Potential role of the lipoxygenase derived lipid mediators in atherosclerosis: leukotrienes, lipoxins and resolvins

Atherogenesis is an inflammatory process with leukocytes infiltrating the arterial intima. The lipoxygenase pathways play a role in leukocyte recruitment through the generation of two classes of arachidonic acid lipid mediators, the leukotrienes and the lipoxins, and one class of omega-3 fatty acid metabolites, the resolvins. There is evidence from animal studies and human genetic studies that the leukotrienes and the enzymes necessary for their generation play a role in atherosclerosis, and possibly even in the development of the vulnerable plaque. Less is known about the effect of the anti-inflammatory lipid mediators in atherosclerosis, the lipoxins and the resolvins. Studies modulating the activity of an enzyme necessary for the production of these lipid mediators, 12/15-lipoxygenase, showed discrepant results in several animal models. Also, human genetic studies have not clearly dissected the effect of the enzyme on atherosclerosis. However, stable forms of the lipoxins and the resolvins protect animals from inflammatory diseases. Whether blocking the leukotrienes or applying anti-inflammatory lipoxins and resolvins will be effective in attenuating human atherosclerosis needs to be demonstrated in future studies. In this review, the biosynthesis of these lipid mediators, their biological effects and the evidence for their possible role in atherosclerosis are discussed with an emphasis on human disease. Clin Chem Lab Med 2010;48:1063-7

Impact of a community pharmacist-led medication review on medicines use in patients on polypharmacy - a prospective randomised controlled trial

In 2010 the 'Polymedication Check' (PMC), a pharmacist-led medication review, was newly introduced to be delivered independently from the prescriber and reimbursed by the Swiss health insurances. This study aimed at evaluating the impact of this new cognitive service focusing on medicines use and patients' adherence in everyday life.; This randomised controlled trial was conducted in 54 Swiss community pharmacies. Eligible patients used ≥4 prescribed medicines over >3 months. The intervention group received a PMC at study start (T-0) and after 28 weeks (T-28) while the control group received only a PMC at T-28. Primary outcome measure was change in patients' objective adherence, calculated as Medication Possession Ratio (MPR) and Daily Polypharmacy Possession Ratio (DPPR), using refill data from the pharmacies and patient information of dosing. Subjective adherence was assessed as secondary outcome by self-report questionnaires (at T-0 and T-28) and telephone interviews (at T-2 and T-16), where participants estimated their overall adherence on a scale from 0-100 %.; A total of 450 patients were randomly allocated to intervention (N = 218, 48.4 %) and control group (N = 232, 51.6 %). Dropout rate was fairly low and comparable for both groups (N Int = 37 (17.0 %), NCont = 41 (17.7 %), p = 0.845). Main addressed drug-related problem (DRP) during PMC at T-0 was insufficient adherence to at least one medicine (N = 69, 26.7 %). At T-28, 1020 chronic therapies fulfilled inclusion criteria for MPR calculation, representing 293 of 372 patients (78.8 %). Mean MPR and adherence to polypharmacy (DPPR) for both groups were equally high (MPRInt = 88.3, SD = 19.03; MPRCont = 87.5, SD = 20.75 (p = 0.811) and DPPRInt = 88.0, SD = 13.31; DPPRCont = 87.5, SD = 20.75 (p = 0.906), respectively). Mean absolute change of subjective adherence between T-0 and T-2 was +1.03 % in the intervention and -0.41 % in the control group (p = 0.058). The number of patients reporting a change of their adherence of more than ±5 points on a scale 0-100 % between T-0 and T-2 was significantly higher in the intervention group (NImprovement = 30; NWorsening = 14) than in the control group (NImprovement = 20; NWorsening = 24; p = 0.028).; Through the PMC pharmacist were able to identify a significant number of DRPs. Participants showed high baseline objective adherence of 87.5 %, providing little potential for improvement. Hence, no significant increase of objective adherence was observed. However, regarding changes in subjective adherence of more than ±5 % the PMC showed a positive effect.; Clinical trial registry database, NCT01739816 ; first entry on November 27, 2012

CSF prostaglandin D synthase is reduced in excessive daytime sleepiness

Lipocalin-type prostaglandin D synthase (L-PGDS) is a brain enzyme, which produces prostaglandin D2, a substance with endogenous somnogenic effects. Using a standardized protocol for immunonephelometric determination of cerebrospinal fluid (CSF) L-PGDS levels, we show that CSF L-PGDS levels are significantly lower in 34 patients with excessive daytime sleepiness when compared with levels in 22 healthy controls. Thus, L-PGDS may represent the first neurochemical measure of excessive daytime sleepines

Raucherentwöhnung in Apotheken — Evaluation der Raucherentwöhnungskampagne "Tabak adieu” der Apotheker/-innen beider Basel

Zusammenfassung: Nach wie vor stellt der Tabakkonsum ein grosses gesundheitliches Problem in der Schweiz dar. Dementsprechend werden viele Anstrengungen und Massnahmen zur Reduktion des Tabakkonsums unternommen. Obwohl sich auch die Offizinapothekerl-innen in den letzten Jahren vermehrt im Bereich der Gesundheitsförderung und der Prävention engagierten, existiert bisher keine Dokumentation ihrer Rolle bei der Tabakprävention. Die Raucherentwöhnungskampagne "Tabak adieu”, die von Apothekerl-innen im Jahr 1996 in Basel als niederschwelliges Angebot durchgeführt wurde, und deren Evaluation ist ein Versuch, diese Rolle zu untersuchen. In der Evaluation wurden einerseits die beteiligten Apotheken befragt und ihre auf diesem Gebiet geleisteten Dienstleistungen erfasst. Andererseits wurden diejenigen aufhörwilligen Raucherl-innen, die sich während der Kampagne in der Apotheke über die Raucherentwöhnung beraten liessen, mittels standardisiertem Fragebogen über ihr Rauchverhalten und die in den Apotheken gemachten Erfahrungen befragt. Das Interesse am niederschwelligen Angebot der Apotheken für die Raucherentwöhnung war sehr gross: Während der vierwöchigen Kampagne wurden in den 63 beteiligten Apotheken rund 2000 Kundenkontakte mit an Raucherentwöhnung interessierten Personen registriert. Im Vergleich zur Situation vor der Kampagne verschob sich dabei die nachfrage zu den beratungsintensiven Dienstleistungen hin. Die in den Apotheken beratenen Entwöhnungswilligen beurteilten die erhaltene Raucherberatung als gut. Neben der Raucherberatung wurden den Aufhörwilligen auch Betreuung während der Entwöhnungsphase angeboten. In 76 Prozent der dokumentierten Raucherberatungen wurden Folgebesuche zwischen den Entwöhnungwilligen und dem Apothekenteam vereinbart. Die Untersuchung zeigt, dass Raucherberatung in Apotheken möglich ist, und dass das niederschwellige Angebot genutzt wird. Ein weiterer Ausbau dieser Präventionsmassnahme über die öffentlichen Apotheken scheint aufgrund der durchgeführten Evaluation sinnvoll. Voraussetzungen für erfolgreiche pharmazeutische Raucherberatungen und-ent-wöhnungen sind aber eine eingehende Fortbildung und ein motiviertes Tea

Neural Network Models of Memory Span

A model is presented in which short term memory is maintained by movement of vectors from one layer to another. This architecture is ideal for representing item order. Two mechanisms for accounting for serial position curves are considered, lateral inhibition, and noise from neighboring items. These also account for effects of grouping by inserting pauses during presentation. Two other effects, a reverse word-length effect and the effect of phonological similarity, are attributed to the reconstruction of items from partially decayed traces. If all the phonemes in an item are intact at recall, the item is recalled correctly. Otherwise, the subject guesses according to a model developed by Paul Luce for identification of words presented in noise

Success of a sustained pharmaceutical care service with electronic adherence monitoring in patient with diabetes over 12 months

We report on the first polypharmacy adherence monitoring over 371 days, integrated into a pharmaceutical care service (counselling, electronic multidrug punch cards, feedback on recent electronic records) for a 65-year-old man with diabetes after hospital discharge. The initial daily regimen of four times per day with 15 pills daily changed after 79 days into a daily regimen of two times per day with 9 pills daily for the next 292 days. The patient removed all medication from the multidrug punch cards (taking adherence 100%) and had 96.9% correct dosing intervals (timing adherence). The 57 evening doses showed the least variation in intake times at 17 h 45 min±8 min. Over the observation year, the patient was clinically stable. He was very satisfied with the multidrug punch card and the feedback on electronic records. In conclusion, long-term monitoring of polypharmacy was associated with the benefit of successful disease management

Hospital discharge: What are the problems, information needs and objectives of community pharmacists? A mixed method approach

After hospital discharge, community pharmacists are often the first health care professionals the discharged patient encounters. They reconcile and dispense prescribed medicines and provide pharmaceutical care. Compared to the roles of general practitioners, the pharmacists' needs to perform these tasks are not well known.; This study aims to a) Identify community pharmacists' current problems and roles at hospital discharge, b) Assess their information needs, specifically the availability and usefulness of information, and c) Gain insight into pharmacists' objectives and ideas for discharge optimisation.; A focus group was conducted with a sample of six community pharmacists from different Swiss regions. Based on these qualitative results, a nationwide online-questionnaire was sent to 1348 Swiss pharmacies.; The focus group participants were concerned about their extensive workload with discharge prescriptions and about gaps in therapy. They emphasised the importance of more extensive information transfer. This applied especially to medication changes, unclear prescriptions, and information about a patient's care. Participants identified treatment continuity as a main objective when it comes to discharge optimisation. There were 194 questionnaires returned (response rate 14.4%). The majority of respondents reported to fulfil their role as defined by the Joint-FIP/WHO Guideline on Good Pharmacy Practice (rather) badly. They reported many unavailable but useful information items, like therapy changes, allergies, specifications for "off-label" medication use or contact information. Information should be delivered in a structured way, but no clear preference for one particular transfer method was found. Pharmacists requested this information in order to improve treatment continuity and patient safety, and to be able to provide better pharmaceutical care services.; Surveyed Swiss community pharmacists rarely receive sufficient information along with discharge prescriptions, although it would be needed for medication reconciliation. According to the pharmacist's opinions, appropriate pharmaceutical care is therefore impeded