Contemp Clin Trials
Pharmacy Department, Uppsala University Hospital, Ing.13 2 tr, 751 85 Uppsala, Sweden.
Published: October 2017
Background: Mismanaged prescribing and use of medication among elderly puts major pressure on current healthcare systems. Performing a medication review, a structured critical examination of a patient's medications, during hospital stay with active follow-up into primary care could optimise treatment benefit and minimise harm. However, a lack of high quality evidence inhibits widespread implementation. This manuscript describes the rationale and design of a pragmatic cluster-randomised, crossover trial to fulfil this need for evidence.
Aim: To study the effects of hospital-initiated comprehensive medication reviews, including active follow-up, on elderly patients' healthcare utilisation compared to 1) usual care and 2) solely hospital based reviews.
Design: Multicentre, three-treatment, replicated, cluster-randomised, crossover trial.
Setting: 8 wards with a multidisciplinary team within 4 hospitals in 3 Swedish counties.
Participants: Patients aged 65years or older, admitted to one of the study wards.
Exclusion Criteria: Palliative stage; residing in other than the hospital's county; medication review within the last 30days; one-day admission.
Interventions: 1, comprehensive medication review during hospital stay; 2, same as 1 with the addition of active follow-up into primary care; 3, usual care.
Primary Outcome Measure: Incidence of unplanned hospital visits during a 12-month follow-up period.
Data Collection And Analyses: Extraction and collection from the counties' medical record system into a GCP compliant electronic data capture system. Intention-to-treat-analyses using hierarchical models.
Relevance: This study has a high potential to show a reduction in elderly patients' morbidity, contributing to more sustainable healthcare in the long run.
Download full-text PDF |
Source |
---|---|
http://dx.doi.org/10.1016/j.cct.2017.07.019 | DOI Listing |
Crit Care Resusc
December 2024
Department of Intensive Care, The Royal Melbourne Hospital, Melbourne, Australia.
Background: Patients in the intensive care unit (ICU) frequently develop hyperactive delirium, which may be accompanied by behaviour that increases clinical risks to themselves as well as other patients and staff. There is a paucity of evidence to inform the urgent enteral administration of antipsychotic drugs to treat such hyperactive delirium and behavioural disturbances.
Objective: The aim of this study is to test the efficacy and safety of administering enteral olanzapine when compared to quetiapine in critically ill patients with hyperactive delirium.
BMJ
January 2025
Biostatistics Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
This article presents the CONSORT (consolidated standards of reporting trials) extension for cluster randomised crossover trials. A cluster randomised crossover trial involves randomisation of groups of individuals (known as clusters) to different sequences of interventions over time. The design has gained popularity in settings where cluster randomisation is required because it can largely overcome the loss in power due to clustering in parallel cluster trials.
View Article and Find Full Text PDFBMJ Open
December 2024
Health Services, University of Washington, Seattle, Washington, USA.
Introduction: Ineffective coordination during care transitions from hospitals to skilled nursing facilities (SNFs) costs Medicare US$2.8-US$3.4 billion annually and results in avoidable adverse events.
View Article and Find Full Text PDFCochrane Database Syst Rev
December 2024
Cochrane Denmark and Centre for Evidence-Based Medicine Odense (CEBMO), University of Southern Denmark, Odense, Denmark.
Rationale: Postpartum iron deficiency anaemia is caused by antenatal iron deficiency or excessive blood loss at delivery and might affect up to 50% of labouring women in low- and middle-income countries. Effective and safe treatment during early motherhood is important for maternal well-being and newborn care. Treatment options include oral iron supplementation, intravenous iron, erythropoietin, and red blood cell transfusion.
View Article and Find Full Text PDFCochrane Database Syst Rev
December 2024
Scientific Director's Office, Carlo Besta Foundation and Neurological Institute, Milan, Italy.
Background: Multiple sclerosis (MS) is an immune-mediated, chronic, inflammatory demyelinating disease of the central nervous system, impacting around 2.8 million people worldwide. Characterised by recurrent relapses or progression, or both, it represents a substantial global health burden, affecting people, predominantly women, at a young age (the mean age of diagnosis is 32 years).
View Article and Find Full Text PDFEnter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!
© LitMetric 2025. All rights reserved.