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Background The Swiss Society of General Internal Medicine (SGAIM) has chosen the topic "Recognising drug interactions and preventing side effects" as a quality indicator in the primary care setting. Methodology Retrospectively, in a group practice of 6 general practitioners (GPs), all patients aged 65 and over who were prescribed ≥ 5 long-term medications were identified in the year 2022. These medications were systematically checked for interaction reports using the Compendium® software. Results The 226 patients were on average 77 years old and took an average of 7 different medications. In 188 (83.2%) individuals with drug interaction signals, the severity of the drug interaction was classified as mild in 164 (87.3%), moderate in 21 (11.1%) and severe in 3 (1.6%). Diuretics, antidiabetics and ACE-inhibitors/sartans were most frequently involved. In case of severe drug interaction reports, antidepressant agents and amiodarone were most frequently involved. In the multivariate analysis, no statistically significant associations were identified between the number of drug interaction reports and age, gender or type of residence. Conclusion In over 65-year-olds with polypharmacy (≥ 5 medications) in a GP setting, a software-supported systematic drug interaction check identified drug interactions of the prescribed medication in nine out of ten patients. The vast majority of drug interaction reports were minor and not clinically relevant. The number of drug interactions as an indicator of quality of care is limited, as patient-specific information other than their medication regimens is not taken into account. GPs' classification in the clinical context and the context and the assessment of the benefits and risks of (poly-)medication is indispensable. [ABSTRACT FROM AUTHOR]

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Copyright of Die Kardiologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Many older patients are permanently prescribed one or more psychotropic drugs for treatment of symptoms, such as behavioral and psychological symptoms in dementia, depressive symptoms, anxiety, and insomnia. They therefore contribute to the risk of polypharmacy. Recently, deprescribing studies have been published in order to clarify if inadequate medications can be safely discontinued. This mini-review summarizes the study results and derives practical recommendations for routine use. Method: A literature search was carried out in PubMed for clinical studies on deprescribing in association with psychotropic substances. Results: After removal of duplications, 12 heterogeneous clinical studies were identified and reduction of psychotropic substances could be successfully achieved in 8 studies. In four of these studies psychological, behavioral and functional endpoints were reported. Criteria for successful deprescribing of sedatives were in particular motivation, information and sufficient cooperation of the patients and for antipsychotic drugs in people with dementia, the sustainable establishment of nonpharmaceutical treatment strategies. Deprescribing was not attempted in cases of a history of severe chronic mental illness and in cases of severe behavioral symptoms in dementia. Evidence for antidepressants was not sufficient to extract practical recommendations. Conclusion: Safe deprescribing of antipsychotic drugs in patients with dementia is justified if non-pharmacological treatment options are sustainably implemented, and for sedative drugs in well-informed, highly motivated and cooperative patients. [ABSTRACT FROM AUTHOR]

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Background: In a large proportion of patients admitted to the emergency department (ED), the initial main symptom is nonspecific. One possible reason for this, especially in older patients, may be adverse drug reactions (ADR) due to their frequent polypharmacy. Aim: To illustrate the incidence of ADRs, the affected patient population including risk factors, and drug classes with ADRs leading to nonspecific symptoms. To provide practice recommendations for the management of ADRs in the ED. Material and methods: Presentation of the pharmacological principles on ADRs, statistics of pharmacovigilance centers as well as original literature including experiences from clinical practice and own projects. Results: In 10% of patients with nonspecific symptoms an ADR is responsible for presentation in the ED. In 60% of cases these ADRs are not correctly identified in the ED setting. A small number of drug classes are responsible for most of these referrals. Databases, risk stratification, clinical pharmacists, or clinical decision support systems are available to improve ADR identification and management. As these options are partly associated with considerable costs or the validation for German EDs is missing, a widespread application does not take place. Conclusion: Correct identification of ADRs in patients with nonspecific symptoms in the ED is necessary to initiate adequate treatment. These ADRs are often overlooked because processes and tools for identification and management are not applied in the ED, leading to a lack of awareness. For high-risk patients in the ED, the focus should be on drug history, ideally considering patient-specific risk factors and specific drug classes. [ABSTRACT FROM AUTHOR]

Abstract: Delirium often occurs in elderly hospitalized patients. Multimorbidity and associated polypharmacy are known risk factors for developing delirium. Moreover, delirium itself often leads to the prescription of additional drugs. This article aims to enlighten the interrelation of delirium and polypharmacy in the context of recent evidence. It also tries to show possibilities of deprescribing. [ABSTRACT FROM AUTHOR]

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Aim: Interprofessional collaboration is particularly relevant to patient safety in outpatient care with polypharmacy. The educational project "PILLE" is meant to give medical and pharmacy students an understanding of the roles and competencies needed for cooperation in the provision of healthcare and to enable interprofessional learning. Method: The curriculum is aimed at pharmacy and medical students and was developed in six steps according to the Kern cycle. It is comprised of an interprofessional seminar, a joint practical training in a simulated pharmacy, and a tandem job shadowing at a primary care practice. The project was implemented in three stages due to the pandemic: The interprofessional online seminar based on the ICAP model and the digital inverted classroom was held in the 2020 winter semester; the interprofessional practical training was added in the 2021 summer semester; and the interprofessional tandem job shadowing at a primary care practice in the 2021 winter semester. Attitudes toward interprofessional learning, among other things, was measured in the evaluation using the SPICE-2D questionnaire (Student Perceptions of Physician-Pharmacist Interprofessional Clinical Education). Results: In the first three semesters, a total of 105 students (46 pharmacy, 59 medicine) participated in the project, of which 78 participated in the evaluation (74% response rate). The students stated, in particular, that they had learned about the competencies and roles of the other profession and desired additional and more specific preparatory materials for the course sessions. The SPICE-2D questionnaire showed high values for both groups of students already in the pre-survey and these increased further as a result of the project. Conclusion: Joint case-based learning could be implemented under the conditions imposed by the pandemic. Online teaching is a low-threshold means to enable interprofessional exchange. [ABSTRACT FROM AUTHOR]

Polypharmacy and potentially inappropriate medication have a negative impact on health. For reducing or stopping medication (deprescribing) patient benefits are crucial. The following stepwise approach has turned out to be successful: a. ask patients to bring along all their medication and compare them with the current medication list; b. offer shared decision making; c. evaluate every drug for indication, balance between benefit and harm, side effects and dose; d. prioritize benefit and harm according to values, preferences and goals of the patient; e. decide together about deprescribing; f. track changes in the medication plan und arrange a follow-up consultation. We illustrate this approach by the example of an older, frail female patient with polypharmacy. Deprescribing is just as important for patients' well-being as is prescribing! [ABSTRACT FROM AUTHOR]

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Copyright of Gefaesschirurgie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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Copyright of Zeitschrift für Gerontologie und Geriatrie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Der Internist is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Der Hautarzt is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Zeitschrift für Gerontologie und Geriatrie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Despite its relevant medical risks, polypharmacy is common particularly among difficult to treat conditions, e.g. treatment refractory depression (TRD). According to numerous guidelines, electroconvulsive therapy (ECT) is the treatment of choice in severe and treatment-resistant major depression due to the high effectiveness; however, to date limited data are available concerning the effects of ECT on the concomitant prescription of psychiatric medication. Methods: For a retrospective explorative analysis of psychiatric polypharmacy (MED) in TRD, data from 58 inpatient treatments were collected. Due to depressive episodes, all patients received psychopharmacological treatment and cognitive behavioral therapy (MED group). Of the patients 29 also underwent ECT (ECT group). Using a modified drug burden index (mod-DBI), the psychiatric medication was quantified at admission (TP0), start (TP1) and termination of ECT (TP2) and discharge in the ECT group or in comparable periods in the MED group (TP3). Differences in distribution were tested with the t-test and alterations in measurements were tested by means of variance analysis (F-test). Results: Patients treated with ECT showed higher mod-DBI values at TP0, mainly due to more frequent prescription of benzodiazepines (BZD), mood stabilizers (MS) and antipsychotic drugs (AP). At the beginning of the inpatient treatment (TP0–TP1) there was an increase in BZD use (in both groups); in the ECT group MS were reduced and AP increased. In the time interval TP1–TP3, BZD (in both groups) and AP (ECT group) were again less frequently prescribed and MS (ECT and MED group) were increased again. Excluding BZD, there was a significant increase in mod-DBI in both groups, whereas the mod-DBI no longer showed significant differences at TP2 and TP3. Conclusion: The data possibly indicate that patients with TRD who receive ECT during inpatient treatment already have a more extensive psychiatric medication at admission. Also, psychiatric medication appears to be increased less prominently when ECT is performed. These findings and the possibly associated long-term benefits should be addressed in future research. [ABSTRACT FROM AUTHOR]

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Copyright of Rechtsmedizin is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Bipolar disorder and schizophrenia are severe mental illnesses, each with a prevalence of approximately 1-2% in the general population. There is considerable controversy about differentiating schizophrenia from schizoaffective or bipolar disorder owing to many similarities in psychopathology, progression, and biological factors. The aim of this study was to identify similarities and differences in the pharmacological treatment of these disorders by comparing the prescription patterns.Method: In this retrospective, explorative study we analyzed the prescribed medication of 300 patients with bipolar, schizophrenic, or schizoaffective disorders from data obtained from ten German adult psychiatric clinics of the LWL ("Landschaftsverband Westfalen-Lippe") psychiatric network.Results: Only 21.8% of patients analyzed were consistently compliant in taking their medication before hospitalization. Polypharmacy was applied in 75.6% of cases, whereby 2.27 psychopharmacological agents were prescribed at discharge. Briefly, we observed greater similarity between prescription patterns associated with bipolar and schizoaffective disorders than with schizophrenia prescription patterns.Conclusion: Polypharmacy tends to be more the rule than the exception, especially when patients present with affective psychotic features. Bipolar and schizoaffective disorders cannot be differentiated according to their prescription patterns. [ABSTRACT FROM AUTHOR]

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Copyright of Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This is the case report of an 80-year-old woman with advanced chronic obstructive pulmonary disease (COPD), multimorbidity and frailty. Despite regular critical re-evaluation of on-going medication, a significant reduction of prescribed medication was not achieved up until the patient’s terminal phase, and this may have contributed to several episodes of delirium. It was particularly difficult to reduce the number of prescribed drugs due to cardiovascular, endocrinologic, orthopaedic, neurologic, psychiatric and pulmonary comorbidities. Probable drug-drug interactions and side effects were repeatedly observed. This case report aims to describe a dilemma frequently encountered in the care of patients with progressed pulmonary disease in the context of frailty and multimorbidity. [ABSTRACT FROM AUTHOR]

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Copyright of Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Zeitschrift für Gerontologie und Geriatrie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: This overview focuses on the aspects of the pharmacotherapy of Parkinson's disease, which is one of the most common disorders of the nervous system. This article presents the complexity of the pharmacotherapy of geriatric patients with neurological diseases. Objectives: Information about the potential risk factors and aspects of drug safety in the pharmacotherapy of Parkinson's disease. Materials and methods: Selective literature search using PubMed and the scientific-clinical experience of the authors. Results: Patients with Parkinson's disease are usually geriatric patients with concomitant diseases. As a result they are often treated with comedication which leads to a complex medication regime with more than five drugs. Such polypharmacy increases the risk of adverse drug events due to the rising number of possible interactions and contraindications. To control this risk and maintain a safe therapy, certain measures should be considered. This implies additional need for educational work in order to create awareness regarding potential adverse drug events. In certain cases of diagnosed comorbidities or relevant drug prescriptions in the medication regime, follow-up examinations should be conducted. Conclusion: Specific parameters of Parkinson's disease, the health-related quality of life of affected patients and the quality of pharmacotherapeutic drug safety can be improved by targeted monitoring of the medication regime. As a result, the overall drug safety can be increased. [ABSTRACT FROM AUTHOR]

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Zunehmendes Alter, Multimorbidität, Polypharmazie und daraus resultierende Risiken sind nahezu untrennbar miteinander verbunden. Trotz zahlreicher Bemühungen gibt es bisher keine langfristig wirksame Strategie zur Reduktion einer Polypharmazie durch den Hausarzt. Basierend auf aktuellen Erkenntnissen und unter Berücksichtigung hemmender Faktoren wird eine mögliche komplexe Intervention für die hausärztliche Praxis abgeleitet. Increasing age, multimorbidity, polypharmacy and resulting risks are almost inseparable. In spite of numerous efforts, there has been no long-term effective strategy to reduce polypharmacy by general practitioners (GPs). Based on current knowledge with a special focus on inhibitory factors, a suitable, complex intervention is deduced for primary medical care. [ABSTRACT FROM AUTHOR]

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Copyright of Der Hautarzt is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)