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Dementia patients have greater anti-cholinergic drug burden on discharge from hospital: A multicentre cross-sectional study
- J. Randall, A. Hook, C-M. Grubb, N. Ellis, J. Wellington, A. Hemmad, A. Zerdelis, B. Geers, B. Sykes, C. Auty, C. Vinchenzo, C. Thorburn, D. Asogbon, E. Granger, H. Boagey, J. Raphael, K. Patel, K. Bhargava, M.-K. Dolley, M. Maden, M. Shah, Q. Lee, R. Vaidya, S. Sehdev, S. Barai, S. Roche, U. Khalid, J. Harrison, D. Codling
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- Journal:
- European Psychiatry / Volume 64 / Issue S1 / April 2021
- Published online by Cambridge University Press:
- 13 August 2021, pp. S422-S423
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Introduction
Anticholinergic medications block cholinergic transmission. The central effects of anticholinergic drugs can be particularly marked in patients with dementia. Furthermore, anticholinergics antagonise the effects of cholinesterase inhibitors, the main dementia treatment.
ObjectivesThis study aimed to assess anticholinergic drug prescribing among dementia patients before and after admission to UK acute hospitals.
Methods352 patients with dementia were included from 17 hospitals in the UK. All were admitted to surgical, medical or Care of the Elderly wards in 2019. Information about patients’ prescriptions were recorded on a standardised form. An evidence-based online calculator was used to calculate the anticholinergic drug burden of each patient. The correlation between two subgroups upon admission and discharge was tested with Spearman’s Rank Correlation.
ResultsTable 1 shows patient demographics. On admission, 37.8% of patients had an anticholinergic burden score ≥1 and 5.68% ≥3. At discharge, 43.2% of patients had an anticholinergic burden score ≥1 and 9.1% ≥3. The increase was statistically significant (rho 0.688; p=2.2x10-16). The most common group of anticholinergic medications prescribed at discharge were psychotropics (see Figure 1). Among patients prescribed cholinesterase inhibitors, 44.9% were also taking anticholinergic medications.
ConclusionsThis multicentre cross-sectional study found that people with dementia are frequently prescribed anticholinergic drugs, even if also taking cholinesterase inhibitors, and are significantly more likely to be discharged with a higher anticholinergic drug burden than on admission to hospital.
Conflict of interestThis project was planned and executed by the authors on behalf of SPARC (Student Psychiatry Audit and Research Collaborative). We thank the National Student Association of Medical Research for allowing us use of the Enketo platform. Judith Harrison was su
A Portable Common Executable Environment for Ada
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- By D. Auty, SofTech, USA, A. Burns, University of Bradford, UK, C. W. McKay, University of Houston - Clear Lake, USA, C. Randall, GHG Corporation, USA, P. Rogers, University of Houston - Clear Lake, USA
- Edited by Judy M. Bishop, University of Southampton
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- Book:
- Distributed Ada: Developments and Experiences
- Published online:
- 13 October 2009
- Print publication:
- 10 May 1990, pp 259-291
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Summary
INTRODUCTION
Perhaps the greatest challenge facing Ada is in the domain of the large distributed real-time system. Because of the long lead time associated with such complex applications no real experience of the use of Ada, in this type of domain, has yet been gained. Nevertheless there are projects of a large and complex nature that are committed to the use of Ada, even though the full potential of the language has yet to prove itself in this challenging domain.
The Portable Common Execution Environment (PCEE) project is a research effort addressing the life cycle support of large, complex, non-stop, distributed computing applications with Mission And Safety Critical (MASC) components. Such applications (for example the International Space Station — Freedom) typically have extended life-time (e.g., 30 years) requirements. PCEE focuses on the system software, the interface to applications and the system architecture necessary to reliably build and maintain such systems. The requirements extend from the target system environment to the integration environment, and ultimately to the host environment. The integration environment serves as the single logical point of integration, deployment, and configuration control whereas system development occurs in the host environment. Life cycle issues include an integrated approach to the technologies (environments, tools, and methodologies) and theoretical foundations (models, principles, and concepts) that span these three environments. The scope of the effort is necessarily broad. There are, however, substantial research foundations to support development across the breadth of the project.