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

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

HAWC and Fermi-LAT detection of extended emission from the unidentified source 2HWC J2006+341

The discovery of the TeV point source 2HWC J2006+341 was reported in the second HAWC gamma-ray catalog. We present a follow-up study of this source here. The TeV emission is best described by an extended source with a soft spectrum. At GeV energies, an extended source is significantly detected in Fermi-LAT data. The matching locations, sizes, and spectra suggest that both gamma-ray detections correspond to the same source. Different scenarios for the origin of the emission are considered and we rule out an association to the pulsar PSR J2004+3429 due to extreme energetics required, if located at a distance of 10.8 kpc.Universidad de Costa Rica/[112-B9-171]/UCR/Costa RicaUniversidad de Costa Rica/[112-B6-509]/UCR/Costa RicaUniversidad de Costa Rica/[829-B5-198]/UCR/Costa RicaUCR::Vicerrectoría de Docencia::Ciencias Básicas::Facultad de Ciencias::Escuela de Físic

Subcutaneous anti-COVID-19 hyperimmune immunoglobulin for prevention of disease in asymptomatic individuals with SARS-CoV-2 infection: a double-blind, placebo-controlled, randomised clinical trialResearch in context

Summary: Background: Anti-COVID-19 hyperimmune immunoglobulin (hIG) can provide standardized and controlled antibody content. Data from controlled clinical trials using hIG for the prevention or treatment of COVID-19 outpatients have not been reported. We assessed the safety and efficacy of subcutaneous anti-COVID-19 hyperimmune immunoglobulin 20% (C19-IG20%) compared to placebo in preventing development of symptomatic COVID-19 in asymptomatic individuals with SARS-CoV-2 infection. Methods: We did a multicentre, randomized, double-blind, placebo-controlled trial, in asymptomatic unvaccinated adults (≥18 years of age) with confirmed SARS-CoV-2 infection within 5 days between April 28 and December 27, 2021. Participants were randomly assigned (1:1:1) to receive a blinded subcutaneous infusion of 10 mL with 1 g or 2 g of C19-IG20%, or an equivalent volume of saline as placebo. The primary endpoint was the proportion of participants who remained asymptomatic through day 14 after infusion. Secondary endpoints included the proportion of individuals who required oxygen supplementation, any medically attended visit, hospitalisation, or ICU, and viral load reduction and viral clearance in nasopharyngeal swabs. Safety was assessed as the proportion of patients with adverse events. The trial was terminated early due to a lack of potential benefit in the target population in a planned interim analysis conducted in December 2021. ClinicalTrials.gov registry: NCT04847141. Findings: 461 individuals (mean age 39.6 years [SD 12.8]) were randomized and received the intervention within a mean of 3.1 (SD 1.27) days from a positive SARS-CoV-2 test. In the prespecified modified intention-to-treat analysis that included only participants who received a subcutaneous infusion, the primary outcome occurred in 59.9% (91/152) of participants receiving 1 g C19-IG20%, 64.7% (99/153) receiving 2 g, and 63.5% (99/156) receiving placebo (difference in proportions 1 g C19-IG20% vs. placebo, −3.6%; 95% CI -14.6% to 7.3%, p = 0.53; 2 g C19-IG20% vs placebo, 1.1%; −9.6% to 11.9%, p = 0.85). None of the secondary clinical efficacy endpoints or virological endpoints were significantly different between study groups. Adverse event rate was similar between groups, and no severe or life-threatening adverse events related to investigational product infusion were reported. Interpretation: Our findings suggested that administration of subcutaneous human hyperimmune immunoglobulin C19-IG20% to asymptomatic individuals with SARS-CoV-2 infection was safe but did not prevent development of symptomatic COVID-19. Funding: Grifols