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PurposeTo investigate the clinical relevance of potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs), and to evaluate the association between PIMs/PPOs and inadequate drug treatment.MethodsPIMs/PPOs, concordantly identified by two physicians applying the STOPP/START criteria, the EU(7)-PIM list, and a Swedish set in 302 consecutive older primary care patients, were assessed regarding clinical relevance for the specific patient. The physicians determined, in consensus, whether an action related to the medication was medically justified prior to the next regular consultation. If so, the drug treatment was categorised as inadequate, and if not, the treatment was considered adequate.ResultsIn all, 259 (86%) patients had 1010 PIMs/PPOs, 150 (15%) of which, in 81 (27%) patients, were assessed as clinically relevant (kappa: 0.26). A total of 75 (50%) clinically relevant PIMs and PPOs were prioritised for medical action before the next regular consultation. Action-requiring clinically relevant PIMs most often concerned acetylsalicylic acid (ASA) for primary prevention (four out of 68 patients on ASA). The corresponding PPOs concerned beta-blockers in ischaemic heart disease (four out of 61 patients with this condition). When an overall medical perspective was applied, 164 (63%) out of 259 patients with PIMs/PPOs were assessed as having adequate treatment. In adjusted logistic regression, number of PIMs and/or PPOs and number of drugs were associated with inadequate drug treatment.ConclusionOne in seven PIMs/PPOs may be clinically relevant, half of these not of priority for medical action. Cautious interpretation is warranted when PIMs/PPOs are used as outcome measures.

Background Intimate partner violence (IPV) against women is a serious health problem that affects pregnancy more frequently than other obstetric complications usually evaluated in antenatal visits. We aimed to estimate the accuracy of the Women Abuse Screening Tool-Short (WAST-Short) and the Abuse Assessment Screen (AAS) for the detection of IPV during and before pregnancy. Methods Consecutive eligible mothers in 21 public primary health antenatal care centres in Andalusia (Spain) who received antenatal care and gave birth during January 2017–March 2019, had IPV data gathered by trained midwives in the first and third pregnancy trimesters. The index tests were WAST-Short (score range 0–2; cut-off 2) and AAS (score range 0–1; cut-off 1). The reference standard was World Health Organization (WHO) IPV questionnaire. Area under receiver operating characteristics curve (AUC), sensitivity and specificity with 95% confidence intervals (CI) were estimated for test performance to capture IPV during and before pregnancy, and compared using paired samples analysis. Results According to the reference standard, 9.5% (47/495) and 19.4% (111/571) women suffered IPV during and before pregnancy, respectively. For capturing IPV during pregnancy in the third trimester, the WAST-Short (AUC 0.73, 95% CI 0.63, 0.81), performed better than AAS (AUC 0.57, 95% CI 0.47, 0.66, P = 0.0001). For capturing IPV before pregnancy in the first trimester, there was no significant difference between the WAST-Short (AUC 0.69, 95% CI 0.62, 0.74) and the AAS (AUC 0.69, 95% CI 0.62, 0.74, P = 0.99). Conclusions The WAST-Short could be useful to screen IPV during pregnancy in antenatal visits.

Older adults are vulnerable to unsafe medication practices. This cross-sectional study estimated the prevalence and factors of polypharmacy and self-medication among 600 older adults from six Indian cities. The updated Screening Tool of Older Persons’ Prescriptions and Screening Tool to Alert to Right Treatment criteria (version 3) were used. Knowledge, attitudes, and reported practices regarding self-medication were assessed. Descriptive statistics, binary logistic regression, and multivariable analysis were used. The prevalence of polypharmacy was 33.7% (95% CI 29.9–37.6%), with significant associations to multiple comorbidities [adjusted odds ratio (aOR) 2.5 (95% CI 1.1–4.1)], recent transition of care [aOR 3.3 (95% CI 1.4–5.7)], and recent hospitalization [aOR 4.6 (95% CI 2–7.7)]. The proportions of prescriptions with potentially inappropriate medications and potential prescribing omissions were 28.8% (95% CI 25.2–32.6%) and 20.3% (95% CI 17.2–23.8%), respectively. The prevalence of self-medication was 19.7% (95% CI 16.6–23.1%), associated with factors, such as staying alone [aOR 4.5 (95% CI 2.4–6.6)], multiple comorbidities [aOR 3 (95% CI 1.4–6.7)], and recent hospitalization [aOR 4.8 (95% CI 1.5–8)]. Among those who self-medicated, 65.3% lacked knowledge of self-medication, 50% did not comprehend the risks, and 40.7% reported unsafe self-medication practices. The findings emphasize interventions’ necessity for promoting safe medication use in older adults.

Background Care givers of Palliated patients are at risk of adverse physical, psychosocial and emotional sequelae in varied nature. Efficient and valid assessment tools facilitate early detection to take corrective measures. The Modified Caregiver Strain Index (MCSI), composed of domains associated with caregiver strain is a simple and brief tool that can be used in both clinical and field settings. This study aimed to adapt and validate this in order to cater effective palliative care services in Sri Lanka. Methods After cross-cultural adaptation, 200 primary caregivers in 3 teaching hospitals were recruited. The internal consistency, item-total correlations, of the 13-item S-MCSI were performed. The criterion validity was assessed by Pearson correlation between the total scores of S-MCSI, the Karnofky Performance Scale and the Barthel index. Construct validity was determined by the principal component analysis keeping the Varimax with Keiser normalization as the rotation method. The Kaiser-Meyer-Olkin test (KMO) and Bartlett’s test of sphericity statistics were also performed to determine the adequacy of the sample and correlations between items, respectively. The number of factors was determined by the Scree plot, percentage of variance explained by each component and number of Eigen values over 01 (Kaiser-Guttman rule). Results The total MCSI score ranged 0 to 26. The overall Cronbach’s alpha of the 13-item questionnaire was 0.80 while item-total corrections ranged 0.34 to 0.62, exception of one item (0.11). Inverse correlations were demonstrated in total scores of MCSI and Karnofky Performance Scale (r =- 0.32, p < 0.001) and Barthel index (r =-0.34, P < 0.001). A Kaiser-Meyer-Olkin value of 0.79 (p < 0.001) for Bartlett’s test indicated adequate sampling and nonlinearity of factors. The Scree plot showed a three-factor structure explaining 57% of the variation. Items regarding personal wellbeing of caregiver loaded together while the effects on the family loaded separately. Adjustment of personal concerns and family issues along with time alteration grouped as the third factor. Conclusions The study showed that the Sinhala version of MCSI has adequate psychometric properties and reliability to be used as a validated tool to estimate the caregiver burden within a short time period for any health care workers.

Background/Objectives: It would be helpful for primary healthcare professionals to have access to a brief, general screening tool allowing them to detect patients suffering from major mental illness. This also holds for organizations and institutions at which pregnant women ask for support during the perinatal period. An evaluation of the psychometric properties, validity, and reliability of the Fainareti mental health screening tool was carried out in Greek women in this study. Methods: The study participants consisted of 518 women retrospectively followed from pregnancy to their first year postpartum as part of a health intervention at the Day Center for Women’s Mental Health Care (Perinatal Mental Health Disorders), operated by the non-profit organization Fainareti. Alongside the newly developed screening tool, this study utilized the Perinatal Anxiety Screening Scale (PASS), the Patient Health Questionnaire (PHQ-9), and the Edinburgh Postnatal Depression Scale (EPDS). Results: The assessment of the tool’s internal reliability included computing two separate internal consistency indices, with both indicating its significant level of reliability. The correlation analysis between the tool and the scales included in this study demonstrated the tool’s strong convergent validity, while factor analyses confirmed its satisfactory construct validity. Conclusions: Overall, these findings suggest that the one-factor Fainareti mental health screening tool is suitable for initial assessments of the mental health of Greek women.

Background: Inappropriate medication prescribing in older patients increases the risk of poorer health outcomes and increased costs. The IMMENSE trial, integrated a clinical pharmacist into the health care team, to improve medication therapy among older patients, and to investigate the impact on acute revisits to hospital. Objectives: This study investigated the prevalence of potentially inappropriate medications (PIMs) and prescribing omissions (PPOs) at hospital admission and discharge. It also explored the impact of the pharmacist intervention on PIMs and PPOs, and other factors associated with PIMs and PPOs at discharge. Design: The STOPP/START criteria version 2 were retrospectively applied at admission and discharge. PIM and PPO changes were compared, and Poisson regression was used to assess factors influencing prevalence at discharge. Results: At hospital admission, PIM prevalence was 58.6% among intervention patients and 64.8% among control patients. PPO prevalence was 55.3% and 55.5%, respectively. A larger proportion of PIMs identified at admission were resolved by discharge in the intervention group (42.9%) compared to the control group (27.4%). No difference was seen for PPOs. Poisson regression identified a significantly higher risk for PIMs at discharge in the control group compared to the intervention group (IRR 1.255; 95% CI 1.063–1.480, p = 0.007), but no effect for PPOs. Patients living in a nursing home, a home care facility, or an institution showed a higher risk of PPOs at discharge compared to patients living at home (IRR 1.378; 95% CI 1.156–1.644, p < 0.001). Conclusion: The IMMENSE intervention significantly reduced the risk of PIMs at discharge, with no effect on PPOs. Living in nursing homes, home care facilities, or institutions prior to hospitalization increased the risk of PPOs at discharge. Pharmacists may contribute to improved medication appropriateness in older hospitalized patients. Plain language summary How a pharmacist’s contribution in a hospital ward can reduce inappropriate medication prescribing in older patients: insights from a study Why Was This Study Done? The IMMENSE trial explored whether integrating a clinical pharmacist into the healthcare team could reduce inappropriate medications and improve health outcomes for older patients, potentially decreasing unnecessary hospital revisits. What Did the Researchers Do? The researchers assessed the presence of potentially inappropriate medications (PIMs) and prescribing omissions (PPOs) at hospital admission and discharge. They used the STOPP/START criteria to evaluate medication lists to compare changes and understand factors influencing these issues at discharge. What Did the Researchers Find? The study revealed that 57-65% of patients had inappropriate medications, and 55-57% experienced prescribing omissions during their hospital stay. Patients in the group with a pharmacist on their healthcare team had a significant reduction in PIMs at discharge. However, there was no significant change in PPOs. Additionally, patients from nursing homes or similar facilities were more likely to have PPOs at discharge compared to those living at home. What Do the Findings Mean? The findings suggest that including a pharmacist in the healthcare team significantly helps in reducing inappropriate medications among hospitalized older patients, enhancing medication safety. However, the intervention did not significantly affect prescribing omissions. This indicates a need for targeted strategies to address omissions, especially for patients in nursing homes or care facilities. The role of pharmacists is crucial in improving medication management and safety in hospital settings, particularly for the elderly.

\"Background and Objectives: Nutritional screening has been recommended for hospitalized patients. The goal of this study was to compare the screening value of Nutritional Risk Screening 2002 (NRS-2002), Malnutrition Universal Screening Tool (MUST), and Malnutrition Screening Tool (MST) in inpatients with laryngeal cancer, and to identify which is the most accurate. Methods and Study Design: An observational cross-sectional study of 197 laryngeal cancer patients admitted for surgery was conducted using continuous sampling. NRS-2002, MUST, and MST were used to screen the nutritional risk of patients after admission and before discharge. Diagnostic information and the length-of-hospital stay (LOS) data were extracted from the hospital HIS system. Results: The detection rates of NRS-2002, MUST, and MST in admission or discharge patients were 14.7%/27.9%, 22.3%/26.9%, and 4.6%/11.2%, respectively. Using NRS-2002 as the reference, high sensitivity (82.8%) and a Kappa coefficient (k=0.584) were achieved using MUST in admission patients, while MST presented the lowest sensitivity (17.3%) and Kappa coefficient (k=0.208). MST maintained low sensitivity (25.5%) and Kappa coefficient (k=0.243) in discharge patients. NRS-2002 >/= 3 was an independent risk factor for longer LOS in patients with laryngeal cancer (odds ratio (OR)=5.59, 95% confidence interval (CI)=1.86-16.81, p=0.002). The MUST and MST scores did not predict long LOS. Conclusions: Compared with NRS-2002, MUST is superior to MST in sensitivity, specificity, and Kappa coefficient. NRS-2002 better identified patients at risk for longer LOS, but a consistent conclusion was not reached with MUST and MST. Further validation in larger samples is needed.\"

Background In sub-Saharan Africa (SSA), malnutrition remains a major public health challenge, particularly among children under 5 years of age. Despite nutritional screening tools being developed and available to detect early malnutrition in under five-year-old children, malnutrition continues to be a health concern. However, the level of evidence on nutritional screening tools for predicting early malnutrition at the community level in a high disease burden setting is unclear. The objective of this scoping review is to systematically map the evidence on malnutrition screening tools for children under 5 years in sub-Saharan Africa (SSA) and to identify knowledge gaps. Methods The proposed study will be guided by an improved Arksey and O’Malley’s framework, Levac et al . 2010 recommendations, and the 2015 Joanna Briggs Institute guidelines. We will conduct a systematic search of relevant imperial sources of evidence from the following databases: CINAHL with full text, Academic search complete via EBSCOhost, Google Scholar, Science Direct, and PubMed. We will search for grey literature from the following humanitarian and aid organization websites: World Health Organization (WHO), The United Nations International Children’s Emergency Fund (UNICEF), and governmental departments. Following the database searches and title screening, eligible sources of evidence will be exported to an EndNote X9 reference library. Thereafter, duplicate articles will be removed in preparation for abstract and full article screenings. Data from the included sources of evidence will be extracted, and the emerging themes will be analyzed. The relationship between the emerging themes and the research questions will be critically examined. The quality of the included sources of evidence will be determined by using the Mixed Method Appraisal Tool (MMAT) version 2018. The search results will be presented in adapted Preferred Reporting Items for Systematic Reviews and Meta-Analysis: Extension for Scoping Reviews chart (PRISMA-ScR). Discussion We anticipate finding relevant literature on malnutrition screening tools for children under 5 years in SSA. This study is likely to reveal research gaps, which could guide future research on malnutrition screening tools.

A suite of complementary high-throughput screening systems for combinatorial films was developed at National Institute of Standards and Technology to facilitate the search for efficient thermoelectric materials. These custom-designed capabilities include a facility for combinatorial thin film synthesis and a suite of tools for screening the Seebeck coefficient, electrical resistance (electrical resistivity), and thermal effusivity (thermal conductivity) of these films. The Seebeck coefficient and resistance are measured via custom-built automated apparatus at both ambient and high temperatures. Thermal effusivity is measured using a frequency domain thermoreflectance technique. This paper will discuss applications using these tools on representative thermoelectric materials, including combinatorial composition-spread films, conventional films, single crystals, and ribbons.

To validate the Thai language version of the Psoriasis Epidemiology Screening Tool (PEST) and the Early Arthritis for Psoriatic Patients Questionnaire (EARP), as well as also to develop a new tool for screening psoriatic arthritis (PsA) among psoriasis (Ps) patients. This was a cross-sectional study. Ps patients visiting the psoriasis clinic at Siriraj Hospital were recruited. They completed the EARP and PEST. Full musculoskeletal history, examination, and radiography were evaluated. PsA was diagnosed by a rheumatologist’s evaluation and fulfillment of the classification criteria for psoriatic arthritis. Receiver operator characteristic (ROC) curves, sensitivity, and specificity were used to evaluate the performances of the tools. The Siriraj Psoriatic Arthritis Screening Tool (SiPAT) contained questions most relevant to peripheral arthritis, axial inflammation, and enthesitis, selected from multivariate analysis. Of a total of 159 patients, the prevalence of PsA was 78.6 %. The ROC curve analyses of Thai EARP, PEST, and SiPAT were 0.90 (95 % CI 0.84, 0.96), 0.85 (0.78, 0.92), and 0.89 (0.83, 0.95), respectively. The sensitivities of SiPAT, Thai EARP, and PEST were 91.0, 83.0, and 72.0 %, respectively, while the specificities were 69.0, 79.3, and 89.7 %, respectively. All screening questionnaires showed good diagnostic performances. SiPAT could be considered as a screening tool with its desirable properties: higher sensitivity and taking less time. Thai PEST and EARP could possibly be sequentially administered for people with a positive test from SiPAT to reduce the number of false positives.