Coping with information style and family burden:Possible roles of self-stigma and hope among parents of children in a psychiatric inpatient unit

Objective: Parents of children who are hospitalized in inpatient psychiatric units must cope with significant challenges. One of these challenges relates to the way in which they cope with illness-related information. The current study examined the relationship between two such coping styles - monitoring and blunting - and family burden among parents of children in a psychiatric inpatient unit. Moreover, the possible moderating roles.played by hope and self-stigma in these associations were also examined. Methods: Questionnaires regarding coping with information style, self-stigma, hope and family burden were administered to 70 parents. Results: A main positive effect of hope and a main negative effect of self-stigma were uncovered. An interaction between self-stigma and monitoring was also revealed, suggesting that for parents with high self-stigma, compared to those with low self-stigma, more monitoring was related to more burden. Conclusions: Tailoring family interventions according to coping style and self-stigma is highly recommended as a mean to reduce the family burden of parents whose child is hospitalized in a psychiatric inpatient unit. (C) 2016 Elsevier Masson SAS. All rights reserved

Modelling multiphase flow in vertical pipe using CFD method.

Investigations of gas-liquid-solid flows in large diameter vertical pipes are scarce and detailed three phase flow study is still required to understand the flow interactions. Further investigation using high fidelity modelling is thus necessary due to complex flow interactions of the phases. In this study, a Computational Fluid Dynamics (CFD) method is used to investigate multiphase gas-liquid-solid flow in vertical pipe. Firstly, an appropriate validated numerical simulation scheme for two phase gas-liquid flow using ANSYS Fluent has been used to simulate possible flow regime transitions in vertical pipe. The scheme could predict the various flow regimes spanning bubbly to annular flow without prior knowledge of the flow patterns. The scheme was further extended to investigate the impact of solid particles in the flow field. More importantly the impact of solid concentration on the flow regime development and sand deposition was investigated. The results showed that the particulate deposition is greatly influenced by the particle concentration. In addition, the regime transitions and development in gas-liquid flows are different than that of gas-liquid-solid flows

Women’s beliefs about medicines and adherence to pharmacotherapy in pregnancy: Opportunities for community pharmacists?

Background During pregnancy women might weigh benefits of treatment against potential risks to the unborn child. However, non-adherence to necessary treatment can adversely affect both mother and child. To optimize pregnant women’s beliefs and medication adherence, community pharmacists are ideally positioned to play an important role in primary care. Objective This narrative review aimed to summarize the evidence on 1) pregnant women’s beliefs, 2) medication adherence in pregnancy, and 3) community pharmacists’ counselling during pregnancy. Method Three search strategies were used in Medline and Embase to find original studies evaluating women’s beliefs, medication adherence and community pharmacists’ counselling during pregnancy. All original descriptive and analytic epidemiological studies performed in Europe, North America and Australia, written in English and published from 2000 onwards were included. Results We included 14 studies reporting on women’s beliefs, 11 studies on medication adherence and 9 on community pharmacists’ counselling during pregnancy. Women are more reluctant to use medicines during pregnancy and tend to overestimate the teratogenic risk of medicines. Risk perception varies with type of medicine, level of health literacy, education level and occupation. Furthermore, low medication adherence during pregnancy is common. Finally, limited evidence showed current community pharmacists’ counselling is insufficient. Barriers hindering pharmacists are insufficient knowledge and limited access to reliable information. Conclusion Concerns about medication use and non-adherence are widespread among pregnant women. Community pharmacists’ counselling during pregnancy is insufficient. Further education, training and research are required to support community pharmacists in fulfilling all the opportunities they have when counselling pregnant women

A CFD-DEM solver to model bubbly flow. Part I: Model development and assessment in upward vertical pipes

[EN] In the computational modeling of two-phase flow, many uncertainties are usually faced in simulations and validations with experiments. This has traditionally made it difficult to provide a general method to predict the two-phase flow characteristics for any geometry and condition, even for bubbly flow regimes. Thus, we focus our research on studying in depth the bubbly flow modeling and validation from a critical point of view. The conditions are intentionally limited to scenarios where coalescence and breakup can be neglected, to concentrate on the study of bubble dynamics and its interaction with the main fluid. This study required the development of a solver for bubbly flow with higher resolution level than TFM and a new methodology to obtain the data from the simulation. Part I shows the development of a solver based on the CFD-DEM formulation. The motion of each bubble is computed individually with this solver and aspects as inhomogeneity, nonlinearity of the interfacial forces, bubble-wall interactions and turbulence effects in interfacial forces are taken into account. To develop the solver, several features that are not usually required for traditional CFD-DEM simulations but are relevant for bubbly flow in pipes, have been included. Models for the assignment of void fraction into the grid, seeding of bubbles at the inlet, pressure change influence on the bubble size and turbulence effects on both phases have been assessed and compared with experiments for an upward vertical pipe scenario. Finally, the bubble path for bubbles of different size have been investigated and the interfacial forces analyzed. (C) 2017 Elsevier Ltd. All rights reserved.The authors sincerely thank the ''Plan Nacional de I + D+ i" for funding the project MODEXFLAT ENE2013-48565-C2-1-P and ENE2013-48565-C2-2-P.Peña-Monferrer, C.; Monrós Andreu, G.; Chiva Vicent, S.; Martinez-Cuenca, R.; Muñoz-Cobo, JL. (2018). A CFD-DEM solver to model bubbly flow. Part I: Model development and assessment in upward vertical pipes. Chemical Engineering Science. 176:524-545. https://doi.org/10.1016/j.ces.2017.11.005S52454517

Long-Term Costs and Health Consequences of Issuing Shorter Duration Prescriptions for Patients with Chronic Health Conditions in the English NHS.

BACKGROUND: The National Health Service (NHS) in England spends over £9 billion on prescription medicines dispensed in primary care, of which over two-thirds is accounted for by repeat prescriptions. Recently, GPs in England have been urged to limit the duration of repeat prescriptions, where clinically appropriate, to 28 days to reduce wastage and hence contain costs. However, shorter prescriptions will increase transaction costs and thus may not be cost saving. Furthermore, there is evidence to suggest that shorter prescriptions are associated with lower adherence, which would be expected to lead to lower clinical benefit. The objective of this study is to estimate the cost-effectiveness of 3-month versus 28-day repeat prescriptions from the perspective of the NHS. METHODS: We adapted three previously developed UK policy-relevant models, incorporating transaction (dispensing fees, prescriber time) and drug wastage costs associated with 3-month and 28-day prescriptions in three case studies: antihypertensive medications for prevention of cardiovascular events; drugs to improve glycaemic control in patients with type 2 diabetes; and treatments for depression. RESULTS: In all cases, 3-month prescriptions were associated with lower costs and higher QALYs than 28-day prescriptions. This is driven by assumptions that higher adherence leads to improved disease control, lower costs and improved QALYs. CONCLUSION: Longer repeat prescriptions may be cost-effective compared with shorter ones. However, the quality of the evidence base on which this modelling is based is poor. Any policy rollout should be within the context of a trial such as a stepped-wedge cluster design

The impact of pharmacist face-to-face counseling to improve medication adherence among patients initiating statin therapy

Michael Taitel1, Jenny Jiang1, Kristi Rudkin2, Susan Ewing2, Ian Duncan 1Clinical Outcomes and Analytics, Walgreens, 2Corporate Innovation Team, Walgreens, Deerfield, Illinois, USAPurpose: To evaluate the impact of a community-based pharmacist-led face-to-face counseling program on medication adherence for patients who were new to therapy (NTT) for statin medications.Patients and methods: This retrospective cohort study evaluated a program that was implemented in 76 national community pharmacies located in the midwest USA. It consisted of two face-to-face patient counseling sessions with a pharmacist that addressed patient barriers to adherence. A group of 2056 NTT statin patients was identified between September 1, 2010 and October 31, 2010, and was followed for 12 months. The intervention group consisted of 586 patients, and the comparison group comprised 516 patients. Outcomes were measured using the continuous medication possession ratio (MPR), categorical MPR, and medication persistency.Results: After adjusting for covariates, the intervention group had statistically greater MPR than the comparison group at every month measured. For example, at 12 months the intervention group had a MPR of 61.8% (CI, 54.5%–69.2%) and the comparison group had a MPR of 56.9% (CI, 49.5%–64.3%); this 4.9% difference is significant (P < 0.01). The 12 month categorical MPR also showed significant differences between groups (χ2 = 6.12, P < 0.05); 40.9% of the intervention group and 33.7% of comparison group had a MPR greater than or equal to 80%. Finally, the intervention group had significantly greater persistency with their medication therapy than the comparison group at 60, 90, 120, and 365 days.Conclusion: Patients who participated in brief face-to-face counseling sessions with a community pharmacist at the beginning of statin therapy demonstrated greater medication adherence and persistency than a comparison group. This brief targeted intervention at the initiation of maintenance drug therapy moderates the high risk of nonadherence and discontinuation; it helps patients establish a routine of daily self-medication and potentially improves their long-term clinical outcomes.Keywords: community pharmacy, adherence, counseling, motivational interviewing, statin