Medicare part D in long-term care: special consideration for the vulnerable elderly nursing facility resident.
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Biomedical subjects
Publications and source records attributed to William Simonson.
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The elderly population is at great risk for medication-related problems as a result of age-related physiological changes, the presence of multiple chronic diseases and conditions, and the types and numbers of prescription and nonprescription medications they consume.Medication-related problems have received international attention. In the US, as many as 200,000 people may die of medication-related problems each year. Studies from other developed nations where patients have access to medications have determined that various types of medication-related problems occur in the elderly population in health care environments ranging from nursing homes to community dwelling settings.A variety of initiatives have been developed in an attempt to reduce the likelihood of medication-related problems in the elderly. The role that a pharmacist can play in identifying and preventing the negative health outcomes and costs of medication-related problems is being increasingly recognised. Indeed, numerous studies have now documented the positive impact that pharmacists can have in this area, and ongoing research is being conducted. With the growing numbers of elderly, and the increase in the numbers and types of medications available, it is imperative that awareness of medication-related problems be increased and that further initiatives be developed to optimise the positive outcomes of drug therapy in the elderly.
OBJECTIVE: To review and summarize key studies of secondary prevention of atherothrombotic events. DATA SOURCES: English language clinical trials and guidelines. STUDY SELECTION: Key clinical trials and guidelines were selected by the authors based on their perceived importance and relevance to consultant pharmacists. DATA EXTRACTION: The authors reviewed and summarized clinical trials and guidelines published in the English literature. DATA SYNTHESIS: Each clinical trial and guideline was summarized by the authors. CONCLUSION: Key clinical trials and guidelines regarding the secondary prevention of atherothrombotic events have great significance to consultant pharmacy.
Dietary factors have been reported to affect the development of spontaneous diabetes in various colonies of inbred and outbred diabetes-prone (DP) BioBreeding (BB) rats. Several studies have attributed a protective effect to a diet omitting crude protein mixtures in favor of purified casein, hydrolyzed casein, or free amino acids. We have used inbred BB rats, all of which become diabetic in specific pathogen-free (SPF) conditions when fed ordinary rat chow, to test the capacity of 2 different protein-free diets to modulate BB rat diabetes in 2 distinct pathogen-free environments. BB rats known to all develop diabetes by 100 days of age were fed from birth with 1 of 3 diets. By 120 days of age, 100% of the animals on a standard diabetogenic chow diet, 83% of animals on an amino acid-based protein-free diet, and 100% of animals on a hydrolyzed casein-based diet had developed diabetes (P >.05). A slight delay in the age of onset was observed among rats fed the amino acid-based diet, but this delay coincided with a reduction in weight gain among these animals compared with the rats on a standard diet. Histology showed insulitis in all rats at either diabetes onset or 120 days of age. We conclude that our unique strain of specific pathogen-free BB rats are not protected from diabetes when fed an amino acid-based diet and suggest that their insensitivity to dietary manipulation may be due to an as yet unknown factor present in the diabetes-resistant (DR), but not the DP BB rat genetic background.
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