Interest in and use of person-centred pharmacy services - a Swiss study of people with diabetes

BACKGROUND: Diabetes is one of the most important chronic diseases and affects 9% of the world's population. To support these people in the day-to-day management of their treatments, pharmacies can offer professional pharmacy services. These are defined as one or more actions organized or provided in a pharmacy to optimize the process of care, with the goal of improving health outcomes and the value of healthcare. Such services have to be tailored to the needs and interests of patients. This study aimed to evaluate interest in and use of pharmacy services among people with diabetes in the canton of Vaud, Switzerland. METHODS: This cross-sectional study analysed self-reported data from 790 people with diabetes included in the CoDiab-VD cohort. Questions focused on sociodemographic and economic characteristics, diabetes and its management, and interest in and use of pharmacy services related to (1) medication intake and adherence and (2) diabetes and general health. Descriptive analyses were first conducted. Logistic regression analyses were then performed for pharmacy services that were of interest to ≥50% of respondents. RESULTS: The mean age of participants was 66 years, and the sample included more males (59%) than females. The pharmacy services that interested the most respondents were individual interview, pill boxes or weekly pill boxes, treatment plans, checks of all medications, first medical opinions from pharmacists and counselling on devices. Factors significantly associated with interest in pharmacy services were being older, having a lower self-efficacy score, taking more than three medications and having a positive opinion about pharmacists. CONCLUSIONS: This study provides key information on interest in and use of pharmacy services among patients with diabetes in Switzerland; it should help pharmacists individualize their services for patients

Atomic and Electronic Structure of a Rashba pp-nn Junction at the BiTeI Surface

The non-centrosymmetric semiconductor BiTeI exhibits two distinct surface terminations that support spin-split Rashba surface states. Their ambipolarity can be exploited for creating spin-polarized $p$-$n$ junctions at the boundaries between domains with different surface terminations. We use scanning tunneling microscopy/spectroscopy (STM/STS) to locate such junctions and investigate their atomic and electronic properties. The Te- and I-terminated surfaces are identified owing to their distinct chemical reactivity, and an apparent height mismatch of electronic origin. The Rashba surface states are revealed in the STS spectra by the onset of a van Hove singularity at the band edge. Eventually, an electronic depletion is found on interfacial Te atoms, consistent with the formation of a space charge area in typical $p$-$n$ junctions.Comment: 5 pages, 4 figure

Longitudinal analysis of safety and medication adherence of patients in the Fingolimod patient support program: a real-world observational study.

The Fingolimod Patient Support Program (F-PSP) is an interprofessional specialty pharmacy service designed to ensure responsible use of fingolimod by promoting patient safety and medication adherence. This study aims to evaluate the safety and medication adherence of patients who joined the F-PSP between 2013 and 2016. Sociodemographic and medical characteristics, patient safety data (patient-reported symptoms, discontinuations due to adverse events (AEs), repeated first-dose monitoring), and medication adherence (implementation, persistence, reasons for discontinuation, influence of covariates, barriers and facilitators) were described. Sixty-seven patients joined the F-PSP. Patients reported a high frequency of symptoms. Due to AEs, 7 patients discontinued fingolimod, 3 took therapeutic breaks, and 1 reduced the regimen temporarily. Three patients repeated the first-dose monitoring. Patients had a high medication adherence over the 18-month analysis period: implementation decreased from 98.8 to 93.7%, and fingolimod persistence was 83.2% at 18 months. The patients' level of education, professional situation, and living with child(ren) influenced implementation. Patients reported more facilitators of medication adherence than barriers. The F-PSP seems valuable for supporting individual patients (ensuring responsible use of fingolimod and inviting patients for shared-decision making) and public health (indirectly gathering real-world evidence)

Physicians', Nurses' and Pharmacists' Perceptions of Determinants to Deprescribing in Nursing Homes Considering Three Levels of Action: A Qualitative Study.

Background: Polypharmacy and the use of potentially inappropriate medications are frequent safety issues among nursing home (NH) residents. Deprescribing can significantly reduce the number of drugs used, medication costs, and mortality. This qualitative study sought to understand and compare the perceptions and practices of nurses, pharmacists, and physicians regarding deprescribing in Swiss NHs, referring to an implementation approach on three levels of action: the individual, the institution, and the healthcare system. Methods: Two focus groups were held with 21 participants: one focus group with 11 pharmacists, another with 10 nurses and six semi-structured interviews with physicians were conducted and focused on their individual experience and practices. They were audiotaped and fully transcribed, and a content analysis was performed using to MAXQDA (Ver 12) software. Results: (1) At an individual level, physicians were concerned by consequences of deprescribing in terms of safety. Nurses were closest to residents and stressed the importance of finding the right time, creating a bond of trust before deprescribing and considering the purpose of the stay in the NH. Pharmacists relied on structured guides for deprescribing, which led their reflection and practice. All professionals saw the complexity of the clinical situations, as well as residents' and relatives' fears of interruption of care. (2) At an institutional level, the professionals stressed the lack of time to discuss patients' health and treatment, while pre-existing interprofessional collaboration, specifically, quality circles, seemed useful tools to create common knowledge. In order to reduce prescriptions, better coordination between physicians, nurses, pharmacists and specialists seemed crucial. (3) At the health system level, funding still needs to be provided to consolidate the process, go beyond organisational constraints and ensure deprescribing serves the patient's wellbeing above all. Conclusions: At the individual level of implementation, the different healthcare professionals expressed specific concerns about deprescribing, depending on their defined role in NHs. Their perspective about the different levers to promote deprescribing at institutional and healthcare system levels converge towards interprofessional collaboration supported by the healthcare system. Specific funding and incentives are therefore needed to support a sustainable interprofessional team

BiTeCl and BiTeBr: a comparative high-pressure optical study

We here report a detailed high-pressure infrared transmission study of BiTeCl and BiTeBr. We follow the evolution of two band transitions: the optical excitation $\beta$ between two Rashba-split conduction bands, and the absorption $\gamma$ across the band gap. In the low pressure range, $p< 4$~GPa, for both compounds $\beta$ is approximately constant with pressure and $\gamma$ decreases, in agreement with band structure calculations. In BiTeCl, a clear pressure-induced phase transition at 6~GPa leads to a different ground state. For BiTeBr, the pressure evolution is more subtle, and we discuss the possibility of closing and reopening of the band gap. Our data is consistent with a Weyl phase in BiTeBr at 5$-$6~GPa, followed by the onset of a structural phase transition at 7~GPa.Comment: are welcom

Antibiotic consumption in nursing homes of the Canton of Vaud: trends over the years 2009 - 2014

Background &amp; Objectives: Excessive use of antibiotics in nursing homes was reported in several studies1-3. Surveillance of their use in nursing homes is essential to plan interventions fostering an appropriate use and to measure the impact of these interventions. The aims of the study were to describe the antibiotic consumption in nursing homes of the Canton of Vaud and to examine whether the antibiotic consumption was correlated to the urinary catheter use and to methicillin-resistant Staphylococcus aureus (MRSA) colonization. Methods: Data on the use of systemic antibiotics (class J01 of WHO Anatomical Therapeutic Chemical (ATC) system, 2015) were collected from the community pharmacies' annual invoice data including 13 nursing homes in 2009. The number of nursing homes in the database increased to 67 in 2014, representing 46% of all nursing homes of the Canton of Vaud and 54% of the available beds. Aggregated data were converted into defined daily doses (DDD) and antibiotic consumption expressed in number of defined daily doses per 1000 beds and per day (DDD/1000B/D). Proportion of urinary catheter use and MRSA colonization data were provided through a point prevalence study. Results: The total consumption of systemic antibiotics was 52.2 DDD/1000B/D in 2009 and 48.3 in 2014. Beta-lactam antibacterials other than penicillins, macrolides and other antibacterials (including nitrofurantoin) consumption increased resp. by 80%, 45% and 187% between 2009 and 2014, while the use of sulfonamides and trimethoprim decreased by 41%. Penicillin and quinolone use remained relatively stable between 2009 and 2014. Amoxicillin and clavulanic acid (oral) was the most common antibiotic prescribed (31% of the total use), followed by ciprofloxacin (oral) (20%) and nitrofurantoin (10%). Among nursing homes, we reported a large variation in antibiotic consumption from 6.8 to 164.6 DDD/1000B/D in 2014. No correlation was found between global antibiotic consumption and urinary catheter use and between quinolone consumption and proportion of MRSA in 2010 and 2011 (p&gt;0.05). Discussion &amp; Conclusions: This study is the first that analyzes longitudinal data of antibiotic consumption in nursing homes of the Canton of Vaud. The findings suggest that a large variation in antibiotic consumption exists among nursing homes. Thus, antibiotic stewardship programs should be implemented to promote a more accurate use

The momentum and photon energy dependence of the circular dichroic photoemission in the bulk Rashba semiconductors BiTeX (X = I, Br, Cl)

Bulk Rashba systems BiTeX (X = I, Br, Cl) are emerging as important candidates for developing spintronics devices, because of the coexistence of spin-split bulk and surface states, along with the ambipolar character of the surface charge carriers. The need of studying the spin texture of strongly spin-orbit coupled materials has recently promoted circular dichroic Angular Resolved Photoelectron Spectroscopy (cd-ARPES) as an indirect tool to measure the spin and the angular degrees of freedom. Here we report a detailed photon energy dependent study of the cd-ARPES spectra in BiTeX (X = I, Br and Cl). Our work reveals a large variation of the magnitude and sign of the dichroism. Interestingly, we find that the dichroic signal modulates differently for the three compounds and for the different spin-split states. These findings show a momentum and photon energy dependence for the cd-ARPES signals in the bulk Rashba semiconductor BiTeX (X = I, Br, Cl). Finally, the outcome of our experiment indicates the important relation between the modulation of the dichroism and the phase differences between the wave-functions involved in the photoemission process. This phase difference can be due to initial or final state effects. In the former case the phase difference results in possible interference effects among the photo-electrons emitted from different atomic layers and characterized by entangled spin-orbital polarized bands. In the latter case the phase difference results from the relative phases of the expansion of the final state in different outgoing partial waves.Comment: 6 pages, 4 figure

Giant ambipolar Rashba effect in a semiconductor: BiTeI

We observe a giant spin-orbit splitting in bulk and surface states of the non-centrosymmetric semiconductor BiTeI. We show that the Fermi level can be placed in the valence or in the conduction band by controlling the surface termination. In both cases it intersects spin-polarized bands, in the corresponding surface depletion and accumulation layers. The momentum splitting of these bands is not affected by adsorbate-induced changes in the surface potential. These findings demonstrate that two properties crucial for enabling semiconductor-based spin electronics -- a large, robust spin splitting and ambipolar conduction -- are present in this material.Comment: 4 pages, 3 figure

Momentum resolved spin dynamics of bulk and surface excited states in the topological insulator Bi2Se3\mathrm{Bi_{2}Se_{3}}

The prospective of optically inducing a spin polarized current for spintronic devices has generated a vast interest in the out-of-equilibrium electronic and spin structure of topological insulators (TIs). In this Letter we prove that only by measuring the spin intensity signal over several order of magnitude in spin, time and angle resolved photoemission spectroscopy (STAR-PES) experiments is it possible to comprehensively describe the optically excited electronic states in TIs materials. The experiments performed on $\mathrm{Bi_{2}Se_{3}}$ reveal the existence of a Surface-Resonance-State in the 2nd bulk band gap interpreted on the basis of fully relativistic ab-initio spin resolved photoemission calculations. Remarkably, the spin dependent relaxation of the hot carriers is well reproduced by a spin dynamics model considering two non-interacting electronic systems, derived from the excited surface and bulk states, with different electronic temperatures.Comment: 5 pages and 4 figure