A newly developed algorithm for switching outpatient medications to medications listed in the hospital formulary: a prospective real-word evaluation in patients admitted electively to hospital.

PURPOSE: In many countries, outpatient and inpatient care are separated. During hospitalization, therefore, switching the outpatient medication to medication of the hospital formulary is required. METHODS: We newly designed a switching algorithm in six switching steps (S0-S5) and conducted a study at Bundeswehr Hospital Hamburg (300 beds, 80% civilians). We performed (i) a medication reconciliation to obtain information on outpatient medications and (ii) a medication review to solve drug-related-problems, e.g., drug-drug interactions. We applied (iii) the algorithm to switch medications to the hospital formulary. RESULTS: (i) We identified 475 outpatient medications (median per patient: 4; Q25/Q75 2/7) in 100 patients consecutively admitted to hospital (median age: 71; Q25/Q75: 64/80 years). Of 475 medications, the switching algorithm could not be used since product names were missing in 23.9% and strength in 1.7%. In 3.2%, switching was not required since medication was not prescribed during the hospital stay. (ii) Drug-drug interactions were identified in 31 of 79 patients with more than one medication. (iii) Of 475 medications, 18.5% were on the hospital formulary and therefore did not need to be  switched (S0), 0.2% were on a substitution-exclusion list not allowing switching (S1), 42.0% were switched to a generic medication of the hospital formulary (S2), 1.7% to a therapeutically equivalent medication (S3), 0.4% were patient-individually switched (S4), and for 8.2% a standardized/patient-individual switching was not possible (S5). CONCLUSIONS: Despite comprehensive medication reconciliation, patient- and medication-related information for switching medications to the hospital formulary was often missing. Once all the necessary information was available, standardized switching could be easily carried out according to a newly developed switching algorithm.

Altered states of consciousness: processed EEG in mental disease.

Due to increasing life expectancy and a rising elderly population in Europe, the incidence of mild cognitive impairment which may predict diseases like Alzheimer's Disease or Vascular Dementia, is rising. Neurophysiological techniques are simple and inexpensive tools for early diagnosis and provide useful and objective correlates of cognitive activity both in normal subjects and patients suffering from the above conditions. Cognitive impairment due to different mental disease is characterized by decreased power and coherence in the alpha/beta band, which suggests functional disconnection among cortical areas, whereas both power and coherence in the delta and theta bands increase as a sign of cortical deafferentation from subcortical structures. Quantification of power and phase relationship by bispectral analysis suggests the Bispectral Index could be a useful but simple tool for early diagnosis of mental disease.