The impact of number of drugs prescribed on the risk of potentially inappropriate medication among outpatient older adults with chronic diseases.

BACKGROUND: Older patients with chronic diseases often take multiple prescription drugs, increasing their risk of adverse health events. However, polypharmacy remains ill-defined. AIM: To investigate the impact of number of drugs prescribed on potentially inappropriate medication (PIM) and the associated risk factors in older outpatients with chronic diseases. DESIGN: Retrospective cross-sectional study. METHODS: We retrospectively assessed 780 older patients (mean, 75.5 ± 7.1 years) with long-term (≥ 28 days) prescriptions for chronic diseases at the geriatric clinics of a university hospital from January to June 2012 using the Screening Tool of Older Person's potentially inappropriate Prescriptions (STOPP). Clinical information for each patient was analyzed. Logistic regression and receiver operating characteristic curve (ROC) analyses were performed; number needed to harm (NNH) was also estimated. RESULTS: According to STOPP criteria, 302 patients (39%) had at least one PIM. Multivariate analysis revealed that PIM risk was associated with the number of medications prescribed (P < 0.001) and the presence of cardiovascular (P < 0.001) or gastrointestinal disease (P = 0.003). The estimated area under the ROC for the number of medications needed to predict PIM risk was 0.680 (P < 0.001) with the optimal cut-off value of five medications. After adjusting covariates, patients prescribed ≥ 5 drugs [adjusted odds ratio (OR) = 5.4; adjusted NNH = 4.25; P < 0.001] and those prescribed 4 drugs (adjusted OR = 3.5; adjusted NNH = 6.88; P = 0.003) had significantly higher PIM risk than those prescribed ≤ 2 drugs. CONCLUSIONS: The number of prescribed medications can be an index of PIM risk in older patients with chronic diseases. Clinicians should suspect high PIM risk in older outpatients with ≥ 5 prescriptions.

The effects of weight reduction on the rehabilitation of patients with knee osteoarthritis and obesity.

OBJECTIVE: To evaluate the effect of weight reduction on the rehabilitation of patients with knee osteoarthritis and obesity. METHODS: A total of 126 patients with bilateral knee osteoarthritis and obesity were classified into 3 groups by their stages of osteoarthritis. Each group was divided into subgroups a, b, and c. The subjects in subgroup a received weight reduction treatment, those in subgroup b received weight reduction and electrotherapy modalities, and those in subgroup c received electrotherapy modalities to relieve pain. RESULTS: Pain reduction, weight reduction, ambulation speed, and changes of Lequesne's index were greater in patients in subgroups a and b than in subgroup c after treatment. Although the last pain scores in subgroup b were less than those in subgroup a, as measured by a visual analog scale (VAS), there was no significant difference between their functional status. Significant pain relief (VAS < 2) and an acceptable functional status (Lequesne's index < 7) were indicated when weight reduction was more than 15% and 12%, respectively, of the initial body weight of the individual. CONCLUSION: Weight reduction was found to be a practical adjuvant treatment in the rehabilitation of patients with knee osteoarthritis.

The effect of electroacupuncture on shoulder subluxation for stroke patients.

In this study, we evaluated the effect of electroacupuncture on shoulder subluxation for stroke patients. Twenty hemiplegic patients with shoulder subluxation were randomly and equally divided into two groups. The subjects in the control group received conventional therapy, and the subjects in the study group were treated with electroacupuncture and conventional therapy for four weeks. The visual analog scale (VAS) for shoulder pain, motor function status, anthropometry, and X-ray assessment were used to evaluate the status of shoulder subluxation before and after treatment. The results indicated that the pain scores decreased in the study groups significantly more than those in the control group. The degrees of shoulder reduction, including the measurement of anthropometry and X-ray assessment in the study group, were more than those of the control group. However, the motor function status showed no significant difference between two groups. It is concluded that electroacupuncture can be an effective adjuvant management in the treatment of shoulder subluxation for stroke patients.

Clinical spectrum of Pseudomonas putida infection.

The clinical and microbiologic characteristics of 55 cases of Pseudomonas putida infection in 53 patients in a medical center in Taiwan from April 1988 to March 1993 are reported. P. putida was cultured in the decreasing order of frequency from urine (24 isolates), sputum (12), blood (10), wound discharge (3), peritoneal fluid (3), cerebrospinal fluid (2) and umbilical swab (1). Of the adult patients, 23% (12/53) were considered to be contaminated or colonized with P. putida. Of the 41 patients with manifest disease. 17 (41%) had urinary tract infections, 10 (24%) had pneumonia, 8 (19%) had septicemia, 3 (7%) had wound infections, 2 (5%) had meningitis and 1 (2%) had peritonitis. Of these, 55% were nosocomial infections. The case fatality rate was 29% (12/41). There was no significant correlation between patient mortality and the type of disease caused by the bacterium. Results of in vitro susceptibility tests suggested that imipenem and ceftazidime were more effective than other antimicrobials. This study indicates that the clinical spectrum of diseases caused by P. putida is broader and the incidence of true infection is higher than previously expected, especially among hospitalized patients who undergo invasive procedures such as placement of intravascular devices, urinary catheterization and intubation.

Analysis of 109 cases of infective endocarditis in a tertiary care hospital.

BACKGROUND: Early diagnosis and treatment can benefit the outcome of patients with infective endocarditis. The older diagnostic criteria (von Reyn criteria) relied upon tissue pathology and blood culture results, but the sensitivity was low. A newly proposed criteria, Duke criteria which apply echocardiographic findings as a major factor in diagnosis, have shown a better sensitivity in the diagnosis of infective endocarditis. METHODS: From 1984 to 1994, 120 episodes of endocarditis in 119 patients were reviewed retrospectively. One hundred and nine episodes fulfilling the Duke criteria were enrolled. The demographic data, antecedent disease, predisposing factors for infective endocarditis including systemic disease, prosthetic valve, intravenous drug abuse, dental or surgical manipulation, culture results, echocardiographic findings, complications and outcome were recorded and analyzed. RESULTS: Sixty-six percent (72/109) was definite endocarditis, and 34% (37/109) was possible endocarditis, as categorized by Duke criteria. Eleven percent (12/109) of the patients were rejected by von Reyn criteria. The common possible predisposing factors were rheumatic heart disease, congenital heart disease, mitral valve prolapse, dental manipulation and intravenous drug abuse. Both patients with positive blood culture and negative blood culture results had one-fourth mortality rate. A notably higher mortality rate was found in patients with S. aureus endocarditis as compared with those of endocarditis caused by viridans streptococci(44% vs. 8%, p < 0.05). Patients with echocardiographic vegetations had a higher mortality rate (32% vs. 11%, p < 0.05) and more peripheral or organ embolic events (26% vs. 6%, p < 0.05) than those without vegetation. CONCLUSIONS: The Duke criteria are more sensitive than the von Reyn criteria for diagnosis of infective endocarditis. S. aureus endocarditis carried a higher mortality rate than viridans streptococci endocarditis. The present study also indicated that patients with discernible valvular vegetation on echocardiogram had a high mortality rate and occurrence of peripheral or organ embolic events. However, there was no statistical significance in the development of congestive heart failure and CNS complications between the patients with and without vegetation.

Cardiotoxicity related to 5-fluorouracil chemotherapy: a report of two cases.

5-Fluorouracil (5-FU) is a chemotherapeutic agent which has been used to treat many solid tumors including cancers of the breast, ovary, cervix, bladder, prostate gland and gastrointestinal tract. Side effects related to the drug include bone marrow suppression, stomatitis, nausea, vomiting and diarrhea. However another less frequent but lethal event cardiotoxicity--appears to have been ignored by physicians. Recently, two cases of cardiac toxicity induced by 5-FU have been encountered here. One patient developed supraventricular tachycardia and the other illustrated silent myocardial infarction with congestive heart failure. Since these side effects may result in death when 5-FU is prescribed to those patients who have had previous heart disease or are concomitantly receiving inevitable radiotherapy over the cardiac region, it should be recommended with extreme caution.