BackgroundPolypharmacy is common in older people and associated with potential harms. The aim of this study was to analyse the characteristics of an older multimorbid population with polypharmacy and to identify factors contributing to excessive polypharmacy in these patients.MethodsThis cross-sectional analysis is based on the PRIMA-eDS trial, a large randomised controlled multicentre study of polypharmacy in primary care. Patients’ baseline data were used for analysis. A number of socioeconomic and medical data as well as SF-12-scores were entered into a generalized linear mixed model to identify variables associated with excessive polypharmacy (taking ≥10 substances daily).ResultsThree thousand nine hundred four participants were recruited. Risk factors significantly associated with excessive polypharmacy were frailty (OR 1.45; 95% CI 1.22–1.71), > 8 diagnoses (OR 2.64; 95% CI 2.24–3.11), BMI ≥30 (OR 1.18; 95% CI 1.02–1.38), a lower SF-12 physical health composite score (OR 1.47; 95% CI 1.26–1.72), and a lower SF-12 mental health composite score (OR 1.33; 95% CI 1.17–1.59) than the median of the study population (≤36.6 and ≤ 48.7, respectively). Age ≥ 85 years (OR 0.83; 95% CI 0.70–0.99) led to a significantly lower risk for excessive polypharmacy. No association with excessive polypharmacy could be found for female sex, low educational level, and smoking. Regarding the study centres, being recruited in the UK led to a significantly higher risk for excessive polypharmacy compared to being recruited in Germany 1/Rostock (OR 1.71; 95% CI 1.27–2.30). Being recruited in Germany 2/Witten led to a slightly significant lower risk for excessive polypharmacy compared to Germany 1/Rostock (OR 0.74; 95% CI 0.56–0.97).ConclusionsFrailty, multimorbidity, obesity, and decreased physical as well as mental health status are risk factors for excessive polypharmacy. Sex, educational level, and smoking apparently do not seem to be related to excessive polypharmacy. Physicians should especially pay attention to their frail, obese patients who have multiple diagnoses and a decreased health-related quality of life, to check carefully whether all the drugs prescribed are evidence-based, safe, and do not interact in an unfavourable way.Trial registrationThis trial has been registered with Current Controlled Trials Ltd. on 31 July 2014 (ISRCTN10137559).Electronic supplementary materialThe online version of this article (10.1186/s12875-018-0795-5) contains supplementary material, which is available to authorized users.
BackgroundAlthough a number of studies have evaluated the effectiveness of computerized decision-support systems (CDSS), there is lack of data on user perspectives, barriers, and facilitators to the implementation of CDSSs in real-life surroundings. The aim of this study was to assess individually perceived barriers, facilitators and ideas influencing the CDSS implementation and usability.MethodsIn this qualitative study, five focus groups were carried out with physicians and nurses separately at the Tampere City Health Center, Finland. The participants were end-users of the EBMeDS computerized decision support system. An explorative data content analysis was applied.ResultsThe most important barrier to benefitting from CDSS was the lack of structured and coded diagnosis documentation and outdated medication information in the electronic health records. This led to false alerts and distrust towards the system. Among the major facilitators found were e.g. the beneficial reminders that helped practitioners take into account matters otherwise ignored; automatic glomerular filtration rate (GFR) calculations; medication safety checks; and the summaries in the single medication review at a glance.ConclusionsPhysicians’ and nurses’ are keen to use the CDSS and it may enhance their inter-professional collaboration. Documenting patient information in a structured, uniform and easy manner is the essential starting point for electronic decision support. When implementing CDSS, managers need to focus on common practices in documenting structured data in their organizations in order to prevent undermining trust in the system.
An effective-medium model is introduced for the elasticity of two-dimensional random fiber networks. These networks are commonly used as basic models of heterogeneous fibrous structures such as paper. Using the exact Poissonian statistics to describe the microscopic geometry of the network, the tensile modulus can be expressed by a single-parameter function. This parameter depends on the network density and fiber dimensions, which relate the macroscopic modulus to the relative importance of axial and bending deformations of the fibers. The model agrees well with simulation results and experimental findings. We also discuss the possible generalizations of the model.
Holography is usually considered as the ultimate way to visually reproduce a three-dimensional scene. Computer-generated holography constitutes an important branch of holography, which enables visualization of artificially generated scenes as well as real three-dimensional scenes recorded under white-light illumination. In this article, we present a comprehensive survey of methods for synthesis of computer-generated holograms, classifying them into two broad categories: wavefront-based methods and ray-based methods. We examine their modern implementations in terms of the quality of reconstruction and computational efficiency. As it is an integral part of computer-generated holography, we devote a special section to speckle suppression, which is also discussed under two categories following the classification of underlying computer-generated hologram methods.
Rigidity percolation is analyzed in two-dimensional random fibrous networks. The model consists of central forces between the adjacent crossing points of the fibers. Two strategies are used to incorporate rigidity: adding extra constraints between second-nearest crossing points with a probability p(sn), and "welding" individual crossing points by adding there four additional constraints with a probability p(weld), and thus fixing the angles between the fibers. These additional constraints will make the model rigid at a critical probability p(sn)=p(sn)(c) and p(weld)=p(weld)(c), respectively. Accurate estimates are given for the transition thresholds and for some of the associated critical exponents. The transition is found in both cases to be in the same universality class as that of the two-dimensional central-force rigidity percolation in diluted lattices.
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