Bridging the Location Gap: Physician Perspectives of Physician-Pharmacist Collaboration in Patient Care (BRIDGE Phase II)

Background: To optimize patient outcomes, the patient-centred medical home model emphasizes comprehensive team-based care. Pharmacists are qualified to enhance appropriate medication use and help improve patient outcomes through provision of medication therapy management (MTM) services. To optimally provide MTM, pharmacists must effectively collaborate with physicians. This study explored factors that influence pharmacist-physician collaboration. Methods and Findings: A convenience sample of five physicians participated in semi-structured interviews and the resulting data were analyzed using qualitative methods. Transcripts of the interviews were independently coded for themes by two researchers. Five themes emerged: trustworthiness, role specification, relationship initiation, effects on practice, and professional awareness/expectations. Conclusions: Overall interviewees spoke positively about pharmacists; however, when discussing collaboration, they spoke almost exclusively about pharmacists within their clinic. Since most pharmacists practice outside of clinics, bridging the location gap is imperative for collaboration. In addition, physicians lacked an overall understanding of pharmacists’ training and clinical capacity. This may inhibit pharmacists from participating to their full professional capability within integrated healthcare teams. One approach to resolve this lack of physician understanding of pharmacists’ role and value may be to co-educate health professional students. Further research is needed to explore ways to improve interprofessional collaborative care

FOSS as an efficient tool for extraction of MOSFET compact model parameters

A GNU Octave - based application for device-level compact model evaluation and parameter extraction has been developed. The applications main features are as follows: experimental I-V data importing, generating input data for different circuit simulation programs, running the simulation program to calculate I-V characteristics of the specified models, calculating model misfit and its sensitivity to selected parameter variation, and the comparison of experimental and simulated characteristics. Measured I-V data stored by different measurement systems are accepted. Circuit simulations may be done with Ngspice, Qucs and LTSpiceIV © . Selected aspects of the application are presented and discussed

Conservative treatment and outcome of upper cervical spine fractures in young children: A STROBE-compliant case series.

Cervical spine (C-spine) fractures in young children are very rare, and little information on treatment modalities and functional, radiographic, and patient-reported outcome exists. In this 2-center, retrospective case series, we assessed subjective and functional mid-term outcomes in children aged ≤5 years whose C-spine fractures were treated nonoperatively.Between 2000 and 2018, 6 children (median age at injury: 23.5 months; range: 16-31 months) with C1 or C2 injuries were treated with Minerva cast/brace or soft collar brace at 1 of the 2 study centers. Two patients suffered C1 fractures, and 4 patients had lysis of the odontoid synchondrosis. Overall, 3 children had sustained polytrauma. One child died due to the consequences of massive head injury.For the primary outcome parameter, we recorded subjective symptoms such as pain and functional restrictions due to the sequelae of C-spine injuries at follow-up.Based on medical records, we also assessed the causes of injury, diagnostic procedures, treatments and complications, and time to fracture consolidation.Median follow-up of the 5 surviving children was 51 months (range: 36-160 months). At the latest follow-up, 4 of 5 children did not complain of any pain. One child who sustained an open head injury in combination with a subluxation of the odontoid and undisplaced fracture of the massa lateralis reported occasional headache. All patients experienced complete fracture healing and normal range of motion of the cervical spine.Median duration of cast/brace treatment was 8.5 weeks. Fracture healing was confirmed by computed tomography in all patients.All C-spine injuries were managed with either Minerva cast/Halo brace or soft collar brace without complications.In our retrospective case series, nonoperative treatment of atlas fractures and dislocations or subluxations of the odontoid in young children using Minerva casts or prefabricated Halo braces resulted in good subjective and functional outcomes at mid-term. We observed no complications of conservative treatment of C1 and C2 injuries in young children

CMOS Readout Circuit Integrated with Ionizing Radiation Detectors

This paper describes the work performed in ITE on integration in one CMOS chip the ionizing radiation detectors with dedicated readout electronics. At the beginning, some realizations of silicon detectors of ionizing radiation are presented together with most important issues related to these devices. Next, two developed test structures for readout electronics are discussed in detail together with main features of non-typical silicon process deployed.

Relationship between self-efficacy and patient knowledge on adherence to oral contraceptives using the Morisky Medication Adherence Scale (MMAS-8)

BackgroundPreconception care, including family planning, is a vital component of healthcare for women of reproductive age. An average female spends the majority of her reproductive life trying to prevent a pregnancy. In order to prevent unintended pregnancy, women often rely on the use of hormonal contraceptives. In the United States, the majority of hormonal contraceptive users are prescribed oral contraceptive pills (OCPs). Reduced adherence to OCPs decreases their ability to prevent pregnancy. The study aimed to measure OCP adherence among female college students, and explore the relationship between OCP adherence, knowledge, and self-efficacy. MethodsThis cross-sectional study recruited a random sample of female college students to participate in an online survey. OCP adherence was based on the 8-item Morisky Medication Adherence Scale (MMAS-8). Secondary reporting of medication adherence included participant reports of the number of missed OCP doses in the previous month and typical month of use. ResultsOf the 5000 invited, 1559 (31.3%) completed the survey. Of those responding, 670 (41.3%) reported use of OCPs. A total of 293 (44.3%) OCP users met criteria for low adherence, 241 (36.4%) met criteria for medium adherence, and 128 (19.3%) met criteria for high adherence. Those with high adherence had higher self-efficacy (P \u3c 0.001) and perceived knowledge (p \u3c 0.001). After controlling for other factors, self-efficacy (b = .37) and perceived knowledge (b = .09) remained associated with OCP adherence. ConclusionLess than 20% of respondents met the criteria for high adherence to OCPs. Self-efficacy and knowledge were associated with higher OCP adherence. Targeted interventions from healthcare providers, health educators, and other adherence related media to increase the knowledge and self-efficacy of patients using OCPs may improve adherence rates. Additional research is needed to evaluate the impact of innovative interventions focused on social and behavioral patient factors, like knowledge and self-efficacy, on adherence to OCPs

Low-frequency, low-magnitude vibrations (LFLM) enhances chondrogenic differentiation potential of human adipose derived mesenchymal stromal stem cells (hASCs)

The aim of this study was to evaluate if low-frequency, low-magnitude vibrations (LFLM) could enhance chondrogenic differentiation potential of human adipose derived mesenchymal stem cells (hASCs) with simultaneous inhibition of their adipogenic properties for biomedical purposes. We developed a prototype device that induces low-magnitude (0.3 g) low-frequency vibrations with the following frequencies: 25, 35 and 45 Hz. Afterwards, we used human adipose derived mesenchymal stem cell (hASCS), to investigate their cellular response to the mechanical signals. We have also evaluated hASCs morphological and proliferative activity changes in response to each frequency. Induction of chondrogenesis in hASCs, under the influence of a 35 Hz signal leads to most effective and stable cartilaginous tissue formation through highest secretion of Bone Morphogenetic Protein 2 (BMP-2), and Collagen type II, with low concentration of Collagen type I. These results correlated well with appropriate gene expression level. Simultaneously, we observed significant up-regulation of α3, α4, β1 and β3 integrins in chondroblast progenitor cells treated with 35 Hz vibrations, as well as Sox-9. Interestingly, we noticed that application of 35 Hz frequencies significantly inhibited adipogenesis of hASCs. The obtained results suggest that application of LFLM vibrations together with stem cell therapy might be a promising tool in cartilage regeneration

Parental Psychosocial Factors Moderate Opioid Administration Following Children’s Surgery

BACKGROUND: This investigation aimed to examine the impact of parental psychosocial variables on the administration of opioids to young children experiencing postoperative pain. METHODS: Participants in this longitudinal analysis were children ages 2–12 undergoing tonsillectomy with or without adenoidectomy and their parents. Parents completed validated instruments assessing trait anxiety, perceived stress, and coping style before surgery, and children and parents completed instruments assessing pain and administration of opioids and acetaminophen on days 1, 2, 3, and 7 at home after surgery. The structure of the data was such that parents and children completed multiple data assessments making the data multilevel (ie, days of data within dyads). To address this issue of data structure, multilevel modeling was used to analyze the dataset. RESULTS: Participants included 173 parent-child dyads (mean child age = 5.99 ± 2.51) recruited between 2012 and 2017. We found that parent-related psychosocial variables, such as trait anxiety, stress, and coping style, moderated the relationship between the child’s pain and postoperative medication administration. Specifically, when predicting hydrocodone, the interactions between anxiety and pain and stress and pain were significant; when child pain was high, high-anxiety and high-stressed parents gave their children 19% and 12% more hydrocodone, respectively, compared to low-anxiety and low-stressed parents. When predicting acetaminophen, the interactions between anxiety and pain, a blunting coping style and pain, and a monitoring coping style and pain were significant. CONCLUSIONS: These results suggest the need to identify parents who experience high levels of perceived stress and trait anxiety and use appropriate interventions to manage stress and anxiety. This may ensure children receive optimal amounts of pain medication following surgery

Development of the Adherence Predictive Index (API) for Medication Taking

The objective for this study was to explore if characteristics of personality type using the Preferred Communication Style Questionnaire, in concert with the demographic characteristics of age, education, and race/ethnicity, are associated with, and help predict, individuals’ medication adherence behavior. Data were collected via an on-line survey, sent to a sample of adults residing in the United States, between April 28 and June 22, 2015. Out of 26,173 responses to the survey, 16,736 reported taking one or more medications and were eligible for inclusion in this study. The development of the Adherence Predictive Index (API) used mean Morisky Medication Adherence Scale (MMAS-8) scores for each of eight personality types as a starting point. API scores were calculated by adding or subtracting specific values to each group’s mean MMAS-8 score based on personality type, age, education and race/ethnicity characteristics which were demonstrated to have significant effects on adherence. The weighting system was informed by linear regression, logistic regression, personality type literature, researcher experience, and previous qualitative and quantitative research. The resultant score was converted to an API score that ranged from 1 to 5 so that it would be feasible for health care providers to understand and use. The findings showed that an Adherence Predictive Index (API) could be developed based upon a relatively small number of questions that focus on personality type and generational, educational, and cultural experiences. It was developed in order to be a component of a comprehensive program that has the goals of (1) identifying and describing specific behavioral strategies individuals are most likely to successfully employ, (2) motivating patients by using their preferred communication style, and (3) predicting each patient’s propensity to adhere. Future research is needed to evaluate the index’s validity, sensitivity, and effectiveness in actual practice compared with other risk indices