Effects of Occupational Therapy on Hospitalized Chronic Schizophrenia Patients with Severe Negative Symptoms

The aim of this study was to determine whether occupational therapy (OT) can improve the interpersonal relationships and negative symptoms of hospitalized chronic schizophrenia patients with severe negative symptoms. Subjects were 38 patients with chronic schizophrenia. They were randomly divided into an OT group and a control group. Patients in the OT group participated in cooking activities once a week for 15 weeks, while patients in the control group did not. During this period, both groups had the usual treatment except for the cooking activities. In interviews, the patient was asked to place a chair toward the interviewer (a therapist). The angle and distance from the interviewer were taken as indicators of an ability to have interpersonal relationships. Negative symptoms were evaluated with the Scale for the Assessment of Negative Symptoms (SANS). Patients who received OT were able to sit at the smaller angle and shorter distance from the interviewer than before OT (p=0.015 and p=0.013, respectively). The total SANS score was lower after OT than before OT (p=0.033). In the control group, the distance from the interviewer also decreased during the experimental period (p=0.040) but the seating angle and the SANS scores did not change. The results suggest that OT can help to improve a relationship allowing the patient to face the therapist and that it might improve negative symptoms of schizophrenia

Steering protein and salt ad- and desorption by an electrical switch applied to polymer-coated electrodes

Although solid-phase chromatography is a well-established method for protein separation, chemically intensive and often costly regeneration steps are needed to make reuse of the adsorbent possible. Here, we demonstrate the use of electrochemical principles as sustainable alternative. We make use of spontaneous adsorption of proteins to solid electrodes and reverse this process by applying an electric potential to regenerate the interface. This allows for adsorption of proteins to take place at 0 V difference between the electrodes, due to electrostatic interactions between the protein and the electrode surface. The desorption is then triggered by applying a potential difference (−1.2 V) between the electrodes.It is demonstrated that the incorporation of negatively charged polystyrene sulfonate (PSS) or positively charged polydiallyldimethylammonium chloride (PDMAC) in or on top of the respective activated carbon electrodes increases the amount of exchanged protein from 1 to 10 mg g−1, as compared to simple activated carbon electrodes. Interestingly, salt ad- and desorption occurs in opposite cycles compared to protein ad- and desorption, resulting in simultaneous concentration and desalting of the protein when 0 V is applied. On top of that, we also found that an enrichment in β-lactoglobulin could be achieved starting from whey protein isolate. These results clearly demonstrate that electrochemical technologies can be used not only for protein separation (including removal of salt), but also for protein fractionation, while not requiring solvent use

Prediction of clinically relevant adverse drug events in surgical patients

Background Risk stratification of hospital patients for adverse drug events would enable targeting patients who may benefit from interventions aimed at reducing drug-related morbidity. It would support clinicians and hospital pharmacists in selecting patients to deliver a more efficient health care service. This study aimed to develop a prediction model that helps to identify patients on the day of hospital admission who are at increased risk of developing a clinically relevant, preventable adverse drug event during their stay on a surgical ward. Methods Data of the pre-intervention measurement period of the P-REVIEW study were used. This study was designed to assess the impact of a multifaceted educational intervention on clinically relevant, preventable adverse drug events in surgical patients. Thirty-nine variables were evaluated in a univariate and multivariate logistic regression analysis, respectively. Model performance was expressed in the Area Under the Receiver Operating Characteristics. Bootstrapping was used for model validation. Results 6780 admissions of patients at surgical wards were included during the pre-intervention period of the PREVIEW trial. 102 patients experienced a clinically relevant, adverse drug event during their hospital stay. The prediction model comprised five variables: age, number of biochemical tests ordered, heparin/LMWH in therapeutic dose, use of opioids, and use of cardiovascular drugs. The AUROC was 0.86 (95% CI 0.83–0.88). The model had a sensitivity of 80.4% and a specificity of 73.4%. The positive and negative predictive values were 4.5% and 99.6%, respectively. Bootstrapping generated parameters in the same boundaries. Conclusions The combined use of a limited set of easily ascertainable patient characteristics can help physicians and pharmacists to identify, at the time of admission, surgical patients who are at increased risk of developing ADEs during their hospital stay. This may serve as a basis for taking extra precautions to ensure medication safety in those patients

Safety assessment of essential medicines for elderly people: a bibliographic survey

Certain medicines are considered potentially inappropriate (PIM) for elderly people as they increase the risk of adverse drug events (ADE) and because safer alternative therapies are available on the market. In this context, in order to identify the instruments that assess the quality of medical prescriptions for elderly and to determine which drugs are considered PIM, a bibliographic survey was conducted in PUBMED, LILACS and PAHO databases, in February and March/2010. The search strategy included the use of health descriptors and a manual search in the references cited by selected papers. During the period of data collection, 15 instruments were identified. In 2012, with the publication of the update of Beers criteria, this instrument was included in the study. We identified 163 PIM of 25 therapeutic classes, of which 125 (76.7%) are marketed in Brazil. Of these, 31 (24.8%) are essential medicines (RENAME 2012), of which 13 have safer therapeutic equivalents and 19 (15.2%) are over-the-counter drugs. Data suggest the need for inclusion of safer alternatives for the elderly in the national list of essential medicines and the pharmaceutical care for early detection of ADE in this age group, in order to contribute to the safe use of medicines

Hamstring muscles: Architecture and innervation

Knowledge of the anatomical organization of the hamstring muscles is necessary to understand their functions, and to assist in the development of accurate clinical and biomechanical models. The hamstring muscles were examined by dissection in six embalmed human lower limbs with the purpose of clarifying their gross morphology. In addition to obtaining evidence for or against anatomical partitioning ( as based on muscle architecture and pattern of innervation), data pertaining to architectural parameters such as fascicular length, volume, physiological cross-sectional area, and tendon length were collected. For each muscle, relatively consistent patterns of innervation were identified between specimens, and each was unique with respect to anatomical organization. On the basis of muscle architecture, three regions were identified within semimembranosus. However, this was not completely congruent with the pattern of innervation, as a primary nerve branch supplied only two regions, with the third region receiving a secondary branch. Semitendinosus comprised two distinct partitions arranged in series that were divided by a tendinous inscription. A singular muscle nerve or a primary nerve branch innervated each partition. In the biceps femoris long head the two regions were supplied via a primary nerve branch which divided into two primary branches or split into a series of branches. Being the only muscle to cross a single joint, biceps femoris short head consisted of two distinct regions demarcated by fiber direction, with each innervated by a separate muscle nerve. Architecturally, each muscle differed with respect to parameters such as physiological cross-sectional area, fascicular length and volume, but generally all partitions within an individual muscle were similar in fascicular length. The long proximal and distal tendons of these muscles extended into the muscle bellies thereby forming elongated musculotendinous junctions. Copyright (C) 2005 S. Karger AG, Basel

Medication incidents related to automated dose dispensing in community pharmacies and hospitals - a reporting system study

Contains fulltext : 135965.pdf (publisher's version ) (Open Access)INTRODUCTION: Automated dose dispensing (ADD) is being introduced in several countries and the use of this technology is expected to increase as a growing number of elderly people need to manage their medication at home. ADD aims to improve medication safety and treatment adherence, but it may introduce new safety issues. This descriptive study provides insight into the nature and consequences of medication incidents related to ADD, as reported by healthcare professionals in community pharmacies and hospitals. METHODS: The medication incidents that were submitted to the Dutch Central Medication incidents Registration (CMR) reporting system were selected and characterized independently by two researchers. MAIN OUTCOME MEASURES: Person discovering the incident, phase of the medication process in which the incident occurred, immediate cause of the incident, nature of incident from the healthcare provider's perspective, nature of incident from the patient's perspective, and consequent harm to the patient caused by the incident. RESULTS: From January 2012 to February 2013 the CMR received 15,113 incidents: 3,685 (24.4%) incidents from community pharmacies and 11,428 (75.6%) incidents from hospitals. Eventually 1 of 50 reported incidents (268/15,113 = 1.8%) were related to ADD; in community pharmacies more incidents (227/3,685 = 6.2%) were related to ADD than in hospitals (41/11,428 = 0.4%). The immediate cause of an incident was often a change in the patient's medicine regimen or relocation. Most reported incidents occurred in two phases: entering the prescription into the pharmacy information system and filling the ADD bag. CONCLUSION: A proportion of incidents was related to ADD and is reported regularly, especially by community pharmacies. In two phases, entering the prescription into the pharmacy information system and filling the ADD bag, most incidents occurred. A change in the patient's medicine regimen or relocation was the immediate causes of an incident