interventions may reduce polypharmacy and the use of potentially inappropriate medications (PIMs); however, few studies have been large enough to evaluate the impact that deprescribing may have on adverse drug events (ADEs).OBJECTIVE To evaluate the effect of an electronic deprescribing decision support tool on ADEs after hospital discharge among older adults with polypharmacy.DESIGN, SETTING, AND PARTICIPANTS This was a cluster randomized clinical trial of older (Ն65 years) hospitalized patients with an expected survival of more than 3 months who were
Introduction
Frailty is a robust predictor of adverse outcomes in older people. Practice guidelines recommend routine screening for frailty; however, this does not occur regularly. The Clinical Frailty Scale (CFS) is a validated, feasible instrument that can be used in a variety of clinical settings and is associated with many adverse outcomes. Our objective was to develop and evaluate an online training module to guide frailty assessment using the CFS.
Methods
A multidisciplinary team of clinical experts developed an evidence-based, theory-grounded online training module for users who wished to perform frailty assessment using the CFS. The module was prospectively evaluated for user satisfaction, effectiveness and feasibility using a standardised questionnaire. Qualitative feedback was analysed with thematic analysis.
Results
Version 1 of the CFS module was used 627 times from 21 October 2019 to 24 March 2020. Satisfaction, effectiveness and feasibility of the module were positively rated (≥4/5 on a 5-point Likert scale n = 582 [93%], n = 507, [81%], n = 575, [91%], respectively). Qualitative feedback highlighted ease of use, likelihood of users to share the module with others and opportunities to increase multimedia content.
Conclusion
An online tutorial, designed using evidence and theory to guide frailty assessment using the CFS, was positively rated by users. The module’s content and structure was rated effective and feasible, and users were satisfied with, and likely to share, the module. Research evaluating the module’s impact on the accuracy of frailty assessment is required.
Most of the evidence for the use of statins in heart failure originates from retrospective trials and post-hoc analyses, and is not supported by prospective randomized clinical trials. There is no evidence to support initiating statin therapy in patients with symptomatic New York Heart Association II-IV heart failure, regardless of the cause.
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