Clinical Medication Review and Falls in Older People—What Is the Evidence Base?

Background: This paper reports findings from a literature review undertaken to assess the current evidence base for clinical medication review and falls in older people. This forms part of a larger, organisational supported project design work-stream, where the objectives are to define the operational details for clinical medication review as part of multi-factorial assessment for elderly fallers in the community. Patients will be identified and targeted through an integrated care pathway mapping and elderly patient care screening service. Objective: A review of national and best practice guidance to help our understanding of how clinical medication review could be optimised. Methods: A PubMed database search was undertaken with search terms including “elderly” and “falls” and “medicines” followed by study of relevant publications in English and including cited referenced publications within selected papers. Results: Our findings were that both medication over-use and under-use in the elderly occur frequently and can be harmful. Many drugs commonly used by older persons have not been systematically studied as risk factors for falls. The screening tool of older people’s prescriptions (STOPP) and screening tool to alert to right treatment (START), validated for assessment of potentially inappropriate prescribing in the elderly, offer the possibility of provision of a structured clinical medication review to patients, with a need for more research on the impact of the STOPP START interventions on both the rates of falls and risk of falls in the elderly.

Patients’time in therapeutic range on warfarin among atrial fibrillation patients in Warfarin Medication Therapy Adherence Clinic

BACKGROUND The quality of warfarin therapy can be determined by the time in the therapeutic range(TTR)of international normalized ratio(INR).The estimated minimum TTR needed to achieve a benefit from warfarin therapy is≥60%.AIM To determine TTR and the predictors of poor TTR among atrial fibrillation patients who receive warfarin therapy.METHODS A retrospective observational study was conducted at a cardiology referral center in Selangor,Malaysia.A total of 420 patients with atrial fibrillation and under follow-up at the pharmacist led Warfarin Medication Therapeutic Adherence Clinic between January 2014 and December 2018 were included.Patients’clinical data,information related to warfarin therapy,and INR readings were traced through electronic Hospital Information system.A data collection form was used for data collection.The percentage of days when INR was within range was calculated using the Rosendaal method.The poor INR control category was defined as a TTR<60%.Predictors for poor TTR were further determined by using logistic regression.RESULTS A total of 420 patients[54.0%male;mean age 65.7(10.9)years]were included.The calculated mean and median TTR were 60.6%±20.6%and 64%(interquartile range 48%-75%),respectively.Of the included patients,57.6%(n=242)were in the good control category and 42.4%(n=178)were in the poor control category.The annual calculated mean TTR between the year 2014 and 2018 ranged from 59.7%and 67.3%.A high HAS-BLED score of≥3 was associated with poor TTR(adjusted odds ratio,2.525;95%confidence interval:1.6-3.9,P<0.001).CONCLUSION In our population,a high HAS-BLED score was associated with poor TTR.This could provide an important insight when initiating an oral anticoagulant for these patients.Patients with a high HAS-BLED score may obtain less benefit from warfarin therapy and should be considered for other available oral anticoagulants for maximum benefit.

Analysis on the mechanism of core drugs in treating exogenous cough in Clinical Guidelines and Medical Records

Objective:To explore the core drug of Tian-shi Ye(1666 C.E.–1745 C.E.,a famous medical experts in Qing Dynasty)for treating exogenous cough and its mechanism of action.Methods:The database of prescriptions for treating exogenous cough was established in Clinical Guide to Medical Records,and the complex network was constructed with frequency analysis and Gephi 0.9.2 software to obtain the core drug for exogenous cough,and the network of traditional Chinese medicine-component-disease-target regulation was constructed through network pharmacology to reveal the potential mechanism.Results:Xingren(Amygdalus Communis Vas)is the core drug for the treatment of exogenous cough in the“Clinical Guidelines and Medical Records”.It contains 19 active ingredients and forms 27 traditional Chinese medicine-disease targets for the treatment of acute bronchitis.Kyoto Encyclopedia of Genes and Genomes analysis involving 114 pathways,including arachidonic acid metabolism pathways,peroxidase pathways,estrogen metabolism pathways,and tryptophan metabolism pathways are the main signal pathways involved.Conclusion:Xingren(Amygdalus Communis Vas)-acute bronchitis has a multi-molecule,multi-target,and multi-pathway,and may be regulating the arachidonic acid metabolism pathway,peroxidase pathway,estrogen metabolism pathway,and tryptophan metabolism pathway.Such interventions as various biological processes in the body play a role in the treatment of acute bronchitis.

Fibromatosis Colli in Bamako: An Entity to Know in Infants

Introduction: Fibromatosis colli is a congenital muscle tumor with an incidence of 0.4%. This lesion is fibrous involving the sternocleidomastoid muscle, discovered after a few weeks of life in a patient who had known or unknown perinatal trauma. Rarely bilateral, it evolves spontaneously favorably in a few weeks or months in the vast majority of cases. Objectives: The purpose of this work is to bring the interest in ultrasound in the management of fibromatosis colli. Material and Methods: This is a descriptive cross-sectional study covering a period of 21 months from December 2019 to December 2021 in the medical imaging department of the medical clinic “Marie Cuire” in Bamako. The variables analyzed were age, sex and ultrasound results. The ultrasound system used was General Electric (GE). Data analysis was performed using Excel software. Results: During the 21-month study period, 1260 infants were seen in our service, including 0.95% for cervical swelling. We had a male predominance with 8 cases out of 12 cases and the age of the patients was mainly between 21 days and 30 days. The diagnosis was made by ultrasound, which revealed within the Sterno-cleido-mastoid muscle (MSCM) a hypo-isoechoic or heterogeneous oblong mass or thickening without any other associated anomaly. Conclusion: Cervical ultrasound is a significant examination in the management of fibromatosis colli for diagnostic confirmation and therapeutic follow-up.

Mode B Ultrasound in the Study of the Posterior Segment in the Medical Clinic “Marie Curie” in Bamako

Introduction: The study of the posterior segment of the eye has nowadays become one of the most frequent indications for diagnostic ultrasound in the ophthalmological field. The objective of this work is to contribute to the improvement of the diagnostic management of pathologies of the posterior segment of the eye in the radiology department of the medical clinic “Marie Curie” in Bamako. Material and Methods: This was a cross-sectional study carried out in the medical imaging department from January 2020 to January 2022. It concerned all patients who presented for the study of the ocular posterior segment on ultrasound. Results: Fifty-two (52) patients out of a total of 109 were included in the study, i.e. a frequency of 47.70%. The average age was 33.90 with the extremes ranging from 05 years to 75 years. The male sex dominated with a frequency of 69.23%. Ocular ultrasound was prescribed mainly by ophthalmologists (100%). In the study of the posterior segment, preoperative assessment represented the most frequent indications with respectively 55.76% and 23.10%. Retinal detachment and vitreous hemorrhage were the most found lesions on ultrasound with 50% and 34.61% respectively. Conclusion: Ocular ultrasound is accessible in Bamako and has allowed the study of the posterior segment of the eye. It occupies an important place in the study and management of ocular pathologies of the posterior segment.

The 2016 Lasker-DeBakey Clinical Medical Research Award: Innovative hepatitis C virus(HCV) replicons leading to drug development for hepatitis C cure

The 2016 Lasker-DeBakey Clinical Medical Research Award was given to three scientists working on different stages of the translational sciences on bringing a high efficacious therapy against hepatitis C virus(HCV)infection to a reality.An effective treatment of HCV chronic infection was developed,by a team led by Michael Sofia,using

Application of the Data Mining Algorithm in the Clinical Guide Medical Records

Objective:This study analyzed the data of the medical cases in the book,“Clinical Guide Medical records”using a data mining method,to provide a reference for Ye Tianshi’s academic thoughts.Methods:We used the web version of the ancient and modern medical records cloud platform to complete distribution statistics,association rules,cluster analysis,and complex network analysis of all the medical records in the“Clinical Guide Medical records.”These methods were used to summarize the baseline data and to identify the core relationship between Chinese medicine diseases and Chinese medicine,as well as the Chinese medicine Classification.Results:A total of 2572 medical records,3136 visits,and 2879 prescriptions of 1127 traditional Chinese medicines were included in this study.The most common diseases(such as hematemesis),syndromes(such as liver–stomach disharmony),symptoms(such as rapid pulse),disease sites(such as gastric cavity),disease properties(such as Yang deficiency),treatment methods(such as activating Yang),and traditional Chinese medicines(such as Poria cocos)were identified.Furthermore,medicines with a warm,flat,cold,sweet,or bitter taste with its effects on the lungs,spleen,and heart were the most common.The observed effects of the drugs included clearing dampness,promoting diuresis,and strengthening the spleen.The association analysis showed that the associations between TCM diseases and traditional Chinese medicines that had a high confidence were“phlegm and fluid retention–Poria cocos,”“diarrhea–Poria cocos,”etc.The cluster analysis showed that traditional Chinese medicines were classified into five categories.The complex network showed the core relationship between nine high-frequency diseases and nine high-frequency traditional Chinese medicine.Conclusion:This study revealed the most important relationships between traditional Chinese medicines diseases and traditional Chinese medicines and classified the most used traditional Chinese medicines.These findings may help the coming generations of doctors to make accurate diagnoses and treat patients effectively and to improve the clinicians’efficacy in clinical diagnosis and treatment.

2011 Lasker Clinical Medical Research Award Honors Prof.TU You-you for the Discovery of Artemisinin

The 2011 Lasker Clinical Medical Research Award honors a scientist who discovered artemisinin and its utility for treating malaria. Prof. TU You-you （China Academy of Chinese Medical Sciences, Beijing） transformed an ancient Chinese healing method into the most powerful antimalarial medicine currently available that has saved millions of lives across the globe, especially in the developing world. An artemisinin-based drug combination is now the standard regimen for malaria recommended by the World Health Organization （WHO）.

ITS2 barcoding DNA region combined with high resolution melting(HRM) analysis of Hyoscyami Semen, the mature seed of Hyoscyamus niger

Hyoscyami Semen, the mature dried seed of Hyoscyamus niger L., has long been used as a traditional Chinese medicine to treat human diseases. Hyoscyami Semen is found in local markets in China. In markets, sellers and buyers commonly inadvertently mix the seeds of H. niger with the seeds of related species such as Hygrophila salicifolia(Vahl) Nees, Astragalus complanatus R. Br., Cuscuta australis R. Br., Cuscuta chinensis Lam., and Impatiens balsamina L. because of their similar morphologies or similar names. Thus, developing a reliable method for discriminating H. niger seeds from its adulterants is necessary to reduce confusion and ensure the safe use of Hyoscyami Semen. The present study was designed to evaluate the efficiency of high-resolution melting analysis combined with DNA barcoding(Bar-HRM) with internal transcribed spacer 2 to discriminate H. niger. Our results show that Bar-HRM successfully identified the adulterants and detected the proportion of H. niger DNA extract within an admixture. In particular, HRM detected H. niger DNA extract in A. complanatus DNA extract at concentrations as low as 1%. In conclusion, the Bar-HRM method developed in the present study for authenticating H. niger is rapid and cost-effective. It can be used in the future to guarantee the purity of Hyoscyami Semen for the clinical use.

A Curriculum Using Simulation Models to Teach Gynecology and Obstetrics to Trainees

With the development of science and technology, great changes have taken place in medical education, making it increasingly complicated and diversified. For medical students who have just finished basic medicine courses and are preparing for their hospital internships, it is difficult to gain experience performing direct physical examinations on patients. Currently, residents＇ clinical skills are assessed very strictly; simply taking notes and reciting facts will not suffice. Because considerable attention is being paid to medical students＂ clinical skills on a national level,