Нові явища у функціонально-стилістичному вживанні протиставних сполучників в українській літературній мові кінця ХХ — початку ХХІ століть

У статті досліджено зміни у функціонуванні найуживаніших протиставних сполучників у мові української преси та художньої літератури кінця ХХ — почат ку ХХІ століть, обґрунтовано слабку семантико-синтаксичну спеціалізацію протиставних сполучників та визначено їхні транспозиційні можливості.In the article the changes in the functioning of the most used adversative conjunctions in the language of Ukrainian press and artistic literature of the end of the XX — the beginning of the XXI centuries have been investigated, weak semantic-syntactic specialization of adversative conjunctions has been explained and their transisting resources have been determined

Electronic monitoring of adherence, treatment of hypertension, and blood pressure control

Contains fulltext : 107733.pdf (publisher's version ) (Open Access)BACKGROUND: Although it is generally acknowledged that electronic monitoring of adherence to treatment improves blood pressure (BP) control by increasing patients' awareness to their treatment, little information is available on the long-term effect of this intervention. METHODS: In this observational study among a total of 470 patients with mild-to-moderate hypertension, adherence was measured in 228 patients by means of both the Medication Event Monitoring System (MEMS) and pill count (intervention group), and in 242 patients by means of pill count alone (control group). During a follow-up period of 1 year consisting of seven visits to the physician's office, BP measurements were performed and medication adjusted based on the achieved BP. In addition, at each visit adherence to treatment was assessed. RESULTS: On the basis of pill counts, median adherence to treatment did not differ between the intervention group and the control group (96.1% vs. 94.2%; P = 0.97). In both groups, systolic and diastolic BP decreased similarly: 23/13 vs. 22/12 mm Hg in the intervention and control group respectively. Drug changes and the number of drugs used were associated with BP at the start of study, but not with electronic monitoring. CONCLUSIONS: In this study, electronic monitoring of adherence to treatment by means of MEMS did not lead to better long-term BP control nor did it result in less drug changes and drug use

Cotreatment with methotrexate in routine care patients with rheumatoid arthritis receiving biological treatment yields better outcomes over time

Objectives We aimed to evaluate the effects of methotrexate (MTX) comedication added to biological disease-modifying antirheumatic drugs (bDMARD) on disease activity measures in patients with rheumatoid arthritis (RA) in routine care. Methods Patients with RA on treatment with either bDMARDs or conventional synthetic DMARDs were included in this prospective cohort study. The effect of (time-varying) combination therapy with bDMARD and MTX compared with bDMARD monotherapy was tested in longitudinal generalised estimating equation models using as outcomes: (1) the likelihood to be in remission according to the 28-joint Disease Activity Score (DAS28) erythrocyte sedimentation rate (ESR) (<2.6) and to the Routine Assessment of Patient Index Data 3 (RAPID3) (0-30; ≤3), a patient-reported outcome measure about RA symptoms; and (2) DAS28-ESR and RAPID3 as continuous variables. All models were adjusted for potential confounders: age, gender, drugs for comorbidities (yes/no), oral steroids (yes/no) and non-steroidal anti-inflammatory drug (yes/no). Results In total, 330 patients were included (mean (SD) follow-up; 10.7 (9.7) months). Compared with bDMARD monotherapy, MTX combination therapy was significantly associated with a 55% higher likelihood to be in DAS28 remission, but not RAPID3 remission, over time. Combination therapy resulted in slightly, but statistically significant, lower levels of DAS28-ESR over time (β=-0.42 (95% CI -0.67 to - 0.17)), but not RAPID3 (β=-0.58 (95% CI -0.65 to 0.49)). The effect on DAS28-ESR was entirely explained by lower swollen joint counts and was persistent after correction for confounders. Conclusion These results give support to the policy that MTX should be continued in routine care patients with RA on biological therapy since this leads to better objective but not subjective clinical outcomes.publishersversionpublishe

How would final-year medical students perform if their skill-based prescription assessment was real life?

Aims: Prescribing errors occur frequently, especially among junior doctors. Our aim was to investigate prescribing errors made by final-year medical students. Information on these errors can help to improve education on and assessment of clinical pharmacotherapy (CPT). Methods: This was a retrospective cohort study amongst final-year medical students at Erasmus Medical Centre, The Netherlands. Errors made in the final prescribing assessment were analysed. Errors were categorized by type, possible consequence and possibility of reaching the patient in real life. Results: A total of 381 students wrote 1502 analysable prescriptions. Forty per cent of these contained at least one error, and 54% of errors were of the inadequate information type. The rating of prescriptions for children was lower than for other question categories (P = <.001). Fifty per cent of errors were classified as “would have reached the patient but would not have had the potential to cause harm”. In total, 253 (29%) errors would not have been intercepted by an electronic prescribing system or a pharmacist. Ten (4%) of these would probably have caused harm in the patient. Conclusions: There is a high rate of errors in prescriptions written by final-year medical students. Most errors were of the inadequate information type, indicating that students had difficulties determining the content and amount of information needed to make treatment successful. Prescriptions for children contained most errors. Curricula could be improved by offering more case-based CPT education, focusing on the practical issues of prescribing, especially for paediatric cases, and offering more practice time for prescribing during clerkships

How would final-year medical students perform if their skill-based prescription assessment was real life?

Aims: Prescribing errors occur frequently, especially among junior doctors. Our aim was to investigate prescribing errors made by final-year medical students. Information on these errors can help to improve education on and assessment of clinical pharmacotherapy (CPT). Methods: This was a retrospective cohort study amongst final-year medical students at Erasmus Medical Centre, The Netherlands. Errors made in the final prescribing assessment were analysed. Errors were categorized by type, possible consequence and possibility of reaching the patient in real life. Results: A total of 381 students wrote 1502 analysable prescriptions. Forty per cent of these contained at least one error, and 54% of errors were of the inadequate information type. The rating of prescriptions for children was lower than for other question categories (P = <.001). Fifty per cent of errors were classified as “would have reached the patient but would not have had the potential to cause harm”. In total, 253 (29%) errors would not have been intercepted by an electronic prescribing system or a pharmacist. Ten (4%) of these would probably have caused harm in the patient. Conclusions: There is a high rate of errors in prescriptions written by final-year medical students. Most errors were of the inadequate information type, indicating that students had difficulties determining the content and amount of information needed to make treatment successful. Prescriptions for children contained most errors. Curricula could be improved by offering more case-based CPT education, focusing on the practical issues of prescribing, especially for paediatric cases, and offering more practice time for prescribing during clerkships

Participation in a clinical trial increases therapy compliance

Doel:Het ef fec t van deelname aan een klinische studie op de therapietrouw en de duur van het geneesmiddelengebruikonderzoeken bij patiënten met hypertensie.Opzet:Retrospectief, observationeel cohortonderzoek.Methode Gedurende de periode 1 januari 2001-31 december 2004 liep de ‘Home versus of f ice blood pressure measurements:reduc tion of unnecessar y treatment study’ (HOMERUS). Van 182 deelnemers werden de af levergegevens vangeneesmiddelen uit de periode 1 januari 1999-31 december 2009 bij de openbare apotheek opgevraagd. Op basisvan deze gegevens werd de therapietrouw vergeleken in de periodes vóór, tijdens en na de HOMERUS-studie. Metgegevens uit de periode na beëindiging van de HOMERUS-studie werd onderzocht hoe lang patiënten de therapiecontinueerden.Resultaten:Af levergegevens waren beschikbaar van 22.600 voorschrif ten. Deelname aan de HOMERUS-studie verhoogde de therapietrouw significant, van 90,6 naar 95,6% (p &lt; 0,001). Na de studieperiode daalde de therapietrouw voor de medicatie van de HOMERUS-studie naar 91,8% (p &lt; 0,001), wat niet verschilde met de therapietrouw vóór de star t vande klinische studie (p = 0,45). De therapietrouw voor andere, niet aan de studiegerelateerde medicatie nam doordeelname aan de studie eveneens toe, van 77,6 naar 89,6% (p &lt; 0,001). Na beëindiging van de studie continueerden de deelnemers de studiemedicatie gedurende een mediane periode van 1424 dagen. Deelnemers die warengeclassificeerd als therapietrouw (&gt; 90%) continueerden de studiemedicatie langer dan deelnemers geclassificeerd als niet-therapietrouw: 1440 versus 1000 dagen (oddsratio: 0,66; 95%-BI: 0,45-0,98).Conclusie:Deelname aan een klinische studie verhoogt therapietrouw voor zowel studie- als niet-studiegerelateerde medicatie.Dit wordt mogelijk verklaard door een grotere betrokkenheid van de deelnemers bij hun aandoeningen en behandelingen

Alterations in structural macromolecules and chondrocyte deformations in lapine retropatellar cartilage 9 weeks after anterior cruciate ligament transection

Abstract The structural integrity and mechanical environment of the articular cartilage matrix directly affect chondrocytedeformations. Rabbit models of early osteoarthritis at 9 weeks following anterior cruciate ligament transection (ACLT) have beenshown to alter the deformation behavior of superficial zone chondrocytes in mechanically loaded articular cartilage. However, it is notfully understood whether these changes in cell mechanics are caused by changes in structural macromolecules in the extracellularmatrix. Therefore, the purpose of this study was to characterize the proteoglycan content, collagen content, and collagen orientation at9 weeks post ACLT using microscopic techniques, and relate these changes to the altered cell mechanics observed upon mechanicalloading of cartilage. At 9 weeks following ACLT, collagen orientation was significantly (p&lt;0.05) altered and proteoglycan content wassignificantly (p&lt;0.05) reduced in the superficial zone cartilage matrix. These structural changes either in the extracellular orpericellular matrix (ECM and PCM) were also correlated significantly (p&lt;0.05) with chondrocyte width and height changes, therebysuggesting that chondrocyte deformation response to mechanical compression in early OA changes primarily because of alterations inmatrix structure. However, compared to the normal group, proteoglycan content in the PCM from the ACLT group decreased less thanthat in the surrounding ECM. Therefore, PCM could play a key role to protect excessive chondrocyte deformations in the ACLT group

Therapietrouw bij de behandeling van hypertensie: Combinatie van meetmethoden geeft meer inzicht in innamegedrag

OBJECTIVE: To investigate adherence patterns in detail by comparing and matching electronically derived adherence data with pill count data and the effect of adherence on blood pressure reduction in patients with mild to moderate hypertension. DESIGN: Observational study. METHODS: Among a total of 228 patients with mild to moderate hypertension, adherence to treatment was measured by means of both the Medication Event Monitoring System (MEMS) and pill count. Patients were followed up for seven visits over a period of one year. At each visit to the physician's office, patient's adherence was assessed by both methods. RESULTS: Median adherence according to MEMS was lower than median adherence according to pill count (91.6% vs. 96.1%; P < 0.001). Both methods agreed in defining patients as adherent in 107 (47%) and nonadherent in 33 (14%) cases. 31 patients (14%) were considered adherent only by MEMS and 59 patients (25%) only by pill count. At the end of the study, patients in the four categories reached comparable blood pressure values, and reductions. CONCLUSION: Pill count can be a useful adjunct to electronic monitoring in assessing adherence patterns. Although deviant intake behaviour occurred frequently, the effect on achieved blood pressure and blood pressure reduction was not remarkable