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Introduction: Frailty is associated with an increased risk of death and morbid events. Frail individuals are known to have multiple comorbidities which are often associated with polypharmacy. Whilst a relationship between polypharmacy and frailty has been demonstrated, it is not clear if there is an independent relationship between frailty and medication harm. Aims: This scoping review aimed to identify and critically appraise studies evaluating medication harm in patients with frailty. Methods: PubMed, EMBASE, CINAHL and Cochrane databases were searched from inception until 1 February 2021 using key search terms that are synonymous with frailty (such as frail and frail elderly) and medication harm (such as adverse drug events and adverse drug reactions). To be included, studies must have identified medication harm as a primary or secondary outcome measure, and used a frailty assessment tool to determine frailty, or clearly defined how frailty was assessed. Data were narratively synthesised and presented in tables. The checklist from the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies from the National Heart, Lung, and Blood Institute was used to assess the quality and risk of bias of studies that met the inclusion criteria. Results: Of 2685 retrieved abstracts, 24 underwent full-text review and nine studies met the inclusion criteria. Three studies were retrospective cohort studies, and six were prospective observational studies. Six studies comprised two distinct groups of frail and non-frail individuals, and the remaining three studies evaluated medication harm in an entirely frail population. Seven studies used validated frailty tools such as the Clinical Frailty Scale, Fried Frailty Index, and Fried Frailty Phenotype. Two studies measured frailty using self-defined criteria. Overall, frail individuals were at risk of medication harm with rates ranging between 18.7 and 77% across the nine studies. However, whether frailty is an independent predictor of medication harm remains uncertain, as this was only evaluated in one study. The risk of bias assessment identified limitations in methods and reporting with all nine studies. Conclusion: This scoping review identified nine studies evaluating medication harm in frail patients. However, all were limited by the methodological quality and inadequate reporting of study factors. There are few high-quality studies that described a relationship between medication harm and frailty. More robust studies are required that examine the independent relationship between frailty and medication harm, after adjusting for all possible confounders and in particular polypharmacy. [ABSTRACT FROM AUTHOR]

Since the introduction of systematic population-based cervical cancer screening in Australia in 1991, age-standardized incidence of cervical cancer has halved. Given recent advances in human papillomavirus (HPV) vaccination and screening, cervical cancer may be eliminated nationally within 20 years. However, immigrant women are not equitably reached by screening efforts. This study systematically reviewed evidence on cervical cancer screening practices among immigrant women in Australia. A systematic search of MEDLINE, Embase, PubMed, CINAHL, and PsycINFO and gray literature for English language studies published till March 1, 2019, was conducted. Observational and qualitative studies evaluating cervical cancer screening awareness and participation of immigrant women were screened. Of 125 potentially relevant studies, 25 were eligible: 16 quantitative (four cohort, 12 cross-sectional), six qualitative, and three mixed-methods studies. Quantitative studies indicated 1% to 16% lower screening rates among migrant women compared with Australian-born women, with participation of South Asian women being significantly lower. Qualitative studies illustrated factors affecting women's willingness to participate in screening, including insufficient knowledge, low-risk perception, and unavailability of a female health professionals being key barriers. Future studies should focus on South Asian women, due to recent increase in their immigration. [ABSTRACT FROM AUTHOR]

Biosimilar products are now readily available for infliximab which is routinely used to treat rheumatoid arthritis (RA), inflammatory bowel disease (IBD) and ankylosing spondylitis (AS) along with other conditions. This review aimed to summarise the available evidence on the clinical efficacy, safety profile, and immunogenicity of a biosimilar as compared to the reference product to address the concern of clinicians in switching from the reference product to a biosimilar. We searched PubMed, Embase, and Cochrane Library using the following terms: 'infliximab', 'biosimilar', 'reference product', AND 'switch'. Further relevant articles were identified through exploring the reference lists of the identified articles. Ten randomised clinical trials, enrolling 2308 patients, and 13 observational studies, enrolling 4453 patients, were identified. The results of these studies suggest that the efficacy of a biosimilar is comparable to that of the reference product in patients with RA, AS, and IBD. This study found that a biosimilar is well‐tolerated and has a similar profile of safety as the reference product. The observational cohort studies involving patients switched from the reference product to a biosimilar reported comparable efficacy at maintaining disease remission. They also indicated stable disease activity and no considerable changes in the inflammatory markers after the switch. The evidence, which is ever‐increasing, indicates that the use of a biosimilar is effective, well‐tolerated, safe, and comparable in terms of immunogenicity, even in the long run. The availability of a biosimilar would ultimately improve patient access to treatment, and in turn, reduce the price of the reference drug. [ABSTRACT FROM AUTHOR]

Background: Older adults living with dementia may have a higher risk of medication toxicity than those without dementia. Optimising prescribing in this group of people is a critically important yet challenging process.Objective: Our aim was to systematically review the evidence for the effectiveness of interventions for optimising prescribing in older people with dementia.Methods: This systematic review searched the Pubmed, Embase, CINAHL, PsycINFO and Cochrane Library electronic databases for studies that evaluated relevant interventions. Experimental, quasi-experimental and observational studies published in English prior to August 2018 were included. Data were synthesised at a narrative level.Results: The 18 studies accepted for review included seven randomised, two nonrandomised controlled, five quasi-experimental and four observational studies. Half the studies were conducted in nursing homes and the other half in hospital and community settings. There was great variability in the interventions and outcomes reported and a meta-analysis was not feasible. The three randomised and four nonrandomised studies examining medication appropriateness all reported improvements on at least one measure of the outcome. Six studies reported on interventions that identified and resolved drug-related problems. The results for other outcomes, including the number of medications (10 studies), healthcare utilisation (7 studies), mortality (7 studies), quality of life (3 studies) and falls (3 studies), were mixed and difficult to synthesise because of variability in the study design and measures used.Conclusion: Emerging evidence suggests that interventions in older people with dementia may have positive effects on medication appropriateness and resolution of drug-related problems; however, whether optimisation of medication results in clinically meaningful outcomes remains uncertain. [ABSTRACT FROM AUTHOR]