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  • 1
    Language: English
    In: Drugs & Aging, 2012, Vol.29(11), pp.925-926
    Keywords: Female–Prevention & Control ; Humans–Statistics & Numerical Data ; Inappropriate Prescribing–Methods ; Male–Therapeutic Use ; Patient Education As Topic–Therapeutic Use ; Proton Pump Inhibitors–Therapeutic Use ; Proton Pump Inhibitors;
    ISSN: 1170-229X
    E-ISSN: 1179-1969
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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: Medical Journal of Australia, July 2011, Vol.195(2), pp.69-73
    Description: To determine the Australian native ant species associated with ant sting anaphylaxis, geographical distribution of allergic reactions, and feasibility of diagnostic venom‐specific IgE (sIgE) testing. Descriptive clinical, entomological and immunological study of Australians with a history of ant sting anaphylaxis, recruited in 2006–2007 through media exposure and referrals from allergy practices and emergency physicians nationwide. We interviewed participants, collected entomological specimens, prepared reference venom extracts, and conducted serum sIgE testing against ant venom panels relevant to the species found in each geographical region. Reaction causation attributed using a combination of ant identification and sIgE testing. 376 participants reported 735 systemic reactions. Of 299 participants for whom a cause was determined, 265 (89%; 95% CI, 84%–92%) had reacted clinically to species and 34 (11%; 95% CI, 8%–16%) to green‐head ant (). Of those with reactions to species, 176 reacted to jack jumper ant ( species complex), 18 to other jumper ants (15 to , three to ) and 56 to a variety of bulldog ants, with some participants reacting to more than one type of bulldog ant. Variable serological cross‐reactivity between bulldog ant species was observed, and sera from patients with bulldog ant allergy were all positive to one or more venoms extracted from , and . Four main groups of Australian ants cause anaphylaxis. Serum sIgE testing enhances the accuracy of diagnosis and is a prerequisite for administering species‐specific venom immunotherapy.
    Keywords: Emergency Medicine ; Immune System Diseases
    ISSN: 0025-729X
    E-ISSN: 1326-5377
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  • 4
    In: Journals of Gerontology Series A: Biomedical Sciences and Medical Sciences, 2016, Vol. 71(6), pp.831-837
    Description: Background: Adverse drug events are a leading cause of hospitalization among older people. Up to half of all medication-related hospitalizations are potentially preventable. The objective of this study was to investigate and compare the association between medication regimen complexity and number of medications with unplanned hospitalizations over a 3-year period. Methods: Data were analyzed for 3,348 participants aged 60 years or older in Sweden. Regimen complexity was assessed using the 65item Medication Regimen Complexity Index (MRCI) and number of medications was assessed as a continuous variable. Cox proportional hazard models were used to compute unadjusted and adjusted hazard ratios with 95% confidence intervals (CIs) for associations between regimen complexity and number of medications with unplanned hospitalizations over a 3-year period. Receiver operating characteristics curves with corresponding areas under the curve were calculated for regimen complexity and number of medications in relation to unplanned hospitalizations. The population attributable fraction of unplanned hospitalizations was calculated for MRCI and number of medications. Results: In total, 1,125 participants (33.6%) had one or more unplanned hospitalizations. Regimen complexity (hazard ratio 1.22; 95% CI 1.14-1.34) and number of medications (hazard ratio 1.07; 95% CI 1.04-1.09) were both associated with unplanned hospitalizations and had similar sensitivity and specificity (area under the curve 0.641 for regimen complexity and area under the curve 0.644 for number of medications). The population attributable fraction was 14.08% (95% CI 9.62-18.33) for MRCI and 17.61% (95% CI 12.59- 22.35) for number of medications. Conclusions: There was no evidence that using a complex tool to assess regimen complexity was better at predicting unplanned hospitalization than number of medications. Keywords: Medication regimen complexity--Polypharmacy--Hospitalization--Aged--Inappropriate prescribing doi: 10.1093/gerona/glv219
    Keywords: Medication Regimen Complexity ; Polypharmacy ; Hospitalization ; Aged ; Inappropriate Prescribing
    ISSN: 1079-5006
    E-ISSN: 1758-535X
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  • 5
    Language: English
    In: European Journal of Clinical Pharmacology, 2015, Vol.71(9), pp.1099-1108
    Description: Byline: Barbara Caecilia Wimmer (1), Kristina Johnell (2), Johan Fastbom (2), Michael David Wiese (3), J. Simon Bell (1,3) Keywords: Medication regimen complexity; Polypharmacy; Aged; Inappropriate prescribing; Population-based study Abstract: Purpose There is a lack of population-based research about factors associated with medication regimen complexity. This study investigated factors associated with medication regimen complexity in older people, and whether factors associated with regimen complexity were similar to factors associated with number of medications. Methods This cross-sectional population-based study included 3348 people aged a[yen]60 years. Medication regimen complexity was computed using the validated 65-item Medication Regimen Complexity Index (MRCI). Multinomial logistic regression was used to compute unadjusted and adjusted odds ratios (ORs) with 95 % confidence intervals (CIs) for factors associated with regimen complexity. Multivariable quantile regression was used to compare factors associated with regimen complexity and number of medications. Results In adjusted analyses, participants in the highest MRCI quintile (MRCI〉20) were older (OR=1.04, 95 % CI 1.02 1.05), less likely to live at home (OR=0.35, 95 % CI 0.15 0.86), had greater comorbidities (OR=2.17, 95 % CI 1.89 2.49), had higher cognitive status (OR=1.06, 95 % CI 1.01 1.11), a higher prevalence of self-reported pain (OR=2.85, 95 % CI 2.16 3.76), had impaired dexterity (OR=2.39, 95 % CI 1.77 3.24) and were more likely to receive help to sort their medications (OR=4.43 95 % CI 2.39 8.56) than those with low regimen complexity (MRCI 〉0--5.5). Similar factors were associated with both regimen complexity and number of medications. Conclusion Older people with probable difficulties managing complex regimens, including those with impaired dexterity and living in institutional settings, had the most complex medication regimens even after adjusting for receipt of help to sort medications. The strong correlation between regimen complexity and number of medications suggests that clinicians could use a person's number of medications to target interventions to reduce complexity. Author Affiliation: (1) Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia (2) Aging Research Center, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden (3) Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia (4) 381 Royal Parade, Parkville, VIC, 3052, Australia Article History: Registration Date: 02/06/2015 Received Date: 16/04/2015 Accepted Date: 02/06/2015 Online Date: 14/06/2015
    Keywords: Medication regimen complexity ; Polypharmacy ; Aged ; Inappropriate prescribing ; Population-based study
    ISSN: 0031-6970
    E-ISSN: 1432-1041
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  • 6
    Language: English
    In: Pharmacogenomics, September 2012, Vol.13(12), pp.1427-34
    Description: Leflunomide is a disease-modifying antirheumatic drug used in the treatment of rheumatoid arthritis. Not all patients respond to leflunomide and, as it has potentially serious side effects, targeting only those most likely to benefit would address a clinical need. We aimed to determine whether variations in the gene encoding DHODH, the molecular target of leflunomide, might include biomarkers that could be used to rationalize provision of this drug. We analyzed six haplotype-tagging SNPs in DHODH in 56 patients with rheumatoid arthritis treated with leflunomide. Clinical response was determined by assessing the change in 28 joint disease activity score over the first 3 months of treatment. Carriage of a six-marker DHODH haplotype was associated with a reduced treatment response (p = 0.008). This suggests that a functional variant in strong linkage disequilibrium with this haplotype may predispose to reduced leflunomide efficacy.
    Keywords: Antirheumatic Agents -- Therapeutic Use ; Arthritis, Rheumatoid -- Drug Therapy ; Isoxazoles -- Therapeutic Use ; Oxidoreductases Acting on Ch-Ch Group Donors -- Genetics
    ISSN: 14622416
    E-ISSN: 1744-8042
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  • 7
    Language: English
    In: The Lancet, 22 March 2003, Vol.361(9362), pp.1001-1006
    Description: The jack jumper ant is responsible for about 90% of ant venom anaphylaxis in southeastern Australia. We aimed to establish whether venom immunotherapy (VIT) prevents lifethreatening sting anaphylaxis in otherwise healthy adults. We did a double-blind, placebo-controlled crossover trial of VIT. Participants were randomly allocated either immunotherapy, in accordance with the semirush hyposensitisation regimen, or placebo. The primary endpoint was systemic reaction after a deliberate sting challenge. Analysis was per protocol. We randomly allocated 68 healthy volunteers (aged 20–63 years) who were allergic to venom to placebo (33) and VIT (35). Four on placebo were stopped early and 12 on VIT had their treatment allocations revealed before the sting challenge, thus 29 on placebo and 23 on VIT were included in the primary analysis. Objectively defined systemic reactions to sting challenges arose in 21 of 29 participants (72%) on placebo (8 reactions were associated with hypotension) and none of 23 on VIT (p〈0·0001). Of the remaining 12 on VIT who underwent sting challenges after treatment allocations were revealed, only one reacted to sting challenge with transient urticaria that did not require treatment. After crossover of the placebo group to VIT, one of 26 had a reaction to sting challenge (transient urticaria). In all patients who had VIT, we recorded objective systemic reactions in 22 of 64 (34%) during VIT; two of which were hypotensive. In well motivated, highly allergic, but otherwise healthy adults, VIT is highly effective in prevention of sting anaphylaxis. The risk of systemic reactions during VIT means that treatment should be given where there is immediate access to resuscitation facilities.
    Keywords: Medicine
    ISSN: 0140-6736
    E-ISSN: 1474-547X
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  • 8
    Language: English
    In: Drugs & Aging, 2014, Vol.31(8), pp.623-630
    Description: Background Older people often take multiple medications. It is a policy priority to facilitate older people to stay at home longer. Three-quarters of nursing home placements in the US are preceded by a hospitalization. Objective To investigate the association between polypharmacy and medication regimen...
    Keywords: Medical And Health Sciences ; Clinical Medicine ; Geriatrics ; Medicin Och Hälsovetenskap ; Klinisk Medicin ; Geriatrik
    ISSN: 1170-229X
    E-ISSN: 11791969
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  • 9
    Language: English
    In: Annals of Pharmacotherapy, January 2015, Vol.49(1), pp.29-38
    Description: Background: Proton pump inhibitors (PPIs) are inappropriately prescribed in up to 50% of users. Systematic medication review and cessation of inappropriate medications or deprescribing may improve patient outcomes and reduce costs. Objective: The aim of this study was to assess the feasibility of a patient-centered deprescribing process in a population of adults with complex polypharmacy. Methods: This was a prospective feasibility study. Participants were recruited from hospital outpatient clinics. The patient-centered deprescribing process consisted of 5 steps: comprehensive medication history, identification of potentially inappropriate medications, determining if the medication can be ceased, planning the withdrawal regimen (eg, tapering where necessary), and provision of monitoring, support, and documentation. Feasibility was determined by assessing time taken to complete the different steps of the deprescribing process and participant feedback. Results: In all, 57 PPI users were recruited; participants were 70 ± 14 years old and took 14 ± 6 medications. The indication for PPI use was verified in 43 participants and judged as potentially inappropriate in 19 (44%); 8 were suitable for trial withdrawal, and 6 consented. All 6 successfully ceased (n = 3) or reduced (n = 3) their PPI use, and this was sustained at 6 months postintervention in 4 participants. Conclusions: The patient-centered deprescribing process can safely reduce inappropriate PPI prescribing in a small proportion of people. Although the process was acceptable to participants, difficulties in accessing complete medical histories, time limitations, and minimal evidence to support effectiveness in certain indications were barriers to implementation of the process in clinical practice.
    Keywords: Deprescribing ; Inappropriate Medication Use ; Medication Withdrawal ; Older Adults ; Polypharmacy ; Proton Pump Inhibitors ; Pharmacy, Therapeutics, & Pharmacology
    ISSN: 1060-0280
    E-ISSN: 1542-6270
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  • 10
    In: British Journal of Clinical Pharmacology, June 2016, Vol.81(6), pp.1046-1057
    Description: Byline: Jessica Wojciechowski, Michael D. Wiese, Susanna M. Proudman, David J. R. Foster, Richard N. Upton Keywords: disease activity; disease modifying anti-rheumatic drugs; population modelling; rheumatoid arthritis Aims Composite indices for quantifying rheumatoid arthritis (RA) disease activity such as the 28-joint disease activity score (DAS28) are comprised of single parameters ('metrics') in various combinations. Population modelling methods were used to evaluate single metrics for their ability to reflect changes in disease activity with a view to understanding and improving composite indices. Methods A total of 11 single metrics of RA disease activity (tender and swollen joint counts, acute phase reactants and global health, pain and physical function assessments) were obtained from 203 patients with recent onset RA. Participants received combination disease-modifying anti-rheumatic drugs (DMARDs) according to a treat-to-target approach with a pre-defined protocol for treatment intensification. Models describing each metric's magnitude and variability of change from baseline to a single 'treated' state in the population were developed using nonmem.sub.[R]. Measures that displayed uniformly large changes between states across the population were ranked higher in terms of discriminatory capacity. Results Joint counts demonstrated a greater ability to discriminate changes in RA disease activity than others. Correlations between metrics demonstrated that erythrocyte sedimentation rate (ESR) had limited relationships with others for baseline scores and changes in RA disease activity (r generally 〈0.2). However it appeared to be important in describing changes for those individuals where ESR levels were initially elevated. Conclusion It appears unlikely that a single group of metrics may be suitable to capture disease activity changes across all RA patients and defining the most appropriate metric(s) for individual patients will be an important area of future research. CAPTION(S): Supporting Information Supporting Information Supporting Information
    Keywords: Disease Activity ; Disease Modifying Anti‐Rheumatic Drugs ; Population Modelling ; Rheumatoid Arthritis
    ISSN: 0306-5251
    E-ISSN: 1365-2125
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