Comprehensibility of a personalized medication overview compared to usual-care prescription drug labels

Poor understanding of prescription drug label (PDL) instructions can lead to medication errors, suboptimal treatment (side) effects, and non-adherence. A personalized medication hard-copy overview listing PDL instructions and visual information may support patients in their medication use. This study aimed to investigate the comprehensibility of PDL instructions on a personalized medication overview compared to usual-care PDL instructions presented on a medication box. A hypothetical-online-experiment was set up, comparing groups of respondents exposed vs not exposed to the medication overview and who received PDL instructions for three, five, or eight medications. Participants were divided randomly in six groups. Online questionnaires were sent to a stratified sample of 900 members from the Nivel Dutch Healthcare Consumer Panel. Outcome measures included comprehension of instructions for medication use, e.g. how often, dose timing, usage advice and warnings for a medication with simple use instructions (omeprazol) and more complex use instructions (levodopa/carbidopa (L/C)). To analyze differences between experimental conditions ANOVA testing was used. 604 respondents (net response 67%) completed the questionnaires. Respondents exposed (E) to the overview gave a higher proportion of correct answers compared to non-exposed (NE) respondents for usage advice (L/C: mean 0.83, SD 0.4 E; 0.03, SD 0.2 NE, p < 0.001; omeprazol: mean 0.85, SD 0.4 E; 0.10, SD 0.3 NE, p < 0.001). Both groups gave the same proportion of correct answers (mean 0.80, SD 0.4, p = 1.0) for dose timing of omeprazol. More NE respondents gave correct answers for how often (mean 0.85, SD 0.4 NE; mean 0.76, SD 0.4 E, p = 0.02) and dose timing (mean 0.92, SD 0.3 NE; mean 0.86, SD 0.4 E, p = 0.04) of L/C. No differences were found regarding number of medications nor were interaction effects found between the number of medications and information type. As a medication overview contains additional information, it can be a good addition in supporting patients in their medication use compared to usual-care PDLs. Future research should focus on identifying patient groups who might benefit more from a medication overview, by testing the effect of such overview on this group

Womens' self-management skills for prevention and treatment of recurring urinary tract infection

Background The guideline on urinary tract infections (UTI) of the Dutch College of General Practitioners provides recommendations on patient-initiated treatment and prevention of recurring UTI.Aim To study familiarity with self-management skills for prevention of recurring UTI amongst adult women.Design and settings An online questionnaire was developed, based on the UTI guideline and interviews with women having recurring UTI. Pharmacists in a postgraduate education programme (N = 76) aimed to invite 10 adult women with a recurring UTI prescription to complete the questionnaire. Women were asked for informed consent to link medication record data to questionnaire data.Method We calculated proportions of the scores for self-management skills and analysed differences between age groups with chi-square test.Results Complete questionnaires were available for 719 women (mean age 55.1 +/- 18.5 years). The proportions of women 18-50 years and women 51 years or older were 36.4% and 63.6%, respectively. Education levels of women 18-50 years were significantly higher than those of women 51 years and older. Before consulting a general practitioner (GP) for symptoms, 32.1% of all women increased fluid intake; additionally, 15.0% used analgesics and increased fluid intake. Of all women, 33.9% searched internet for information on self-management and 18% occasionally received a prescription for patient-initiated treatment, half of these prescriptions for use during vacation. Cranberry was used by 47%, d-mannose by 5% and vitamin C by 29% of all women. Awareness of different preventive behavioural measures (eg, fluid intake, washing without soap and emptying bladder after sexual intercourse) varied between 20% and 90%.Conclusion Almost half of all women applied self-management (increased fluid intake, analgesics) before consulting a GP for recurring UTI. Awareness of preventive behavioural measures for recurring UTI varied considerably. Thus, education of women about the use of analgesics and behavioural measures deserves attention.Clinical Pharmacy and Toxicolog

Factors influencing pharmacists' clinical decision making in pharmacy practice

BackgroundPharmacists’ clinical decision-making is considered a core process of pharmaceutical care in pharmacy practice, but little is known about the factors influencing this process.ObjectiveTo identify factors influencing clinical decision-making among pharmacists working in pharmacy practice.MethodsSemi-structured interviews were conducted with pharmacists working in primary, secondary, and tertiary care settings in the Netherlands between August and December 2021. A thematic analysis was conducted using an inductive approach. The emerged themes were categorized into the Capability–Opportunity-Motivation–Behaviour (COM-B) model domains.ResultsIn total, 16 pharmacists working in primary care (n = 7), secondary care (n = 4) or tertiary care (n = 5) were interviewed. Factors influencing pharmacists' capability to make clinical decisions are a broad theoretical knowledge base, clinical experience, and skills, including contextualizing data, clinical reasoning, and clinical judgment. The pharmacy setting, data availability, rules and regulations, intra- and interprofessional collaboration, education, patient perspectives, and time are mentioned as factors influencing their opportunity. Factors influencing pharmacists’ motivation are confidence, curiosity, critical thinking, and responsibility.ConclusionsThe reported factors covered all domains of the COM-B model, implying that clinical decision-making is influenced by a combination of pharmacists' capability, opportunity, and motivation. Addressing these different factors in pharmacy practice and education may improve pharmacists’ clinical decision-making, thereby improving patient outcomes.</p

Survey on general practitioners' and pharmacists' opinions regarding patient-initiated treatment of recurring urinary tract infections

Background The Dutch general practitioners (GP) guideline for urinary tract infections (UTI) recommends patient-initiated treatment for women with recurring UTI. In countries other than the Netherlands, community pharmacists play a role in dispensing antibiotics for recurring UTI without preceding GP consultation. Objective To study GP and pharmacist opinions regarding the desirability of patient-initiated treatment, including potential pharmacist support for, and consequences of, facilitated access to antibiotics. Setting Dutch community pharmacies that cooperate with at least two GPs in their regional primary care network. Method Pharmacists in a postgraduate education program invited their residency pharmacist and 2-3 GPs to anonymously complete an online questionnaire. Questions related to diagnosis, treatment and potential role of the pharmacist. Answers were formulated as multiple-choice or ratings on a 5-point Likert scale. Data were analysed per professional group using descriptive statistics. Answers of pharmacists and GP to corresponding questions were analysed using a Chi-square test (p < 0.05). Main outcome measure Desirability of patient-initiated treatment and supporting role of the pharmacist. Results A total of 170 GPs and 76 pharmacists completed the questionnaires. Of the GPs, 35.1% supported patient-initiated treatment. Of the pharmacists, 69.7% were willing to dispense an antibiotic to a patient without preceding GP consultation after performing a probability check. In total, 65.7% of GPs and 44.7% of pharmacists thought that facilitated access to antibiotics would increase use of antibiotics (p < 0.05). Conclusion Support of GPs for facilitated access to antibiotic treatment by patient-initiated UTI treatment was limited, even with pharmacist support. The majority of pharmacists were willing to dispense an antibiotic after a probability check of an episode of recurring UTI, but both pharmacists and GPs were concerned about overuse of antibiotics.Clinical Pharmacy and Toxicolog

Adolescents’ Perspectives on Atopic Dermatitis Treatment: Experiences, Preferences, and Beliefs

IMPORTANCE For a considerable proportion of pediatric patients, atopic dermatitis symptoms persist into adolescence. Previous studies have focused mainly on (parents of) children, whereas little is known about adolescents with atopic dermatitis. OBJECTIVE To explore the beliefs, experiences, and preferences of adolescents with atopic dermatitis toward their treatment. DESIGN, SETTING, AND PARTICIPANTS We conducted a qualitative study employing focus group interviews of 15 adolescents (aged 12-18 years) who collected at least 1 prescription for topical corticosteroids in class 2 (moderately potent) or 3 (potent) in the preceding year. The study included 9 community pharmacies in 3 different regions in the Netherlands. Data were collected from November to December 2016, until data saturation was reached. Focus groups were recorded, transcribed verbatim, and data were analyzed by 2 researchers. MAIN OUTCOMES AND MEASURES Adolescents’ beliefs, experiences, and preferences toward their atopic dermatitis treatment were explored during focus groups. We used a thick analysis approach to analyze the transcripts; both deductive and inductive coding were used to analyze the transcripts. RESULTS Three focus groups including 15 adolescents (8 male) with a mean age of 15.3 (range, 12-18) years were conducted. Adolescents were in general satisfied with the efficacy of the treatment; however, they prefer a faster and more persistent effect. Most adolescents had little contact with their physicians and did not completely adhere to the prescribed medication regimen; they developed their own routine of using topical corticosteroids in combination with emollients and moisturizers. They also seemed to have incorrect beliefs about the mechanism of action. CONCLUSIONS AND RELEVANCE Adolescents developed their own way of using topical treatment for atopic dermatitis. Some practical suggestions were mentioned to improve medication use. Health care providers should devote special attention to adolescents with atopic dermatitis to make them more aware of the principles of topical treatment and ensure proper use

Preconceptional Maternal Vegetable Intake and Paternal Smoking Are Associated with Pre-implantation Embryo Quality

Inadequate nutrition and lifestyle behaviors, particularly during the periconception period, are associated with a negative impact on embryonic and subsequent fetal development. We investigated the associations between parental nutritional and lifestyle factors and pre-implantation embryo development. A total of 113 women and 41 partners, with a corresponding 490 embryos, who underwent intracytoplasmic sperm injection (ICSI) treatment subscribed to the mHealth coaching platform “Smarter Pregnancy.” At baseline, nutrition and lifestyle behaviors (intake of fruits, vegetables, folic acid, and smoking and alcohol use) were identified and risk scores were calculated. A lower risk score represents healthier behavior. As outcome measure, a time-lapse morphokinetic selection algorithm (KIDScore) was used to rank pre-implantation embryo quality on a scale from 1 (poor) to 5 (good) after being cultured in the Embryoscope™ time-lapse incubator until embryonic day 3. To study the association between the nutritional and lifestyle risk scores and the KIDScore in men and women, we used a proportional odds model. In women, the dietary risk score (DRS), a combination of the risk score of fruits, vegetables, and folic acid, was negatively associated with the KIDScore (OR 0.86 (95% CI 0.76 to 0.98), p = 0.02). This could mainly be attributed to an inadequate vegetable intake (OR 0.76 (95% CI 0.59 to 0.96), p = 0.02). In men, smoking was negatively associated with the KIDscore (OR 0.53 (95% CI 0.33 to 0.85), p < 0.01). We conclude that inadequate periconceptional maternal vegetable intake and paternal smoking significantly reduce the implantation potential of embryos after ICSI treatment. Identifying modifiable lifestyle risk factors can contribute to directed, personalized, and individual recommendations that can potentially increase the chance of a healthy pregnancy

Manufacturing flow line systems: a review of models and analytical results

The most important models and results of the manufacturing flow line literature are described. These include the major classes of models (asynchronous, synchronous, and continuous); the major features (blocking, processing times, failures and repairs); the major properties (conservation of flow, flow rate-idle time, reversibility, and others); and the relationships among different models. Exact and approximate methods for obtaining quantitative measures of performance are also reviewed. The exact methods are appropriate for small systems. The approximate methods, which are the only means available for large systems, are generally based on decomposition, and make use of the exact methods for small systems. Extensions are briefly discussed. Directions for future research are suggested.National Science Foundation (U.S.) (Grant DDM-8914277

Towards better treatment outcomes in childhood asthma

Standard treatment for peadiatric asthmatics is based on regular use of inhaled corticosteroids (ICS) combined with short-acting beta-agonists (SABA). Despite the effectiveness of this standard treatment strategy in most patients, there is large variability in treatment response. Many factors can influence effectiveness of therapy, roughly these factors can be divided into three categories: (1) environmental factors, (2) medication use related factors and (3) genetic factors. In this thesis we aimed to contribute to the knowledge on asthma medication use and treatment outcomes in childhood asthma. In line with treatment guidelines, SABA and ICS were the most frequently prescribed drugs among the children included in our studies. We found that asthma medication was frequently initiated at an age at which an asthma diagnosis cannot yet be firmly made (before age 3). Furthermore, only few children used medication continuously. These findings might indicate that therapy initiation is used as diagnostic tool to strengthen or reject the possible diagnosis of asthma. Good adherence rates were observed in approximately half of the population. Increased fractional exhaled nitric oxide (FeNO) values, which are an indication for airway inflammation, were associated with lower adherence rates, this underlines the need of good adherence to reach sufficient disease control. Stronger parental necessity beliefs towards their child's medication use were associated with better adherence, as was Dutch ethnicity (non-immigrant). Up to half of the populations we studied suffered from uncontrolled asthma. Low maternal educational level and parental concerns about potential adverse consequence of medication use were associated with a higher risk of uncontrolled asthma. In addition, stronger necessity beliefs were also associated with uncontrolled asthma. Perhaps these strong need beliefs reflect more severe asthma and therefore an even higher need for medication. Immigrant children were more often non-adherent. We showed significant seasonal differences in asthma control. There was a decline in symptoms and asthma medication use during the summer period and a peak occurred from autumn to spring. To study genetic predictors of treatment response we initiated a new study: the PACMAN (Pharmacogenetics of Asthma medication in Children: Medication with ANti-inflammatory Effects)-study. Paediatric asthma medication users were recruited from community pharmacies and information was collected on respiratory symptoms, adherence, medication use and environmental factors. In addition, we measured FeNO values and collected saliva samples for DNA isolation. One of the main aims of the PACMAN-study is to investigate genetic factors related to treatment outcomes in childhood asthma. We found the T2206C FCER2 variant (encoding for the low-affinity IgE receptor) to be associated with ICS treatment outcomes. Carriers of the variant allele had more often asthma exacerbations, uncontrolled asthma and requirement for increased daily dose of ICS. Furthermore, we explored genetic variation in candidate genes that were part of the corticosteroid receptor complex. This study revealed genes that might play a role in ICS treatment effectiveness; however, these findings need to be confirmed in a larger population

A dynamic, usage-based approach to communicative language teaching of Dutch as a second language

Language teaching follows trends in theory of second language development (SLD). In recent years, a dynamic usage based (DUB) approach to SLD has gotten a firm foothold. A DUB approach to SLD holds that language learning is a dynamic process in which all relevant factors to language learning interact dynamically over time and that language is lexically driven (if driven at all), rather than grammatically. In addition, Langacker (2008:81) points out that mastering a language requires the specific, usage-based learning of a vast array of conventional units. Frequent exposure to such units is needed, ideally occurring in meaningful context exchanges, approximating socially and culturally normal usage events. With DUB principles in mind, Hong & Verspoor (2013) developed a communicative language teaching program for Vietnamese learners of English, based on a popular movie. In this replication study we developed a similar like communicative language teaching program for advanced, German learners of Dutch at university. This method was tested by means of pre-/post-test design, in a semester long experiment. Results show that the method proved to engage learners and had significant effects in increasing language proficiency.