The Consultant pharmacist : the journal of the American Society of Consultant Pharmacists
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Review the clinical manifestations and treatment of primary Sjögren's syndrome. DATA SOURCES: Articles indexed in PubMed, Scopus, and the Cochrane Library in the past 10 years using the key words "Sjögren," "Sjögren's syndrome," "Sjögren's disease," and "Sjögren's syndrome AND treatment." Primary sources were used to locate additional resources. STUDY SELECTION AND DATA EXTRACTION: Forty-six publications were reviewed and criteria supporting the primary objective were used to identify useful resources. DATA SYNTHESIS: The literature included practice guidelines, review articles, original research articles, and prescribing information for the manifestations, diagnosis, and treatment of primary Sjögren's syndrome. ⋯ Primary Sjögren's syndrome is a chronic autoimmune disease with various clinical manifestations, notably dry eye, dry mouth, fatigue, and inflammatory musculoskeletal pain. Most patients are under the care of a dentist, ophthalmologist, and rheumatologist. There is currently no cure; therapy is tailored for each patient to reduce symptoms, avoid complications, and improve quality of life. Respondents to a recent survey conducted by the Sjögren's Syndrome Foundation reported using more than eight medications and treatments for their symptoms; more than 60% of respondents were older than 60 years of age. Pharmacists familiar with recommended treatment options can provide advice and counseling to Sjögren's syndrome patients on multi-drug regimens prescribed by different health care practitioners.
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To describe the prevalence of potentially inappropriate medications (PIMs) in older patients (65 years of age and older) in three selected polyclinics (PCs) and gather the perceptions of the health care providers in these PCs on the barriers and facilitators of deprescribing in their practice. To analyze the patients' age, number of active chronic diseases, and number of medicines, and investigate if they could influence the presence of PIMs. DESIGN: The study has two separate parts: The first part is a retrospective cross-sectional data collection of prescriptions; the second part is a prospective cross-sectional analysis of questionnaires by health care providers. SETTING: The study is in an institutional primary care setting. PATIENTS, PARTICIPANTS: Prescriptions were from 210 randomly selected patients 65 years of age or older with at least five long-term medications, who had attended the PCs over a selected 10-day period. Health care providers from the PCs were surveyed via an anonymous questionnaire. ⋯ PPI is a feasible drug class to start deprescribing in primary care. Knowing the barriers and facilitators would set the impetus for future work to make deprescribing more widespread and acceptable for primary care in Singapore.
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Multicenter Study
Polypharmacy in Assisted Living and Impact on Clinical Outcomes.
The purpose of this study was to describe medication use and polypharmacy in assisted living settings. We hypothesized that: 1) age, gender, race, setting, multi-morbidity, and cognitive status would influence polypharmacy; and 2) polypharmacy would be associated with falls, emergency room visits, and hospitalizations. ⋯ Continued research is needed to explore the factors that influence polypharmacy. Identification of these factors will help guide deprescribing so that medication management does not harm older adults physically or cause unnecessary financial burden.
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With the rise of the opioid epidemic in the United States and increased mortality as a result of opioid overdoses, there have been many national and statewide initiatives to combat this health crisis. Many states have expanded accessibility to naloxone, an opioid-reversal agent. Naloxone is safe, cost-effective, and nonaddictive. ⋯ While a great emphasis has been placed on the prescribing practices of health care providers as it pertains to opioid therapy for chronic pain, a new focus has been placed on coprescribing naloxone with opioids for high-risk patients. Naloxone standing orders have allowed health care providers, including pharmacists, to prescribe, dispense, and/ or administer the medication in an attempt to save lives. In addition, pharmacists play a role in counseling and educating patients, family members, caregivers, and bystanders on the safe administration of naloxone in the event of an emergency.