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1.
Br J Gen Pract ; 70(692): 110-111, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32107224
2.
BMJ ; 368: m650, 2020 02 20.
Artigo em Inglês | MEDLINE | ID: mdl-32079582
3.
Sr Care Pharm ; 34(10): 678-686, 2019 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-31818354

RESUMO

OBJECTIVE: Assess the impact of a pharmacist-driven deprescribing procedure on reduction of target medications at discharge among geriatric patients receiving care in a hospital-based transitional care unit.
DESIGN: Retrospective, single-center chart review.
SETTING: Transitional care unit located within a hospital.
PARTICIPANTS: Patients 65 years of age and older were included if they were admitted to the transitional care unit between June 1, 2017, and December 15, 2017, on one or more of the following target medication classes: antihistamines, benzodiazepines, hypnotic sleep aids, proton-pump inhibitors, and skeletal muscle relaxants.
INTERVENTIONS: Pharmacists performed a structured review of patient's medications upon admission and utilized the deprescribing procedure developed by our institution to identify and deprescribe target medications in an attempt to optimize the patient's medication regimen prior to discharge.
RESULTS: Overall, 129 patients on 198 target medications were included in the study. Patients were on an average of 1.5 ± 0.78 target medications at admission, which was reduced to 0.78 ± 0.73 at discharge (P < 0.001). Overall, a 50% reduction of target medications was achieved.
CONCLUSION: A pharmacist-driven deprescribing procedure significantly reduced the quantity of target medications that older patients were discharged on.


Assuntos
Desprescrições , Idoso , Humanos , Farmacêuticos , Estudos Retrospectivos , Cuidado Transicional
5.
Drug Res (Stuttg) ; 69(S 01): S14-S15, 2019 11.
Artigo em Alemão | MEDLINE | ID: mdl-31731304
6.
Tijdschr Psychiatr ; 61(8): 527-535, 2019.
Artigo em Holandês | MEDLINE | ID: mdl-31512736

RESUMO

BACKGROUND: In an era of patient centered care, the question rises whether practitioners of these patients are sufficiently aware of their treatment preferences.
AIM: To study the opinion and knowledge of older, long-term psychiatric patients about their medication and health priorities.
METHOD: Patients were interviewed with the Patient's Attitudes Towards Deprescribing questionnaire. Furthermore patients were asked to name their medication by heart, their health priorities and preferences in medication changes. These preferences were compared with those of their practitioners.
RESULTS: 47 patients (median age 67 years, median 11 drugs) were interviewed. The mean percentage of spontaneously recalled drugs was 37%. Though 64% believed all used drugs were necessary, 77% would like to deprescribe if the doctor said it was possible. Preferences in deprescribing of patients and doctors didn't correspond in about 80%.
CONCLUSION: Most of old psychiatric patients are willing to deprescribe, but await initiative of their doctor. They can recall little of their currently used drugs. Preferences in deprescribing of the patient and doctor do often not match. We recommend to include a patient interview about the need for education and treatment preferences in the annual medication reviews in order to deprescribe and deliver more patient centered care.


Assuntos
Antipsicóticos/uso terapêutico , Desprescrições , Transtornos Mentais/tratamento farmacológico , Preferência do Paciente , Assistência Centrada no Paciente , Idoso , Feminino , Humanos , Pacientes Internados , Masculino
7.
Expert Opin Drug Saf ; 18(11): 1091-1098, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31524003

RESUMO

Objectives: Inappropriate prescription is a problem related to aging and deprescription could be a possible strategy. The aim of this study was to adapt the available evidence on deprescribing to the medication management of older people living in long-term care facilities. Methods: The authors carried out a bibliographic search based on the most prevalent drugs in our context to develop a specific deprescribing intervention. A committee of experts reviewed this intervention which was later validated through an interobserver variability study. Finally, the authors evaluated it in a sample of patients through a controlled before-after study. Results: The authors included 119 subjects living in a public elderly long-term care center and 122 controls living in a center with similar clinical characteristics. The authors evaluated 852 medications, identifying a total of 175 (20.5%) potentially inappropriate medications and 162 (92.5%) drugs were deprescribed (1.4 per patient). The application of the intervention meant an annual saving of 9.525.25 €. Conclusion: The implementation of a deprescribing intervention aimed at the most prevalent drugs prescribed in a particular setting improves the appropriateness of pharmacotherapy in the patients.


Assuntos
Desprescrições , Prescrição Inadequada/prevenção & controle , Conduta do Tratamento Medicamentoso/organização & administração , Lista de Medicamentos Potencialmente Inapropriados , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Custos de Medicamentos , Feminino , Instituição de Longa Permanência para Idosos , Humanos , Prescrição Inadequada/economia , Assistência de Longa Duração/normas , Masculino , Casas de Saúde , Padrões de Prática Médica/normas
8.
Urology ; 134: 192-198, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31542460

RESUMO

OBJECTIVE: To test the hypothesis that transurethral prostate procedures (TUPPs) eliminating tissue result in greater medication discontinuation and lower de novo initiation rates than procedures inducing tissue necrosis. METHODS: Retrospective review of all men undergoing first time TUPPs at a large tertiary center from 2001 to 2016 was completed. Procedure type and urologic medication use before, 3-12 months after, and greater than 12 months after TUPP were analyzed with simple open prostatectomy as a comparator. Tissue-eliminating TUPPs included transurethral resection of the prostate and laser prostatectomy. Tissue-necrosing procedures included microwave therapy (transurethral microwave therapy) and radiofrequency ablation (transurethral needle ablation), which were grouped in analyses. Medication types were 5-alpha reductase inhibitors (5ARI), alpha blockers, anticholinergics, and beta-3 agonists (B3A). RESULTS: A total 5150 TUPPs were analyzed. Preoperative medication use significantly varied across TUPPs for 5ARI (P <.01), alpha-blockers (P .01), and anticholinergics (P .047), but not B3A (P .476). Transurethral resection of the prostate and laser prostatectomy were associated with significantly higher medication discontinuation rates and lower resumption and initiation rates compared to tissue-necrosing procedures. Relative to TUPPs, simple prostatectomy had significantly higher medication discontinuation, as well as the lowest resumption and initiation rates. CONCLUSION: Tissue-eliminating benign prostatic hyperplasia procedures were associated with better medication discontinuation, resumption, and de novo initiation rates compared to tissue-necrosing benign prostatic hyperplasia procedures.


Assuntos
Uso de Medicamentos/estatística & dados numéricos , Micro-Ondas/uso terapêutico , Prostatectomia , Hiperplasia Prostática/terapia , Terapia por Radiofrequência , Ressecção Transuretral da Próstata , Inibidores de 5-alfa Redutase/uso terapêutico , Antagonistas Adrenérgicos alfa/uso terapêutico , Agonistas de Receptores Adrenérgicos beta 3/uso terapêutico , Idoso , Antagonistas Colinérgicos/uso terapêutico , Desprescrições , Humanos , Masculino , Prostatectomia/métodos , Estudos Retrospectivos
9.
BMC Pregnancy Childbirth ; 19(1): 320, 2019 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-31477047

RESUMO

BACKGROUND: Oxytocin is an effective drug for induction of labour, but is associated with serious adverse effects of which uterine tachysystole, fetal distress and the need of immediate delivery are the most common. Discontinuation of oxytocin once the active phase of labour is established could reduce the adverse effects. The objective is to investigate how the caesarean section rate is affected when oxytocin stimulation is discontinued in the active phase of labour compared to labours where oxytocin is continued. METHODS: CONDISOX is a double-blind multicentre randomised controlled trial conducted at Danish and Dutch Departments of Obstetrics and Gynaecology. The first participant was recruited on April 8 2016. Based on a clinically relevant relative reduction in caesarean section rate of 7%, an alpha of 0.05, a beta of 80%, we aim for 1200 participating women (600 in each arm). The CONDISOX trial includes women at a gestational age of 37-42 complete weeks of pregnancy, who have uterine activity stimulated with oxytocin infusion for the induction of labour. Women are randomised when the active phase of labour becomes established, to study medication containing either oxytocin (continuous group) or placebo (discontinued group) infusion. Women are stratified by birth site, indication for oxytocin stimulation (induction of labour, prelabour rupture of membranes) and parity (nulliparous, parous +/- previous caesarean section). We will compare the primary outcome, caesarean section rate, in the two groups using a chi-square test with a p-value of 0.05. If superiority is not demonstrated, we have a pre-defined post hoc non-inferiority boundary (margin, delta) at 1.09. Secondary outcomes include duration of the active phase of labour, incidence of uterine tachysystole, postpartum haemorrhage, admission to the neonatal intensive care unit, Apgar score, umbilical arterial blood pH, and birth experience. DISCUSSION: The high frequency of oxytocin use and the potential risks of both maternal and fetal adverse effects of oxytocin emphasise the need to determine the optimal oxytocin regime for induction of labour. TRIAL REGISTRATION: NCT02553226 (registered September 17, 2015). Eudra-CT number: 2015-002942-30.


Assuntos
Trabalho de Parto Induzido/métodos , Ocitócicos , Ocitocina , Hemorragia Pós-Parto/epidemiologia , Índice de Apgar , Cesárea/estatística & dados numéricos , Desprescrições , Método Duplo-Cego , Feminino , Sangue Fetal/química , Humanos , Concentração de Íons de Hidrogênio , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Complicações do Trabalho de Parto/epidemiologia , Gravidez , Contração Uterina
10.
Br J Hosp Med (Lond) ; 80(9): 517-524, 2019 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-31498658

RESUMO

Nocturia may be a multifactorial condition and should be regarded as a syndrome rather than a diagnosis, with many factors contributing to the clinical presentation. The effects of sleep deprivation can have a severely detrimental impact on the quality of life and productivity of the working age population, with considerable economic implications. Patients are unlikely to seek an appointment with their GP complaining of nocturia - they are more likely to complain of the effects of the condition, such as chronic tiredness, or injuries resulting from falls. The main criterion in deciding whether a patient should undergo further investigations into suspected nocturia is the degree to which the patient finds the condition bothersome. In some patients, lifestyle modifications may be an effective way to manage nocturia before medication is considered. As the only licensed product for all adults including those over 65 years of age, low dose desmopressin (Noqdirna® (as lyophilisate) Ferring Pharmaceuticals Ltd) is highly effective in the management of idiopathic nocturnal polyuria, producing improvements in clinical symptoms, sleep parameters and quality of life. Care should be administered as a joint enterprise between the patient's GP and colleagues in secondary care. This article outlines the findings of a roundtable discussion into the optimal management of patients with nocturnal polyuria.


Assuntos
Algoritmos , Noctúria/terapia , Antidiuréticos/uso terapêutico , Desamino Arginina Vasopressina/uso terapêutico , Desprescrições , Dieta Hipossódica , Comportamento de Ingestão de Líquido , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Humanos , Estilo de Vida , Noctúria/induzido quimicamente , Noctúria/diagnóstico
13.
Arthritis Rheumatol ; 71(10): 1599-1613, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31436036

RESUMO

OBJECTIVE: To update evidence-based recommendations for the treatment of patients with ankylosing spondylitis (AS) and nonradiographic axial spondyloarthritis (SpA). METHODS: We conducted updated systematic literature reviews for 20 clinical questions on pharmacologic treatment addressed in the 2015 guidelines, and for 26 new questions on pharmacologic treatment, treat-to-target strategy, and use of imaging. New questions addressed the use of secukinumab, ixekizumab, tofacitinib, tumor necrosis factor inhibitor (TNFi) biosimilars, and biologic tapering/discontinuation, among others. We used the Grading of Recommendations, Assessment, Development and Evaluation methodology to assess the quality of evidence and formulate recommendations and required at least 70% agreement among the voting panel. RESULTS: Recommendations for AS and nonradiographic axial SpA are similar. TNFi are recommended over secukinumab or ixekizumab as the first biologic to be used. Secukinumab or ixekizumab is recommended over the use of a second TNFi in patients with primary nonresponse to the first TNFi. TNFi, secukinumab, and ixekizumab are favored over tofacitinib. Co-administration of low-dose methotrexate with TNFi is not recommended, nor is a strict treat-to-target strategy or discontinuation or tapering of biologics in patients with stable disease. Sulfasalazine is recommended only for persistent peripheral arthritis when TNFi are contraindicated. For patients with unclear disease activity, spine or pelvis magnetic resonance imaging could aid assessment. Routine monitoring of radiographic changes with serial spine radiographs is not recommended. CONCLUSION: These recommendations provide updated guidance regarding use of new medications and imaging of the axial skeleton in the management of AS and nonradiographic axial SpA.


Assuntos
Anti-Inflamatórios não Esteroides/uso terapêutico , Antirreumáticos/uso terapêutico , Inibidores de Proteínas Quinases/uso terapêutico , Espondilite Anquilosante/tratamento farmacológico , /uso terapêutico , Anticorpos Monoclonais Humanizados/uso terapêutico , Produtos Biológicos/uso terapêutico , Medicamentos Biossimilares/uso terapêutico , Desprescrições , Humanos , Imagem por Ressonância Magnética , Piperidinas/uso terapêutico , Pirimidinas/uso terapêutico , Pirróis/uso terapêutico , Radiografia , Sociedades Médicas , Espondiloartropatias/diagnóstico por imagem , Espondiloartropatias/tratamento farmacológico , Espondilite Anquilosante/diagnóstico por imagem
14.
Am J Health Syst Pharm ; 76(4): 236-241, 2019 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-31415680

RESUMO

PURPOSE: In this article we describe a novel required longitudinal experience focused on deprescribing designed for postgraduate year 2 (PGY2) geriatric pharmacy residents. This experience was embedded within a clinical pharmacist-driven deprescribing service. Insights on challenges faced and benefits gained during the first offering are also highlighted. SUMMARY: Through collaboration with the University of Pittsburgh School of Pharmacy (UPMC) Palliative and Supportive Institute and the UPMC St. Margaret PGY2 geriatric pharmacy residency program, a year-long required deprescribing-focused experience was developed and executed. The experience was aligned with the American Society of Health-System Pharmacists' standard goals and objectives and was designed to focus and evaluate 3 skills necessary for all pharmacy practitioners: empathy, critical thinking, and communication. There is a need for proactive deprescribing initiatives to reduce the unnecessary burden and cost associated with potentially inappropriate medications for older patients. Focused deprescribing experiences can better equip pharmacist learners with the ability to lead these initiatives. CONCLUSION: A required longitudinal deprescribing-focused experience can provide PGY2 geriatric pharmacy residents with opportunities to practice empathy, critical thinking, and communication beyond those typically offered in a residency program.


Assuntos
Desprescrições , Educação de Pós-Graduação em Farmácia/organização & administração , Residências em Farmácia/organização & administração , Desenvolvimento de Programas , Idoso de 80 Anos ou mais , Avaliação Educacional , Feminino , Geriatria/educação , Humanos , Masculino , Cuidados Paliativos/métodos , Farmacêuticos , Serviço de Farmácia Hospitalar , Papel Profissional
15.
Farm. hosp ; 43(4): 140-145, jul.-ago. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-183901

RESUMO

Objetivo: Elaborar un protocolo de uso de fármacos antipsicóticos en pacientes institucionalizados que presenten alteraciones conductuales que incluya criterios de prescripción y deprescripción y valorar su aplicabilidad en el ámbito de los centros sociosanitarios. Método: El protocolo de actuación se elaboró por consenso de un equipo interdisciplinar a partir de una búsqueda bibliográfica de las propuestas publicadas sobre el uso de antipsicóticos en estos pacientes. La valoración de su aplicabilidad en la deprescripción de antipsicóticos se realizó mediante un estudio prospectivo antes-después con un seguimiento de 6 meses tras la intervención en una residencia para personas mayores dependientes. Resultados: Se elaboró un protocolo que incluye criterios de prescripción y deprescripción de antipsicóticos. La intervención se realizó sobre 35 pacientes, 21 (60%) de las cuales eran mujeres. La retirada del tratamiento antipsicótico fue completa en 28 pacientes (80%) y se redujo a la mínima dosis eficaz en 7 (20%). El tratamiento se reinició en 2 pacientes por agravamiento de los síntomas. Los resultados de la evaluación conductual previa y a los 6 meses indicaron que no se produjeron modificaciones significativas en dichas alteraciones (12,91 ± 12,80 frente a 13,76 ± 16,68; p = 0,124). Conclusiones: El establecimiento de un protocolo que incluya criterios de prescripción y deprescripción, unido a la incorporación del farmacéutico en el equipo interdisciplinar, puede ser una herramienta eficaz para mejorar el uso de este tipo de medicamentos en los pacientes institucionalizados con demencia


Objective: To develop a clinical protocol for the use of antipsychotic drugs in dementia patients with behavioral disturbances that includes prescribing and deprescribing criteria and to assess its applicability in longterm care institutions. Method: The protocol was developed from an interdisciplinary perspective based on a literature search of the published proposals on antipsychotic drug use in dementia patients. Its applicability to the antipsychotic deprescribing process was assessed in a single center in a prospective before-after study with a follow-up of 6 months after the intervention study. Results: A protocol was developed that includes prescribing and deprescribing criteria. The intervention was performed in 35 patients (21 [60%] female). Antipsychotic treatment was completely withdrawn in 28 patients (80%) and was reduced to the minimum effective dose in 7 (20%). Treatment was resumed in 2 patients due to worsening symptoms. The pre- and 6-month post-test results showed that there were no significant changes in neuropsychiatric symptoms (12.91 ± 12.80 vs 13.76 ± 16.68; P = 0.124). Conclusions: The establishment of a protocol that includes prescribing and deprescribing criteria, in combination with the incorporation of a pharmacist in the multidisciplinary team, can be effective in improving the use of these drugs in elderly dementia patients in long-term care institutions


Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Desprescrições , Antipsicóticos/uso terapêutico , Protocolos Clínicos , Demência/tratamento farmacológico , Prescrições de Medicamentos/normas , Estudos Prospectivos , Análise Estatística
16.
Trials ; 20(1): 412, 2019 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-31288859

RESUMO

BACKGROUND: Opioid use has risen to epidemic proportions across Canada, with increasing evidence of harms including accidental overdose and death. Policy-makers have called for effective approaches to promote opioid reduction. One promising method from deprescribing randomized trials is to empower patients through direct-to-patient education. The current trial will evaluate the effectiveness of a government-led mail-out of educational information to adult community-dwelling, chronic opioid users on the reduction of opioids compared to usual care. METHODS: This is a pragmatic, prospective, cluster randomized, parallel-arm controlled trial, comparing mailed distribution of a direct-to-patient educational brochure for chronic opioid use (intervention arm) to usual care (control arm). Eligible participants from across Manitoba, Canada, will be identified by the Provincial Drug Programs Branch within the Manitoba Health, Seniors and Active Living Department of the Manitoba Government, allocated to primary care providers, and the latter will be randomized in clusters of family medicine practices to achieve a 1:1 ratio. The primary outcome is complete cessation of opioids after 6 months assessed using Drug Program Information Network data. Secondary outcomes include ≥ 25% dose reduction in the mean morphine milligram equivalent (MME) daily dose, reduction of daily dose to < 90 mg MME, or therapeutic switch to another opioid or non-opioid medication. Data will be analyzed using intent-to-treat generalized estimating equations. DISCUSSION: This trial will test the efficacy of a population-based, wide-scale, government-led direct-to-patient educational initiative to drive reductions in chronic opioid use by community-dwelling adults across Manitoba. TRIAL REGISTRATION: ClinicalTrials.gov, ID: NCT03400384 . Registered on 18 January 2018.


Assuntos
Analgésicos Opioides/administração & dosagem , Dor Crônica/tratamento farmacológico , Desprescrições , Substituição de Medicamentos , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Folhetos , Educação de Pacientes como Assunto/métodos , Analgésicos Opioides/efeitos adversos , Dor Crônica/diagnóstico , Dor Crônica/psicologia , Esquema de Medicação , Conhecimentos, Atitudes e Prática em Saúde , Política de Saúde , Humanos , Manitoba , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Transtornos Relacionados ao Uso de Opioides/psicologia , Formulação de Políticas , Serviços Postais , Ensaios Clínicos Pragmáticos como Assunto , Estudos Prospectivos , Fatores de Proteção , Medição de Risco , Fatores de Risco , Fatores de Tempo
17.
Farm Hosp ; 43(4): 140-145, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31276444

RESUMO

OBJECTIVE: To develop a clinical protocol for the use of antipsychotic drugs in dementia patients with  behavioral disturbances that includes prescribing and deprescribing criteria and to assess its  applicability in longterm care institutions. METHOD: The protocol was developed from an interdisciplinary perspective based on a literature  search of the published proposals on antipsychotic drug use in dementia patients. Its applicability to  the antipsychotic deprescribing process was assessed in a single center in a prospective before-after study  with a follow-up of 6 months after the intervention study. RESULTS: A protocol was developed that includes prescribing and deprescribing criteria. The  intervention was performed in 35 patients (21 [60%] female). Antipsychotic treatment was  completely withdrawn in 28 patients (80%) and was reduced to the minimum effective dose in 7  (20%). Treatment was  resumed in 2 patients due to worsening symptoms. The pre- and 6-month post-test results showed that  there were no significant changes in neuropsychiatric symptoms (12.91 ± 12.80 vs 13.76 ± 16.68; P = 0.124). Conclusions: The establishment of a protocol that includes prescribing and deprescribing criteria, in  combination with the incorporation of a pharmacist in the multidisciplinary team, can be effective in  improving the use of these drugs in elderly dementia patients in long-term care institutions.


Assuntos
Antipsicóticos/uso terapêutico , Demência/tratamento farmacológico , Desprescrições , Idoso , Idoso de 80 Anos ou mais , Antipsicóticos/administração & dosagem , Sintomas Comportamentais , Demência/psicologia , Progressão da Doença , Feminino , Humanos , Assistência de Longa Duração/organização & administração , Masculino , Casas de Saúde , Equipe de Assistência ao Paciente , Estudos Prospectivos
18.
Drugs Aging ; 36(10): 947-955, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31317420

RESUMO

BACKGROUND: Although compelling evidence exists supporting statins (HMG-CoA reductase inhibitors) for secondary prevention in older patients with clinical atherosclerotic diseases, the same cannot be said for primary prevention. OBJECTIVES: The objectives of this study were to estimate the frequency of potential statin overuse in older patients, the potential drug cost savings if corrected, and the associated factors. METHODS: A retrospective cross-sectional study was conducted in Alsace and Lorraine (France) from 1 January to 30 April 2017. All statin users aged 80 years or over living in the community (including nursing homes) and identified from the French health insurance database were analyzed. Potential statin overuse was defined according to the STOPP/START (Screening Tool of Older People's Prescriptions/Screening Tool to Alert to Right Treatment) criteria. RESULTS: Among the 38,268 aged insured, 23,228 (60.7%) had potential statin overuse. Of those living in the community, 22,132 (60.0%) patients had potential statin overuse: 12,352 (55.8%) for primary and 9780 (44.2%) for secondary prevention. Among nursing home residents, 1096 (79.0%) had potential statin overuse: 394 (35.9%) for primary and 702 (64.1%) for secondary prevention. The potential drug cost savings associated with the adjustment of potential statin overuse were €924,100 for the study period. Living in nursing home [adjusted odds ratio (ORadjusted) 3.91, 95% confidence interval (CI) 2.82-5.41] and being a female (ORadjusted 2.84, 95% CI 2.54-3.17) were the main risk factors associated with potential statin overuse. CONCLUSION: The frequency of potential statin overuse is very high among older people aged 80 years or over, highlighting the need to re-evaluate statin therapy and consider deprescribing, particularly for primary prevention and in nursing homes.


Assuntos
Inibidores de Hidroximetilglutaril-CoA Redutases/administração & dosagem , Fatores Etários , Idoso de 80 Anos ou mais , Aterosclerose/tratamento farmacológico , Aterosclerose/epidemiologia , Aterosclerose/prevenção & controle , Estudos Transversais , Bases de Dados Factuais , Desprescrições , Feminino , França/epidemiologia , Humanos , Seguro Saúde/estatística & dados numéricos , Masculino , Prevenção Primária , Estudos Retrospectivos , Prevenção Secundária
19.
Artigo em Russo | MEDLINE | ID: mdl-31317906

RESUMO

The review deals with the problem of polypragmasia and associated adverse drug reactions, which is very relevant for the elderly and senile age. Based on the frequent unjustified prescription of antipsychotic drugs in clinical practice and the serious consequences associated with it, especially in elderly people with cognitive impairment, the aim of this review was to analyze the current literature and an evidence base for antipsychotic therapy optimization in elderly. One of the most effective way to decrease drug-associated harm is deprescribing, the planned process of decreasing dose, discontinuation of drug or switching to another one aimed to improve quality of life of the patient. The article describes different types of deprescribing, presents the results of the analysis of literature on deprescribing of antipsychotics in long-term use in elderly patients with dementia. Central to this is the analysis of a systematic review of Cochrane E. Van Leeuwen and co-authors (2018), the leading research in the evidence base of deprescribing. Based on the available literature, the authors make the conclusion about the safety of deprescribing of antipsychotic drugs. The effect of abrupt discontinuation of treatment with antipsychotic drugs was evaluated in available literature. Most of the evidence relates only to residents of nursing homes or to patients in long-term psychogeriatric or geriatric wards (in-patient treatment). However, the evidence base of deprescribing of antipsychotic drugs is small, many studies have methodological limitations, the initial characteristics of the patients included in the study are extremely heterogeneous, methodologies for diagnosing and determining the severity of dementia, types and dosages of antipsychotic drugs, duration of observation periods differed greatly. Attention is drawn to the short duration of observation periods. All of the above dictates the need for specially planned randomized clinical trials, the results of which will develop detailed algorithms for deprescribing antipsychotics.


Assuntos
Antipsicóticos , Demência , Desprescrições , Idoso , Antipsicóticos/uso terapêutico , Demência/tratamento farmacológico , Humanos , Pacientes , Qualidade de Vida , Revisão Sistemática como Assunto
20.
Pediatr Rheumatol Online J ; 17(1): 48, 2019 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-31331351

RESUMO

BACKGROUND: We describe a Childhood Arthritis and Rheumatology Research Alliance (CARRA) survey of North American pediatric rheumatologists that assesses physician attitudes on withdrawal of medications in systemic juvenile idiopathic arthritis (SJIA). METHODS: A REDCap anonymous electronic survey was distributed to 100 random CARRA JIA workgroup physician-voting members. The survey had three broad sections including: A) demographic information; B) physicians' opinions on clinical inactive disease (CID) in SJIA and C) existing practices for withdrawing medications in SJIA. RESULTS: The survey had an 86% response rate. 88 and 93% of participants agreed with the current criteria for CID and clinical remission on medications (CRM) respectively. 78% thought it necessary to meet CRM before tapering medications except steroids. 76% use CARRA SJIA consensus treatment plans always or the majority of the time. All participants weaned steroids first in SJIA patients on combination therapy, 47% waited > 6 months before tapering additional medications. 35% each tapered methotrexate over > 6 months and 2-6 months; however, 39% preferred tapering anakinra, canakinumab and tocilizumab more quickly over 2-6 months and favored spacing the dosing interval for canakinumab and tocilizumab. When patients are on combination therapy with methotrexate and biologics, 58% preferred tapering methotrexate first while others considered patient/family preference and adverse effects to guide their choice. CONCLUSION: Most CARRA members surveyed use published consensus treatment plans for SJIA and agree with validated definitions of CID and CRM. There was agreement with tapering steroids first in SJIA. There was considerable variability with tapering decisions of all other medications.


Assuntos
Antirreumáticos/uso terapêutico , Artrite Juvenil/tratamento farmacológico , Atitude do Pessoal de Saúde , Desprescrições , Reumatologistas , Corticosteroides/uso terapêutico , Anticorpos Monoclonais Humanizados/uso terapêutico , Artrite Juvenil/fisiopatologia , Tomada de Decisão Clínica , Humanos , Proteína Antagonista do Receptor de Interleucina 1/uso terapêutico , Metotrexato/uso terapêutico , Inquéritos e Questionários
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