Article

Use of proton pump inhibitors and mortality among institutionalized older people

Unit of General Practice, Helsinki University Central Hospital, PO Box 20, 00014 Helsinki, Finland. .
Archives of internal medicine (Impact Factor: 17.33). 09/2010; 170(17):1604-5. DOI: 10.1001/archinternmed.2010.304
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    • "Contrary to many previous trials, this study will also collect data on participants’ hospitalizations. Inappropriate drugs according to Beers, anticholinergic drugs, as well as psychotropic drugs have been suggested to increase hospitalizations and complications [16,19,23,25]. "
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    ABSTRACT: Background: Use of inappropriate drugs is common among institutionalized older people. Rigorous trials investigating the effect of the education of staff in institutionalized settings on the harm related to older people's drug treatment are still scarce. The aim of this trial is to investigate whether training professionals in assisted living facilities reduces the use of inappropriate drugs among residents and has an effect on residents' quality of life and use of health services. Methods and design: During years 2011 and 2012, a sample of residents in assisted living facilities in Helsinki (approximately 212) will be recruited, having offered to participate in a trial aiming to reduce their harmful drugs. Their wards will be randomized into two arms: one, those in which staff will be trained in two half-day sessions, including case studies to identify inappropriate, anticholinergic and psychotropic drugs among their residents, and two, a control group with usual care procedures and delayed training. The intervention wards will have an appointed nurse who will be responsible for taking care of the medication of the residents on her ward, and taking any problems to the consulting doctor, who will be responsible for the overall care of the patient. The trial will last for twelve months, the assessment time points will be zero, six and twelve months. The primary outcomes will be the proportion of persons using inappropriate, anticholinergic, or more than two psychotropic drugs, and the change in the mean number of inappropriate, anticholinergic and psychotropic drugs among residents. Secondary endpoints will be, for example, the change in the mean number of drugs, the proportion of residents having significant drug-drug interactions, residents' health-related quality of life (HRQOL) according to the 15D instrument, cognition according to verbal fluency and clock-drawing tests and the use and cost of health services, especially hospitalizations. Discussion: To our knowledge, this is the first large-scale randomized trial exploring whether relatively light intervention, that is, staff training, will have an effect on reducing harmful drugs and improving QOL among institutionalized older people. Trial registration: ACTRN12611001078943.
    Full-text · Article · Jun 2012 · Trials
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    • "Their short-term use has been associated with infections such as community-acquired pneumonia [18] [19] [20] [21] or Clostridium difficile diarrhea [22] [24] due to low gastric acidity, and with a loss of efficacy of clopidogrel as a result of drug interaction [25] [26] [27] [28] [29] [30]. Longterm use has been related to increases in hip fractures [31] [32] [33], delayed diagnosis of gastric cancer and increased risk of all-cause mortality [34] [35]. "
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    ABSTRACT: Proton pump inhibitors (PPI) are among the most commonly prescribed medicines and their overuse is widespread in both primary and secondary care. Inappropriate prescription is of particular concern among elderly patients, who have often multiple comorbidities and need many drugs. We evaluate the appropriateness of drugs for peptic ulcer or gastro-esophageal reflux disease (GERD) in a sample of elderly patients (65 years old or older) at admission and discharge in 38 internal medicine wards between January 2008 and December 2008, according to the presence of specific conditions or gastro-toxic drug combinations. Among 1155 patients eligible for the analysis, 466 (40.3%) were treated with drugs for GERD or peptic ulcer were at hospital admission and 647 (56.0%) at discharge; 62.4% of patients receiving a drug for peptic ulcer or GERD at admission and 63.2% at discharge were inappropriately treated. Among these, the number of other drugs prescribed was associated with greater use of drugs for peptic ulcer or GERD, even after adjustment for age, sex and number of diagnoses at admission (OR 95% CI=1.26 (1.18-1.34), p=.0001) or discharge (OR 95% CI=1.11 (1.05-1.18), p=0.0003). Prevalence of inappropriate prescription of drugs for peptic ulcer or GERD remained almost the same at admission and discharge. Inappropriate use of these drugs is related to the concomitant use of other drugs. Careful assessment of clinical conditions and stricter adherence to evidence-based guidelines are essential for a rational and cost-effective use of drugs for peptic ulcer or GERD.
    Full-text · Article · Apr 2011 · European Journal of Internal Medicine
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    ABSTRACT: Main pharmacovigilance updates are reviewed. Rosiglitazone and sibutramine have been suspended due to cardiovascular risks. The safety profile of H1N1 vaccines is similar to the established profile of seasonal influenza vaccines. Paroxetine reduces the benefit of tamoxifen. The use of serotoninergic antidepressants in pregnancy is still disputed. The risk of venous thromboembolism could be higher with oral combined contraceptives containing drospirenone compared to those containing levonorgestrel. Prolonged QT and PR intervals have been observed with saquinavir. The correct use of transdermal patches is reviewed with the example of rivastigmine. Aseptic meningitis is a rare adverse reaction of lamotrigine. An increased risk of fractures after long term use of proton pump inhibitors is suspected.
    No preview · Article · Jan 2011 · Revue médicale suisse
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