Caregivers’ experiences of medication management advice for people living with dementia at discharge

Acknowledgments: StepUp for Dementia Research, which is funded by the Australian Government Department of Health and implemented by a dedicated team at the University of Sydney. Journal of Evaluation in Clinical Practice Funding : The project and DG was supported by the Australian National Health and Medical Research Council Dementia Leadership Fellowship.Peer reviewedPostprin

Development of a tool to evaluate medication management guidance provided to carers of people living with dementia at hospital discharge : a mixed methods study

Acknowledgements We thank our research advisory group and the members of the Sydney Dementia Network Lived Experience Expert Advisory Panel for their valuable feedback, and StepUp for Dementia Research, which is funded by the Australian Government Department of Health and implemented by a dedicated team at the University of Sydney. Funding This article was supported by a grant from the National Health and Medical Research Council Dementia Leadership Fellowship (grant number 1136849) and Dementia Centre for Research Postdoctoral Fellowship.Peer reviewedPublisher PD

Patterns of high-risk prescribing and other factors in relation to receipt of a home medicines review: A prospective cohort investigation among adults aged 45 years and over in Australia

© Author(s) (or their employer(s)) 2019. Objectives: To quantify the relationship between home medicines review (HMR) receipt in older adults and sociodemographic, medication-related and health factors. Design: Prospective cohort analysis. Settings, participants, measurements: Questionnaire data from a population-based cohort study of individuals aged ≥45 years, Sydney, Australia were linked with primary healthcare data, medication and hospitalisation data, to ascertain factors associated with HMR receipt during the period July 2009-June 2014. Medication-related factors included exposure to five and more medications (polypharmacy), narrow therapeutic index medicines, potentially inappropriate prescribing defined using Beers Criteria medicines, and anticholinergic and sedative drugs, defined using the Drug Burden Index (DBI). Poisson and Cox regression models were used to evaluate HMR receipt in relation to sociodemographic, behavioural and health characteristics, and time-varying factors including medication use and hospitalisations. Primary outcome: HMR receipt during the 5-year study period. Results: Over 5 years of follow-up, 4.7% (n=6115) of 131 483 participants received at least one HMR. Five-year HMR receipt was: 1.5% in people using <5 medications at baseline, 6.8% with 5-9 medications, 12.7% with ≥10 medications, 8.8% using Narrow Therapeutic Index medicines, 6.8% using Beers Criteria potentially inappropriate medicines and 7.4% using DBI medicines. Age-sex stratified HRs for HMR receipt were 6.07 (95% CI: 5.58 to 6.59) and 12.46 (11.42 to 13.59) for concurrent use of 5-9 and ≥10 versus <5 medications, respectively. The age-sex adjusted rate ratio for HMR receipt was 2.65 (2.51 to 2.80) with poor versus good self-reported health; this association was attenuated substantially following additional adjustment for polypharmacy. Conclusions: HMR was common in individuals using multiple medications, a formal indication for general practitioner referral and, to a lesser extent, with poorer health and other markers of high-risk prescribing. Despite this, HMR use over a 5-year period was generally below 10%, even in high-risk groups, suggesting substantial potential for improvement in uptake and targeting

Recent changes in the surface salinity of the North Atlantic subpolar gyre

Sea surface salinity (SSS) was measured since 1896 along 60°N between Greenland and the North Sea and since 1993 between Iceland and Newfoundland. Along 60°N away from the shelves, and north of 53°N, the amplitude of the seasonal cycle is comparable to or less than interannual variability. In these parts of the North Atlantic subpolar gyre, large-scale deviations from the seasonal cycle correlate from one season to the next. This suggests that in these regions, summer and autumn surface data are useful for monitoring changes in upper ocean salinity best diagnosed from less common winter surface data. Further south near the subarctic front, the Labrador Current or near shelves where seasonal variability is strong, this is not the case. Along 60°N, the multiannual low-frequency variability is well correlated across the basin and exhibits fresher surface water since the mid 1970s than in the late 1920s to 1960s. SSS in the Irminger Sea along 60°N lags by 1-year SSS farther east in the Iceland Basin. Variability between Iceland and Newfoundland within the Irminger Sea north of 54°N presents similar characteristics to what is observed along 60°N. Variability near the northwest corner of the North Atlantic Current (52°N/45°W) is larger and is not correlated to what is found further north. Maps of SSS were constructed for a few recent seasons between July 1996 and June 2000, which illustrate the fresh conditions found usually during that period across the whole North Atlantic subpolar gyre, although this includes an episode of higher salinity. The SSS anomaly maps have large uncertainties but suggest that the highest SSS occurred before the spring of 1998 in the Iceland Basin, and after that, in the Irminger Sea. This is followed by fresher conditions, first in the Labrador and Iceland Basin, reaching recently the Irminger Sea

Neoliberalism as a Political Rationality: Australian Public Policy Since the 1980s

Since the 1980s, a remarkable transformation has occurred in the rationale that informs public policy in Australia. This transformation reflects a fundamental change in the way national economies and populations are conceived by policy makers and has led to the emergence of new strategies of governance as a consequence. We argue that this change of direction in Australian public policy may be best thought of as a specific neoliberal political rationality. The first section of the paper outlines changes to conceptions of the economy and subjectivity which are associated with neoliberalism as a political rationality. The second part of the paper examines the articulation and implementation of neoliberalism in Australia over the last couple of decades

A germanate transparent conductive oxide

Wide bandgap conductors such as In2O3 and ZnO are used as transparent conducting oxides (TCOs). To date, TCOs are realized using post transition metal cations with largely spread s-orbitals such as In3+, Sn4+, Zn2+ and Cd2+. On the other hand, no good electronic conductor has been realized in oxides of Al, Si and Ge. Here we report the conversion of an oxide of Ge into a good electronic conductor by employing the concept of superdegeneracy. We find that cubic SrGeO3, synthesized under high pressure, displays a direct bandgap of 3.5 eV, a carrier mobility of 12 cm2(Vs)−1, and conductivities of 3 Scm−1 (DC) and 400 Scm−1 (optical conductivity). This is the first Ge-based electronic conductive oxide, and expands the family of TCOs from ionic oxides to covalent oxides

Архетип свобода у контексті французької політичної теорії та історії

Розглянуто сучасні підходи щодо аналізу політичної ментальності. У межах політологічного аналізу окреслено коло проблем, які потребують вирішення з використанням підходів психології. Зроблено висновок про те, що архетип “свобода” становить важливий елемент політичної ментальності французів.Modern approaches of analysis of political mentality are considered. Within the limits of political science analysis outlined circle of problems which need decision with the use of approaches of psychology. A conclusion is done that archetype freedom makes the important element of political mentality of French’s

Anticholinergic drug burden tools/scales and adverse outcomes in different clinical settings: a systematic review of reviews

Background: Cumulative anticholinergic exposure (anticholinergic burden) has been linked to a number of adverse outcomes. To conduct research in this area, an agreed approach to describing anticholinergic burden is needed. Objective: This review set out to identify anticholinergic burden scales, to describe their rationale, the settings in which they have been used and the outcomes associated with them. Methods: A search was performed using the Healthcare Databases Advanced Search of MEDLINE, EMBASE, Cochrane, CINAHL and PsycINFO from inception to October 2016 to identify systematic reviews describing anticholinergic burden scales or tools. Abstracts and titles were reviewed to determine eligibility for review with eligible articles read in full. The final selection of reviews was critically appraised using the ROBIS tool and pre-defined data were extracted; the primary data of interest were the anticholinergic burden scales or tools used. Results: Five reviews were identified for analysis containing a total of 62 original articles. Eighteen anticholinergic burden scales or tools were identified with variation in their derivation, content and how they quantified the anticholinergic activity of medications. The Drug Burden Index was the most commonly used scale or tool in community and database studies, while the Anticholinergic Risk Scale was used more frequently in care homes and hospital settings. The association between anticholinergic burden and clinical outcomes varied by index and study. Falls and hospitalisation were consistently found to be associated with anticholinergic burden. Mortality, delirium, physical function and cognition were not consistently associated. Conclusions: Anticholinergic burden scales vary in their rationale, use and association with outcomes. This review showed that the concept of anticholinergic burden has been variably defined and inconsistently described using a number of indices with different content and scoring. The association between adverse outcomes and anticholinergic burden varies between scores and has not been conclusively established

Body Temperature Patterns and Rhythmicity in Free-Ranging Subterranean Damaraland Mole-Rats, Fukomys damarensis

Body temperature (Tb) is an important physiological component that affects endotherms from the cellular to whole organism level, but measurements of Tb in the field have been noticeably skewed towards heterothermic species and seasonal comparisons are largely lacking. Thus, we investigated patterns of Tb patterns in a homeothermic, free-ranging small mammal, the Damaraland mole-rat (Fukomys damarensis) during both the summer and winter. Variation in Tb was significantly greater during winter than summer, and greater among males than females. Interestingly, body mass had only a small effect on variation in Tb and there was no consistent pattern relating ambient temperature to variation in Tb. Generally speaking, it appears that variation in Tb patterns varies between seasons in much the same way as in heterothermic species, just to a lesser degree. Both cosinor analysis and Fast Fourier Transform analysis revealed substantial individual variation in Tb rhythms, even within a single colony. Some individuals had no Tb rhythms, while others appeared to exhibit multiple rhythms. These data corroborate previous laboratory work showing multiplicity of rhythms in mole-rats and suggest the variation seen in the laboratory is a true indicator of the variation seen in the wild

Systematic Review of Medicine-Related Problems in Adult Patients with Atrial Fibrillation on Direct Oral Anticoagulants

New oral anticoagulant agents continue to emerge on the market and their safety requires assessment to provide evidence of their suitability for clinical use. There-fore, we searched standard databases to summarize the English language literature on medicine-related problems (MRPs) of direct oral anticoagulants DOACs (dabigtran, rivaroxban, apixban, and edoxban) in the treatment of adults with atri-al fibrillation. Electronic databases including Medline, Embase, International Pharmaceutical Abstract (IPA), Scopus, CINAHL, the Web of Science and Cochrane were searched from 2008 through 2016 for original articles. Studies pub-lished in English reporting MRPs of DOACs in adult patients with AF were in-cluded. Seventeen studies were identified using standardized protocols, and two reviewers serially abstracted data from each article. Most articles were inconclusive on major safety end points including major bleeding. Data on major safety end points were combined with efficacy. Most studies inconsistently reported adverse drug reactions and not adverse events or medication error, and no definitions were consistent across studies. Some harmful drug effects were not assessed in studies and may have been overlooked. Little evidence is provided on MRPs of DOACs in patients with AF and, therefore, further studies are needed to establish the safety of DOACs in real-life clinical practice