Impact of quality circles for improvement of asthma care: results of a randomized controlled trial

Contains fulltext : 69846.pdf (publisher's version ) (Closed access)RATIONALE AND AIMS: Quality circles (QCs) are well established as a means of aiding doctors. New quality improvement strategies include benchmarking activities. The aim of this paper was to evaluate the efficacy of QCs for asthma care working either with general feedback or with an open benchmark. METHODS: Twelve QCs, involving 96 general practitioners, were organized in a randomized controlled trial. Six worked with traditional anonymous feedback and six with an open benchmark; both had guided discussion from a trained moderator. Forty-three primary care practices agreed to give out questionnaires to patients to evaluate the efficacy of QCs. RESULTS: A total of 256 patients participated in the survey, of whom 185 (72.3%) responded to the follow-up 1 year later. Use of inhaled steroids at baseline was high (69%) and self-management low (asthma education 27%, individual emergency plan 8%, and peak flow meter at home 21%). Guideline adherence in drug treatment increased (P = 0.19), and asthma steps improved (P = 0.02). Delivery of individual emergency plans increased (P = 0.008), and unscheduled emergency visits decreased (P = 0.064). There was no change in asthma education and peak flow meter usage. High medication guideline adherence was associated with reduced emergency visits (OR 0.24; 95% CI 0.07-0.89). Use of theophylline was associated with hospitalization (OR 7.1; 95% CI 1.5-34.3) and emergency visits (OR 4.9; 95% CI 1.6-14.7). There was no difference between traditional and benchmarking QCs. CONCLUSIONS: Quality circles working with individualized feedback are effective at improving asthma care. The trial may have been underpowered to detect specific benchmarking effects. Further research is necessary to evaluate strategies for improving the self-management of asthma patients

Associations of frailty with health care costs – results of the ESTHER cohort study

Background: The concept of frailty is rapidly gaining attention as an independent syndrome with high prevalence in older adults. Thereby, frailty is often related to certain adverse outcomes like mortality or disability. Another adverse outcome discussed is increased health care utilization. However, only few studies examined the impact of frailty on health care utilization and corresponding costs. The aim of this study was therefore to investigate comprehensively the relationship between frailty, health care utilization and costs. Methods: Cross sectional data from 2598 older participants (57–84 years) recruited in the Saarland, Germany, between 2008 and 2010 was used. Participants passed geriatric assessments that included Fried’s five frailty criteria: weakness, slowness, exhaustion, unintentional weight loss, and physical inactivity. Health care utilization was recorded in the sectors of inpatient treatment, outpatient treatment, pharmaceuticals, and nursing care. Results: Prevalence of frailty (≥3 symptoms) was 8.0 %. Mean total 3-month costs of frail participants were €3659 (4 or 5 symptoms) and €1616 (3 symptoms) as compared to €642 of nonfrail participants (no symptom). Controlling for comorbidity and general socio-demographic characteristics in multiple regression models, the difference in total costs between frail and non-frail participants still amounted to €1917; p < .05 (4 or 5 symptoms) and €680; p < .05 (3 symptoms). Among the 5 symptoms of frailty, weight loss and exhaustion were significantly associated with total costs after controlling for comorbidity. Conclusions: The study provides evidence that frailty is associated with increased health care costs. The analyses furthermore indicate that frailty is an important factor for health care costs independent from pure age and comorbidity. Costs were rather attributable to frailty (and comorbidity) than to age. This stresses that the overlapping concepts of multimorbidity and frailty are both necessary to explain health care use and corresponding costs among older adults

Manipulation of drugs to achieve the required dose is intrinsic to paediatric practice but is not supported by guidelines or evidence

Background: A lack of age-appropriate formulations can make it difficult to administer medicines to children. A manipulation of the dosage form may be required to achieve the required dose. This study aimed to describe medicines that are manipulated to achieve the required dose in paediatric practice.Method: A structured, undisguised observational study and postal survey. The observational study investigated drug manipulations occurring in clinical practice across three sites. The questionnaire, administered to a sample of paediatric nurses throughout the UK, surveyed manipulations conducted and nurses' experiences and views.Results: The observational study identified 310 manipulations, of which 62% involved tablets, 21% were intravenous drugs and 10% were sachets. Of the 54 observed manipulations 40 involved tablets with 65% of the tablets being cut and 30% dispersed to obtain a smaller dose. 188 manipulations were reported by questionnaire respondents, of these 46% involved tablets, 12% were intravenous drugs, and 12% were nebuliser solutions. Manipulations were predominantly, but not exclusively, identified in specialist clinical areas with more highly dependent patients. Questionnaire respondents were concerned about the accuracy of the dose achieved following manipulations and the lack of practice guidance.Conclusion: Manipulations to achieve the required dose occur throughout paediatric in-patient settings. The impact of manipulations on the efficacy of the drugs, the accuracy of the dose and any adverse effects on patients is not known. There is a need to develop evidence-based guidance for manipulations of medicines in children

Insolubilization and thermal stabilization of a long-chain polyester by noncatalyzed melt-polycondensation synthesis in air

Self-standing films of poly(ω-hydroxyl hexadecanoic acid) [poly(ω-OHC16)] have been prepared by noncatalyzed melt-polycondensation in air at 150, 175, and 200 °C. Poly(ω-OHC16)s obtained are characterized as polyesters by infrared spectroscopy (FT-IR) and solid state magic angle spinning 13C nuclear magnetic resonance (13C MAS-NMR). Structurally, poly(ω-OHC16)s are quite crystalline as revealed by wide angle X-ray diffraction (WAXD). The presence of oxygen in the reaction atmosphere causes a mild oxidation in the form of peroxyester species, tentatively at the interphase between poly(ω-OHC16) crystallites, and the structure amorphization. The interfacial peroxyester phase ends up in the encapsulation of the polyester grains and provides a barrier towards the action of solvents. Thermal stabilization and insolubility resulting from the synthesis conditions used are interesting features to prepare solvent and heat resistant poly(ω-OHC16) coatings. Thus, a few microns thick poly(ω-OHC16) layer has been fabricated on aluminum foil and its resistivity towards a chloroform:methanol (1:1, v:v) mixture has been confirmedJunta de Andalucía TEP-7418BIOPROTO FP

Methodologies for Assessing the Acceptability of Oral Formulations among children and older adults: A Systematic Review

This is an open access article distributed under the terms and conditions of the Creative Commons Attribution NonCommercial-NoDerivatives 4.0 International CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/Acceptability of medicinal products in children and older populations is pivotal in ensuring adherence and therapeutic outcomes. This review systematically identifies studies reporting on formulation aspects of oral medications that affect their acceptability in these patient groups. Particular emphasis is placed on the evaluation of the methodologies employed in the studies. Sixty-eight studies were included for analysis, with 51 (75%) in children and 17 (25%) in older populations. The studies evaluated a range of oral formulations; however, the methodologies used differ considerably in participants’ characteristics, study settings, tools, acceptability definitions and criteria. It is evident that there is a lack of standardisation in study design as well as the assessment methods used in assessing acceptability of medicines in children and older populations. This review presents a systematic analysis on methods employed for assessing acceptability of oral medicines in children and older adults, to provide insights and recommendations regarding the design of reliable instruments in future studies.Peer reviewe

Therapeutische Hyperkapnie im Akuten Atemnotsyndrom (ARDS) am Tiermodell

In der hier dargestellten Studie wurden an einem Kaninchen-Tiermodell mit induziertem Surfactantmangel die Effekte einer Beatmungsstrategie mit reduzierten Atemzugvolumina und permissiver hyperkapnischen Azidose getrennt von denen der isolierten hyperkapnischen Azidose auf den Gasaustausch, die Hämodynamik und die Lungenschädigung untersucht. Hierzu wurden jeweils 10 weiße Neuseelandkaninchen nach einer pulmonalen Lavage mit Kochsalzlösung in drei Versuchsgruppen (Normoventilation-Normokapnie [Atemzugvolumen (VT) = 7,5 ml/kg / arterieller Kohlendstoffdioxidpartialdruck (PaCO2) = 35 - 45 mmHg], Normoventilation-Hyperkapnie [VT = 7,5 ml/kg / PaCO2 = 75 - 85 mmHg, Einspeisung von Kohlenstoffdioxid (CO2) in das Inspirationsgas] und Hypoventilation-Hyperkapnie [VT = 4 - 5 ml/kg / PaCO2 = 75 - 85 mmHg]) randomisiert und über sechs Stunden beatmet. Dabei wurden arterielle Blutgasanalysen und Laktat alle 30 Minuten bestimmt. Nach sechs Stunden wurden die Tiere getötet und eine bronchoalveoläre Lavage vorgenommen, das Feucht-/ Trockengewicht der Lunge bestimmt und die Lungenhistologie anhand eines Scores beurteilt: Dabei waren bei den Tieren der Gruppen Hypoventilation-Hyperkapnie der arterielle Sauerstoffpartialdruck signifikant höher und die histopathologische Punktebewertung, das Feucht-/ Trockengewicht sowie die Proteinkonzentrationen der abschließenden bronchoalveolären Lavage und das Plasmalaktat signifikant niedriger als bei den Tieren der Gruppe Normoventilation-Normokapnie. Bei den Tieren der Gruppe Normoventilation-Hyperkapnie lag der arterielle Sauerstoffpartialdruck tendenziell über den Werten der Tiere der Gruppe Normoventilation-Normokapnie. Auch die histologische Punktebewertung, das Feucht-/ Trockengewicht und die Proteinkonzentrationen der abschließenden bronchoalveolären Lavage waren im Trend niedriger als bei den Tieren der Gruppe Normoventilation-Normokapnie. Bei den Parametern der Hämodynamik (Blutdruck, Herzfrequenz) wurden keine Unterschiede gefunden