What Medication-Related Factors Are Important For Polypharmacy And Deprescribing Assessment By Physicians And Pharmacists Using A Novel Website To Rate Clinical Cases?

Background: Little is known about how clinicians assess polypharmacy in real-world practice. Objectives: To identify which medication-related factors influence clinicians’ ratings of polypharmacy, harm from medicines and deprescribing of medicines when presented with a patient’s list of medications and comorbidities.Setting: A novel website called What Is Polypharmacy Exactly (WIPE) was created with 50 de-identified real-world cases with varying numbers of comorbidities and medicines.Methods: Participants, consisting of physicians and pharmacists were asked to rate each case from zero (lowest) to 10 (highest) on three questions: i) degree of polypharmacy, ii) potential for medication-related harm and iii) potential to deprescribe medicines. Medication-related factors including medicines count, high-risk medicines, inappropriate duplication, drug-drug and drug-disease interactions were assessed. Multiple linear regression was used to determine which medication-related factors influenced median ratings for the three questions. Main outcome measures: The primary outcome measure was the median rating for the degree of polypharmacy for each case. Secondary outcome measures were the median rating for the potential for harm from medicines for each case and median rating for the potential to deprescribe medicines for each case. Results: Ninety-two clinicians were included in the study, comprising of 76.1% pharmacists (n=70) and 23.9% physicians (n=22). The comorbidity count (P=0.001), medicines count (P<0.001), inappropriate medication duplication (P=0.017), high-risk medicines (P=0.049), use of NSAIDs (P=0.032) and antihypertensives (P=0.040) were predictive of the perceived degree of polypharmacy. The comorbidity count (P<0.001), medicines count (P<0.001), inappropriate medication duplication (P=0.016) and high-risk medicines (P=0.036) were predictive of the recognised potential for medication-related harm. The medicines count (P<0.001), inappropriate medication duplication (P=0.017), benzodiazepine use (P=0.003) and antipsychotic use (P=0.039) were predictive of the recognised potential to deprescribe medicines. Conclusion: Whilst polypharmacy has traditionally been defined using the medicines count, our findings suggest that clinicians also consider other factors such as high-risk medicines and inappropriate medicines duplication to identify patients at risk of adverse outcomes. Future polypharmacy assessment tools should additionally include these factors.

Quality assessment of a consultation-liaison psychiatry service

Background Consultation-Liaison Psychiatry (CLP) provides services for patients with medical-psychiatric comorbidity at the general hospital. Referral satisfaction is considered as one of the most important outcome measures of CLP interventions. Our aim was to assess the levels of satisfaction with the CLP service amongst medical staff at a university hospital in Denmark. Methods Medical staff answered an online survey regarding their experience with different aspects of inpatient and outpatient CLP services. Results There were 152 responses from 16 medical units, with a survey return rate above 85%. Measured on a 5-point Likert scale, there was a median rating of 4 in response to questions regarding communication and organizational aspects, a median rating of 5 in response to questions regarding overall evaluation of the CLP service on both inpatient and outpatient questionnaire. The questions regarding treatment quality were rated with a median of 4 on the inpatient questionnaire and 2 of the outpatient questionnaire items, and with a median of 5 on 2 outpatient items. Physicians´ evaluations were statistically more positive than nurses´. As a group, respondents already employed before the CLP unit was established and those who used the CLP services more were statistically significantly more satisfied then respondents employed after the establishment of the CLP unit and those who used the CLP service less. Conclusion The CLP services were positively appreciated and considered to be valuable among medical hospital staff. We believe that Consultation-Liaison Psychiatry deserves further help to implement and expand its services in general hospital settings. In addition, our results underline the feasibility of surveys as quality measures of clinical care.

Development of Evidence-Based Chinese Medicine Clinical Service Recommendations for Cancer Palliative Care Using Delphi Approach Based on the Evidence to Decision Framework

Objectives: Existing evidence supports the use of certain Chinese medicine (CM) interventions for symptom management among palliative cancer patients. However, evidence-based service recommendations tailored to the local context are needed for CM planning and implementation. In response, we aimed to establish consensus on CM clinical service recommendations for cancer palliative care among Hong Kong experts. Methods: Seven CM interventions showing statistically significant favorable results in existing systematic reviews (SRs) and overviews of SRs were subjected to a GRADE-ADOLOPMENT–based 2-round Delphi survey. Twelve Hong Kong experts in cancer palliative care, including conventionally trained physicians, CM practitioners, and nurses (n = 4 from each category), were invited to participate. Use of the Evidence to Decision framework within the GRADE-ADOLOPMENT approach enabled experts to consider aspects of problem priority, benefits, harms, equity, acceptability, and feasibility when making CM recommendations in cancer palliative care. Results: Three evidence-based CM interventions reached positive consensus as service recommendations, namely: (1) acupuncture for reducing fatigue among palliative cancer patients; (2) acupressure for reducing fatigue among palliative cancer patients; and (3) moxibustion for reducing nausea and vomiting among patients receiving chemotherapy. Median rating of recommendation ranged from 2.5 to 3.0 (interquartile range = 0.00-1.00) on a 4-point Likert-type scale, and the percentage agreement ranged from 83.4% to 91.7%. Conclusions: The GRADE-ADOLOPMENT approach facilitates a consensus-based process of reaching 3 evidence-based CM recommendations for cancer palliative care. Future studies may develop tailored strategies to implement these recommendations in the Hong Kong health system.

An assessment of the trainability of beggars and the destitute in Abakaliki Nigeria: implication for policy on their health, vocational rehabilitation and social reintegration

Background: Begging and destitution constitute serious health and social problems in low and middle-income countries (LMICs).Objectives: The objective of this study was to assess the trainability of beggars and the destitute in Abakaliki Nigeria in order to provide scientific evidence required for the development of a policy on their health, vocational rehabilitation and social reintegration.Methods: The study was a cross-sectional descriptive survey of 50 purposively selected beggars and destitute persons identified from motor parks, church cathedrals, market places etc. Data was collected using a structured interviewer-administered questionnaire. Analysis was based on mean rating (MNR), median rating (MDR), and range. Interview of each respondent lasted approximately 20 minutes. Results: Of the 50 respondents who participated in this study, 17 (34%) were females. Most subjects were of age category 31-35 years (30%) and 36-40 years (34%). Fifteen (30%) admitted having sight impairment while 17 (34%) admitted that they were physically challenged. The outcome of the trainability assessment showed relatively high mean ratings (MNRs) ranging from 3.42-4.06 on a scale of 5 points.Conclusion: The findings of this study clearly suggest that there is a very high potential for the vocational rehabilitation and social reintegration of beggars and the destitute in the study area.Keywords: Beggars, destitute, policy, health, vocational, rehabilitation, reintegration, Nigeria.

Examination of Early Feedbacks for Effective Product Retailing on E-Commerce Websites

Online reviews became a essential information base for customers prior to the creation of the buy call affiliate. Early item reviews tend to have a strong effect on the following item revenues. Throughout this article, we tend to take the action to check early reviewers ' behavioral features through their announcement videos on two real-world gigantic e-commerce platforms, i.e., Amazon. Specifically, we tend to split the item cycle into three successive phases, especially early, majority and laggards. A person who published a review early on is considered as an early review associate We tend to quantitatively characterize early critics who have endorsed their ranking behaviors, the helpfulness results obtained from others, and hence the correlation between their ratings and the performance of the item. We discovered that combine early reviewers tend to give a stronger median rating score; linked with[ 2] early reviewers tend to publish more helpful feedback. Additionally, our item reviews assessment shows the ratings of these early reviewers and their earned helpfulness scores square measure that can affect the performance of the item. By watching the posting technique of evaluation as a competitive multiplayer game, we tend to suggest a totally distinctive embedding model for early reviewer prediction. Intensive tests on 2 completely distinct e-commerce datasets have shown that our suggested strategy exceeds various competitive baselines

FACTOR ANALYSIS OF UPPER LIMB PROSTHETIC ACCEPTANCE FROM RETROSPECTIVE PROSTHETIC CLINICIAN SURVEY

INTRODUCTION Upper limb prosthetic acceptance seems to be relatively unchanged from 1958 where it was measured to be 75% for transradial, 61% for transhumeral, and 35% for shoulder disarticulation levels. A practitioner survey from 2013 by the author found this to be largely unchanged at 79.6%, 57.8%, and 32.8% respectively. An upper limb meta-analysis showed that the most significant factors affecting prosthetic rejection using a median rating were function, comfort, ease of use, weight, heat, lack of sensory feedback, inconvenience, lifestyle, dissatisfaction with technology, irritation, and availability of services. An earlier survey by the author condensed these factors of rejection to amputation level, functional advantage, and comfort, and included confidence of the prosthetist, availability of therapy, and support of the patient context. Also it was speculated that the value of factors influencing rejection of prostheses may not be simply the converse of those accepting the prosthesis but different scales. Abstract PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/32045/24459 How to cite: Stark G E. FACTOR ANALYSIS OF UPPER LIMB PROSTHETIC ACCEPTANCE FROM RETROSPECTIVE PROSTHETIC CLINICIAN SURVEY. CANADIAN PROSTHETICS & ORTHOTICS JOURNAL, VOLUME 1, ISSUE 2, 2018; ABSTRACT, ORAL PRESENTATION AT THE AOPA’S 101ST NATIONAL ASSEMBLY, SEPT. 26-29, VANCOUVER, CANADA, 2018. DOI: https://doi.org/10.33137/cpoj.v1i2.32045 Abstracts were Peer-reviewed by the American Orthotic Prosthetic Association (AOPA) 101st National Assembly Scientific Committee. http://www.aopanet.org/

An evaluation of portion size estimation aids: precision, ease of use and likelihood of future use

ObjectiveThe present study aimed to evaluate the precision, ease of use and likelihood of future use of portion size estimation aids (PSEA).DesignA range of PSEA were used to estimate the serving sizes of a range of commonly eaten foods and rated for ease of use and likelihood of future usage.SettingFor each food, participants selected their preferred PSEA from a range of options including: quantities and measures; reference objects; measuring; and indicators on food packets. These PSEA were used to serve out various foods (e.g. liquid, amorphous, and composite dishes). Ease of use and likelihood of future use were noted. The foods were weighed to determine the precision of each PSEA.SubjectsMales and females aged 18–64 years (n 120).ResultsThe quantities and measures were the most precise PSEA (lowest range of weights for estimated portion sizes). However, participants preferred household measures (e.g. 200 ml disposable cup) – deemed easy to use (median rating of 5), likely to use again in future (all scored either 4 or 5 on a scale from 1=‘not very likely’ to 5=‘very likely to use again’) and precise (narrow range of weights for estimated portion sizes). The majority indicated they would most likely use the PSEA preparing a meal (94 %), particularly dinner (86 %) in the home (89 %; all P<0·001) for amorphous grain foods.ConclusionsHousehold measures may be precise, easy to use and acceptable aids for estimating the appropriate portion size of amorphous grain foods.

Survey of 575 Daylily Cultivars for Severity of Daylily Rust in a Southern Mississippi Landscape

Daylily (Hemerocallis sp.) is a popular and widely planted herbaceous perennial in the landscape, with over 78,000 cultivars registered with the American Hemerocallis Society. Daylily performs well in full sun, heat, humidity, and periods of dry weather, and has generally been considered to be pest free. However, a rust disease (Puccinia hemerocallidis) was introduced in the United States on imported plants in 2000, quickly spreading to become a widespread problem on daylily in and beyond the southern United States. In Aug. 2013, 575 daylily cultivars (mostly newer hybrids) were surveyed for daylily rust in a large landscape planting that had not received any fungicide treatment during the 2013 growing season. Weather conditions during the growing season were favorable for daylily rust. Individual clumps were rated as 1 (no or little visual sign of infection), 2 (moderate infection), or 3 (severe infection). In this survey, 119 cultivars (21%) received a median rating of 1 or 1.5, 230 cultivars (40%) received a rating of 2, and 226 (39%) received a rating of 2.5 or 3. Most cultivars were represented by a single clump, and may thus be more susceptible to daylily rust than a single rating might indicate. Diploid cultivars were associated with lower daylily rust severity ratings than tetraploid cultivars.

Consensus on Severity for Ocular Emergency: The BAsic SEverity Score for Common OculaR Emergencies [BaSe SCOrE]

Purpose. To weigh ocular emergency events according to their severity.Methods. A group of ophthalmologists and researchers rated the severity of 86 common ocular emergencies using a Delphi consensus method. The ratings were attributed on a 7-point scale throughout a first-round survey. Then, the experts were provided with the median and quartiles of the ratings of each item to reevaluate the severity levels being aware of the group’s first-round responses. The final severity rating for each item corresponded to the median rating provided by the last Delphi round.Results. We invited 398 experts, and 80 (20%) of them, from 18 different countries, agreed to participate. A consensus was reached in the second round, completed by 24 experts (43%). The severity ranged from subconjunctival hemorrhages (median = 1, Q1 = 0; Q3 = 1) to penetrating eye injuries collapsing the eyeball with intraocular foreign body or panophthalmitis with infection following surgery (median = 5, Q1 = 5; Q3 = 6). The ratings did not differ according to the practice of the experts.Conclusion. These ratings could be used to assess the severity of ocular emergency events, to serve in composite algorithms for emergency triage and standardizing research in ocular emergencies.

Computer-assisted survey of attitudes to HIV and sexually transmissible infection partner notification in HIV-positive men who have sex with men

Background: HIV infection continues to rise in men who have sex with men (MSM) in the UK. Of concern are the high rates of sexually transmissible infections (STI) among HIV-positive MSM, as this is associated with onward HIV transmission. Conventional partner notification (PN) may be limited in this group by the presence of multiple non-contactable partners and the fear of breach of HIV status. Methods: We explored attitudes to PN in HIV-positive MSM having an STI screen using a computer-assisted self interview. Results and Conclusion: Our study shows HIV+ MSM, rate conventional methods of PN highly (median rating 8/10) but are also supportive of new approaches to PN particularly anonymous email when linked to website information. They would also be open to targeted interventions such as peer recruitment.