A rising concern among clinicians is treatment of unplanned weight loss in the elderly, especially given the predicted growth of this population over the next few decades. Unexpected weight loss in the geriatric patient worsens overall health outcomes. A variety of pharmacotherapeutic options are available for treatment; however, evidence underlying their use is limited, and none has gained approval from the United States Food and Drug Administration for this indication. At present, no guidelines support the choice of one agent over another. Although several drug interventions have been employed for this problem, megestrol acetate and mirtazapine are becoming increasingly used for appetite stimulation. These drugs represent two feasible options for geriatric patients because of their generally favorable adverse-effect profiles and few drug interactions, but they are often misused. In a comprehensive search of the MEDLINE and International Pharmaceutical Abstracts databases, we identified all published reports on the use of megestrol acetate or mirtazapine for the treatment of weight loss and on any adverse events associated with these drugs. Special emphasis was placed on trials performed in an elderly population. Results were conflicting, most likely because of differing study designs and small numbers of patients. Megestrol acetate and mirtazapine appear to be effective for appetite stimulation and weight gain in some settings. However, applicability of the data to elderly individuals is unclear, and adverse events reported in a few of the trials and in case reports were not benign. Therefore, the use of megestrol acetate or mirtazapine for weight loss should be thoroughly evaluated on an individual basis. Pharmacotherapy should be used only after all underlying causes of weight loss are assessed and treated.
What is known and objective Few studies have evaluated the effect of vancomycin dosing on the health outcomes in geriatric patients. Data are needed to determine if higher vancomycin dosing strategies are more effective in geriatric patients and/or lead to excessive rates of adverse events. Methods This study used a subset of patients ages ≥ 65 years from a multicenter, retrospective, cohort study of methicillin resistant Staphylococcus aureus (MRSA) bacteremia. Patients received ≥ 48 hours of empiric vancomycin between 07/01/2002 and 06/30/2008. We compared the incidence of nephrotoxicity and in-hospital mortality in patients who received guideline-recommended dosing (at least 15 mg/kg/dose) to patients who received lower dosing. Multivariable generalized mixed effects models were constructed to determine independent risk factors for nephrotoxicity and in-hospital mortality. Results and discussion Half of the cohort (46% of 92 patients) received guideline-recommended dosing. Empiric use of weight-based dosing did increase the percentage of patients achieving a vancomycin trough ≥ 15 mg/L (57% vs. 42%). Nephrotoxicity occurred in 32% of patients and 26% died during their hospitalization. Guideline-recommended dosing was not associated with significant changes in nephrotoxicity (OR 1.03; 95% CI 0.38–2.82) or in-hospital mortality (OR 1.01; 95% CI 0.40–2.54) in the multivariable analysis. What is new and conclusion In this study of geriatric patients, guideline-recommended dosing was not associated with significant changes in nephrotoxicity or mortality. Since 40% of the patients who received guideline-recommended dosing failed to achieve a target vancomycin trough of ≥ 15 mg/L, future studies should focus on dosing strategies to increase target attainment rate.
Periodic monitoring of glucose should be considered for patients with dementia begun on atypical antipsychotics, although aggressive monitoring may be controversial for end-stage dementia. Overall, weight reduction and improvement in lipid parameters were observed in this study. The common metabolic adverse effects noted frequently with atypical antipsychotics may not be as much of a concern with the elderly population.
Failure to intensify diabetic medications was common in this outpatient setting. There were no disparities in the receipt of insulin therapy between white and nonwhite patients.
Objective. To assess whether the Jellybean Polypharmacy Simulation Exercise (JPSE) improved empathy in pharmacy students. Methods. The JPSE was given to all third-professional year pharmacy students in a required Special Populations course with pre-and post-scores on the Kiersma-Chen Empathy Scale (KCES) assessed, and open-ended questions on lessons learned from the exercise. Results. Pharmacy students showed a statistically significant increase in KCES scores after completing the JPSE. Open-ended question responses reflected personal growth and appreciation for patients managing difficult medication regimens. Conclusion. This polypharmacy simulation showed the ability to increase empathy in pharmacy students, as well as mimic a realistic experience in managing a multi-drug, multi-dose medication regimen.Keywords: polypharmacy, simulation, empathy INTRODUCTIONThe ability to empathize is an essential element of the health care provider-patient relationship, yet is difficult to assess formally. [1][2][3] Empathy is a core element of improving patient outcomes and has been shown to decrease the potential for litigation in the medical literature. [4][5][6][7][8] Empathy is enhanced through experiences in which an individual has the opportunity to view a situation from the perspective of another. The demographics of the pharmacy student body evaluated was different in average age and in overall health status as compared to those of the patient population represented by this exercise. It is this difference in life experience that offers an opportunity for a simulated activity to have value for inculcating empathy. With the aging of America, and the dependence of our nation's seniors on complex medication regimens for the care of chronic conditions, it is imperative for health professionals not only to understand what polypharmacy is, but how it feels. 9Given the potential impact of age and health discordance between the pharmacy learner and patient, the use of a simulated polypharmacy exercise could be an important tool for increasing the learner's empathy for those managing complex medication regimens. The Jellybean Polypharmacy Simulation Exercise (JPSE) was developed as a way to inculcate empathy for those managing multi-drug, multi-dose regimens on a daily basis. The JPSE is an eight-"prescription" regimen students manage for 7 consecutive days. This regimen includes varied dosing schedules, a drug-drug interaction that needs to be mitigated by a 2-hour separation, and meal-time dosing considerations.While multi-drug simulation exercises are not new to pharmacy education, research has focused on the ability of students to adhere to a complex regimen.10-13 Researchers have also attempted to assess the impact of interventions on empathy within simulation education; however, there is no research to date on the impact of a polypharmacy simulation on empathy using a validated empathy scale.14 The objective of this study was to determine the effectiveness of the JPSE to inculcate student METHODSAll third-year pharmacy...
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