David O'Sullivan

STOPP/START criteria for potentially inappropriate prescribing in older people: version 2

Abstract Purpose: screening tool of older peoples prescriptions (STOPP) and screening tool to alert to right treatment (START) criteria were first published in 2008. Due to an expanding therapeutics evidence base, updating of the criteria was required. Methods: we reviewed the 2008 STOPP/START criteria to add new evidence-based criteria and remove any obsolete criteria. A thorough literature review was performed to reassess the evidence base of the 2008 criteria and the proposed new criteria. Nineteen experts from 13 European countries reviewed a new draft of STOPP & START criteria including proposed new criteria. These experts were also asked to propose additional criteria they considered important to include in the revised STOPP & START criteria and to highlight any criteria from the 2008 list they considered less important or lacking an evidence base. The revised list of criteria was then validated using the Delphi consensus methodology. Results: the expert panel agreed a final list of 114 criteria after two Delphi validation rounds, i.e. 80 STOPP criteria and 34 START criteria. This represents an overall 31% increase in STOPP/START criteria compared with version 1. Several new STOPP categories were created in version 2, namely antiplatelet/anticoagulant drugs, drugs affecting, or affected by, renal function and drugs that increase anticholinergic burden; new START categories include urogenital system drugs, analgesics and vaccines. Conclusion: STOPP/START version 2 criteria have been expanded and updated for the purpose of minimizing inappropriate prescribing in older people. These criteria are based on an up-to-date literature review and consensus validation among a European panel of experts.

Application of the STOPP/START criteria: a systematic review of the prevalence of potentially inappropriate prescribing in older adults, and evidence of clinical, humanistic and economic impact

Potentially inappropriate prescribing (PIP) has significant clinical, humanistic and economic impacts. Identifying PIP in older adults may reduce their burden of adverse drug events. Tools with explicit criteria are being developed to screen for PIP in this population. These tools vary in their ability to identify PIP in specific care settings and jurisdictions due to such factors as local prescribing practices and formularies. One promising set of screening tools are the STOPP (Screening Tool of Older Persons potentially inappropriate Prescriptions) and START (Screening Tool of Alert doctors to the Right Treatment) criteria. We conducted a systematic review of research studies that describe the application of the STOPP/START criteria and examined the evidence of the impact of STOPP/START on clinical, humanistic and economic outcomes in older adults.

Novel type I restriction specificities through domain shuffling of HsdS subunits in Lactococcus lactis

This study identifies a natural system in Lactococcus lactis, in which a restriction modification specificity subunit resident on a 6159 bp plasmid (pAH33) alters the specificity of a functional R/M mechanism encoded by a 20.3 kb plasmid, pAH82. The new specificity was identified after phenotypic and molecular analysis of a 26.5 kb co‐integrate plasmid (pAH90), which was detected after bacteriophage challenge of the parent strain. Analysis of the regions involved in the co‐integration revealed that two novel hybrid hsdS genes had been formed during the co‐integration event. The HsdS chimeras had interchanged the C‐ and N‐terminal variable domains of the parent subunits, generating two new restriction specificities. Comparison of the parent hsdS genes with other type I specificity determinants revealed that the region of the hsdS genes responsible for the co‐integration event is highly conserved among lactococcal type I hsdS determinants. Thus, as hsdS determinants are widespread in the genus Lactococcus, new restriction specificities may evolve rapidly after homologous recombination between these genes. This study demonstrates that, similar to previous observations in Gram‐negative bacteria, a Gram‐positive bacterium can acquire novel restriction specificities naturally through domain shuffling of resident HsdS subunits.

Use of a frailty index to identify potentially inappropriate prescribing and adverse drug reaction risks in older patients

BACKGROUND potentially inappropriate prescribing (PIP) is a significant problem in health care today. We hypothesise that if doctors were given a single indicator of PIP and adverse drug reaction (ADR) risk on a patients prescription, it might stimulate them to review the medicines. We suggest that a frailty index (FI) score may be such a suitable indicator. OBJECTIVES to determine whether a positive relationship exists between a patients frailty status, the appropriateness of their medications and their propensity to develop ADRs. Compare this to just using the number of medications a patient takes as an indicator of PIP/ADR risk. SETTING AND METHOD a frailty index was constructed and applied to a patient database. The associations between a patients FI score, the number of instances of PIP on their prescription and their likelihood of developing an ADR were determined using Pearson correlation tests and χ(2) tests. RESULTS significant correlation between FI score instances of PIP was shown (R = 0.92). The mean FI score above which patients experienced at least one instance of PIP was 0.16. Patients above this threshold were twice as likely to experience PIP (OR = 2.6, P < 0.0001) and twice as likely to develop an ADR (OR = 2.1, P < 0.0001). Patients taking more than six medications were 3 times more likely to experience PIP. CONCLUSION an FI score is a potentially relevant clinical indicator for doctors to critically assess a patients prescription for the presence of PIP and ultimately prevent ADRs, especially when used in tandem with the number of medications a patient takes.

Perceived social support and neuroticism interact in predicting depression level among depressed university students

Although perceived social support (PSS) is associated with lower depression in younger people, it is unclear whether the relationship is moderated by other factors. The objective of this study was to examine the interaction of neuroticism and PSS in predicting depression levels. A cross-sectional survey design was employed. Data from 362 students of University College Cork, all in emerging adulthood (18–25), were included in the analysis. Correlational analyses identified a positive relationship between neuroticism and depression scores and a negative relationship between PSS and depression scores. In those respondents who were classified as depressed, and controlling for age and sex, neuroticism and PSS were unique predictors of depression score, and a PSS × neuroticism interaction emerged such that PSS was particularly beneficial in those with high neuroticism. The finding suggests that PSS is an important protection against severe depression in depressed younger people, especially in those with high ne...

The LifeMatters programme for developing life-skills in children: an evaluation

Purpose – LifeMatters is a cognitive behavioural coaching programme that provides tools and techniques for developing and applying five areas of life skill competency: taking care of the body, feeling positive, thinking wisely, acting wisely, and taking care of the spirit. The purpose of paper is to evaluate the viability of the LifeMatters programme with a cohort of secondary school students (12-15 years) in Ireland. Design/methodology/approach – Open-ended feedback obtained from 196 participants who completed an open-ended questionnaire. These responses were subjected to a thematic analysis. Subsequent quantitative analysis of the resulting categorical data were carried out using correspondence analysis. Findings – Categorical analysis produced statistically significant sex and age differences showing that males and females differed in their experience of the programme. Girls benefited more from a focus upon stress and self-confidence whereas boys benefited more from a focus on relationship building. Or...