Systems to identify potentially inappropriate prescribing in people with advanced dementia: A systematic review

© 2016 The Author(s). Background: Systems for identifying potentially inappropriate medications in older adults are not immediately transferrable to advanced dementia, where the management goal is palliation. The aim of the systematic review was to identify and synthesise published systems and make recommendations for identifying potentially inappropriate prescribing in advanced dementia. Methods: Studies were included if published in a peer-reviewed English language journal and concerned with identifying the appropriateness or otherwise of medications in advanced dementia or dementia and palliative care. The quality of each study was rated using the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) checklist. Synthesis was narrative due to heterogeneity among designs and measures. Medline (OVID), CINAHL, the Cochrane Database of Systematic Reviews (2005 - August 2014) and AMED were searched in October 2014. Reference lists of relevant reviews and included articles were searched manually. Results: Eight studies were included, all of which were scored a high quality using the STROBE checklist. Five studies used the same system developed by the Palliative Excellence in Alzheimer Care Efforts (PEACE) Program. One study used number of medications as an index, and two studies surveyed health professionals' opinions on appropriateness of specific medications in different clinical scenarios. Conclusions: Future research is needed to develop and validate systems with clinical utility for improving safety and quality of prescribing in advanced dementia. Systems should account for individual clinical context and distinguish between deprescribing and initiation of medications

Multidisciplinary perspectives on medication-related decision-making for people with advanced dementia living in long-term care: a critical incident analysis.

PURPOSE:This study aimed to explore medication-related decision-making by health professionals from different disciplines and specialties caring for people with advanced dementia living in long-term care facilities, focusing on dilemmas associated with starting, continuing or deprescribing medications commonly regarded as potentially inappropriate. METHODS:Four focus groups were undertaken, each on a different medication type (antibiotics, lipid-lowering agents, opioids and acetylcholinesterase inhibitors). Transcripts underwent qualitative analysis using line by line inductive coding and then a person-centred framework to highlight themes across medication types. RESULTS:Sixteen participants participated in focus groups. Regardless of medication type or dilemma, results suggested decision-making for residents with advanced dementia should begin with discussing goals of care and engaging with families, and be viewed as an iterative process involving regular monitoring and adjustment. Decision-making was seen as requiring a dialectical approach involving multiple perspectives, with an emphasis on establishing communication between health professionals, family and the person with dementia to better understand goals/preferences for care. CONCLUSION:Inter-professional collaboration enables sharing of clinical experience/expertise, differing disciplinary perspectives and knowledge about the resident. Continuing a medication should be considered an active decision that carries as much responsibility as starting or deprescribing

Intramolecular hydrogen transfer reactions catalyzed by pentamethylcyclopentadienyl rhodium and cobalt olefin complexes: Mechanistic studies

The mechanism of intramolecular transfer dehydrogenation catalyzed by [Cp * M(VTMS) 2 ] ( 1 , M=Rh, 2 , M=Co, Cp* = C 5 Me 5 , VTMS = vinyltrimethylsilane) complexes has been studied using vinyl silane protected alcohols as substrates. Deuterium-labeled substrates have been synthesized and the regioselectivity of H/D transfers investigated using 1 H and 2 H NMR spectroscopy. The labeling studies establish a regioselective pathway consisting of alkene directed α C-H activation, 2,1 alkene insertion, and finally β-hydride elimination to give silyl enol ether products

Properties of HxTaS2

The preparation of Hx TaS2 (0 \u3c x \u3c 0.87) is described. The compounds are only marginally stable at room temperature, slowly evolving H2S and H2 (and possibly Hp in air). Magnetic susceptibility data show that a low temperature transformation in 2H ... TaS2 (at so•K) is suppressed with the addition of hydrogen, and· at the same time the superconducting transition temperature T c rises from 0.8 to ~4.2•K at x = 0.11. Heat capacity measurements near this concentration show the superconductivity to be a bulk effect. Finally, by correlation of this data with susceptibility and T c measurements in other intercalation compounds, we suggest that the rise of T c (at low electron transfer) is due to suppression of the low temperature transformation and not due to an excitonic mechanism of superconductivity

Cornell Fuel Cell Institute: Materials Discovery to Enable Fuel Cell Technologies

The discovery and understanding of new, improved materials to advance fuel cell technology are the objectives of the Cornell Fuel Cell Institute (CFCI) research program. CFCI was initially formed in 2003. This report highlights the accomplishments from 2006-2009. Many of the grand challenges in energy science and technology are based on the need for materials with greatly improved or even revolutionary properties and performance. This is certainly true for fuel cells, which have the promise of being highly efficient in the conversion of chemical energy to electrical energy. Fuel cells offer the possibility of efficiencies perhaps up to 90 % based on the free energy of reaction. Here, the challenges are clearly in the materials used to construct the heart of the fuel cell: the membrane electrode assembly (MEA). The MEA consists of two electrodes separated by an ionically conducting membrane. Each electrode is a nanocomposite of electronically conducting catalyst support, ionic conductor and open porosity, that together form three percolation networks that must connect to each catalyst nanoparticle; otherwise the catalyst is inactive. This report highlights the findings of the three years completing the CFCI funding, and incudes developments in materials for electrocatalyts, catalyst supports, materials with structured and functional porosity for electrodes, and novel electrolyte membranes. The report also discusses developments at understanding electrocatalytic mechanisms, especially on novel catalyst surfaces, plus in situ characterization techniques and contributions from theory. Much of the research of the CFCI continues within the Energy Materials Center at Cornell (emc2), a DOE funded, Office of Science Energy Frontier Research Center (EFRC)

Getter sputtering system for high-throughput fabrication of composition spreads

We describe a sputtering system that can deposit composition spreads in an effectively UHV environment but which does not require the high-throughput paradigm to be compromised by a long pump down each time a target is changed. The system deploys four magnetron sputter guns in a cryoshroud (getter sputtering) which allows elements such as Ti and Zr to be deposited with minimal contamination by oxygen or other reactive background gases. The system also relies on custom substrate heaters to give rapid heating and cool down. The effectiveness of the gettering technique is evaluated, and example results obtained for catalytic activity of a pseudoternary composition spread are presented

Getter sputtering system for high-throughput fabrication of composition spreads

We describe a sputtering system that can deposit composition spreads in an effectively UHV environment but which does not require the high-throughput paradigm to be compromised by a long pump down each time a target is changed. The system deploys four magnetron sputter guns in a cryoshroud (getter sputtering) which allows elements such as Ti and Zr to be deposited with minimal contamination by oxygen or other reactive background gases. The system also relies on custom substrate heaters to give rapid heating and cool down. The effectiveness of the gettering technique is evaluated, and example results obtained for catalytic activity of a pseudoternary composition spread are presented