Aims
This audit aimed to assess the prevalence and completeness of documented medication handover regarding opioid substitution therapy (OST) during transitions of care in to and out of a major ...tertiary teaching hospital, focusing on surgical admissions. The secondary aim was to evaluate the proportion of handover episodes that involved a clinical pharmacist, and to determine the impact of pharmacist involvement on the completeness of documented OST handover.
Method and Results
A 5‐year retrospective audit was conducted for surgical patients undergoing OST prior to admission to a major tertiary teaching hospital. Data were collected pertaining to: handover on admission of 13 OST‐related metrics deemed important for appropriate ongoing clinical care, whether medication handover to the community OST team was documented on discharge, and the involvement and impact of pharmacists in these processes. Sixty‐one admissions were included in the audit. On average, just over half (7.4/13) of the predefined OST‐related metrics audited, were documented on admission. Only 57% of patients had OST handover to the community team documented on discharge. Pharmacist involvement on discharge significantly increased completeness of OST handover documentation on admission and increased the proportion of patients with documented OST handover on discharge.
Conclusion
Medication handover relating to OST on admission and discharge was frequently incomplete, posing a potential risk to safe and appropriate ongoing care, highlighting the need for education and procedures to guide this process. Pharmacist contribution in handover of OST medication‐related information increased completeness of documentation, demonstrating their role in facilitating medication‐related communication during transitions of care.
Burden and bother Sallis, James A.; Wagner, Tasma J.; May, Frank W.
Journal of pharmacy practice and research,
December 2017, 2017-12-00, Letnik:
47, Številka:
6
Journal Article
Recenzirano
Odprti dostop
As polypharmacy continues to be a key issue for pharmacy in the care of older people, understanding an older person‘s perceived bother from medication‐related side effects is important for informed ...clinical decision making. In a small study of hospitalised people over 65, perceived ‘bother’ from anticholinergic side‐effects did not appear to be correlated with differing degrees of exposure in the week prior to admission.
Background Disparities in health outcomes and health behaviors may be partially explained by neighborhood environments that are poor in resources that could support healthy behaviors. The purpose of ...this study was to test the hypothesis that low-income and high-minority neighborhoods have less access to public parks, open space, and private recreation facilities. Methods From 2004 to 2005, an inventory of 351 private recreation facilities and 465 public parks was conducted in 833 Census block groups in Maryland. In 2-way ANCOVAs, numbers of private facilities and public parks, as well as maximum park size, were studied in relation to categories of median income and percent non-white population in the block groups. Results For the number of private recreation facilities, there was no significant effect of income or percent minority. For number and size of parks, the interaction between income and percent minority was significant. Mixed-race neighborhoods had the highest number of parks, regardless of income. Low- and middle-income groups living in mostly-white block groups and high-income groups living in mostly-minority block groups had the lowest access to public parks. Conclusions The expected deprivation of recreation facilities in low-income and high-minority neighborhoods was not found. There are exceptions to the inequalities found nationally, so the policies or practices associated with a fairer distribution of recreation resources in some local areas need to be better understood.
Summary Land-use and transport policies contribute to worldwide epidemics of injuries and non-communicable diseases through traffic exposure, noise, air pollution, social isolation, low physical ...activity, and sedentary behaviours. Motorised transport is a major cause of the greenhouse gas emissions that are threatening human health. Urban and transport planning and urban design policies in many cities do not reflect the accumulating evidence that, if policies would take health effects into account, they could benefit a wide range of common health problems. Enhanced research translation to increase the influence of health research on urban and transport planning decisions could address many global health problems. This paper illustrates the potential for such change by presenting conceptual models and case studies of research translation applied to urban and transport planning and urban design. The primary recommendation of this paper is for cities to actively pursue compact and mixed-use urban designs that encourage a transport modal shift away from private motor vehicles towards walking, cycling, and public transport. This Series concludes by urging a systematic approach to city design to enhance health and sustainability through active transport and a move towards new urban mobility. Such an approach promises to be a powerful strategy for improvements in population health on a permanent basis.
Summary Significant global health challenges are being confronted in the 21st century, prompting calls to rethink approaches to disease prevention. A key part of the solution is city planning that ...reduces non-communicable diseases and road trauma while also managing rapid urbanisation. This Series of papers considers the health impacts of city planning through transport mode choices. In this, the first paper, we identify eight integrated regional and local interventions that, when combined, encourage walking, cycling, and public transport use, while reducing private motor vehicle use. These interventions are destination accessibility, equitable distribution of employment across cities, managing demand by reducing the availability and increasing the cost of parking, designing pedestrian-friendly and cycling-friendly movement networks, achieving optimum levels of residential density, reducing distance to public transport, and enhancing the desirability of active travel modes (eg, creating safe attractive neighbourhoods and safe, affordable, and convenient public transport). Together, these interventions will create healthier and more sustainable compact cities that reduce the environmental, social, and behavioural risk factors that affect lifestyle choices, levels of traffic, environmental pollution, noise, and crime. The health sector, including health ministers, must lead in advocating for integrated multisector city planning that prioritises health, sustainability, and liveability outcomes, particularly in rapidly changing low-income and middle-income countries. We recommend establishing a set of indicators to benchmark and monitor progress towards achievement of more compact cities that promote health and reduce health inequities.
Summary On the eve of the 2012 summer Olympic Games, the first Lancet Series on physical activity established that physical inactivity was a global pandemic, and global public health action was ...urgently needed. The present paper summarises progress on the topics covered in the first Series. In the past 4 years, more countries have been monitoring the prevalence of physical inactivity, although evidence of any improvements in prevalence is still scarce. According to emerging evidence on brain health, physical inactivity accounts for about 3·8% of cases of dementia worldwide. An increase in research on the correlates of physical activity in low-income and middle-income countries (LMICs) is providing a better evidence base for development of context-relevant interventions. A finding specific to LMICs was that physical inactivity was higher in urban ( vs rural) residents, which is a cause for concern because of the global trends toward urbanisation. A small but increasing number of intervention studies from LMICs provide initial evidence that community-based interventions can be effective. Although about 80% of countries reported having national physical activity policies or plans, such policies were operational in only about 56% of countries. There are important barriers to policy implementation that must be overcome before progress in increasing physical activity can be expected. Despite signs of progress, efforts to improve physical activity surveillance, research, capacity for intervention, and policy implementation are needed, especially among LMICs.
Abstract Background Parents’ diets are believed to influence their children’s diets. Previous studies have not adequately and simultaneously assessed the relationship between parent and child total ...diet quality and energy intakes. Objective Our aim was to investigate whether parent and child diet quality and energy intakes are related. Design We conducted a cross-sectional analysis using baseline dietary intake data from the Neighborhood Impact on Kids study collected in 2007 to 2009. Participants/setting Participants were parents and 6- to 12-year-old children from households in King County (Seattle area), WA, and San Diego County, CA, targeted by Neighborhood Impact on Kids were recruited. Eligible parent−child dyads (n=698) with two or three 24-hour dietary recalls were included in this secondary analysis. Main outcome measures Child diet quality (Healthy Eating Index-2010, Dietary Approaches to Stop Hypertension score, and energy density for food only) and energy intake were derived from the dietary recalls using Nutrition Data Systems for Research. Statistical analyses performed Multiple linear regression models examined the relationship between parent diet quality and child diet quality, and the relationship between parent energy intake and child energy intake. In both analyses, we controlled for parent characteristics, child characteristics, household education, and neighborhood type. Results Parent diet quality measures were significantly related to corresponding child diet quality measures: Healthy Eating Index-2010 (standardized β=.39; P <0.001); Dietary Approaches to Stop Hypertension score (β=.33; P <0.001); and energy density (β=.32; P <0.001). Parent daily mean energy intake (1,763±524 kcal) was also significantly related (β=.30; P <0.001) to child daily mean energy intake (1,751±431 kcal). Conclusions Parent and child intakes were closely related across various metrics of diet quality and for energy intake. Mechanisms of influence are likely to be shared food environments, shared meals, and parent modeling.
ObjectivesTo compare hospitalisation rates, intensive care unit (ICU) admissions and mortality for patients with COVID-19 who were consistently inactive, doing some activity or consistently meeting ...physical activity guidelines.MethodsWe identified 48 440 adult patients with a COVID-19 diagnosis from 1 January 2020 to 21 October 2020, with at least three exercise vital sign measurements from 19 March 2018 to 18 March 2020. We linked each patient’s self-reported physical activity category (consistently inactive=0–10 min/week, some activity=11–149 min/week, consistently meeting guidelines=150+ min/week) to the risk of hospitalisation, ICU admission and death after COVID-19 diagnosis. We conducted multivariable logistic regression controlling for demographics and known risk factors to assess whether inactivity was associated with COVID-19 outcomes.ResultsPatients with COVID-19 who were consistently inactive had a greater risk of hospitalisation (OR 2.26; 95% CI 1.81 to 2.83), admission to the ICU (OR 1.73; 95% CI 1.18 to 2.55) and death (OR 2.49; 95% CI 1.33 to 4.67) due to COVID-19 than patients who were consistently meeting physical activity guidelines. Patients who were consistently inactive also had a greater risk of hospitalisation (OR 1.20; 95% CI 1.10 to 1.32), admission to the ICU (OR 1.10; 95% CI 0.93 to 1.29) and death (OR 1.32; 95% CI 1.09 to 1.60) due to COVID-19 than patients who were doing some physical activity.ConclusionsConsistently meeting physical activity guidelines was strongly associated with a reduced risk for severe COVID-19 outcomes among infected adults. We recommend efforts to promote physical activity be prioritised by public health agencies and incorporated into routine medical care.
Abstract The objective of this cohort study was to explore relationships among the home food environment (HFE), child/parent characteristics, diet quality, and measured weight status among 699 ...child-parent pairs from King County, WA, and San Diego County, CA. HFE variables included parenting style/feeding practices, food rules, frequency of eating out, home food availability, and parents’ perceptions of food costs. Child dietary intake was measured by 3-day recall and diet quality indicators included fruits and vegetables, sweet/savory snacks, high-calorie beverages, and Dietary Approaches to Stop Hypertension (DASH) score. Individual linear regression models were run in which child BMI z score and child diet quality indicators were dependent variables and HFE variables and child/parent characteristics were independent variables of interest. Fruit and vegetable consumption was associated with parental encouragement/modeling (β=.68, P <0.001) and unhealthful food availability (−0.27, P <0.05); DASH score with food availability (healthful: 1.3, P <0.01; unhealthful: −2.25, P <0.001), food rules (0.45, P <0.01), and permissive feeding style (−1.04, P <0.05); high-calorie beverages with permissive feeding style (0.14, P <0.01) and unhealthful food availability (0.21, P <0.001); and sweet/savory snacks with healthful food availability (0.26, P <0.05; unexpectedly positive). Children's BMI z score was positively associated with parent's use of food restriction (0.21, P <0.001), permissive feeding style (0.16, P <0.05), and concern for healthy food costs (0.10, P <0.01), but negatively with verbal encouragement/modeling (−0.17, P <0.05), and pressure to eat (−0.34, P <0.001). Various HFE factors associated with parenting around eating and food availability are related to child diet quality and weight status. These factors should be considered when designing interventions for improving child health.
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