Objective: The objective of this analysis was to examine the use of 11 non-essential medications in actively dying patients.
Methods: This was a planned secondary analysis of data from the Best Practices for End-of-Life Care for Our Nation's Veterans trial, a multicentre implementation trial of an intervention to improve processes of end-of-life care in inpatient settings. Supported with an electronic comfort care decision support tool, intervention included training hospital staff to identify actively dying patients, communicate the prognosis to patients/families and implement best practices of traditionally home-based hospice care. Data on medication use before and after intervention were derived from electronic medical records of 5476 deceased veterans.
Results: Five non-essential medications, clopidogrel, donepezil, glyburide, metformin and propoxyphene, were ordered in less than 5% of cases. More common were orders for simvastatin (15.8%/15.1%), calcium tablets (8.4%/7.9%), multivitamins (11.6%/10.8%), ferrous sulfate (9.1%/7.6%), diphenhydramine (7.2%/5.1%) and subcutaneous heparin (29.9%/27.5%). Significant decreases were found for donepezil (2.5%/1.3%; p=0.001), propoxyphene (0.8%/0.1%; p=0.001), metformin (0.8%/0.3%; p=0.007) and multivitamins (11.6%/10.8%; p=0.01). Orders for one or more non-essential medications were less likely to occur in association with palliative care consultation (adjusted OR (AOR)=0.64, p<0.001), do-not-resuscitate orders (AOR=0.66, p=0.001) and orders for death rattle medication (AOR=0.35, p<0.001). Patients who died in an intensive care unit were more likely to receive a non-essential medication (AOR=1.60, p=0.009), as were older patients (AOR=1.12 per 10 years, p=0.002).
Conclusions: Non-essential medications continue to be administered to actively dying patients. Discontinuation of these medications may be facilitated by interventions that enhance recognition and consideration of patients' actively dying status.
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http://dx.doi.org/10.1136/bmjspcare-2016-001229 | DOI Listing |
Nutrients
January 2025
3rd Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece.
Maternal amino acid intake and its biological value may influence glucose regulation and insulin sensitivity, impacting the risk of developing gestational diabetes mellitus (GDM). This study aimed to evaluate the association between amino acid intake from maternal diet before and during pregnancy and the risk of GDM. This study is part of the ongoing BORN2020 epidemiological Greek cohort.
View Article and Find Full Text PDFBiol Trace Elem Res
January 2025
Clinical Research Centre, University Medical Centre Ljubljana, Zaloška Cesta 2, 1000, Ljubljana, Slovenia.
Premature ovarian insufficiency (POI) is poorly understood, with causes identified in only 25% of cases. Emerging evidence suggests links between trace elements (TEs) and POI. This study is the first to compare concentrations of manganese (Mn), copper (Cu), zinc (Zn), selenium (Se), molybdenum (Mo), arsenic (As), cadmium (Cd), mercury (Hg), and lead (Pb) across urine, serum, and whole blood in women with POI compared to healthy controls (HC), aiming to explore their distribution and potential associations with POI.
View Article and Find Full Text PDFBackground: The lack of effective pharmacological measures during the early phase of the COVID-19 pandemic prompted the implementation of non-pharmaceutical interventions (NPIs) as initial mitigation strategies. The impact of these NPIs on COVID-19 in Nigeria is not well-documented. This study sought to assess the effectiveness of NPIs to support future epidemic responses.
View Article and Find Full Text PDFBull World Health Organ
January 2025
Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Newcastle upon TyneNE2 4AX, England.
Access to essential medicines is still suboptimal in many countries. Recent studies examining the registration of medicines at the country level show that a considerable proportion of essential medicines do not have any corresponding products registered for use at the country level and therefore cannot be available at all times. Conversely, many non-essential medicines are registered by regulatory authorities for local markets, potentially facilitating inappropriate drug use and antimicrobial resistance.
View Article and Find Full Text PDFLife (Basel)
November 2024
Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA.
Amino acids are basic building blocks of structural proteins and enzymes. They also act as signaling molecules and as fuel. They are characterized as essential if sufficient quantities must be supplied exogenously or as non-essential if they can be endogenously synthesized.
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