Inappropriate polypharmacy is a significant problem among the elderly, and it has been linked to adverse health consequences. A priority is determining the optimal approaches to optimize proper polypharmacy. As a result, polypharmacy, or the use of many medications to improve clinical outcomes for patients, is gaining popularity (Rankin et al., 2018; Whitman et al., 2021). The study’s primary goal is to determine which therapies are most beneficial alone or in combination. Effectiveness is demonstrated in promoting proper polypharmacy use and lowering medication-related issues in the elderly. Researchers used CENTRAL, MEDLINE, Embase, CINAHL, and two trial registrations to find further studies until February 7, 2018, and hand-searching reference lists.
The researchers used random, non-randomized, controlled before-after studies and interrupted time series. Eligible studies described prescribing interventions designed to improve appropriate polypharmacy in people 65 and older who were prescribed polypharmacy (four or more medicines) and used a validated tool to assess prescribing appropriateness (Rankin et al., 2018). These are what are known as implicit tools (Garfinkel & Bilek, 2020). Such tools might be based on one’s judgment or the professional assessment of others. Furthermore, it is explicit techniques such as criterion-based, which include lists of pharmaceuticals to avoid in the elderly.
During the research, two review writers independently assessed the risk of bias in included studies by reviewing abstracts of eligible studies, extracting data, and assessing the risk of bias in included studies. To get summary estimates of impact and 95 percent confidence intervals, researchers combined study-specific data and utilized a random-effects model (CIs) (Rankin et al., 2018). The GRADE method was used to assess the overall certainty of the evidence for each outcome. Researchers found 32 studies, 20 of which came from this update. There were 18 randomized trials included in the study (Rankin et al., 2018). Computerized decision help was one of the interventions. Thirty-one were multi-faceted pharmacological and care-based treatments that were sophisticated and multi-faceted. To answer this topic, researchers gathered and examined all relevant studies. The review authors discovered 32 relevant studies, including 28,672 older individuals from 12 countries (Rankin et al., 2018). This research compared strategies aimed at improving medication adherence to standard care.
When the findings of these investigations were merged, the evidence gained was relatively poor. It is unclear if efforts aimed at improving proper polypharmacy resulted in clinically meaningful improvements. The number of PPOs may be reduced marginally if pharmaceutical treatment is provided (Rankin et al., 2018). Doctors should carefully analyze sources of information and suggestions in order to strike the optimal balance between avoiding the “risk/treatment dilemma” and preventing prescription misuse. Controlling procedures to support fidelity and controlling the interventions selected is obvious. To maintain uniformity, employees must be trained well, including practicing the new experience.
The papers in this review were of poor quality, and future research should focus on study design rigor. More study is needed to see if existing methods for a thorough drug evaluation (such as the hyper pharmacotherapy assessment tool) can help with proper polypharmacy (Mangin et al., 2018; Uchida et al., 2019). Details on the creation and delivery of the intervention were limited. Uncertainty over which intervention aspects are most important for effective results must be addressed (Rankin et al., 2018). The Medical Research Council’s recommendations for future intervention studies aimed at proper polypharmacy might be helpful. If an incorrect prescription persists, there appears to be a ceiling impact (about 75% of the time) (Rankin et al., 2018). Prescribers’ responses to interventions may be revealed through qualitative interviews. It is necessary to investigate and comprehend poor prescription practices.
Based on the study, in which the central patients of the study were the elderly, it can be concluded that the problems of polypharmacy are for all types of patients. New practices of a subtler and detailed approach are much more effective in treating people. This saves them money and avoids serious problems caused by side effects and incompatible drugs. Moreover, this study shows that new approaches in polypharmacy allow deepening the research potential of the topic.
References
Garfinkel, D., & Bilek, A. (2020). Inappropriate medication use and polypharmacy in older people. BMJ, m2023.
Mangin, D., Bahat, G., Golomb, B. A., Mallery, L. H., Moorhouse, P., Onder, G., Petrovic, M., & Garfinkel, D. (2018). International group for reducing inappropriate medication use & polypharmacy (IGRIMUP): Position statement and 10 recommendations for action. Drugs & Aging, 35(7), 575–587.
Rankin, A., Cadogan, C. A., Patterson, S. M., Kerse, N., Cardwell, C. R., Bradley, M. C., Ryan, C., & Hughes, C. (2018). Interventions to improve the appropriate use of polypharmacy for older people. Cochrane Database of Systematic Reviews, 2018(9).
Uchida, M., Suzuki, S., Sugawara, H., Suga, Y., Kokubun, H., Uesawa, Y., Nakagawa, T., & Takase, H. (2019). A nationwide survey of hospital pharmacist interventions to improve polypharmacy for patients with cancer in palliative care in Japan. Journal of Pharmaceutical Health Care and Sciences, 5(1).
Whitman, A., Erdeljac, P., Jones, C., Pillarella, N., & Nightingale, G. (2021). Managing polypharmacy in older adults with cancer across different healthcare settings. Drug, Healthcare and Patient Safety, Volume 13, 101–116.
The Security Dilemma In The Educational Context Of Worldwide Politics
After a grueling day at work, one of my favorite things to do is to relax on the chair with a cup of hot cocoa while watching international news stations. With the help of my wonderful chair, which lifts and leans forward to make it easier for me to sit down and get up without straining my muscles, the hot chocolate makes for the most pleasant experience ever. This pleasant feeling does not last long as reports on security problems destroying the world break my heart.
The security dilemma is a vital issue in the educational context of worldwide politics and foreign affairs. This uncertainty illustrates how actions adopted by one country to boost its safety, such as developing defense capabilities, mobilizing military forces, and creating strategic partnerships, are likely to jeopardize the safety of other nations and force them to take comparable actions (Akchurina and Della Sala 1638). The end effect is a vicious cycle of hatred where no party appears ahead. Think about the video the NATO command tweeted in response to several Russian thoughts about the group (“Setting the Record Straight”). The video describes the NATO alliance as solely defensive and having no aggressive plans toward Russia (“Setting the Record Straight”). The security problem explains why Russia is unlikely to accept these guarantees at a total price and may have reasonable cause to see NATO’s territorial expansion to the East as a worry, even though these claims may be factually accurate.
Although some of those countries may have felt that joining NATO would increase their security, it should be clear why Russia may well not approve and why it might act in ways that are unpleasant in return, such as invading Ukraine. NATO leaders may view Russia’s concerns as misconceptions, but it does not always mean that the Russian people do not share those concerns (Della Sala 266). Surprisingly, many intelligent, well-educated Westerners, notably some well-known former diplomats, cannot understand that their noble intentions are not immediately apparent to others.
In Asia, a similar dynamic is in play. It should be no surprise that China sees America’s long-standing position of regional influence—particularly it’s extensive military infrastructure and marine and aviation presence—as a possible danger (Jie 184). Interestingly, while increasing its military budget, the George W. Bush government once attempted to convince China that, “Seeking more military power is just an outdated route that would impede your own goal of national greatness (Jie 184).” The tension between the two nations has been ongoing for a while.
Every party’s attempts to address what it sees as a prospective security issue in each of these situations only amplify the other side’s safety concerns, leading to a reaction that only confirms the former’s initial worries. The most important realization is that aggression, including the use of pressure and muscle, does not always result from bad or antagonistic intentions, such as the purely selfish desire for money, notoriety, or dominance (Della Sala 266). The mentioned NATO video implies that figureheads genuinely think their motivations are primarily strategic and that this fact should be apparent to everyone else (“Setting the Record Straight”). On that thought, they are more likely to interpret an adversary’s hostile response as proof of their inherent antagonism, avarice, or a vicious foreign leader’s nefarious and unappealing ambitions (Della Sala 266). Diplomacy quickly turns into a name-calling contest when sensibility is abandoned.
Could the security dilemma’s logic thus call for accommodating policies instead? The answer strongly stands as a no. Since governments cannot ensure their safety by withdrawing arbitrarily or making frequent compromises to an antagonist, the security puzzle is, as its name suggests, a problem. While the root of most antagonistic partnerships is shared insecurity, agreements that shifted the scale in one side’s favor may have caused that side to act aggressively to secure an unbeatable position and permanent security (Della Sala 266). States must attempt to overcome these issues through statesmanship, humanism, and wise military strategies.
Works Cited
Akchurina, Viktoria, and Vincent Della Sala. “Russia, Europe and the Ontological Security Dilemma: Narrating the Emerging Eurasian Space.” Europe-Asia Studies, vol. 70, no. 10, 2018, pp. 1638–1655.
Della Sala, Vincent. “Narrating Europe: The EU’s Ontological Security Dilemma.” European Security, vol. 27, no. 3, 2018, pp. 266–279.
Jie, Dalei. “The Emerging Ideological Security Dilemma between China and the U.S.” China International Strategy Review, vol. 2, no. 2, 2020, pp. 184–196.
“Setting the Record Straight.” Twitter, uploaded by NATO, 2022.
Research Methods For Business And Social Science Students
When conducting rigorous research into a topical issue, it is natural to expect serious challenges at each stage. In order to overcome them, it appears useful to categorize these challenges per each stage of the project. In terms of planning, the time factor may become a problematic point without due preparations (Adams, Khan, & Raeside, 2014). More specifically, the timeline for each step of the research may be compromised, leaving less space for an in-depth investigation of the research problem. Therefore, both the deadlines and the quality of the project face serious risks. To limit the impact of this factor, the plan is to conduct preliminary evaluation of each stage’s duration. The estimation should be realistic and cover some extra space for manoeuvring in case any issues emerge in the process. Thus, a serious presence of time management is involved at this stage. Unexpected troubles may appear at any moment of such a profound project, which is why time is of the essence in this case.
Next, the collection and consolidation of relevant research data is one of the vital components of a successful study. This phase is multi-tiered, as it includes a series of potentially problematic points. First of all, the presence of bias may compromise the integrity of the entire project (Haffar, Bazerbachi, and Murad, 2019). It is imperative to ensure an objective point of view on the matter at hand, as the findings will not reflect the reality of the situation otherwise. Anticipating this issue, it is important to ensure that the final research includes a variety of evidence-based, academic sources of data. For this purpose, the project will revolve around reliable and reputable sources, mostly including expert books and peer-reviewed journal articles. The range of data sources should also be broad in order to include and synthesize a variety of perspectives in pursuit of an objective conclusion (Cooper, Valentine, and Hedges, 2019). This way, it is expected to anticipate and prevent the influence of researcher bias on the outcome of the study.
Second, the irrelevant nature of the data obtained is another potential issue that can affect the research process. When addressing a topical question, it is possible to stray from the initial direction and concentrate on the wrong aspects of the central problem (O’Gorman and MacIntosh, 2015). This is particularly relevant for major, complex topics that encompass a variety of elements. In other words, the discussion may become too broad and lose focus. As a result, it will be inconclusive, lacking validity and relevance to the subject matter. The plan is to avoid digressing by centering the research process around specific key words that will channel it in the right direction. The exact contents of the key word list will be determined during the final stages of the planning stage. Accordingly, the obtained findings are expected to be pertinent to the discussion, gradually advancing the project toward the answer to the central research question.
In addition, the relevance of the discussion will be ensured by focusing on the contemporary body of academic knowledge. Specifically, it is appropriate to only consider the sources that were released in the past four or five years. Today, social and economic processes occur at a rapid pace, causing major paradigm shifts within the global space (Krishnaswami and Satyaprasad, 2010). Thus, the tendencies that prevailed in the past decade may not reflect the situation as it is at the moment. Overall, these measures are expected to negate the vast majority of potential issues that may impede the research process. By implementing them, it will be possible to produce a relevant and valid project that will contribute to the contemporary discussion.
Reference List
Adams, J., Khan, H.T.A. and Raeside, R. (2014) Research methods for business and social science students. 2nd ed. Sage, New Delhi.
Cooper, H., Valentine, J. C., and Hedges, L V. (2019) The handbook of research synthesis and meta-analysis. Russel Sage Foundation, New York.
Haffar, S., Bazerbachi, F., and Murad, M. H. (2019) ‘Peer review bias: a critical review’, Mayo Clinic Proceedings, 94(4), pp. 670–676.
Krishnaswami, O.R. and Satyaprasad, B.G. (2010) Business Research Methods. Himalaya Publishing House, New Delhi.
O’Gorman, K. and MacIntosh, R. (2015) Research Methods for Business & Management. A guide to writing your dissertation. 2nd ed. Goodfellow Publishers Ltd, Oxford.