Inhibition in Preschool Children at Risk of Developmental Language Disorder

© The Author(s) 2022. This article is distributed under the terms of the Creative Commons Attribution 4.0 License (https://creativecommons.org/licenses/by/4.0/)It has been hypothesised that executive function deficits, specifically inhibition difficulties, may play a central role in Developmental Language Disorder (DLD). The presented study compared the response inhibition abilities of typically developing preschool children, with monolingual and bilingual preschool children who had already been classed as being at risk of developing DLD. A non-word repetition test and two inhibition tasks were used along with a prospective memory task. The results indicated that children at risk of DLD performed significantly worse than typically developing children on all tasks. The findings suggest that children at risk of DLD are impaired in response inhibition. Educational and therapeutic implications are discussed.Peer reviewe

The effect of providing feedback on inhaler technique and adherence from an electronic audio recording device, INCA®, in a community pharmacy setting: study protocol for a randomised controlled trial.

BACKGROUND: Poor adherence to inhaled medication may lead to inadequate symptom control in patients with respiratory disease. In practice it can be difficult to identify poor adherence. We designed an acoustic recording device, the INCA® (INhaler Compliance Assessment) device, which, when attached to an inhaler, identifies and records the time and technique of inhaler use, thereby providing objective longitudinal data on an individual\u27s adherence to inhaled medication. This study will test the hypothesis that providing objective, personalised, visual feedback on adherence to patients in combination with a tailored educational intervention in a community pharmacy setting, improves adherence more effectively than education alone. METHODS/DESIGN: The study is a prospective, cluster randomised, parallel-group, multi-site study conducted over 6 months. The study is designed to compare current best practice in care (i.e. routine inhaler technique training) with the use of the INCA® device for respiratory patients in a community pharmacy setting. Pharmacies are the unit of randomisation and on enrolment to the study they will be allocated by the lead researcher to one of the three study groups (intervention, comparator or control groups) using a computer-generated list of random numbers. Given the nature of the intervention neither pharmacists nor participants can be blinded. The intervention group will receive feedback from the acoustic recording device on inhaler technique and adherence three times over a 6-month period along with inhaler technique training at each of these times. The comparator group will also receive training in inhaler use three times over the 6-month study period but no feedback on their habitual performance. The control group will receive usual care (i.e. the safe supply of medicines and advice on their use). The primary outcome is the rate of participant adherence to their inhaled medication, defined as the proportion of correctly taken doses of medication at the correct time relative to the prescribed interval. Secondary outcomes include exacerbation rates and quality of life measures. Differences in the timing and technique of inhaler use as altered by the interventions will also be assessed. Data will be analysed on an intention-to-treat and a per-protocol basis. Sample size has been calculated with reference to comparisons to be made between the intervention and comparator clusters and indicates 75 participants per cluster. With an estimated 10 % loss to follow-up we will be able to show a 20 % difference between the population means of the intervention and comparator groups with a power of 0.8. The Type I error probability associated with the test of the null hypothesis is 0.05. DISCUSSION: This clinical trial will establish whether providing personalised feedback to individuals on their inhaler use improves adherence. It may also be possible to enhance the role of pharmacists in clinical care by identifying patients in whom alteration of either therapy or inhaler device is appropriate. REGISTRATION: ClinicalTrials.gov NCT02203266

A Method to Calculate Adherence to Inhaled Therapy That Reflects the Changes in Clinical Features of Asthma.

Rationale Currently studies on adherence to inhaled medications report Average Adherence over time. This measure does not account for variations in the interval between doses nor for errors in inhaler use. Objectives We investigated whether adherence calculated as a single Area Under the concentration-time Curve (AUC) measure, incorporating the interval between doses and inhaler technique, was more reflective of patient outcomes than current methods of assessing adherence. Methods We attached a digital audio device (INCATM) to a dry powder inhaler. This recorded when the inhaler was used and analysis of the audio data indicated if the inhaler had been used correctly. These aspects of inhaler use were combined to calculate adherence over time, as an AUC measure. Over a 3 month period a cohort of asthma patients were studied. Adherence to a twice-daily inhaler preventer therapy using this device and clinical measures were assessed. Measurements and Results Recordings from 239 patients with severe asthma were analysed. Average Adherence, based on the dose counter was 84.4%, whereas the ratio of expected to observed accumulated AUC, Actual Adherence, was 61.8% (

Variability in trough total and unbound teicoplanin concentrations and achievement of therapeutic drug monitoring targets in adult patients with hematological malignancy

The objective of this study was to explore the following aspects of teicoplanin use in patients with hematological malignancy: early attainment of target trough concentrations with current high-dose teicoplanin regimens, variability in unbound teicoplanin fractions, factors associated with observed total and unbound trough concentrations, efficacy and toxicity, and renal function estimation. This was a single-center, prospective study. Samples for determination of trough concentrations were taken on days 3, 4, 7, and 10. Total and unbound teicoplanin concentrations were determined using validated high-performance liquid chromatography methods. Regression analyses were used to identify the factors associated with the trough concentration. Thirty teicoplanin-treated adults with hematological malignancy were recruited. Despite the use of dosages higher than the conventional dosages, the proportions of patients with a trough concentration of >= 20 mg/liter at 48 h and at 72 h were 16.7% and 37.9%, respectively. Renal function was significantly negatively associated with total trough concentrations at 48 h and 72 h (P < 0.05). For an average hematological malignancy patient (creatinine clearance = 70 ml/min), sequential loading doses of at least 12 mg/kg of body weight may be needed to achieve early adequate exposure. In the absence of measured creatinine clearance, estimates obtained using the Cockcroft-Gault (total body weight) equation could prove to be an acceptable surrogate. The unbound fractions of teicoplanin were highly variable (3.4 to 18.8%). Higher unbound fractions were observed in patients with low serum albumin concentrations. Teicoplanin was well tolerated. Teicoplanin loading doses higher than those in current use appear to be necessary. Increased dosing is needed in patients with increased renal function. The high variability in protein binding supports the contention for therapeutic drug monitoring of unbound teicoplanin concentrations. (This study has been registered with EudraCT under registration no. 2013-004535-72.

N1-dansyl-spermine: a potent polyamine antagonist.

The potential polyamine antagonist action of N1-dansyl-spermine (a potent NMDA antagonist) was assessed in two in vivo mouse models of polyamine action. Co-administration of N1-dansyl-spermine (2?10 ?g, i.c.v.) with spermine (100 ?g, i.c.v.) resulted in a dose-dependent antagonism of the spermine-induced CNS excitation (body tremor and fatal tonic convulsions). In addition, the same dose of N1-dansyl-spermine antagonised spermine\u27s enhancement of NMDA-induced convulsions. These results suggest that N1-dansyl-spermine is in vivo a potent antagonist of the CNS effects of spermine and of its action at the positive polyamine modulatory site on the NMDA receptor

Measuring and benchmarking safety culture: application of the safety attitudes questionnaire to an acute medical admissions unit.

Objectives: To assess the safety culture in an acute medical admissions unit (AMAU) of a teaching hospital in order to benchmark results against international data and guide a unit-based, integrated, risk management strategy. Methods: The Safety Attitudes Questionnaire (SAQ), a validated instrument for the measurement of safety culture, was applied to an AMAU. All AMAU healthcare staff (n = 92) were surveyed: doctors, nurses, healthcare assistants (HCAs) and allied healthcare professionals (AHPs). Safety attitude scores for the overall unit and individual caregiver types were assessed across six domains of safety culture. Results: When compared against an international benchmark, the AMAU scored significantly higher for four of the six safety domains: p<0.01 for `teamwork climate?, `safety climate? and `stress recognition?, and p<0.05 for `job satisfaction?. The difference between nurse manager scores and the overall mean for the study group was statistically significant for the domains of `teamwork climate? (p<0.05) and `safety climate? (p<0.01). HCAs scored significantly lower relative to staff overall with regard to `working conditions? (p<0.05) and `perceptions of management? (p<0.01). Conclusions: The SAQ was successfully applied to an AMAU setting giving a valuable insight into staff issues of concern across the safety spectrum: employee and environmental safety, clinical risk management and medication safety

Profiling harmful medication errors in an acute Irish teaching hospital.

Background: Medication error reporting systems in hospitals are faced with the challenge of processing vast numbers of reports which identify a myriad of safety issues. With such large volumes of data and limited resources it makes sense to adopt a prioritisation approach. Several published studies have focused solely on the subset of errors which cause patient harm. The majority of such research has concerned the individual analysis of criteria associated with medication errors. However, the research described here used an alternative approach which involved linking the three criteria of medication class, patient outcome, and type of error, in order to describe the medication-related scenarios presenting greatest risk to the organisation. Aims: To identify the highest-priority medication-related risks in an acute teaching hospital. To profile harmful medication errors submitted to a voluntary reporting system in a tertiary healthcare setting in Ireland. Methods: A database of medication errors, reported via an internal voluntary reporting system over a 5-year period, was analysed. The criteria of medication class, patient outcome and type of error were analysed separately and then cross-tabulated. Results: The medication classes, error types and adverse patient outcomes most frequently associated with harm were identified. The cross-tabulation highlighted ten priority risk areas which accounted for the majority of patient harm. Conclusions: A cross-tabulation strategy for prioritising medication-associated risks was successfully applied to a hospital database comprising medication errors. The profile developed for harmful medication errors in this acute tertiary healthcare setting was broadly in line with that published for error reporting systems internationally

A comparison of community pharmacy methadone services between Dublin and Glasgow: (1) Extent of service provision in 1997/8 and views of pharmacists on existing provision and future service developments.

Objectives: To determine the extent of pharmacists\u27 participation in methadone services, type of services provided, views on current service provision and suggestions for future service developments. Methods and setting: An anonymous postal questionnaire was distributed to all community pharmacies in the greater Dublin area (n=291) and in Glasgow (n=200), excluding 12 pharmacies in each city that had participated in the pilot study. Key findings: The response rates were 50% (146/291) and 56% (112/200) for Dublin and Glasgow respectively. Participation in methadone services was considerably higher in Glasgow (80%, 90/112, of respondents) than in Dublin (38%, 55/146) and the number of patients per pharmacy was higher. A majority of pharmacists participating in methadone services (76% in Dublin, 92% in Glasgow) felt they had a professional responsibility to provide such services. In both cities the most common grounds for lack of service provision were business reasons, including risk to staff or property and theft. Current non?participants identified increased demand for the service and improved security measures as two factors that may encourage their participation in the future. Conclusion: Pharmacists in Dublin and Glasgow differed significantly in the extent and types of services provided. This may be because a structured scheme was in place in Glasgow but not in Dublin at the time of the study. Despite these differences in service provision, views were very similar in both cities

Design template for a medication safety programme in an acute teaching hospital

Background: Very limited data have been published about the design of medication safety programmes in hospitals. Objective: To describe a template for the structure and operation of a medication safety programme in an acute tertiary setting. Methods/results: A model of an ideal medication safety programme was developed by combining the lessons learnt by the lead author in the role of medication safety officer in an acute teaching hospital for 7 years with the published accounts of best practice from the literature. Conclusions: Given the limited guidance currently available regarding the structure and operation of such programmes, this template goes some way towards addressing a gap in the current patient safety literature. It should be of practical value to healthcare organisations considering either introducing a medication safety programme for the first time or expanding an existing system