Home medicines reviews following acute coronary syndrome: study protocol for a randomized controlled trial

Background: Despite continual improvements in the management of acute coronary syndromes, adherence to guideline-based medications remains suboptimal. We aim to improve adherence with guideline-based therapy following acute coronary syndrome using an existing service that is provided by specifically trained pharmacists, called a Home Medicines Review. We have made two minor adjustments to target the focus of the existing service including an acute coronary syndrome specific referral letter and a training package for the pharmacists providing the service.Methods/Design: We will be conducting a randomized controlled trial to compare the directed home medicines review service to usual care following acute coronary syndromes. All patients aged 18 to 80 years and with a working diagnosis of acute coronary syndrome, who are admitted to two public, acute care hospitals, will be screened for enrolment into the trial. Exclusion criteria will include: not being discharged home, documented cognitive decline, non-Medicare eligibility, and presence of a terminal malignancy. Randomization concealment and sequence generation will occur through a centrally-monitored computer program. Patients randomized to the control group will receive usual post-discharge care. Patients randomized to receive the intervention will be offered usual post-discharge care and a directed home medicines review at two months post-discharge. The study endpoints will be six and twelve months post-discharge. The primary outcome will be the proportion of patients who are adherent to a complete, guideline-based medication regimen. Secondary outcomes will include hospital readmission rates, length of hospital stays, changes in quality of life, smoking cessation rates, cardiac rehabilitation completion rates, and mortality.Discussion: As the trial is closely based on an existing service, any improvements observed should be highly translatable into regular practice. Possible limitations to the success of the trial intervention include general practitioner approval of the intervention, general practitioner acceptance of pharmacists' recommendations, and pharmacists' ability to make appropriate recommendations. A detailed monitoring process will detect any barriers to the success of the trial. Given that poor medication persistence following acute coronary syndrome is a worldwide problem, the findings of our study may have international implications for the care of this patient group.Trial registration: Australian New Zealand Clinical Trials Registry ACTRN12611000452998. © 2012 Bernal et al; licensee BioMed Central Ltd

Combining Voltammetry with HPLC: Application to Electro-Oxidation of Glycerol

The combination of cyclic voltammetry and "online" chromatographic techniques for product detection is limited by the typically long analysis times in chromatographic columns. Therefore, traditionally, product analysis is performed offline after long bulk electrolysis experiments. To overcome the limitation of the inherently different time scales of voltammetry and high-performance liquid chromatography (HPLC), we suggest here to adopt rapid online sample collection with a micrometer-sized sampling tip placed close to the working electrode, followed by offline analysis of the sample fractions in an HPLC system. To demonstrate this concept, we applied online fraction collection and offline HPLC analysis to the glycerol electro-oxidation on Au and Pt electrodes in alkaline media and show that we can successfully follow the concentration changes of glycerol and its reaction products in good correspondence with the current profile obtained simultaneously with voltammetry. Moreover, the method allows for a detailed discrimination of the different mechanisms of glycerol oxidation on both electrodes. Therefore, this simple approach enables the monitoring of soluble reaction products during voltammetry with an HPLC system and thereby allows for new insights into the mechanisms of complex multistep electrode reactions

The Effect of Serum and Follicular Fluid Amyloid-Associated Protein Levels on in Vitro Fertilization Outcome in Patients with Polycystic Ovary Syndrome

In this study, we aimed to investigate serum and follicular fluid amyloid A protein levels in non-obese non-hyperandrogenic patients with polycystic ovary syndrome (PCOS) undergoing in vitro fertilization (IVF) and IVF outcome. A total of 81 patients undergoing IVF treatment, 41 patients diagnosed as PCOS according to the Rotterdam criteria (group I) and 40 patients with the etiology of male factor infertility (group II), were included in the study. On the day of oocyte pickup, serum and follicular fluid samples were collected from all patients. Serum E2 level on the day of hCG (2849.93 +/- 541.54 vs. 2494.28 +/- 712.98) and total number of retrieved oocytes (13.73 +/- 3.57 vs. 10.53 +/- 4.07) were significantly higher in group I when compared to group II (p 0.05). No significant difference was found between two groups regarding the serum and follicular fluid amyloid A protein levels on the day of oocyte retrieval (p > 0.05).Wo