Potentially inappropriate prescribing in nursing home residents detected with the community pharmacist specific GheOP3S-tool

Background: The Ghent Older People’s Prescriptions community Pharmacy Screening (GheOP3S-)tool was recently developed to screen for potentially inappropriate prescribing (PIP). Objective: We aimed (1) to determine PIP prevalence in older nursing home (NH) residents with polypharmacy using the GheOP3S-tool and (2) to identify those PIPs that are most frequently detected. Method: A cross-sectional study was carried out between February and June 2014 in 10 NHs in Belgium, supplied by a community pharmacy chain. For each NH, 40 residents (>70 years, using >5 chronic drugs) were included. PIP prevalence was determined using the GheOP3S-tool. Results: 400 NH residents were included [mean age (±SD) 86.2 (±6.3) years; median number of drugs (±IQR) 10 (7–12)]. A total of 1728 PIPs were detected in 387 (97 %) participants (Median 4; IQR 2–6). The most prevalent items can be assigned to three categories: long-term use of central nervous system drugs (i.e. benzodiazepines, antidepressants and antipsychotics), use of anticholinergic drugs (mutual combinations and with underlying constipation/dementia) and underuse of osteoporosis prophylaxis. Conclusion: Screening for PIP by means of the GheOP3S-tool revealed a high prevalence of PIP among older NH residents with polypharmacy. This finding urges for initiatives on the patient-level, but also on a broader, institutional level

Are the spatial features of bodily threat limited to the exact location where pain is expected?

Previous research has revealed that anticipating pain at a particular location of the body prioritizes somatosensory input presented there. The present study tested whether the spatial features of bodily threat are limited to the exact location of nociception. Participants judged which one of two tactile stimuli, presented to either hand, had been presented first, while occasionally experiencing a painful stimulus. The distance between the pain and tactile locations was manipulated. In Experiment 1, participants expected pain either proximal to one of the tactile stimuli (on the hand; near condition) or more distant on the same body part (arm; far condition). In Experiment 2, the painful stimulus was expected either proximal to one of the tactile stimuli (hand; near) or on a different body-part at the same body side (leg; far). The results revealed that in the near condition of both experiments, participants became aware of tactile stimuli presented to the "threatened" hand more quickly as compared to the "neutral" hand. Of particular interest, the data in the far conditions showed a similar prioritization effect when pain was expected at a different location of the same body part as well as when pain was expected at a different body part at the same body side. In this study, the encoding of spatial features of bodily threat was not limited to the exact location where pain was anticipated but rather generalized to the entire body part and even to different body parts at the same side of the body

Do patients with chronic unilateral orofacial pain due to a temporomandibular disorder show increased attending to somatosensory input at the painful side of the jaw?

Background. Patients with chronic orofacial pain due to temporomandibular disorders (TMD) display alterations in somatosensory processing at the jaw, such as amplified perception of tactile stimuli, but the underlying mechanisms remain unclear. This study investigated one possible explanation, namely hypervigilance, and tested if TMD patients with unilateral pain showed increased attending to somatosensory input at the painful side of the jaw. Methods. TMD patients with chronic unilateral orofacial pain (n = 20) and matched healthy volunteers (n = 20) performed a temporal order judgment (TOJ) task indicated which one of two tactile stimuli, presented on each side of the jaw, they had perceived first. TOJ methodology allows examining spatial bias in somatosensory processing speed. Furthermore, after each block of trials, the participants rated the perceived intensity of tactile stimuli separately for both sides of the jaw. Finally, questionnaires assessing pain catastrophizing, fear-avoidance beliefs, and pain vigilance, were completed. Results. TMD patients tended to perceive tactile stimuli at the painful jaw side as occurring earlier in time than stimuli at the non-painful side but this effect did not reach conventional levels of significance (p = .07). In the control group, tactile stimuli were perceived as occurring simultaneously. Secondary analyses indicated that the magnitude of spatial bias in the TMD group is positively associated with the extent of fear-avoidance beliefs. Overall, intensity ratings of tactile stimuli were significantly higher in the TMD group than in the control group, but there was no significant difference between the painful and non-painful jaw side in the TMD patients. Discussion. he hypothesis that TMD patients with chronic unilateral orofacial pain preferentially attend to somatosensory information at the painful side of the jaw was not statistically supported, although lack of power could not be ruled out as a reason for this. The findings are discussed within recent theories of pain-related attention

Percutaneous angioplasty with drug eluting balloon for infra-inguinal venous bypass stenosis

peer reviewe

Femoropopliteal angioplasty with paclitaxel-coated balloon – 3 Belgian centres experience

peer reviewe

Family physician perceptions of climate change, migration, health, and healthcare in Sub-Saharan Africa : an exploratory study

Although family physicians (FPs) are community-oriented primary care generalists and should be the entry point for the populationâs interaction with the health system, they are underrepresented in research on the climate change, migration, and health(care) nexus (hereafter referred to as the nexus). Similarly, FPs can provide valuable insights into building capacity through integrating health-determining sectors for climate-resilient and migration-inclusive health systems, especially in Sub-Saharan Africa (SSA). Here, we explore FPsâ perceptions on the nexus in SSA and on intersectoral capacity building. Three focus groups conducted during the 2019 WONCA-Africa conference in Uganda were transcribed verbatim and analyzed using an inductive thematic approach. Participantsâ perceived interactions related to (1) migration and climate change, (2) migration for better health and healthcare, (3) health impacts of climate change and the role of healthcare, and (4) health impacts of migration and the role of healthcare were studied. We coined these complex and reinforcing interactions as continuous feedback loops intertwined with socio-economic, institutional, and demographic context. Participants identified five intersectoral capacity-building opportunities on micro, meso, macro, and supra (international) levels: multi-dimensional and multi-layered governance structures; improving FP training and primary healthcare working conditions; health advocacy in primary healthcare; collaboration between the health sector and civil society; and more responsibilities for high-income countries. This exploratory study presents a unique and novel perspective on the nexus in SSA which contributes to interdisciplinary research agendas and FP policy responses on national, regional, and global levels