Erich Gustav Baum on a garden path with his wife Grete nee Dublon Portraits Couples

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David Dublon with his wife Paula; Dülmen, Westfahlen (Westphalia) Portraits Couples

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Markus Dublon with his wife reading newspapers on a park bench Portraits Couples

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Algorithm of medication review in frail older people: Focus on minimizing the use of high-risk medications

Aim Frail older people typically suffer several chronic diseases, receive multiple medications and are more likely to be institutionalized in residential aged care facilities. In such patients, optimizing prescribing and avoiding use of high-risk medications might prevent adverse events. The present study aimed to develop a pragmatic, easily applied algorithm for medication review to help clinicians identify and discontinue potentially inappropriate high-risk medications. Methods The literature was searched for robust evidence of the association of adverse effects related to potentially inappropriate medications in older patients to identify high-risk medications. Prior research into the cessation of potentially inappropriate medications in older patients in different settings was synthesized into a four-step algorithm for incorporation into clinical assessment protocols for patients, particularly those in residential aged care facilities. Results The algorithm comprises several steps leading to individualized prescribing recommendations: (i) identify a high-risk medication; (ii) ascertain the current indications for the medication and assess their validity; (iii) assess if the drug is providing ongoing symptomatic benefit; and (iv) consider withdrawing, altering or continuing medications. Decision support resources were developed to complement the algorithm in ensuring a systematic and patient-centered approach to medication discontinuation. These include a comprehensive list of high-risk medications and the reasons for inappropriateness, lists of alternative treatments, and suggested medication withdrawal protocols. Conclusions The algorithm captures a range of different clinical scenarios in relation to potentially inappropriate medications, and offers an evidence-based approach to identifying and, if appropriate, discontinuing such medications. Studies are required to evaluate algorithm effects on prescribing decisions and patient outcomes.

Geriatrician interventions on medication prescribing for frail older people in residential aged care facilities

Objective: In Australian residential aged care facilities (RACFs), the use of certain classes of high-risk medication such as antipsychotics, potent analgesics, and sedatives is high. Here, we examined the prescribed medications and subsequent changes recommended by geriatricians during comprehensive geriatric consultations provided to residents of RACFs via videoconference. Design: This is a prospective observational study. Setting: Four RACFs in Queensland, Australia, are included. Participants: A total of 153 residents referred by general practitioners for comprehensive assessment by geriatricians delivered by video-consultation. Results: Residents’ mean (standard deviation, SD) age was 83.0 (8.1) years and 64.1% were female. They had multiple comorbidities (mean 6), high levels of dependency, and were prescribed a mean (SD) of 9.6 (4.2) regular medications. Ninety-one percent of patients were taking five or more medications daily. Of total medications prescribed (n=1,469), geriatricians recommended withdrawal of 9.8% (n=145) and dose alteration of 3.5% (n=51). New medications were initiated in 47.7% (n=73) patients. Of the 10.3% (n=151) medications considered as high risk, 17.2% were stopped and dose altered in 2.6%. Conclusion: There was a moderate prevalence of potentially inappropriate high-risk medications. However, geriatricians made relatively few changes, suggesting either that, on balance, prescription of these medications was appropriate or, because of other factors, there was a reluctance to adjust medications. A structured medication review using an algorithm for withdrawing medications of high disutility might help optimize medications in frail patients. Further research, including a broader survey, is required to understand these dynamics.

Wedding portrait of Berta and Justin Landauer Portraits Couples

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Paula Stern nee Rosenbaum and Maier Stern standing outdoors in a field Portraits Couples

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Photo button portrait of unidentified couple, possibly cattle dealer Julius Herzberg and his wife Olga Herzberg née Eckermann Portraits Couples

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Comments on "Room temperature interfacial reactions in electrodeposited Au/Sn couples"

Recently, Tang et al. (Acta Mater. 56 (2008) 5818) published a paper explaining room temperature growth of the phases in the Au/Sn system. In their analysis, they considered Au as the only mobile species for all the product phases, and Sn as virtually immobile. It is shown here that this analysis is not correct, since Sn has a higher diffusion rate through the AuSn4 phase. On the other hand, the mobilities of species in the AuSn2 phase are as yet unknown.

Paula Pohl Rieser nee Wagner and Max Rieser Portraits Couples

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Portrait of William and Charlotte Engel Levison Portraits Couples

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Ludwig Levy displaying his sketch pad, showing a drawing of an older man with beard and hat.

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Studio portrait of the sister of Max Rieser with her husband Mr. Karpf; Krakow Portraits Couples

Max Rieser's sister and her husband died in a concentration camp in Poland during the Holocaust

Studio portrait of Joseph and Meta Gruenstein Portraits Couples

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Studio portrait of Max Gruenspecht and Regina Gruenspecht nee Epstein Portraits Couples

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