Impact of a DSS-supported medication review on the safety of drug therapy and quality of life in patients with antithrombotic therapy

Polypharmacy is common among patients with antithrombotic medication, giving rise to concerns about Drug-Related Problems (DRPs). Therefore, these patients would benefit from a Medication Review (MR) along with pharmacist counselling to reduce the risks accompanying polymedication. This prospective study presents a concept for MRs that are applicable in German community pharmacies and can efficiently support pharmacist counselling and improve the safety of drug therapy. As this is a major challenge in everyday pharmacy practice, we used a Decision Support System (DSS) to evaluate its ability to support the process of pharmacist-led MRs. The primary endpoint was the impact of a community pharmacist on the reduction of DRPs. We investigated the impact of the interventions resulting from MRs on patients taking at least one antithrombotic drug as part of their polymedication regimen. Secondary endpoints were the reduction in the number of patients with bleeding risks and the improvement of patients’ Quality of Life (QoL) and therapy adherence. Furthermore, the DSS used in the study was controlled for correct data assessment and plausibility of data. We selected adult patients who were taking no less than three different medications for long-term treatment, at least one of which had to be an antithrombotic drug, and who were customers in one of eight selected pharmacies over a period of 6 months. Data from 87 patients were analyzed with DSS-support. A total of 234 DRPs were identified by the pharmacist (2.7 DRPs per patient). MR reduced DRPs by 43.2% which, resulting to a reduction of 1.2 DRPs per patient. The intervention also led to a significant improvement in the patients’ QoL (assessed via EQ-5D-5L questionnaire; p < 0.001) and enhanced therapy adherence (assessed via A14 questionnaire; p < 0.001). The control of correct data assessment (with 93.8% concordance) and plausibility of data (with 91.7% concordance) of the DSS software were conducted by an external auditor. No significant effect was found for overall bleeding risk. The results of this study indicate that DSS-supported and structured MR conducted by pharmacists can contribute to a reduction in DRPs and significantly improve patient’s QoL and adherence to treatment

Låt oss fästa

För att fånga den perfekta bilden krävs rätt ljus och timing, men det finns även mycket annat som kan hjälpa dig när du fotograferar. Fotografering är en prylhobby och även hobbyfotografer har en tendens att samla på sig diverse gadgets. Jonas Lundin var en av dessa hobbyfotografer som kände att han saknade en produkt på marknaden. En produkt där han kunde ha sina kameraobjektiv mer lättillgängliga. En produkt som gjorde det möjligt att snabbt byta objektiv och att aldrig missa det perfekta fotoögonblicket. Jonas Lundin valde att ta fram produkten själv, TriLens. TriLens tillåter användaren att, med hjälp av ett fäste som man för över sitt skärp, hänga upp till tre kameraobjektiv på höften. Detta examensarbete behandlar just fästet för TriLens och tar fram ett designförslag som är bättre anpassat för kund. Den här rapporten beskriver en produktutvecklingsprocess från ax nästan hela vägen till limpa. Den beskriver en gedigen marknadsundersökning för att hitta användarnas faktiska behov. Vidare utförs en marknads- samt patentundersökning och vilka olika bredder och tjocklekar bälten och ryggsäckar har. Något som upptäcks under denna period var även läran om Compliant Mechanisms vilket kom att ligga som grund till mycket av prototyparbetet i rapportens senare del. Efter den utforskande fasen inleds en analyserande del som sedan går över till just idégenerering och prototypande. Med hjälp av brainstorming och en hel del skissande tas olika koncept fram för att sedan mynna ut till val av koncept. Under denna del kombineras, itereras och testas valda koncept för att sedan avslutas med ett designförslag. Slutresultatet som presenteras består av en skruvande mekanism för att fästa på rem och blockerande mekanism för låsning av TriLens. Rapporten beskriver även utmaningar som kommer med en pandemi och hur viktigt det är med goda marginaler i en tidsplanering. Framförallt ger det en gedigen bild av hur en produktutvecklingsprocess kan se ut för att göra en redan befintlig produkt bättre, både för beställare och användare

Ecophysiological Evaluation of Three Maize (Zea mays L.) Cultivars under Irrigation Regimes and Use of Super Absorbent

To evaluate the effects of using super absorbent and irrigation regimes on seed yield and yield components of maize cultivars a split plot experiment based on randomized complete block design with three replications was performed at the Research Field of Malekan Islamic Azad University. Main factor consisted of three irrigation regimes (irrigation after 70, 110 and 150 mm evaporation from pan) and subfactor of two levels of super absorbent applications (application and without application) and three maize cultivars (704, Iranian maxima and overseas maxima). Based on the results obtained it was revealed that highest seed yield (985 g/m2) belonged to the plants irrigated after 70 mm evaporation from the pan without using super absorbent. Irrigation after evaporation of 150 mm from the pan decreased both seed numbers per plant and 100 seed weight, and seed yield loss amounted to be 46.1% as compared with irrigation after 70 mm evaporation from the pan. Without using super absorbent and irrigation after 150 mm evaporation from the pan decreased seed number per ear by 38.8% and 100 seed weight by 13.8%. However, application of super absorbent and irrigation of plants after 150 mm evaporation from the pan increased by grain yield 38% as compared with out using super absorbent. There were not significant difference between cultivars for seed yield and yield components. It could be concluded that application of super absorbent under water shortage conditions may reduce crop yield losses

Survey on gastrointestinal parasitic helminthes in club and rural horses of Ardabil city, Iran

Parasitic diseases are considered as a major obstacle in the growth and development of animal health all over the world. Horses, in comparison to other domestic animals are reported to be more susceptible to a large number of parasites and may harbor different species at any time. The present study was carried out to establish the Gastrointestinal Parasites (GIP) profile of club and rural horses in Ardabil city. A total of 50 horses made up of 34 males and 16 females were examined in spring and summer, 2015. Fecal samples were processed by flotation techniques. GIP encountered were Strongyles (34%), Parascaris equorum (20%), Strongyloides westrii (12%), Anoplocephalidae (6%), Trichostrongylus spp. (4%), Ornithobilharzia turkestanicum (4%) and Dicrocoelium dendriticum­ (2%). According to the results, no significant differences in infection rate were found between male and female horses. But infection rates were significantly higher in horses without a history of anti-parasitic treatment in comparison with those with a history of anti-parasitic treatment (p<0.05). There was no significant difference between infected and uninfected horses regarding age despite  more infection being observed in horses aged 6–10 yrs. Also, significant difference in infection rate between club and rural horses was not observed. Meanwhile in 4% of samples (2 rural horses), infection with Ornithobilharzia was found which is the first report of this parasite in horses in the region

The Association between Skeletal Protrusion and Labiolingual Inclination of Teeth with Anterior Alveolar Bone Thickness by Computed Beam Computed TomographyImages

Evaluation of alveolar bone thickness is crucial for proper implant placement and support and aesthetics of soft tissue around implant restorations. The aim of this study was to determine the relationship between skeletal protrusion of jaw and labiolingual inclination of teeth with maxillary and mandibular anterior alveolar bone thickness using computed beam computed tomography (CBCT).Materials & Methods:In this descriptive-analytical study, cone beam computed tomography images were obtained from 100 patients referred to the radiology department of Tabriz Dental School from 2013-2015 before implant insertion. Maxillary and mandibular protrusion was determined by measuring SNA (Sella-nasion-A point) and SNB (Sella-nasion-B point) angles and labiolingual inclination of maxillary and mandibular anterior teeth was determined by measuring U1-NA (Upper 1-Nasion A point) and L1-NB (Lower1-Nasion B point) angles. Then, thickness of buccal bone was measured at three levels: 3 mm below the CEJ (A), the middle part of the root (B) and the apex (C). Data were analyzed by using descriptive statistics (mean and standard deviation) and Pearson’s correlation coefficient and p value 0.05) except for B region on canine (Pearson correlation coefficient = 0.305 and p value 0.05).Conclusion:There was no statistically significant relation between maxillary and mandibular protrusion and labiolingual inclination of upper and lower anterior teeth with alveolar bone thicknes

Interfacial Polar Interactions Affect Gramicidin Channel Kinetics

Critical to biological processes such as secretion and transport, protein-lipid interactions within the membrane and at the membrane-water interface still raise many questions. Here we examine the role of lipid headgroups in these interactions by using gramicidin A (gA) channels in planar bilayers as a probe. We show that although headgroup demethylation from phosphatidylcholine (DOPC) to phosphatidylethanolamine decreases the lifetime of gA channels by an order of magnitude in accordance with the currently accepted hydrophobic mismatch mechanism, our findings with diether-DOPC suggest the importance of the headgroup-peptide interactions. According to our x-ray diffraction measurements, this lipid has the same hydrophobic thickness as DOPC but increases gA lifetime by a factor of 2. Thus we demonstrate that peptide-headgroup interactions may dominate over the effect of hydrophobic mismatch in regulating protein function