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Objectives The South Peace Polypharmacy Reduction Project is a quality improvement project in three communities in rural Canada that aimed to reduce polypharmacy and inappropriate prescribing practices in older adults. This study aims to evaluate the impact of a multifaceted intervention consisting of online team-based medication reviews and educational workshops on the number of chronic medications. Methods A controlled before-after design was used to compare if a decrease in the number of chronic medications was associated with the intervention comprising of online team-based medication reviews and educational workshops, compared with two matched control groups that received either a standard medication review or no medication review. Logistic regression models fit with generalized estimated equations were used to identify the impact of the interventions on decreasing the number of chronic medications. Key findings Following a medication review, the percentage of individuals that had deprescribed at least one medication was highest in the intervention group (52%), followed by the medication review controls at 45%, and 36% in non-medication review controls. Individuals in the intervention group were 20% more likely to have at least one medication deprescribed than individuals in the medication review control group (adjusted odds ratio: 1.20; 95% CI: 1.03 to 1.39), whereas they were 42% more likely to deprescribe at least one medication compared with non-medication review controls (adjusted odds ratio: 1.42; 95% CI: 1.25 to 1.61). Conclusions Online team-based medication reviews had a significant impact on decreasing the number of chronic medications in older adults. Furthermore, providing healthcare providers with education can complement the role of other healthcare interventions. [ABSTRACT FROM AUTHOR]

Elucidating changes in prey behavior in response to a novel predator is key to understanding how individuals acclimate to shifting predation regimes. Such responses are predicted to vary among individuals as a function of the level of risk to which individuals are exposed, temporal changes in risk, and landscape‐mediated changes in perceived risk. We tested how GPS‐tracked moose (Alces alces, n = 19) responded to an emerging risk landscape with the introduction of hunting to a naïve population (large‐scale reduction experiment in Gros Morne National Park, Canada). We predicted that predation risk associated with hunters would influence moose habitat selection: Avoidance responses would be stronger during the day when hunting was allowed, and moose would learn to avoid risky locations which would strengthen in successive years for survivors occupying overall riskier home ranges. We found that moose avoided areas associated with a high risk of encounters with hunters but did not alter selection patterns between day and night. We did not find evidence of moose reacting more strongly to emerging risk as a function of risk within their home range. Moose did not increase their avoidance of areas associated with hunter risk across years but over time survivors selected non‐hunted refuge areas more frequently. Our results suggest that while moose did not adjust fine‐scale habitat selection through time to increased hunting risk, they did adjust selection at broader scales (based on proportions of hunter‐free habitat included in home range relative to study area). This finding supports the hypothesis that habitat selection at larger spatio‐temporal scales may reflect behavioral responses to a population's most important limiting factors, which may not be apparent at finer scales. [ABSTRACT FROM AUTHOR]

Background: Over three-quarters of the older population take medications that can potentially cause dry mouth. Physicians or pharmacists rarely inform patients about this adverse effect and its potentially severe damage to the teeth, mouth and general health. Objectives: The objectives of this study were to (1) identify warnings in the literature about dry mouth associated with the most frequently prescribed pharmaceutical products in Canada; and (2) consider how this information might be obtained by physicians, pharmacists and patients. Methods: Monographs on the 72 most frequently prescribed medications during 2010 were retrieved from the Compendium of Pharmaceuticals and Specialties (CPS, a standard drug information reference for physicians and pharmacists), the National Library of Medicine's 'DailyMed' database, directly from the manufacturers, and from a systematic search of biomedical journals. Results: The CPS provided monographs for 43 % of the medications, and requests to manufacturers produced the remaining monographs. Mentions of dry mouth were identified in 61 % of the products (43 % amongst CPS monographs; an additional 43 % amongst manufacturers' monographs; 7 % in the DailyMed database and 7 % from biomedical journals); five medications had contradictory reports in different monographs. Conclusion: Nearly two-thirds (61 %) of the most commonly prescribed medications can cause dry mouth, yet warnings about this adverse effect and its potentially serious consequences are not readily available to physicians, pharmacists, dentists or patients. [ABSTRACT FROM AUTHOR]

The University of British Columbia medical school relies mostly on lectures and problem based learning tutorials (PBL) in the first two years of its undergraduate medical program. While PBL exposes students to clinical scenarios, most students do not acquire experience with patients until their clerkships in 3rd and 4th year. Introduction of PBL starting in 1997 resulted in curtailment of some aspects of the former curriculum, notably basic and clinical pharmacology. Graduating medical students across Canada recognize this deficiency. Canadian medical schools make an abrupt transition between the classroom-based years and clerkship years. The shift from classroom to bedside is often difficult for students. By 2nd year many students are weary of PBL and eager to be part of a medical team, while in 3rd year many students find the change of learning environment extremely stressful. We felt that short educational videos could help bridge this transition, by exposing first and second year students to the stories of real patients, told in their own words. During summer 2010, 30 videos were prepared by 9 undergraduate medical students, under the direction of Dr. Thomas Perry (Internal Medicine and Clinical Pharmacology). The videos are edited from patient interviews and physical examinations. The videos range from 2-7 minutes in length, and demonstrate: *common and classical (but uncommon) conditions (e.g. diabetes, adrenal failure) *the use of drugs to solve clinical problems (e.g. intravenous opioids for acute pain) *pathophysiologically important medical phenomena (e.g. idiopathic orthostatic hypotension, symptoms of adrenal insufficiency) *the importance of the doctor-patient relationship (e.g. a man dying of metastatic lung cancer who experienced neglectful treatment) *routine hospital procedures (eg. the process of converting a urine sample into useful information) Many of the videos are currently being introduced across the first two years of the undergraduate curriculum, particularly during "PBL case wrap-up" lectures to illustrate how the principles learned from the week's PBL case can be applied to similar cases in clinical practice. [ABSTRACT FROM AUTHOR]