Deprescribing tool for STOPPFall (screening tool of older persons prescriptions in older adults with high fall risk) items

Background: Health care professionals are often reluctant to deprescribe fall-risk-increasing drugs (FRIDs). Lack of knowledge and skills form a significant barrier. To support clinicians in the management of FRIDs and to facilitate the deprescribing process, a deprescribing tool was developed by a European expert group for STOPPFall (Screening Tool of Older Persons Prescriptions in older adults with high fall risk) items. Methods: STOPPFall was created using an expert Delphi consensus process in 2019 and in 2020, 24 panellists from EuGMS SIG on Pharmacology and Task and Finish on FRIDs completed deprescribing tool questionnaire. To develop the questionnaire, a Medline literature search was performed. The panellists were asked to indicate for every medication class a possible need for stepwise withdrawal and strategy for withdrawal. They were asked in which situations withdrawal should be performed. Furthermore, panellists were requested to indicate those symptoms patients should be monitored for after deprescribing and a possible need for follow-ups. Results: Practical deprescribing guidance was developed for STOPPFall medication classes. For each medication class, a decision tree algorithm was developed including steps from medication review to symptom monitoring after medication withdrawal. Conclusion: STOPPFall was combined with a practical deprescribing tool designed to optimize medication review. This practical guide can help overcome current reluctance towards deprescribing in clinical practice by providing an up-to-date and straightforward source of expert knowledge

STOPPFall (Screening Tool of Older Persons Prescriptions in older adults with high fall risk): a Delphi study by the EuGMS Task and Finish Group on Fall-Risk-Increasing Drugs.

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadBackground: Healthcare professionals are often reluctant to deprescribe fall-risk-increasing drugs (FRIDs). Lack of knowledge and skills form a significant barrier and furthermore, there is no consensus on which medications are considered as FRIDs despite several systematic reviews. To support clinicians in the management of FRIDs and to facilitate the deprescribing process, STOPPFall (Screening Tool of Older Persons Prescriptions in older adults with high fall risk) and a deprescribing tool were developed by a European expert group. Methods: STOPPFall was created by two facilitators based on evidence from recent meta-analyses and national fall prevention guidelines in Europe. Twenty-four panellists chose their level of agreement on a Likert scale with the items in the STOPPFall in three Delphi panel rounds. A threshold of 70% was selected for consensus a priori. The panellists were asked whether some agents are more fall-risk-increasing than others within the same pharmacological class. In an additional questionnaire, panellists were asked in which cases deprescribing of FRIDs should be considered and how it should be performed. Results: The panellists agreed on 14 medication classes to be included in the STOPPFall. They were mostly psychotropic medications. The panellists indicated 18 differences between pharmacological subclasses with regard to fall-risk-increasing properties. Practical deprescribing guidance was developed for STOPPFall medication classes. Conclusion: STOPPFall was created using an expert Delphi consensus process and combined with a practical deprescribing tool designed to optimise medication review. The effectiveness of these tools in falls prevention should be further evaluated in intervention studies. Keywords: accidental falls; adverse effects; aged; deprescribing; fall-risk-increasing drugs; older people.Amsterdam Public Health Aging and Later Life Innovation Price and Clementine Brigitta Maria Dalderup fund Amsterdam University fun

Efficacy of clozapine versus standard treatment in adult individuals with intellectual disability and treatment-resistant psychosis (CLOZAID): study protocol of a multicenter randomized clinical trial

BackgroundIntellectual disability (ID) affects approximately 1% of the worldwide population and individuals with ID have a higher comorbidity with mental illness, and specifically psychotic disorders. Unfortunately, among individuals with ID, limited research has been conducted since ID individuals are usually excluded from mental illness epidemiological studies and clinical trials. Here we perform a clinical trial to investigate the effectiveness of clozapine in the treatment of resistant psychosis in individuals with ID. The article highlights the complexity of diagnosing and treating psychopathological alterations associated with ID and advocates for more rigorous research in this field.MethodsA Phase IIB, open-label, randomized, multicenter clinical trial (NCT04529226) is currently ongoing to assess the efficacy of oral clozapine in individuals diagnosed with ID and suffering from treatment-resistant psychosis. We aim to recruit one-hundred and fourteen individuals (N=114) with ID and resistant psychosis, who will be randomized to TAU (treatment as usual) and treatment-with-clozapine conditions. As secondary outcomes, changes in other clinical scales (PANSS and SANS) and the improvement in functionality, assessed through changes in the Euro-QoL-5D-5L were assessed. The main outcome variables will be analyzed using generalized linear mixed models (GLMM), assessing the effects of status variable (TAU vs. Clozapine), time, and the interaction between them.DiscussionThe treatment of resistant psychosis among ID individuals must be directed by empirically supported research. CLOZAID clinical trial may provide relevant information about clinical guidelines to optimally treat adults with ID and treatment-resistant psychosis and the benefits and risks of an early use of clozapine in this underrepresented population in clinical trials.Trial registrationClinicaltrials.gov: NCT04529226. EudraCT: 2020-000091-37

Papel de la marcha y equilibrio en sujetos ancianos (70-79 años) y muy ancianos (>80 años)

Tesis inédita presentada en la Universidad Europea de Madrid. Escuela de Doctorado e Investigación. Programa de Doctorado en Medicina y CirugíaLa marcha y el equilibrio en las personas mayores son dos exploraciones básicas que cada día tienen más impacto en la valoración geriátrica integral y, por lo tanto, en la atención de las personas mayores. Especialmente la velocidad de la marcha, considerada una de las exploraciones con mayor poder predictivo de eventos adversos como ítem independiente. A pesar de ello, hay muchas lagunas de conocimiento en este tema y una gran escasez de estudios, particularmente sobre personas sanas, lo que impide establecer parámetros de referencia. En este sentido, no encontramos estudios españoles que analicen la marcha y el equilibrio en personas mayores de 70 años, y los estudios de otros países difieren mucho tanto en sus resultados como en sus criterios de selección de lo que consideran una muestra sana. Tampoco encontramos estudios de posturografía sobre personas mayores de 80 años, por lo que hay que extrapolar datos de poblaciones más jóvenes. Además, la mayoría de los estudios realizan la selección de una muestra considerada normal extrapolando criterios de exclusión de las personas jóvenes en lugar de tener en cuenta otros criterios propios de las personas mayores, como la fragilidad y las caídas. Por otro lado, la evaluación de la marcha y el equilibrio, como hemos mencionado, puede ser de ayuda para detectar distintas trayectorias de envejecimiento y predecir eventos adversos. El objetivo principal de este trabajo es establecer criterios de normalidad en los parámetros temporoespaciales de la marcha, equilibrio y postura en las personas mayores con marcha visual normal (definida como la ausencia de marcha patológica diagnosticada por un evaluador experto). Los objetivos secundarios son analizar si los criterios de exclusión e inclusión usados actualmente para seleccionar una muestra para explorar los parámetros de normalidad en la marcha son los adecuados en las personas mayores, así como analizar posibles trayectorias de envejecimiento tras dos años de seguimiento y posibles factores influyentes. Para responder a estas preguntas, se diseñó un estudio observacional, longitudinal, en población no institucionalizada que contaba con una valoración inicial y un seguimiento tras dos años. Los resultados muestran diferencias significativas en todos los parámetros temporoespaciales de la marcha que impiden extrapolar los datos de personas más jóvenes. Teniendo en cuenta las diferencias que hemos encontrado entre países en la primera parte de esta Tesis (revisión bibliográfica), explicables por la distinta morfología de los participantes, lo adecuado sería usar los parámetros españoles en lugar de las referencias internacionales. Para extrapolar estos resultados a distintas poblaciones, este trabajo ha generado una fórmula de determinación personalizada de los valores de normalidad para cada sujeto con marcha visual normal y para cada variable de la marcha considerados y propone usar un intervalo de confianza con nuestros datos y la mencionada fórmula, siempre que se pueda. En el caso de la posturografía, a excepción del test de carga de simetrías y la mayoría de los ítems de control de ritmo y control direccional, también hay evidencia de su relación con la edad. En la literatura disponible no hay datos de estudios en personas mayores de 79 años, por lo que proponemos valores de referencia. Aunque tienen menos potencia estadística, son los primeros analizados. Por otro lado, hemos encontrado que, aunque nuestra muestra tuviera una marcha visual normal, hay factores patológicos (como la fragilidad y las caídas) que modifican los parámetros de normalidad y pueden estar presentes en individuos con marcha visual normal. Los sujetos frágiles y los caedores con marcha visual normal tienen un mayor riesgo de presentar alteraciones en los parámetros de marcha que aumentan el riesgo de padecer consecuencias adversas en su evolución y que, por tanto, deben evaluarse sistemáticamente en este subgrupo de pacientes. Por todo ello, concluimos que no es correcto extrapolar ni datos ni criterios de selección de personas jóvenes a las mayores, ni siquiera los valores medios habitualmente aceptados. Aportamos con este trabajo tanto parámetros como fórmulas que pueden ser utilizados en la población española, especialmente para la marcha. La posibilidad de determinar los valores de normalidad para cada individuo puede tener gran relevancia clínica, dada la gran heterogeneidad de estos valores en la población mayor. Por tanto, cubrimos una brecha en el diagnóstico de la práctica clínica. Además, proponemos el uso de posturografía y Gait Rite como diagnóstico de cribado de fragilidad y caídas. Por un lado, puede ayudar a detectarlas antes que escalas de cribado ya validadas como el SPPB y la velocidad de la marcha y antes de que se detecten visualmente alteraciones en la marcha. Las variables clásicas en los diferentes modelos logísticos y en la mayoría de los casos no permiten construir modelos con gran capacidad explicativa, lo que avala su multicausalidad y la dificultad en un abordaje sistematizado, tanto desde el punto de vista diagnóstico como terapéutico. Aun así, la exploración por posturografía y Gait Rite puede servir para detectar trayectorias de envejecimiento independientemente de la fragilidad y las caídas (factores ya demostrados predictores de trayectorias) en los participantes considerados sanos. Con ello, este trabajo puede contribuir a disminuir las lagunas de conocimiento en el tema y a mejorar la práctica clínica diaria de las personas mayores.Gait and balance in the elderly are two basic examinations that each day have more impact on the comprehensive geriatric assessment and, therefore, on the care of the elderly. Especially gait speed, considered one of the examinations with the greatest predictive power of adverse events as an independent element. Despite this, there are many knowledge gaps on this subject and a great paucity of studies, particularly on healthy people, which prevents establishing reference parameters. In this sense, we did not find Spanish studies that analyze gait and balance in people over 70 years old, and studies from other countries differ greatly both in their results and in their selection criteria for what they consider to be a healthy sample. We also did not find posturography studies on people over 80 years old, so data from younger populations must be extrapolated. In addition, most studies select a sample considered normal by extrapolating exclusion criteria from young people instead of taking into account other typical of older people criteria, such as frailty and falls. On the other hand, the evaluation of gait and balance, as we have mentioned, can help to detect different aging trajectories and predict adverse events. The main objective of this work is to establish normality criteria in the temporospatial parameters of gait, balance and posture in older people with visually normal gait (defined as the absence of pathological gait diagnosed by an expert evaluator). The secondary objectives are to analyze whether the exclusion and inclusion criteria currently used to select a sample to explore the parameters of normal gait are adequate in the elderly, as well as to analyze possible aging trajectories after two years of follow-up and possible influential factors To answer these questions, an observational, longitudinal study was designed in a non-institutionalized population that included an initial assessment and a follow-up after two years. The results show significant differences in all gait temporospatial parameters that prevent extrapolating the data from younger people. Taking into accountthe differences we found among countries in the first part of this thesis (bibliographic review), can be explained through the different morphology of the participants, it would be more appropriate to use Spanish parameters instead of international references. In order to extrapolate these results to different populations, this work has generated a formula for personalized determination of normality values for each subject with visually normal gait and for each variable of the march considered and proposes using a confidence interval with our data and the aforementioned formula, whenever possible. In the case of posturography, with the exception of the symmetries load test and most of the rhythm control and directional control items, there is also evidence of its relationship with age. In the available literature there are no data from studies in people over 79 years old, so we propose reference values. Although they have less statistical power, they are the first to be reported. On the other hand, we have found that, even if our sample had a visually normal gait, there are pathological factors (such as frailty and falls) that can modify the normal parameters and may be present in individuals with visually normal gait. Frail and faller subjects with visually normal gait have a higher risk of presenting alterations in gait parameters that increase their risk of suffering adverse consequences in their evolution and, therefore, should be systematically evaluated in this subgroup of patients. For all these reasons, we conclude that it is not correct to extrapolate neither data nor selection criteria from young people to older people, not even the usually accepted average values. With this work we provide both parameters and formulas that can be used in the Spanish population, especially for gait. The possibility of determining normal values for each individual may have great clinical relevance, given the great heterogeneity of these values in the larger population. Thus, we fill a diagnostic gap in clinical practice. In addition, we propose the use of posturography and Gait Rite as diagnostic screening for frailty and falls. On the one hand, it can help to detect them before already validated screening scales such as the SPPB and gait speed and before gait alterations are visually detected. The classical variables in the different logistic models and in most cases do not allow the construction of models with great explanatory capacity, which supports their multicausality and the difficulty in a systematized approach, both from the diagnostic and therapeutic point of view. Even so, examination by posturography and Gait Rite may serve to detect aging trajectories independently of frailty and falls (factors already proven predictors of trajectories) in participants considered healthy. With this, this work can contribute to reduce the knowledge gaps in the subject and to improve the daily clinical practice of the elderly.No data 2022UE

Gait speed measurement for elderly patients with risk of frailty

The ageing of the population poses a threat to both public and private health and social systems. In the last 50 years, life expectancy has increased by an average of 20 years, and by the year 2050, life expectancy will exceed 90 years of age. However, quality of life in the last years of life is not guaranteed due to conditions such as functional decline and frailty, ultimately progressing to disability. Thus, the detection of such a condition in time is of utmost importance. This paper presents an ultrasonic sensor-based gait speed measurement device controlled via a mobile interface, which permits patients to self-assess physical performance. The system was developed and validated in an iterative process involving a total of 28 subjects (21 in the first round and 7 in the second one). After first evaluation at Hospital Universitario de Getafe, some technical problems arose whereas usability testing was well evaluated. The second version addressing the identified issues was technically validated at university premises with good and promising results. Future work envisages deployment of the system developed at subjects? homes to be remotely and unobtrusively monitored

El Forau de la Tuta (Artieda, Jacetania, Zaragoza), una ciudad imperial romana, hasta ahora desconocida, de la vertiente sur de los Pirineos: El Forau de la Tuta (Artieda, Jacetania, Zaragoza), a Roman Imperial city, hitherto unknown, on the southern slope on the Pyrenees

National audienceEn este trabajo realizamos una breve presentación de los últimos descubrimientos llevados a cabo en el yacimiento de El Forau de la Tuta (Artieda), que identificamos como el asentamiento urbano de una comunidad ciudadana de época imperial romana, hasta ahora desconocida y de nombre indeterminado, a juzgar por los restos de superficie, los datos aportados por la teledetección y los sondeos arqueológicos llevados a cabo en 2021, en los que se documentó la existencia de dos calles pertenecientes a una trama urbanística regular y un edificio termal público provisto en una de sus salas de un mosaico opus tessellatum blanquinegro decorado con un complejo programa iconográfico de thíasos marino. Además, sobre las ruinas de este asentamiento romano se documenta la presencia de una segunda fase de cronología altomedieval (siglos IX-XIII) correspondiente a la villa denominada Arteda Civitate de los diplomas latinos.PALABRAS CLAVE: Urbanismo Romano; Arquitectura Romana; Hispania Tarraconense; Opus Tessellatum Blanquinegro; Thíasos marino; Alta Edad Media.ABSTRACTThis paper is a brief presentation about the latest discoveries made at the archaeological site of El Forau de la Tuta (Artieda), which we identify as the urban settlement of a civic community from the Roman imperial era, hitherto unknown and of indeterminate name, according to the surface remains, the data provided by remote sensing and the archaeological surveys carried out in 2021, in which were documented the existence of two streets that belong to a regular grid pattern urban planning and a public thermal building provided in one of its rooms with a black and white opus tessellatum mosaic decorated with a complex iconographic program of marine thíasos. In addition, in this archaeological site is documented the presence of a second phase of Early Medieval period (9th-13th centuries), that we identify with the Arteda Civitate mentioned in the Christian Latin documents.KEYWORDS: Roman Urbanism; Roman Architecture; Hispania Tarraconensis; Black and White Opus Tessellatum; Marine Thíasos; Early Middle Age

STOPPFall (Screening Tool of Older Persons Prescriptions in older adults with high fall risk): a Delphi study by the EuGMS Task and Finish Group on Fall-Risk-Increasing Drugs

BACKGROUND: Healthcare professionals are often reluctant to deprescribe fall-risk-increasing drugs (FRIDs). Lack of knowledge and skills form a significant barrier and furthermore, there is no consensus on which medications are considered as FRIDs despite several systematic reviews. To support clinicians in the management of FRIDs and to facilitate the deprescribing process, STOPPFall (Screening Tool of Older Persons Prescriptions in older adults with high fall risk) and a deprescribing tool were developed by a European expert group. METHODS: STOPPFall was created by two facilitators based on evidence from recent meta-analyses and national fall prevention guidelines in Europe. Twenty-four panellists chose their level of agreement on a Likert scale with the items in the STOPPFall in three Delphi panel rounds. A threshold of 70% was selected for consensus a priori. The panellists were asked whether some agents are more fall-risk-increasing than others within the same pharmacological class. In an additional questionnaire, panellists were asked in which cases deprescribing of FRIDs should be considered and how it should be performed. RESULTS: The panellists agreed on 14 medication classes to be included in the STOPPFall. They were mostly psychotropic medications. The panellists indicated 18 differences between pharmacological subclasses with regard to fall-risk-increasing properties. Practical deprescribing guidance was developed for STOPPFall medication classes. CONCLUSION: STOPPFall was created using an expert Delphi consensus process and combined with a practical deprescribing tool designed to optimise medication review. The effectiveness of these tools in falls prevention should be further evaluated in intervention studies

Esclerosi múltiple: preguntes i respostes per a pacients i familiars

Ha colaborado en este proyecto el Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL).Este libro pretende resolver algunas dudas que plantea la Esclerosis Múltiple, mediante un formato de preguntas y respuestas que los autores de este libro (profesionales y especialistas multidisciplinares involucrados en el diagnóstico y tratamiento de la enfermedad) han intentado condensar en estas páginas. Trasladando de este modo los conocimientos y la experiencia acumulados. Este libro tiene algunas peculiaridades. La primera es que en su redacción y revisión han participado pacientes de la Asociación de Esclerosis Múltiple de Alicante (ADEMA) y de la Asociación Alicantina de Esclerosis Múltiple "Vega Baja" y ello ha ayudado a conseguir una redacción y contenido claro y conciso, sin tecnicismos innecesarios, pero de gran aplicación y contenido científico clínico. La segunda peculiaridad es que, al ser la Comunidad Valenciana, donde vivimos, una comunidad plurilingüe, este libro tiene versiones en castellano y en valenciano. La tercera peculiaridad es que el libro no tiene patrocinio de la industria farmacéutica y ninguno de los autores ha recibido remuneración por su contribución. Conscientes de que los conocimientos y los tratamientos sobre la enfermedad van cambiando con el tiempo, se intentará actualizarlo periódicamente y tras esta edición de mayo de 2017. Se estructura en los siguientes capítulos: 1) ¿Qué es la esclerosis múltiple i por qué se produce?; 2) Los síntomas de la enfermedad; 3) Diagnóstico; 4) Tratamiento; 5) Tratamiento rehabilitador y sintomático; 6) Dolor y Esclerosis Múltiple; 7) Aspectos emocionales en la Esclerosis Múltiple; 8) La Esclerosis Múltiple y la mujer; 9) Mi vida día día; 10) Actividad física y ejercicio; 11) Ármate de valor.Aquest llibre pretén resoldre alguns dubtes que planteja l'Esclerosi Múltiple, mitjançant un format de preguntes i respostes que els autors d'aquest llibre (professionals i especialistes multidisciplinaris involucrats en el diagnòstic i tractament de la malaltia) han intentat condensar en aquestes pàgines. Traslladant d'aquesta manera els coneixements i l'experiència acumulats. Aquest llibre té algunes peculiaritats. La primera és que en la seua redacció i revisió han participat pacients de l'Associació d'Esclerosi Múltiple d'Alacant (ADEMA) i de l'Associació Alacantina d'Esclerosi Múltiple "Vega Baixa" i això ha ajudat a aconseguir una redacció i contingut clar i concís, sense tecnicismes innecessaris, però de gran aplicació i contingut científic clínic. La segona peculiaritat és que, en ser la Comunitat Valenciana, on vivim, una comunitat plurilingüe, aquest llibre té versions en castellà i en valencià. La tercera peculiaritat és que el llibre no té patrocini de la indústria farmacèutica i cap dels autors ha rebut remuneració per la seua contribució. Conscients que els coneixements i els tractaments sobre la malaltia van canviant amb el temps, s'intentarà actualitzar-lo periòdicament i després d'aquesta edició de maig de 2017. S'estructura en els següents capítols: 1) Què és l'esclerosi múltiple i per què es produeix?; 2) Els símptomes de la malaltia; 3) Diagnòstic; 4) Tractament; 5) Tractament rehabilitador i simptomàtic; 6) Dolor i Esclerosi Múltiple; 7) Aspectes emocionals en l'Esclerosi Múltiple; 8) L'Esclerosi Múltiple i la dona; 9) La meua vida dia dia; 10) Activitat física i exercici; 11) Arma't de valor