Queen Caroline's umbilical hernia
Harold Ellis in Operations that Made History, 2018
One of the things that we can appreciate from medical history is how immense the improvement has been in the management of everyday emergencies. Caroline of Ansbach was born in 1683 and married George, Prince of Wales, in her early twenties. She possessed ample Germanic charms: flaxen hair, sky-blue eyes, fair skin and a voluptuous figure. Caroline was seized with severe colicky pain and vomiting while at St. James's Palace. Dr. George Tesier, physician to the household, and Dr. Noel Broxolme, of St. George's Hospital were summoned. The usual polypharmacy of the early eighteenth century was immediately put into operation; snake root and brandy, Daffy's Elixir and Sir Walter Raleigh's cordial were prescribed and just as quickly vomited. Caroline called George to her side and told him that on her death he should marry again.
Nursing adults in general medical or surgical contexts
Nathan Wilson, Peter Lewis, Leanne Hunt, Lisa Whitehead in Nursing in Australia, 2020
This chapter offers the reader an outline of the current medical and surgical setting in Australia, and a description of contemporary key practice challenges that medical and surgical nurses face. It also offers a description of pathways to practice in medical and surgical nursing and an overview of challenges to nursing and nurses. Key practice issues in the delivery of care in medical and surgical wards are the organisational factors to do with the organisation of nursing work and the patient-related factors of an ageing population, multimorbidity and polypharmacy. In the Australian medical surgical setting, the two most common ways of organizing nursing work are patient allocation and team nursing. Primary nursing and task-based allocations are usually practiced in medical and surgical wards because a significant proportion of the workforce comprises inexperienced, newly graduated registered nurses. Reduced length of stay and increasing numbers of patient admissions has resulted in a high rate of patient turnover in some medical and surgical contexts.
Define Efficacy for Medication Changes
Scott A. Simpson, Anna K. McDowell in The Clinical Interview, 2019
Patients request changes to medication regimens, or that new medications be prescribed, when they feel a current regimen is not working. A shared understanding of what constitutes medication efficacy is especially important for medication changes that are driven by subjectively reported symptoms. In defining objective goals for a medication change, the clinician and patient are more likely to agree on efficacy or, conversely, lack of efficacy. Clinicians and patients should establish a shared understanding of what constitutes efficacy for proposed medication changes. In an era when polypharmacy is common, this technique reduces the risks from ever larger medication regimens prescribed in service of uncertain targets. Patients who perpetually focus on medication options at the exclusion of other treatments risk missing out on the benefits of non-pharmacologic treatments like physical therapy or psychotherapy.
Polypharmacy: a healthcare conundrum with a pharmacogenetic solution
Published in Critical Reviews in Clinical Laboratory Sciences, 2020
Cierra N. Sharp, Mark W. Linder, Roland Valdes
The use of multiple medications is growing at an alarming rate with some reports documenting an average of 12–22 prescriptions being used by individuals ≥50 years of age. The indirect consequences of polypharmacy include exacerbation of drug–drug interactions, adverse drug reactions, increased likelihood of prescribing cascades, chronic dependence, and hospitalizations – all of which have significant health and economic burden. While many practical solutions for reducing polypharmacy have been proposed, they have been met with limited efficacy. This highlights the need for a new systematic approach for fine-tuning dispensing of medications. Pharmacogenetic testing provides an empirical and scientifically rigorous approach for guiding appropriate selection of medicines, with the potential to reduce unnecessary polypharmacy while improving clinical outcomes. The goal of this review article is to provide healthcare providers with an understanding of polypharmacy, its adverse effects on the healthcare system and highlight how pharmacogenetic information can be used to avoid polypharmacy in patients.
Polypharmacy in older adults: the role of the multidisciplinary team
Published in Hospital Practice, 2020
Joshua M. Baruth, Melanie T. Gentry, Teresa A. Rummans, Donna M. Miller, M. Caroline Burton
Patients over the age 65 are a quickly expanding segment of the US population and represent a large percentage of patients requiring inpatient care. Older adults are more likely to experience polypharmacy and adverse drug effects. This review explains the risks of polypharmacy and potentially inappropriate medications in the elderly. Specific classes of medications frequently used in older adults in acute care settings are examined, including anticholinergic, sedative hypnotics, and antipsychotic medications. We discuss strategies aimed at addressing polypharmacy in this population including a drug regimen review (which is distinct from medication reconciliation), screening tools, pharmacist-led interventions, and computer-based strategies in the context of current literature and research findings. We provide a summary of general guidelines that may be helpful for geriatricians and hospitalists in improving patient care and clinical outcomes.
Association between polypharmacy and dementia – A systematic review and metaanalysis
Published in Aging & Mental Health, 2019
Nattawut Leelakanok, Ronilda R. D'Cunha
Objective: The association between polypharmacy and dementia is controversial. This systematic review and meta-analysis aims to summarize existing literature concerning the association between polypharmacy and dementia. Methods: A systematic literature review was performed by searching the EMBASE, PubMed, Scopus and International Pharmaceutical Abstract databases using terms related to polypharmacy and dementia. A meta-analysis was performed using random effect models. Results: Seven studies were included in this meta-analysis. The included studies were of medium to high quality with a potential for publication bias. A strong association between polypharmacy and dementia was found (pooled adjusted risk ratio (aRR) = 1.30 (95% CI: 1.16–1.46), I2 = 68%). Excessive polypharmacy was also strongly associated with dementia (pooled aRR = 1.52 (95% CI: 1.39–1.67), I2 = 24%). Conclusion: Pooled risk estimates from this meta-analysis showed that polypharmacy was associated with dementia. Although the causality of the relationship cannot be concluded from this analysis, the finding encourages the use of multidimensional assessment tools for dementia that includes the number of medications as a component.
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