Nurse-Led Medicines' Monitoring for Patients with Dementia in Care Homes: A Pragmatic Cohort Stepped Wedge Cluster Randomised Trial

People with dementia are susceptible to adverse drug reactions (ADRs). However, they are not always closely monitored for potential problems relating to their medicines: structured nurse-led ADR Profiles have the potential to address this care gap. We aimed to assess the number and nature of clinical problems identified and addressed and changes in prescribing following introduction of nurse-led medicines' monitoring.Pragmatic cohort stepped-wedge cluster Randomised Controlled Trial (RCT) of structured nurse-led medicines' monitoring versus usual care.Five UK private sector care homes.41 service users, taking at least one antipsychotic, antidepressant or anti-epileptic medicine.Nurses completed the West Wales ADR (WWADR) Profile for Mental Health Medicines with each participant according to trial step.Problems addressed and changes in medicines prescribed.Information was collected from participants' notes before randomisation and after each of five monthly trial steps. The impact of the Profile on problems found, actions taken and reduction in mental health medicines was explored in multivariate analyses, accounting for data collection step and site.Five of 10 sites and 43 of 49 service users approached participated. Profile administration increased the number of problems addressed from a mean of 6.02 [SD 2.92] to 9.86 [4.48], effect size 3.84, 95% CI 2.57-4.11, P <0.001. For example, pain was more likely to be treated (adjusted Odds Ratio [aOR] 3.84, 1.78-8.30), and more patients attended dentists and opticians (aOR 52.76 [11.80-235.90] and 5.12 [1.45-18.03] respectively). Profile use was associated with reduction in mental health medicines (aOR 4.45, 1.15-17.22).The WWADR Profile for Mental Health Medicines can improve the quality and safety of care, and warrants further investigation as a strategy to mitigate the known adverse effects of prescribed medicines.ISRCTN 48133332

Magnetic Resonance Imaging for tracking cellular patterns obtained by Laser-Assisted Bioprinting

Recent advances in the field of Tissue Engineering allowed to control the three-dimensional organization of engineered constructs. Cell pattern imaging and in vivo follow-up remain a major hurdle in in situ bioprinting onto deep tissues. Magnetic Resonance Imaging (MRI) associated with Micron-sized superParamagnetic Iron Oxide (MPIO) particles constitutes a non-invasive method for tracking cells in vivo. To date, no studies have utilized Cellular MRI as a tool to follow cell patterns obtained via bioprinting technologies. Laser-Assisted Bioprinting (LAB) has been increasingly recognized as a new and exciting addition to the bioprinting’s arsenal, due to its rapidity, precision and ability to print viable cells. This non-contact technology has been successfully used in recent in vivo applications. The aim of this study was to assess the methodology of tracking MPIO-labeled stem cells using MRI after organizing them by Laser-Assisted Bioprinting. Optimal MPIO concentrations for tracking bioprinted cells were determined. Accuracy of printed patterns was compared using MRI and confocal microscopy. Cell densities within the patterns and MRI signals were correlated. MRI enabled to detect cell patterns after in situ bioprinting onto a mouse calvarial defect. Results demonstrate that MRI combined with MPIO cell labeling is a valuable technique to track bioprinted cells in vitro and in animal models

Does the presence of a pharmacist in primary care clinics improve diabetes medication adherence?

<p>Abstract</p> <p>Background</p> <p>Although oral hypoglycemic agents (OHAs) are an essential element of therapy for the management of type 2 diabetes, OHA adherence is often suboptimal. Pharmacists are increasingly being integrated into primary care as part of the move towards a patient-centered medical home and may have a positive influence on medication use. We examined whether the presence of pharmacists in primary care clinics was associated with higher OHA adherence.</p> <p>Methods</p> <p>This retrospective cohort study analyzed 280,603 diabetes patients in 196 primary care clinics within the Veterans Affairs healthcare system. Pharmacists presence, number of pharmacist full-time equivalents (FTEs), and the degree to which pharmacy services are perceived as a bottleneck in each clinic were obtained from the 2007 VA Clinical Practice Organizational Survey—Primary Care Director Module. Patient-level adherence to OHAs using medication possession ratios (MPRs) were constructed using refill data from administrative pharmacy databases after adjusting for patient characteristics. Clinic-level OHA adherence was measured as the proportion of patients with MPR >= 80%. We analyzed associations between pharmacy measures and clinic-level adherence using linear regression.</p> <p>Results</p> <p>We found no significant association between pharmacist presence and clinic-level OHA adherence. However, adherence was lower in clinics where pharmacy services were perceived as a bottleneck.</p> <p>Conclusions</p> <p>Pharmacist presence, regardless of the amount of FTE, was not associated with OHA medication adherence in primary care clinics. The exact role of pharmacists in clinics needs closer examination in order to determine how to most effectively use these resources to improve patient-centered outcomes including medication adherence.</p