The algorithm captures a range of different clinical scenarios in relation to potentially inappropriate medications, and offers an evidence-based approach to identifying and, if appropriate, discontinuing such medications. Studies are required to evaluate algorithm effects on prescribing decisions and patient outcomes. Geriatr Gerontol Int 2016; 16: 1002-1013.

Different BZDs may vary in their propensity to predispose to falls, with diazepam having the strongest association. The selection of particular BZDs for older patients should be carefully evaluated.

BackgroundUse of antipsychotic (AP) medications is high and often inappropriate among institutionalized populations. Little is known about the correlates of new AP drug use following admission to long-term care (LTC) settings. This study investigated the frequency and correlates of new AP drug use among newly admitted LTC residents.MethodsThis longitudinal, retrospective study used data from the interRAI - Nursing Home Minimum Data Set version 2.0 (MDS 2.0) instrument. Data about demographic, clinical and social characteristics, and medication use, were collected in Ontario, Canada, from 2003–2011 by trained nurses. Residents with complete admission and 3–6 month follow-up data were included (N = 47,768). Multivariate logistic regression analyses, stratified by gender, explored correlates of new AP drug use upon admission to LTC.ResultsNew AP drug users comprised 7 % of the final cohort. Severe cognitive impairment, dementia, and motor agitation were significantly associated with new AP drug use among both sexes. Additionally, behavioural problems, conflicts with staff and reduced social engagement were strong correlates of new AP drug use.ConclusionsSocial factors were as strongly associated with new AP drug use after LTC admission as clinical factors. Strategies to prevent the potential misuse of AP drugs upon LTC admission should consider the social determinants of such prescribing.

No abstract

2016-11-03T14:11:40

Angiogenesis plays a crucial role in tumor progression. Prominent among angiogenic factors is vascular endothelial growth factor (VEGF). VEGF is produced by cancer cells as well as by the cells infiltrating tumor stroma, mainly macrophages. Macrophage activation may be assessed by measuring serum or urinary neopterin. Systemic inflammatory response could be evaluated by measuring serum C-reactive protein concentrations. The aim of the present study was to examine the effect of a regimen combining dose dense combination of doxorubicin and cyclophosphamide with sequential weekly paclitaxel on plasma VEGF, urinary neopterin and serum C-reactive protein concentrations. Thirty-four female patients with histologically verified breast carcinoma treated with dose-dense regimen combining doxorubicin and cyclophosphamide with sequential weekly paclitaxel administration were studied. Plasma VEGF was measured by enzyme-linked immunosorbent assay. Urinary neopterin was determined by high performance liquid chromatography. Compared to baseline plasma VEGF was significantly decreased one week after the start of therapy. VEGF concentrations subsequently increased, but this increase was significant compared to baseline only at week 16. Urinary neopterin was significantly increased compared to baseline at every visit with the exception of visits 12 and 20 at which the significance was borderline. Serum C-reactive protein was increased compared to baseline only at visits 4, 6 and 8. A positive correlation was observed between plasma VEGF and serum C-reactive protein at baseline and at visits 5 and 19. Significant correlations were observed between serum C-reactive protein and urinary neopterin at visits 6, 7, 9, 11, 14, 15 and 17. In conclusion, only minor changes in plasma VEGF and serum C-reactive protein were observed during dose-dense chemotherapy. In contrast, urinary neopterin was increased throughout the course of treatment. Correlations between VEGF and C-reactive protein and between Creactive protein and urinary neopterin were observed only at some time points.