Prevalence and risk factors of drug-related problems identified in pharmacy-based medication reviews

Background: Medication safety is a major health concern, especially for older patients, in whom drug-related problems occur frequently as a consequence of polypharmacy and frailty, increasing the risk of adverse drug events. Objective: To investigate the prevalence and types of drug-related problems in community pharmacies and to identify associated risk factors in order to adjust the focus of care. Setting: 300 German community pharmacies in Saxony-Anhalt (Germany). Method: In April 2015, community pharmacists conducted brown bag medication reviews for primary care patients, in which they identified and solved drug-related problems with patients or their physicians. Data from these reviews were analyzed, including frequency and nature of problems and their respective resolutions. Potentially inappropriate medications according to the PRISCUS list were identified by post hoc analysis. Risk factors for drug-related problems were determined using bivariate and multivariate logistic regression analysis. Main outcome measure: Prevalence and risk factors of drug-related problems. Results: 1090 medication reviews were conducted. On average, patients were 72.0 ± 9.1 years old and had 10.6 ± 3.7 medications, 62.0% (n = 676) presented a medication plan. Knowledge gaps about medications were detected in almost a third of patients (n = 345). Drug-related problems were identified in 84.2% (n = 918) of patients (in 3836 medications). Frequent problems concerned drug–drug-interactions (53.7%, n = 585) as well as drug use and adherence (46.7%, n = 509). Most problems (72.2%, n = 2769) were resolved between pharmacist and patient. Knowledge gaps and the number of drugs were independently associated with a higher risk of drug-related problems. For older patients, potentially inappropriate medications were a risk factor in bivariate, but not in multivariate analysis. Conclusion: Pharmacists identified and resolved considerable rates of drug-related problems, suggesting that they are capable and well-positioned to conduct medication reviews. Knowledge gaps, the number of drugs, patient age and, in older patients, potentially inappropriate medications may indicate an increased risk for drug-related problems

Do neurologists in Germany adhere to the national Parkinson’s disease guideline?

Implementation of guidelines can improve clinical practice. The aim in this study was to investigate whether neurologists in Germany adhered to the national Parkinson’s disease guideline. Data were obtained from a cross-sectional survey of 60 neurologists. Analyses were performed on 320 patients with idiopathic Parkinson’s disease with either low grades of functional impairment (Hoehn and Yahr stage I) or higher grades of functional impairment (stage II–V) but without motor complications. The sample was divided into four groups depending on age and grade of functional impairment. For each group, a biometric parameter on the use of dopamine agonists and L-dopa was defined based on the guideline. In patients aged <70 years, the recommendation to use dopamine agonists without L-dopa (parameter 1) was observed in 53% of patients with lower grades of functional impairment, whilst recommended use of dopamine agonists in more functionally impaired patients (parameter 2) was followed to a greater extent (84%). In patients aged ≥70 years, recommendations to use L-dopa without dopamine agonists were adhered to in only 50% of less functionally impaired (parameter 3) and 52% of more functionally impaired (parameter 4) patients. In conclusion, our results indicated there was moderate but not full adherence to the guideline

A Qualitative Study

Background: Social media is frequently used by consumers and health care professionals; however, our knowledge about its use in a professional capacity by pharmacists is limited. Objective: Our aim was to investigate the professional use of social media by pharmacists. Methods: In-depth semistructured interviews were conducted with practicing pharmacists (N=31) from nine countries. Interviews were recorded, transcribed verbatim, and thematically analyzed. Results: Wikipedia, YouTube, and Facebook were the main social media platforms used. Professional use of social media included networking with peers, discussion of health and professional topics, accessing and sharing health and professional information, job searching, and professional promotion. Wikipedia was the participants’ first choice when seeking information about unfamiliar topics, or topics that were difficult to search for. Very few pharmacy-related contributions to Wikipedia were reported. YouTube, a video-sharing platform, was used for self-education. University lectures, “how-to” footage, and professionally made videos were commonly watched. No professional contribution was made to YouTube. Facebook, a general social networking site, was used for professional networking, promotion of achievements, and job advertisements. It also afforded engagement in professional discussions and information sharing among peers. Conclusions: Participants used social media in a professional capacity, specifically for accessing and sharing health and professional information among peers. Pharmacists, as medicines experts, should take a leading role in contributing to health information dissemination in these user-friendly virtual environments, to reach not only other health care professionals but also health consumers. J Med Internet Res 2016;18(9):e258 doi:10.2196/jmir.570

MEDIAÇÃO E CONCILIAÇÃO: DO CONFLITO À AUTOCOMPOSIÇÃO

O presente estudo objetiva verificar os institutos da mediação e da conciliação a partir do contexto no qual estão inseridos. Tem-se notado a crescente adoção de meios autocompositivos em diversas áreas, contudo observa-se também, que existe uma determinada dificuldade em diferenciá-los. Por essa razão buscar-se-á responder ao seguinte questionamento: quais são as principais características de cada instituto? O método de abordagem empregado é o dedutivo, que consiste, basicamente, na apreciação de informações gerais que visam uma conclusão. Quanto à técnica de pesquisa, foi utilizada a bibliografia, consubstanciada principalmente de livros e artigos científicos acerca da temática proposta. Inicialmente, o debate verifica o conflito, considerando a sua importância social e a possibilidade de composição. Após, abordam-se a mediação e a conciliação, respectivamente, a partir da análise da tipologia conflitiva, do terceiro interventor e do resultado. Ao final, constata-se que a importância de identificar corretamente os institutos reflete na aplicação adequada, na produção de resultados satisfatórios e, por conseguinte, no fortalecimento dos meios autocompositivos.Palavras-chave: Conciliação. Conflito. Mediação. Meios autocompositivos

LA POLÍTICA PÚBLICA DE MEDIACIÓN DE CONFLICTOS APLICADA AL TRÍPODE ACADÉMICO: UN ANÁLISIS DE LAS ACTIVIDADES DE LA UNIVERSIDAD COMUNITARIA DE SANTA CRUZ DO SUL – UNISC

Objetivo: analizar la mediación como política pública aplicada en la enseñanza, investigación   y   extensión   en   universidades   comunitarias, basándose   en   las actividades realizadas por la Universidad de Santa Cruz do Sul. El problema de la investigación es: ¿cuál es la contribución de las universidades comunitarias en la aplicación   de   la   política   pública   de   mediación? Metodología:   para   lograr   esta intención, se   utilizó   el   método   de   enfoque   inductivo, centrado   en   el   análisis bibliográfico. Resultados: las universidades comunitarias reiteran su compromiso social, ya que fortalecen la interacción entre el trípode académico y la comunidad.Contribuciones: la pesquisa trae un estudio sobre las universidades comunitarias ysu funcionamiento en Brasil y comentarios sobre la Universidad de Santa Cruz doSul como modelo de institución comunitaria.Palabras-Clave: Conflictos; Enseñanza; investigación y extensión; Mediación; Políticas públicas; Universidades comunitarias. ABSTRACTObjective: to analyze mediation as a public policy applied to teaching, research andextension   in   community   universities,   based   on   the   activities   carried   out   by   theUniversity of Santa Cruz do Sul. The research problem is: what is the contribution ofcommunity universities in implementing public mediation policy? Methodology: toachieve this goal the inductive approach method is used, centered on bibliographicanalysis.Results: the community universities reiterate their social commitment, sincethey strengthen the interaction between the academic tripod and the community.Contributions:  the  research  brings  a  study  on   community  universities  and   theirfunctioning in Brazil and comments on the University of Santa Cruz do Sul as amodel of community institution.Keywords: Conflict; Teaching; research and extension; Mediation; Public policy; Community universities.RESUMOObjetivo: analisar a mediação como política pública aplicada no ensino, na pesquisa e na extensão nas universidades comunitárias, a partir das atividades realizadas pela Universidade de Santa Cruz do Sul. Têm-se como problema de pesquisa  a seguinte   investigação:   qual   a   contribuição   das   universidades   comunitárias   na concretização   da   política   pública   da   mediação?Metodologia:   para alcançar tal intento,  recorreu-se   ao   método   de   abordagem   indutivo,   centrado   na   análise bibliográfica. Resultados:   as   universidades   comunitárias   reiteram   o   seu compromisso social, uma vez que fortalecem a interação entre o tripé acadêmico e a comunidade. Contribuições:   o   estudo   traz   um   estudo   sobre   as   universidades comunitárias e o seu funcionamento no Brasil e comenta sobre a Universidade deSanta Cruz do Sul como modelo de instituição comunitária.Palavras-Chave:  Conflitos; Ensino; pesquisa e extensão; Mediação; Políticas públicas; Universidades comunitárias

NOVOS PARADIGMAS: PRÁTICAS COLABORATIVAS ENQUANTO FERRAMENTAS CONCRETIZADORAS DO ACESSO À JUSTIÇA

O exaurimento da jurisdição é de conhecimento dos operadores do direito, bem como dos consumidores da justiça. Desta forma, as alternativas à jurisdição vêm sendo pensadas e precisam ser aplicadas com mais afinco. O presente trabalho traz como problema de pesquisa: advocacia colaborativa pode ser considerada um mecanismo de fomento ao acesso humanizado à justiça? O método de abordagem utilizado será dedutivo, partindo de uma premissa geral para chegar a uma específica, o procedimento utilizado será o monográfico.  Concluiu-se que as práticas colaborativas, em especial o procedimento de advocacia colaborativa, podem concretizar o acesso mais humanizado à justiça

O ENSINO JURÍDICO RESSIGNIFICADO: AS ATIVIDADES ACADÊMICAS DE EXTENSÃO COMO MECANISMOS DE ACESSO À JUSTICA QUALITATIVO

Esse trabalho objetiva examinar os principais aspectos das atividades acadêmicas de extensão, a partir das implementações inseridas pela Resolução CNE/CES nº 7/2018, no intuito de identificar suas contribuições para uma formação jurídica alinhada aos preceitos de acesso à justiça. Assim, questiona-se: quais as potencialidades contributivas das atividades extensionistas para a formação de juristas aptos a garantir um acesso à justiça qualitativo aos cidadãos? O método de abordagem é o dedutivo, com levantamento de dados efetuados por fontes primárias e secundárias.  A conclusão aponta que o acesso à justiça pode ser impulsionado por experiências interativas entre comunidade acadêmica e sociedade

Mitophagy-Related Cell Death Mediated by Vacquinol-1 and TRPM7 Blockade in Glioblastoma IV

Glioblastoma IV (GBM) is one of the deadliest malignant diseases in adults and is characterized by a high mutation rate and multiple traits to suppress inborn and acquired immunity. We here approached autophagy-related cell death in newly established GBM cell lines derived from individual tumor isolates. Treatment with a small molecule, termed Vacquinol-1 (Vac) exhibited 100% GBM cell death, which was related to mitochondrial dysfunction, calcium-induced endoplasmic reticulum (ER)-stress, and autophagy. The toxicity of Vac was significantly increased by the inhibition of transient receptor potential cation channel, subfamily M, member 7 (TRPM7). TRPM7 is overexpressed in GBM as well as in many other tumors and thus may be a potential target by the natural compound carvacrol. Of note, at higher concentrations, Vac also induced growth inhibition and cell death in non-transformed cell types. However, in the presence of the TRPM7 inhibitor carvacrol, the tumor-selective effect of Vac was very much increased. Results given in the present study are based on long-term video microscopy using IncuCyteZOOM®, calcium measurements, and 3D ultrastructural analysis using the cryofixed material

SN 2003du: Signatures of the Circumstellar Environment in a Normal Type Ia Supernova?

We present observations of the Type Ia supernova 2003du and report the detectionof an unusual, high-velocity component in the Ca II infrared triplet, similar tofeatures previously observed in SN 2000cx and SN 2001el. This feature exhibits a large expansion velocity (~18,000 km/s) which is nearly constant between -7 and +2 days relative to maximum light, and disappears shortly thereafter. Otherthan this feature, the spectral evolution and light curve resemble those of a normal SN Ia. We find that the Ca II feature can plausibly be caused by a dense shell formed when circumstellar material of solar abundance is overrun by the rapidly expanding outermost layers of the SN ejecta. Model calculations show that the optical and infrared spectra are remarkably unaffected by the circumstellar interaction. In particular, no hydrogen lines are detectable in either absorption or emission. The only qualitatively different features are the strong, high-velocity feature in the Ca II IR-triplet, and a somewhat weaker O I feature near 7,300 AA. The morphology and time evolution of these features provide an estimate for the amount of accumulated matter and an indication of the mixing in the dense shell. We apply these diagnostic tools to SN 2003du and infer that about 2 x 10^{-2} M_sun of solar abundance material may have accumulated in a circumstellar shell prior to the observations. Furthermore, the early light curve data imply that the circumstellar material was originally very close to the progenitor system, perhaps from an accretion disk, Roche lobe or common envelope.Comment: 35 Pages, 11 Figures, to appear in ApJ. Resubmission includes expanded discussion & new figures to match with accepted journal versio