Background: Adverse drug reactions (ADRs), particularly in the context of polypharmacy, remain a persistent, unresolved problem for patients and healthcare professionals. The ADRe Profile identifies medicine-related harms, and supports their resolution, thereby improving care quality and preventing future problems. Objective: The objective of this study was to assess the validity and reliability of the ADRe Profile (https://www.swansea.ac.uk/adre/) in U.K. primary care general practices, building on assessments in other settings. Methods: The ADRe Profile's validity and reliability were investigated using complementary mixed methods: content validity index, contrast group construct validity, cognitive interviewing, and inter-rater reliability. Results: Cognitive interviews (n = 5) confirmed that the ADRe Profile needed only minor adjustments. The scale-level content validity index was 0.67 (n = 14), items ranging from 0.08 to 1. Significant differences in signs and symptoms associated with ADRs between service users taking different numbers of regular prescribed medicines confirmed construct validity (n = 68, U = 870.50, p < 0.001). Inter-rater reliability testing showed substantial agreement between service users and research nurse: 10 items had 100% agreement. Overall kappa mean was 0.71 (range: 0.31-1), (n = 42). Conclusions and Relevance: The ADRe Profile is suitable for use with older service users in primary care who live at home. Users understood the questions and provided meaningful answers. ADRe Profile responses were sufficiently reliable to be used as a basis for further investigations, prescriber referral and clinical actions. However, clinician judgement of content validity may depend on knowledge and experience, highlighting the importance of training. Clinicians acknowledged that the ADRe Profile was comprehensive but identified practical difficulties. Instruments to reduce ADRs should be validated before testing in feasibility studies and randomised controlled trials. Implications for Nursing Management: Managers need to optimise patient safety by introducing patient-centred symptom monitoring, with decision support. Before instruments are adopted, managers should check the reliability and validity data. Trial Registration: ClinicalTrials.gov identifier: NCT04663360.
- MeSH
- Middle Aged MeSH
- Humans MeSH
- Drug-Related Side Effects and Adverse Reactions * prevention & control MeSH
- Polypharmacy MeSH
- Surveys and Questionnaires MeSH
- Psychometrics * instrumentation methods standards MeSH
- Reproducibility of Results MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Randomized Controlled Trial MeSH
- Validation Study MeSH
- Geographicals
- United Kingdom MeSH
Asthma bronchiale je chronické, zánětlivé onemocnění dýchacích cest. Podle posledních doporučení hodnotíme tíži astmatu retrospektivně podle intenzity léčby nutné k dosažení dlouhodobé prevence symptomů a exacerbací, označované jako „kontrola astmatu“. K vyjádření intenzity léčby používáme pětistupňovou škálu a do kategorie těžkého astmatu zahrnujeme všechny pacienty ve 4. a 5. stupni léčby podle této škály. Pacienti s nedostatečně kontrolovaným těžkým astmatem by měli být odesláni k vyšetření do Národního centra pro těžké astma (NCTA). V České republice jsou pracoviště NCTA v 15 fakultních nebo krajských nemocnicích napříč republikou. Pokud se u pacientů nedaří dosáhnout kontroly astmatu ani maximální konvenční terapií, tedy podle doporučení pro 5. stupeň léčby, při současné dobré adherenci k léčbě a vyloučení či adekvátní léčbě komorbidit (těžké refrakterní astma), měli bychom vždy zvážit možnosti biologické léčby dříve, než zahájíme preventivní terapii systémovými kortikosteroidy. V posledních letech zaznamenáváme rostoucí počet pacientů v NCTA i pacientů na biologické léčbě. Dostupnost biologické léčby astmatu se v posledním roce v České republice zvýšila také díky zmírnění úhradových kritérií. Pacienti na biologické léčbě často využívají možností domácí aplikace. Pracoviště NCTA v současnosti disponují kapacitou pro příjem nových pacientů v přiměřených časových lhůtách.
Asthma is a chronic inflammatory airway disease. Following current recommendations, we retrospectively assess the severity of asthma based on the intensity of treatment required to achieve long-term symptoms control and prevent exacerbations, known as “asthma control”, using a fivestep treatment intensity scale. All patients on Step 4 and Step 5 are included in the severe asthma group. Patients with poorly controlled severe asthma should be referred to the National Centre for Severe Asthma (NCSA). There are 15 sites in faculty or regional hospitals in the Czech Republic included to the NCSA. We should always consider biologics in the patients with uncontrolled asthma despite maximal conventional therapy on Step 5, good adherence to treatment and exclusion of comorbidities (severe refractory asthma patients) before starting oral corticosteroid therapy. The number of patients in NCSA and patients on biologics has increased in recent years. The availability of biologics has also increased in the Czech Republic in the last year due to a change in the reimbursement criteria, which are more lenient. Patients on biologic therapy are often on home use therapy. NCSA in the Czech Republic currently has the capacity to admit new patients within a reasonable timeframe.
- MeSH
- Biological Therapy statistics & numerical data MeSH
- Asthma * therapy MeSH
- Tertiary Care Centers MeSH
- Humans MeSH
- Antibodies, Monoclonal therapeutic use MeSH
- Check Tag
- Humans MeSH
- Geographicals
- Czech Republic MeSH
BACKGROUND: Person-centred care (PCC) is a fundamental principle in general practice, emphasising practices tailored to individual patient preferences, needs, and values. Despite the importance of PCC, general practitioners (GPs) face obstacles in effectively implementing it, with associated factors remaining unclear. OBJECTIVES: The PACE GP/FP study aims to explore GPs' attitudes towards PCC and the factors facilitating or hindering its implementation in daily practice across European countries. This paper outlines the PACE GP/FP study protocol. METHODS: The cross-sectional design with data collection via an online survey distribution to GPs in 24 European countries. Study instruments include two validated questionnaires (Perceived Stress Scale (PSS) and Patient Physician Orientation Scale (PPOS)) and additional items covering general information about the doctor and their practice, as well as facilitators and barriers to PCC. These additional items were specifically developed for the study, translated using the forward-backward method, evaluated through cognitive debriefing, and integrated into the REDCap platform to create language and country-specific survey links. The STROBE checklist guides the reporting of the manuscript. CONCLUSION: The PACE GP/FP study will provide a comprehensive exploration of GPs' attitudes towards PCC and the factors shaping its practice in Europe. The findings from the PACE GP/FP study will provide evidence for designing future implementation strategies and guide targeted interventions to promote PCC in primary care across Europe.
- MeSH
- Humans MeSH
- Patient-Centered Care * MeSH
- Attitude of Health Personnel * MeSH
- General Practice organization & administration MeSH
- General Practitioners * psychology MeSH
- Cross-Sectional Studies MeSH
- Surveys and Questionnaires MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Geographicals
- Europe MeSH
Cíl: Cílem výzkumu bylo posouzení kognitivních funkcí u seniorů v domovech pro seniory prostřednictvím standardizovaných testů – Montrealský kognitivní test (MoCA) a Pojmenování obrázků a jejich vybavení (POBAV). Metodika: Výzkum zahrnoval 76 klientů ze tří domovů pro seniory. Hodnocení kognitivních funkcí bylo provedeno standardizovanými testy MoCA a POBAV (ježková verze). Statistické zpracování bylo provedeno na hladině významnosti a = 0,05. Výsledky: Průměrný skór v MoCA byl 20 bodů, průměrné výsledky u POBAV byly 3/5. Normální kognitivní stav mělo dle MoCA (při hraničním skóre ≤ 24 bodů) 21 % seniorů a dle POBAV dosáhlo normy 25 % dotázaných. U obou testů MoCA a POBAV nebyl zjištěn statisticky významný rozdíl v úrovni kognitivních funkcí v závislosti na pohlaví, vzdělání ani na délce pobytu v domově pro seniory. Byl však prokázán statisticky významný rozdíl v úrovni kognitivních funkcí v závislosti na věku, kognitivním tréninku i na kondičním cvičení a bylo zjištěno, že osoby absolvující kognitivní trénink a kondiční cvičení dosahují v obou testech lepších výsledků. Byla potvrzena shoda v detekci kognitivní poruchy pomocí MoCA a POBAV v 97 % případů. Mezi testy MoCA a POBAV byla zjištěna významná korelace. Pearsonův korelační koeficient mezi testy MoCA a POBAV – Chyby v pojmenování obrázků, znázorňuje negativní korelaci –0,625 (p < 0,001). Pearsonův korelační koeficient mezi testy MoCA a POBAV – Správně vybavené obrázky, představuje pozitivní korelaci 0,86 (p < 0,001). Závěr: Časný záchyt a monitoring kognitivního deficitu pomocí screeningových testů by měly být nedílnou součástí při poskytování dlouhodobé péče u seniorů. Test POBAV je vhodnou volbou pro včasný záchyt kognitivního deficitu a může sloužit jako srovnatelná alternativa testu MoCA.
Aim: The aim of the research was to assess cognitive functions of elderly people in nursing homes using standardized tests – Montreal Cognitive Assessment (MoCA) and Picture Naming and Immediate Recall (PICNIR). Methodology: The study included 76 clients from three nursing homes. The assessment of cognitive functions was carried out using the standardized tests MoCA and PICNIR (Hedgehog Version). Statistical processing was performed at a significance level of α = 0.05. Results: The average score in MoCA was 20 points, and the average results in PICNIR were 3/5. According to MoCA (with a threshold score of ≤ 24 points), 21% of elderly people had a normal cognitive state, and according to PICNIR, 25% of respondents reached the norm. No statistically significant difference in the level of cognitive functions was found in either the MoCA or PICNIR tests in relation to sex, education, or length of stay in the nursing home. However, a statistically significant difference in the level of cognitive functions was demonstrated in relation to age, cognitive training, and physical exercise, and it was found that individuals undergoing cognitive training and physical exercise achieved better results in both tests. A concordance in the detection of cognitive impairment using MoCA and PICNIR was confirmed in 97% of cases. A significant correlation was found between the MoCA and PICNIR tests. The Pearson correlation coefficient between MoCA and PICNIR – Mistakes in Naming demonstrated a negative correlation of –0.625 (P < 0.001). The Pearson correlation coefficient between MoCA and PICNIR – Correctly Recalled Picture Names indicated a positive correlation of 0.86 (P < 0.001). Conclusion: Early detection and monitoring of cognitive deficits using screening tests should be an integral part of providing long-term care for elderly people. The PICNIR test is a suitable choice for early detection of cognitive deficits and can serve as a comparable alternative to the MoCA test.
- MeSH
- Homes for the Aged statistics & numerical data MeSH
- Epidemiologic Studies MeSH
- Cognition MeSH
- Correlation of Data MeSH
- Humans MeSH
- Neurocognitive Disorders * diagnosis epidemiology MeSH
- Neuropsychological Tests * statistics & numerical data MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Mental Status and Dementia Tests statistics & numerical data MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
OBJECTIVE: The aim of this study was to determine the prevalence of potentially inappropriate medications (PIMs) in nursing home residents across eight countries and investigate differences between residents with and without cognitive impairment, as well as those with and without life expectancy of six months or less. METHODS AND DEIGN: The study utilized the second edition of the STOPP-Frail criteria to operationalize PIMs in the baseline assessment of nursing home residents participating in the Services and Health for Elderly in Long TERm care (SHELTER) project. The data were collected between 2009 and 2012. The project was conducted in eight countries: Czech Republic, England, Finland, France, Germany, Italy, the Netherlands, and Israel. Cognitive impairment was measured by the cognitive performance scale (CPS). The presence of end-stage disease with a life expectancy of six months or less was recorded. The study included residents aged 60 years or older who underwent a valid medication assessment. RESULTS: Among the 3,832 eligible residents, 87.9% had at least one PIM. Specifically, 24.3%, 23.5%, 18.8%, and 19.3% of residents had one, two, three, and four or more PIMs, respectively. On average, each person was prescribed 2.16 PIMs. Cognitively impaired residents (n = 1999) had an average of 1.96 PIMs (SD 1.49) per person, while residents with a low CPS score (n = 1783) had an average of 2.40 PIMs (SD 1.57) per person, showing a statistically significant difference (P < 0.001). Similarly, NH residents with life expectancy of six months or less had an average of 1.66 PIMs (SD 1.30), whereas those without had an average of 2.17 PIMs (SD 1.55) (p < 0.001). The average number of PIMs varied across countries, ranging from 3.23 in Finland to 2.15 in the UK (P < 0.001). Anti-platelets and aspirin were the most prescribed PIMs, accounting for over 38.0% of prescriptions. CONCLUSIONS: This study highlights the high prevalence of PIMs among nursing home residents. However, PIMs were somewhat lower in residents with cognitive impairment and life expectancy of six months or less. Efforts must continue to improve the rationale behind prescribing practices in nursing homes.
- MeSH
- Homes for the Aged MeSH
- Frail Elderly MeSH
- Middle Aged MeSH
- Humans MeSH
- Inappropriate Prescribing statistics & numerical data MeSH
- Nursing Homes * MeSH
- Prevalence MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Potentially Inappropriate Medication List * MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
- Geographicals
- Germany MeSH
Introduction: Nurse activities play an important role in the prevention of falls in old age, both in home care and institutional care. Objective: The aim of this study is to investigate nurses' falls prevention practices and the factors influencing them. Methods: A cross-sectional descriptive study was conducted between December 1, 2022, and February 16, 2023, using a self-designed questionnaire that included a knowledge test of falling and an attitude scale related to falling. Results: 442 nurses working in health or social care in Csongrád-Csanád county, Hungary, participated in the survey. Significant differences in fall prevention practices were found by sex (p = 0.03), age (p = 0.02), work experience (p = 0.03), fall experience (p = 0.001), information received at work (p < 0.001), presence of a risk assessment scale (p < 0.001), and presence of a fall prevention protocol (p < 0.001). Positive correlations were detected between practical activity and attitude (r = 0.42, p < 0.001), and knowledge and attitude (r = 0.40, p < 0.001). Nurses' fall prevention activities were significantly influenced by their attitudes towards falls (β = 0.43, p < 0.001). Conclusion: Our study highlights the need to improve fall prevention practice with the help of further education and case discussions. This may improve attitudes and communication within the team regarding fall prevention.
BACKGROUND: Cardiac rehabilitation is a beneficial multidisciplinary treatment of exercise promotion, patient education, risk factor management, and psychosocial counseling for people with coronary heart disease (CHD) that is underutilized due to substantial disparities in access, referral, and participation. Empirical studies suggest that cardiac telerehabilitation (CTR) have safety and efficacy comparable to traditional in-person cardiac rehabilitation, however, older adults are under-reported with effectiveness, feasibility, and usability remains unclear. METHODS: The study randomized 43 older adults (84 % males) to the 12-week CTR intervention or standard of care. Guided by Social Cognitive Theory, participants received individualized in-person assessment and e-coaching sessions, followed by CTR usage at home. Data were collected at baseline (T0), six-week (T1), and 12-week (T2). RESULTS: Participants in the CTR intervention group showed significant improvement in daily steps (T1: β = 4126.58, p = 0.001; T2: β = 5285, p = 0.01) and health-promoting lifestyle profile (T1: β = 23.26, p < 0.001; T2: β = 12.18, p = 0.008) across study endpoints. Twenty participants completed the intervention, with 40 % used the website for data-uploading or experiential learning, 90 % used the pedometer for tele-monitoring. Improving awareness of rehabilitation and an action focus were considered key facilitators while physical discomforts and difficulties in using the technology were described as the main barriers. CONCLUSIONS: The CTR is feasible, safe and effective in improving physical activity and healthy behaviors in older adults with CHD. Considering the variation in individual cardiovascular risk factors, full-scale RCT with a larger sample is needed to determine the effect of CTR on psychological symptoms, body weight and blood pressure, and quality of life.
- Publication type
- Journal Article MeSH
BACKGROUND: Adequate postoperative pain treatment is important for quality of life, patient satisfaction, rehabilitation, function, and total opioid consumption, and might lower both the risk of chronic postoperative pain and the costs for society. Prolonged opioid consumption is a well-known risk factor for addiction. Previous studies in upper extremity surgery have shown that total opioid consumption is a third of the amount prescribed, which can be explained by package size. The aim of this study was to examine whether implementation of prepacked takehome analgesia bags reduced the quantity of prescribed and dispensed opioids. MATERIAL AND METHODS: We introduced prepacked take-home analgesia bags for postoperative pain treatment in outpatient surgery. The bags came in two sizes, each containing paracetamol, etoricoxib, and oxycodone. The first 147 patients who received the prepacked analgesia bags were included in the study, and received a questionnaire one month after surgery covering self-assessed pain (visual analog scale of 0-10) and satisfaction (0-5), as well as opioid consumption. Prescription data after introducing the analgesia bags were compared with data before the bags were introduced. RESULTS: Of the 147 patients included in the study, 58 responded. Compared to standard prescription (small bag group: 14 oxycodone immediate release capsules (5 mg), large bag group: additional 28 oxycodone extended release tablets (5 mg), based on the smallest available package), the patients in the small analgesia bag group received 50% less oxycodone and 67% less for the large bag group. Patients with small bags consumed a median of 0.0 mg oxycodone and those with large bags consumed a median of 25.0 mg oxycodone. The median satisfaction was 5.0 (range: 2-5) and the median pain score was acceptable at the first postoperative day. Prescription data showed a significant reduction of 60.0% in the total amount of prescribed opioids after the introduction of prepacked analgesia bags. CONCLUSIONS: The introduction of prepacked analgesia bags dramatically reduced the quantity of opioids prescribed after outpatient hand surgery. Patient satisfaction was high and the postoperative pain level was acceptable. KEY WORDS: analgesia, hand surgery, opioids, outpatint surgery, wrist surgery.
- MeSH
- Ambulatory Surgical Procedures * methods MeSH
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Pain Management methods MeSH
- Pain Measurement MeSH
- Analgesics, Opioid * administration & dosage MeSH
- Oxycodone administration & dosage MeSH
- Acetaminophen administration & dosage therapeutic use MeSH
- Pain, Postoperative * prevention & control drug therapy MeSH
- Hand surgery MeSH
- Patient Satisfaction MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
This study aimed to create a Czech questionnaire for pediatric obstructive sleep apnea (POSA) risk screening, a first of its kind in the Czech Republic, where options for child polysomnography are limited. Compiling items from established English questionnaires and supplementing them with additional items, we designed the first version of the Czech questionnaire and tested it in a pilot study with parents of 30 children. After pilot feedback, a revised version with dichotomous and 5-item Likert scale questions was tested on 71 children's parents. All children (7-12 years old) underwent a home sleep apnea test to record their apnea-hypopnea index (AHI). The second (40-item) version showed high reliability (93%), with 17 items identified as the most significant. Findings from the final 17-item SEN CZ questionnaire correlated positively with AHI (p < 0.001), demonstrating 84% sensitivity, 86% specificity, and 93% reliability. Three factors, namely breathing problems, inattention, and hyperactivity (characterized by multiple items), were identified to form a higher-order factor of POSA risk, which was further supported by the correlations of their total scores with AHI (p < 0.001). The resulting SEN CZ questionnaire can serve as a tool for POSA risk screening in the Czech Republic without the need to involve medical professionals.
- MeSH
- Child MeSH
- Humans MeSH
- Sleep Apnea, Obstructive * diagnosis epidemiology MeSH
- Pilot Projects MeSH
- Mass Screening methods MeSH
- Polysomnography methods MeSH
- Surveys and Questionnaires MeSH
- Reproducibility of Results MeSH
- Risk Factors MeSH
- Check Tag
- Child MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Geographicals
- Czech Republic MeSH
INTRODUCTION: Previous research has raised concerns about high prevalence of drug-related problems, polypharmacy and inappropriate benzodiazepine prescribing in nursing homes (NHs) and confirmed lack of studies from Central and South-Eastern Europe. The aim of our study was to determine the prevalence and characteristics of polypharmacy, hyperpolypharmacy and inappropriate benzodiazepine prescribing in NH residents in Croatia. METHODS: Data from 226 older NH residents from five Croatian NHs were collected using the InterRAI Long-Term Care Facilities assessment form. The prevalence and determinants of polypharmacy/hyperpolypharmacy and patterns of inappropriate benzodiazepine prescribing were documented. RESULTS: The prevalence of polypharmacy (49.6%) and hyperpolypharmacy (25.7%) among NH residents was high. In our study, 72.1% of NH residents were prescribed at least one psychotropic agent, 36.7% used 2-3 psychotropics and 6.6% used 4+ psychotropics. Among benzodiazepine users (55.8%), 28% of residents were prescribed benzodiazepines in higher than recommended geriatric doses, 75% used them for the long term and 48% were prescribed concomitant interacting medications. The odds of being prescribed polypharmacy/hyperpolypharmacy were significantly higher for older patients with polymorbidity (6+ disorders, proportional odds ratio (POR) = 19.8), type II diabetes (POR = 5.2), ischemic heart disease (POR = 4.6), higher frailty (Clinical Frailty Scale (CFS ≥5); POR = 4.3) and gastrointestinal problems (POR = 4.8). CONCLUSIONS: Our research underscores the persistent challenge of inappropriate medication use and drug-related harms among older NH residents, despite existing evidence and professional campaigns. Effective regulatory and policy interventions, including the implementation of geriatrician and clinical pharmacy services, are essential to address this critical issue and ensure optimal medication management for vulnerable NH populations.
- MeSH
- Benzodiazepines * therapeutic use adverse effects administration & dosage MeSH
- Homes for the Aged statistics & numerical data MeSH
- Practice Patterns, Physicians' statistics & numerical data standards MeSH
- Humans MeSH
- Inappropriate Prescribing * statistics & numerical data MeSH
- Nursing Homes * statistics & numerical data MeSH
- Polypharmacy * MeSH
- Prevalence MeSH
- Psychotropic Drugs therapeutic use adverse effects MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Geographicals
- Croatia MeSH
