Implementation of medication reviews in community pharmacies and their effect on potentially inappropriate drug use in elderly patients

BACKGROUND: In 2008 recommendations were launched to prevent medication-related hospital admissions in the Netherlands. Elderly patients using several drugs on a chronic basis were among the target group. Pharmacy-led medication reviews (MRs) were identified as having potential for improving patient safety. OBJECTIVE: This observational study evaluated the implementation success rate of performing all five steps of a complete MR for patients and changes in the presence of nine issues of potentially inappropriate medication (PIM) use. This change was compared between patients with a complete MR (intervention group, IG) and a reference group (RG) who attended the same pharmacy; all patients were eligible for MR, but only selected patients formed the IG. SETTING: Dutch community pharmacy. METHOD: After appropriate training, the rate of IG with complete MRs was measured by pharmacists registering the various MR steps in the MR tool. Patients were eligible for a MR if aged >/= 65 years with >/= 5 drugs being used chronically. MAIN OUTCOME MEASURES: The success rate of implementing MRs with five steps completed; the presence of nine PIMs for both study groups. RESULTS: In pharmacies with specifically trained pharmacists, 63 % of selected patients received a complete MR. This was 12 % higher than in pharmacies without trained pharmacists. PIMs reported at study start declined in the IG and at study end had decreased by an average of 19 % (with a range between 34 and 100 % per PIM); this decrease did not significantly differ from the RG. CONCLUSION: Additional efforts are needed to improve the implementation of pharmacist-led MRs in order to realize its full potential in general practice, and for a substantial decrease of PIMs to occur in susceptible patients. These efforts should focus on training courses and additional support using computerized systems to share information with GPs and to register MR activities, together with sufficient financial reimbursement

Feed intake, growth, and body and carcass attributes of feedlot steers supplemented with two levels of calcium nitrate or urea

Nitrate supplementation has been shown to be effective in reducing enteric methane emission from ruminants, but there have been few large-scale studies assessing the effects of level of nitrate supplementation on feed intake, animal growth, or carcass and meat quality attributes of beef cattle. A feedlot study was conducted to assess the effects of supplementing 0.25 or 0.45% NPN in dietary DM as either urea (Ur) or calcium nitrate (CaN) on DMI, ADG, G:F, and carcass attributes of feedlot steers (n = 383). The levels of NPN inclusion were selected as those at which nitrate has previously achieved measurable mitigation of enteric methane. The higher level of NPN inclusion reduced ADG as did replacement of Ur with CaN (P 0.05). Analysis of composited meat samples showed no detectable nitrates or nitrosamines in raw or cooked meat, and the level of nitrate detected in meat from nitrate-supplemented cattle was no higher than for Ur-fed cattle (P > 0.05). We conclude that increasing NPN inclusion from 0.25 to 0.45% NPN in dietary DM and replacing Ur with CaN decreased ADG in feedlot cattle without improving G:F

Equivalent models in covariance structure analysis

equivalent models, covariance structure analysis, LISREL, EQS, model modification, modification index, Lagrange multiplier statistic, identification, regular point,

On estimating true change interrelationships with other variables

Longitudinal research design, measurement of change, correlates and predictors of latent growth or decline, structural equation modeling methodology,

Alternative test criteria in covariance structure analysis: A unified approach

covariance structure analysis, test statistics, asymptotic equivalence, noncentral chi-square, power of the test,