Женский роман в гендерной перспективе

В статье излагаются результаты анализа становления и развития англо- и немецкоязычного женского романа – от канонического, через эмансипированный, к постфеминистскому, – в связи с широким распространением идей феминизма и опирающихся на них гендерных исследований.У статті представлено результати аналізу становлення й розвитку англо- та німецько-мовного жіночого роману – від канонічного, через емансипований до постфеміністського, – у його зв'язку з широким розповсюдженням ідей фемінізму та породженими останнім гендерними дослідженнями.The article offers the results of the author's analysis of Romance in the USA, UK and Germany, following its development from the Canon, through the Emancipated, to the present-day Post-feminist, all stages connected with and influenced by the growth of the ideas of feminism and Gender Studies

Preferences of patients and pharmacists with regard to the management of drug-drug interactions: A choice-based conjoint analysis

Background For the management of drug-drug interactions (DDI), a risk-benefit assessment should be combined with the patient's perspective. Objective To investigate patients' and pharmacists' preferences regarding DDI management Design and methods We conducted an online choice-based conjoint survey among patients and pharmacists. The choice task was about the management of a fictitious DDI: the combination of a cardiovascular drug and an antibiotic for pneumonia leading to a risk for developing muscle problems. Respondents answered twelve choice sets of two DDI-management options. The options were only described by their five characteristics (attributes) regarding risk for adverse events, benefit, and practical consequences. Each of the five attributes could have two different levels (e.g. low or high risk), which were varied over the 12 choice tasks. Data were analysed by latent class analysis in order to identify potential classes (subgroups) of respondents with similar preference patterns. Results The survey was completed by 298 patients and 178 pharmacists. The latent class model for both patients and pharmacists resulted in three classes. The first class of patients attached most importance to fewer adverse events (class probability 41%), the second class attached most importance to avoiding a medication switch (20%), and the third class attached most importance to blood sampling (39%). For pharmacists, the first class attached most importance to curing pneumonia (31%), the second class to avoiding a medication switch (31%), and the third class to avoiding blood sampling (38%). Conclusion Among patients and pharmacists diverging preferences regarding DDI management were observed. Some subgroups of respondents attached most value to risk or benefit while others attached more value to practical considerations. Awareness of existing variability in preferences among and between pharmacists and patients can contribute to shared decision making in DDI management

Impact of medicine shortages on patients - a framework and application in the Netherlands

Background: Medicine shortages are often described in plain numbers, suggesting all shortages have a uniform impact. However, some shortages have a direct and serious effect on patients and need a prompt reaction from stakeholders. This study aims to create a broad framework to assess the impact of a shortage. Method: We identified high impact shortages and selected exemplary shortages which we considered our learning cases. From five learning cases, we identified elements that had a potentially profound impact on one or more of these cases. We tested data saturation on the elements with another five test cases. Based on these elements, we created a framework to assess impact of shortages on patients and presented practical examples how to rate these different elements. Subsequently, we visualised the impact of these five learning cases on patients in radar charts. Results: The five elements which we identified as potentially having a large impact were 1) alternative product, 2) disease, 3) susceptibility, 4) costs and 5) number of patients affected. The five learning cases rated high on different elements, leading to diverse and sometimes even opposite patterns of impact. Conclusion: We created a framework for assessing the impact of a medicine shortage on patients by means of five key elements. By rating these elements, an indication of the impact can be obtained

Health-related votive tablets from Japan : Ema for healing and well-being

Many Shinto shrines and Buddhist temples in Japan sell small wooden votive tablets (ema) which are meant to be left on a rack at the sanctuary. The reverse of these tablets offers space to send a self-written wish or personal thank you message to the enshrined deity or buddha. Their front usually has a pre-printed or hand-painted design that is indicative of the intended purpose. In this book hundreds of contemporary ema designs for health-related purposes are reproduced and placed into their religious and biomedical context. A final chapter explores why there are differences between these purposes and current epidemiological patterns. This is the first book in English on the long-standing tradition of ema.Published to accompany the exhibition held at Japan Museum SieboldHuis, March 17 - June 11, 2017Wetensch. publicati

Health-related Votive Tablets from Japan:Ema for healing and well-being

Many Shinto shrines and Buddhist temples in Japan sell small wooden votive tablets (ema) which are meant to be left on a rack at the sanctuary. The reverse of these tablets offers space to send a self-written wish or personal thank you message to the enshrined deity or buddha. Their front usually has a pre-printed or hand-painted design that is indicative of the intended purpose. In this book hundreds of contemporary ema designs for health-related purposes are reproduced and placed into their religious and biomedical context. A final chapter explores why there are differences between these purposes and current epidemiological patterns. This is the first book in English on the long-standing tradition of ema.Published to accompany the exhibition held at Japan Museum SieboldHuis, March 17 - June 11, 2017Wetensch. publicati

Pharmacokinetic-Pharmacodynamic Drug Interactions with Nonsteroidal Anti-Inflammatory Drugs

The nonsteroidal anti-inflammatory drugs (NSAIDs) are very commonly prescribed, especially in the elderly population. In many countries more than 10 different NSAIDs are available. As the older pyrazole compounds like phenylbutazone, oxyphenbutazone and azapropazone are most prone to pharmacokinetic interactions, the use of these compounds should be avoided where possible. Acidic NSAIDs interact with bile acid-binding resins, resulting in decreased concentrations of NSAIDs in the blood. In earlier reports it was suggested that the absorption of NSAIDs was affected by antacids and sucralfate. More recently, it was shown that there is delayed absorption of these drugs, but there is no difference in the extent of absorption. Only salicylates had their urinary secretion enhanced by antacids, which increase the urinary pH to values >7. Histamine H-2-receptor antagonists can be combined safely with NSAIDs. The concomitant administration of probenecid increased the blood concentration of NSAIDs, so an enhanced anti-inflammatory effect can be expected when these 2 drugs are combined. More importantly, NSAIDs can cause pharmacokinetic drug-drug interactions with other drugs. As can be expected, interactions with drugs that have a small therapeutic window art most likely to be of clinical significance. For example, lithium, medium to high dose methotrexate and, to a lesser extent, cyclosporin may be affected by concomitant administration of an NSAID. Aspirin (acetylsalicylic acid) and/or pyrazoles interact with oral anticoagulants, oral antihyperglycaemic agents and the anticonvulsants phenytoin and valproic acid (sodium valproate). Elevation of blood concentrations of these agents can be potentially dangerous. Similarly, NSAIDs interact with digoxin. This interaction is most likely to occur in the elderly, in neonates or in patients with renal impairment. Indomethacin can influence the blood concentrations of aminoglycosides in neonates. Unfortunately, this effect seems unpredictable, so practical therapeutic recommendations cannot be made. When NSAIDs are combined with salicylates or diflunisal, the blood concentrations of the salicylate or diflunisal may increase. However, the clinical relevance of this increase in drug concentration seems to be of minor importance. Gastrointestinal bleeding caused by NSAIDs is the most dangerous when it results from a mixed pharmacokinetic/pharmacodynamic interaction; however, patients are also at risk when pharmacodynamic interactions only are involved

Better specification of triggers to reduce the number of drug interaction alerts in primary care

Objective Drug interaction alerts (drug–drug and drug-disease interaction alerts) for chronic medications substantially contribute to alert fatigue in primary care. The aim of this study was to determine which events require (re)assessment of a drug interaction and whether using these events as triggers in clinical decision support systems (CDSSs) would affect the alert rate. Methods Two random 5% data samples from the CDSSs of 123 community pharmacies were used: dataset 1 and 2. The top 10 of most frequent drug interaction alerts not involving laboratory values were selected. To reach consensus on events that should trigger alerts (e.g. first time dispensing, dose modification) for these drug interactions, a two-step consensus process was used. An expert panel of community pharmacists participated in an online survey and a subsequent consensus meeting. A CDSS with alerts based on the consensus was simulated in both datasets. Results Dataset 1 and 2 together contained 1,672,169 prescriptions which led to 591,073 alerts. Consensus on events requiring alerts was reached for the ten selected drug interactions. The simulation showed a reduction of the alert rate of 93.0% for the ten selected drug interactions (comparable for dataset 1 and 2), corresponding with a 28.3% decrease of the overall drug interaction alert rate. Conclusion By consensus-based better specification of the events that trigger drug interaction alerts in primary care, the alert rate for these drug interactions was reduced by over 90%. This promising approach deserves further investigation to assess its consequences and applicability in daily practice

Better specification of triggers to reduce the number of drug interaction alerts in primary care

Objective Drug interaction alerts (drug–drug and drug-disease interaction alerts) for chronic medications substantially contribute to alert fatigue in primary care. The aim of this study was to determine which events require (re)assessment of a drug interaction and whether using these events as triggers in clinical decision support systems (CDSSs) would affect the alert rate. Methods Two random 5% data samples from the CDSSs of 123 community pharmacies were used: dataset 1 and 2. The top 10 of most frequent drug interaction alerts not involving laboratory values were selected. To reach consensus on events that should trigger alerts (e.g. first time dispensing, dose modification) for these drug interactions, a two-step consensus process was used. An expert panel of community pharmacists participated in an online survey and a subsequent consensus meeting. A CDSS with alerts based on the consensus was simulated in both datasets. Results Dataset 1 and 2 together contained 1,672,169 prescriptions which led to 591,073 alerts. Consensus on events requiring alerts was reached for the ten selected drug interactions. The simulation showed a reduction of the alert rate of 93.0% for the ten selected drug interactions (comparable for dataset 1 and 2), corresponding with a 28.3% decrease of the overall drug interaction alert rate. Conclusion By consensus-based better specification of the events that trigger drug interaction alerts in primary care, the alert rate for these drug interactions was reduced by over 90%. This promising approach deserves further investigation to assess its consequences and applicability in daily practice

Patients with an ApoE <i>ε</i>4 allele require lower doses of coumarin anticoagulants

Objective: Vitamin K is an essential cofactor for the synthesis of several blood coagulation factors. It has been suggested that the apolipoprotein E (ApoE) genotype has profound effects on vitamin K status. Therefore, we investigated whether this common genetic polymorphism influenced dose requirements and effects of coumarin anticoagulants. Methods: We did a cohort study in 1637 patients from an outpatient anticoagulation clinic treated with acenocoumarol or phenprocoumon. Results: To attain the same level of anticoagulation, patients with genotype ε4/ε4 and genotype ε3/ε4 required respectively 3.4 mg (95%CI: -6.0 to -0.9) and 0.8 mg (95%CI: -1.6 to 0.1) acenocoumarol per week less than patients with genotype ε3/ε3. Patients homozygous for the ε2 allele required 3.5 mg (95%CI: 0.1 to 6.9) acenocoumarol per week more than patients with genotype ε3/ε3. The acenocoumarol maintenance dose showed a gene dose effect of the ε4 allele, but not of the ε2 allele. No significant dose difference was observed for phenprocoumon, possibly because of low numbers. Conclusion: The ApoE genotype affects the dose requirements of acenocoumarol.</p