Effects of an interprofessional Quality Circle-Deprescribing Module (QC-DeMo) in Swiss nursing homes: a randomised controlled trial.

Potentially inappropriate medications (PIMs) are common among nursing homes (NH) residents, as is polypharmacy. Deprescribing has emerged in the past decade as a safe and effective way to reduce the use of PIMs and improve patient outcomes. However, effective deprescribing interventions are expensive, as they require specialised staff and a great amount of time for each resident. The Quality Circle Deprescribing Module (QC-DeMo) intervention was designed to be less resource-intensive than medication reviews, the current deprescribing gold standard. It consists of a QC session in which physicians, nurses, and pharmacists define a local deprescribing consensus for specific PIMs classes, which is then implemented in the NH. The intervention was trialled in a RCT, with the NH as unit of analysis. After randomisation, intervention NHs enacted the QC-DeMo at the start of the follow-up year. The primary outcomes were the proportion of PIM galenic units and number of PIM defined daily dose per average resident and per day (DDD/res). PIM status was assessed by a combination of the 2015 Beers list and the Norwegian General Practice-Nursing Home criteria. Secondary outcomes were the number of DDD/res to avoid and to reevaluate; safety outcomes were mortality, hospitalisations, falls, and use of physical restraints. Outcomes were evaluated at follow-up using linear regression models, adjusting for the outcome baseline values. Fifty-eight NHs took part in the trial; no individual residents were recruited. The intervention did not reduce the primary outcomes, but a strong trend towards reduction was seen for the number of PIM DDD/res, which accounts for the doses used. PIM DDD/res to reevaluate were significantly reduced, mostly through a reduction in the use of proton-pump inhibitors. Falls and use of physical restraints were not affected, but a statistical interaction between the mission of the NH (geriatric unit or specialised dementia unit) and the intervention group was seen for mortality and hospitalisations. The QC-DeMo intervention can reduce the use of some PIM classes, and could usefully complement other deprescribing interventions. ClinicalTrials.gov ( NCT03688542 ), registered on 26.09.2018, retrospectively registered

Physicians', Nurses' and Pharmacists' Perceptions of Determinants to Deprescribing in Nursing Homes Considering Three Levels of Action: A Qualitative Study.

Background: Polypharmacy and the use of potentially inappropriate medications are frequent safety issues among nursing home (NH) residents. Deprescribing can significantly reduce the number of drugs used, medication costs, and mortality. This qualitative study sought to understand and compare the perceptions and practices of nurses, pharmacists, and physicians regarding deprescribing in Swiss NHs, referring to an implementation approach on three levels of action: the individual, the institution, and the healthcare system. Methods: Two focus groups were held with 21 participants: one focus group with 11 pharmacists, another with 10 nurses and six semi-structured interviews with physicians were conducted and focused on their individual experience and practices. They were audiotaped and fully transcribed, and a content analysis was performed using to MAXQDA (Ver 12) software. Results: (1) At an individual level, physicians were concerned by consequences of deprescribing in terms of safety. Nurses were closest to residents and stressed the importance of finding the right time, creating a bond of trust before deprescribing and considering the purpose of the stay in the NH. Pharmacists relied on structured guides for deprescribing, which led their reflection and practice. All professionals saw the complexity of the clinical situations, as well as residents' and relatives' fears of interruption of care. (2) At an institutional level, the professionals stressed the lack of time to discuss patients' health and treatment, while pre-existing interprofessional collaboration, specifically, quality circles, seemed useful tools to create common knowledge. In order to reduce prescriptions, better coordination between physicians, nurses, pharmacists and specialists seemed crucial. (3) At the health system level, funding still needs to be provided to consolidate the process, go beyond organisational constraints and ensure deprescribing serves the patient's wellbeing above all. Conclusions: At the individual level of implementation, the different healthcare professionals expressed specific concerns about deprescribing, depending on their defined role in NHs. Their perspective about the different levers to promote deprescribing at institutional and healthcare system levels converge towards interprofessional collaboration supported by the healthcare system. Specific funding and incentives are therefore needed to support a sustainable interprofessional team

Déprescrire en EMS: regards croisés entre les résidents, leurs proches et les professionnels de la santé [Deprescribing in nursing homes: comparative views of residents, their relatives, and healthcare professionals]

Deprescribing, in order to reduce both polypharmacy and the use of potentially inappropriate medications, remains a challenge, especially in nursing homes. Healthcare professionals perceive residents of these homes as wary of change and reluctant to take part in such endeavours. The results of two studies, one qualitative and the other quantitative, show that, on the contrary, nursing home residents and their relatives would be ready to consider a treatment reduction, provided that time is invested to explain the expected benefits of such changes

Antibiotic consumption in nursing homes of the Canton of Vaud: trends over the years 2009 - 2014

Background & Objectives: Excessive use of antibiotics in nursing homes was reported in several studies1-3. Surveillance of their use in nursing homes is essential to plan interventions fostering an appropriate use and to measure the impact of these interventions. The aims of the study were to describe the antibiotic consumption in nursing homes of the Canton of Vaud and to examine whether the antibiotic consumption was correlated to the urinary catheter use and to methicillin-resistant Staphylococcus aureus (MRSA) colonization. Methods: Data on the use of systemic antibiotics (class J01 of WHO Anatomical Therapeutic Chemical (ATC) system, 2015) were collected from the community pharmacies' annual invoice data including 13 nursing homes in 2009. The number of nursing homes in the database increased to 67 in 2014, representing 46% of all nursing homes of the Canton of Vaud and 54% of the available beds. Aggregated data were converted into defined daily doses (DDD) and antibiotic consumption expressed in number of defined daily doses per 1000 beds and per day (DDD/1000B/D). Proportion of urinary catheter use and MRSA colonization data were provided through a point prevalence study. Results: The total consumption of systemic antibiotics was 52.2 DDD/1000B/D in 2009 and 48.3 in 2014. Beta-lactam antibacterials other than penicillins, macrolides and other antibacterials (including nitrofurantoin) consumption increased resp. by 80%, 45% and 187% between 2009 and 2014, while the use of sulfonamides and trimethoprim decreased by 41%. Penicillin and quinolone use remained relatively stable between 2009 and 2014. Amoxicillin and clavulanic acid (oral) was the most common antibiotic prescribed (31% of the total use), followed by ciprofloxacin (oral) (20%) and nitrofurantoin (10%). Among nursing homes, we reported a large variation in antibiotic consumption from 6.8 to 164.6 DDD/1000B/D in 2014. No correlation was found between global antibiotic consumption and urinary catheter use and between quinolone consumption and proportion of MRSA in 2010 and 2011 (p>0.05). Discussion & Conclusions: This study is the first that analyzes longitudinal data of antibiotic consumption in nursing homes of the Canton of Vaud. The findings suggest that a large variation in antibiotic consumption exists among nursing homes. Thus, antibiotic stewardship programs should be implemented to promote a more accurate use

New high level application software for the control of the SPS-LEP beam transfer lines

New high level application software is being developed for the control of the SPS and LEP Transfer Lines. This paper briefly describes the model for the operation of these Transfer Lines, which is largely based on previous experience gained during the development and upgrades of the SPS and LEP control systems. The software system is then presented, followed by a description of the high level applications for the control room operators. Tools and methods used for the design and implementation of the system are mentioned

Proton-induced degradation of Thin-Film Microcrystalline Silicon Solar Cells

This paper investigates the stability of dilution series of pin and nip microcrystalline silicon solar cells under low-energy proton irradiation (E = 405 keV). Variation of electrical parameters, defect-related absorption and Urbach parameter are investigated as a function of irradiation and annealing steps. Highly microcrystalline cells show a relative efficiency loss of up to 80% after proton irradiation. The efficiency loss is observed not to be completely reversible under thermal annealing. Increase of defect-related absorption and Urbach parameter is also only partially reversible. The electrical parameters (Jsc, Voc, FF) show proton-induced reductions which increase with crystallinity for both pin and nip series; short-circuit current density suffers the largest variations with relative losses of up to 65%. Defect-related absorption is shown to be low for cells of medium crystallinity, before and after irradiation. © 2006 Elsevier B.V. All rights reserved

Influence of the substrate's surface morphology and chemical nature on the nucleation and growth of microcrystalline silicon

Hydrogenated microcrystalline silicon (μc-Si:H) layers about 500 nm thick were deposited in the same run on flat and rough substrates (rms = 60 nm) of various chemical nature. This study reveals that the spatial distribution of the microcrystalline/amorphous phases within the layer depends on the substrate's topography. The influence of the chemical nature of the substrate is shown to be preponderant on the layers nucleation. In particular, this study shows that nucleation density is the highest on plasma enhanced chemical vapor deposited silicon dioxide, whereas it is independent of the substrate's surface topography. Finally, the interpretation of Micro-Raman experiments for the evaluation of the respective volume fractions of amorphous/microcrystalline phases in the layers is discussed in relation with their spatial distribution. © 2005 Elsevier B.V. All rights reserved