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Background Potentially inappropriate prescribing (PIP) is usually associated with a higher risk of adverse health outcomes. It is therefore important to identify PIP in older adults. However, there are no clear prioritisation strategies to select patients requiring prescription reviews. Aim The aim of this study was to assess the association between the identification of seniors at risk (ISAR) score and the number of PIPs. Method A 12-month retrospective hospital-based study was conducted. PIPs, including potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs), were detected using the STOPP/START tool. Multivariate linear regressions were conducted to identify factors associated with the number of PIPs. Sensitivity, specificity, Youden index, and ROC curve were calculated to determine the predictive power of ISAR score. Results This study included 266 records. The analysis led to the detection of 420 PIMs and 210 PPOs, with a prevalence of 80.1% and 54.9%, respectively. Multivariate linear regression revealed that the ISAR score ( p  = 0.041), and the number of medications ( p  < 0.001) were determinants of PIP. The number of medications remained the sole determinant of the number of PIMs ( p  < 0.001), while living in a nursing home was the only determinant of the number of PPOs ( p  = 0.036). Conclusion The study showed that the ISAR score and the number of medications were independently associated with the number of PIPs. Considering the use of the ISAR score and the number of medications may be useful strategies to prioritise patients for whom prescribing appropriateness should be assessed using explicit criteria.

ObjectiveThe main objective was to develop a policy for the management of patients’ own medications (POM) in a tertiary university hospital and to evaluate the outcomes of its implementation. The secondary objective was to explore the effects of introducing a policy on the incidence and severity of drug-related problems (DRPs).MethodsThe implementation evaluation was based on the mixed method using the RE-AIM model (reach, effectiveness, adoption, implementation and maintenance). Each POM was analysed to identify the cause and severity of the DRP (pre-implementation and after 1 week, 3 months and 1 year). Three months after the implementation, an interview with hospital providers explored barriers and facilitators of the POM management policy as well as factors impacting the programme’s sustainability.Results205 patients were included pre-implementation, and over the three post-implementation periods, a total of 586 additional patients were included in the quantitative study. 17 interviews were conducted. Approximately 60% of the included patients brought their POM to the hospital during each period (reach). There was a statistically significant decrease in the percentage of POM self-administered (p<0.001), the percentage of POM used by nurses to administer doses (p<0.001), the rate (p=0.005) and severity (p=0.008) of DRP when compared with the situation before and after 1 week and 3 months of policy implementation (effectiveness, implementation). The rate (p=0.074) and severity (p=0.062) of DRP decrease after 1 year of policy implementation was not significant (maintenance).ConclusionsThis study presents a POM management policy and highlights the unique challenges of implementing and, in particular, maintaining it in the hospital setting. A POM management policy reduces the incidence and severity of DRP caused by POM if the policy is fully communicated and staff are appropriately trained.

Background/Objectives: The aim of this study was to assess NB CE-Chirps for diagnosing Superior Semicircular Canal Dehiscence Syndrome (SSCDS) with cervical and ocular vestibular evoked myogenic potentials (cVEMPs and oVEMPs), and to compare them with Tone Bursts (TBs). Methods: Nine subjects diagnosed with SSCDS were included (four men/five women, median = 61 years, range = 31–79 years). Intensity thresholds at 500 Hz were investigated with both stimuli. A response was also sought when NB CE-Chirps and TBs were delivered at 4000 Hz for c and oVEMPs. Results: Both 500 Hz TBs and 500 Hz NB CE-Chirps significantly differentiated affected ears from healthy ears for cVEMPs (p < 10−3 in both cases) and oVEMPs (p < 10−3 in both cases). Furthermore, we observed significantly lower intensity thresholds in SSCDS ears with 500 Hz NB CE-Chirps than with 500 Hz TBs for both cVEMPs (p < 10−3) and oVEMPs (p = 0.036). Regarding the response rate at 4000 Hz, only TBs consistently showed a response in 100% of cases for the affected ears, with no response in healthy ears for both cVEMPs and oVEMPs. However, there was no significant difference between the response rates obtained at 4000 Hz using TBs and NB CE-Chirps in affected ears (p = 1.000 for cVEMPs and p = 1.000 for oVEMPs). Conclusions: Searching for intensity thresholds with NB CE-Chirps 500 Hz in cVEMPs and oVEMPs is an effective method for diagnosing SSCDS, likely with better frequency specificity than with 500 Hz TBs. Stimulation at 4000 Hz with both TBs and NB CE-Chirps appears to be a promising test for easily screening this syndrome, reducing both sound exposure and the duration of the examination. The possibility to reduce rise time in 4000 Hz TBs may favor this stimulus over NB CE-Chirps at this frequency for this disease. These results should be confirmed in larger cohorts including patients with more severe forms.

Infection is often difficult to recognize in critically ill patients because of the marked coexisting inflammatory process. Lack of early recognition prevents timely resuscitation and effective antimicrobial therapy, resulting in increased morbidity and mortality. Measurement of a biomarker, such as C-reactive protein (CRP) concentration, in addition to history and physical signs, could facilitate diagnosis. Although frequently measured in clinical practice, few studies have reported on the pathophysiological role of this biomarker and its predictive value in critically ill patients. In this review, we discuss the pathophysiological role of CRP and its potential interpretation in the inflammatory processes observed in critically ill patients.

Objectives: to retrospectively evaluate the clinical relevance of the 1000/500 Hz inter-frequency amplitude ratio (IFAR) in cervical and ocular vestibular evoked myogenic potentials (cVEMPs and oVEMPs) in patients with unilateral definite Ménière’s disease (MD) to identify the pathological ear. Method: cVEMPs and oVEMPs results obtained at 500 Hz and 1000 Hz were retrospectively analyzed in 28 patients with unilateral definite MD. 1000/500 Hz IFAR were calculated and compared for each ear. Spearman correlation tests between patient age and 1000/500 Hz IFAR were also performed. Results: No significant difference was observed between the 1000/500 Hz IFAR calculated in both pathological and healthy ears when the cVEMPs were performed (p = 0.74; Wilcoxon signed-rank test). 1000/500 Hz IFAR results obtained in healthy and pathological ears were also not different for oVEMPs (p = 0.73; Wilcoxon signed-rank test). Analysis of modified 1000/500 Hz IFARs for healthy and pathological ears showed no difference in both cVEMPs and oVEMPs (p = 0.44; p = 0.95, respectively; Wilcoxon signed-rank test). There was a significant positive correlation between IFARs, modified IFARs, and patient age for cVEMPs (p = 0.017; p = 0.012, respectively, Spearman’s correlation test). A significant positive correlation was also found between modified IFARs and the subject age in oVEMPs (p = 0.019, Spearman’s correlation test). Conclusions: We did not observe any significant increase of 1000/500 Hz IFARs and 1000/500 Hz modified IFARs in ears affected by definite MD compared to healthy ears. Moreover, our research suggests that the age of the participants may influence IFAR results, which may lead to misdiagnosis in the elderly. It is, therefore, essential to conduct further prospective studies in larger cohorts, stratifying results by participant age, to better understand the role of 1000/500 Hz IFAR values in the diagnosis of MD.