205 research outputs found
Optimising medication management for polymedicated home-dwelling older adults with multiple chronic conditions: a mixed-methods study protocol.
Optimal medication management is one of the basic conditions necessary for home-dwelling older adults living with multiple chronic conditions (OAMCC) to be able to remain at home and preserve their quality of life. Currently, the reasons for such high numbers of emergency department visits and the very significant rate of hospitalisations for OAMCC, due to medication-related problems (MRPs), is poorly explored. This study aims to reveal the current state of the medication management practices of polymedicated, home-dwelling OAMCC and to make proposals for improving clinical and medication pathways through an innovative and integrated model for supporting medication management and preventing adverse health outcomes.
A mixed-methods study will address the medication management of polymedicated, home-dwelling OAMCC. Its explanatory sequential design will involve two major phases conducted sequentially over time. The quantitative phase will consist of retrospectively exploiting the last 5 years of electronic patient records from a local hospital (N ≈ 50 000) in order to identify the different profiles-made up of patient-related, medication-related and environment-related factors-of the polymedicated, home-dwelling OAMCC at risk of hospitalisation, emergency department visits, hospital readmission (notably for MRPs), institutionalisation or early death. The qualitative study will involve: (a) obtaining and understanding the medication management practices and experiences of the identified profiles extracted from the hospital data of OAMCC who will be interviewed at home (N ≈ 30); (b) collecting and analysing the perspectives of the formal and informal caregivers involved in medication management at home in order to cross-reference perspectives about this important dimension of care at home. Finally, the mixed-methods findings will enable the development of an innovative, integrated model of medication management based on the Agency for Clinical Innovation framework and Bodenheimer and Sinsky's quadruple aim.
Ethical approval has been obtained from the Human Research Ethics Committee of the Canton Vaud (2018-02196). Findings will be disseminated in peer-reviewed journals, professional conferences and other knowledge transfer activities with primary healthcare providers, hospital care units, informal caregivers' and patients' associations
Shear-banding in a lyotropic lamellar phase, Part 1: Time-averaged velocity profiles
Using velocity profile measurements based on dynamic light scattering and
coupled to structural and rheological measurements in a Couette cell, we
present evidences for a shear-banding scenario in the shear flow of the onion
texture of a lyotropic lamellar phase. Time-averaged measurements clearly show
the presence of structural shear-banding in the vicinity of a shear-induced
transition, associated to the nucleation and growth of a highly sheared band in
the flow. Our experiments also reveal the presence of slip at the walls of the
Couette cell. Using a simple mechanical approach, we demonstrate that our data
confirms the classical assumption of the shear-banding picture, in which the
interface between bands lies at a given stress . We also outline
the presence of large temporal fluctuations of the flow field, which are the
subject of the second part of this paper [Salmon {\it et al.}, submitted to
Phys. Rev. E]
Medication Management Models for Polymedicated Home-Dwelling Older Adults With Multiple Chronic Conditions: Protocol of a Systematic Review.
Older adults with multiple chronic diseases commonly require complex medication regimes. When combined with frailty, cognitive impairment, and changing pharmacological prescriptions, older adults' polymedication regimes increase the risk of medication-related problems (MRPs) and hospitalization. Effective, well-organized medication management could avoid MRPs and their clinical outcomes.
Identify medication management models and analyze their impact on managing and preventing MRPs for polymedicated, home-dwelling older adults.
We will conduct a systematic review of published articles in relevant professional scientific journals from inception until March 31, 2019, in the following electronic databases,: Embase; Medline OvidSP; PubMed (NOT Medline[sb]); Cumulative Index to Nursing and Allied Health Literature (CINAHL) EBSCO; PsycINFO OvidSP; Cochrane Library, Wiley; and Web of Science. We will also hand search the bibliographies of all the relevant articles found and search for unpublished studies. We will consider publications in English, French, German, Spanish, Italian, and Portuguese. Retrieved articles will be screened for eligibility. Statistical analyses will be conducted following the recommendations of the Cochrane Handbook for Systematic Reviews of Interventions, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), and Meta-analysis Of Observational Studies in Epidemiology (MOOSE) statements. Data will be analyzed using SPSS Statistics for Windows, version 25.0 (IBM Corp), and Review Manager, version 5.5 (The Nordic Cochrane Centre, The Cochrane Collaboration).
A preliminary search in Embase delivered 3272 references. This preliminary search allows us to complete our research strategy with equation development and to search the other databases. Relevant articles identified will allow for searching the reference lists for unpublished studies. The inclusion and exclusion criteria will be rigorously respected in the study selection. The entire study is expected to be completed by January 2020.
This review will provide an exhaustive view of medication management models that could be effective for polymedicated, home-dwelling older adults and will allow us to analyze their impact on managing and preventing MRPs.
PROSPERO CRD42018117287; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=117287 (Archived by WebCite at http://www.webcitation.org/77fCfbCjT).
DERR1-10.2196/13582
Shear-banding in a lyotropic lamellar phase, Part 2: Temporal fluctuations
We analyze the temporal fluctuations of the flow field associated to a
shear-induced transition in a lyotropic lamellar phase: the layering transition
of the onion texture. In the first part of this work [Salmon et al., submitted
to Phys. Rev. E], we have evidenced banded flows at the onset of this
shear-induced transition which are well accounted for by the classical picture
of shear-banding. In the present paper, we focus on the temporal fluctuations
of the flow field recorded in the coexistence domain. These striking dynamics
are very slow (100--1000s) and cannot be due to external mechanical noise.
Using velocimetry coupled to structural measurements, we show that these
fluctuations are due to a motion of the interface separating the two
differently sheared bands. Such a motion seems to be governed by the
fluctuations of , the local stress at the interface between the
two bands. Our results thus provide more evidence for the relevance of the
classical mechanical approach of shear-banding even if the mechanism leading to
the fluctuations of remains unclear
Phase Separation of Rigid-Rod Suspensions in Shear Flow
We analyze the behavior of a suspension of rigid rod-like particles in shear
flow using a modified version of the Doi model, and construct diagrams for
phase coexistence under conditions of constant imposed stress and constant
imposed strain rate, among paranematic, flow-aligning nematic, and log-rolling
nematic states. We calculate the effective constitutive relations that would be
measured through the regime of phase separation into shear bands. We calculate
phase coexistence by examining the stability of interfacial steady states and
find a wide range of possible ``phase'' behaviors.Comment: 23 pages 19 figures, revised version to be published in Physical
Review
Differential leaf gas exchange performance of mango cultivars infected by different isolates of Ceratocystis fimbriata
ABSTRACT Caused by the vascular fungus Ceratocystis fimbriata, mango wilt is considered to be one of the most serious threats in mango-producing regions worldwide. However, changes in leaf gas exchange level and the mechanisms underlying host responses to this fungal infection remain poorly described. This study aimed to evaluate potential changes in the leaf gas exchange of different mango cultivars (Ubá, Espada, Haden and Tommy Atkins) in response to two Brazilian isolates of C. fimbriata (CEBS15 and MSAK16) to non-invasively assess cultivar variability in relation to the basal level of resistance to mango wilt. Both isolates, regardless of the cultivar, caused reductions in stomatal conductance and, thus, a reduction in CO2 assimilation via diffusive limitations. Taking into account the full length of the internal lesion and the radial colonization of the stem tissues, both isolates showed equivalent aggressiveness when inoculated into the Haden and Tommy Atkins cultivars. Conversely, when compared to the CEBS15 isolate of C. fimbriata, the MSAK16 isolate was more aggressive in cv. Espada and less aggressive in cv. Ubá
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