An external pilot cluster randomised controlled trial of a theory-based intervention to improve appropriate polypharmacy in older people in primary care (PolyPrime).

BACKGROUND: For older populations with multimorbidity, polypharmacy (use of multiple medications) is a standard practice. PolyPrime is a theory-based intervention developed to improve appropriate polypharmacy in older people in primary care. This pilot study aims to assess the feasibility of the PolyPrime intervention in primary care in Northern Ireland (NI) and the Republic of Ireland (ROI). METHODS: This external pilot cluster randomised controlled trial (cRCT) aimed to recruit 12 general practitioner (GP) practices (six in NI; six in the ROI counties that border NI) and ten older patients receiving polypharmacy (≥ 4 medications) per GP practice (n = 120). Practices allocated to the intervention arm watched an online video and scheduled medication reviews with patients on two occasions. We assessed the feasibility of collecting GP record (medication appropriateness, health service use) and patient self-reported data [health-related quality of life (HRQoL), health service use)] at baseline, 6 and 9 months. HRQoL was measured using the EuroQol-5 dimension-5 level questionnaire (EQ-5D-5L) and medication-related burden quality-of-life (MRB-QoL) tool. An embedded process evaluation and health economics analysis were also undertaken. Pre-specified progression criteria were used to determine whether to proceed to a definitive cRCT. RESULTS: Twelve GP practices were recruited and randomised. Three GP practices withdrew from the study due to COVID-related factors. Sixty-eight patients were recruited, with 47 (69.1%) being retained until the end of the study. GP record data were available for 47 patients for medication appropriateness analysis at 9 months. EQ-5D-5L and MRB-QoL data were available for 46 and 41 patients, respectively, at 9 months. GP record and patient self-reported health service use data were available for 47 patients at 9 months. Health service use was comparable in terms of overall cost estimated from GP record versus patient self-reported data. The intervention was successfully delivered as intended; it was acceptable to GPs, practice staff, and patients; and potential mechanisms of action have been identified. All five progression criteria were met (two 'Go', three 'Amend'). CONCLUSION: Despite challenges faced during the COVID-19 pandemic, this study has demonstrated that it may be feasible to conduct an intervention to improve appropriate polypharmacy in older people in primary care across two healthcare jurisdictions. TRIAL REGISTRATION: ISRCTN, ISRCTN41009897 . Registered 19 November 2019. CLINICALTRIALS: gov, NCT04181879 . Registered 02 December 2019.

Compassion Fatigue: Strategies for Minimizing Impact on Aesthetic Medical Providers.

Compassion fatigue is emotional, physical, and spiritual exhaustion from witnessing and absorbing the problems of others. Aesthetic providers are prone to becoming victims of compassion fatigue because of the stress of meeting the often overwhelming needs of pºatients. This article discusses what is known about compassion fatigue, what differentiates it from burnout, and how to recognize and combat it.

The Art of the Consultation Experience.

Looks matter! "Almost from the moment of birth, each of us is judged-silently, unconsciously, and nearly instantly on the basis of everything that goes into the mix of qualities known as "physical attractiveness" (). Aging may be one of the most foreseeable facts of life. As aesthetic providers, we routinely hear concerns about the effects of aging on our looks; it is important that we address these concerns. How do we set our client/provider relationship up for success by providing superb aesthetic solutions to the age-old challenges that we are faced with every day? Having an advanced clinical knowledge, a thorough aesthetic analysis, and an aesthetic plan specific to the client's needs ensure success. The aesthetic plan requires a shift from a two-dimensional to a three-dimensional approach as well as a shift from one product and/or procedure to combination therapy. Providing safe treatments, establishing trust, managing expectations, producing positive outcomes, and creating an engaging experience will ensure loyalty, future treatments, referrals, and a long-term client/provider relationship.

Botulinum Toxin Type-A (BoNT-A) Injections of the Corrugator Muscles for Aesthetics and Depression?

The treatment of glabellar lines with botulinum toxin type-A (BoNT-A) is a staple for aesthetic providers who specialize in facial rejuvenation. Clinical efforts are currently underway to substantiate upper facial injections (the corrugator muscles are the target muscles) of BoNT-A as an antidepression therapy. This article describes the origin of "facial feedback" by Charles Darwin nearly 150 years ago, as well as "emotional proprioception"-2 neuroanatomical concepts that help provide the scientific rationale behind the general influence facial muscles have on the emotional centers of the brain, and, specifically, how the corrugator muscles-involved with frowning-promote a gloomy mood. The journey researchers have taken to clinically qualify BoNT-A injections of the corrugator muscles-to inhibit frowning, and thereby mitigate depression-will also be highlighted so that aesthetic providers are up to date on this emerging benefit of BoNT-A.

Leadership and Management in Aesthetic Medicine.

The aesthetic provider is obligated to leverage their leadership, management, and teamwork skills on a daily basis in order to deliver optimum aesthetic outcomes for their clients. This article discusses leadership and motivational theories, leadership and management traits, complexity theory, Gardner's tasks of leadership, and the role of emotional intelligence in leading, managing, and following, so the aesthetic provider can identify and align with a particular leadership and management style that suits their practice philosophy.

Compassion Fatigue: Strategies for Minimizing Impact on Aesthetic Medical Providers.

Compassion fatigue is emotional, physical, and spiritual exhaustion from witnessing and absorbing the problems of others. Aesthetic providers are prone to becoming victims of compassion fatigue because of the stress of meeting the often overwhelming needs of patients. This article discusses what is known about compassion fatigue, what differentiates it from burnout, and how to recognize and combat it.

Aesthetic Policy and Procedure Protocols: A "Must Have" for Every Aesthetic Medical Provider.

Treatment guidelines are a crucial part of every medical aesthetic practice and must be in place before utilizing aesthetic medical injectables. An "Aesthetic Policy and Procedure Manual" features specific details (e.g., patient assessment, indication, contraindications, warnings and precautions, injection techniques, documentation, etc.) around dermal fillers (e.g., Restylane, Juvéderm, Voluma), hyaluronidase, neurotoxins (e.g., Botox Cosmetic, Dysport, and Xeomin) and Sculptra. This article describes why an "Aesthetic Policy and Procedure" manual is a necessary tool in every aesthetic provider's armamentarium, what it is composed of, as well as how these guidelines serve as a protective mechanism for the aesthetic provider's clinic if legal action is brought against their staff, their medical director, and/or their clinic.

Update on neurotoxins for facial rejuvenation: what they are, how they work, and how to effectively and safely use them.

The formal aesthetic introduction of botulinum toxin (i.e., neurotoxins) more than a decade ago has revolutionized the nonsurgical aesthetic market and transformed society's view of facial rejuvenation. Understanding the similarities and differences between U.S. commercially available neurotoxins, their characteristics and composition, where they are effective, their mechanism of action, and how to safely administer them will enable the aesthetic provider to successfully utilize this powerful tool and ultimately deliver optimal facial rejuvenation outcomes. An update on neurotoxins on the horizon is also provided. Please note that this article discusses neurotoxin use in treatment areas that are considered "off label" by the Food and Drug Administration.

"Skin facts" to optimize aesthetic outcomes.

Aesthetic providers need to be well versed in the anatomy and intricacies of the skin. This foundational skin knowledge is critical in assessing clients' aged skin during the aesthetic consultation. A sound understanding of the skin is also a prerequisite to any facial rejuvenation procedure. This article provides the aesthetic provider with the basics of skin anatomy and how the skin changes over time.

Avoiding the "danger zones" when injecting dermal fillers and volume enhancers.

Aesthetic providers need to be aware of the serious potential complications that can result from occlusion of specific facial arterial and venous structures. This article focuses on the anatomical "danger zones" to avoid during dermal filler and volume enhancer injection procedures. Clinical pearls are provided on how to avoid these "danger zones" and what to do if a rare complication (e.g., skin necrosis or vision loss) does occur.

The "nuts & bolts" of becoming an aesthetic provider: part 3-maximizing your aesthetic practice and client outcomes.

The final installment of this 3-part series of articles on becoming an aesthetic provider centers on the steps necessary to maximize an aesthetic medical practice and tips for optimal client outcomes. We discuss the importance of education for the aesthetic provider, the staff, and the client, as well as how to create client loyalty. On the basis of years of experience, "pearls and pitfalls" are discussed, so the novice, intermediate, and advanced aesthetic providers can minimize mistakes and maximize their success in this exciting and growing profession.

Stop "cruising for a bruising": mitigating bruising in aesthetic medicine.

The quest to restore a more youthful appearance by filling and volumizing facial deformities and deficiencies continues to be an ongoing pursuit in the noninvasive aesthetics market. Bruising can result from the delivery of neuromodulators and dermal fillers--common tools in the aesthetic provider's armamentarium to combat the ravages of aging. There are steps both the aesthetic provider and the client can take to minimize the potential for bruising. This article focuses on the etiology of bruising, the pharmacological and herbal agents to avoid prior to an aesthetic procedure, techniques to utilize during aesthetic procedures that lessen the potential of bruise formation, and pharmacological and herbal agents to administer after an aesthetic procedure to ultimately mitigate bruise formation.

The "nuts & bolts" of becoming an aesthetic provider: part 2-building your aesthetic practice.

Part 2 of this three-part series of articles on becoming an aesthetic provider centers on the steps necessary to build an aesthetic practice. We will discuss the legal (e.g., licensure, scope of practice, malpractice, and documentation) and the business aspects (e.g., "your brand," staff development, networking, marketing, and revenue possibilities) of building a successful aesthetic practice. On the basis of years of experience, "pearls and pitfalls" will be discussed so novice, intermediate, and advanced aesthetic providers can minimize mistakes and maximize their success in this exciting and growing profession.

The art of the aesthetic consultation.

Aging may be one of the most foreseeable facts of life. As aesthetic providers, we routinely hear concerns about facial aging, and it is important that we address these concerns by consistently delivering the best care possible while managing our clients' expectations. How do we set our clients and ourselves up for success by providing superb aesthetic solutions to the age-old challenges we are faced with every day? A thorough Aesthetic Analysis of the clients' needs and an Aesthetic Plan to their specific needs ensure success. An Aesthetic Plan requires a shift from a two-dimensional approach to a three-dimensional approach. Providing safe treatments, establishing trust, producing positive outcomes, and creating engaging experiences will ensure loyalty, future treatments, and continued maintenance.