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  • 1
    In: Journal of Pharmacy Practice and Research, April 2017, Vol.47(2), pp.85-86
    Keywords: Pharmacy, Therapeutics, & Pharmacology;
    ISSN: 1445-937X
    E-ISSN: 2055-2335
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  • 2
    In: Journal of the American Geriatrics Society, September 2013, Vol.61(9), pp.1508-1514
    Description: Byline: Emily Reeve, Michael D. Wiese, Ivanka Hendrix, Michael S. Roberts, Sepehr Shakib Keywords: elderly; polypharmacy; deprescribing; potentially inappropriate medications; discontinuation Objectives To capture people's attitudes, beliefs, and experiences regarding the number of medications they are taking and their feelings about stopping medications. Design Administration of a validated questionnaire. Setting Multidisciplinary ambulatory consulting service at the Royal Adelaide Hospital. Participants Participants were individuals aged 18 and older (median 71.5) taking at least one regular prescription medication; 100 participants completed all items of the questionnaire, 65 of whom were aged 65 and older. Measurements Participants were administered the 15-item Patients' Attitudes Towards Deprescribing (PATD) questionnaire. Results Participants were taking an average of 10 different prescription and nonprescription (including complementary), regular and as-needed medications. More than 60% felt that they were taking a "large number" of medications, and 92% stated that they would be willing to stop one or more of their current medications if possible. Number of regular medications, age, and number of medical conditions were not found to be correlated with willingness to stop a medication. The findings were similar in older and younger participants. Conclusion This study has shown that a cohort of mostly older adults were largely accepting of a trial of cessation of medication(s) that their prescriber deemed to be no longer required. Because few factors were associated with willingness to cease medications, all patients should be individually evaluated for deprescribing. CAPTION(S): Figure S1. Distribution of propensity score for Intervention and Control participants. Table S1. List of Exclusionary Comorbidities, ICD-9 Codes, and CPT Codes. Table S2. Control county selection criteria. Table S3. ICD-9-CM diagnosis codes for disease classification of participants. Table S4. Regression specifications. Table S1. Comparison of frailty components for Men in the Cardiovascular Health Study (CHS) and Men in the Osteoporotic Fractures in Men (MrOS) Study.
Table S2. Association between Cystatin C and frailty status among 1,257 Subjects with eGFRCr 〉60 ml/min/1.73 m2. Table S1. Adjusted* odds ratios (95% CI) from logistic regression analyses for cognitive impairment (lowest 10% performance within ethnic group) on individual cognitive tests per 10 mmHg increment in each listed blood pressure measurement.
    Keywords: Elderly ; Polypharmacy ; Deprescribing ; Potentially Inappropriate Medications ; Discontinuation
    ISSN: 0002-8614
    E-ISSN: 1532-5415
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  • 3
    In: PLoS ONE, 2014, Vol.9(4)
    Description: Objective To assess the impact of individualised, reconciled evidence-based recommendations (IRERs) and multidisciplinary care in patients with chronic heart failure (CHF) on clinical guideline compliance for CHF and common comorbid conditions. Design and setting A retrospective hospital clinical audit conducted between 1 st July 2006 and February 2011. Participants A total of 255 patients with a diagnosis of CHF who attended the Multidisciplinary Ambulatory Consulting Services (MACS) clinics, at the Royal Adelaide Hospital, were included. Main outcome measures Compliance with Australian clinical guideline recommendations for CHF, atrial fibrillation, diabetes mellitus and ischaemic heart disease. Results Study participants had a median of eight medical conditions (IQR 6–10) and were on an average of 10 (±4) unique medications. Compliance with clinical guideline recommendations for pharmacological therapy for CHF, comorbid atrial fibrillation, diabetes or ischaemic heart disease was high, ranging from 86% for lipid lowering therapy to 98% anti-platelet agents. For all conditions, compliance with lifestyle recommendations was lower than pharmacological therapy, ranging from no podiatry reviews for CHF patients with comorbid diabetes to 75% for heart failure education. Concordance with many guideline recommendations was significantly associated if the patient had IRERs determined, a greater number of recommendations, more clinic visits or if patients participated in a heart failure program. Conclusions Despite the high number of comorbid conditions and resulting complexity of the management, high compliance to clinical guideline recommendations was associated with IRER determination in older patients with CHF. Importantly these recommendations need to be communicated to the patient’s general practitioner, regularly monitored and adjusted at clinic visits.
    Keywords: Research Article ; Medicine And Health Sciences
    E-ISSN: 1932-6203
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  • 4
    Language: English
    In: Australian family physician, July 2010, Vol.39(7), pp.480-3
    Description: Warfarin is commonly used in a number of clinical settings. Given the difficulties in managing patients taking warfarin, several questions are usually raised by clinicians in relation to its use. This article addresses some of the clinical questions related to warfarin use. Routine genetic testing before warfarin initiation is not currently recommended. None of the new oral anticoagulants is marketed in Australia for long term therapy as warfarin substitutes. Strategies to prevent thrombosis associated with air travel are discussed and measures to minimise the risk of bleeding are highlighted.
    Keywords: Anticoagulants -- Therapeutic Use ; Thrombosis -- Drug Therapy
    ISSN: 0300-8495
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  • 5
    Language: English
    In: Australian family physician, July 2010, Vol.39(7), pp.476-9
    Description: Warfarin is a commonly used medication for the prevention and treatment of venous thromboembolism. It can be challenging for both the patient and the prescriber to manage at times. To describe the mechanism of action of warfarin, and to discuss the indications for warfarinisation, the risks associated with warfarin use, and some of its drug interactions. The common indications for warfarinisation are atrial fibrillation, venous thromboembolism and prosthetic heart valves. Contraindications include absolute and relative contraindications, and an individualised risk-benefit analyses is required for each patient. There are many interactions with warfarin, including pharmacokinetic and pharmacodynamic. Pharmacokinetic interactions can be monitored by using International Normalised Ratio levels. Pharmacodynamic interactions require knowledge by the prescriber to predict any interactions with warfarin, and International Normalised Ratio monitoring assists.
    Keywords: Anticoagulants -- Therapeutic Use ; Atrial Fibrillation -- Drug Therapy ; Venous Thromboembolism -- Drug Therapy ; Warfarin -- Therapeutic Use
    ISSN: 0300-8495
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  • 6
    Language: English
    In: Aging & Mental Health, 01 November 2012, Vol.16(8), pp.1058-1064
    Description: Primary care providers often struggle to identify depression, with patients with multiple chronic conditions presenting additional unique challenges. Whilst the diagnosis and treatment of depression has been explored in a range of contexts in the literature, there is a paucity of information...
    Keywords: Comorbidity ; Primary Care ; General Practice ; Grounded Theory ; Medicine ; Psychology
    ISSN: 1360-7863
    E-ISSN: 1364-6915
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  • 7
    In: Medical Journal of Australia, October 2014, Vol.201(7), pp.386-389
    Description: Deprescribing is the process of trial withdrawal of inappropriate medications. Currently, the strongest evidence for benefit of deprescribing is from cohort and observational studies of withdrawal of specific medication classes that have shown better patient outcomes, mainly through resolution of adverse drug reactions. Additional potential benefits of deprescribing include reduced financial costs and improved adherence with other medications. The harms of ceasing medication use include adverse drug withdrawal reactions, pharmacokinetic and pharmacodynamic changes and return of the medical condition. These can be minimised with proper planning (ie, tapering), monitoring after withdrawal, and reinitiation of the medication if the condition returns. More evidence is needed regarding negative, non‐reversible effects of ceasing use of certain classes of medication, such as acetylcholinesterase inhibitors. Cessation of use has not been studied for many medication classes, and large‐scale randomised controlled trials of systematic deprescribing are required before the true benefits and harms can be known.
    Keywords: Gerontology ; Pharmaceutical Preparations
    ISSN: 0025-729X
    E-ISSN: 1326-5377
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  • 8
    In: Medical Journal of Australia, January 2010, Vol.192(1), pp.9-13
    Description: To determine whether heart failure with preserved systolic function (HFPSF) has different natural history from left ventricular systolic dysfunction (LVSD). A retrospective analysis of 10 years of data (for patients admitted between 1 July 1994 and 30 June 2004, and with a study census date of 30 June 2005) routinely collected as part of clinical practice in a large tertiary referral hospital. Sociodemographic characteristics, diagnostic features, comorbid conditions, pharmacotherapies, readmission rates and survival. Of the 2961 patients admitted with chronic heart failure, 753 had echocardiograms available for this analysis. Of these, 189 (25%) had normal left ventricular size and systolic function. In comparison to patients with LVSD, those with HFPSF were more often female (62.4% v 38.5%; = 0.001), had less social support, and were more likely to live in nursing homes (17.9% v 7.6%; 〈 0.001), and had a greater prevalence of renal impairment (86.7% v 6.2%; = 0.004), anaemia (34.3% v 6.3%; = 0.013) and atrial fibrillation (51.3% v 47.1%; = 0.008), but significantly less ischaemic heart disease (53.4% v 81.2%; = 0.001). Patients with HFPSF were less likely to be prescribed an angiotensin‐converting enzyme inhibitor (61.9% v 72.5%; = 0.008); carvedilol was used more frequently in LVSD (1.5% v 8.8%; 〈 0.001). Readmission rates were higher in the HFPSF group (median, 2 v 1.5 admissions; = 0.032), particularly for malignancy (4.2% v 1.8%; 〈 0.001) and anaemia (3.9% v 2.3%; 〈 0.001). Both groups had the same poor survival rate ( = 0.912). Patients with HFPSF were predominantly older women with less social support and higher readmission rates for associated comorbid illnesses. We therefore propose that reduced survival in HFPSF may relate more to comorbid conditions than suboptimal cardiac management.
    Keywords: Cardiovascular Diseases
    ISSN: 0025-729X
    E-ISSN: 1326-5377
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  • 9
    In: Journal of the American Geriatrics Society, October 2014, Vol.62(10), pp.1900-1905
    Description: To purchase or authenticate to the full-text of this article, please visit this link: http://onlinelibrary.wiley.com/doi/10.1111/jgs.13051/abstract Byline: Justin P. Turner, Sepehr Shakib, Nimit Singhal, Jonathon Hogan-Doran, Robert Prowse, Sally Johns, Tilenka Thynne, J. Simon Bell Keywords: aged; aged 80 and older; geriatric oncology; statins; HMG-CoA; deprescribe Objectives To investigate statin use and pain in people with cancer aged 70 to 79 and 80 and older. Design Cross-sectional. Setting Medical oncology outpatient clinic at the Royal Adelaide Hospital. Participants Individuals aged 70 and older who presented consecutively between January 2009 and June 2010 (n = 385), of whom 106 were aged 80 and older. Measurements Participants completed a structured data collection instrument, documenting medication use, comorbidities and a general pain assessment (10-point visual analogue scale (VAS)). Unadjusted and adjusted logistic regression was used to compute odds ratios (ORs) and 95% confidence intervals (CIs) for factors associated with statin use. Results The prevalence of statin use was 35% (n = 97) in people aged 70 to 79 and 39% (n = 41) in those aged 80 and older. After adjusting for age, sex, Charlson Comorbidity Index, and analgesic use, statin use was associated with self-reported pain (VAS a[yen]5) (OR = 4.09, 95% CI = 1.32-12.68) in people aged 80 and older but not in those aged 70 to 79. Half of participants using statins (51% n = 70) had a palliative treatment approach. Of the 41 statin users aged 80 and older, 20 (49%) were using statins for primary prevention. Conclusion The prevalence of statin use was similar in people aged 70 to 79 years and those aged 80 and older, with statin use associated with self-reported pain in people aged 80 and older. This highlights a potential benefit of "deprescribing" statins in older people with cancer, especially those aged 80 and older.
    Keywords: Aged ; Aged 80 And Older ; Geriatric Oncology ; Statins ; Hmg ‐Coa ; Deprescribe
    ISSN: 0002-8614
    E-ISSN: 1532-5415
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  • 10
    In: Medical Journal of Australia, February 2016, Vol.204(3), pp.104-105
    Description: The article discusses some of the concerns with regards to the efficacy and safety of novel oral anticoagulants (NOACs) in reducing the risk of stroke in patients with atrial fibrillation. Research has demonstrated the benefits following the use of NOACs among patients. However, the need for prescribers to remain vigilant to the risk of bleeding with NOACs, particularly in patients who are taking other medicines that might increase bleeding risk is highlighted.
    Keywords: Cardiovascular Diseases ; Pharmaceutical Preparations
    ISSN: 0025-729X
    E-ISSN: 1326-5377
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