#GeriMedJC: December 19, 2014

The two articles critically appraised during  #GeriMedJC on Dec 19 were:

Smith T, Pelpola K, Ball M, Ong A, Myint PK. Pre-operative indicators for mortality following hip fracture surgery: a systematic review and meta-analysis. Age Ageing. 2014 Jul;43(4):464-71. 

Frankenthal D1, Lerman Y, Kalendaryev E, Lerman Y. Intervention with the screening tool of older persons potentially inappropriate prescriptions/screening tool to alert doctors to right treatment criteria in elderly residents of a chronic geriatric facility: a randomized clinical trial. J Am Geriatr Soc. 2014 Sep;62(9):1658-65. 

What a great discussion! Thanks especially to international expert involvement from @DrPhilipBraude who has a special interest in perioperative geriatrics. We also welcomed the McMaster University Division of Geriatric Medicine (Hamilton, Ontario, Canada) crew to the live telemedicine version of the journal club.

This is what Symplur analytics had to say about the December tweet chat:

Missed the discussion?  You can get the transcript of the #GeriMedJC tweet chat here.

Thanks again to all those who participated in the Tweet chat:

The next #GeriMedJC will be on January 30, 2015 08:00 EST / 13:00 GMT.  See you then!

Our live journal club is also growing!

We are growing!  Just look at this list of sites participating via telemedicine!

The University of Toronto Division of Geriatric Medicine organizes a monthly Geriatric Medicine Journal Club where residents and faculty have the opportunity to critically appraise recent geriatric medicine literature. Two Geriatric Medicine residents review and present a critical appraisal of an original research article. There is one long presentation of 45 minutes and one short presentation of 15 minutes. The meetings take place on the fourth Friday of each month from 08:00 to 09:00. The Journal Club is broadcast by video-conference via the Ontario Telemedicine Network (OTN) to satellite sites around the province of Ontario.  

1. Sunnybrook Health Sciences Centre (Toronto)
2. Grand River Hospital (Kitchener-Waterloo)
3. Mount Sinai Hospital (Toronto)
4. St. Mary's General Hospital (Kitchener-Waterloo)
5. Orillia Soldiers' Memorial Hospital (Orillia)
6. St. Joseph's Health Centre (Toronto)
7. North York General Hospital (Toronto)
8. St. Joseph's Healthcare (Hamilton) 
9. Juravinski Hospital (Hamilton)
10. Hamilton Health Sciences Corporation - General Hospital Site (Hamilton)
11. St. Michael's Hospital (Toronto)
12. Baycrest Centre for Geriatric Care (Toronto)
13. Lakeridge Health (Oshawa)
14. St. Peter's Hospital (Hamilton)
15. Trillium Health Centre (Mississauga)

We hope the #GeriMedJC hashtag on Twitter will complement the live journal club discussion but also engage participation internationally for a much more enriched analysis of the literature.

Short article chosen for December 2014 #GeriMedJC

What does a short article mean?  In the live version of the Geriatric Medicine Journal Club held at the University of Toronto, the last 15 minutes of the hour is devoted to the presentation and discussion of the article.

When to start and when to stop.  Potentially inappropriate prescriptions (PIPs) occur when the risks associated with prescribing a medication outweigh the potential benefits of that medication. Does this use of validated criteria for PIP, such as the Screening Tool of Older Person's potentially inappropriate Prescriptions and Screening Tool to Alert doctors to Right Treatment (STOPP/START) in chronic geriatric facilities result in clinically meaningful outcomes?

Frankenthal D1, Lerman Y, Kalendaryev E, Lerman Y. Intervention with the screening tool of older persons potentially inappropriate prescriptions/screening tool to alert doctors to right treatment criteria in elderly residents of a chronic geriatric facility: a randomized clinical trial. J Am Geriatr Soc. 2014 Sep;62(9):1658-65. 

The article can be found here: and the abstract is posted below.

Engage in the discussion on Twitter on December 19, 2014 at 08:00 EST / 13:00 GMT and don't forget to use the hashtag #GeriMedJC.

OBJECTIVES: To assess the effect of a Screening Tool of Older Persons potentially inappropriate Prescriptions/Screening Tool to Alert doctors to Right Treatment (STOPP/START) medication intervention on clinical and economic outcomes.

DESIGN: Parallel-group randomized trial.

SETTING: Chronic care geriatric facility.

PARTICIPANTS: Residents aged 65 and older prescribed with at least one medication (N = 359) were randomized to receive usual pharmaceutical care or undergo medication intervention.

INTERVENTION: Screening medications with STOPP/START criteria followed up with recommendations to the chief physician.

MEASUREMENTS: The outcome measures assessed at the initiation of the intervention and 1 year later were number of hospitalizations and falls, Functional Independence Measure (FIM), quality of life (measured using the Medical Outcomes Study 12-item Short-Form Health Survey), and costs of medications.

RESULTS: The average number of drugs prescribed was significantly lower in the intervention than in the control group after 1 year (P < .001). The average drug costs in the intervention group decreased by 103 shekels (US$29) per participant per month (P < .001). The average number of falls in the intervention group dropped significantly (P = .006). Rates of hospitalization, FIM scores, and quality of life measurements were similar for both groups.

CONCLUSION: Implementation of STOPP/START criteria reduced the number of medications, falls, and costs in a geriatric facility. Their incorporation in those and similar settings is recommended.

Long article chosen for the December 2014 #GeriMedJC.

What does a long article mean?  In the live version of the Geriatric Medicine Journal Club held at the University of Toronto, the first 45 minutes of the hour is devoted to the presentation and discussion of the article.

Hip fracture is an important cause of mortality in the elderly. When cumulative mortality at on year among hip fracture patients is about 25-35%, should we be identifying and quantifying the impact of pre-operatively risk factors? This systematic review and meta-analysis attempts to achieve this.

Smith T, Pelpola K, Ball M, Ong A, Myint PK. Pre-operative indicators for mortality following hip fracture surgery: a systematic review and meta-analysis. Age Ageing. 2014 Jul;43(4):464-71. 

The full text of the article can be found here and the abstract is posted below.

Engage in the discussion on Twitter on December 19, 2014 at 08:00 EST / 13:00 GMT and don't forget to use the hashtag #GeriMedJC.

OBJECTIVE:
hip fracture is a common and serious condition associated with high mortality. This study aimed to identify pre-operative characteristics which are associated with an increased risk of mortality after hip fracture surgery.

DESIGN:
systematic search of published and unpublished literature databases, including EMBASE, MEDLINE, AMED, CINAHL, PubMed and the Cochrane Library, was undertaken to identify all clinical studies on pre-operative predictors of mortality after surgery in hip fracture with at least 3-month follow-up. Data pertaining to the study objectives was extracted by two reviewers independently. Where study homogeneity was evidence, a meta-analysis of pooled relative risk and 95% confidence intervals was performed for mortality against pre-admission characteristics.

RESULTS:
fifty-three studies including 544,733 participants were included. Thirteen characteristics were identified as possible pre-operative indicators for mortality. Following meta-analysis, the four key characteristics associated with the risk of mortality up to 12 months were abnormal ECG (RR: 2.00; 95% CI: 1.45, 2.76), cognitive impairment (RR: 1.91; 95% CI: 1.35, 2.70), age >85 years (RR: 0.42; 95% CI: 0.20, 0.90) and pre-fracture mobility (RR: 0.13; 95% CI: 0.05, 0.34). Other statistically significant pre-fracture predictors of increased mortality were male gender, being resident in a care institution, intra-capsular fracture type, high ASA grade and high Charlson comorbidity score on admission.

CONCLUSIONS:
this review has identified the characteristics of patients with a high risk of mortality after a hip fracture surgery beyond the peri-operative period who may benefit from comprehensive assessment and appropriate management.