Multimodal interventions to enhance adherence to secondary preventive medication after stroke: a systematic review and meta-analyses

Summary: Introduction: Nonadherence to secondary preventative medications after stroke is common and is associated with poor outcomes. Numerous strategies exist to promote adherence. We performed a systematic review and meta-analysis to describe the efficacy of strategies to improve adherence to stroke secondary prevention. Methods: We created a sensitive search strategy and searched multiple electronic databases (MEDLINE, EMBASE, CINAHL, PsycINFO, CENTRAL, and Web of Knowledge) for studies of interventions that aimed to enhance adherence to secondary preventative medication after stroke. We assessed quality of included studies using the Cochrane tool for assessing risk of bias. We performed narrative review and performed meta-analysis where data allowed. Results: From 12,237 titles, we included seventeen studies in our review. Eleven studies were considered to have high risk of bias, 3 with unclear risk, and 3 of low risk. Meta-analysis of available data suggested that these interventions improved adherence to individual medication classes (blood pressure-lowering drugs – OR, 2.21; 95% CI (1.63, 2.98), [P < 0.001], lipid-lowering drugs – OR, 2.11; 95% CI (1.00, 4.46), [P = 0.049], and antithrombotic drugs – OR, 2.32; 95% CI (1.18, 4.56, [P = 0.014]) but did not improve adherence to an overall secondary preventative medication regimen (OR, 1.96; 95% CI (0.50, 7.67), [P = 0.332]). Conclusion: Interventions can lead to improvement in adherence to secondary preventative medication after stroke. However, existing data is limited as several interventions, duration of follow-up, and various definitions were used. These findings need to be interpreted with caution

Capital structure and stock returns: Evidence from an emerging market with unique financing arrangements

We investigate capital structure dynamics in a unique financing environment where (1) we avoid the complex tax environments faced by previous studies and where (2) firms rely primarily on bank loans rather than the public debt market.Consistent with recent empirical evidence, we find that stock returns are a first-order determinant of capital structure. Firms show some tendency to rebalance towards their target capital structure. However, the impact of stock returns dominates the effects of rebalancing. We also find that firm\u27s stock returns induce some corporate issuing activity, and managers use issuing activity to counteract some of the mechanistic effects of stock returns

The Motivators and Benefits of Sharing Knowledge to a KMS Repository in an Omani Organization

Knowledge is a powerful resource that enables individuals and organizations to achieve several benefits such as improved learning and decisionmaking. Repository knowledge management system (KMS) assists organizations to efficiently capture their knowledge for later reuse. However, the breadth and depth of a knowledge management system depends on the magnitude of knowledge contributed to the system. This paper aimed to empirically investigate the motivators of knowledge sharing behavior and the individual benefits of such behavior in a culture where knowledge is perceived as power and private. Based on 104 employees in a major private petroleum organization in Oman and the partial least square analysis methodology, the results suggested that knowledge contributors were motivated by the system technical characteristics and the organizational-culture dimensions such as management support and rewards policy. Information technology service quality and peers trustworthiness were not significant motivators for sharing knowledge

Revealing the Antecedents and Benefits of KMS Use: An Exploratory Study in a Petroleum Company in Oman

This pilot study aimed to explore technical and social antecedents and benefits of KMS use in a petroleum company in Oman. Data was collected through questionnaire given to KMS users. From the technical perspective, results uncovered that both knowledge utilizers and contributors were concerned about the system ease of use, speed and integration. Knowledge utilizers also valued knowledge richness in terms of relevancy and timeliness. From the social perspective, both knowledge utilizers and contributors considered time/availability as the major determinant of their behaviors. The results also suggested that knowledge utillizers valued the technical factors more than the social factors, whereas, knowledge contributors valued the social factors more than the technical factors. The study also revealed that KMS use resulted not only in individual benefits, but also organizational benefits. These achieved net benefits further boost KMS use

ResearchMedical and pharmacy students’ attitudes towards physician-pharmacist collaboration in Kuwait

Objective : To assess and compare the attitudes of medical and pharmacy students towards physician - pharmacist collaboration and explore their opinions about the barriers to collaborative practice in Kuwait. Methods : A cross - sectional survey of p harmacy and medical students (n=467) was conducted in Faculties of Medicine and Pharmacy, Kuwait University. Data were collected via self - administered questionnaire from first - year pharmacy and medical students and students in the last two professional yea rs of the pharmacy and medical programs. Descriptive and comparative analyses were performed using SPSS, version 22. Statistical significance was accepted at p \u3c 0.05. Results : The response rate was 82.4%. Respondents had overall positive attitudes toward s physician - pharmacist collaboration. Pharmacy students expressed significantly more positive attitudes than medical students (p\u3c 0.001). Medical students rated th e three most significant barriers to collaboration to be: pharmacists’ separation from patien t care areas (n=100, 70.0%), lack of pharmacists’ access to patients’ medical record (n=90, 63.0%) and physicians assuming total responsibility for clinical decision - making (n=87, 60.8%). Pharmacy students’ top three perceived barriers were : lack of pharmac ists’ access to patients’ medical record (n=80, 84.2%), organizational obstacles (n=79, 83.2%), and pharmacists’ separation from patient care areas (n=77, 81.1%). Lack of interprofe ssional education was rated the fourth - largest barrier by both medical (n=7 9, 55.2%) and pharmacy (n=76, 80.0%) students. Conclusions : Medical and pharmacy students in Kuwait advocate physician - pharmacist collaborative practice, but both groups identified substantial barriers to implementation. Efforts are needed to enhance under graduate/postgraduate training in interprofessional collaboration, and to overcome barriers to physician - pharmacist collaboration to advance a team approach to patient care

Revealing the Antecedents and Benefits of KMS Use: An Exploratory Study in a Petroleum Company in Oman

This pilot study aimed to explore technical and social antecedents and benefits of KMS use in a petroleum company in Oman. Data was collected through questionnaire given to KMS users. From the technical perspective, results uncovered that both knowledge utilizers and contributors were concerned about the system ease of use, speed and integration. Knowledge utilizers also valued knowledge richness in terms of relevancy and timeliness. From the social perspective, both knowledge utilizers and contributors considered time/availability as the major determinant of their behaviors. The results also suggested that knowledge utillizers valued the technical factors more than the social factors, whereas, knowledge contributors valued the social factors more than the technical factors. The study also revealed that KMS use resulted not only in individual benefits, but also organizational benefits. These achieved net benefits further boost KMS use