PRESS-NEWS.org - Press Release Distribution
PRESS RELEASES DISTRIBUTION

JAMA Internal Medicine commentary: 'Improving Prescribing for Patients Late in Life'

JAMA Internal Medicine commentary: 'Improving Prescribing for Patients Late in Life'
2014-09-08
(Press-News.org) INDIANAPOLIS -- Older adults are typically prescribed a large number of medications, often including drugs that should not be taken by individuals late in life. In a commentary published online by JAMA Internal Medicine on September 8, Regenstrief Institute investigator Greg Sachs, M.D., calls for physicians to carefully review older patients' medication lists.

According to Dr. Sachs, current prescribing guidelines fail to adequately address instances in which specific drugs are not beneficial or may even be harmful to older adults. Current guidelines also fail to identify age-adjusted standards for dosages and fail to address use, drug interactions and metabolism concerns. Dr. Sachs, professor of medicine and director of the Division of General Internal Medicine and Geriatrics at Indiana University School of Medicine, and colleagues have proposed a model for prescribing medications that additionally incorporates a patient's anticipated life expectancy, the treatment target, the time needed for medication to produce its intended benefit and the patient's goals of care.

"Caring for older patients with their multiple health problems is problematic," said Dr. Sachs, a geriatrician. "Doctors, who only have limited time with each person they see, tend to reach for prescription pads or e-prescribing tools. Patients expect prescriptions and if they don't receive one will wonder what their doctor has done for them. As a result, the elderly receive too many prescriptions.

"Physicians often have trouble talking with patients and their families about where the patient is in their lifespan. But goals of care conversations about what does and what doesn't make sense given the patient's medical conditions and mental status should inform or influence goals of care and the treatment to be given in support of these goals. These conversations shouldn't be put off until the patient is in the ICU; they should occur during routine office visits and be updated as the patient ages."

The commentary, "Improving Prescribing Practices Late in Life," accompanies "Medications of Questionable Benefit Used in Advanced Dementia," a research study of nursing home residents from across the United States. The University of Massachusetts Medical School and Harvard Medical School authors of the study reported that a majority of nursing home residents with advanced dementia received at least one medication with questionable benefits, possible harms and substantial associated costs.

Dr. Sachs's commentary concludes, "Perhaps before I retire, I will get to hear more presentations [oral reports from medical students, residents, fellows or fellows to attending physicians] that sound like the following: Mrs. Jones is a 74-year-old, ambulatory woman who lives at home with her daughter. She was recently hospitalized briefly after a fall. Because of her limited remaining life expectancy and prior preferences, our discussions of her goals of care centered on maximizing comfort, maintaining function and mobility to the extent possible, and minimizing trips to the emergency department and hospital, and less stringent targets for her chronic diseases. We cancelled the screening mammogram that had been scheduled in the hospital; took her off one of her anti-hypertensives; stopped her statin altogether; recommended daily supervised walks; and completed a Physician Orders for Life-Sustaining Treatment form."

INFORMATION: END

[Attachments] See images for this press release:
JAMA Internal Medicine commentary: 'Improving Prescribing for Patients Late in Life'

ELSE PRESS RELEASES FROM THIS DATE:

Sodium's influence on blood pressure statistically insignificant

2014-09-08
A new study published in American Journal of Hypertension finds evidence that increased Body Mass Index, age, and non-sodium dietary factors are much more closely related to increases in systolic blood pressure than sodium intake. The study, "Relationship between nutrition and blood pressure: A cross-sectional analysis from the NutriNet-Santé study, a French web-based cohort study," measured the effects of sodium intake, Body Mass Index, physical activity, alcohol consumption, and non-sodium dietary factors on the blood pressure of 8,670 French adults and concluded ...

Agricultural revolution in Africa could increase global carbon emissions

Agricultural revolution in Africa could increase global carbon emissions
2014-09-08
WEST LAFAYETTE, Ind. - Productivity-boosting agricultural innovations in Africa could lead to an increase in global deforestation rates and carbon emissions, a Purdue University study finds. Historically, improvements in agricultural technology have conserved land and decreased carbon emissions at the global level: Gaining better yields in one area lessens the need to clear other areas for crops, sidestepping a land conversion process that can significantly raise the amount of carbon dioxide released into the atmosphere. Agricultural advances in Africa, however, could ...

Watchful waiting isn't right for everyone

2014-09-08
(PHILADELPHIA) – There is an active controversy among oncologists about when to treat prostate cancer patients, with some suggesting that the word "cancer" be removed from the description of low grade disease, in order to prevent overtreatment. However a new study shows that these guidelines may not be appropriate for everyone, especially African American men. "We know that African American men have more aggressive prostate cancer than Caucasian men," says Kosj Yamoah M.D., Ph.D., Chief Resident, Department of Radiation Oncology at Thomas Jefferson University. "Our study ...

Study traces ecological collapse over 6,000 years of Egyptian history

2014-09-08
Depictions of animals in ancient Egyptian artifacts have helped scientists assemble a detailed record of the large mammals that lived in the Nile Valley over the past 6,000 years. A new analysis of this record shows that species extinctions, probably caused by a drying climate and growing human population in the region, have made the ecosystem progressively less stable. The study, published September 8 in Proceedings of the National Academy of Sciences (PNAS), found that local extinctions of mammal species led to a steady decline in the stability of the animal communities ...

Broken signals lead to neurodegeneration

2014-09-08
Researchers from the RIKEN Brain Science Institute in Japan, in collaboration with Juntendo University and the Japan Science and Technology Agency, have discovered that a cell receptor widely involved in intracellular calcium signaling--the IP3R receptor--can be locked into a closed state by enzyme action, and that this locking may potentially play a role in the reduction of neuron signaling seen in neurodegenerative diseases such as Huntington's and Alzheimer's disease. In the research published today in the Proceedings of the National Academy of Sciences, the scientists ...

In directing stem cells, study shows context matters

In directing stem cells, study shows context matters
2014-09-08
MADISON, Wis. — Figuring out how blank slate stem cells decide which kind of cell they want to be when they grow up — a muscle cell, a bone cell, a neuron — has been no small task for science. Human pluripotent stem cells, the undifferentiated cells that have the potential to become any of the 220 types of cells in the body, are influenced in the lab dish by the cocktail of chemical factors and proteins upon which they are grown and nurtured. Depending on the combination of factors used in a culture, the cells can be coaxed to become specific types of cells. Now, in ...

Co-flowing liquids can stabilize chaotic 'whipping' in microfluidic jets

Co-flowing liquids can stabilize chaotic whipping in microfluidic jets
2014-09-08
VIDEO: This video show jets emerging from the same glass needle in chaotic whipping (left) and a steady state helical whipping. By controlling the viscosity and speed of the liquid surrounding... Click here for more information. Industrial wet spinning processes produce fibers from polymers and other materials by using tiny needles to eject continuous jets of liquid precursors. The electrically charged liquids ejected from the needles normally exhibit a chaotic "whipping" structure ...

Brain injuries no match for sPIF treatment

Brain injuries no match for sPIF treatment
2014-09-08
New Haven, Conn. — Researchers at Yale School of Medicine and their colleagues have uncovered a new pathway to help treat perinatal brain injuries. This research could also lead to treatments for traumatic brain injuries and neurodegenerative disorders such as Alzheimer’s and Parkinson’s. The findings are published in the Sept. 8 issue of Proceedings of the National Academy of Sciences. The microRNA let-7 is known to cause the death of neurons in the central nervous system. The research team found that a synthetic molecule derived from the embryo called PreImplantation ...

Textbook theory behind volcanoes may be wrong

2014-09-08
In the typical textbook picture, volcanoes, such as those that are forming the Hawaiian islands, erupt when magma gushes out as narrow jets from deep inside Earth. But that picture is wrong, according to a new study from researchers at Caltech and the University of Miami in Florida. New seismology data are now confirming that such narrow jets don't actually exist, says Don Anderson, the Eleanor and John R. McMillian Professor of Geophysics, Emeritus, at Caltech. In fact, he adds, basic physics doesn't support the presence of these jets, called mantle plumes, and the ...

UCLA biologists delay the aging process by 'remote control'

UCLA biologists delay the aging process by remote control
2014-09-08
UCLA biologists have identified a gene that can slow the aging process throughout the entire body when activated remotely in key organ systems. Working with fruit flies, the life scientists activated a gene called AMPK that is a key energy sensor in cells; it gets activated when cellular energy levels are low. Increasing the amount of AMPK in fruit flies' intestines increased their lifespans by about 30 percent — to roughly eight weeks from the typical six — and the flies stayed healthier longer as well. The research, published Sept. 4 in the open-source journal Cell ...

LAST 30 PRESS RELEASES:

Signs identified that precede sudden arrhythmic death syndrome in young people

Discovery of bacteria's defence against viruses becomes a piece of the puzzle against resistance

Pre-eclampsia is associated with earlier onset and higher incidence of cardiovascular risk factors

Warwick astronomers discover doomed pair of spiralling stars on our cosmic doorstep

Soil conditions significantly increase rainfall in world’s megastorm hotspots

NK cells complexed with bispecific antibody yield high response rates in patients with lymphoma

Planetary health diet and mediterranean diet associated with similar survival and sustainability benefits

Singapore launches national standard to validate antimicrobial disinfectant products

Molecular stool test could improve detection of tuberculosis in adults with HIV

Suspected fibrocartilaginous embolus in Asian small-clawed otter (Aonyx cinereus)

Enhancing heat transfer using the turbulent flow of viscoelastic fluids

Exercise as an anti-ageing intervention to avoid detrimental impact of mental fatigue

UMass Amherst Nursing Professor Emerita honored as ‘Living Legend’

New guidelines aim to improve cystic fibrosis screening

Picky eaters by day, buffet by night: Butterfly, moth diets sync to plant aromas

Pennington Biomedical’s Dr. Leanne Redman honored with the E. V. McCollum Award from the American Society for Nutrition

CCNY physicists uncover electronic interactions mediated via spin waves

Researchers’ 3D-printing formula may transform future of foam

Nurture more important than nature for robotic hand

Drug-delivering aptamers target leukemia stem cells for one-two knockout punch

New study finds that over 95% of sponsored influencer posts on Twitter were not disclosed

New sea grant report helps great lakes fish farmers navigate aquaculture regulations

Strain “trick” improves perovskite solar cells’ efficiency

How GPS helps older drivers stay on the roads

Estrogen and progesterone stimulate the body to make opioids

Dancing with the cells – how acoustically levitating a diamond led to a breakthrough in biotech automation

Machine learning helps construct an evolutionary timeline of bacteria

Cellular regulator of mRNA vaccine revealed... offering new therapeutic options

Animal behavioral diversity at risk in the face of declining biodiversity

Finding their way: GPS ignites independence in older adult drivers

[Press-News.org] JAMA Internal Medicine commentary: 'Improving Prescribing for Patients Late in Life'