Pharmacist-driven medication recognition/ reconciliation in older medical patients

Background: In older medical patients polypharmacy is often associated with poor prescription appropriateness and harmful drug-drug interactions. An effort that jointly involved hospital pharmacists and clinicians attending multimorbid older patients acutely admitted to medical wards was implemented for medication recognition and reconciliation aided by the use of a computerized support system. Methods: Six internal medicine wards enrolled consecutively 90 acutely admitted multimorbid patients aged 75 years or more taking 5 or more different drugs. Two hospital pharmacists carried out the recognition of medications taken at hospital ward admission, and interacted with the clinicians in a process of drug reconciliation, using also the computerized support system to evaluate drug related problems, prescription inappropriateness or drug-drug interactions. The process was repeated at hospital discharge. Results: Among a total number of 911 drugs prescribed to 90 older medical patients at ward admission, the pharmacists identified during their recognition/reconciliation 455 drug-related problems, mainly due to prescription of medications inappropriate for older multimorbid patients and clinically harmful drug-drug interactions. When these drug-related problems were identified by the pharmacist, the attending clinicians accepted and implemented the suggestions for changes for approximately two thirds of the discrepancies, thereby leading to deprescribing the implicated drugs or at least to their closer monitoring. Conclusions: This interventional prospective study based upon the integrated expertise of hospital pharmacists and clinicians confirms that drug-related problems are frequent in multimorbid older patients acutely admitted to hospital medical wards, and demonstrates afresh the feasibility and mutual acceptance of a trajectory of recognition/reconciliation based upon an integrated collaboration between hospital pharmacists and ward clinicians in the process of medication optimization

The HARP detector at the CERN PS

HARP is a high-statistics, large solid angle experiment to measure hadron production using proton and pion beams with momenta between 1.5 and 15 GeV/c impinging on many different solid and liquid targets from low to high Z. The experiment, located in the T9 beam of the CERN PS, took data in 2001 and 2002. For the measurement of momenta of produced particles and for the identification of particle types, the experiment includes a large-angle spectrometer, based on a Time Projection Chamber and a system of Resistive Plate Chambers, and a forward spectrometer equipped with a set of large drift chambers, a threshold Cherenkov detector, a time-of-flight wall and an electromagnetic calorimeter. The large angle system uses a solenoidal magnet, while the forward spectrometer is based on a dipole magnet. Redundancy in particle identification has been sought, to enable the cross-calibration of efficiencies and to obtain a few percent overall accuracy in the cross-section measurements. Detector construction, operation and initial physics performances are reported. In addition, the full chain for data recording and analysis, from trigger to the software framework, is described

The HARP detector at the CERN PS

HARP is a high-statistics, large solid angle experiment to measure hadron production using proton and pion beams with momenta between 1.5 and 15 GeV/c impinging on many different solid and liquid targets from low to high Z. The experiment, located in the T9 beam of the CERN PS, took data in 2001 and 2002. For the measurement of momenta of produced particles and for the identification of particle types, the experiment includes a large-angle spectrometer, based on a Time Projection Chamber and a system of Resistive Plate Chambers, and a forward spectrometer equipped with a set of large drift chambers, a threshold Cherenkov detector, a time-of-flight wall and an electromagnetic calorimeter. The large angle system uses a solenoidal magnet, while the forward spectrometer is based on a dipole magnet. Redundancy in particle identification has been sought, to enable the cross-calibration of efficiencies and to obtain a few percent overall accuracy in the cross-section measurements. Detector construction, operation and initial physics performances are reported. In addition, the full chain for data recording and analysis, from trigger to the software framework, is describe

Measurement of the production cross-section of positive pions in p–Al collisions at 12.9 GeV/c

A precision measurement of the double-differential production cross-section, View the MathML source, for pions of positive charge, performed in the HARP experiment is presented. The incident particles are protons of 12.9 GeV/c momentum impinging on an aluminium target of 5% nuclear interaction length. The measurement of this cross-section has a direct application to the calculation of the neutrino flux of the K2K experiment. After cuts, 210 000 secondary tracks reconstructed in the forward spectrometer were used in this analysis. The results are given for secondaries within a momentum range from 0.75 to 6.5 GeV/c, and within an angular range from 30 mrad to 210 mrad. The absolute normalization was performed using prescaled beam triggers counting protons on target. The overall scale of the cross-section is known to better than 6%, while the average point-to-point error is 8.2%

Gamma-glutamyltransferase, arterial remodeling and prehypertension in a healthy population at low cardiometabolic risk

Plasma gamma-glutamyltransferase (GGT) was suggested to reflect the level of systemic oxidative stress. Oxidative stress induces changes in arterial structure and function and contributes to the development of hypertension. Therefore, GGT may be associated with arterial remodeling and blood pressure (BP) increment, even in absence of disease. To test this hypothesis, we evaluated, in 825 healthy subjects at low cardiometabolic risk, the associations of plasma GGT with carotid artery intima-media thickness (IMT), luminal diameter and prehypertension; in 154 subjects was evaluated also the association with aortic stiffness (cfPWV). Associations were controlled for insulin sensitivity, C-reactive protein, and life-style habits. In the main population, BP was remeasured after 3 years. Carotid diameter and cfPWV, but not IMT, were directly and independently related to plasma GGT. Subjects with prehypertension (N = 330) had higher GGT as compared with subjects with normal BP (22 [14] vs 17 [11] IU/L; adjusted P = 0.001), and within prehypertensive subjects, those who developed hypertension during 3 years had higher GGT than those without incident hypertension (27 [16] vs 21 [14] IU/L; adjusted P < 0.05). Within subjects with arterial stiffness measurement, those with prehypertension (N = 79) had higher both GGT and arterial stiffness (25 [14] vs 16 [20] IU/L and 9.11 ± 1.24 vs 7.90 ± 0.94 m/s; adjusted P < 0.01 and <0.05). In the view of previous evidence linking plasma GGT concentration to the level of systemic oxidative stress, our findings suggest a role of oxidative stress in subclinical arterial damage and in prehypertension, even in healthy subjects free of cardiometabolic risk. Arterial organ damage may represent the link between GGT and hypertension. © 2020, The Author(s), under exclusive licence to Springer Nature Limited

The effect of menopause on carotid artery remodeling, insulin sensitivity, and plasma adiponectin in healthy women

Background: The mechanisms by which menopause may influence the systemic subclinical atherosclerosis are unexplained. The aim of this cross-sectional study was to evaluate the associations between early menopause, established cardiovascular (c-v) risk factors, metabolic parameters (insulin secretion and sensitivity, plasma adiponectin), and carotid intima-media thickness (IMT) in healthy women. Methods: In 74 menopausal women (mean age = 51 ± 3 years, mean duration of menopause = 2.9 ± 1.2 years) and in 74 nonmenopausal women comparable for age and body mass index (BMI), common carotid artery (CCA) luminal diameter, and IMT in different carotid segments were measured in digitized ultrasound images. Insulin sensitivity and secretion were assessed using the euglycemic hyperinsulinemic clamp technique and oral glucose tolerance test (OGTT). Insulin secretion was reconstructed by mathematical modeling. Results: CCA diameter (5.55 ± 0.46 vs. 5.21± 0.51 mm, P < 0.001), CCA IMT (608 ± 78 vs. 576 ± 74 νm, P < 0.01) and systolic blood pressure (BP) (117 ± 12 vs. 113 ± 11 mm Hg, P < 0.05) were higher in menopausal women, whereas CCA IMT/diameter ratio and IMT in other carotid segments did not differ between the groups. By multivariate models, independent predictors of CCA diameter were menopause and body weight (cumulative R2= 0.37) and independent correlates of CCA IMT were luminal diameter, systolic BP and low-density lipoprotein (LDL) cholesterol (cumulative R2= 0.48). Fasting insulin, insulin secretion, and sensitivity and plasma adiponectin were similar in the two groups and were not related to carotid IMT. Conclusions: Early menopause is associated with CCA remodeling, characterized by a proportional increase in luminal diameter and wall thickness, independent of atherosclerotic risk factors and metabolic variables. © 2009 American Journal of Hypertension, Ltd