Older people experience more concurrent illnesses, are prescribed more medications and suffer more adverse drug events than younger people. Many drugs predispose older people to adverse events such ...as falls and cognitive impairment, thus increasing morbidity and health resource utilization. At the same time, older people are often denied potentially beneficial, clinically indicated medications without a valid reason. We aimed to validate a new screening tool of older persons' prescriptions incorporating criteria for potentially inappropriate drugs called STOPP (Screening Tool of Older Persons' Prescriptions) and criteria for potentially appropriate, indicated drugs called START (Screening Tool to Alert doctors to Right, i.e. appropriate, indicated Treatment).
A Delphi consensus technique was used to establish the content validity of STOPP/START. An 18-member expert panel from academic centers in Ireland and the United Kingdom completed two rounds of the Delphi process by mail survey. Inter-rater reliability was assessed by determining the kappa-statistic for measure of agreement on 100 data-sets.
STOPP is comprised of 65 clinically significant criteria for potentially inappropriate prescribing in older people. Each criterion is accompanied by a concise explanation as to why the prescribing practice is potentially inappropriate. START consists of 22 evidence-based prescribing indicators for commonly encountered diseases in older people. Inter-rater reliability is favorable with a kappa-coefficient of 0.75 for STOPP and 0.68 for START.
STOPP/START is a valid, reliable and comprehensive screening tool that enables the prescribing physician to appraise an older patient's prescription drugs in the context of his/her concurrent diagnoses.
Background
EGFR
mutated lung cancer represents a subgroup with distinct clinical presentations, prognosis, and management requirements. We investigated the survival, prognostic factors, and ...real-world treatment of NSCLC patients with
EGFR
mutation in clinical practice.
Methods
A retrospective review of all specimens sent for
EGFR
analysis from December 2009 to September 2015 was performed. Patient demographics, specimen type,
EGFR
mutation status/type, stage at diagnosis, treatment, response rate, and survival data were recorded.
Results
27/334 (8%) patient specimens sent for
EGFR
testing tested positive for a sensitising
EGFR
mutation. The median age was 65 years (40–85 years). Exon 19 deletion represented the most commonly detected alteration, accounting for 39% (
n
= 11). First-line treatment for those with Exon 18, 19, or 21 alterations (
n
= 24) was with an EGFR tyrosine kinase inhibitor (TKI) in 79% (
n
= 19). Objective response rate among these patients was 74% and median duration of response was 13 months (range 7–35 months).
Conclusion
The incidence of
EGFR
mutation in our cohort of NSCLC is 9% which is consistent with mutation incidence reported in other countries. The rate of
EGFR
mutation in our population is slightly below that reported internationally, but treatment outcomes are consistent with published data. Real-world patient data have important contributions to make with regard to quality measurement, incorporating patient experience into guidelines and identifying safety signals.
Introduction: STOPP (Screening Tool of Older Persons’ potentially inappropriate Prescriptions) is a new, systems-defined medicine review tool. We compared the performance of STOPP to that of ...established Beers’ criteria in detecting potentially inappropriate medicines (PIMs) and related adverse drug events (ADEs) in older patients presenting for hospital admission. Methods: we prospectively studied 715 consecutive acute admissions to a university teaching hospital. Diagnoses, reason for admission and concurrent medications were recorded. STOPP and Beers’ criteria were applied. PIMs with clear causal connection or contribution to the principal reason for admission were determined. Results: median patient age (interquartile range) was 77 (72–82) years. Median number of prescription medicines was 6 (range 0–21). STOPP identified 336 PIMs affecting 247 patients (35%), of whom one-third (n = 82) presented with an associated ADE. Beers’ criteria identified 226 PIMs affecting 177 patients (25%), of whom 43 presented with an associated ADE. STOPP-related PIMs contributed to 11.5% of all admissions. Beers’ criteria-related PIMs contributed to significantly fewer admissions (6%). Conclusion: STOPP criteria identified a significantly higher proportion of patients requiring hospitalisation as a result of PIM-related adverse events than Beers’ criteria. This finding has significant implications for hospital geriatric practice.
Inappropriate prescribing (IP) is a common and serious global healthcare problem in elderly people, leading to increased risk of adverse drug reactions (ADRs), polypharmacy being the main risk factor ...for both IP and ADRs. IP in older people is highly prevalent but preventable; hence screening tools for IP have been devised, principally Beers' Criteria and the Inappropriate Prescribing in the Elderly Tool (IPET). Although Beers' Criteria have become the most widely cited IP criteria in the literature, nevertheless, they have serious deficiencies, including several drugs that are rarely prescribed nowadays, a lack of structure in the presentation of the criteria and omission of several important and common IP instances. New, more up-to-date, systems-based and easily applicable criteria are needed that can be applied in the routine clinical setting.
Inappropriate prescribing in the elderly Gallagher, P.; Barry, P.; O'Mahony, D.
Journal of clinical pharmacy and therapeutics,
April 2007, Letnik:
32, Številka:
2
Journal Article
Recenzirano
Odprti dostop
Summary
Background and objective: Drug therapy is necessary to treat acute illness, maintain current health and prevent further decline. However, optimizing drug therapy for older patients is ...challenging and sometimes, drug therapy can do more harm than good. Drug utilization review tools can highlight instances of potentially inappropriate prescribing to those involved in elderly pharmacotherapy, i.e. doctors, nurses and pharmacists. We aim to provide a review of the literature on potentially inappropriate prescribing in the elderly and also to review the explicit criteria that have been designed to detect potentially inappropriate prescribing in the elderly.
Methods: We performed an electronic search of the PUBMED database for articles published between 1991 and 2006 and a manual search through major journals for articles referenced in those located through PUBMED. Search terms were elderly, inappropriate prescribing, prescriptions, prevalence, Beers criteria, health outcomes and Europe.
Results and discussion: Prescription of potentially inappropriate medications to older people is highly prevalent in the United States and Europe, ranging from 12% in community‐dwelling elderly to 40% in nursing home residents. Inappropriate prescribing is associated with adverse drug events. Limited data exists on health outcomes from use of inappropriate medications. There are no prospective randomized controlled studies that test the tangible clinical benefit to patients of using drug utilization review tools. Existing drug utilization review tools have been designed on the basis of North American and Canadian drug formularies and may not be appropriate for use in European countries because of the differences in national drug formularies and prescribing attitudes.
Conclusion: Given the high prevalence of inappropriate prescribing despite the widespread use of drug‐utilization review tools, prospective randomized controlled trials are necessary to identify useful interventions. Drug utilization review tools should be designed on the basis of a country's national drug formulary and should be evidence based.
Summary
Background: Treatment of hypertension in the elderly people reduces the risk of cardiovascular and cerebrovascular events. Effective treatment often will require the use of two or more ...antihypertensive agents. Elderly people are at increased risk of adverse events from medication because of physiological changes in pharmacokinetics and pharmacodynamics, polypharmacy and drug interactions. They might not tolerate conventional add‐on regimens of antihypertensives as a result.
Objective: To investigate the use of the I1‐imidazoline receptor agonist moxonidine as an ‘add‐on’ agent in elderly patients with resistant hypertension.
Methods: We investigated the safety and efficacy of moxonidine (200–400 μg) in a group of elderly patients whose blood pressure (BP) control remained poor despite treatment with two or more antihypertensives. BP was assessed by ambulatory BP monitoring with Spacelabs oscillometric equipment (Model 90207) before and after 6 weeks of treatment with moxonidine used as an ‘add‐on’ agent with the patients normal medication.
Results: Following treatment with moxonidine, the mean daytime systolic BP fell from 169·2 to 153·8 mmHg, a significant reduction of 15·4 ± 8·9 mmHg (P = 0·003). The mean daytime diastolic BP fell from 91·6 to 84·2 mmHg, a reduction of 7·4 ± 5·8 mmHg (P = 0·017). For the night‐time readings, the systolic BP fell from 151·1 to 141·2 mmHg, a reduction of 9·3 ± 9·3 mmHg (P = 0·05). The corresponding diastolic fall in BP was not significant (77·9–74·7 mmHg). The 24 h‐readings showed a significant reduction in the mean systolic BP from 163·0 to 148·6 mmHg (P = 0·004). The mean diastolic BP also fell significantly from 87·2 to 80·2 mmHg (P = 0·013). Clinical BP readings also showed a significant reduction from 195·9 ± 19·6 to 174 ± 17·8 mmHg (P = 0·002) and 103·6 ± 9·5 to 99·0 ± 12·4 mmHg (P = 0·013) for systolic and diastolic readings respectively. Moxonidine was well tolerated in 11 of the14 patients.
Conclusion: These results suggest that moxonidine might have a place as an ‘add‐on’ treatment in elderly patients whose hypertension is poorly controlled despite treatment with two or more antihypertensive agents.
Inappropriate prescribing (IP) encompasses the use of medicines where the risk of an adverse drug event (ADE) outweighs the clinical benefit, particularly when safer or more effective alternatives ...are available. IP also includes the use of medicines that increase the likelihood of drug-drug and drug-disease interactions, the mis-prescribing of medicines (incorrect dose, frequency and duration) and the under-use of clinically indicated medicines. IP is highly prevalent in older people and has been associated with preventable ADEs, hospitalisation, institutionalisation, death and resource wastage. With increasing proportions of older people worldwide, quality and safety of prescribing are becoming a global healthcare concern. One way of identifying IP is to use prescribing indicators such as the recently validated STOPP (Screening Tool of Older Persons' Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment) criteria.
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