Reproductive Performance of Late Pregnant Gilts Treated with Baypamun© before Farrowing

The aim of this study was to investigate whether the production results of pregnant gilts, grown under commercial farm conditions and moved from the sow keeping unit to the prefarrowing unit, could be increased by non-specific immunization with Baypamun© (Bayer, Leverkusen, Germany; BPM), an immune response modifier (IRM). We used three groups of pregnant gilts that obtained different treatments. Non-treated group A served as control; two experimental groups were treated on Day 6, 4 and 2 (group B), or on Day 5, 3 and 1 (group C), respectively, before their transfer from the sow keeping unit to the prefarrowing unit. The experimental gilts received i.m. 2 ml of IRM BPM, i.e. inactivated Parapoxovis virus (1 x 106.75 TCID50). Throughout the trial, the numbers of liveborn and stillborn piglets and the duration of farrowing were recorded. Variance analysis with the type of treatment as independent variable showed a significant difference between control (group A) and experimental group B in the number of liveborn piglets (P < 0.0001) as well as between group A and group B (P < 0.0001) or group C (P < 0.0001) in the number of stillborn piglets, respectively. No differences in duration of farrowing between groups were recorded

Half a Century of Fragmented Research on Deviations from Advised Therapies: Is This a Good Time to Call for Multidisciplinary Medication Adherence Research Centres of Excellence?

Medication adherence is a key precondition of the effectiveness of evidence-based therapies. However, in real-life settings, non-adherence to medication is still very common. This leads to profound health and economic consequences at both individual and public health levels. The problem of non-adherence has been extensively studied in the last 50 years. Unfortunately, with more than 130,000 scientific papers published on that subject so far, we are still far from finding an ultimate solution. This is, at least partly, due to fragmented and poor-quality research that has been conducted in this field sometimes. To overcome this deadlock, there is a need to stimulate the adoption of best practices in medication adherence-related research in a systematic way. Therefore, herein we propose the establishment of dedicated medication adherence research Centres of Excellence (CoEs). These Centres could not only conduct research but could also create a profound societal impact, directly serving the needs of patients, healthcare providers, systems and economies. Additionally, they could play a role as local advocates for good practices and education. In this paper, we propose some practical steps that might be taken in order to establish such CoEs. We describe two success stories, i.e., Dutch and Polish Medication Adherence Research CoEs. The COST Action "European Network to Advance Best practices & technoLogy on medication adherencE" (ENABLE) aims to develop a detailed definition of the Medication Adherence Research CoE in the form of a list of minimal requirements regarding their objectives, structure and activities. We hope that it will help to create a critical mass and catalyse the setup of regional and national Medication Adherence Research CoEs in the near future. This, in turn, may not only increase the quality of the research but also raise the awareness of non-adherence and promote the adoption of the best medication adherence-enhancing interventions

Pan‐European survey on medication adherence management by healthcare professionals /

Aims: While medication adherence (MA) is a key prerequisite for achieving optimalclinical and economic outcomes, nonadherence is highly prevalent. Assessing howhealthcare professionals (HCPs) in Europe manage MA, focusing on measurement,reporting and interventions, is the subject of this study.Methods: A cross-sectional study was conducted among 40 European countries andquantitative analysis was conducted via an online survey. The multi-language onlinesurvey was created using Webropol 3.0 survey and reporting tool. Descriptive statis-tics and chi-squared tests were applied.Results: In total, 2875 HCPs (pharmacists: 39.9%; physicians: 36.7%; nurses: 16.4%)from 37 European countries participated. The most used methods for MA assess-ment were direct communication with patients (86.4%) and referring to personalpatient records (56.7%) (P < 0.0001). Physicians (74.9%) and nurses (58.8%) weremore aware of problems related to MA in contrast to pharmacists (48.6%)(P < 0.001). Almost all HCPs (92.6%) indicated that MA-enhancing interventionsinvolved mainly direct communication with nonadherent patients (93.3%) and theircaregivers (55.7%). Medication review and related optimization of therapy weremainly performed in Western European countries (46.8%). Technological solutionswere ranked as one of the less applied approaches (10–15%) (P < 0.001).Conclusions: HCPs in all European regions recognize MA management as an integralelement of overall patient-centred care. More efforts are needed to ensure timely,adequate and relevant MA assessment, reporting and improvement and involvementof all HCPs, especially among pharmacists who were generally less aware of MA issues. Promotion and use of digital technological solutions should be the focus ofcurrent and future clinical practice to optimize MA management processes

Barriers and unmet educational needs regarding implementation of medication adherence management across Europe: insights from COST Action ENABLE /

BACKGROUND: Medication adherence is essential for the achievement of therapeutic goals. Yet, the World Health Organization estimates that 50% of patients are nonadherent to medication and this has been associated with 125 billion euros and 200,000 deaths in Europe annually. OBJECTIVE: This study aimed to unravel barriers and unmet training needs regarding medication adherence management across Europe. DESIGN: A cross-sectional study was conducted through an online survey. The final survey contained 19 close-ended questions. PARTICIPANTS: The survey content was informed by 140 global medication adherence experts from clinical, academic, governmental, and patient associations. The final survey targeted healthcare professionals (HCPs) across 39 European countries. MAIN MEASURES: Our measures were barriers and unmet training needs for the management of medication adherence across Europe. KEY RESULTS: In total, 2875 HCPs (pharmacists, 40%; physicians, 37%; nurses, 17%) from 37 countries participated. The largest barriers to adequate medication adherence management were lack of patient awareness (66%), lack of HCP time (44%), lack of electronic solutions (e.g., access to integrated databases and uniformity of data available) (42%), and lack of collaboration and communication between HCPs (41%). Almost all HCPs pointed out the need for educational training on medication adherence management. CONCLUSIONS: These findings highlight the importance of addressing medication adherence barriers at different levels, from patient awareness to health system technology and to fostering collaboration between HCPs. To optimize patient and economic outcomes from prescribed medication, prerequisites include adequate HCP training as well as further development of digital solutions and shared health data infrastructures across Europe

Individual Dismissal in Croatia

This contribution analyses the Croatian legislation regulating individual dismissal in the context of liberalisation of dismissal legislation of the EU Member States. The new Labour Act adopted in 2014 introduced some novelties concerning the concept of a valid reason for the termination of employment, as well as in regard to the dismissal procedure. Departing from this background, the author also discusses relevant case law and gives proposals de lege ferenda

CYP2D6 *6/*6

A 66-year-old male Caucasian, received 1 mg of haloperidol orally and rapidly developed severe iatrogenic extrapyramidal symptoms. Treatment was immediately discontinued, and the side effects resolved. Haloperidol is mainly metabolized by Phase I CYP2D6 and to the lesser extent by CYP3A4 and by Phase II UGT2B7 enzymes. Genotyping was performed revealing CYP2D6*6/*6, CYP3A4*1/*1, and UGT2B7 -161 C/T genotypes, implicating poor, extensive and intermediate metabolism, respectively. Of the CYPs, haloperidol is metabolized by CYP2D6 and CYP3A4 primarily. It was the introduction of ciprofloxacin which was a trigger for the development of adverse drug reaction due to inhibition of CYP3A4, which was in presented patient main metabolic pathway for haloperidol since he was CYP2D6 poor metabolizer. Presented case report highlights the importance of genotyping. Pharmacogenetics testing should be considered when drug toxicity is suspected, polymorphic metabolic pathways used and drugs concomitantly applied