ABSTRACT
BACKGROUND: In appropriate prescribing is a significant and persistent problem in elderly people, both in hospital and the community and has been described in several countries in Europe and also the USA. The problem of inappropriate prescribing has not been quantified in the Republic of Ireland. The most commonly used criteria for the identification of inappropriate prescribing are the Beers' criteria [both independent of diagnosis (ID) and considering diagnosis (CD) - 2003 version]. The Beers' criteria ID includes 48 different categories of either single medications or multiple medications of a similar class identified as inappropriate prescriptions and the Beers' criteria CD contains 19 different categories containing possible drug-disease interactions. A second tool, the improved prescribing in the elderly tool (IPET) has also been validated and used in hospital and community studies and has 14 categories of either explicitly contraindicated medications or possible drug-disease interactions. OBJECTIVES: The primary aim of the study is to measure the incidence of inappropriate prescribing among older community-dwelling individuals presenting to an acute hospital in the Republic of Ireland. A secondary aim of this study was also therefore to compare the efficacy of the above two tools in identifying inappropriate prescribing. METHODS: A prospective, consecutive observational cohort study was carried out over a 4-month period. The setting was an urban-based university hospital acute geriatric medicine assessment unit. Subjects in this study (n = 350) were consecutively screened on admission to hospital (mean age = 80.3 +/- 6.1 years) and all patients had both Beers' criteria ID and CD and IPET applied to their list of prescription drugs on admission, cross-referenced with their list of current active medical diagnosis. RESULTS: The results of the study identified a high rate of inappropriate prescribing among this population of community-dwelling subjects. The total number of inappropriate prescriptions identified using the Beers' criteria (ID) was 148 affecting 121 patients. The Beers' criteria (CD) identified 69 inappropriate prescriptions in 60 patients and the IPET identified 112 inappropriate prescriptions in 78 patients. The Beers criteria (ID and CD combined) identified at least one inappropriate prescription in 34% of subjects and the IPET identified one in at least 22% of subjects. CONCLUSIONS: This study identifies high rates of use of inappropriate medications in community-dwelling elderly presenting with acute illness to hospital. These are comparable with inappropriate prescribing rates identified in previous studies. The revised Beers' criteria (2003) identified more inappropriate prescriptions than the IPET in this population of elders.
Subject(s)
Drug Prescriptions/standards , Drug Utilization/standards , Medication Errors/statistics & numerical data , Aged , Aged, 80 and over , Female , Humans , Male , Practice Patterns, Physicians'ABSTRACT
Forty-five potential living donors participated in this study to see if a human interest video featuring living donors and recipients who had been through the transplant process would increase living-donor donation rates and knowledge about living-donor organ donation. While neither donation rates nor knowledge achieved statistical significance, the data clearly demonstrated a clinically significant (clinically relevant) increase in donation rates.
Subject(s)
Kidney Transplantation/statistics & numerical data , Living Donors/education , Tissue Donors/education , Videotape Recording , Adult , Female , Humans , Kidney Transplantation/psychology , Living Donors/psychology , Living Donors/statistics & numerical data , Male , Random Allocation , Tissue Donors/psychology , Tissue Donors/statistics & numerical data , Videotape Recording/statistics & numerical dataABSTRACT
Fluorescence studies of membrane fluidity were conducted double-blind using platelet and red cell membranes prepared from 24 demented patients with probable Alzheimer's disease and 36 neurologically healthy subjects. The fluidity of the hydrocarbon and lipid-aqueous interface regions of cell membranes was determined at 37 degrees C by fluorescence spectroscopy using the lipid probes 1,6-diphenyl-1,3,5-hexatriene (DPH) and 1-[4-(trimethylamino)phenyl]-6-phenyl-1,3,5-hexatriene (TMA-DPH), respectively. The rotation rate of TMA-DPH in labeled platelet membranes did not differ between the groups. In contrast, the rotation rate of DPH in labeled platelet membranes from the demented patients (2.15 +/- 0.24 X 10(8)/sec, SD) was greater than that for the normal controls (1.93 +/- 0.13 X 10(8)/sec, SD, p = 3.8 X 10(-5)). This difference was reflected by a reduction in the steady-state anisotropy of DPH in labeled platelets from the demented group (0.1887 +/- 0.0085, SD) when compared to the respective mean for the controls (0.2000 +/- 0.0060, SD; p = 1.3 X 10(-7)). Abnormal membrane fluidity was significantly correlated with severity of dementia, but not with duration of illness or apparent age of onset. The findings do not support the hypothesis that Alzheimer's disease results from a pathological acceleration of the normal aging process, since normal aging is associated with decreased fluidity of cell membranes from platelets, as well as from lymphocytes, hepatocytes, and neurons.
Subject(s)
Alzheimer Disease/blood , Blood Platelets/metabolism , Aged , Aged, 80 and over , Alzheimer Disease/pathology , Alzheimer Disease/physiopathology , Alzheimer Disease/psychology , Blood Platelets/ultrastructure , Diphenylhexatriene/analogs & derivatives , Female , Humans , Male , Membrane Fluidity , Microscopy, Electron , Middle AgedABSTRACT
Double-blind fluorescence studies of platelet membrane fluidity were conducted at 37 degrees C for 51 patients with Alzheimer-type dementia, 24 nondemented depressed patients, and 50 neurologically healthy subjects. The fluidity of the hydrocarbon region of platelet membranes from the demented group, as reflected by the steady-state anisotropy of the fluorescent probe 1,6-diphenyl-1,3,5-hexatriene (DPH), was significantly greater than that for the depressed and normal control subjects. Within the demented group, platelet membrane fluidity was significantly correlated with severity of dementia but not with duration of illness or age at onset. Demented patients with "increased" platelet membrane fluidity had an earlier onset, were more severely demented, and deteriorated more rapidly.
Subject(s)
Alzheimer Disease/blood , Blood Platelets/metabolism , Depressive Disorder/blood , Membrane Fluidity , Aged , Alzheimer Disease/metabolism , Alzheimer Disease/psychology , Cell Membrane/metabolism , Depressive Disorder/metabolism , Diphenylhexatriene/metabolism , Female , Humans , Male , Middle Aged , Psychiatric Status Rating Scales , Time FactorsABSTRACT
We investigated the role of perceptual and motor factors in visuospatial impairment in 30 patients with Parkinson's disease (PD) and 30 matched controls. All subjects were administered visuospatial tests, which included "visuoperceptual" tasks, requiring minimal motor responses, and "visuomotor" tasks. The performance of patients with PD was considerably impaired on several tasks from both groups, and this impairment was not related to depression or intellectual impairment. Patients in stage 3 of the disease tended to show the greatest impairment. Those in stage 1 (unilateral symptoms), however, tended to show more impairment than those in stage 2.
