Shared decision making and experiences of patients with long-term conditions : has anything changed?

Background Medication problems among patients with long-term conditions (LTCs) are well documented. Measures to support LTC management include: medicine optimisation services by community pharmacists such as the Medicine Use Review (MUR) service in England, implementation of shared decision making (SDM), and the availability of rapid access clinics in primary care. This study aimed to investigate the experience of patients with LTCs about SDM including medication counselling and their awareness of community pharmacy medication review services. Methods A mixed research method with a purposive sampling strategy to recruit patients was used. The quantitative phase involved two surveys, each requiring a sample size of 319. The first was related to SDM experience and the second to medication counselling at discharge. Patients were recruited from medical wards at St. George’s and Croydon University Hospitals.The qualitative phase involved semi-structured interviews with 18 respiratory patients attending a community rapid access clinic. Interviews were audio-recorded and transcribed verbatim. Thematic analysis using inductive/deductive approaches was employed. Survey results were analysed using descriptive statistics. Results The response rate for surveys 1 and 2 survey was 79% (n = 357/450) and 68.5% (240/350) respectively. Survey 1 showed that although 70% of patients had changes made to their medications, only 40% were consulted about them and two-thirds (62.2%) wanted to be involved in SDM. In survey 2, 37.5% of patients thought that medication counselling could be improved. Most patients (88.8%) were interested in receiving the MUR service; however 83% were not aware of it. The majority (57.9%) were interested in receiving their discharge medications from community pharmacies. The interviews generated three themes; lack of patient-centered care and SDM, minimal medication counselling provided and lack of awareness about the MUR service. Conclusion Although patients wanted to take part in SDM, yet SDM and medication counselling are not optimally provided. Patients were interested in the MUR service; however there was lack of awareness and referral for this service. The results propose community pharmacy as a new care pathway for medication supply and counselling post discharge. This promotes a change of health policy whereby community-based services are used to enhance the performance of acute hospitals

Suicide risk in schizophrenia: learning from the past to change the future

Suicide is a major cause of death among patients with schizophrenia. Research indicates that at least 5–13% of schizophrenic patients die by suicide, and it is likely that the higher end of range is the most accurate estimate. There is almost total agreement that the schizophrenic patient who is more likely to commit suicide is young, male, white and never married, with good premorbid function, post-psychotic depression and a history of substance abuse and suicide attempts. Hopelessness, social isolation, hospitalization, deteriorating health after a high level of premorbid functioning, recent loss or rejection, limited external support, and family stress or instability are risk factors for suicide in patients with schizophrenia. Suicidal schizophrenics usually fear further mental deterioration, and they experience either excessive treatment dependence or loss of faith in treatment. Awareness of illness has been reported as a major issue among suicidal schizophrenic patients, yet some researchers argue that insight into the illness does not increase suicide risk. Protective factors play also an important role in assessing suicide risk and should also be carefully evaluated. The neurobiological perspective offers a new approach for understanding self-destructive behavior among patients with schizophrenia and may improve the accuracy of screening schizophrenics for suicide. Although, there is general consensus on the risk factors, accurate knowledge as well as early recognition of patients at risk is still lacking in everyday clinical practice. Better knowledge may help clinicians and caretakers to implement preventive measures. This review paper is the results of a joint effort between researchers in the field of suicide in schizophrenia. Each expert provided a brief essay on one specific aspect of the problem. This is the first attempt to present a consensus report as well as the development of a set of guidelines for reducing suicide risk among schizophenia patients

Магнітно-резонансна томографія в оцінюванні морфологічних і структурних змін тіл хребців поперекового відділу хребта під час зниження мінеральної щільності кісткової тканини

The aim of the study was to study the morphological and structural changes of the vertebral bodies in patients with different bone mineral density by MRI.Materials and methods. 81 patients with different bone mineral density (BMD) of the vertebral bodies of the lumbar spine (LS) had taken part in the study. Osteopenia was diagnosed in 33 patients, 28 have osteoporosis and 20 patients without evidence of osteoporosis (according to the DXA, which was made all the investigated) were in the control group. 69 of them were women and 12 men with a mean age 49,6 ± 7,6 years (control group), 56,5 ± 9,8 years (patients with osteopenia), 66,0 ± 9,4 years (with osteoporosis). All patients underwent dual-energy X-ray absorptiometry (DXA) and magnetic resonance imaging (MRI). DXA has been made on the unit «Lunar PRODIGY Primo DHA» (analysis version: 11.40) manufacture GE Healthcare, according to the standard protocol with the definition of osteoporosis by WHO (1994). In this case, average bone mineral density BMD (g/cm2) in the bodies of L1-L4 were: in healthy ones -1,232 ± 0,06; when osteopenia - 1,032 ± 0,07; osteoporosis - 0,757 ± 0,08. The average T -test was consistent, respectively: T - 1,27 ± 0,71; T - 1,40 ± 011 , T - 3,09 ± 1,73. The difference in BMD between I and II groups was 16,2 % , between I and III groups - 25%. MRI morphometry in patients with osteopenia changes of the vertebral bodies were accompanied by POP: marked reduction in the average height of the vertebral bodies, more pronounced than in osteoporosis, a slight drop height of the front body, reducing of the Barnett-Nordin index (B/N) - 0,84. Osteopenia significantly correlated with BMD of vertebral body height rear L1, the index of B/N in the body of L4. In osteoporosis MRI morphometry data were characterized by the fact that the front and the average height of the vertebral bodies were not changed significantly. In patients with osteoporosis BMD was significantly correlated with rear height of the vertebral bodies - L1 (r - 0,49, p = 0,02), L2 (r - 0,46, p = 0,04), L3 (r - 0,45 p = 0,04). B/N index in the bodies of L1, L2 and L3 had weak connection correlation (respectively, r + 0,31 *, r + 0,25 *, r - 0,27 *). It was found that Veins Brescia visualization with MRI along with morphological changes are indicators of the bone mineral density disturbance.Results. 81 patients with different bone mineral density (BMD) of the vertebral bodies of the lumbar spine (LS) had taken part in the study. Osteopenia was diagnosed in 33 patients, 28 have osteoporosis and 20 patients without evidence of osteoporosis (according to the DXA, which was made all the investigated) were in the control group. 69 of them were women and 12 men with a mean age 49,6 ± 7,6 years (control group), 56,5 ± 9,8 years (patients with osteopenia), 66,0 ± 9,4 years (with osteoporosis). All patients underwent dual-energy X-ray absorptiometry (DXA) and magnetic resonance imaging (MRI). DXA has been made on the unit «Lunar PRODIGY Primo DHA» (analysis version: 11.40) manufacture GE Healthcare, according to the standard protocol with the definition of osteoporosis by WHO (1994). In this case, average bone mineral density BMD (g/cm2) in the bodies of L1-L4 were: in healthy ones -1,232 ± 0,06; when osteopenia - 1,032 ± 0,07; osteoporosis - 0,757 ± 0,08. The average T -test was consistent, respectively: T - 1,27 ± 0,71; T - 1,40 ± 011 , T - 3,09 ± 1,73. The difference in BMD between I and II groups was 16,2 % , between I and III groups - 25%. MRI morphometry in patients with osteopenia changes of the vertebral bodies were accompanied by POP: marked reduction in the average height of the vertebral bodies, more pronounced than in osteoporosis, a slight drop height of the front body, reducing of the Barnett-Nordin index (B/N) - 0,84. Osteopenia significantly correlated with BMD of vertebral body height rear L1, the index of B/N in the body of L4. In osteoporosis MRI morphometry data were characterized by the fact that the front and the average height of the vertebral bodies were not changed significantly. In patients with osteoporosis BMD was significantly correlated with rear height of the vertebral bodies - L1 (r - 0,49, p = 0,02), L2 (r - 0,46, p = 0,04), L3 (r - 0,45 p = 0,04). B/N index in the bodies of L1, L2 and L3 had weak connection correlation (respectively, r + 0,31 *, r + 0,25 *, r - 0,27 *).ConclusionIt was found that Veins Brescia visualization with MRI along with morphological changes are indicators of the bone mineral density disturbance.Обследовали 81 пациента с различной минеральной плотностью костной ткани тел позвонков поясничного отдела позвоночника. При остеопении статистически значимо коррелируют с показателями минеральной плотности костной ткани тел позвонков задняя высота тела L1, индекс Барнетта-Нордина в теле L4. При остеопорозе данные МРТ морфометрии характеризовались тем, что передняя и средняя высота тел позвонков существенно не изменились при слегка увеличенной задней высоте и соответствующем индексом Барнетта-Нордина (0,81). При остеопорозе статистически значимо с показателями минеральной плотности костной ткани коррелируют задние высоты тел позвонков при слабой коррелятивной связи индекса Барнетта-Нордина в телах L1, L2 и L3. Установлено, что визуализация вены Бреше на МРТ – признак, свидетельствующий о нарушении минеральной плотности костной ткани.  Обстежили 81 пацієнта з різною мінеральною щільністю кісткової тканини тіл хребців поперекового відділу хребта. При остеопенії статистично значущо корелюють з показниками мінеральної щільності кісткової тканини тіл хребців задня висота тіла L1, індекс Барнета-Нордіна в тілі L4. При остеопорозі дані МРТ морфометрії характеризувались тим, що передня і середня висота тіл хребців істотно не змінились при дещо збільшеній задній висоті і відповідному індексом Барнета-Нордіна (0,81). При остеопорозі статистично значущо з показниками мінеральної щільності кісткової тканини корелюють задні висоти тіл хребців при слабкому корелятивному зв’язку індексу Барнета-Нордіна в тілах L1, L2 і L3. Встановили, що візуалізація вени Бреше на МРТ є ознакою, що свідчить про порушення мінеральної щільності кісткової тканини

MAGNETIC RESONANCE IMAGING IN THE EVALUATION OF MORPHOLOGICAL AND STRUCTURAL CHANGES OF THE VERTEBRAL BODIES OF THE LUMBAR SPINE WITH BONE MINERAL DENSITY REDUCTION

The aim of the study was to study the morphological and structural changes of the vertebral bodies in patients with different bone mineral density by MRI. Materials and methods. 81 patients with different bone mineral density (BMD) of the vertebral bodies of the lumbar spine (LS) had taken part in the study. Osteopenia was diagnosed in 33 patients, 28 have osteoporosis and 20 patients without evidence of osteoporosis (according to the DXA, which was made all the investigated) were in the control group. 69 of them were women and 12 men with a mean age 49,6 ± 7,6 years (control group), 56,5 ± 9,8 years (patients with osteopenia), 66,0 ± 9,4 years (with osteoporosis). All patients underwent dual-energy X-ray absorptiometry (DXA) and magnetic resonance imaging (MRI). DXA has been made on the unit «Lunar PRODIGY Primo DHA» (analysis version: 11.40) manufacture GE Healthcare, according to the standard protocol with the definition of osteoporosis by WHO (1994). In this case, average bone mineral density BMD (g/cm2) in the bodies of L1-L4 were: in healthy ones -1,232 ± 0,06; when osteopenia - 1,032 ± 0,07; osteoporosis - 0,757 ± 0,08. The average T -test was consistent, respectively: T - 1,27 ± 0,71; T - 1,40 ± 011 , T - 3,09 ± 1,73. The difference in BMD between I and II groups was 16,2 % , between I and III groups - 25%. MRI morphometry in patients with osteopenia changes of the vertebral bodies were accompanied by POP: marked reduction in the average height of the vertebral bodies, more pronounced than in osteoporosis, a slight drop height of the front body, reducing of the Barnett-Nordin index (B/N) - 0,84. Osteopenia significantly correlated with BMD of vertebral body height rear L1, the index of B/N in the body of L4. In osteoporosis MRI morphometry data were characterized by the fact that the front and the average height of the vertebral bodies were not changed significantly. In patients with osteoporosis BMD was significantly correlated with rear height of the vertebral bodies - L1 (r - 0,49, p = 0,02), L2 (r - 0,46, p = 0,04), L3 (r - 0,45 p = 0,04). B/N index in the bodies of L1, L2 and L3 had weak connection correlation (respectively, r + 0,31 *, r + 0,25 *, r - 0,27 *). It was found that Veins Brescia visualization with MRI along with morphological changes are indicators of the bone mineral density disturbance. Results. 81 patients with different bone mineral density (BMD) of the vertebral bodies of the lumbar spine (LS) had taken part in the study. Osteopenia was diagnosed in 33 patients, 28 have osteoporosis and 20 patients without evidence of osteoporosis (according to the DXA, which was made all the investigated) were in the control group. 69 of them were women and 12 men with a mean age 49,6 ± 7,6 years (control group), 56,5 ± 9,8 years (patients with osteopenia), 66,0 ± 9,4 years (with osteoporosis). All patients underwent dual-energy X-ray absorptiometry (DXA) and magnetic resonance imaging (MRI). DXA has been made on the unit «Lunar PRODIGY Primo DHA» (analysis version: 11.40) manufacture GE Healthcare, according to the standard protocol with the definition of osteoporosis by WHO (1994). In this case, average bone mineral density BMD (g/cm2) in the bodies of L1-L4 were: in healthy ones -1,232 ± 0,06; when osteopenia - 1,032 ± 0,07; osteoporosis - 0,757 ± 0,08. The average T -test was consistent, respectively: T - 1,27 ± 0,71; T - 1,40 ± 011 , T - 3,09 ± 1,73. The difference in BMD between I and II groups was 16,2 % , between I and III groups - 25%. MRI morphometry in patients with osteopenia changes of the vertebral bodies were accompanied by POP: marked reduction in the average height of the vertebral bodies, more pronounced than in osteoporosis, a slight drop height of the front body, reducing of the Barnett-Nordin index (B/N) - 0,84. Osteopenia significantly correlated with BMD of vertebral body height rear L1, the index of B/N in the body of L4. In osteoporosis MRI morphometry data were characterized by the fact that the front and the average height of the vertebral bodies were not changed significantly. In patients with osteoporosis BMD was significantly correlated with rear height of the vertebral bodies - L1 (r - 0,49, p = 0,02), L2 (r - 0,46, p = 0,04), L3 (r - 0,45 p = 0,04). B/N index in the bodies of L1, L2 and L3 had weak connection correlation (respectively, r + 0,31 *, r + 0,25 *, r - 0,27 *). Conclusion It was found that Veins Brescia visualization with MRI along with morphological changes are indicators of the bone mineral density disturbance

Treatment with HIV-protease inhibitor nelfinavir identifies membrane lipid composition and fluidity as a therapeutic target in advanced multiple myeloma

The HIV-protease inhibitor nelfinavir has shown broad anticancer activity in various preclinical and clinical contexts. In patients with advanced, proteasome inhibitor (PI)–refractory multiple myeloma, nelfinavir-based therapy resulted in 65% partial response or better, suggesting that this may be a highly active chemotherapeutic option in this setting. The broad anticancer mechanism of action of nelfinavir implies that it interferes with fundamental aspects of cancer cell biology. We combined proteome-wide affinity-purification of nelfinavir-interacting proteins with genome-wide CRISPR/Cas9–based screening to identify protein partners that interact with nelfinavir in an activity-dependent manner alongside candidate genetic contributors affecting nelfinavir cytotoxicity. Nelfinavir had multiple activity-specific binding partners embedded in lipid bilayers of mitochondria and the endoplasmic reticulum. Nelfinavir affected the fluidity and composition of lipid-rich membranes, disrupted mitochondrial respiration, blocked vesicular transport, and affected the function of membrane-embedded drug efflux transporter ABCB1, triggering the integrated stress response. Sensitivity to nelfinavir was dependent on ADIPOR2, which maintains membrane fluidity by promoting fatty acid desaturation and incorporation into phospholipids. Supplementation with fatty acids prevented the nelfinavir-induced effect on mitochondrial metabolism, drug-efflux transporters, and stress-response activation. Conversely, depletion of fatty acids/cholesterol pools by the FDA-approved drug ezetimibe showed a synergistic anticancer activity with nelfinavir in vitro. These results identify the modification of lipid-rich membranes by nelfinavir as a novel mechanism of action to achieve broad anticancer activity, which may be suitable for the treatment of PI–refractory multiple myeloma. Significance: Nelfinavir induces lipid bilayer stress in cellular organelles that disrupts mitochondrial respiration and transmembrane protein transport, resulting in broad anticancer activity via metabolic rewiring and activation of the unfolded protein response