BACKGROUND:The Medication-Related Burden Quality of Life (MRB-QoL) is a patient-reported measure of medicines burden on functioning and well-being in people with long-term conditions (LTCs). The Arabic version has demonstrated good content validity; however, no data is available on its other psychometric properties. OBJECTIVES:To evaluate the reliability and validity of the Arabic MRB-QoL tool. METHODS:Four hundred patients (≥18 years) with LTCs were recruited from a tertiary hospital in the United Arab Emirates. Exploratory factor analysis (EFA) was performed using Principal Axis Factoring for extraction and Oblimin rotation. Cronbach's alpha, intraclass correlation coefficient (ICC), and minimum detectable change (MDC) assessed internal consistency, test-retest reliability, and measurement error, respectively. Structural, Known-group, convergent, and discriminant validity were evaluated using EFA, Mann Whitney U test, and Spearman's rank correlations tests, respectively. Convergent validity (r > 0.3, moderate to high correlations) and discriminant validity (r < 0.3, weak correlations) were examined through correlation with the Medication Regimen Complexity Index (MRCI), Drug Burden Index (DBI), and 12-item Short Form Health Survey (SF-12) measures. Known-group validity was assessed by comparing MRB-QoL scores across clinically diverse groups. RESULTS:EFA revealed a 31-item, four-factor structure accounting for 78.5 % of the variance. Reliability results showed good internal consistency (Cronbach's α = 0.973) and test-retest reliability (ICC = 0.994). The MDC for the total MRB-QoL was 3.89, indicating that a change of more than 4 points between 2 measurements reflects a true difference with 95 % confidence. There were weak correlations between domains of MRB-QoL and MRCI (r 0.120 to 0.152) indicating discriminant validity. Correlations between the mental component summary of the SF-12 and MRB-QoL (r = -0.387) and its domains (r -0.357 to -0.374) suggested convergent validity. Patients with polypharmacy and multimorbidity had higher median MRB-QoL scores, showing known-group validity. CONCLUSION:This study demonstrated that the Arabic MRB-QoL is a valid and reliable medication-related burden (MRB) measure with good construct validity, including structural, known-group, convergent, and discriminant validity. It also shows excellent reliability, with high internal consistency, low measurement error, and good test-retest reliability. These findings support its use as a psychometrically robust measure for assessing MRB and facilitating person-centred medicines optimisation services in Arabic-speaking populations.

Background:The Medication-Related Burden Quality of Life (MRB-QoL) Arabic version is a 31-item valid and reliable measure of medication burden on functioning and well-being in people with long-term conditions. Aim:To evaluate the feasibility of using the Arabic MRB-QoL tool in clinical pharmacist-led medicines optimisation services in United Arab Emirates (UAE) hospitals. Method:This non-randomised, non-controlled, feasibility study was conducted in 4 UAE hospitals, utilising a mixed-methods approach. The clinical utility of the MRB-QoL Arabic was evaluated, covering various aspects of feasibility, including acceptability, usability, benefits, facilitators, and barriers to its implementation in practice. The study comprised 3 stages: providing training for clinical pharmacists (CPs) and nurses, implementing the Arabic MRB-QoL tool, and the System Usability Scale (SUS) survey and semi-structured interviews with CPs. The usability and perceived benefits were evaluated using qualitative interviews and a Qualtrics survey. The perceived acceptability, barriers, and facilitators were explored through analysis of the interviews. Results:Ten CPs implemented the Arabic MRB-QoL tool during routine medication reviews for 227 admitted patients. Thematic analysis of the interview transcripts identified key themes that highlighted the acceptability, usability, benefits, as well as facilitators, and barriers the CPs faced in implementing the tool in their routine clinical practice. In addition, the SUS survey showed an average score of 82.2, indicating excellent usability of the tool in facilitating medicines optimisation services. Conclusions:This study confirmed the clinical utility of the MRB-QoL Arabic in pharmacist-led medicines optimisation services in UAE hospitals, highlighting preliminary evidence of its acceptability, usability, and benefits, as well as facilitators and barriers to implementation. By promoting patient-centred medicines optimisation, the Arabic MRB-QoL tool has the potential to help healthcare providers gain insights into patients' experiences with medicines and the key dimensions of medication burden patients encounter, optimise medicines regimens, and improve patients' quality of life.

Literature on the development of patient-reported outcome measures (PROMs) has continue to expand over the past two decades. With the increasing global use of PROMs in research and clinical practice, there is a need for their rigorous and systematic translation and cultural adaptation to ensure appropriate use in new contexts. This requires a structured approach to ensure linguistic and cultural equivalence, the quality of cross-cultural adaptation (CCA), and psychometric properties of the adapted PROMs. Poor CCA can be a challenge to the transferability and applicability of PROMs. A reasonable approach to ensure high-quality CCA could involve selecting certified translators, reconciling feedback, conducting pilot tests with end users, forming an expert committee, and consulting with the original tool developers. However, there are gaps in how the process of CCA was applied and reported. Although numerous guidelines for CCA exist, none are regarded as a gold standard. In addition, there is a lack of consensus on the best and most effective method of translation. This methodological paper addresses these gaps by describing methodological guidance for CCA, including comprehensive, step-by-step instructions and toolkits to enhance researchers' understanding and application of the CCA process.

Background: The Medication-Related Burden Quality of Life (MRB-QoL) Arabic version is a 31-item valid and reliable measure of medication burden on functioning and well-being. Objective: To examine the factor structure of the MRB-QoL Arabic in a sample of adults living with long-term conditions (LTC). Methods: Three hundred forty-three patients (≥ 18 years old) living with at least one LTC were recruited from 4 tertiary hospitals in the United Arab Emirates. Confirmatory factor analysis (CFA) was performed using Maximum likelihood estimation with bootstrap. Two models (first order and second order) were examined. Model fit indices, composite reliability (CR), and average variance extracted (AVE) were used to assess the model's goodness of fit, reliability, and convergent/discriminant validity, respectively. The model's fit was evaluated using absolute fit, comparative fit, and parsimony-adjusted indices. The RMSEA and SRMR ≤0.08, χ2/df < 5, and CFI, IFI, and TLI ≥ 0.90 were considered indicators of good model fit. PNFI and PCFI >0.5 were also considered as indicators of good fit. CR ≥ 0.7, AVE ≥ 0.5, and AVE greater than squared factors correlation were considered as evidence indicating reliability, convergent validity, and discriminant validity, respectively. Results: The first-order model showed an excellent fit (χ2/df = 3.262, RMSEA = 0.08, SRMR = 0.05, CFI = 0.913, TLI = 0.914, IFI = 0.914, PNFI = 0.810, PCFI = 0.841) as did the second-order model (χ2/df = 2.845, RMSEA = 0.073, SRMR = 0.072, CFI = 0.934, TLI = 0.923, IFI = 0.915, PNFI = 0.820, PCFI = 0.851). All domains of the MRB-QoL met the convergent/discriminant validity and reliability criteria. Conclusions: The study supports the factor structure from previous research and confirms the MRB-QoL Arabic as a valid and reliable measure. This tool can be used to assess medicines burden from patient perspectives and facilitate person-centred care in medicines optimisation services across Arabic-speaking countries.

Hospitals are central to healthcare systems and understanding the drivers of hospital activity is critical for effective capacity planning, especially amid demographic shifts and fiscal pressure. In the English National Health Service (NHS), there are plans to construct 40 new hospitals. There is limited evidence on factors driving hospital activity. This study provides retrospective estimates of the effects of population growth (P), changes in the age–sex structure (S), shifts in age-specific health status (H), and residual factors (R) on hospital activity in England. Total annual growth is modelled as G = (1 + P)(1 + S)(1 + H)(1 + R) − 1. Negative binomial regression models using hospital episode statistics from 2011 to 2019 were used to decompose total annual growth rates (G) into P,S,H and R by five points of delivery (listed below). The annual growth rate for elective admissions was 2.29

Abstract Background Exposure to high anticholinergic burden is associated with adverse outcomes in older adults. Older adults with frailty have greater vulnerability to adverse anticholinergic effects. There is limited data on anticholinergic burden in hospitalised older adults with frailty particularly, in New Zealand. This study aimed to (i) examine exposure to anticholinergic medicines in older inpatients using multiple scales, and (ii) describe the association of patient factors such as frailty with anticholinergic exposure. Methods We reviewed admission and discharge medicines of 222 older patients (≥ 65 years) in a New Zealand hospital. Sociodemographic, diagnostic and medication data were collected from electronic health records. Anticholinergic burden was quantified using the Anticholinergic Burden Classification (ABC), Anticholinergic Cognitive Burden Scale (ACB), Anticholinergic Risk Scale (ARS), and Drug Burden Index (DBI). Frailty was assessed using frailty index (FI) and the Hospital Frailty Risk score (HFRS); higher scores indicate higher frailty. Multivariable logistic regression analysis was used to determine patient factors associated with anticholinergic burden. Results Depending on the scale used, the mean anticholinergic burden ranged from 0.65 to 1.83 on admission and 0.59 to 1.40 at discharge, with 32–74% of the patients on admission and 25–65% at discharge prescribed at least one anticholinergic medicine. About 1 in 3 patients had high anticholinergic burden on admission and discharge. On admission, being frail (adjusted odds ratio [AOR] 5.16, 95% confidence interval [95% CI] 1.57, 16.97), having history of readmission (AOR 4.96, CI 1.58, 15.59), and higher number of medicines [AOR range 1.18 CI 1.10, 1.26 (ARS scale) to 1.25 CI 1.15, 1.36 (DBI scale)] were associated with higher odds of anticholinergic exposure. At discharge, pre-frail (DBI scale: AOR = 6.58, CI 1.71–25.32) and frail patients (ACB scale: AOR = 5.73, CI 1.66, 19.70) and those with higher number of medicines [AOR range 1.18 CI 1.09, 1.29 (ARS scale) to 1.33 CI 1.20, 1.49 (DBI scale)] had higher odds of anticholinergic exposure. Conclusion A reduction in the anticholinergic burden from admission to discharge was observed in the study population yet, one-third of the study cohort were discharged with high anticholinergic medicines. Enhancing hospital prescribers’ and pharmacists’ awareness about anticholinergic burden and targeted interventions such as in-hospital deprescribing are needed to reduce high anticholinergic exposure in acute setting.

Background:The Medication-Related Burden Quality of Life (MRB-QoL) is a 31-item valid and reliable patient-reported measure of medicine burden on functioning and well-being in people with long-term conditions (LTC). Objectives:To translate, culturally adapt, and content validate the MRB-QoL into Arabic. Methods:A rigorous approach to cross-cultural adaptation proposed by the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) guideline was followed. After 3 forward translations and 2 backward translations, a multidisciplinary expert panel assessed the content validity (CV) of the items through a 2-round e-modified Delphi method followed by two-step cognitive debriefings with patients with LTC using think-aloud and probing techniques. An item-content validity index (I-CVI) score of ≥0.78 was considered acceptable. The original questionnaire developers and other researchers, as members of the review committee, reviewed and approved the Arabic version. Results:Five semantic and 3 cultural translation discrepancies were identified and resolved by rewording the items. The 2 backward translations did not reveal significant problems, and equivalence to the original tool was confirmed following committee review. The Arabic version showed acceptable CV parameters. E-modified Delphi involved 9 experts in round one and 7 in round 2. The I-CVI scores ranged from 0.67 to 1.0, and agreement was reached after 2 rounds. The CVI for the final version of the MRB-QoL was 0.96. Expert panel review showed that the MRB-QoL-Arabic version is relevant (CVI = 0.92), important (CVI = 0.97), clear (CVI = 0.98), and comprehensive in measuring the burden of medicines. Data from 5 cognitive interviews showed that items and concepts included in the Arabic version of the MRB-QoL are relevant to the targeted sample, clear, and easy to understand. Conclusion:The MRB-QoL Arabic version was developed and content validated. However, further evaluation of its other psychometric properties is necessary before it can be utilized in clinical and research settings. Using this tool will enable a more accurate understanding of the effects of treatment burden on patient well-being, thereby guiding care toward minimally disruptive medicine.

Objectives The planning process for a new hospital relies on assumptions about future levels of demand. Typically, such assumptions are characterised by point estimates, the flaw-of-averages, base-rate neglect and overoptimism from an inside view. To counteract these limitations, we elicited an outside view of probabilistic forecasts based on judgements of experts about the extent to which various types of hospital activity might be mitigated over 20 years, in support of the New Hospital Programme (NHP) in the English National Health Service.Design A prospective online elicitation exercise, over two rounds, to forecast the reduction (0% no reduction to 100% total reduction) in 77 types of hospital activity across England via five types of activity mitigation: outpatient attendance avoidance (n=8); inpatient admission avoidance (n=31); A&E attendance avoidance (n=12); outpatient delivery mode (n=4); inpatient length of stay reduction (n=22) and eight types of activity groups.Primary outcomes are the aggregated forecasts representing the percentage reduction (0%–100%) in hospital activity across England based on ‘surprisingly low’ (10th percentile—P10) to ‘surprisingly high’ (90th percentile—P90) forecasts from 17 experts.Results We had 657 forecasts from 17 experts. The most pessimistic forecast was for inpatient avoidance of frail elderly admissions (mean 5.71%, P10=0.43%, P90=16.40%). The most optimistic forecast was for inpatient admission avoidance for vascular surgery (mean 48.27%, P10=19.82%, P90=78.57%). The overall (n=77) aggregate means ranged from a low of 5.71% to a high of 48.27% with an average width of 50.08%. Experts highlighted mainly four types of mitigation mechanisms—prevention, displacement, quality improvement and de-adoption.Conclusion A national elicitation exercise has provided long-term aggregate forecasts across England that make explicit the wide variation and uncertainty associated with future mitigation activities from an outside perspective. These aggregate forecasts may now be incorporated into the NHP, providing a more robust foundation for planning.

Background: The U.S. Food and Drug Administration (FDA) revised the labels of sodiumglucose transporter 2 (SGLT2) inhibitors in December 2015 to inform users regarding the risk of diabetic ketoacidosis (DKA). As more drugs of this class are approved and their indications are expanded, this serious adverse effect has been increasingly reported. Objective: This review evaluated observational studies to inform the prevalence of SGLT2inhibitor-associated DKA compared with other antihyperglycemic agents. Methods: A systematic review was conducted in PubMed and EMBASE until 19 July 2022 (PROSPERO: CRD42022385425). We included published retrospective cohort active comparator/new user (ACNU) and prevalent new user studies assessing SGLT2-inhibitor-associated DKA prevalence in adult patients with type 2 diabetes mellitus (T2DM) against active comparators. We excluded studies which lacked 1:1 propensity score matching. The JBI Checklist for Cohort Studies guided the risk -of -bias assessments. Meta -analysis was conducted based on the inverse variance method in R software. Results: Sixteen studies with a sample of 2,956,100 nonunique patients met the inclusion criteria. Most studies were conducted in North America (n = 9) and adopted the ACNU design (n = 15). Meta -analysis of 14 studies identified 33% higher DKA risk associated with SGLT2 inhibitors (HR = 1.33, 95% CI: 1.14-1.55, P < 0.01). Meta -regression analysis identified the study location (P = 0.02), analysis principle (P < 0.001), exclusion of chronic comorbidities (P = 0.007), and canagliflozin (P = 0.04) as significant moderator variables. Conclusions: Despite limitations related to heterogeneity, generalizability, and misclassification, the results of this study show that SGLT2 inhibitors increase the prevalence of DKA among adult T2DM patients in the real world. The findings supplement evidence from randomized controlled trials (RCTs) and call for continued vigilance. (c) 2023 American Pharmacists Association (R). Published by Elsevier Inc. All rights reserved.

ObjectivesAlthough primary care is central to healthcare provision, inconsistent methods and data sources mean that relatively little is known about long-term trends in general practice consultation rates. We aimed to explore long-term trends in English general practice consultation rates using two electronic health records databases, Clinical Practice Research Datalink Gold and Aurum, from 1995 to 2021.MethodsConsultations were identified and classified using a set of rules and code lists. Consultation rates were calculated as the ratio of the count of consultations and the registration duration. We used negative binomial regression to model the relationship between the number of consultations and the patient’s age, sex and year from each database. These models are then used to estimate annual crude consultation rates for England.ResultsThe number of general practices in the Gold database decreased from 346 (1995) to 41 (2021), while in Aurum, it increased from 555 (1995) to 1347 (2021). In Gold, the average number of consultations per person-year increased from 2.91 in 1995 to 5.12 in 2012, then fell to 4.59 in 2019 and to 4.12 in 2021. In Aurum, average consultations per person-year rose from 2.17 (1995) to 4.89 (2012), then fell to 4.76 (2019) and rose again to 5.40 (2021). Half of the total increase in consultations from Aurum was due to a new consultation code, for ‘AccurX consultations’, an electronic messaging system for communication with patients.ConclusionTrends in general practice consultation showed three distinct epochs: rising from 1995 to 2012, falling from 2012 to 2019 and rising in Aurum but falling in Gold from 2019 to 2021. Consultation rates in Gold were higher than Aurum until the inclusion of a new consultation code in Aurum in 2019, which underscores the need for operational definitions of a consultation.

ObjectivesThe Computer-Aided Risk Score for Mortality (CARM) estimates the risk of in-hospital mortality following acute admission to the hospital by automatically amalgamating physiological measures, blood tests, gender, age and COVID-19 status. Our aims were to implement the score with a small group of practitioners and understand their first-hand experience of interacting with the score in situ.DesignPilot implementation evaluation study involving qualitative interviews.SettingThis study was conducted in one of the two National Health Service hospital trusts in the North of England in which the score was developed.ParticipantsMedical, older person and ICU/anaesthetic consultants and specialist grade registrars (n=116) and critical outreach nurses (n=7) were given access to CARM. Nine interviews were conducted in total, with eight doctors and one critical care outreach nurse.InterventionsParticipants were given access to the CARM score, visible after login to the patients' electronic record, along with information about the development and intended use of the score.ResultsFour themes and 14 subthemes emerged from reflexive thematic analysis: (1) current use (including support or challenge clinical judgement and decision making, communicating risk of mortality and professional curiosity); (2) barriers and facilitators to use (including litigation, resource needs, perception of the evidence base, strengths and limitations), (3) implementation support needs (including roll-out and integration, access, training and education); and (4) recommendations for development (including presentation and functionality and potential additional data). Barriers and facilitators to use, and recommendations for development featured highly across most interviews.ConclusionOur in situ evaluation of the pilot implementation of CARM demonstrated its scope in supporting clinical decision making and communicating risk of mortality between clinical colleagues and with service users. It suggested to us barriers to implementation of the score. Our findings may support those seeking to develop, implement or improve the adoption of risk scores.

Objective: There is an increasing recognition of the burden of cardiovascular disease in Africa. However, little is known about the pooled prevalence of acute coronary syndrome (ACS)-associated in-hospital mortality and contributing factors. Methods: PubMed, Medline, Embase, Web of Science (Core Collection), and supplementary sources including Google Scholar, World Cat, Research Gate, and Cochrane Library were searched. Chi-square test and I 2 -statistic were used to assess heterogeneity. Egger’s and Begg’s tests and funnel plots were used to assess publication bias. Data were analyzed using Stata software (version 15.0). Result: Twenty nine studies with a total sample of 11,788 were included. The pooled estimate of all-cause in-hospital mortality was 22% (pooled proportion (PP) = 0.22; 95% confidence interval (CI): 0.17–0.27. The In-hospital mortality rate was lower at the cardiac centers (PP = 0.14; CI: 0.05–0.23) compared to referral hospitals (PP = 0.24; CI: 0.17–0.31]) The mortality rate was comparable in Eastern (PP = 0.23; CI: 0.19–0.27) and Northern Africa (PP = 0.22; CI: 0.16–0.28). The incidence of in-hospital heart failure, cardiogenic shock, arrhythmia, bleeding, acute stroke, and reinfarction were 42, 17.0, 20.0, 16.0, 4.0, and 5.0%, respectively. Conclusion: All-cause in-hospital mortality rate associated with ACS is high in Africa. The mortality rate at cardiac centers was 10% lower when compared with referral hospitals. Establishing coronary units, strengthening existing cardiac services, and improving availability and access to cardiovascular medicines could help in reducing the burden of ACS in the continent.

Background Older inpatients, particularly those with frailty, have increased exposure to complex medication regimens. It is not known whether frailty and complexity of medication regimens influence attitudes toward deprescribing. This study aimed to investigate (1) older inpatients’ attitudes toward deprescribing; (2) if frailty and complexity of medication regimen influence attitudes and willingness to deprescribe - a relationship that has not been investigated in previous studies. Methods In this cross-sectional study, older adults (≥ 65 years) recruited from general medicine and geriatric services in a New Zealand hospital completed the revised Patients’ Attitudes Towards Deprescribing (rPATD) questionnaire. Hospital frailty risk score (HFRS) was calculated using diagnostic codes and other relevant information present at the time of index hospital admission; higher scores indicate higher frailty risk. Medication regimen complexity was quantified using the medication regimen complexity index (MRCI); higher scores indicate greater complexity. Logistic regression analysis was used to identify predictors of attitudes and willingness to deprescribe. Results A total of 222 patients were included in the study, the median age was 83 years and 63% were female. One in two patients reported feeling they were taking too many medications, and 1 in 5 considered their medications burdensome. Almost 3 in 4 (73%) wanted to be involved in decision-making about their medications, and 4 in 5 (84%) were willing to stop one or more of their medications if their prescriber said it was possible. Patients with higher MRCI had increased self-reported medication burden (adjusted odds ratio (AOR) 2.6, 95% CI 1.29, 5.29) and were more interested in being involved in decision-making about their medications (AOR 1.8, CI 0.99, 3.42) than those with lower MRCI. Patients with moderate HFRS had lower odds of willingness to deprescribe (AOR 0.45, CI 0.22,0.92) compared to the low-risk group. Female patients had a lower desire to be involved in decision-making. The oldest old age group( > 80 years) had lower self-reported medication burden and were less likely to want to try stopping their medications. Conclusion Most older inpatients wanted to be involved in decision-making about their medications and were willing to stop one or more medications if proposed by their prescriber. Medication complexity and frailty status influence patients’ attitudes toward deprescribing and thus should be taken into consideration when making deprescribing decisions. Further research is needed to investigate the relationship between frailty and the complexity of medication regimens.

OBJECTIVES:To assess the relative productivity of primary medical services in England and the impact of the COVID-19 pandemic on productivity levels. SETTING:Primary medical services for 59 million patients (98% of the population in England), in 101 clinical commissioning groups (CCGs), across two time periods: period 1, pre-pandemic, April to December 2019 and period 2, pandemic, April to December 2020. METHODS:We use data envelopment analysis (DEA) to assess relative productivity with four input measures (the number of full-time equivalent general practitioners, nurses, other direct patient contact staff and administrators), and five output measures (face-to-face appointments, remote consultations, home visits, referrals to secondary care and prescriptions). Our units of analysis were CCGs. DEA assigns an efficiency score to a CCG, taking a value between 0 and 100%, by benchmarking it against the most productive CCGs. We use Tobit regression to examine the association between productivity and other factors. RESULTS:The mean bias-corrected efficiency score of primary medical services in CCGs was 92.9% (interquartile range 92.0% to 95.7%) in period 1, falling to 90.6% (interquartile range 86.8% to 95.2%) in period 2. In period 1, CCGs with a higher proportion of registered patients aged over 65 years, higher levels of deprivation, lower levels of disease prevalence, higher nurse to GP ratios and higher GP to other direct patient contact staff ratios, achieved statistically significantly higher general practice efficiency scores (p < 0.05). In period 2, only the ratio of GP to other direct patient contact staff was associated with efficiency scores (p > 0.05). CONCLUSIONS:Our analysis indicates only modest geographic variation in productivity of primary medical services when measured at the level of clinical commissioning groups and a small reduction in productivity during the pandemic. Further work to establish relative productivity of individual GP practices is warranted once sufficient data on appointment rates by GP practice is available.

Background: Patient-reported outcome measures (PROMs) are increasingly recognized as an indicator of healthcare quality and safety. Over the past decades, there has been a growing interest in using PROMs in Arabic -speaking populations. However, there is a paucity of data regarding the quality of their cross-cultural adaptation (CCA) and measurement properties.Objectives: To identify PROMs that have been developed, validated or cross-culturally adapted to Arabic and evaluate methodological qualities of CCA and measurement properties.Methods: MEDLINE, EMBASE, CINAHL, PsycINFO, IPA, and ISI Web of Science were searched using search terms 'PROMs', 'Arabic countries', 'CCA', and 'psychometric properties'. Measurement properties were evaluated using COSMIN quality criteria and CCA quality was assessed using the Oliveria rating method.Results: This review included 260 studies with 317 PROMs, focusing on psychometric testing (83.8%), CCA (75.8%), utilizing PROMs as outcome measures (13.4%), and developing PROMs (2.3%). Out of the 201 cross -culturally adapted PROMs, forward translation was the most frequently reported component of CCA (n = 178), followed by back translation (n = 174). Out of the 235 PROMs that reported measurement properties, internal consistency was the most frequently reported measurement property (n = 214), followed by reliability (n = 160) and hypotheses testing (n = 143). Other measurement properties were less reported, including responsiveness (n = 36), criterion validity (n = 22), measurement error (n = 12), and cross-cultural validity (n = 10). The strongest measurement property was hypotheses testing (n = 143), followed by reliability (n = 132). Conclusion: There are several caveats regarding the quality of CCA and measurement properties of PROMs included in this review. Only 1 out of 317 Arabic PROMs met CCA and psychometric optimal quality criteria. Therefore, there is a need to improve the methodological quality of CCA and measurement properties of PROMs. This review provides valuable information for researchers and clinicians when choosing PROMs for practice and research. There were only 5 treatment-specific PROMs, indicating the necessity for more research focusing on development and CCA of such measures.

OBJECTIVE:Medication errors can have detrimental effects on patient outcomes, yet there are limited data on the prevalence of potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs) among older adult inpatients in New Zealand (NZ). This study investigated exposure to PIMs and PPOs in older adults in a New Zealand hospital.METHODS:Electronic medical records of 846 older adults (≥ 65 years) discharged from the Auckland District Health Board between June 2020 and May 2021 were retrospectively reviewed to extract data on sociodemographic, medication and diagnostic information. STOPP/START version 2 was used to evaluate PIMs and PPOs on admission and discharge.RESULTS:The mean age was 77.47 ± 8.12 years, and 51% were female. On admission, 48% had ≥1 PIMs and 40% had ≥1 PPOs. On discharge, 45% had ≥1 PIMs and 40% had ≥1 PPOs. Increasing age (adjusted odds ratio [AOR] = 1.02, 95% CI [confidence interval] 1.01, 1.04), number of medicines (AOR = 1.23, CI 1.17, 1.29) and 28-day admission history (AOR = 1.58, CI 1.15, 2.18) were associated with higher odds of PIMs use on admission. At discharge, the number of medicines (AOR = 1.19, CI 1.13, 1.25) and history of readmission (AOR = 1.47, CI 1.08, 2.02) were associated with higher odds of PIMs. Female patients had higher odds of PPOs both on admission (AOR = 1.35, CI 1.02, 1.78) and discharge (AOR = 1.34, CI 1.01, 1.78). Māori, Asian and Pacific patients were more likely to have prescribing omissions compared to NZ Europeans.CONCLUSIONS:Prescribing omissions and inappropriate medications were common in older inpatients. There were differences observed between different ethnic groups, with NZ Europeans having fewer omissions than other ethnic groups. These findings highlight key opportunities for health-care providers to improve medication use in older adults in NZ.

The COVID-19 pandemic challenged the NHS to make rapid adjustments to practice to ensure that patients could continue to access vital treatments while reducing the risk of infection. A roundtable discussion was convened, including professionals from cancer care delivery and those working in patient involvement, to discuss experiences during the pandemic and to offer recommendations for the safe transition and implementation of cancer care in the community setting.

Background: The Medication-Related Burden Quality of Life (MRB-QoL) tool has been developed to measure the burden of medications on functioning and wellbeing from a patient perspective. However, predictors of MRB-QoL were not reported in greater detail in the validation study. This study aimed to explore factors associated with MRB-QoL to see whether there is any new information that calls for further research. Methods: Analysis of data from the MRB-QoL validation study was undertaken. Outcome variables were domains of the MRB-QoL (Routine and Regimen Complexity, Psychological Burden, Functional and Role Limitation, Therapeutic Relationship, and Social Burden). Explanatory variables were patient age; disease-related factors; and medication-related factors, such as number of medications, complexity of medication regimen (measured by the Medication Regimen Complexity Index [MRCI]), and exposure to medications with anticholinergic and sedative effects (measured by the Drug Burden Index [DBI]). Linear regression analyses were used to identify factors associated with the MRB-QoL. Results: The study included 367 participants (52.1% male), with a median age of 64 years. In multivariable regression analyses, an increase in the DBI was significantly associated with poorer Psychological wellbeing (beta=-0.15, p<0.001) and Functional and Role Limitation (beta= -1.79, p<0.001). Living with three or more medical conditions was significantly associated with poorer Psychological wellbeing (beta=-0.21, p<0.001). Age was significantly associated with all domains of the MRB-QoL (beta=0.28 to 0.55). Polypharmacy and MRCI were not associated with any of the MRB-QoL domains. Conclusion: In this sample of community-dwelling adults with multiple medications, the DBI was independently associated with the Psychological Burden and Functional and Role Limitation domains of the MRB-QoL. This study provides preliminary evidence on factors affecting medication-related quality of life outcomes from a patient perspective. Future longitudinal studies, along with further psychometric testing of the MRB-QoL measure, are warranted to better understand predictors of MRB-QoL.

Purpose In 2011, community nursing services were reorganised in England in response to a national policy initiative, but little is known about the impact of these changes. A total of three dominant approaches emerged: (1) integration of community nursing services with an acute hospital provider, (2) integration with a mental health provider and (3) the establishment of a stand-alone organisation, i.e. without structural integration. The authors explored how these approaches influenced the trends in emergency hospital admissions and bed day use for older people. Design/methodology/approach The methodology was a longitudinal ecological study using panel data over a ten-year period from April 2006 to March 2016. This study’s outcome measures were (1) emergency hospital admissions and (2) emergency hospital bed use, for people aged 65+ years in 140 primary care trusts (PCTs) in England. Findings The authors found no statistically significant difference in the post-intervention trend in emergency hospital admissions between those PCTS that integrated community nursing services with an acute care provider and those integrated with a mental health provider (IRR 0.999, 95% CI 0.986–1.013) or those that did not structurally integrate services (IRR 0.996, 95% CI 0.982–1.010). The authors similarly found no difference in the trends for emergency hospital bed use. Research limitations/implications PCTs were abolished in 2011 and replaced by clinical commissioning groups in 2013, but the functions remain. Practical implications The authors found no evidence that any one structural approach to the integration of community nursing services was superior in terms of reducing emergency hospital use in older people. Originality/value As far as the authors are aware, previous studies have not examined the impact of alternative approaches to integrating community nursing services on healthcare use.

Background: The SARS-CoV-2 outbreak and associated lockdown measures have challenged healthcare. We examine how attendances to ED in England were impacted. Methods: Interrupted time series regression (January 2019 to June 2020) of data from EDs in 41 English NHS Trusts was used to estimate the initial decrease in attendances and the rate of increase following an interruption from 11 March - 7 April 2020, which included the 23 March lockdown in England. Findings: The SARS-CoV-2 interruption led to an initial 51.1% reduction (95% CI 46.3-55.9%) in ED attendances followed by a linear increase in attendances of 3.0% per week (95% CI 2.5-3.5%). Significantly larger initial reductions were seen in those aged 0-19 years (69.1%), Indian (64.9%), Pakistani (71.8%), Bangladeshi (75.3%), African (63.5%) and Chinese people (74.5%), self-conveying attendees (60.3%) and those presenting with contusions or abrasions (66.9%), muscle and tendon injuries (65.6%), and those with a diagnosis that was not classifiable (72.7%). Significantly smaller initial reductions were seen in those aged 65-74 years (42.6%), 75+ years (40.1%), those conveyed by ambulance (31.9%), and those presenting with the following conditions: central nervous system (44.9%), haematological (44.0%), cardiac (43.7%), gastrointestinal (43.4%), gynaecological (43.2%), psychiatric (40.4%), poisoning (39.7%), cerebro-vascular (39.0%), endocrinological (36.1%), other vascular (34.6%), and maxillo-facial (19.7%). No significant differences in the initial reduction of activity were seen in subgroups defined by sex, deprivation, urbanicity or acuity. Interpretation: The SARS-CoV-2 outbreak and lockdown substantially reduced ED activity. The reduction varied by age groups, ethnicity, arrival mode and diagnostic group but not by sex, deprivation, urbanicity or acuity. (C) 2021 The Author(s). Published by Elsevier Ltd.