Drug-related problems in home-dwelling older adults: a systematic review

Purpose:The complex combination of medicinesassociated with age-related physiological alterationsleads older adults to experience drug-relatedproblems (DRPs). The goal of this study was toreview the frequency and type of DRPs and DRP riskfactors in home-dwelling older adults.Methods:A MEDLINE PubMed and EMBASEscientific databases search was performed. Articlespublished from January 2000 through December2018 reporting DRPs in home-dwelling older adultswere included.Findings:From 668 articles screened, 13 met theinclusion criteria and were included in this study.Overall, the studies included 8935 home-dwellingpatients. The mean number of DRPs per patientobserved was 4.16 (1.37e10). The main causes ofDRPs were“drug selection”(51.41%),“dose selection”(11.62%), and“patient related”(10.70%) problems.The drug classes more frequently associated withDRPs were“cardiovascular system,”“alimentary tractand metabolism,”and“nervous system,”and theyrepresented 32.1%, 29.4%, and 16.5% of all drugselection problems, respectively. Respiratory systemmedicines accounted for 6.65% of all DRPs, of which“patient related”problems accounted for 97.28%.Implications:Despite the heterogeneity ofmethodology of the included studies and theheterogeneity of tools used to identify DRPs, thisanalysis clearly shows the high prevalence of DRPs inhome-dwelling older adults and highlights the needfor interventions to improve medicine use in thispopulation. This work also provides usefulinformation for the development of strategies toimprove medication use in home-dwelling olderadults.publishe

Avaliação biomecânica de uma prótese intervertebral para a coluna cervical

A coluna vertebral tem como função primordial suportar o peso do tronco e da cabeça permitindo o seu movimento, bem como proteger a medula espinhal e proporcionar a inserção muscular. É com base neste princípio que se baseia este trabalho cujo objetivo é efetuar uma análise biomecânica a um modelo simplificado dos segmentos C6-C7, com disco ou prótese intervertebral. Utilizando modelos 2D simplificados foram efetuadas diversas simulações, recorrendo ao método dos elementos finitos através do programa Ansys®, diferindo nestes modelos, as diferentes propriedades dos materiais e carregamentos. Os resultados foram obtidos considerando-se forças compressivas ou momentos fletores para simular o efeito de rotação nas vértebras em estudo. Foi possível concluir que existe uma variação linear dos deslocamentos das vértebras, com o aumento do carregamento imposto e o uso de uma prótese intervertebral diminui os deslocamentos na coluna, comparativamente aos deslocamentos obtidos nos modelos constituídos pelo disco intervertebral

Clinical pharmacists´ interventions in the management of type 2 diabetes mellitus: a systematic review

Background: Type 2 diabetes mellitus is a chronic disease that is reaching epidemic proportions worldwide. It is imperative to adopt an integrated strategy, which involves a close collaboration between the patient and a multidisciplinary team of which pharmacists should be integral elements. Objective: This work aims to identify and summarize the main effects of interventions carried out by clinical pharmacists in the management of patients with type 2 diabetes, considering clinical, humanistic and economic outcomes. Methods: PubMed and Cochrane Central Register of Controlled Trials were searched for randomized controlled trials assessing the effectiveness of such interventions compared with usual care that took place in hospitals or outpatient facilities. Results: This review included 39 studies, involving a total of 5,474 participants. Beneficial effects were observed on various clinical outcomes such as glycemia, blood pressure, lipid profile, body mass index and coronary heart disease risk. For the following parameters, the range for the difference in change from baseline to final follow-up between the intervention and control groups was: HbA1c, -0.05% to -2.1%; systolic blood pressure, +3.45 mmHg to -10.6 mmHg; total cholesterol, +10.06 mg/dL to -32.48 mg/dL; body mass index, +0.6 kg/m2 to -1.94 kg/m2; and coronary heart disease risk, -3.0% and -12.0% (among the studies that used Framinghan prediction method). The effect on medication adherence and health-related quality of life was also positive. In the studies that performed an economic evaluation, the interventions proved to be economically viable. Conclusions: These findings support and encourage the integration of clinical pharmacists into multidisciplinary teams, underlining their role in improving the management of type 2 diabetes

Characterisation of microbial attack on archaeological bone

As part of an EU funded project to investigate the factors influencing bone preservation in the archaeological record, more than 250 bones from 41 archaeological sites in five countries spanning four climatic regions were studied for diagenetic alteration. Sites were selected to cover a range of environmental conditions and archaeological contexts. Microscopic and physical (mercury intrusion porosimetry) analyses of these bones revealed that the majority (68%) had suffered microbial attack. Furthermore, significant differences were found between animal and human bone in both the state of preservation and the type of microbial attack present. These differences in preservation might result from differences in early taphonomy of the bones. © 2003 Elsevier Science Ltd. All rights reserved

Acute effects of 17β-estradiol and genistein on insulin sensitivity and spatial memory in aged ovariectomized female rats

Aging is characterized by decline in metabolic function and insulin resistance, and both seem to be in the basis of neurodegenerative diseases and cognitive dysfunction. Estrogens prevent age-related changes, and phytoestrogens influence learning and memory. Our hypothesis was that estradiol and genistein, using rapid-action mechanisms, are able to modify insulin sensitivity, process of learning, and spatial memory. Young and aged ovariectomized rats received acute treatment with estradiol or genistein. Aged animals were more insulin-resistant than young. In each age, estradiol and genistein-treated animals were less insulin-resistant than the others, except in the case of young animals treated with high doses of genistein. In aged rats, no differences between groups were found in spatial memory test, showing a poor performance in the water maze task. However, young females treated with estradiol or high doses of genistein performed well in spatial memory task like the control group. Only rats treated with high doses of genistein showed an optimal spatial memory similar to the control group. Conversely, acute treatment with high doses of phytoestrogens improved spatial memory consolidation only in young rats, supporting the critical period hypothesis for the beneficial effects of estrogens on memory. Therefore, genistein treatment seems to be suitable treatment in aged rats in order to prevent insulin resistance but not memory decline associated with aging. Acute genistein treatment is not effective to restore insulin resistance associated to the early loss of ovarian function, although it can be useful to improve memory deficits in this condition