1156 IMPROVING RECOGNITION OF POLYPHARMACY AND ADDRESSING INAPPROPRIATE PRESCRIBING ON A CARE OF THE ELDERLY WARD

Introduction

Polypharmacy is an increasing concern in medicine which will lead to prescribing errors, serious drug interactions and potentially inappropriate prescribing.

Aim

To improve recognition of ‘Polypharmacy’, routine medication reviews during patient admissions and better communication and awareness of ‘Polypharmacy’ to General Practitioners (GP).

Methods

This audit consisted of two cycles both performed over 6 weeks.

Inclusion criteria

Patients aged 65 < and on 6 < medications, admitted to Elderly Care ward at Chelsea and Westminster hospital. Interventions after the first cycle included education such as encouragement of clear documentation in medical record and GP summary, introduction of medication reviews as part of ward round, collaborative work with pharmacists. Potentially Inappropriate Medications (PIMS) were assessed using the STOPP/START criteria approved by NICE guidelines for review of medication regimes and highlighting PIMS.

Results

First cycle - 30 patients were recruited with an average age of 79.2 (13 males and 17 females). An average number of PIMS at the time of admission was 1.3 and 0.5 on discharge. Only 1/30 (3.3%) has ‘Polypharmacy’ documented and medication reviewed; Medications Reconciliation was 29/30 (96.7%). None of the patient has documentation for Polypharmacy.

Second cycle - 29 patients were recruited with and average age of 80.1. (7 males and 22 females). PIMs on admission was 1.4 and 0.3 on discharge. 25/29 (86.2%) patients had ‘Polypharmacy being documented and Medication review for 29/29(100%). Medication Reconciliation was 29/29(100%). Most Common PIMS across both cycles were statins, antihypertensive and Proton Pump Inhibitor.

Conclusion

The interventions complete improved significantly the awareness of Polypharmacy. There is a significant increment in number of medication review of 96.7% and 82.9% on documentation for ‘Polypharmacy’, and 20% reductions in PIMS on discharge.

Optical control of two-photon excitation efficiency of α-perylene crystal by pulse shaping

Optimized pulse shaping experiments were carried out on the control of two-photon excitation efficiency of an alpha-perylene crystal in the temperature region from 30 to 290 K. It was found that a pulse train with a pulse interval of 90 fs and an alternately reversing phase relation increased the excitation efficiency by a factor of 2 for the whole temperature region. The pulse shape characteristic for effective efficiency increase was reduced by double pulse experiments in which the dependence of the emission intensity on the pulse interval and relative phase between pulses were measured. The mechanism of the efficiency increase is briefly discussed using a sliding-window Fourier transform of the pulse shape.

Site-selective artificial ribonuclease using pinpoint RNA activation

An acridine residue attached to the end or the inside of a DNA activates the target phosphodiester linkages in complementary RNA. Due to this pinpoint activation, the RNA is site-selectively and efficiently cleaved at these linkages by various free metal ions under mild condition. Spectroscopic analyses show that the acridine moiety is sandwiched between neighboring bases, and pushes the opposite nucleotide out of the hetero-duplex.

[Effectiveness of a new toothbrush with irrigation and suctioning capabilities (ty e-Brush) for removing supragingival plaque]

Patients with dysphagia typically have poor oral health. Because of improper swallowing, they cannot easily and safely clean their mouths. As a solution for such a problem, a manual toothbrush with both irrigation and suctioning functions has been developed, called the "e-Brush". The purpose of this study was to evaluate the cleaning effectiveness of the new e-Brush (9 mm and 11 mm in bristle length) for removing supragingival plaque, compared with a conventional toothbrush, GUM # 211 by Butler. In this study, 12 subjects (12 female of average age 20.6) were selected, and plaque control record (PCR) and scrubbing method were used. The following results were obtained: 1. Significant differences (p < 0.05) were recognized between e-Brush/9 mm (55.54 +/- 18.27%) and the others (e-Brush/11 mm: 30.88 +/- 8.14%, GUM # 211: 35.42 +/- 9.32%). 2. Bristles 9 mm in length were more effective than 11 mm bristles (p < 0.05). 3. Irrigation/suctioning function is more effective than the conventional tooth-brushing method. 4. The irrigation function of e-Brush was meritorious in making almost all users comfortable. These results suggest that this new oral hygiene device, "e-Brush/9 mm", is effective for improving oral care management for patients with dysphagia.

[Oral conditions of inhabitants in Tokashiki Island, Okinawa]

The Department of Health of Okinawa Prefecture with the cooperation of the Ministry of Health and Welfare and eight Dental Schools in Japan, is performing dental treatment and oral health care on inhabitants in areas of Okinawa where no dentists are present. We were asked to offer dental treatment and oral health care for the inhabitants of Tokashiki Island, Okinawa from June 30 to July 29, 1997. The DMF rates of school children of Tokashiki Island was much higher than the average rates in Japan. Among the treatment procedures, conservative treatment was 72.5%, most of which was composite resin filling. Most middle-aged persons had severe periodontal disease rather than severe dental caries. Patients, who suffered from severe dental caries chose extraction of their teeth rather than conservative treatment. The denture wearers of Tokashiki Island used their dentures longer than those who visited our Prosthodontic Department. They were not necessarily dissatisfied with their dentures, but their alveolar ridges were absorbed extensively. These conditions could be due to not only patients' consciousness but also the lack of dental hygiene education. It seems that primary prevention and higher dental hygiene education are needed for the inhabitants of Tokashiki Island where dental treatment must be done in a short time.

A nonparametric algorithm for detecting clusters using hierarchical structure

The present paper discusses a nonparametric algorithm for detecting clusters. In the algorithm a positive value called potential is associated with each datum based on dissimilarities. By defining subordination relations among data, hierarchical structure is introduced into the data set. As a result of the introduction of hierarchical structure, the data set is divided into some subsets called subclusters. A procedure for constructing clusters from the subclusters is also considered. The proposed algorithm can be applied to a very wide range of data set and has great ability to detect clusters, which is verified by computer simulation.

Intraperitoneal pseudocyst after ventriculoperitoneal shunt

A case with intraperitoneal pseudocyst as a complication of a ventriculoperitoneal shunt is reported. The pathophysiology, diagnosis and treatment are discussed.