Regular follow-up as part of an Asthma management plan : a study of hospitalised patients in Malta

Objective: To study the management of specific sub-groups of patients with asthma in Malta, using locally published guidelines for comparison. Method: A piloted, structured interview among patients between the ages of 14-59 years who were hospitalised with an admission diagnosis of acute asthma. In the case of repeated admissions, only the first interview was considered. All interviews were carried out by either of two clinical pharmacists and lasted about 30 minutes. The four-year prospective study started in February 1997 (one year before publication of the Malta guidelines) and finished in January 2001 (three years after publication). Main outcome measures: · Inhaled steroids on admission · Patient partnership: use of a written self-management plan and home peak flow monitoring · Patient compliance with inhaled steroids Results: 304 patients (68% females; mean population age 33.9 years SD 13.41) were interviewed over the four year period. Of the 304 patients, 32% were regularly followed up with the majority of patients (25.3%) being under specialist care; 54% of patients were not followed up as part of a long-term asthma management plan. It was not possible to obtain complete information in 14% of patients. The chi-square test was used to compare the two groups. With the exception of home peak flow monitoring, patients who were regularly followed up had statistically significant better management as recommended by the Malta asthma guidelines compared to those who were not regularly followed up. Conclusion: The findings of this study indicate that regular physician review results in better asthma management when assessed by comparison to published guidelines. However, despite regular follow up, certain aspects of patient care are inadequate in the light of the Malta asthma guidelines. It is suggested that the clinical pharmacist is well-placed to offer advice in order to promote adherence to guidelines.peer-reviewe

Management of infection in primary care : a case-based approach

Resistance is a recognised problem that is affecting management of infection worldwide. It is a very complex problem that is potentially caused by numerous factors including use of inappropriate strengths and routes of antimicrobials, needless use of antimicrobials when managing viral infections, inappropriate use of broad-spectrum antimicrobials, use of poor generics and lack of development of newer antimicrobials with novel modes of actions. Antimicrobials are probably the only drug class where misuse can have a community effect.peer-reviewe

Clinical management of comorbid bipolar disorder and obsessive-compulsive disorder: A case series

Background: Apparent comorbidity between bipolar disorder (BD) and obsessive-compulsive disorder (OCD) is a common condition in psychiatry and it has important nosological and therapeutic implications. Although antidepressants are the first line treatment for OCD, they can induce mood instability in BD. An optimal treatment approach remains to be defined. Methods: Longitudinal clinical observation of three severe OCD patients who developed a manic episode during treatment with different classes of antidepressants. Results: In our cases, three features support the hypothesis of an underlying bipolarity unmasked by the antidepressant used to treat OCD: positive family history for affective disorders, manic switch induced by antidepressant and improvement of affective and obsessive-compulsive symptoms with mood stabilizers and atypical antipsychotics. Conclusions: Osler\u2019s view that medicine should be treatment of diseases, not of symptoms, is consistent with the approach of mood stabilization as a first objective in BD-OCD patients, as opposed to immediate treatment with antidepressants. Only persistent OCD patients should be prescribed antidepressants in as low a dose as feasibl

Government Antipoverty Programmes and Small and Medium Enterprises Performance in Nigeria

Over the years the Nigerian government has come up with a number of antipoverty programmes aimed at fighting poverty by financing her growth induced sector- SMEs, yet, the country is still witnessing rising levels of poverty, corruption, unemployment, low human capital development, inadequate commercial bank credit, high lending rate and low standard of education, thus, affecting the performance of small scale enterprises. In other to address the conundrum, this study examines the effect of government antipoverty programmes on small and medium enterprises’ performance in Nigeria using econometric regression model of the Ordinary Least Square (OLS). From the regression analysis, the result showed that government antipoverty programmes, corruption, unemployment, human capital development, capital, lending rate and education conformed to the a priori expectations of the study and were statistically significant in explaining the SMEs’ performance in Nigeria. The study recommends that: In order to enhance the success of government antipoverty programmes in Nigeria, the programme should be implemented through the local government on the platform of cooperative societies so that the target population will benefit from it. A blueprint for handling corrupt officials should be embedded in the policy framework of the programme before implementation. The programme should be targeted at unemployed youths with real identity rather than sinking back the funds into the pockets of corrupt officials. Every intending beneficiary should be subjected to training/skill acquisition programme and occasional workshop in the line of trade he/she wants to venture into. Adequate funding at a good lending rate should be provided for any beneficiary of the programme in order to enhance the performance of the business in Nigeria

Potentially Low Cost Solution to Extend Use of Early Generation Computed Tomography

In preparing a case report on Brown-Séquard syndrome for publication, we made the incidental finding that the inexpensive, commercially available three-dimensional (3D) rendering software we were using could produce high quality 3D spinal cord reconstructions from any series of two-dimensional (2D) computed tomography (CT) images. This finding raises the possibility that spinal cord imaging capabilities can be expanded where bundled 2D multi-planar reformats and 3D reconstruction software for CT are not available and in situations where magnetic resonance imaging (MRI) is either not available or appropriate (e.g. metallic implants). Given the worldwide burden of trauma and considering the limited availability of MRI and advanced generation CT scanners, we propose an alternative, potentially useful approach to imaging spinal cord that might be useful in areas where technical capabilities and support are limited

Speech Prosody as a Bridge Between Psychopathology and Linguistics: The Case of the Schizophrenia Spectrum

Patients with schizophrenia spectrum disorders experience severe difficulties in interpersonal communication, as described by traditional psychopathology and current research on social cognition. From a linguistic perspective, pragmatic abilities are crucial for successful communication. Empirical studies have shown that these abilities are significantly impaired in this group of patients. Prosody, the tone of voice with which words and sentences are pronounced, is one of the most important carriers of pragmatic meaning and can serve a range of functions from linguistic to emotional ones. Most of the existing literature on prosody of patients with schizophrenia spectrum disorders focuses on the expression of emotion, generally showing significant impairments. By contrast, the use of non-emotional prosody in these patients is scarcely investigated. In this paper, we first present a linguistic model to classify prosodic functions. Second, we discuss existing studies on the use of non-emotional prosody in these patients, providing an overview of the state of the art. Third, we delineate possible future lines of research in this field, also taking into account some classical psychopathological assumptions, for both diagnostic and therapeutic purposes

The NDT Investigations Carry out at the Arudj Cathedral, Armenia

Arudj Cathedral, Armenia, is an example of early-Christian domed-hall that dates 671-672. A deep structural analysis of the building was developed by Politecnico di Milano, during the II° Level Master for Architects and Archaeologists named “Restoration Training and Support to Local Institutions for the Preservation and Conservation of Armenian Heritage”. The preservation project mainly focuses on deepen the knowledge level of the building in relation to the architectonical and structural aspects in order to offer a working method with the aim to propose and teach alternative solutions for static and seismic consolidation. This paper reports the NDT investigations of the surveys carried out at the Cathedral of Arudj and the results obtained at the laboratory of the Politecnico di Milano. The NDT investigations were carried out by the Authors and here following are briefly described. Sonic investigations on masonry structures were applied for a qualitative comparison of the walls, based on the variation of the sonic velocity values in the presence of areas with lower density, voids or cavities. The passive thermographic technique was applied to identify the distribution of capillary ascent in masonry structures. In order to offer a longterm verification of the evolution of the crack pattern, after having identify the cracks present on the masonry structures some displacement transducers have been fixed to state their evolution hourly. Finally, a series of laboratory tests were carried out to determine the main mechanical characteristics of the constituent stone

Shared multisensory experience affects Others' boundary: The enfacement illusion in schizophrenia

Schizophrenia has been described as a psychiatric condition characterized by deficits in one's own and others' face recognition, as well as by a disturbed sense of body-ownership. To date, no study has integrated these two lines of research with the aim of investigating Enfacement Illusion (EI) proneness in schizophrenia. To accomplish this goal, the classic EI protocol was adapted to test the potential plasticity of both Self-Other and Other-Other boundaries. Results showed that EI induced the expected malleability of Self-Other boundary among both controls and patients. Interestingly, for the first time, the present study demonstrates that also the Other-Other boundary was influenced by EI. Furthermore, comparing the two groups, the malleability of the Other-Other boundary showed an opposite modulation. These results suggest that, instead of greater Self-Other boundary plasticity, a qualitative difference can be detected between schizophrenia patients and controls in the malleability of the Other-Other boundary. The present study points out a totally new aspect about body-illusions and schizophrenia disorder, demonstrating that EI is not only confined to self-sphere but it also affects the way we discriminate others, representing a potential crucial aspect in the social domain

Practice characteristics of Emergency Department extracorporeal cardiopulmonary resuscitation (eCPR) programs in the United States: The current state of the art of Emergency Department extracorporeal membrane oxygenation (ED ECMO).

PURPOSE: To characterize the current scope and practices of centers performing extracorporeal cardiopulmonary resuscitation (eCPR) on the undifferentiated patient with cardiac arrest in the emergency department. METHODS: We contacted all US centers in January 2016 that had submitted adult eCPR cases to the Extracorporeal Life Support Organization (ELSO) registry and surveyed them, querying for programs that had performed eCPR in the Emergency Department (ED ECMO). Our objective was to characterize the following domains of ED ECMO practice: program characteristics, patient selection, devices and techniques, and personnel. RESULTS: Among 99 centers queried, 70 responded. Among these, 36 centers performed ED ECMO. Nearly 93% of programs are based at academic/teaching hospitals. 65% of programs are less than 5 years old, and 60% of programs perform ≤3 cases per year. Most programs (90%) had inpatient eCPR or salvage ECMO programs prior to starting ED ECMO programs. The majority of programs do not have formal inclusion and exclusion criteria. Most programs preferentially obtain vascular access via the percutaneous route (70%) and many (40%) use mechanical CPR during cannulation. The most commonly used console is the Maquet Rotaflow(®). Cannulation is most often performed by cardiothoracic (CT) surgery, and nearly all programs (\u3e85%) involve CT surgeons, perfusionists, and pharmacists. CONCLUSIONS: Over a third of centers that submitted adult eCPR cases to ELSO have performed ED ECMO. These programs are largely based at academic hospitals, new, and have low volumes. They do not have many formal inclusion or exclusion criteria, and devices and techniques are variable

Is the pharmacy profession innovative enough?: meeting the needs of Australian residents with chronic conditions and their carers using the nominal group technique

Background Community pharmacies are ideally located as a source of support for people with chronic conditions. Yet, we have limited insight into what innovative pharmacy services would support this consumer group to manage their condition/s. The aim of this study was to identify what innovations people with chronic conditions and their carers want from their ideal community pharmacy, and compare with what pharmacists and pharmacy support staff think consumers want. Methods We elicited ideas using the nominal group technique. Participants included people with chronic conditions, unpaid carers, pharmacists and pharmacy support staff, in four regions of Australia. Themes were identified via thematic analysis using the constant comparison method. Results Fifteen consumer/carer, four pharmacist and two pharmacy support staff groups were conducted. Two overarching themes were identified: extended scope of practice for the pharmacist and new or improved pharmacy services. The most innovative role for Australian pharmacists was medication continuance, within a limited time-frame. Consumers and carers wanted improved access to pharmacists, but this did not necessarily align with a faster or automated dispensing service. Other ideas included streamlined access to prescriptions via medication reminders, electronic prescriptions and a chronic illness card. Conclusions This study provides further support for extending the pharmacist’s role in medication continuance, particularly as it represents the consumer’s voice. How this is done, or the methods used, needs to optimise patient safety. A range of innovative strategies were proposed and Australian community pharmacies should advocate for and implement innovative approaches to improve access and ensure continuity of care