Patient-Centred Management Of Polypharmacy: A Process For Practice

Лекарствата са най-често срещаната интервенция за подобряване на здравето. Броят лекарства, приемани от по-възрастните хора във Великобритания стабилно расте през последните три десетилетия. „Свръхупотреба на лекарства` („полифармация` - ‘polypharmacy`) е термин, който означава предписване или приемане на много лекарства. Нараства загрижеността в средите на първичната и специализираната медицинска помощ относно рисковете на свръхупотребата на лекарства. Тези тревоги са основани на данни за зависимост между свръхупотребата на лекарства и повишената честота на нежелани лекарствени реакции, хоспитализации, увеличени разходи за здравеопазване и неспазване на назначеното лечение. За Великобритания през последните 20 години това в голяма степен може да се отдаде на по-големия спектър налични лечения, базирани върху доказателства, насърчавани чрез терапевтични указания. Тези лечения са предназначени за отделни заболявания, за сметка на комплексен подход към едновременното наличие на повече болести (мултиморбидността), което засяга много пациенти в напреднала възраст. Също така в момента няма достатъчно национални указания, базирани върху доказателства, за намаляване и спиране на лекарства и отчитане на позицията на пациента. В тази статия се прави обзор на наличната литература във Великобритания за свръхупотребата на лекарства, с описание на четири ключови ресурса, всички от които ползващи международна литература и визиращи лекарствените аспекти на свръхупотребата на лекарства от гледна точка на клинициста. Подходът, ориентиран към пациента, съчетава както позицията на клиничните здравни професионалисти, така и на пациента. Материалът е разработен с ползване на съществуващия инструментариум и източници и е предназначен да насърчава извършването на прегледи на приеманите лекарства (medication reviews), които са на принципа на взаимодействието между пациент и клиничен специалист. Идеята е да се предостави информативна база за решения за спиране на лекарства и предприемане на мерки за управление на свръхупотребата на лекарства като част от цялостните стратегии за оптимизиране на лекарствата за пациентите. Представен е нагледно модел от седем стъпки, който включва указания за аспектите, които следва да се отчетат, действията, които да се предприемат и въпросите, които да се задават, за намаляване на свръхупотребата на лекарства и за безопасно преустановяване употребата на предписани лекарствени продукти.Medicines are the most common intervention to improve health. The number of medicines taken by older people in the UK has been steadily increasing for the last three decades. Polypharmacy is a term that refers to either the prescribing or taking many medicines. Concerns about the risks of polypharmacy in primary and secondary care are growing, supported by evidence which associates polypharmacy with increased adverse drug events, hospital admissions, increased healthcare costs and nonadherence. In the UK, this can largely be attributed, over the last 20 years, to the greater availability of evidencebased treatments promoted through therapeutic guidelines which are designed for single conditions, rather than addressing the multimorbidity that affects many older people. There is also currently a paucity of evidence-based national guidance around reducing and stopping medication and incorporating the patient perspective. This paper reviews current UK literature around polypharmacy including a description of four key resources which all make use of international literature and all focus on the medication aspects of polypharmacy from a clinician`s perspective. The patient-centred approach combines both clinical health professionals and patient perspective. Developed using existing resources, it is designed to assist with collaborative (patient and clinician based) medication review to inform decisions around deprescribing and address polypharmacy as part of overall strategies to optimise medicines for the patient. Presented as a diagrammatic representation in seven steps, it also includes guidance on points to consider, actions to take and questions to ask in order to reduce polypharmacy and undertake deprescribing safely

Guidance on Stimulus Materials

PACHELBEL WP4 “Stimulus Materials” uses findings from WP3 (Policy Assumptions) and from additional sources to prepare stimulus materials for the group-based process “STAVE” implemented in WP5. The output was material to inform and stimulate the group-based process. The material was of two types: a set of questionnaires common to all partners (EVOC/CAPA/SIMI questionnaires), and material that is issue-specific and individually produced for each country. EVOC/CAPA/SIMI short questionnaires serve as a comparative tool between countries, giving insight on the social construction of “sustainable consumption” across the PACHELBEL population. Partners asked participants to fill out the set individually at the first meeting of the STAVE group, results were then analyzed and data were fed back for discussion by group participants at their second meeting. A “re-test” was then conducted at the third of three group meetings. The present report details the representations revealed through this methodology – but moreover the impact of applying such a technique in STAVE groups in France, Germany, Romania, Spain, Sweden and the UK (where the methodology was slightly altered). The issue-and-country-specific material consists of an informative simulated newspaper article on the particular issue addressed in a given STAVE process, and/or other materials (for example, humorous drawings). The report details how this material was developed, and the experience of applying these stimulus materials in each country. On this basis, guidance for future STAVE processes is offered. Foremost among observations is that PACHELBEL stimulus materials serve a purpose that is distinct from that of “group exercises” as developed in WP5. The materials contributing to the formation of a group identity, a reflexive group norm, and a shared information basis. As such, stimulus materials prepare the group for a cooperative investigative process

Postmortem screening of opioids, benzodiazepines, and alcohol among rural and urban suicide decedents

PurposeFatal suicides involving opioids are increasingly common, particularly in rural areas. As co-use of opioids with other substances contributes significantly to mortality risk, we examined whether positive screens for opioids with other substances is more prevalent among rural versus urban suicide deaths, as this could have implications for public health strategies to reduce overdose suicides.MethodsData from all states reporting opioid-related overdose suicides in the National Violent Death Reporting System from 2012 to 2015 were used. Relative risk ratios were obtained using multinomial logistic regression, comparing opioid-only to (1) opioid and alcohol, (2) opioid and benzodiazepines, and (3) opioid, alcohol, and benzodiazepines suicides across rurality. Models were fit using robust standard errors and fixed effects for year of death, adjusting for individual, county, and state-level covariates.FindingsThere were 3,781 opioid-overdose suicide decedents (42% female) tested for all 3 substances during the study period. Unadjusted prevalence of positive screens in decedents varied across rurality (P = .022). Urban decedents were more likely to test positive for opioids alone, while rural decedents were more to likely test positive for opioids and benzodiazepines.ConclusionsRural suicides are associated with increased opioid and benzodiazepine positive screens. These findings suggest the need for rural-focused interventions to support appropriate co-prescribing, better health education for providers about risks associated with drug mixing, and more linkages with mental health services

Why we should understand the patient experience: clinical empathy and medicines optimisation

Objectives To critically discuss the need for pharmacists to underpin their consultations with appropriate ‘clinical empathy’ as part of effective medicines optimisation. Methods Use of literature around empathy, consultation and pharmacy practice to develop a case for greater clinical empathy in pharmacy consultations. Key findings Clinical empathy is defined from the literature and applied to pharmacy consultations, with a comparison to empathy in other clinical professions. Historical barriers to the embedding of clinical empathy into pharmacy consultations are also explored. Conclusions We challenge the pharmacy profession to consider how clinical empathy should underpin consultations with a series of introspective questions and provide some sample questions to support pharmacy consultations. We also make the case for appropriate education and professional development of consultation skills at undergraduate and postgraduate level. We contend that patients’ relationships with practitioners are critical, and a lack of empathy can impact the effectiveness of care

Poly[ethano­lbis(μ3-2-thio­xo-1,2-dihydro­pyridin-1-olato)dilithium(I)]

The title compound, [Li2(C5H4NOS)2(C2H6O)]n, having two formula units in the asymmetric unit, forms infinite chains of Li2O2 rhombi along b, consisting of four independent Li and O atoms. Metal binding to 2-thio­oxo-1,2-dihydro­pyridin-1-olate occurs in a bidentate fashion via O and S, and in a monodentate manner via the N-oxide O atom. π–π Inter­actions between polymeric chains are evident from centroid-to-centroid distances of pyridine­thione fragments of 3.461 (6)–3.607 (6) Å. The N—O and C—S bond lengths are distinctively different from those in hitherto investigated NiII, ZnII and (H3C)2TlIII complexes of 2-thio­oxo-1,2-dihydro­pyridin-1-olate, but correlate with those reported for 1-hydr­oxy- and 1-alkoxy­pyridine-2(1H)-thio­nes in the solid state

The Future of Environmental Peace and Conflict Research

Interest in the intersections of environmental issues, peace and conflict has surged in recent years. Research on the topic has developed along separate research streams, which broadened the knowledge base considerably, but hardly interact across disciplinary, methodological, epistemological and ontological silos. Our forum addresses this gap by bringing into conversation six research streams on the environment, peace and conflict: environmental change and human security, climate change and armed conflict, environmental peacebuilding, political ecology, securitisation of the environment, and decolonizing environmental security. For each research stream, we outline core findings, potentials for mutual enrichment with other streams, and prospects for future research

Twenty questions about design behavior for sustainability, report of the International Expert Panel on behavioral science for design

How behavioral scientists, engineers, and architects can work together to advance how we all understand and practice design—in order to enhance sustainability in the built environment, and beyond.https://www.nature.com/documents/design_behavior_for_sustainability.pdfPublished versio