PSM. This study focused on the overall medication burden; however, further research is needed to identify which specific medications in polypharmacy regimens increase the risk of mortality in AF. These findings could inform prescribing practices in the future.

Enabling Access to Pharmacy Law Teaching during COVID-19: Student Perceptions of MyDispense and Assessment Outcomes.

During the COVID-19 pandemic, it was not always possible to teach pharmacy practice and practical dispensing skills in person. Second-year pharmacy students (n = 147) were given access to a virtual simulation tool, MyDispense, to supplement their learning. This software enabled students to work remotely and access exercises in a 'safe' community pharmacy setting. This study evaluated second-year pharmacy students' perceptions of MyDispense, and the impact on assessment performance in the pharmacy law and ethics module. Students were able to access 22 MyDispense activities throughout the academic year (2020/2021). Exercise completion rates and assessment marks were analysed, along with findings from a cross-sectional survey about user experience. MyDispense data were available for all students (n = 147), and 76.1% (n = 115) completed the survey. The mean number of MyDispense exercises completed was nine. Higher levels of MyDispense exercise completion were associated with higher pass rates and mean scores (no exercises completed versus 1-10 activities completed: mean score 77.1 versus 83.1, respectively) and a statistically significant association between exercise usage and in-class assessed prescription scores. Overall, 46.1% (n = 53/115), 33.0% (n = 38/115) and 33.9% (n = 39/115) of students felt that MyDispense had helped them to prepare for their assessed prescriptions, mid-module test, and final exam, respectively. MyDispense has provided an accessible alternative to in-person teaching for students during the COVID-19 pandemic, and results showed a positive association with assessment performance in pharmacy law and ethics.

Central nervous system (CNS) medications and polypharmacy in later life: cross-sectional analysis of the English Longitudinal Study of Ageing (ELSA).

OBJECTIVES: Many central nervous system (CNS) medications are considered potentially inappropriate for prescribing in older people; however, these medications are common in polypharmacy (≥5 medicines) regimens. This paper aims to determine the prevalence of CNS drug classes commonly taken by older people. Furthermore, this paper aims to determine whether polypharmacy and other factors, previously found to be associated with overall polypharmacy, are associated with the most common CNS drug classes. DESIGN: Cross-sectional study. SETTING: English Longitudinal Study of Ageing (wave 6). PARTICIPANTS: 7730 participants (≥50 years). MAIN OUTCOME MEASURES: Adjusted Odds Ratios (OR) and 95% confidence intervals (CI) for CNS drug classes. RESULTS: 31% of the sample were currently taking ≥5 medications (polypharmacy), of whom 58% (n=1362/2356) were taking CNS medicines as part of their regimen. The most common CNS drug classes in polypharmacy regimens were non-opioid analgesics, opioid analgesics, tricyclic and related antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs) (34.6%, 13.2%, 10.9% and 10.4%, respectively). Compared with people currently taking 1-4 prescribed medicines, polypharmacy was associated with adjusted ORs of 5.71 (95% CI: 4.29 to 7.61, p<0.01) for opioid analgesics, 3.80 (95% CI: 3.25 to 4.44, p<0.01) for non-opioid analgesics, 3.11 (95% CI: 2.43 to 3.98, p<0.01) for TCAs and 2.30 (95% CI: 1.83 to 2.89, p<0.01) for SSRIs. Lower wealth was also associated with the aforementioned CNS drug classes. CONCLUSION: Opioid and non-opioid analgesics were the most prevalent classes of CNS medicines in this study. Polypharmacy is strongly associated with the aforementioned classes of analgesics. Polypharmacy is also associated with TCAs and SSRIs, although to a lesser extent than for analgesics. For all CNS medicine classes, polypharmacy may need to be considered in relation to reducing the risk of potential adverse events. After adjustment, lower wealth is associated particularly with analgesics, highlighting that socioeconomic factors may play a role in the prescribing of CNS medicines. These findings provide a baseline for future research into this area.

Type 2 Diabetes: how informed are the general public? A cross-sectional study investigating disease awareness and barriers to communicating knowledge in high-risk populations in London.

BACKGROUND: Preventing type 2 diabetes (T2DM) is one of the biggest health challenges currently facing the UK, with the NHS spending £14 billion each year on treating the disease and associated symptoms. AIMS: The aim of this study was to determine the public's awareness about the symptoms, risk factors and lifestyle choices, commonly associated with T2DM. This study also aimed to determine whether the level of awareness varies if the questions are asked in different languages, primarily those spoken by ethnic minorities. METHODS: This was a cross sectional, multisite study conducted in London, UK, involving 399 participants, who were non-diabetic, aged between 25 and 74 years old and living in one of four selected London boroughs. Descriptive statistics, Chi square and Fisher's Exact Tests were used to highlight and summarise the key findings of this study. RESULTS: A response rate of 23.7% (n = 399/1683) for the English questionnaire was achieved. Overall, 59.4% (n = 237/399) of the cohort were able to identify a minimum of three T2DM symptoms and thus, were considered to have adequate or good awareness. Whereas, 60.6% (n = 242/399) were able to identify a minimum of six T2DM risk factors and were considered to have adequate or good awareness. More participants could correctly identify that obesity was a risk factor of T2DM when they were asked the question in their spoken language, rather than English (p < 0.01). When participants were asked about their current lifestyle choices, there were high levels of inactivity, smoking and alcohol consumption reported. CONCLUSION: Despite approximately half of participants demonstrating adequate or good awareness about the symptoms, risk factors and lifestyle choices commonly associated with T2DM, yet the study still highlights gaps in awareness among the remaining proportion of participants. Future prevention interventions should be tailored to address these existing gaps in awareness.

Perceptions by Adult Patients With Type 1 and 2 Diabetes of Current and Advanced Technologies of Blood Glucose Monitoring: A Prospective Study.

OBJECTIVE: Intensive self-monitoring of blood glucose levels by patients with diabetes achieves optimal glucose control, hence reducing the likelihood of complications. METHODS: This is a prospective, cross-sectional study targeting adults with diabetes through community pharmacies and patient groups in Central and West London over a period of 10 weeks. RESULTS: In all, 195 adults with diabetes were included in the analysis of the results. When monitoring adherence was examined, 43.4% (n=33/76) of participants with type 1 diabetes reported that their health care professionals had asked them to monitor their blood glucose levels between 3 and 4 times per day; however, 10% of this group was not following their health-care professionals' directions. Participants with type 2 diabetes were asked the same question; 42.9% (n=51/119) were asked to monitor their blood glucose between 3 and 4 times a day, but only 2.5% (n=3/119) were following their health-care professionals' directions. When questioned about their reasons for poor adherence, the cohort indicated that it was due to the painful (29.2%, n=57/195), uncomfortable (33.8%, n=66/195) or inconvenient (36.9%, n=72/195) nature of testing. In addition, 75.3% (n=147/195) of the participants expressed their desire for a noninvasive monitoring device, and 74.3% (n=145/195) said they would be satisfied to use one of the preselected advanced technologies to monitor their blood glucose levels. CONCLUSIONS: The favoured advanced technology, selected by 49.7% (n=97/195) of participants, was the wristband. Statistical significance was seen between the type of diabetes and the device selected; patients with type 1 diabetes preferred contact lenses (p<0.05) and tattoos (p<0.0001), whereas participants with type 2 diabetes preferred earlobe sensors (p<0.0001) and saliva analyzers (p<0.0001). Participants' gender, age and ethnicity also influenced device selection.

Evaluating associations between metabolic health, obesity and depressive symptoms: a prospective analysis of data from the English Longitudinal Study of Ageing (ELSA) with a 2­year follow­up.

OBJECTIVES: Conflicting results have been reported when the associations between metabolic health, obesity and depression were examined previously. The primary aim of this study was to determine whether metabolic health or obesity are independently associated with depressive symptoms, among a representative sample of older people living in England. Independent associations between covariates and depression were also examined. DESIGN: Prospective study with a 2-year follow-up. SETTING: The English Longitudinal Study of Ageing Wave 6 (2012-2013) and Wave 7 (2014-2015). PARTICIPANTS: 6804 participants aged older than 50 years. DATA ANALYSIS: Multivariate models were used to determine whether metabolic health or obesity are independently associated with depressive symptoms at 2-year follow-up. Unadjusted and adjusted ORs with corresponding 95% CI were calculated; the adjusted ORs took account of baseline depression, gender, age, wealth, obesity and poor metabolic health. RESULTS: Before adjusting for covariates, poor metabolic health was associated with depressive symptoms at 2-year follow-up (OR 1.24; 95% CI, 1.07 to 1.44, p<0.01). After adjusting for covariates, the association was no longer statistically significant (OR 1.17; 95% CI, 0.99 to 1.38, p=0.07). Similarly, obesity was associated with depressive symptoms at 2-year follow-up before adjusting for covariates (OR 1.54; 95% CI, 1.33 to 1.79, p<0.01). However, after adjusting for covariates the association between obesity and depressive symptoms at 2-year follow-up became statistically insignificant (OR 1.19; 95% CI, 1.00 to 1.41, p=0.06). The strongest predictors for future depression were baseline depression (OR 10.59; 95% CI, 8.90 to 12.53, p<0.01) and lower wealth (OR 3.23; 95% CI, 2.44 to 4.35, p<0.01). CONCLUSION: Neither poor metabolic health nor obesity were associated with a risk of depressive symptoms at 2-year follow-up, after adjusting for covariates. As wealth inequalities continue to rise across England, the risk of depressive symptoms at 2-year follow-up is likely to be elevated in individuals living in the lower wealth quintiles.

Factors associated with polypharmacy in primary care: a cross-sectional analysis of data from The English Longitudinal Study of Ageing (ELSA).

OBJECTIVES: While older age and ill health are known to be associated with polypharmacy, this paper aims to identify whether wealth, body mass index (BMI), smoking and alcohol consumption are also associated with polypharmacy (5-9 prescribed medications) and hyperpolypharmacy prevalence (≥10 prescribed medications), among older people living in England. DESIGN: Cross-sectional study. SETTING: The English Longitudinal Study of Ageing Wave 6 (2012-2013). PARTICIPANTS: 7730 participants aged over 50 years. DATA SYNTHESIS: Two multivariate models were created. HR with corresponding 95% CI, for polypharmacy and hyperpolypharmacy, were calculated after adjusting for gender, age, wealth, smoking, alcohol consumption, BMI, self-rated health and the presence of a chronic health condition. RESULTS: Lower wealth (lowest wealth quintile vs highest wealth quintile, adjusted HR 1.28; 95% CI 1.04 to 1.69, P=0.02) and obesity (adjusted HR 1.81; 95% CI 1.53 to 2.15, p<0.01) were significantly associated with polypharmacy. Increasing age (50-59 years vs 70-79 years, adjusted HR 3.42; 95% CI 2.81 to 4.77, p<0.01) and the presence of a chronic health condition (adjusted HR 2.94; 95% CI 2.55 to 3.39, p<0.01) were also associated with polypharmacy. No statistically significant association between smoking and polypharmacy (adjusted HR 1.06; 95% CI 0.86 to 1.29, P=0.56) was established; while, very frequent alcohol consumption (consuming alcohol >5 times per week) was inversely associated with polypharmacy (never drank alcohol vs very frequently, adjusted HR 0.64; 95% CI 0.52 to 0.78, p<0.01). The adjusted HR for hyperpolypharmacy was accentuated, compared with polypharmacy. CONCLUSION: This study has identified that lower wealth, obesity, increasing age and chronic health conditions are significantly associated with polypharmacy and hyperpolypharmacy prevalence. The effect of these factors, on polypharmacy and especially hyperpolypharmacy prevalence, is likely to become more pronounced with the widening gap in UK wealth inequalities, the current obesity epidemic and the growing population of older people. The alcohol findings contribute to the debate on the relationship between alcohol consumption and health.

The Au(I) catalyzed activation of allenamides and their subsequent transformation into chromanes: a method for the regiocontrolled addition to the α- and γ-positions of the allene unit.

Au(I) activation of allenamides in the presence of phenols leads to the formation of chromanes in moderate to good yields. This catalytic process is dependent on the counterion which facilitates the activation of the in situ formed imine. Furthermore, this iminium can be intercepted by trimethylallyl silane, via the Hosomi-Sakurai reaction, giving a formal procedure for the regioselective intermolecular addition of two carbon nucleophiles to an allenamide at the α- and γ-positions.