The impact of pharmaceutical care interventions for medication underuse in older people: a systematic review and meta-analysis

Aims

The aim of the present study was to conduct a meta-analysis of controlled trials assessing the impact of pharmaceutical care interventions (e.g. medication reviews) on medication underuse in older patients (≥65 years).

Methods

The databases MEDLINE and EMBASE were searched for controlled studies, and data on interventions, patient characteristics and exposure, and outcome assessment were extracted. Risk of bias was assessed using the Cochrane Collaboration’s ‘risk of bias’ table. Results from reported outcomes were synthesized in multivariate random effects meta-analysis, subgroup meta-analysis and meta-regression.

Results

From 954 identified articles, nine controlled studies, mainly comprising a medication review, were included (2542 patients). These interventions were associated with significant reductions in the mean number of omitted drugs per patient (estimate from six studies with 1469 patients: – 0.44; 95% confidence interval –0.61, –0.26) and the proportion of patients with ≥1 omitted drugs (odds ratio from eight studies with 1833 patients: 0.29; 95% confidence interval 0.13, 0.63). The only significant influential factor for improving success was the utilization of explicit screening instruments when conducting a medication review (P = 0.033).

Conclusion

Pharmaceutical care interventions, including medication reviews, can significantly reduce medication underuse in older people. The use of explicit screening instruments alone or in combination with implicit reasoning is strongly recommendable for clinical practice.     

大学生就业能力系统化培养的思考与实践

大学生就业能力培养关系到高校人才培养质量.当前高校大学生的就业能力培养工作多局限于对大学四年级学生的就业指导和就业能力提升,缺乏对学生整个大学期间就业能力培养的深度思考与系统规划,就业管理工作存在着片面性、零碎化和局部化现象,该文讨论了大学期间统筹规划、整合资源、系统化培养提升大学生就业能力的路径.     

Systematic Coronary Risk Evaluation (SCORE): JACC Focus Seminar 4/8

Clinical estimation of the combined effect of several risk factors is unreliable and this resulted in the development of a number of risk estimation systems to guide clinical practice. Here, after defining general principles of risk estimation, the authors describe the evolution of the European Society of Cardiology’s (ESC) Systematic COronary Risk Evaluation (SCORE) risk estimation system and some learnings from the data. They move on to describe the establishment of the ESC’s Cardiovascular Risk Collaboration and outline its proposed research directions. First among these is the evolution of SCORE 2, which provides updated, calibrated risk estimates for total cardiovascular events for low, moderate, high, and very high-risk regions of Europe. The authors conclude by considering that the future of risk estimation may be to express risk as years of exposure to a cardiovascular risk factor profile rather than risk over a fixed time period, such as 10 years, and how advances in genetics may permit individualized lifetime risk estimation from childhood on.     

Patients' and healthcare providers’ perspectives on diabetes management: A systematic review of qualitative studies

BackgroundDespite the availability of evidence-based guidance to deliver effective diabetes care, many patients do not achieve goals as recommendations. This systematic review was to synthesize useful insight perspectives by patients and providers to identify factors related to diabetes management using Chronic Care Model.ObjectiveThis systematic review aimed to synthesize perspectives by patients and providers in order to identify factors related to diabetes management.MethodsDatabases were searched including CINAHL, PubMed, Science Direct, and Web of Science from January 2001 to September 2017. Combination of search terms were used like ‘qualitative,’ ‘diabetes management,’ ‘patients’ perspective,’ and ‘provider's perspective.’ All qualitative studies used were in English with available full text. Chronic Care Model framework was used to analyze the content and to organize the findings.ResultsOf 108 articles used, only 23 of this met the inclusion criteria. Nine factors were identified including community linkage, health service system for diabetic patients, continuity of care, self-management, providers' support, referral system, patient-provider interaction, increasing competency of healthcare providers and family support. Community linkage was revealed to be an important factor to encourage diabetic patients to look after their disease while health service system showed the limit of accessibility due to location, medical service availability, finance, information, and time. Continuity of care has shown lack of coordination in referral system within a health care team and self-management was dependent on the knowledge, beliefs, attitude, and behavior of the patient. More so, providers’ support through an effective plan and/or strategy has also indicated to help patients get their target goal. Poor interaction between patients and health providers was found to be largely attributed to language barrier and lack of communication skill. Improving competency for the health providers can be achieved through continuing professional education. Both perspectives supported a family involvement and community resources for diabetes patients.ConclusionFactors related to diabetes management from nine themes showed various gaps in both perspectives. Further research on new models for diabetes management is required.     

The epidemiological modelling of dysthymia: Application for the Global Burden of Disease Study 2010

Background

In order to capture the differences in burden between the subtypes of depression, the Global Burden of Disease 2010 Study for the first time estimated the burden of dysthymia and major depressive disorder separately from the previously used umbrella term ‘unipolar depression’. A global summary of epidemiological parameters are necessary inputs in burden of disease calculations for 21 world regions, males and females and for the year 1990, 2005 and 2010. This paper reports findings from a systematic review of global epidemiological data and the subsequent development of an internally consistent epidemiological model of dysthymia.

Methods

A systematic search was conducted to identify data sources for the prevalence, incidence, remission and excess-mortality of dysthymia using Medline, PsycINFO and EMBASE electronic databases and grey literature. DisMod-MR, a Bayesian meta-regression tool, was used to check the epidemiological parameters for internal consistency and to predict estimates for world regions with no or few data.

Results

The systematic review identified 38 studies meeting inclusion criteria which provided 147 data points for 30 countries in 13 of 21 world regions. Prevalence increases in the early ages, peaking at around 50 years. Females have higher prevalence of dysthymia than males. Global pooled prevalence remained constant across time points at 1.55% (95%CI 1.50–1.60). There was very little regional variation in prevalence estimates.

Limitations

There were eight GBD world regions for which we found no data for which DisMod-MR had to impute estimates.

Conclusion

The addition of internally consistent epidemiological estimates by world region, age, sex and year for dysthymia contributed to a more comprehensive estimate of mental health burden in GBD 2010.     

Effects of physiological aging on mismatch negativity: A meta-analysis

Mismatch negativity (MMN) is a promising window on how the functional integrity of auditory sensory memory and change discrimination is modulated by age and relevant clinical conditions. However, the effects of aging on MMN have remained somewhat elusive, particularly at short interstimulus intervals (ISIs). We performed a meta-analysis of peer-reviewed MMN studies that had targeted both young and elderly adults to estimate the mean effect size. Nine studies, consisting of 29 individual investigations, were included and the final total study population consisted of 182 young and 165 elderly subjects. The effects of different deviant types and duration of ISIs on the effect size were assessed. The overall mean effect size was 0.63 (95% CI at 0.43–0.82). The effect sizes for long ISI (> 2 s, effect size 0.68, 95% CI at 0.31–1.06) and short ISI (< 2 s, effect size 0.61, 95% CI at 0.39–0.84) were both considered moderate. A further analysis showed a prominent aging-related decrease in MMN responses to duration and frequency changes at short ISIs. It was also interesting to note that the effect size was about 25% larger for duration deviant condition compared to the frequency deviant condition. In conclusion, a reduced MMN response to duration and frequency deviants is a robust feature among the aged adults, which suggests that there has been a decline in the functional integrity of central auditory processing in this population.     

Medication overuse headache: Updating of the French recommendations regarding the treatment strategies

Regular and frequent use of analgesics and acute antimigraine drugs can increase the frequency of headache, and induce the transition from episodic to chronic migraine or medication-overuse headache (MOH). The one-year prevalence of this condition is between 1% and 2% in Europe, provoking substantial burden. MOH is more prevalent in people with comorbid depression, anxiety, and other chronic pain conditions. This paper aims at presenting an updating of French recommendations regarding treatments strategies. Prior French recommendations, published in 2014, were written in French. A literature search in the major medical databases including the terms “medication overuse headache”, “symptomatic medication overuse”, published between 2010 and 2020 was carried out. Three main strategies can be recommended and conducted in parallel: education and explanations about the negative consequences of overusing acute antimigraine drugs, discontinuation of the overused medication, and finally, preventive drug therapy and non-pharmacological prevention. Medication overuse headache remains a debated problem and evidence for the most effective treatment strategy is needed.