How confident are physicians in deprescribing for the elderly and what barriers prevent deprescribing?

WHAT IS KNOWN AND OBJECTIVE: Deprescribing is the process of discontinuing or reducing the dosage of medications that are no longer appropriate or aligned with goals of care, which is paramount in elderly patients with multiple comorbidities and polypharmacy. The objective of this study was to assess the perceptions of primary care physicians on deprescribing for elderly patients and potential barriers to deprescribing that physicians experience in the Local Health Authority (LHA) of Parma, Emilia-Romagna, Italy. METHODS: One hundred and sixty physicians (57% of the total number of primary care physicians in Parma) attended an educational session related to deprescribing and were asked to anonymously complete a paper survey. Participants were asked to assess their level of agreement on nine questions about their perception of deprescribing and potential factors affecting the deprescribing process using a seven-point Likert-type scale. A correlation coefficient was calculated to assess the association between physicians' confidence in deprescribing and attitudes or barriers associated with deprescribing. RESULTS AND DISCUSSION: Many physicians (72%) reported general confidence in their ability to deprescribe. Most respondents (78%) reported they were comfortable deprescribing preventive medications, yet only half (53%) were comfortable deprescribing guideline-recommended therapies. Lack of evidence on discontinuing preventive medicines and concern about withdrawal side effects were reported to impede deprescribing by more than one-third of physicians. When medications were initially prescribed by another physician, 40% of physicians reported hesitance in deprescribing them. About half of physicians (45%) did not feel comfortable deprescribing when patients/caregivers believed that continuation of the medication was needed. Lack of time and difficulty engaging patients/caregivers in the deprescribing process were cited as barriers by about one in four physicians. There was no strong correlation between physicians' confidence and attitudes or barriers associated with deprescribing. WHAT IS NEW AND CONCLUSION: The study results show that physicians believe they are generally comfortable with deprescribing, although there are still several factors that hamper their ability to engage in the process. An improved understanding of physicians' views on deprescribing may help guide further research, and policies to help patients remain healthy while streamlining their medication regimen.

Atypical chondrodysplasia: a further variant of multiple enchondromatosis with vertebral involvement?

We report the case of a child with asymmetrical enchondromatosis and vertebral involvement, who presented in utero, and postulate its relationship to similar rarely reported cases.

MRI in the localization of CSF fistulae: is it of any value?

Coronal T2-weighted magnetic resonance imaging (MRI) has been reported to be a useful technique for the localization of both spontaneous and traumatic CSF (cerebro spinal fluid) fistulae. We reviewed the magnetic resonance imaging (MRI) scans of 50 patients with temporal lobe epilepsy in whom such sequences were routinely acquired to determine if this asymptomatic population fulfilled any of the criteria for the diagnosis of a CSF fistula. We found that a large proportion did and conclude that using MRI as the initial radiological investigation in the localization of CSF fistulae is of such low specificity that it is of little or no value.