The association between prescription change frequency, chronic disease score and hospital admissions: a case control study

BACKGROUND: The aim of this study was to assess the association between prescription changes frequency (PCF) and hospital admissions and to compare the PCF to the Chronic Disease Score (CDS). The CDS measures comorbidity on the basis of the 1-year pharmacy dispensing data. In contrast, the PCF is based on prescription changes over a 3-month period. METHODS: A retrospective matched case–control design was conducted. 10.000 patients were selected randomly from the Dutch PHARMO database, who had been hospitalized (index date) between July 1, 1998 and June 30, 2000. The primary study outcome was the number of prescription changes during several three-month time periods starting 18, 12, 9, 6, and 3 months before the index date. For each hospitalized patient, one nonhospitalized patient was matched for age, sex, and geographic area, and was assigned the same index date as the corresponding hospitalized patient. We classified four mutually exclusive types of prescription changes: change in dosage, switch, stop and start. RESULTS: The study population comprised 8,681 hospitalized patients and an equal number of matched nonhospitalized patients. The odds ratio of hospital admission increased with an increase in PCF category. At 3 months before the index date from PCF=1 OR 1.4 [95% CI 1.3-1.5] to PCF= 2–3 OR 2.2 [95% CI 1.9-2.4] and to PCF ≥ 4 OR 4.1 [95% CI 3.1-5.1]. A higher CDS score was also associated with an increased odds ratio of hospitalization: OR 1.3 (95% CI 1.2-1.4) for CDS 3–4, and OR 3.0 (95% CI 2.7-3.3) for CDS 5 or higher. CONCLUSION: The prescription change frequency (PCF) is associated with hospital admission, like the CDS. Pharmacists and other healthcare workers should be alert when the frequency of prescription changes increases. Clinical rules could be helpful to make pharmacists and physicians aware of the risk of the number of prescription changes

Medication self-management: Considerations and decisions by older people living at home

Background: Medication self-management is complicated for older people. Little is known about older persons’ considerations and decisions concerning medication therapy at home. Objective: (s): To explore how older people living at home self-manage their medication and what considerations and decisions underpin their medication self-management behavior. Methods: Semi-structured interviews with consenting participants (living at home, aged ≥65, ≥5 different prescription medications daily) were recorded and transcribed with supporting photographs. Content was analyzed with a directed approach and presented according to three phases of medication self-management (initiation, execution, and discontinuation). Results: Sixty people were interviewed. In the initiation phase, participants used different techniques to inform healthcare professionals and to fill and check prescriptions. Over-the-counter medication was seldom discussed, and potential interactions were unknown to the participants. Some participants decided to not start treatment after reading the patient information leaflets for fear of side effects. In the execution phase, participants had various methods for integrating the use of new and chronic medication in daily life. Usage problems were discussed with healthcare professionals, but side effects were not discussed, since the participants were not aware that the signs and symptoms of side effects could be medication-related. Furthermore, participants stored medication in various (sometimes incorrect) ways and devised their own systems for ordering and filling repeat prescriptions. In the discontinuation phase, some participants decided to stop or change doses by themselves (because of side effects, therapeutic effects, or a lack of effect). They also mentioned different considerations regarding medication disposal and disposed their medication (in)correctly, stored it for future use, or distributed it to others. Conclusions: Participants’ considerations and decisions led to the following: problems in organizing medication intake, inadequate discussion of medication-related information with healthcare professionals, and incorrect and undesirable medication storage and disposal. There is a need for medication self-management observation, monitoring, and assistance by healthcare professionals

Medication self-management: Considerations and decisions by older people living at home

BACKGROUND: Medication self-management is complicated for older people. Little is known about older persons' considerations and decisions concerning medication therapy at home. OBJECTIVE: (s): To explore how older people living at home self-manage their medication and what considerations and decisions underpin their medication self-management behavior. METHODS: Semi-structured interviews with consenting participants (living at home, aged ≥65, ≥5 different prescription medications daily) were recorded and transcribed with supporting photographs. Content was analyzed with a directed approach and presented according to three phases of medication self-management (initiation, execution, and discontinuation). RESULTS: Sixty people were interviewed. In the initiation phase, participants used different techniques to inform healthcare professionals and to fill and check prescriptions. Over-the-counter medication was seldom discussed, and potential interactions were unknown to the participants. Some participants decided to not start treatment after reading the patient information leaflets for fear of side effects. In the execution phase, participants had various methods for integrating the use of new and chronic medication in daily life. Usage problems were discussed with healthcare professionals, but side effects were not discussed, since the participants were not aware that the signs and symptoms of side effects could be medication-related. Furthermore, participants stored medication in various (sometimes incorrect) ways and devised their own systems for ordering and filling repeat prescriptions. In the discontinuation phase, some participants decided to stop or change doses by themselves (because of side effects, therapeutic effects, or a lack of effect). They also mentioned different considerations regarding medication disposal and disposed their medication (in)correctly, stored it for future use, or distributed it to others. CONCLUSIONS: Participants' considerations and decisions led to the following: problems in organizing medication intake, inadequate discussion of medication-related information with healthcare professionals, and incorrect and undesirable medication storage and disposal. There is a need for medication self-management observation, monitoring, and assistance by healthcare professionals

Home care nurses’ perceptions about their role in interprofessional collaborative practice in clinical medication reviews

Regular clinical medication reviews (CMRs) are recommended for monitoring and addressing potential drug-related problems, especially in elderly people. Interprofessional collaborative practice (ICP) by general practitioners, community pharmacists, and nurses in a CMR is recommended and expected to produce more efficient CMRs. Involving home care nurses in ICP is not yet well implemented, and their perspectives are unclear. This study explores how they perceive their role in ICP in CMRs and the requirements to assume that role. Structured interviews were performed, using case-vignettes; data were analyzed with a thematic analysis approach. Twelve home care nurses were interviewed. Three themes regarding the nurses' role were identified: (1) observing, recognizing, and communicating information for a CMR to prescribers and community pharmacists (2); helping to provide patient information and education about implemented changes in the pharmaceutical care plan; and (3) the nurses’ level of involvement in ICP. Three themes regarding requirements were identified: (1) nursing competences, (2) periodic interprofessional consultation and ad hoc interprofessional communication, and (3) guidelines describing the role of nurses. Home care nurses could provide additional support in a CMR. Nursing competences, periodic interprofessional consultation and ad hoc interprofessional communication, and guidelines describing the role of home care nurses are required

Identification of two novel powdery mildew resistance loci, Ren6 and Ren7, from the wild Chinese grape species Vitis piasezkii

Descriptive statistics of the phenotypic scores within the base mapping population 11-373. Powdery mildew symptoms in the field were evaluated in two subsequent years. Greenhouse, in vitro experiments and the qPCR-based molecular assay were carried out with three to four biological replicates of each seedling plant in 2014. (DOCX 14ย�kb

The Human Immunodeficiency Virus Type 1 Envelope Spike of Primary Viruses Can Suppress Antibody Access to Variable Regions▿

The human immunodeficiency virus type 1 (HIV-1) envelope spike is a heavily glycosylated trimeric structure in which protein surfaces conserved between different HIV-1 isolates are particularly well hidden from antibody recognition. However, even variable regions on the spike tend to be less antigenic and immunogenic than one might have anticipated for external structures. Here we show that the envelope spike of primary viruses has an ability to restrict antibody recognition of variable regions. We show that access to an artificial epitope, introduced at multiple positions across the spike, is frequently limited, even though the epitope has been inserted at surface-exposed regions on the spike. Based on the data, we posit that restricted antibody access may be the result, at least in part, of a rigidification of the epitope sequence in the context of the spike and/or a highly effective flexible arrangement of the glycan shield on primary viruses. Evolution of the HIV envelope structure to incorporate extra polypeptide sequences into nominally accessible regions with limited antibody recognition may contribute to reducing the magnitude of antibody responses during infection and allow the virus to replicate unhindered by antibody pressure for longer periods