Age and ageing
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Review Meta Analysis
Pharmacist-led interventions to reduce unplanned admissions for older people: a systematic review and meta-analysis of randomised controlled trials.
medication problems are thought to cause between 10 and 30% of all hospital admissions in older people. This systematic review aimed to evaluate the effectiveness of interventions led by hospital or community pharmacists in reducing unplanned hospital admissions for older people. ⋯ evidence from three randomised controlled trials suggests that interventions led by hospital pharmacists reduce unplanned hospital admissions in older patients with heart failure, although these trials were heterogeneous. Data from 16 trials do not support the concept that interventions led by hospital or community pharmacists for the general older population reduces unplanned admissions.
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a growing number of older patients undergo cardiac surgery. Some of these patients are at increased risk of post-operative functional decline, potentially leading to reduced quality of life and autonomy, and other negative health outcomes. First step in prevention is to identify patients at risk of functional decline. There are no current published tools available to predict functional decline following cardiac surgery. ⋯ the amended ISAR-HP used in older cardiac surgery patients showed good discriminative values at score ≥1, supporting the generalisability of this prediction model for this patient group.
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The Neuberger report failed to show that the Liverpool Care Pathway was the cause of poor end-of-life care and made it the scapegoat for poor communication and faulty decision-making. The report's discrediting of a quality assurance mechanism that had the potential for improvement is a disservice to dying patients. Several of the report's recommendations are puzzling, but two consequences of the report, an excellent review of care pathways and a recommendation to establish a national end-of-life coalition, have the potential to improve care of the dying individual.
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rapid specialist assessment of patients with transient ischaemic attack (TIA) reduces the risk of recurrent stroke. National guidelines advise that high-risk patients are assessed within 24 h and low-risk patients within 7 days. ⋯ factors contributing to delay include incorrect interpretation of symptoms and failure to invoke emergency services. Delays after presentation could be addressed by direct referral by out of hours services, paramedics and optometrists.