The British journal of general practice : the journal of the Royal College of General Practitioners
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Involving patients and carers in decisions that influence the delivery of health services is a statutory requirement across the NHS. However, current evidence suggests a gap exists between the theory, legislation and policy intentions and their practical implementation. ⋯ The literature suggests that no existing framework addresses all three key themes. Therefore, a revised framework for involvement was developed, informed by the three key themes, that can be tested across a larger sample and different healthcare settings.
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Little is known about the impact of hospitalisation on prescribing in UK clinical practice. ⋯ Perceptions that hospitalisation is a consistent factor driving rises in polypharmacy are unfounded. Increases in prescribing post-hospitalisation reflect appropriate clinical response to acute illness, whereas decreases are more likely in patients who are multimorbid, reflecting a focus on deprescribing and medicines optimisation in these individuals. Increases in PIPs remain a concern.
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There is growing interest in the role of vitamin D in extra-skeletal health, including postural hypotension. Postural hypotension is found in 1 in 5 community-dwelling adults aged 60 years and above. It increases risk of falls, fractures, cardiovascular disease and all-cause mortality. Better understanding of the aetiology of postural hypotension may help yield more effective treatment options than those that are currently available. ⋯ In this study, vitamin D deficiency was associated with increased risk of postural hypotension. Further research may help clarify whether treating vitamin D deficiency can reduce the degree of postural hypotension, or if preventing the progression to vitamin D deficiency can reduce the incidence of postural hypotension.