Study protocol: The Adherence and Intensification of Medications (AIM) study - a cluster randomized controlled effectiveness study

Abstract Background Many patients with diabetes have poor blood pressure (BP) control. Pharmacological therapy is the cornerstone of effective BP treatment, yet there are high rates both of poor medication adherence and failure to intensify medications. Successful medication management requires an effective partnership between providers who initiate and increase doses of effective medications and patients who adhere to the regimen. Methods In this cluster-randomized controlled effectiveness study, primary care teams within sites were randomized to a program led by a clinical pharmacist trained in motivational interviewing-based behavioral counseling approaches and authorized to make BP medication changes or to usual care. This study involved the collection of data during a 14-month intervention period in three Department of Veterans Affairs facilities and two Kaiser Permanente Northern California facilities. The clinical pharmacist was supported by clinical information systems that enabled proactive identification of, and outreach to, eligible patients identified on the basis of poor BP control and either medication refill gaps or lack of recent medication intensification. The primary outcome is the relative change in systolic blood pressure (SBP) measurements over time. Secondary outcomes are changes in Hemoglobin A1c, low-density lipoprotein cholesterol (LDL), medication adherence determined from pharmacy refill data, and medication intensification rates. Discussion Integration of the three intervention elements - proactive identification, adherence counseling and medication intensification - is essential to achieve optimal levels of control for high-risk patients. Testing the effectiveness of this intervention at the team level allows us to study the program as it would typically be implemented within a clinic setting, including how it integrates with other elements of care. Trial Registration The ClinicalTrials.gov registration number is NCT00495794.http://deepblue.lib.umich.edu/bitstream/2027.42/78258/1/1745-6215-11-95.xmlhttp://deepblue.lib.umich.edu/bitstream/2027.42/78258/2/1745-6215-11-95.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/78258/3/1745-6215-11-95-S1.DOCPeer Reviewe

Exploring the character of rural businesses: performing change and continuity

The purpose of this paper is to use a series of business interviews in the UK and Denmark as a means of interrogating the categorisation of rural businesses presented in an earlier publication which sought to understand the rural character of different businesses (Bosworth 2012). Rather than defining a rural business purely on its geographical location, the engagement of a business within a rural economy and its relations with both rural and urban environments are more complex issues. A wider conceptualisation how rural social relations, cultural influences and landscape values, forms the basis for analysing how these assets can create value for rural businesses. Understanding these issues can better inform organisations that are seeking to support the rural economy and rural communities. It can also guide business owners themselves as to how they might benefit from being a part of, or associated with, the rural economy in capturing the possibilities linked to a growing urban population. The findings reveal how landscape assets are intertwined in the business concepts as positive drivers despite many voices within rural and economic research pointing at disadvantages relating to distance, sparseness of infrastructure or service provision. The research analysis draws on Actor-network theory and this tool reveals promising prospects for future place-based studies in how landscape assets can be enacted in the development of the rural economy

Exploring the character of rural businesses: performing change and continuity

The purpose of this paper is to use a series of business interviews in the UK and Denmark as a means of interrogating the categorisation of rural businesses presented in an earlier publication which sought to understand the rural character of different businesses (Bosworth 2012). Rather than defining a rural business purely on its geographical location, the engagement of a business within a rural economy and its relations with both rural and urban environments are more complex issues. A wider conceptualisation how rural social relations, cultural influences and landscape values, forms the basis for analysing how these assets can create value for rural businesses. Understanding these issues can better inform organisations that are seeking to support the rural economy and rural communities. It can also guide business owners themselves as to how they might benefit from being a part of, or associated with, the rural economy in capturing the possibilities linked to a growing urban population. The findings reveal how landscape assets are intertwined in the business concepts as positive drivers despite many voices within rural and economic research pointing at disadvantages relating to distance, sparseness of infrastructure or service provision. The research analysis draws on Actor-network theory and this tool reveals promising prospects for future place-based studies in how landscape assets can be enacted in the development of the rural economy

Genetic differences in the frequency of the hinge variants of porcine IgA is breed dependent

The distribution of the IgAa and IgAb alleles of porcine IgA in over 160 randomly-selected animals revealed an abundance of heterozygotes but only two b/b homozygotes. Since the IgAb allotype is a splice site mutant lacking two-thirds of the hinge, this study tests the hypothesis that pigs with this genotype may be at a selective disadvantage while heterozygous individuals may be at some advantage. This hypothesis was tested by collecting data on 374 animals of known breed and often parentage. We show here that when breed was not considered, young animals of known parentage had genotypic frequencies identical to that expected for Mendelian alleles but that a/b heterozygotes were overrepresented in adults. However, when analyzed with regard to breed, a very strong association between breed and the frequency of the IgAa and IgAb alleles was discovered. Meishan and NIH minipigs were homozygous for IgA while heterozygotes predominated in Berkshire, Chester White, Durocs, Hampshire and Landrace. Animals homozygous for IgAb were best represented in the White Cross line. We show here that this very strong breed dependency of IgA allotypy in swine can produce a sample bias that can explain why only two b/b homozygotes (1.3%) were found in the 160 randomly-selected samples since the original samples came from primarily Landrace and Yorkshire animals. The expected frequency of b/b homozygotes in these breeds would be \u3c3%. Thus, the data presented here reject the hypothesis that swine homozygous for a trait that results in loss of two-thirds of the IgA hinge, are selected against and that heterozygotes are positively selected. Rather, the study shows that IgAa and IgAb appear to be simple, breed-dependent allotypic markers

Narratives of self and identity in women's prisons: stigma and the struggle for self-definition in penal regimes

A concern with questions of selfhood and identity has been central to penal practices in women's prisons, and to the sociology of women's imprisonment. Studies of women's prisons have remained preoccupied with women prisoners’ social identities, and their apparent tendency to adapt to imprisonment through relationships. This article explores the narratives of women in two English prisons to demonstrate the importance of the self as a site of meaning for prisoners and the central place of identity in micro-level power negotiations in prisons

Recommendations for Providers on Person-Centered Approaches to Assess and Improve Medication Adherence

Medication non-adherence is a significant clinical challenge that adversely affects psychosocial factors, costs, and outcomes that are shared by patients, family members, providers, healthcare systems, payers, and society. Patient-centered care (i.e., involving patients and their families in planning their health care) is increasingly emphasized as a promising approach for improving medication adherence, but clinician education around what this might look like in a busy primary care environment is lacking. We use a case study to demonstrate key skills such as motivational interviewing, counseling, and shared decision-making for clinicians interested in providing patient-centered care in efforts to improve medication adherence. Such patient-centered approaches hold considerable promise for addressing the high rates of non-adherence to medications for chronic conditions

Potential of vascular endothelial growth factor as a biomarker of coronary artery disease in subjects undergoing CABG surgery

Introduction: • Coronary artery disease (CAD) causes local hypoxia due to reduced blood flow • Hypoxic conditions are known to induce vascular endothelial growth factor (VEGF) production, a key contributor to angiogenesis • The purpose of this study was to determine the potential of VEGF as a marker of myocardial stress in subjects with CAD undergoing coronary artery bypass grafting (CABG) surger

PRIVATE SAVINGS IN TRANSITION ECONOMIES: ARE THERE TERMS OF TRADE SHOCKS?

The paper examines the impact of terms of trade shocks on private savings in the transition economies after accounting for the effect of other determinants. Economic agents in the transition economies are subject to tight credit constraints which are more pronounced during bad state of nature. Thus, adverse shocks to commodity prices in the world market can force them to reduce savings by a larger amount than they would otherwise have. Empirical analysis using a dynamic panel model and data from twenty one transition economies confirm that most of the determinants of savings identified in the literature also apply to the transition economies. Favorable movements in both the permanent and transitory components of the terms of trade have a significant positive impact on private savings with transitory movements having a larger impact than the permanent component. This reflects the lack of access to foreign borrowing that many of the transition economies have faced during the last decade. Although the impact of terms of trade shocks are found to be asymmetric, the magnitude of the impact appears to be small. The results are robust for alternative estimators, determinants, and country groupings.http://deepblue.lib.umich.edu/bitstream/2027.42/39958/3/wp572.pd