4 research outputs found
Transformation of waterborne hybrid polymer particles into films: Morphology development and modeling
Effectiveness of an intervention for improving drug prescription in primary care patients with multimorbidity and polypharmacy:Study protocol of a cluster randomized clinical trial (Multi-PAP project)
This study was funded by the Fondo de Investigaciones Sanitarias ISCIII (Grant Numbers PI15/00276, PI15/00572, PI15/00996), REDISSEC (Project Numbers RD12/0001/0012, RD16/0001/0005), and the European Regional Development Fund ("A way to build Europe").Background: Multimorbidity is associated with negative effects both on people's health and on healthcare systems. A key problem linked to multimorbidity is polypharmacy, which in turn is associated with increased risk of partly preventable adverse effects, including mortality. The Ariadne principles describe a model of care based on a thorough assessment of diseases, treatments (and potential interactions), clinical status, context and preferences of patients with multimorbidity, with the aim of prioritizing and sharing realistic treatment goals that guide an individualized management. The aim of this study is to evaluate the effectiveness of a complex intervention that implements the Ariadne principles in a population of young-old patients with multimorbidity and polypharmacy. The intervention seeks to improve the appropriateness of prescribing in primary care (PC), as measured by the medication appropriateness index (MAI) score at 6 and 12months, as compared with usual care. Methods/Design: Design:pragmatic cluster randomized clinical trial. Unit of randomization: family physician (FP). Unit of analysis: patient. Scope: PC health centres in three autonomous communities: Aragon, Madrid, and Andalusia (Spain). Population: patients aged 65-74years with multimorbidity (≥3 chronic diseases) and polypharmacy (≥5 drugs prescribed in ≥3months). Sample size: n=400 (200 per study arm). Intervention: complex intervention based on the implementation of the Ariadne principles with two components: (1) FP training and (2) FP-patient interview. Outcomes: MAI score, health services use, quality of life (Euroqol 5D-5L), pharmacotherapy and adherence to treatment (Morisky-Green, Haynes-Sackett), and clinical and socio-demographic variables. Statistical analysis: primary outcome is the difference in MAI score between T0 and T1 and corresponding 95% confidence interval. Adjustment for confounding factors will be performed by multilevel analysis. All analyses will be carried out in accordance with the intention-to-treat principle. Discussion: It is essential to provide evidence concerning interventions on PC patients with polypharmacy and multimorbidity, conducted in the context of routine clinical practice, and involving young-old patients with significant potential for preventing negative health outcomes. Trial registration: Clinicaltrials.gov, NCT02866799Publisher PDFPeer reviewe
Transformation of waterborne hybrid polymer particles into films: Morphology development and modelling
Films cast from multiphase polymer particles have the potential to combine the properties of their components synergistically. The properties of the film depend on the hybrid polymer architecture and the film morphology. However, how the polymer microstructure and particle morphology are transformed during film formation to determine the film morphology is not well understood. Here, using waterborne alkyd-acrylic nanocomposite particles in a case study, it was found that phase migration leading to the formation of aggregates occurred during film formation. A coarse-grained Monte Carlo model was developed to account for the effects of polymer microstructure and particle morphology on the morphology of the film. The model was validated by comparing its predictions with the observed effects, and then used to explore combinations of polymer microstructure and particle morphology not attainable with the system used as a case study. Significantly, the compatibility of the phases was found to have a greater influence than the morphology of the particles in determining the film structure.Fil: Goikoetxea, Monika. Universidad del Pais Vasco; EspañaFil: Reyes, Yuri. Universidad del Pais Vasco; EspañaFil: de Las Heras Alarcón, Carolina. University of Surrey; Reino UnidoFil: Minari, Roque Javier. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Santa Fe. Instituto de Desarrollo Tecnológico para la Industria Química (i); Argentina. Universidad del Pais Vasco; EspañaFil: Beristain, Itxaso. Universidad del Pais Vasco; EspañaFil: Paulis, María. Universidad del Pais Vasco; EspañaFil: Barandiaran, María. Universidad del Pais Vasco; EspañaFil: Keddie, Joseph L.. University of Surrey; Reino UnidoFil: Asua, José M.. Universidad del Pais Vasco; Españ