Potentially inappropriate medications at admission among elderly patients transported to a tertiary emergency medical institution in Japan.

Aim: Potentially inappropriate medications (PIMs) have been reported to be associated with lower adherence, higher rates of adverse events, and higher health-care costs in elderly patients with high comorbidity. However, inappropriate prescribing has not been adequately reported in studies of patients transported to tertiary care hospitals. In this study, we investigated PIMs at the time of admission, on the basis of the prescription status of elderly patients admitted to a tertiary emergency room (ER). Methods: We included 316 patients (168 men and 148 women, aged 75-97 years) who were admitted to our ER from September 2018 to August 2019, whose prescriptions were available on admission. Drugs that met the Screening Tool of Older Persons' Potentially Inappropriate Prescriptions (STOPP) criteria version 2 were defined as PIMs. The primary outcome was the proportion of older adults taking at least one PIM at admission. Results: The proportion of patients taking PIMs at admission was 57% (n = 179). The most common PIMs were benzodiazepines, proton pump inhibitors, and nonsteroidal anti-inflammatory drugs. The total number of medications prescribed at admission, prescriptions from multiple institutions, and prescriptions from clinics were the risk factors for PIMs at admission (P < 0.01, P < 0.001, and P < 0.001, respectively). Conclusion: We must be careful to avoid inappropriate prescribing for patients transported to tertiary care hospitals who have numerous prescriptions at the time of admission, patients who receive prescriptions from multiple medical institutions, and patients who receive prescriptions from clinics.

Potentially inappropriate medications at discharge among elderly patients at a single tertiary emergency medical institution in Japan: a retrospective cross-sectional observational study.

AIM: Potentially inappropriate medications (PIMs) are associated with a lower medication adherence and a higher incidence of adverse events and medical costs among elderly patients. The current study aimed to examine the prescription status of elderly patients transported to tertiary emergency medical institutions to compare the proportion of elderly patients using PIMs at admission and discharge and to investigate the characteristics of PIMs at discharge and their associated factors. METHODS: In total, 264 patients aged 75 years or older who were transferred to and discharged from the emergency room at Tokyo Medical University Hospital, a tertiary care hospital, from September 2018 to August 2019 were included in this study. We quantified the number of PIMs at admission and discharge based on the Screening Tool of Older Persons' Potentially Inappropriate Prescriptions (STOPP) criteria version 2. The primary outcomes were the proportion of elderly patients taking at least one PIM at admission and discharge. RESULTS: The proportions of patients taking PIMs at admission and discharge were 55% (n = 175) and 28% (n = 74), respectively. Old age, greater number of PIMs at admission, and greater number of medications at discharge were directly associated with PIMs at discharge. CONCLUSIONS: Admission to tertiary care hospitals resulted in a lower number of prescribed PIMs. Elderly patients with a higher number of PIMs at admission and higher number of medications at discharge might have been prescribed with PIMs.

Saving patients with out-of-hospital cardiac arrest using Impella: three case reports.

BACKGROUND: The efficacy of Impella for patients with out-of-hospital cardiac arrest is unknown. We report the cases of three patients with cardiogenic out-of-hospital cardiac arrest who received hemodynamic support with Impella. CASE PRESENTATION: Two patients, Case 2 and Case 3, received concomitant treatment with venoarterial extracorporeal membrane oxygenation and Impella. Percutaneous coronary intervention was undertaken in two patients, Case 1 and Case 3. Two patients, Case 1 and Case 3, showed favorable neurological function with the Glasgow-Pittsburgh cerebral performance and overall performance categories score of 1 at discharge. CONCLUSION: These findings suggest that Impella is effective in patients with out-of-hospital cardiac arrest. Further studies are required to understand the use of Impella for patients with out-of-hospital cardiac arrest.