Diminished nitroprusside-induced relaxation of inflamed colonic smooth muscle in mice.

The dextran sodium sulphate (DSS) induced colitis in mice was used as a experimental model to study the contractility of murine longitudinal colonic smooth muscle during inflammation. Smooth muscle segments of proximal, middle and distal colon were mounted in organ baths. Smooth muscle contraction was induced by carbachol showing an aboral increase in activity, whereas in the inflamed middle colonic segment a marked decrease in activity was observed. The dilatative effect of sodium-nitroprusside (SNP) as a nitric oxide donor was investigated after precontraction by carbachol. Both in normal and DSS segments administration of SNP to isolated mouse colonic smooth muscle preparations caused regional differences in relaxation, the highest relaxation seen in normal proximal colonic tissue. However, this relaxation was markedly reduced in inflamed proximal preparations, associated with a diminished cGMP contents

Interventie op maat bij therapie-ontrouwe diabetespatiënten: kwalitatief onderzoek naar de uitvoerbaarheid van de interventie.

Objective: To examine the feasibility of an intervention to improve therapy adherence. Such interventions are often ineffective, possibly because they are not tailored to the patient. We developed a modular intervention which pharmacists can use to improve drug therapy adherence. Patients’ experiences with the intervention were also studied. Design: Focus group interviews with pharmacists and pharmacy technicians and questionnaire interviews among diabetes patients. Methods: Four pharmacy teams in the Rotterdam region were trained in therapy adherence and motivational conversation techniques. Patients with diabetes mellitus type 2, who were not adherent with drug use, were asked to participate. The intervention consisted of a structured interview, an intervention guide and modular interventions tailored to the causes of non-adherence. The interview asked patients for problems with the drug therapy. The intervention modules addressed five common causes of non-adherence: ineffectiveness, side effects, problems with swallowing, forgetting drug taking and motivation. The feasibility of the intervention was discussed in a focus group interview with the pharmacy teams. Patients’ experiences (n = 36) were measured by means of a questionnaire. Results: Pharmacy teams appreciated the intervention, the materials and the involvement of pharmacy technicians. Poor co-operation with the general practitioner, lack of time and lack of financial compensation appeared to be interfering factors. Patients appreciated the intervention and they indicated to be well able to follow the advice of the pharmacists. Conclusion: The intervention is well feasible and patients appreciated the intervention. Poor co-operation between pharmacists and general practitioners, and lack of reimbursement hamper the implementation at a large scale. (aut. ref.

Evaluation of a pilot study to influence medication adherence of patients with diabetes mellitus type-2 by the pharmacy

Background: Interventions aimed to increase adherence to drug treatment usually are not tailored to the needs of individual patients. A modular pharmacy intervention, named ‘Support for Diabetes’, was developed to improve adherence to type 2 diabetes treatment. Objective: To evaluate the implementation of a new care intervention by using focus groups including pharmacy teams, and assess patient satisfaction. Setting: Community pharmacies in The Netherlands Method: The intervention comprises a structured patient interview, an intervention guide and modular interventions tailored to the underlying cause of non-adherence. Feasibility was studied in non-adherent type 2 diabetes mellitus patients, and evaluated by means of focus group interviews with pharmacists and pharmacy technicians. Topics included practicability of the patient selection procedure, patient interviews, materials developed for the intervention and general practitioner (GP) co-operation. Patients’ experiences (n = 36) were assessed by means of a questionnaire. Main outcome measure: Feasibility of the intervention and patients’ satisfaction. Results: Pharmacists and pharmacy technicians considered the intervention feasible and appreciated its pro-active approach. Involvement of pharmacy technicians proved a stimulating factor. Poor co-operation with GPs and lack of time as well as financial compensation were interfering factors. Patients appreciated the intervention and reported to follow the advice of pharmacists. Conclusion: The ‘Support for Diabetes’ intervention is feasible to implement in pharmacy practice. Poor co-operation between pharmacists and GPs and lack of re-imbursement are obstructions for implementation on a wider scale. These issues should receive attention of pharmacists, policymakers and researchers. (aut.ref.