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PURPOSE: Proton pump inhibitors (PPIs) are prescribed frequently and can cause potentially severe hypomagnesemia. Researchers assessed the prevalence of hypomagnesemia and the association between PPI use and hypomagnesemia in hospitalized older patients. METHODS: Researchers conducted a single-center, observational, retrospective cohort study with patients admitted to a geriatric ward at the Jeroen Bosch Hospital in the period between June 24, 2016, and August 30, 2020. Patients were included if they were 65 years of age or older, had a serum magnesium measurement, and a complete overview of patient's current medication was present at the day of admission. The primary outcome was the occurrence of hypomagnesemia at hospital admission. Exposure to PPIs was the primary determinant investigated. Covariates were studied to identify risk factors and to adjust for potential confounding. The strength of the association between PPI and hypomagnesemia was evaluated with unconditional logistic regression, expressed as odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS: The prevalence of hypomagnesemia was 21.9% in PPI users and 15.8% in non-PPI users. Overall, the use of PPIs was associated with hypomagnesemia (ORadj = 1.38, 95% CI 1.09-1.76). A trend for this association was most pronounced in male patients (ORadj = 1.88, 95% CI 1.27-2.79), smokers (ORadj = 3.95, 95% CI 1.52-10.28), and in patients using > 7 units alcohol a week (ORadj = 4.44, 95% CI 1.40-14.12). CONCLUSiON: Older patients who are taking a PPI have a higher risk of developing hypomagnesemia than nonusers; additional factors can contribute to the risk. Physicians should be aware of PPI-induced hypomagnesemia and routinely monitor serum magnesium levels in older patients. [ABSTRACT FROM AUTHOR]

Abstract: Inappropriate prescribing is a major health care issue, especially regarding older patients on polypharmacy. Multiple implicit and explicit prescribing tools have been developed to improve prescribing, but these have hardly ever been used in combination. The Systematic Tool to Reduce Inappropriate Prescribing (STRIP) combines implicit prescribing tools with the explicit Screening Tool to Alert physicians to the Right Treatment and Screening Tool of Older People's potentially inappropriate Prescriptions criteria and has shared decision‐making with the patient as a critical step. This article describes the STRIP and its ability to identify potentially inappropriate prescribing. The STRIP improved general practitioners' and final‐year medical students' medication review skills. The Web‐application STRIP Assistant was developed to enable health care providers to use the STRIP in daily practice and will be incorporated in clinical decision support systems. It is currently being used in the European Optimizing thERapy to prevent Avoidable hospital admissions in the Multimorbid elderly (OPERAM) project, a multicentre randomized controlled trial involving patients aged 75 years and older using multiple medications for multiple medical conditions. In conclusion, the STRIP helps health care providers to systematically identify potentially inappropriate prescriptions and medication‐related problems and to change the patient's medication regimen in accordance with the patient's needs and wishes. This article describes the STRIP and the available evidence so far. The OPERAM study is investigating the effect of STRIP use on clinical and economic outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Many patients experience side effects during treatment with antipsychotics. This article reviews the clinical use and psychometric characteristics of rating scales used to assess side effects in patients treated with antipsychotics. Methods: A systematic literature search was performed using the electronic databases PubMed and Embase, with predefined search terms. Results: In total, 52 different scales were used in the 440 articles retrieved. For multiple side effects measured with one scale, the Udvalg for Kliniske Undersøgelser Side Effects Rating Scale for Clinicians was used the most, whereas the Liverpool University Neuroleptic Side Effect Rating Scale had the best psychometric characteristics (Cronbach’s α 0.81 and test–retest reliability 0.89). The Simpson Angus Scale was used the most to rate extrapyramidal side effects, although the Maryland Psychiatric Research Center scale had the best characteristics (Cronbach’s α 0.80, test–retest reliability 0.92 and inter-rater reliability 0.81–0.90). The Arizona Sexual Experience Scale was used the most to assess sexual dysfunction, but the Antipsychotics and Sexual Functioning Questionnaire and the Nagoya Sexual Functioning Questionnaire had the best characteristics. Conclusion: This review will help researchers and clinicians make a purpose-oriented choice of which scale to use. Systematic review registration number: CRD42014013010. [ABSTRACT FROM AUTHOR]

Purpose Proton pump inhibitors (PPIs) are prescribed frequently and can cause potentially severe hypomagnesemia. Researchers assessed the prevalence of hypomagnesemia and the association between PPI use and hypomagnesemia in hospitalized older patients. Methods Researchers conducted a single-center, observational, retrospective cohort study with patients admitted to a geriatric ward at the Jeroen Bosch Hospital in the period between June 24, 2016, and August 30, 2020. Patients were included if they were 65 years of age or older, had a serum magnesium measurement, and a complete overview of patient's current medication was present at the day of admission. The primary outcome was the occurrence of hypomagnesemia at hospital admission. Exposure to PPIs was the primary determinant investigated. Covariates were studied to identify risk factors and to adjust for potential confounding. The strength of the association between PPI and hypomagnesemia was evaluated with unconditional logistic regression, expressed as odds ratios (ORs) with 95% confidence intervals (CIs). Results The prevalence of hypomagnesemia was 21.9% in PPI users and 15.8% in non-PPI users. Overall, the use of PPIs was associated with hypomagnesemia (ORadj = 1.38, 95% CI 1.09-1.76). A trend for this association was most pronounced in male patients (ORadj = 1.88, 95% CI 1.27-2.79), smokers (ORadj = 3.95, 95% CI 1.52-10.28), and in patients using > 7 units alcohol a week (ORadj = 4.44, 95% CI 1.40-14.12). Conclusion Older patients who are taking a PPI have a higher risk of developing hypomagnesemia than nonusers; additional factors can contribute to the risk. Physicians should be aware of PPI-induced hypomagnesemia and routinely monitor serum magnesium levels in older patients.

Aims: Junior doctors frequently prescribe incorrectly and this can cause serious harm to patients. Pharmacotherapy education in most medical schools falls short in preparing their students to prescribe safely in clinical practice. According to the theory of assessment-driven learning, a pharmacotherapy self-assessment for junior doctors may reduce potential harmful prescriptions in clinical practice, by revealing deficits in prescribing knowledge and skills., Methods: In this single centre, prospective cohort study, the potential harmful prescriptions of junior doctors in clinical practice were compared before and after a pharmacotherapy self-assessment with and without additional pharmacotherapy education., Results: Potential harmful prescriptions best known to cause harm to patients were studied in all the prescriptions written out by 199 junior doctors in the first 2 months of their employment in our hospital. The pharmacotherapy self-assessment reduced the total number of potential harmful prescriptions made by junior doctors relative to those made by junior doctors in the control group (1.3 vs. 3.2%, respectively; P < .001). Additional education did not reduce potential harmful prescriptions beyond the effect of the self-assessment alone (1.3 vs. 1.0%, P > .05)., Conclusions: Pharmacotherapy self-assessment leads to fewer potential harmful prescriptions made by junior doctors in clinical practice, thereby improving patient safety. More research is needed to investigate whether additional pharmacotherapy education strategies reduce potential harmful prescriptions further., (© 2021 British Pharmacological Society.)

Introduction: This review examines whether functional and cognitive decline and mortality after an episode of delirium are comparable between patients with and those without dementia., Methods: MEDLINE and EMBASE were searched systematically for 'dementia' and 'delirium'. After screening of the results, studies were rated on relevance and validity and data were extracted. Cognitive decline was defined as decline in Mini-Mental State Examination (MMSE) score. Functional decline was defined as decline in Barthel Index (BI), score on the Instrumental Activities of Daily Living (IADL) or institutionalisation., Results: From 5092 potentially relevant articles identified, eight studies were included in the review. The one-year mortality rate ranged from 11% to 45% in patients with dementia versus 22% to 44% in patients without dementia, and the overall absolute rate was 34% (95% CI 0.32-0.36). Pooled data did not show a significant difference between the groups. The MMSE scores and the Barthel Index had improved in both groups after six months, but scores on the Instrumental Activities of Daily Living (IADL) had declined. However, on all measurement points, patients with dementia scored significantly lower than patients without dementia. In addition, patients with dementia had a 33% risk of institutionalisation after an episode of delirium versus 20% in patients without dementia (95% CI 0.06-0.20)., Conclusion: No significant differences were seen in mortality after delirium between patients with and without dementia. The overall one-year mortality was high (34%). Patients with dementia had significantly lower functional and cognitive scores and their risk of institutionalisation post-delirium was higher. Patients and their caregivers should be given this information, which may also be useful in advance care planning., (Copyright © 2019. Published by Elsevier B.V.)

Objective: Drug-induced parkinsonism (DIP) is one of the most common adverse effects of antipsychotic agents. The limited agreement about which rating scale should be used in clinical practice to assess DIP prompted us to review the feasibility and the psychometric qualities of the available instruments., Methods: The PubMed and EMBASE databases were searched in November 2008 using the terms "parkinsonism," "scale," and "drug induced" to identify instruments used to measure DIP. Then, the literature was searched for studies investigating the use and psychometric properties of each identified instrument. Outcome measures included feasibility, validity (including appropriateness of used reference test), and reliability (internal consistency and interrater and intrarater reliability)., Results: Seventeen rating scales were identified, each with a different representation of the concept of parkinsonism. The Simpson Angus Scale (SAS) was used the most, followed by the Extrapyramidal Symptom Rating Scale. There were limited psychometric data, especially regarding validity, available for any scale. The SAS, the Drug-Induced Extrapyramidal Scale, and the parkinsonism subscale of the Schedule for the Assessment of Drug-Induced Movement Disorders, which is identical to the St Hans Rating Scale for Extrapyramidal Syndromes, seemed to have moderate to good reliability and acceptable validity. The time-consuming nature of the Schedule for the Assessment of Drug-Induced Movement Disorders would make it less useful in daily practice., Conclusions: Although various scales are used to assess DIP, few have been evaluated for validity and reliability. The SAS, St Hans Rating Scale for Extrapyramidal Syndromes, and Drug-Induced Extrapyramidal Scale seem to be the most valid, reliable, and easy-to-use instruments to evaluate DIP in clinical practice.

Objective: To investigate whether the transition from a conventional, discipline-based curriculum to a problem-orientated, integrated curriculum at the University Medical Center Utrecht, the Netherlands, has resulted in students having less knowledge of the basic medical sciences., Design: Comparative., Method: The difference in the amount of basic science between the curricula was quantitatively assessed. 37 final-year students in each curriculum volunteered to complete a test specifically designed to measure knowledge of the basic sciences, a few weeks before their graduation., Results: The transition from the old to the new curriculum resulted in a decline of almost half in the amount of time dedicated to the basic sciences, from 84 to 48 'fulltime week equivalents'. Students in the old curriculum performed significantly better on the test than students in the new curriculum, with 43.2% (SD: 9.56) correct answers versus 35.8% (SD: 8.19) correct answers respectively, which amounted to an effect size of 0.828 (Cohen-d). Yet, on the pathophysiology/pathology subscale, students in each curriculum showed similar performance: 36.1% (SD: 11.55) correct answers for students in the old curriculum, versus 37.2% (SD: 11.66) correct answers for students in the new curriculum., Conclusion: Students in the old curriculum had overall significantly more knowledge of the basic sciences than students in the new curriculum, except for pathophysiology/pathology, though the time devoted to this discipline in the new curriculum had also decreased considerably.