Browsing by Author "Tipping, Brent"

Now showing 1 - 3 of 3
  • Thumbnail Image
    Item
    Open Access
    Executive cognitive impairment detected by simple bedside testing is associated with poor glycaemic control in type 2 diabetes
    (2007) de Wet, Hayley; Levitt, Naomi; Tipping, Brent
    Aims. Cognitive impairment in people with type 2 diabetes is a barrier to successful disease management. We sought to determine whether impaired executive function as detected by a battery of simple bedside cognitive tests of executive function was associated with inadequate glycaemic control. Methods. People with type 2 diabetes attending a tertiary referral diabetic clinic who consented to participate in the study underwent a brief battery of cognitive testing (the Bedside Executive Screening Test) designed to detect executive function impairment. Glycaemic control was determined using blood glycated haemoglobin levels (HBA1c). Inadequate glycaemic control was defined as HBA1c ≥7%. Results. Executive function impairment was detected in 51 (52%) of the 98 study participants. The presence of executive function impairment was significantly associated with poor glycaemic control (HBA1c ≥7%) (odds ratio 4.9, 95% confidence interval 1.3 - 18.8, p=0.019). There were no significant differences between patients with and without executive function impairment with regard to age, target organ damage, patient reported adherence, and hypoglycaemic therapy. Patients with a lower level of education were more likely to demonstrate executive impairment when glycaemic control was poor (p=0.013). Conclusions. Executive function impairment is common in a population of people with difficult-to-manage type 2 diabetes. The presence of executive impairment is significantly associated with poor glycaemic control.
  • Thumbnail Image
    Item
    Open Access
    The burden and risk factors for adverse drug events in older patients - a prospective cross-sectional study
    (2006) Tipping, Brent; Kalula, Sebastiana; Badri, Motasim
    Objective. To determine the burden and risk factors for adverse drug events (ADEs) in older patients. Design. A prospective cross-sectional study. Methods. Patients (65 years and older) presenting to the tertiary Emergency Unit of Groote Schuur Hospital, Cape Town, between February and May 2005, were assessed for wellestablished ADEs, as defined by the South African Medicines Formulary. Logistic regression models were fitted to determine drugs and other factors associated with the likelihood of developing ADEs. Results. ADEs were identified in 104 of the 517 (20%) presentations. The most frequently involved drug classes were cardiovascular (34%), anticoagulant (27%), analgesic (19%) and antidiabetic (9%). Patients who developed ADEs were more likely to have five or more prescription drugs (p < 0.0001), more than three clinical problems (p = 0.001), require admission (p = 0.04), and report compliance with medication (p = 0.02) than those who did not. Drugs shown to independently confer increased risk of ADEs were angiotensin-converting enzyme inhibitors (RR = 2.6, 95% CI: 1.3 - 5.2, p = 0.009), non-steroidal anti-inflammatory drugs (RR = 4.1, 95% CI: 2.1 - 8.0, p < 0.0001) and warfarin (RR = 3.1, 95% CI: 1.6 - 6.3, p = 0.0014). Conclusion. ADEs contribute significantly to the burden of elderly care in the Emergency Unit. In a setting such as ours, increased pill burden and certain drug classes are likely to result in increased risk of ADEs in the older population group.
  • Thumbnail Image
    Item
    Open Access
    The burden and risk factors for adverse drug events in older patients - a prospective cross-sectional study
    (2006) Tipping, Brent; Kalula, Sebastiana; Badri, Motasim
    Objective. To determine the burden and risk factors for adverse drug events (ADEs) in older patients. Design. A prospective cross-sectional study. Methods. Patients (65 years and older) presenting to the tertiary Emergency Unit of Groote Schuur Hospital, Cape Town, between February and May 2005, were assessed for wellestablished ADEs, as defined by the South African Medicines Formulary. Logistic regression models were fitted to determine drugs and other factors associated with the likelihood of developing ADEs. Results. ADEs were identified in 104 of the 517 (20%) presentations. The most frequently involved drug classes were cardiovascular (34%), anticoagulant (27%), analgesic (19%) and antidiabetic (9%). Patients who developed ADEs were more likely to have five or more prescription drugs (p < 0.0001), more than three clinical problems (p = 0.001), require admission (p = 0.04), and report compliance with medication (p = 0.02) than those who did not. Drugs shown to independently confer increased risk of ADEs were angiotensin-converting enzyme inhibitors (RR = 2.6, 95% CI: 1.3 - 5.2, p = 0.009), non-steroidal anti-inflammatory drugs (RR = 4.1, 95% CI: 2.1 - 8.0, p < 0.0001) and warfarin (RR = 3.1, 95% CI: 1.6 - 6.3, p = 0.0014). Conclusion. ADEs contribute significantly to the burden of elderly care in the Emergency Unit. In a setting such as ours, increased pill burden and certain drug classes are likely to result in increased risk of ADEs in the older population group.