Background:
Polypharmacy remains problematic for individuals ≥65.
Objective:
To summarise the percentages of patients meeting 2015 STOPP criteria for Potentially
Inappropriate Prescriptions (PIPs), 2015 Beers criteria for Potentially Inappropriate Medications
(PIMs), and START criteria Potential Prescribing Omissions (PPOs).
Methods:
Searches conducted on 2 January 2019 in Medline, Embase, and PubMed identified 562
studies and 62 studies were retained for review. Data were abstracted independently.
Results:
62 studies (n=1,854,698) included two RCTs and 60 non-randomised studies. For thirty
STOPP/START studies (n=1,245,974) average percentages for ≥1 PIP weighted by study size were
42.8% for 1,242,010 community patients and 51.8% for 3,964 hospitalised patients. For nineteen
Beers studies (n = 595,811) the average percentages for ≥1 PIM were 58% for 593,389 community
patients and 55.5% for 2,422 hospitalised patients. For thirteen studies (n=12,913) assessing both
STOPP/START and Beers criteria the average percentages for ≥1 STOPP PIP were 33.9% and
Beers PIMs 46.8% for 8,238 community patients, and for ≥ 1 STOPP PIP were 42.4% and for ≥1
Beers PIM 60.5% for 4,675 hospitalised patients. Only ten studies assessed changes over time and
eight found positive changes.
Conclusions:
PIP/PIM/PPO rates are high in community and hospitalised patients in many countries.
RCTs are needed for interventions to: reduce new/existing PIPs/PIMs/PPO prescriptions, reduce
prescriptions causing adverse effects, and enable regulatory authorities to monitor and reduce
inappropriate prescriptions in real time. Substantial differences between Beers and STOPP/START
assessments need to be investigated whether they are due to the criteria, differential medication
availability between countries, or data availability to assess the criteria.
There are high rates of trauma in MMA. The authorities who regulate MMA and referees and physicians who monitor MMA fighters have an inadequate database to guide their work. Researchers need to adopt the same set of complete definitions of all possible injuries and measure the high and early rate of neurological damage.
Purpose To investigate the effects of four office chairs on the postural angles of the lumbopelvic and cervical regions. Research question Which chair(s) produce an ''ideal'' spinal posture? Methods An experimental same subject design was used involving healthy subjects (n = 14) who conducted a typing task whilst sitting on four different office chairs; two ''dynamic'' chairs (Vari-Kneeler and Swopper), and two static chairs (Saddle and Standard Office with back removed). Data collection was via digital photogrammetry, measuring pelvic and lumbar angles, neck angle and head tilt which were then analysed within MatLab. A repeated measures ANOVA with Bonferroni corrections for multiple comparisons was conducted. Results Statistically significant differences were identified for posterior pelvic tilt and lumbar lordosis between the Vari-Kneeler and Swopper chairs (p = 0.006, p = 0.001) and the Vari-Kneeler and Standard Office chairs (p = 0.000, 0.000); and also for neck angle and head tilt between the Vari-Kneeler and Swopper chairs (p = 0.000, p = 0.000), the Vari-Kneeler and Saddle chairs (p = 0.002, p = 0.001), the Standard Office and Swopper chairs (p = 0.000, p = 0.000), and the Standard Office and Saddle chairs (p = 0.005, p = 0.001). This study confirms a within region association between posterior pelvic tilt and lumbar lordosis, and between neck angle and head tilt. It was noted that an ideal lumbopelvic position does not always result in a corresponding ideal cervical position resulting in a spinal alignment mismatch. Conclusion In this study, the most appropriate posture for the lumbopelvic region was produced by the Saddle chair and for the cervical region by both the Saddle and Swopper chairs. No chair consistently produced an ideal posture across all regions, although the Saddle chair created the best posture of those chairs studied. Chair selection should be based on individual need.
There are published data on 20,210 Taekweondo competitors. Only 8/18 studies reported prior injuries. Longitudinal studies are needed of injuries, ascertainment of causes, identify participants with higher rates, measure the results of preventive measures, rule change to exclude head kicks, and encourage non-contact Taekwondo especially for participants with high injury rates.
There is moderate quality evidence to suggest that family-based interventions can have a positive effect on preventing children and adolescents from starting to smoke. There were more studies of high intensity programmes compared to a control group receiving no intervention, than there were for other compairsons. The evidence is therefore strongest for high intensity programmes used independently of school interventions. Programmes typically addressed family functioning, and were introduced when children were between 11 and 14 years old. Based on this moderate quality evidence a family intervention might reduce uptake or experimentation with smoking by between 16 and 32%. However, these findings should be interpreted cautiously because effect estimates could not include data from all studies. Our interpretation is that the common feature of the effective high intensity interventions was encouraging authoritative parenting (which is usually defined as showing strong interest in and care for the adolescent, often with rule setting). This is different from authoritarian parenting (do as I say) or neglectful or unsupervised parenting.
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