The potential for deprescribing in care home residents with Type 2 diabetes

Background: Type 2 diabetes is a common diagnosis in care home residents that is associated with potentially inappropriate prescribing and thus risk of additional suffering. Previous studies found that diabetes medicines can be safely withdrawn in care home residents, encouraging further investigation of the potential for deprescribing amongst these patients. Objectives: Describe comorbidities and medicine use in care home residents with Type 2 diabetes; identify number of potentially inappropriate medicines prescribed for these residents using a medicines optimisation tool; assess clinical applicability of the tool. Setting Thirty care homes for older people, East Anglia, UK. Method: Data on diagnoses and medicines were extracted from medical records of 826 residents. Potentially inappropriate medicines were identified using the tool ‘Optimising Safe and Appropriate Medicines Use’. Twenty percent of results were validated by a care home physician. Main outcome measure: Number of potentially inappropriate medicines. Results: The 106 residents with Type 2 diabetes had more comorbidities and prescriptions than those without. Over 90 % of residents with Type 2 diabetes had at least one potentially inappropriate medication. The most common was absence of valid indication. The physician unreservedly endorsed 39 % of the suggested deprescribing, and would consider discontinuing all but one of the remaining medicines following access to additional information. Conclusion: UK care home residents with Type 2 diabetes had an increased burden of comorbidities and prescriptions. The majority of these patients were prescribed potentially inappropriate medicines. Validation by a care home physician supported the clinical applicability of the medicines optimisation tool

The UW digital ozonesonde: Characteristics and flow rate calibration

During the austral springs of 1986 and 1987, a series of balloon soundings were conducted to characterize the temporal and vertical development of Antarctic ozone depletion using the electrochemical concentration cell method (ECC). An important part of this study was to perform correlative studies between ozone and aerosol particles. In order to facilitate these simultaneous measurements, a digital ozonesonde system was developed to interface with aerosol counters. The ozone measurements will be described herein. The ozonesonde modification was accomplished by converting the current output of the sonde to a frequency and adding this digital signal to the serial data stream of a Vaisala Corporation RS-80 radiosonde under microprocessor control. A number of advantages over the standard ozonesonde system currently in use are noted

Data from 617 healthy participants performing the Iowa gambling task: a "many labs" collaboration

This data pool (N = 617) comes from 10 independent studies assessing performance of healthy participants (i.e., no known neurological impairments) on the Iowa gambling task (IGT) - a task measuring decision making under uncertainty in an experimental context. Participants completed a computerized version of the IGT consisting of 95 - 150 trials. The data consist of the choices of each participant on each trial, and the resulting rewards and losses. The data are stored as .rdata, .csv, and .txt files, and can be reused to (1) analyze IGT performance of healthy participants; (2) create a "super control group"; or (3) facilitate model-comparison efforts

Power dynamics and interprofessional collaboration: How do community pharmacists position general practitioners, and how do general practitioners position themselves?

Power differentials and medical dominance can negatively affect collaboration between physicians and pharmacists. Norway is recognized as having a relatively egalitarian work sector, which could affect power differentials. In this qualitative study, we used positioning theory as a framework to explore the aspect of power dynamics between Norwegian general practitioners (GPs) and community pharmacists. We used the concepts of reflexive and interactive positioning to identify how GPs positioned themselves and how they were positioned by pharmacists in six focus groups. Data were analyzed using systematic text condensation. We found positioning theory to be a useful lens through which to study power dynamics in relation to collaboration between community pharmacists and GPs. Our findings imply that the presence of medical dominance poses challenges even in an egalitarian Norwegian setting. However, although both GPs and pharmacists draw on a ‘medical dominance’ storyline, we have also identified how both pharmacists and GPs draw on alternative and promising storylines of collaboration between the two professions.publishedVersio

Changes in Dentists' Prescribing Patterns in Norway 2005-2015.

Background There is scant knowledge of dentists' total prescribing patterns, and little is published on this internationally. The Norwegian Prescription Database (NorPD) includes data on all dispensed prescription medication in Norway from 2004 and can be used to investigate how dentists' prescribing has changed over time. There are few Norwegian guidelines supporting dentists' prescribing, and Norwegian legislation on dentists' prescribing rights leaves room for interpretation. The aim of this study was therefore to give an overview of all prescribing from dentists in Norway in the period 2005 to 2015 and to identify trends in their prescribing pattern over this time span. We also give characteristics of the prescribing dentists. Methods The study had a retrospective pharmacoepidemiologic design. Data on all medication prescribed by dentists and dispensed from Norwegian pharmacies in the time period 2005 to 2015 were extracted from the NorPD. Changes over time in the prescribers, patients, and medications are reported. Results There was an increase of 50% in total number of prescriptions from dentists in Norway from 2005 to 2015; adjusted for the growth in population, there was a 33% increase. The majority of prescriptions from dentists were for antibiotics and analgesics; however, the data reveal that the dentists prescribed from all major therapeutic groups. Dentists increased antibiotic prescribing in a period when total antibiotic prescribing in Norway decreased. Conclusions Our study finds antibiotics and analgesics dominate prescriptions from Norwegian dentists and shows an increase in use over time. It highlights the need for creating evidence-based prescribing guidelines for dentists and for ensuring that existing guidelines are implemented.publishedVersio

Investigation of the structure and dynamics of the ozone layer in the Eastern Arctic region during EASOE Campaign

Balloon measurements of the vertical distribution of ozone and aerosol were made at Dickson Island (73 deg N, 81 deg E), Kiruna (68 deg N, 20 deg E) and Heiss Island (81 deg N, 58 deg E) from December 1991 to March 1992. To acquire data on the seasonal variability of the vertical ozone distribution, electrochemical ozonesondes ECC-4A were flown three times a week. With ozonesondes on the same balloons, backscattersondes were flown on the average of two or three times per month. Using these instruments, altitude profiles of backscatter ratio were measured at two wavelengths centered at 490 nm and 940 nm. Additionally, at Heiss Island, Dickson, and Yakutsk (63 deg N, 130 deg E) regular total ozone measurements were obtained using Brewer spectrophotometers. Based on measurements of backscatter ratio it was found that after the Pinatubo eruption in June 1991 significant amount of stratospheric aerosols were formed and transported to the Arctic before the polar vortex was well developed. Analysis of ozone data has shown a deep decrease of ozone concentration in the lower stratosphere in times of intensive transportation of air masses from low latitudes to the polar region in the second half of January and also for some periods in February and March of 1992. When the values of backscatter ratio beta were more than 8-10 at a wavelength of 940 nm strong anticorrelation occurred between aerosol loading and ozone concentration in the lower stratosphere. At 50-70 deg N, the mean monthly values of total ozone in winter-spring 1992 proved to be much lower than the climatic mean values

Less is more: The impact of deprescribing psychotropic drugs on behavioral and psychological symptoms and daily functioning in nursing home patients. Results from the Cluster-Randomized Controlled COSMOS Trial

Objective: To investigate the impact of medication reviews using collegial mentoring and systematic clinical evaluation on psychotropic prescriptions, behavioral and psychological symptoms of dementia (BPSD), and activities of daily living (ADL). Design: Four-month multicenter, multicomponent, cluster-randomized, single-blinded controlled trial. Setting: Thirty-three Norwegian nursing homes including 67 nursing home wards (clusters). Participants: A total of 723 enrolled patients, of which 428 participated in the study; 217 were randomized to the intervention and 211 to care as usual (control). Intervention: The COSMOS intervention consisted of Communication, Systematic pain management, Medication reviews, Organization of activities, and Safety. During medication review, the nursing home physician evaluated treatment with colleagues systematically using the results from validated clinical assessments. Measurements: Mean changes from baseline to month 4 in the number of prescribed psychotropic drugs (antipsychotics, anxiolytics, hypnotics or sedatives, antidepressants, and antidementia drugs); Neuropsychiatric Inventory Nursing Home Version (NPI-NH) and Cornell Scale of Depression in Dementia (CSDD); Lawton and Brody's Physical Self Maintenance Scale (PSMS). Results: Compared to control, the mean change in prescribed psychotropic drugs was reduced both in total and regular number, while mean changes in NPI-NH and CSDD scores did not differ between the groups. Mean change in PSMS showed improvement in the intervention group, and deterioration in the control group. Conclusion: Medication reviews using collegial mentoring and systematic clinical evaluation led to safe deprescribing, as the reductions in psychotropic drug use did not negatively affect BPSD, while ADL improved.publishedVersio

Dermatological cancer screening: Evaluation of a new community pharmacy service

Background: Skin cancer accounts for one third of all cancers. Prognosis is inversely related to identification stage. Objectives: To describe a novel service, mole scans, performed in community pharmacy, the findings from the first 3.5 years it was in place, and to explore patient acceptability of the service. Methods: Norwegian Boots' pharmacies offer a mole scanning service in cooperation with ScreenCancer. Scans are undertaken within pharmacy consultation rooms. Image interpretation is undertaken remotely by a specialist. Number and result of scans performed from 2010 to 2014 are reported. A satisfaction questionnaire was returned by 10% of participants. Results: A total of 25836 scans were performed on 15777 individuals. Of these, 83.6% had normal scans, 1% had melanoma, and 15.4% had another skin condition. In 2014 the service identified 4.1% of melanoma cases registered in the Norwegian Cancer Registry. Most responders (88%) would use a similar service again. Nearly all (99%) felt the pharmacy was a suitable venue, and 95% would recommend the service to others. In total, 99% of respondents scored their overall satisfaction as “good” or higher. Conclusions: This approach was acceptable among participants who provided feedback. Providing mole scanning through pharmacies enables individuals to obtain a rapid check of moles causing concern, in an acceptable environment with a high level of satisfaction

Type 2-diabetes i fastlegepraksis – en fokusgruppestudie

BAKGRUNN Nasjonal diabetesplan 2017–21 har iverksatt tiltak for å bedre diagnostisering og oppfølging av personer med type 2-diabetes i primærhelsetjenesten. Formålet med denne studien var å undersøke norske fastlegers erfaringer og tanker rundt diagnostisering og oppfølging av pasientgruppen. MATERIALE OG METODE I denne kvalitative studien ble det gjennomført tre fokusgruppeintervjuer med totalt 17 fastleger. Intervjuene ble tatt opp på bånd, transkribert og analysert med systematisk tekstkondensering. RESULTATER Fastlegene fortalte om en travel arbeidshverdag der målrettet identifikasjon av pasienter i risikosonen for sykdommen sjelden ble prioritert. De beskrev en pasientsentrert diabetesomsorg, hvor motivering til livsstilsendring ble ansett som en nødvendig, men krevende arbeidsoppgave. Legene problematiserte balansegangen mellom å følge generelle kliniske retningslinjer og det å individtilpasse oppfølging til den enkelte pasient. Samtidig uttrykte deltakerne at de var mindre faglig oppdatert enn de ønsket, grunnet tidspress. FORTOLKNING Fastlegene i studien beskrev en pasientsentrert diabetesomsorg som drives av klinisk erfaring. Retningslinjer har en veiledende, men ikke førende funksjon. En slik tilpasning muliggjør individualisert og tilpasset behandling, men kan også være en medvirkende årsak til mangelfull oppfølging i henhold til nasjonale retningslinjer.publishedVersio

Perception of the Professional Knowledge of and Education on the Medical Technology Products among the Pharmacists in the Baltic and Nordic Countries—A Cross-Sectional Exploratory Study

With increased development of medical technology (MT), new challenges emerge related to education and training of pharmacists and other healthcare specialists. Currently, only a few universities in the EU promote MT education and research. Objectives: The aim of this study was to evaluate the current status, views on, and need for the education on MT for the pharmacy students and practicing pharmacists in the Baltic and Nordic countries. Methods: The representatives of higher education institutions and community/hospital pharmacists from six Baltic and Nordic countries participated in a qualitative cross-sectional exploratory internet-based study from May to October 2014. Results: Approximately two-third of the respondents considered professional knowledge about MT products important for pharmacists, but half of them had never participated in any MT courses. More practicing pharmacists than representatives of academia underlined the need for increased MT education for pharmacy students in the future. Conclusions: The pharmacists in the Baltic and Nordic countries consider the professional knowledge about MT as pertinent in their education and work. The limited number and status of MT courses available today, however, is a major concern among both pharmacy students and practicing pharmacists in these countries. In the future, increasing education combining theory and practice about MT products would be one possible solution to overcome this challenge.Peer reviewe