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Identifying Orthostatic Hypotension caused by Medication.pdf
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England to support GPs, pharmacists and other healthcare professionals who undertake prescribing or medication reviews to understand the complex issues around stopping inappropriate medicines safely. \n\nTo drive and accelerate changes in practice, delegates complete a quality improvement project to address problematic polypharmacy in their workplace. 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offline</span></div></div><div class="MetadataToolbar_underline__QQn0C"></div></div></div><!--/$--><!--$--><!--/$--><div class="player Player_root__L1AmF"><div id="new-player" class="vertical-player VerticalPlayer_root__K8_YS" data-slideshow-id="263726202"><div><div id="slide1" class="VerticalSlide_root__jU_9r slide-item" style="aspect-ratio:2384 / 3370" data-cy="slide-container"><div class="VerticalSlideImage_root__64KSA"><img id="slide-image-0" alt="Falls within the elderly frail population is a growing concern due to its link to morbidity, mortality and hospitalisation.[1,2,3] Recent Worlds Falls Guidelines (WFG) published in 2022 set out key multifactorial assessments to help reduce risk of falls. One part of the assessment was to screen for orthostatic hypotension (OH) routinely [4]. The WFG identified older patients who live in settings such as care homes as being at an increased risk of falls [4]. I n t r o d u c t i o n Utilising recent Worlds Falls Guidance on falls prevention to help minimise falls risk by identifying orthostatic hypotension caused by medication in a care home population. Reports ran on system one to identify patients that aligned with the practice’s care homes. Identified patients are reviewed in line with the medication lasted in table 1. Patients identified with OH or being borderline were reviewed at the practice by the multi-disciplinary team (MDT) consisting of GP’s, Pharmacists and Advanced Nurse Practitioners to make changes to appropriate medication 4 Patients identified on the search had sitting and standing blood pressure (BP) taken. A drop in BP of >20mmhg systolic or >10mmhg diastolic upon standing was classed as OH with a variation of +/- 2 mmhg being classed as borderline. 2 3 1 M e t h o d R e s u l t s The aim of the project was to implement part of the WFG in patients taking medication known to cause OH in a care home setting. A i m s Across the two care homes a total of 64 patients were assessed, to identify anyone on OH causing medication, such as antihypertensives, beta-blockers and diuretics[5]. A total of 35 patients were identified as being at risk of OH (see chart 1). 25 of the 35 patients were able to provide sitting and standing BP readings. Of the 25 blood pressure readings taken, 6 were identified as having OH or being borderline. A drop in blood pressure of >20mmhg systolic or >10mmhg diastolic upon standing was classed as OH with a variation of +/- 2 mmhg being classed as borderline. 5 of the 6 patients were then flagged to the multi disciplinary team to have their medication reviewed. The changes made to their medication included reducing doses of hypertensive medication such as lisinopril and amlodipine. Follow up sitting and standing bp were taken 2 months after dose changes and 4 of the 5 patients who had their medication changed no longer had OH (see chart 2). Screening asymptomatic patients in a care home setting for OH in line with WFG has highlighted that asymptomatic patients were present in a care home setting. The number of patients on OH causing medication was more than 50% of the care home population looked at, showing there is a need for opportunistic OH case finding in this population. Screening patients for OH allowed for changes to be made to medication that was potentially causing or worsening the OH subsequently putting patients at a higher risk of falls. This intervention has shown practices can proactively engage with care homes to help reduce patients falls risk. With more of an ageing population and the increase in prevalence of multimorbidity and polypharmacy the number of falls will likely increase[1]; further highlighting the importance of engaging with this population to establish if OH is a concern. It is recognised only 20% of the 25 patients had interventions made via the MDT, however it is important to remember only one part of the multifactorial assessment recommended by the WFG was implemented. As more of the guideline is implemented potentially more interventions can be made further reducing falls risk and its associated morbidity and mortality risk. The next steps would be to roll out opportunistic findings of OH in other care homes as this sample was small. Not all of the patients identified had medication changes made, therefore could conduct a qualitative study to look into what affected the MDT’s decisions. C o n c l u s i o n & D i s c u s s i o n Class of medicine Examples Antihypertensive Furosemide, Spironolactone Lisinopril, Losartan Amlodipine and Diltiazem Atenolol, Bisoprolol Anti-anginal Glycerol trinitrate, Hydralazine, Isosorbide Mononitrate Antidepressant Amitriptyline, Impramine Anti-parkinsonian Levodopa, Dopamine agonist Antimuscarinic Oxybutynin, Solifenacin, Tolterodine Patients not at risk of OH, 45% Patients at risk of OH, 55% Number of patients identified as being ‘at risk’ of OH after a medication review. Patients who still had OH 20% Patients who no longer had OH 80% Follow up of patients after having medication changes made References 1. James SL, Lucchese LR, Bisignano C, Castle CD, Dingels ZV, Fox JT, et al. The global burden of falls: global, regional and national estimates of morbidity and mortality from the Global Burden of Disease Study 2017. Injury Prevention. 2020 Jan 15;26(2):injuryprev-2019-043286. 2. World Health Organization. Falls [Internet]. World Health Organization. 2021 [cited 2023 Mar 11]. Available from: https://www.who.int/news-room/fact-sheets/detail/falls 3. Tinetti ME, Williams CS. The Effect of Falls and Fall Injuries on Functioning in Community-Dwelling Older Persons. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences. 1998 Mar 1;53A(2):M112–9. 4. Montero-Odasso M, van der Velde N, Martin FC, Petrovic M, Tan MP, Ryg J, et al. World guidelines for falls prevention and management for older adults: a global initiative. Age and Ageing [Internet]. 2022 Sep [cited 2023 Jan 15];51(9). Available from: https://academic.oup.com/ageing/article/51/9/afac205/6730755 5. Gibbon, J.R. and Frith, J. (2020) ‘Orthostatic hypotension: A pragmatic guide to diagnosis and treatment’, Drug and Therapeutics Bulletin, 58(11), pp. 166–171. doi:10.1136/dtb.2020.000056. Table 1 – Examples of OH causing medication[5] Jaspanth Kaur Foundation pharmacist jaspanth.kaur@nhs.net Chart 1 Chart 2 " class="vertical-slide-image VerticalSlideImage_image__VtE4p" data-testid="vertical-slide-image" loading="eager" srcSet="https://image.slidesharecdn.com/identifyingorthostatichypotensioncausedbymedication-231121162622-e0d81912/85/Identifying-Orthostatic-Hypotension-caused-by-Medication-pdf-1-320.jpg 320w, https://image.slidesharecdn.com/identifyingorthostatichypotensioncausedbymedication-231121162622-e0d81912/85/Identifying-Orthostatic-Hypotension-caused-by-Medication-pdf-1-638.jpg 638w, https://image.slidesharecdn.com/identifyingorthostatichypotensioncausedbymedication-231121162622-e0d81912/75/Identifying-Orthostatic-Hypotension-caused-by-Medication-pdf-1-2048.jpg 2048w" src="https://image.slidesharecdn.com/identifyingorthostatichypotensioncausedbymedication-231121162622-e0d81912/85/Identifying-Orthostatic-Hypotension-caused-by-Medication-pdf-1-320.jpg" sizes="100vw"/></div><!--$--><!--/$--></div></div></div></div></div><!--$--><div class="RelatedContent_root__29Np1"><div class="RelatedContent_wrapper__riU7l"><h2 class="Heading_heading__3MAvZ Heading_h2__f9yvs RelatedContent_title__QUhpL">More Related Content</h2><div></div><div></div><div id="between-recs-ad-1-container" class="freestar-ad-container FreestarAdContainer_root__qPPC_" style="--fallback-aspect-ratio:undefined / undefined" data-testid="freestar-ad-container"><div><div class="" id="between-recs-ad-1"></div></div></div><div></div><div id="between-recs-ad-2-container" class="freestar-ad-container FreestarAdContainer_root__qPPC_" style="--fallback-aspect-ratio:undefined / undefined" data-testid="freestar-ad-container"><div><div class="" id="between-recs-ad-2"></div></div></div></div></div><!--/$--><div class="Transcript_root__Vrf6Q"><h2 class="Transcript_title__YgAka"><span class="icon Icon_root__AjZyv" style="--size:24px"><span class="Icon_icon__4zzsG" style="mask-image:url(https://public.slidesharecdn.com/_next/static/media/file.5db1ba24.svg);background-color:currentColor"></span><span class="sr-only"></span></span>Identifying Orthostatic Hypotension caused by Medication.pdf</h2><div><ul class="Transcript_list__faItj"><div><li>1. <a class="Transcript_link__MLbGS" href="https://www.slideshare.net/slideshow/identifying-orthostatic-hypotension-caused-by-medicationpdf/263726202#1">Falls within the </a> elderly frail population is a growing concern due to its link to morbidity, mortality and hospitalisation.[1,2,3] Recent Worlds Falls Guidelines (WFG) published in 2022 set out key multifactorial assessments to help reduce risk of falls. One part of the assessment was to screen for orthostatic hypotension (OH) routinely [4]. The WFG identified older patients who live in settings such as care homes as being at an increased risk of falls [4]. I n t r o d u c t i o n Utilising recent Worlds Falls Guidance on falls prevention to help minimise falls risk by identifying orthostatic hypotension caused by medication in a care home population. Reports ran on system one to identify patients that aligned with the practice’s care homes. Identified patients are reviewed in line with the medication lasted in table 1. Patients identified with OH or being borderline were reviewed at the practice by the multi-disciplinary team (MDT) consisting of GP’s, Pharmacists and Advanced Nurse Practitioners to make changes to appropriate medication 4 Patients identified on the search had sitting and standing blood pressure (BP) taken. A drop in BP of >20mmhg systolic or >10mmhg diastolic upon standing was classed as OH with a variation of +/- 2 mmhg being classed as borderline. 2 3 1 M e t h o d R e s u l t s The aim of the project was to implement part of the WFG in patients taking medication known to cause OH in a care home setting. A i m s Across the two care homes a total of 64 patients were assessed, to identify anyone on OH causing medication, such as antihypertensives, beta-blockers and diuretics[5]. A total of 35 patients were identified as being at risk of OH (see chart 1). 25 of the 35 patients were able to provide sitting and standing BP readings. Of the 25 blood pressure readings taken, 6 were identified as having OH or being borderline. A drop in blood pressure of >20mmhg systolic or >10mmhg diastolic upon standing was classed as OH with a variation of +/- 2 mmhg being classed as borderline. 5 of the 6 patients were then flagged to the multi disciplinary team to have their medication reviewed. The changes made to their medication included reducing doses of hypertensive medication such as lisinopril and amlodipine. Follow up sitting and standing bp were taken 2 months after dose changes and 4 of the 5 patients who had their medication changed no longer had OH (see chart 2). Screening asymptomatic patients in a care home setting for OH in line with WFG has highlighted that asymptomatic patients were present in a care home setting. The number of patients on OH causing medication was more than 50% of the care home population looked at, showing there is a need for opportunistic OH case finding in this population. Screening patients for OH allowed for changes to be made to medication that was potentially causing or worsening the OH subsequently putting patients at a higher risk of falls. This intervention has shown practices can proactively engage with care homes to help reduce patients falls risk. With more of an ageing population and the increase in prevalence of multimorbidity and polypharmacy the number of falls will likely increase[1]; further highlighting the importance of engaging with this population to establish if OH is a concern. It is recognised only 20% of the 25 patients had interventions made via the MDT, however it is important to remember only one part of the multifactorial assessment recommended by the WFG was implemented. As more of the guideline is implemented potentially more interventions can be made further reducing falls risk and its associated morbidity and mortality risk. The next steps would be to roll out opportunistic findings of OH in other care homes as this sample was small. Not all of the patients identified had medication changes made, therefore could conduct a qualitative study to look into what affected the MDT’s decisions. C o n c l u s i o n & D i s c u s s i o n Class of medicine Examples Antihypertensive Furosemide, Spironolactone Lisinopril, Losartan Amlodipine and Diltiazem Atenolol, Bisoprolol Anti-anginal Glycerol trinitrate, Hydralazine, Isosorbide Mononitrate Antidepressant Amitriptyline, Impramine Anti-parkinsonian Levodopa, Dopamine agonist Antimuscarinic Oxybutynin, Solifenacin, Tolterodine Patients not at risk of OH, 45% Patients at risk of OH, 55% Number of patients identified as being ‘at risk’ of OH after a medication review. Patients who still had OH 20% Patients who no longer had OH 80% Follow up of patients after having medication changes made References 1. James SL, Lucchese LR, Bisignano C, Castle CD, Dingels ZV, Fox JT, et al. The global burden of falls: global, regional and national estimates of morbidity and mortality from the Global Burden of Disease Study 2017. Injury Prevention. 2020 Jan 15;26(2):injuryprev-2019-043286. 2. World Health Organization. Falls [Internet]. World Health Organization. 2021 [cited 2023 Mar 11]. Available from: https://www.who.int/news-room/fact-sheets/detail/falls 3. Tinetti ME, Williams CS. The Effect of Falls and Fall Injuries on Functioning in Community-Dwelling Older Persons. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences. 1998 Mar 1;53A(2):M112–9. 4. Montero-Odasso M, van der Velde N, Martin FC, Petrovic M, Tan MP, Ryg J, et al. World guidelines for falls prevention and management for older adults: a global initiative. Age and Ageing [Internet]. 2022 Sep [cited 2023 Jan 15];51(9). Available from: https://academic.oup.com/ageing/article/51/9/afac205/6730755 5. Gibbon, J.R. and Frith, J. (2020) ‘Orthostatic hypotension: A pragmatic guide to diagnosis and treatment’, Drug and Therapeutics Bulletin, 58(11), pp. 166–171. doi:10.1136/dtb.2020.000056. Table 1 – Examples of OH causing medication[5] Jaspanth Kaur Foundation pharmacist jaspanth.kaur@nhs.net Chart 1 Chart 2 </li></div></ul></div></div><div class="actions-menu-container ActionsMenu_root__4k507" data-cy="actions-menu-mobile"><button type="button" class="Button_root__i1yp0 Button_secondary__hHiHI Button_text__ZT_3O Button_small__sqsEx Button_icon__1C4qi save-button" data-testid="button" aria-label="Save Identifying Orthostatic Hypotension caused by Medication.pdf for later" data-saved="false" data-cy="loggedout-save-slideshow-button" aria-haspopup="dialog" aria-controls=":Radh6:" popovertarget=":Radh6:" style="anchor-name:--popover-Radh6"><span class="icon Icon_root__AjZyv SaveLoggedOut_icon__ny9X2" style="--size:24px"><span class="Icon_icon__4zzsG" style="mask-image:url(https://public.slidesharecdn.com/_next/static/media/save.ef1812e2.svg);background-color:currentColor"></span><span class="sr-only"></span></span></button><div class="Tooltip_root__7FS0Y" id=":Radh6:" popover="manual" data-popover-position="top" style="position-anchor:--popover-Radh6"></div><button type="button" class="unstyled-button more-button MoreDropdownButton_trigger__x7wGs" aria-label="More options" data-cy="more-options-icon" data-testid="ellipsis" aria-haspopup="dialog" aria-controls=":R1edh6:" popovertarget=":R1edh6:" style="anchor-name:--popover-R1edh6"><span class="icon Icon_root__AjZyv MoreDropdownButton_moreOptionsIcon__TpJLA" style="anchor-name:--popover-Rdedh6" aria-haspopup="dialog" aria-controls=":Rdedh6:" popovertarget=":Rdedh6:"><span class="Icon_icon__4zzsG" style="mask-image:url(https://public.slidesharecdn.com/_next/static/media/more-horizontal.f69be1b8.svg);background-color:currentColor"></span><span class="sr-only"></span></span><div class="Tooltip_root__7FS0Y" id=":Rdedh6:" popover="manual" data-popover-position="top" style="position-anchor:--popover-Rdedh6"></div></button><div class="" id=":R1edh6:" popover="manual" data-popover-position="bottom-start" style="position-anchor:--popover-R1edh6"></div><div class="DownloadButton_root__adY00 ActionsMenu_downloadButton__s7Iqj"><button type="button" class="Button_root__i1yp0 Button_primary__K25Gq Button_contained__gyjai Button_large__Yv_oe" data-testid="download-button" data-cy="download-button-actions-menu"><span><span class="icon Icon_root__AjZyv" style="--size:24px"><span class="Icon_icon__4zzsG" style="mask-image:url(https://public.slidesharecdn.com/_next/static/media/download.b1b2622c.svg);background-color:currentColor"></span><span class="sr-only"></span></span>Download</span></button></div></div><dialog class="Modal_root__TYkzh FullscreenModal_root__efM9m" id=":R2th6:"><div class="Modal_wrapper__4UTGq"><div class="modal-content Modal_content__R1F4d FullscreenModal_content__bQ6mt"></div></div></dialog><div class="ad textads banner-ads banner_ads ad-unit ad-zone ad-space adsbox ads prebid" style="position:absolute;height:1px"></div><script id="gtm"> performance.mark('gtm.start'); (function (w, d, s, l, i) { w[l] = w[l] || []; w[l].push({ 'gtm.start': new Date().getTime(), event: 'gtm.js' }); var f = d.getElementsByTagName(s)[0], j = d.createElement(s), dl = l != 'dataLayer' ? 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It summarizes that intensive glycemic control can reduce microvascular complications but may increase mortality risk. The guidelines emphasize individualizing treatment based on patient preferences, needs, and tolerances. A patient-centered approach engages patients in medical decisions to improve adherence and outcomes for their chronic condition.","tags":[],"url":"https://www.slideshare.net/julietacorreia92/dia-care-2012inzucchi136479","userLogin":"julietacorreia92","userName":"Julieta Correia","viewCount":415},{"algorithmId":"3","displayTitle":"and Brian G. FeaganRoss D. Feldman, Guang Y. Zou, Margaret K.docx","isSavedByCurrentUser":false,"pageCount":38,"score":0.5217,"slideshowId":"254238406","sourceName":"cm_text","strippedTitle":"and-brian-g-feaganross-d-feldman-guang-y-zou-margaret-kdocx","thumbnail":"https://cdn.slidesharecdn.com/ss_thumbnails/andbriang-221116062908-a5d5fd36-thumbnail.jpg?width=600\u0026height=600\u0026fit=bounds","description":"and Brian G. Feagan\nRoss D. Feldman, Guang Y. Zou, Margaret K. Vandervoort, Cindy J. Wong, Sigrid A.E. Nelson\n\nRandomized, Controlled Trial\nA Simplified Approach to the Treatment of Uncomplicated Hypertension: A Cluster\n\nPrint ISSN: 0194-911X. Online ISSN: 1524-4563 \nCopyright © 2009 American Heart Association, Inc. All rights reserved.\n\nis published by the American Heart Association, 7272 Greenville Avenue, Dallas, TX 75231Hypertension \ndoi: 10.1161/HYPERTENSIONAHA.108.123455\n2009;53:646-653; originally published online February 23, 2009;Hypertension. \n\n http://hyper.ahajournals.org/content/53/4/646\nWorld Wide Web at: \n\nThe online version of this article, along with updated information and services, is located on the\n\n \n http://hyper.ahajournals.org//subscriptions/\n\nis online at: Hypertension Information about subscribing to Subscriptions:\n \n\n http://www.lww.com/reprints\n Information about reprints can be found online at: Reprints:\n\n \ndocument. Permissions and Rights Question and Answer this process is available in the\n\nclick Request Permissions in the middle column of the Web page under Services. Further information about\nOffice. Once the online version of the published article for which permission is being requested is located, \n\n can be obtained via RightsLink, a service of the Copyright Clearance Center, not the EditorialHypertensionin\n Requests for permissions to reproduce figures, tables, or portions of articles originally publishedPermissions:\n\n by guest on September 24, 2014http://hyper.ahajournals.org/Downloaded from by guest on September 24, 2014http://hyper.ahajournals.org/Downloaded from \n\nhttp://hyper.ahajournals.org/content/53/4/646\nhttp://www.ahajournals.org/site/rights/\nhttp://www.lww.com/reprints\nhttp://hyper.ahajournals.org//subscriptions/\nhttp://hyper.ahajournals.org/\nhttp://hyper.ahajournals.org/\n\n\nClinical Trial\n\nA Simplified Approach to the Treatment of\nUncomplicated Hypertension\n\nA Cluster Randomized, Controlled Trial\n\nRoss D. Feldman, Guang Y. Zou, Margaret K. Vandervoort, Cindy J. Wong,\nSigrid A.E. Nelson, Brian G. Feagan\n\nAbstract—Notwithstanding the availability of antihypertensive drugs and practice guidelines, blood pressure control\nremains suboptimal. The complexity of current treatment guidelines may contribute to this problem. To determine\nwhether a simplified treatment algorithm is more effective than guideline-based management, we studied 45 family\npractices in southwestern Ontario, Canada, using a cluster randomization trial comparing the simplified treatment\nalgorithm with the Canadian Hypertension Education Program guidelines. The simplified treatment algorithm consisted\nof the following: (1) initial therapy with a low-dose angiotensin-converting enzyme inhibitor/diuretic or angiotensin\nreceptor blocker/diuretic combination; (2) up-titration of combination therapy to the highest dose; (3) addition of a\ncalcium channel blocker and up-titration; and (4) addition of a non—first-line antihypertensive age.","tags":[],"url":"https://www.slideshare.net/slideshow/and-brian-g-feaganross-d-feldman-guang-y-zou-margaret-kdocx/254238406","userLogin":"rossskuddershamus","userName":"rossskuddershamus","viewCount":22},{"algorithmId":"3","displayTitle":"ADVERSE DRUG REACTION | PHARMACY PRACTICE | PDF | SHIVAM DUBEY B PHARMA | PHA...","isSavedByCurrentUser":false,"pageCount":4,"score":0.5206,"slideshowId":"250194534","sourceName":"cm_text","strippedTitle":"adverse-drug-reaction-pharmacy-practice-pdf-shivam-dubey-b-pharma-pharmacy","thumbnail":"https://cdn.slidesharecdn.com/ss_thumbnails/mcqsdocx2-210914182239-thumbnail.jpg?width=600\u0026height=600\u0026fit=bounds","description":"PHARMACY PRACTICE\r\nSHIVAM DUBEY\r\nBPYN1PY18041\r\nADVERSE DRUG REACTION Abstract\r\nWe define an adverse drug reaction as \"an appreciably harmful or \r\nunpleasant reaction","tags":["adverse drug reaction","what is adverse drug reaction","adverse drug reactions"],"url":"https://www.slideshare.net/slideshow/adverse-drug-reaction-pharmacy-practice-pdf-shivam-dubey-b-pharma-pharmacy/250194534","userLogin":"MrHotmaster1","userName":"MrHotmaster1","viewCount":250},{"algorithmId":"3","displayTitle":"Healthcare spending 1996 2013","isSavedByCurrentUser":false,"pageCount":20,"score":0.519,"slideshowId":"70532994","sourceName":"cm_text","strippedTitle":"healthcare-spending-1996-2013","thumbnail":"https://cdn.slidesharecdn.com/ss_thumbnails/healthcarespending1996-2013-161229175913-thumbnail.jpg?width=600\u0026height=600\u0026fit=bounds","description":"This study analyzed US health care spending from 1996-2013 using 183 data sources to estimate spending for 155 conditions stratified by age, sex, and type of care. 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The goal is to minimize excess opioid prescribing while maintaining adequate pain management, especially for those at high risk of prolonged use.","tags":[],"url":"https://www.slideshare.net/slideshow/iatrogenic-opioid-dependenceintheunitedstates18/73195473","userLogin":"101N","userName":"Paul Coelho, MD","viewCount":212},{"algorithmId":"3","displayTitle":"A DIRECT MEDICAL COST ANALYSIS OF PATIENTS WITH T2DM AND ITS MACROVASCULAR CO...","isSavedByCurrentUser":false,"pageCount":10,"score":0.5172,"slideshowId":"234024545","sourceName":"cm_text","strippedTitle":"a-direct-medical-cost-analysis-of-patients-with-t2dm-and-its-macrovascular-complications","thumbnail":"https://cdn.slidesharecdn.com/ss_thumbnails/manuscript5thyear-200515073205-thumbnail.jpg?width=600\u0026height=600\u0026fit=bounds","description":"A DIRECT MEDICAL COST ANALYSIS OF PATIENTS WITH T2DM AND ITS MACROVASCULAR COMPLICATIONS\r\n-A PHARMACOECONOMIC STUDY\r\n-assessment of cost of treatment of diabetis with its macrovascular complication patients\r\n","tags":["pharmacoeconomic study","direct medical cost analysis","t2dm and its macrovascular complications"],"url":"https://www.slideshare.net/slideshow/a-direct-medical-cost-analysis-of-patients-with-t2dm-and-its-macrovascular-complications/234024545","userLogin":"AbithBaburaj","userName":"Abith Baburaj","viewCount":69},{"algorithmId":"3","displayTitle":"JOURNAL CLUB PRESENTATION","isSavedByCurrentUser":false,"pageCount":20,"score":0.5164,"slideshowId":"247724137","sourceName":"cm_text","strippedTitle":"journal-club-presentation-247724137","thumbnail":"https://cdn.slidesharecdn.com/ss_thumbnails/kaviya-210504181307-thumbnail.jpg?width=600\u0026height=600\u0026fit=bounds","description":"The study assessed adherence to cardiovascular medications in rural patients attending a tertiary hospital in India. It found that adherence was lowest in hypertension patients at 20.83% and highest in ischemic heart disease patients at 32%. The most common reason for non-adherence was carelessness. The study concluded that rural Indians adhere poorly to cardiovascular medications and that more efforts are needed to address this issue.","tags":["presentations","journal club","model"],"url":"https://www.slideshare.net/slideshow/journal-club-presentation-247724137/247724137","userLogin":"kaviyaap1","userName":"KAVIYA AP","viewCount":7780},{"algorithmId":"3","displayTitle":"Preprint review article letter to all pharmacist 2016 pharmaceutical care la...","isSavedByCurrentUser":false,"pageCount":8,"score":0.5157,"slideshowId":"125422248","sourceName":"cm_text","strippedTitle":"preprint-review-article-letter-to-all-pharmacist-2016-pharmaceutical-care-laboratory-medicine-and-imaging-update-2019-125422248","thumbnail":"https://cdn.slidesharecdn.com/ss_thumbnails/preprintreviewarticlelettertoallpharmacist2016pharmaceuticalcarelaboratorymedicineandimagingupdate20-181209074315-thumbnail.jpg?width=600\u0026height=600\u0026fit=bounds","description":"The document summarizes research on the benefits of clinical pharmacists participating as members of medical teams. Several studies found that including clinical pharmacists reduced mortality rates in hospitals and improved outcomes across disease states. Pharmacists improved medication management by addressing drug-related problems, which led to decreased mortality for conditions like heart attacks. Their interventions enhanced clinical outcomes for diabetes, cardiovascular disorders, and other conditions. Effective implementation of these pharmacy services requires support from healthcare organizations and infrastructure support within facilities.","tags":[],"url":"https://www.slideshare.net/slideshow/preprint-review-article-letter-to-all-pharmacist-2016-pharmaceutical-care-laboratory-medicine-and-imaging-update-2019-125422248/125422248","userLogin":"MLuisettoWebsiteFARM","userName":"M. Luisetto Pharm.D.Spec. Pharmacology","viewCount":102},{"algorithmId":"3","displayTitle":"Cia 5-075","isSavedByCurrentUser":false,"pageCount":13,"score":0.5099,"slideshowId":"50957753","sourceName":"cm_text","strippedTitle":"cia-5075","thumbnail":"https://cdn.slidesharecdn.com/ss_thumbnails/cia-5-075-150727074102-lva1-app6891-thumbnail.jpg?width=600\u0026height=600\u0026fit=bounds","description":"This document discusses inappropriate prescribing in hospitalized elderly patients. It defines inappropriate prescribing as using medications that significantly increase the risk of adverse drug events when safer alternatives exist. Inappropriate prescribing is common in the elderly and associated with increased morbidity, mortality and healthcare costs. Risk factors in hospitals include advanced age, polypharmacy due to multiple comorbidities, and transitions of care involving multiple providers. The document reviews validated tools to evaluate inappropriate prescribing, including Beers Criteria, IPET, STOPP and MAI. It concludes inappropriate prescribing in hospitals is an important public health problem given the aging population.","tags":[],"url":"https://www.slideshare.net/slideshow/cia-5075/50957753","userLogin":"ynegara","userName":"rahma Neg","viewCount":502},{"algorithmId":"3","displayTitle":"Running head CREATING A PLAN OF CARE .docx","isSavedByCurrentUser":false,"pageCount":26,"score":0.5093,"slideshowId":"253934263","sourceName":"cm_text","strippedTitle":"running-head-creating-a-plan-of-care-docx","thumbnail":"https://cdn.slidesharecdn.com/ss_thumbnails/runningheadcreatingaplanofcare-221101071014-3621f487-thumbnail.jpg?width=600\u0026height=600\u0026fit=bounds","description":"Running head: CREATING A PLAN OF CARE 1\nCREATING A PLAN OF CARE 10\nCreating a Plan of Care\nSouth University\n\nNSG4055 Illness \u0026 Disease Management across Life Span\n\nProfessor \n\nCreating a Plan of Care\nThe chronic disease selected for the plan of care is cardiovascular disease. This disease continues to pose major challenges not only for patients and their family members but also to the nation’s health care system. The rationale for choosing cardiovascular disease is because of the high rates of mortality and the effects of the co-morbidities associated with the chronic illness. According to Santulli (2013), cardiovascular disease is the single leading cause of fatalities in the United States, accounting for approximately 600,000 deaths annually. In 2011, approximately 26.6 million Americans were living with the chronic disease. The health care costs associated with the disease account for more than $500 billion annually. There are also many disparities in prevalence of risk factors, mortality, access to treatment and treatment outcomes based on race/ethnicity, socioeconomic status, gender, age and geographic area. Hence, tackling the disease should be a major priority for the US government. The main objective of the Healthy People 2020 initiative for cardiovascular disease is “improving cardiovascular health through early detection, prevention and treatment of the risk factors for stroke and heart attack”. This report outlines a comprehensive plan of care that can help in addressing and mitigating cardiovascular disease. \nHolistic Plan of Care\n\nCreating a holistic plan of care will indeed be essential for ensuring that people with chronic conditions such as cardiovascular disease lead a healthy life. Cardiovascular disease has a significant impact on the patient and the health care system. Apart from the emotional distress, patients with this condition also face some financial burdens, social burdens and increased levels of discrimination (Earnshaw \u0026 Quinn, 2012). In the course of completing the project, I administered a questionnaire to a coworker by the initials C.K. during week 2 to find out how she deals with the condition. \nThe questionnaire looked into various aspects such as family history, related medical conditions, the risk factors of cardiovascular disease, lifestyle choices and the coping strategies or support received by the patient. Understanding all these aspects can help in developing a well-managed care plan (Larsen \u0026 Lubkin, 2013). The results of the questionnaire revealed that C.K. observes healthy lifestyle, has the right levels of support and adheres to the medication regimen. All these factors helped her to cope effectively with the condition. However, even though she attested to leading a healthy lifestyle, C.K. also revealed that her family faced s ...","tags":[],"url":"https://www.slideshare.net/slideshow/running-head-creating-a-plan-of-care-docx/253934263","userLogin":"susanschei","userName":"susanschei","viewCount":22},{"algorithmId":"3","displayTitle":"CARDIOVASCULAR DISEASECARDIOVASCULAR DISEASECa","isSavedByCurrentUser":false,"pageCount":12,"score":0.5092,"slideshowId":"253108013","sourceName":"cm_text","strippedTitle":"cardiovascular-diseasecardiovascular-diseaseca","thumbnail":"https://cdn.slidesharecdn.com/ss_thumbnails/cardiovasculardiseasecardiovasculardiseaseca-220922041646-0c50f296-thumbnail.jpg?width=600\u0026height=600\u0026fit=bounds","description":"CARDIOVASCULAR DISEASE\nCARDIOVASCULAR DISEASE\n\n\n\n\n\n\n\n\nCardiovascular Disease\n\n\n\n\n\n\n\n\n\nIntroduction\nCardiovascular disease posits a major cause of premature deaths and disability throughout the world and contributes to a significant increase in healthcare costs, particularly in medication, healthcare services, and production loss. Specifically, heart diseases and stroke accommodate the highest prevalence rate in the USA; accommodate an average of 610,000 and 365,000 annual deaths from CVD (CDC, 2015). Similarly, every year, CVD causes the USA approximately, $207 billion for medication, healthcare services, and productivity loss. Noteworthy, heart diseases and stroke incidences vary with factors such as ethnicity, gender, age, and individuals with certain disorders. Similarly, the project accommodates notable articulations on intervention, comparison, outcome, and time as a fundamental consideration in heart diseases and stroke in the USA. Thus, an enriched articulation on heart diseases and stroke are underscoring for the project presentation.\nDefinition\nAccording to (Mayo Clinic, 2018), Heart disease describes a condition that affects the heart; including blood vessels diseases arrhythmias, and other heart defects. Significantly, the heart disease is interchangeable for the CVD, articulating on the infections involving narrowed or blocked blood vessels, causing a heart attack, chest pain, and stroke, among other clinical presentations. Similarly, (Mayo Clinic, 2018) acknowledges that many CVD is preventable and treatable with healthy lifestyle choices.\nEpidemiology\nCardiovascular diseases posits an undying cause of death in the USA, projected at 840, 678 deaths in 2016, averagely one in three deaths (Salim et al. 2020). Similarly, between 2013 and 2016 121.5 million adults Americans presented notable for of the CVD. Notably, between 2013 and 2015 direct and indirect costs of managing the CVD in the USA, recorded $213.8 billion and $137.4 billion respectively. Statistically, between 2013 and 2016, 57.1% of non-HN black females and 60.1% of non-HN black males presenting CVD manifestations (Salim et al. 2020). According to the researcher causes of the CVD Include atherosclerosis resulting from an unhealthy diet, lacking exercise, overweight, and smoking. In the epistemology studies, risk factors such as age, sex, family history, smoking, chemotherapy and radiation drugs, high blood pressure, poor diet, obesity, physical inactivity, stress, and poor hygiene are underscoring risk factors in the CVD (Mayo Clinic, 2018). Thus, heart disease epistemological indicates the patterns, causes, risk factors, and specific populations in the USA.\nClinical Presentations\nCardiovascular disease acclaims clinical presentations that may differ between men and women. According to (Mayo Clinic, 2018), men present significant chest pain that women and women clinical presentations such as shortness in breathing, nausea, and fatigue are more evident than in men. Admi ...","tags":[],"url":"https://www.slideshare.net/slideshow/cardiovascular-diseasecardiovascular-diseaseca/253108013","userLogin":"TawnaDelatorrejs","userName":"TawnaDelatorrejs","viewCount":41},{"algorithmId":"3","displayTitle":"Multiple health problems in elderly peoplepage 950Ex.docx","isSavedByCurrentUser":false,"pageCount":125,"score":0.5091,"slideshowId":"253934158","sourceName":"cm_text","strippedTitle":"multiple-health-problems-in-elderly-peoplepage-950exdocx","thumbnail":"https://cdn.slidesharecdn.com/ss_thumbnails/multiplehealthproblemsinelderlypeoplepage950ex-221101071005-a243a75b-thumbnail.jpg?width=600\u0026height=600\u0026fit=bounds","description":"Multiple health \nproblems in \nelderly people\npage 950\n\nExcessive \ndrinking in \nyoung women\npage 952\n\nAdverse drug \nreactions in \nelderly people\npage 956\n\nPalliative care \nbeyond cancer\npage 958\n\nDrug resistant \ninfections in \npoor countries\npage 948\n\nManagement \nof chronic pain\npage 954\n\nM\nA\n\nK\nIN\n\nG\n A\n\n D\nIF\n\nFE\nR\n\nE\nN\n\nC\nE\n\n 945BMJ | 26 APRIL 2008 | VOLUME 336 \n\n\n\nBMJ | Making a difference | 26 april 2008 | VoluMe 336 947\n\nRunning the gauntlet to improve \npatient care\nThis supplement is the result of a gauntlet \nthrown down, and picked up, during a dinner \nin London just over a year ago. The gauntlet \nthrower was Don Berwick, president of the \nInstitute for Healthcare Improvement in Boston. \nWhat, he asked, was the BMJ Publishing Group \nreally for? What were we trying to achieve? In \nreply, I and our chief executive, Stella Dutton, \nwere quick to quote the BMJ’s mission, which \nends with the crucial words “to improve \noutcomes for patients.” Fine, said Don, but how \nabout being more specific: which outcomes, \nwhat patients, by how much?\n\nWe took his suggestion seriously. Why not \ntarget a few important healthcare problems, \ntaking a quality improvement approach \nand focusing on the evidence on how to \nmake a difference in these areas? But how \nto choose which issues to tackle among \nthe many millions of pressing healthcare \nchallenges facing the world? We turned in the \nfirst instance to BMJ readers. In May 2007 \nwe asked you to tell us what information was \nmost needed to improve the quality of care of \npatients in clinical practice. From your many \nrapid responses we harvested more than 200 \nideas. After categorising these and matching \nthem against the priorities of national and \ninternational bodies, we created a shortlist \nof 12. With the help of an expert panel (see \nhttp://makingadifference.bmj.com) we cut \nthese down to six.\n\nInevitably the choice of topics is subjective \nrather than scientific, but the six we have \nended up with are interesting. Several turn the \nspotlight on areas that are less than glamorous \nand are perhaps all too often passed over, even \nas their impact on individual lives and society \nincreases. Two topics deal with problems of \nold age: multiple illness and adverse drug \nreactions. Two deal with palliation: of chronic \n\npain and in dying from non-malignant disease. \nThe remaining topics deal with two very \ndifferent but serious and growing public health \nchallenges: drug resistant infections in the \ndeveloping world and excessive drinking in \nyoung women. You will no doubt find important \ngaps in what we have chosen. But if this \ninitiative proves useful we can expand it further.\n\nOn each of the six topics we’ve invited \nleading commentators to write the pairs \nof articles that make up this supplement. \nOne article in each pair aims to describe \nthe importance of the problem in terms of \nits health and societal impact. The other \nlooks at the available evidence on quality \nimprovement initiat ...","tags":[],"url":"https://www.slideshare.net/slideshow/multiple-health-problems-in-elderly-peoplepage-950exdocx/253934158","userLogin":"gilpinleeanna","userName":"gilpinleeanna","viewCount":20},{"algorithmId":"3","displayTitle":"The art of the possible ideas","isSavedByCurrentUser":false,"pageCount":53,"score":0.509,"slideshowId":"7192321","sourceName":"cm_text","strippedTitle":"the-art-of-the-possible-ideas","thumbnail":"https://cdn.slidesharecdn.com/ss_thumbnails/theartofthepossible-ideas-110308095035-phpapp01-thumbnail.jpg?width=600\u0026height=600\u0026fit=bounds","description":"The document discusses quality improvement initiatives in several countries aimed at reducing patient harm and mortality in healthcare. It outlines specific interventions and goals for the UK, Scotland, Denmark, Canada, Wales, and the US including reducing surgical complications, preventing central line infections, reducing harm from high-risk medicines, and preventing MRSA infections. Evidence is presented on the impact of certain interventions like proper use of antibiotics, beta blockers, and venous thromboembolism prophylaxis in surgery.","tags":[],"url":"https://www.slideshare.net/slideshow/the-art-of-the-possible-ideas/7192321","userLogin":"howardcooper","userName":"howardcooper","viewCount":486},{"algorithmId":"3","displayTitle":"Fletcher et al-2013-pediatric_blood_\u0026amp;_cancer","isSavedByCurrentUser":false,"pageCount":8,"score":0.5068,"slideshowId":"139757923","sourceName":"cm_text","strippedTitle":"fletcher-et-al2013pediatricbloodampcancer-139757923","thumbnail":"https://cdn.slidesharecdn.com/ss_thumbnails/fletcheretal-2013-pediatricbloodcancer-190405195703-thumbnail.jpg?width=600\u0026height=600\u0026fit=bounds","description":"el inicio temprano de antibióticos intravenosos y orales en niños con cáncer para el manejo de la neutropenia febril mejora la sobrevida.","tags":["artículo"],"url":"https://www.slideshare.net/slideshow/fletcher-et-al2013pediatricbloodampcancer-139757923/139757923","userLogin":"mayagomez7","userName":"mayagomez7","viewCount":24},{"algorithmId":"3","displayTitle":"Fletcher et al-2013-pediatric_blood_\u0026amp;_cancer","isSavedByCurrentUser":false,"pageCount":8,"score":0.5068,"slideshowId":"139758101","sourceName":"cm_text","strippedTitle":"fletcher-et-al2013pediatricbloodampcancer","thumbnail":"https://cdn.slidesharecdn.com/ss_thumbnails/fletcheretal-2013-pediatricbloodcancer-190405200016-thumbnail.jpg?width=600\u0026height=600\u0026fit=bounds","description":"El inicio temprano de antibióticos en niños con cáncer con neutropenia febril mejora los resultados en la sobrevida.","tags":["artículo 2"],"url":"https://www.slideshare.net/slideshow/fletcher-et-al2013pediatricbloodampcancer/139758101","userLogin":"isabelerazochaves","userName":"isabelerazochaves","viewCount":54},{"algorithmId":"3","displayTitle":"Study on achievement of target LDC-C in Dyslipidimic patients","isSavedByCurrentUser":false,"pageCount":5,"score":0.5051,"slideshowId":"42211206","sourceName":"cm_text","strippedTitle":"ijrpp-13-314","thumbnail":"https://cdn.slidesharecdn.com/ss_thumbnails/ijrpp13314-141201061100-conversion-gate02-thumbnail.jpg?width=600\u0026height=600\u0026fit=bounds","description":"This study analyzed 80 dyslipidemic patients to assess achievement of target LDL-C levels as recommended by ATP III guidelines. The majority of patients had high LDL-C levels and were receiving statin therapy. Based on risk factors, patients were categorized as CHD, high risk non-CHD, or low risk non-CHD. Only 22.5% of patients achieved their target LDL-C levels, which was unsatisfactory. More aggressive lipid management is needed to help more patients reach targets through interventions like pharmacist counseling and medication adjustments.","tags":[],"url":"https://www.slideshare.net/slideshow/ijrpp-13-314/42211206","userLogin":"pharmaindexing","userName":"pharmaindexing","viewCount":284},{"algorithmId":"3","displayTitle":"Ajp mrecs dsme","isSavedByCurrentUser":false,"pageCount":6,"score":0.505,"slideshowId":"5698658","sourceName":"cm_text","strippedTitle":"ajp-mrecs-dsme","thumbnail":"https://cdn.slidesharecdn.com/ss_thumbnails/ajpmrecsdsme-101107210141-phpapp01-thumbnail.jpg?width=600\u0026height=600\u0026fit=bounds","description":"The document summarizes recommendations from a task force on interventions to reduce morbidity and mortality from diabetes. It finds:\n\n1) Disease management in clinical settings is strongly recommended based on evidence it improves glycemic control and monitoring. \n\n2) Case management is also strongly recommended based on evidence it improves glycemic control when combined with disease management.\n\n3) Diabetes self-management education in community gathering places is recommended for adults with type 2 diabetes based on evidence of improved glycemic control.","tags":[],"url":"https://www.slideshare.net/slideshow/ajp-mrecs-dsme/5698658","userLogin":"nhso03","userName":"สปสช นครสวรรค์","viewCount":246},{"algorithmId":"3","displayTitle":"clin news samples","isSavedByCurrentUser":false,"pageCount":4,"score":0.5044,"slideshowId":"49985867","sourceName":"cm_text","strippedTitle":"clin-news-samples-49985867","thumbnail":"https://cdn.slidesharecdn.com/ss_thumbnails/ef2f2b00-1395-4584-91ad-ac73d5346a9a-150630033857-lva1-app6892-thumbnail.jpg?width=600\u0026height=600\u0026fit=bounds","description":"The document summarizes several clinical trends from internal corporate newsletters, including:\n\n1) Psychotropic polypharmacy among office-based psychiatrists has increased from 1996-2006, with the average number of medications prescribed per visit doubling. This raises concerns about potential drug interactions and unclear benefits. \n\n2) Osteoarthritis accounts for approximately 3 lost work days annually per patient costing employers $469-520 per patient in absenteeism costs, totaling $10 billion annually in the US. \n\n3) A study found chronic kidney disease in 42% of individuals with undiagnosed diabetes and 18% of individuals with prediabetes, indicating the need for earlier CKD screening in pre","tags":[],"url":"https://www.slideshare.net/slideshow/clin-news-samples-49985867/49985867","userLogin":"RoxanneCorbin","userName":"Roxanne Corbin","viewCount":168},{"algorithmId":"3","displayTitle":"Thesis_PhD_Improving medication safety in the elderly","isSavedByCurrentUser":false,"pageCount":154,"score":0.5033,"slideshowId":"43772827","sourceName":"cm_text","strippedTitle":"these-ph-d-improving-medication-safety-in-the-elderly","thumbnail":"https://cdn.slidesharecdn.com/ss_thumbnails/thesephdimprovingmedicationsafetyintheelderly-150122031442-conversion-gate01-thumbnail.jpg?width=600\u0026height=600\u0026fit=bounds","description":"The document discusses medication safety issues for elderly patients, noting that physiological changes with aging increase their risk of adverse drug reactions and interactions from polypharmacy. Polypharmacy, defined as using multiple medications, is common in elderly patients due to multiple chronic conditions but can increase problems with adherence and side effects. Improving medication safety for elderly patients requires addressing polypharmacy issues through individualized treatment reviews that consider life expectancy, treatment goals and targets.","tags":["phd","improving medication safety in the elderly","thesis"],"url":"https://www.slideshare.net/slideshow/these-ph-d-improving-medication-safety-in-the-elderly/43772827","userLogin":"VoHa1","userName":"HA VO THI","viewCount":1258},{"algorithmId":"3","displayTitle":"P\u0026T Newsletter February 2015","isSavedByCurrentUser":false,"pageCount":6,"score":0.5033,"slideshowId":"50118480","sourceName":"cm_text","strippedTitle":"pt-newsletter-february-2015","thumbnail":"https://cdn.slidesharecdn.com/ss_thumbnails/79d1ed82-d3e0-4725-94e4-85aeddc5df0e-150703030952-lva1-app6891-thumbnail.jpg?width=600\u0026height=600\u0026fit=bounds","description":"This study evaluated whether continuing dual antiplatelet therapy (DAPT) beyond one year after drug-eluting stent placement reduces adverse events. It was a large randomized controlled trial comparing aspirin + thienopyridine to aspirin + placebo in patients who had completed one year of standard DAPT. Continuing thienopyridine therapy until 30 months reduced stent thrombosis and major adverse cardiovascular events, but increased moderate or severe bleeding risks compared to placebo. The study provides evidence that prolonging DAPT to 30 months may benefit patients who complete one year of standard therapy without adverse events.","tags":[],"url":"https://www.slideshare.net/slideshow/pt-newsletter-february-2015/50118480","userLogin":"FlorentinaEller","userName":"Florentina Eller","viewCount":1216}],"moreFromUser":[{"algorithmId":"","displayTitle":"Improving access to appropriately fitted equipment to support mothers express...","isSavedByCurrentUser":false,"pageCount":18,"score":0,"slideshowId":"275415025","sourceName":"MORE_FROM_USER","strippedTitle":"improving-access-to-appropriately-fitted-equipment-to-support-mothers-expressing-breast-milk-a-project-toolkit","thumbnail":"https://cdn.slidesharecdn.com/ss_thumbnails/expressingbreastmilktoolkit1-250206090920-304d7143-thumbnail.jpg?width=600\u0026height=600\u0026fit=bounds","description":"Funded by NHS England South West (NHSE SW), Health Innovation Wessex (HIW) is supporting the spread of a quality improvement project initiated in University Hospital Southampton (UHS). 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One part of the assessment was to screen for orthostatic\nhypotension (OH) routinely [4]. The WFG identified older patients who live in settings such as care homes as being at an increased risk of falls [4].\nI n t r o d u c t i o n\nUtilising recent Worlds Falls Guidance on falls prevention to help\nminimise falls risk by identifying orthostatic hypotension caused by\nmedication in a care home population.\nReports ran on system one to identify patients that aligned\nwith the practice’s care homes.\nIdentified patients are reviewed in line with the medication\nlasted in table 1.\nPatients identified with OH or being borderline were\nreviewed at the practice by the multi-disciplinary team\n(MDT) consisting of GP’s, Pharmacists and Advanced Nurse\nPractitioners to make changes to appropriate medication\n4\nPatients identified on the search had sitting and standing\nblood pressure (BP) taken. A drop in BP of \u003e20mmhg systolic\nor \u003e10mmhg diastolic upon standing was classed as OH with\na variation of +/- 2 mmhg being classed as borderline.\n2\n3\n1\nM e t h o d R e s u l t s\nThe aim of the project was to implement part of the WFG in patients taking medication known to cause OH in a care home setting.\nA i m s\nAcross the two care homes a total of 64 patients were assessed, to identify anyone on\nOH causing medication, such as antihypertensives, beta-blockers and diuretics[5]. A\ntotal of 35 patients were identified as being at risk of OH (see chart 1). 25 of the 35\npatients were able to provide sitting and standing BP readings. Of the 25 blood\npressure readings taken, 6 were identified as having OH or being borderline. A drop in\nblood pressure of \u003e20mmhg systolic or \u003e10mmhg diastolic upon standing was classed\nas OH with a variation of +/- 2 mmhg being classed as borderline. 5 of the 6 patients\nwere then flagged to the multi disciplinary team to have their medication reviewed.\nThe changes made to their medication included reducing doses of hypertensive\nmedication such as lisinopril and amlodipine. Follow up sitting and standing bp were\ntaken 2 months after dose changes and 4 of the 5 patients who had their medication\nchanged no longer had OH (see chart 2).\nScreening asymptomatic patients in a care home setting for OH in\nline with WFG has highlighted that asymptomatic patients were\npresent in a care home setting. The number of patients on OH\ncausing medication was more than 50% of the care home\npopulation looked at, showing there is a need for opportunistic OH\ncase finding in this population. Screening patients for OH allowed\nfor changes to be made to medication that was potentially causing\nor worsening the OH subsequently putting patients at a higher risk\nof falls. This intervention has shown practices can proactively\nengage with care homes to help reduce patients falls risk. With\nmore of an ageing population and the increase in prevalence of\nmultimorbidity and polypharmacy the number of falls will likely\nincrease[1]; further highlighting the importance of engaging with\nthis population to establish if OH is a concern. It is recognised only\n20% of the 25 patients had interventions made via the MDT,\nhowever it is important to remember only one part of the\nmultifactorial assessment recommended by the WFG was\nimplemented. As more of the guideline is implemented potentially\nmore interventions can be made further reducing falls risk and its\nassociated morbidity and mortality risk. The next steps would be to\nroll out opportunistic findings of OH in other care homes as this\nsample was small. Not all of the patients identified had medication\nchanges made, therefore could conduct a qualitative study to look\ninto what affected the MDT’s decisions.\nC o n c l u s i o n \u0026 D i s c u s s i o n\nClass of medicine Examples\nAntihypertensive Furosemide, Spironolactone\nLisinopril, Losartan\nAmlodipine and Diltiazem\nAtenolol, Bisoprolol\nAnti-anginal Glycerol trinitrate, Hydralazine, Isosorbide Mononitrate\nAntidepressant Amitriptyline, Impramine\nAnti-parkinsonian Levodopa, Dopamine agonist\nAntimuscarinic Oxybutynin, Solifenacin, Tolterodine\nPatients not at\nrisk of OH, 45%\nPatients at risk\nof OH, 55%\nNumber of patients identified as being ‘at risk’ of\nOH after a medication review.\nPatients who\nstill had OH\n20%\nPatients who no\nlonger had OH\n80%\nFollow up of patients after having medication\nchanges made\nReferences\n1. James SL, Lucchese LR, Bisignano C, Castle CD, Dingels ZV, Fox JT, et al. The global burden of falls: global, regional and national estimates of morbidity and mortality from the\nGlobal Burden of Disease Study 2017. Injury Prevention. 2020 Jan 15;26(2):injuryprev-2019-043286.\n2. World Health Organization. Falls [Internet]. World Health Organization. 2021 [cited 2023 Mar 11]. Available from: https://www.who.int/news-room/fact-sheets/detail/falls\n3. Tinetti ME, Williams CS. The Effect of Falls and Fall Injuries on Functioning in Community-Dwelling Older Persons. The Journals of Gerontology Series A: Biological Sciences and\nMedical Sciences. 1998 Mar 1;53A(2):M112–9.\n4. Montero-Odasso M, van der Velde N, Martin FC, Petrovic M, Tan MP, Ryg J, et al. World guidelines for falls prevention and management for older adults: a global initiative. Age and\nAgeing [Internet]. 2022 Sep [cited 2023 Jan 15];51(9). Available from: https://academic.oup.com/ageing/article/51/9/afac205/6730755\n5. Gibbon, J.R. and Frith, J. 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