A guideline to assist in the de-escalation of inappropriate medications in palliative cancer patients was developed from current literature. The OncPal Deprescribing Guideline was successfully validated, demonstrating statistically significant concordance with an expert panel. We found that the incidence of PIMs was high in our patient group, demonstrating the potential benefits for the OncPal Deprescribing Guideline in clinical practice.

BACKGROUND:Hospital readmissions are common and costly. A recent previous hospitalization preceding the index admission is a marker of increased risk of future readmission.OBJECTIVES:To identify factors associated with an increased risk of recurrent readmission in medical patients with 2 or more hospitalizations in the past 6 months.DESIGN:Prospective cohort study.SETTING:Australian teaching hospital acute medical wards, February 2006‐February 2007.PARTICIPANTS:142 inpatients aged ≥50 years with a previous hospitalization ≤6 months preceding the index admission. Patients from residential care, with terminal illness, or with serious cognitive or language difficulties were excluded.VARIABLES OF INTEREST:Demographics, previous hospitalizations, diagnosis, comorbidities and nutritional status were recorded in hospital. Participants were assessed at home within 2 weeks of hospital discharge using validated questionnaires for cognition, literacy, activities of daily living (ADL)/instrumental activities of daily living (IADL) function, depression, anxiety, alcohol use, medication adherence, social support, and financial status.MAIN OUTCOME MEASURE:Unplanned readmission to the study hospital within 6 months.RESULTS:A total of 55 participants (38.7%) had a further unplanned hospital admission within 6 months. In multivariate analysis, chronic disease (adjusted odds ratio [OR] 3.4; 95% confidence interval [CI], 1.3‐9.3, P = 0.002), depressive symptoms (adjusted OR, 3.0; 95% CI, 1.3‐6.8, P = 0.01), and underweight (adjusted OR, 12.7; 95% CI, 2.3‐70.7, P = 0.004) were significant predictors of readmission after adjusting for age, length of stay and functional status.CONCLUSIONS:In this high‐risk patient group, multiple chronic conditions are common and predict increased risk of readmission. Post‐hospital interventions should consider targeting nutritional and mood status in this population. Journal of Hospital Medicine 2010. © 2010 Society of Hospital Medicine.

Keywords adverse drug events, adverse drug reactions, clinical pharmacology, clinical pharmacy, drug related problems, medication errors, predictive risk model, risk score AIMAn emerging approach to reducing hospital adverse drug events is the use of predictive risk scores. The aim of this systematic review was to critically appraise models developed for predicting adverse drug event risk in inpatients. METHODSEmbase, PubMed, CINAHL and Scopus databases were used to identify studies of predictive risk models for hospitalized adult inpatients. Studies had to have used multivariable logistic regression for model development, resulting in a score or rule with two or more variables, to predict the likelihood of inpatient adverse drug events. The Checklist for the critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies (CHARMS) was used to critically appraise eligible studies. RESULTSEleven studies met the inclusion criteria and were included in the review. Ten described the development of a new model, whilst one study revalidated and updated an existing score. Studies used different definitions for outcome but were synonymous with or closely related to adverse drug events. Four studies undertook external validation, five internally validated and two studies did not validate their model. No studies evaluated impact of risk scores on patient outcomes. CONCLUSIONAdverse drug event risk prediction is a complex endeavour but could help to improve patient safety and hospital resource management. Studies in this review had some limitations in their methods for model development, reporting and validation. Two studies, the BADRI and Trivalle's risk scores, used better model development and validation methods and reported reasonable performance, and so could be considered for further research.British Journal of Clinical Pharmacology Br J Clin Pharmacol (2018) 84 846-864 846