The American journal of geriatric pharmacotherapy
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Am J Geriatr Pharmacother · Feb 2009
Randomized Controlled Trial Comparative StudyEfficacy and safety profile of a single dose of hydromorphone compared with morphine in older adults with acute, severe pain: a prospective, randomized, double-blind clinical trial.
Older adults (ie, those aged > or =65 years) are the fastest growing segment of the US population, with an estimated approximately 71 million expected by 2030. Over the past 10 years, there has been an 11% increase in the number of emergency department (ED) visits by older adults, and pain is their most common chief complaint. ⋯ A single dose of IV hydromorphone at 0.0075 mg/kg was neither clinically nor statistically different from IV morphine at 0.05 mg/kg for the treatment of acute, severe pain at 30 minutes postbaseline in these older adults in the ED. The incidence of adverse effects was not statistically different. Our data suggest that hydromorphone and morphine in the doses given had similar efficacy and safety profiles in these older adults. Neither regimen provided > or =50% pain relief for the majority of patients. Future investigations of acute pain management in older adults should examine the efficacy and safety of higher initial (loading) doses of opioids titrated at frequent intervals until adequate analgesia is achieved.
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Am J Geriatr Pharmacother · Oct 2008
Comparative StudyAddressing delays in medication administration for patients transferred from the hospital to the nursing home: a pilot quality improvement project.
Patients being transferred to a nursing home (NH) after an acute hospitalization are subject to adverse effects, including medication errors, related to poor coordination of care across settings. ⋯ The intervention to improve patient safety by reducing medication delays for patients making the transition from the hospital to the NH was not successfully implemented, as medication orders were not transmitted to the NH-contracted pharmacies before patients' arrival at the NH. All patients making the transition from hospital to NH experienced a >12-hour delay in medication administration, and the mean number of missed doses of medications was >3. There is a need for further exploration of the reasons for and possible solutions to delays in medication administration during the transition to the NH, as well as of the impact of such delays on patient outcomes, including adverse drug events, emergency department visits, and rehospitalizations.
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Am J Geriatr Pharmacother · Oct 2008
Quantification and classification of errors associated with hand-repackaging of medications in long-term care facilities in Germany.
The aim of this study was to quantify and classify errors associated with the repackaging of residents' medications in long-term care facilities in Germany. ⋯ Among 48,512 medications inspected over 8 weeks in 3 German long-term care facilities, the rate of repackaging errors was 1.3%, involving 7.3% of daily pill organizers and the medications of 53.00% of residents. The largest proportion of errors involved incorrect halving of tablets.
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Am J Geriatr Pharmacother · Aug 2008
Comparative StudyRisk of hospitalizations/emergency department visits and treatment costs associated with initial maintenance therapy using fluticasone propionate 500 microg/salmeterol 50 microg compared with ipratropium for chronic obstructive pulmonary disease in older adults.
Cost-effective treatments for chronic obstructive pulmonary disease (COPD) are needed to reduce the burden on the Medicare system. ⋯ Compared with the IPR cohort, the FSC 500/50 cohort was 45% less likely to have a COPD-related exacerbation event and had similar medical costs. FSC 500/50 was a more effective initial maintenance therapy than IPR for this Medicare population, and, despite the $260 increase in COPD-related pharmacy costs, there was no significant difference in COPD-related medical costs.
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Am J Geriatr Pharmacother · Aug 2008
Comparative StudyComparison of estimated glomerular filtration rate with estimated creatinine clearance in the dosing of drugs requiring adjustments in elderly patients with declining renal function.
The National Kidney Foundation's practice guidelines for chronic kidney disease recommend using the Modification of Diet in Renal Disease (MDRD) equation for calculating the estimated glomerular filtration rate (GFR). ⋯ Although an MDRD equation may be useful for estimating GFR, the CG(CrCl)-Eq should still be used for drug dosage adjustments. The CG(CrCl)-Eq may require a slight "adjustment factor" to be applied using serum creatinine values measured by newly established assay procedures.