Selection of medication in hospitalised elderly patients with Angina Pectoris

Objective: To evaluate medication changes in hospitalised elderly patients diagnosed with angina pectoris and to compare the selection of medication with evidence-based treatment guidelines. Design: Review of medical notes and patient interview. Setting: St. Luke's Hospital, Malta; January - May 2001. Subjects: 226 patients, aged 60 years or over, with a history of chronic stable angina and a discharge diagnosis of angina. Main outcome measures: Prevalence of use of antiplatelet agents, lipid lowering agents, beta-blockers, calcium channel blockers, nitrates, potassium channel openers and cellular anti-ischaemic agents; presence of co-morbidities, concurrent medication and adverse effects. Results: Prior to discharge, 77% of patients were receiving antiplatelet agents and 27% were receiving lipid lowering agents. The most frequent anti-ischaemic agents used were nitrates (97%) and second-generation dihydropyridine calcium channel blockers (59%). Beta-blockers were used in 31% of patients and non-dihydropyridine calcium channel blockers were used in 4% of patients. Potassium channel openers (nicorandil) and cellular anti-ischaemic agents (trimetazidine) were used in 5% and 19% of patients respectively. Of patients discharged on a single anti-ischaemic agent, 96% were prescribed nitrates, while 64% of those on two agents were prescribed nitrates and dihydropyridine calcium channel blockers. Beta-blockers, nicorandil and trimetazidine were generally used in conjunction with at least two other antiischaemic agents. The major medication changes involved the addition, or increase in dose, of amlodipine and isosorbide dinitrate. The major determinants affecting choice of medication were age and co-morbidities. Conclusion: Medication selection for chronic stable angina was not in accordance with treatment guidelines.peer-reviewe

Infectious intestinal disease : do we know it all?

Infectious intestinal disease (IID), with associated high morbidity and considerable mortality worldwide, causes a wide spectrum of illness. This ranges from mild discomfort to illness with severe complications. The economic burden from direct and indirect costs may be high. It is acquired by oral ingestion of micro-organisms which are transmitted from person to person; via food or water or through contact with animals or contaminated objects. Viruses are the commonest cause in developed countries. In Malta, medical practitioners and laboratories are the main source of data on IID. However, under-reporting is a problem. In order to fill in the lacunae in information on the disease burden, population-based-studies are required. Along with other countries, Malta has embarked on a number of studies to describe and quantify under-reporting of IID. This may assist in strengthening the surveillance system which, in combination with other measures, should result in an improvement of the control of IID.peer-reviewe

Laboratory surveillance of communicable diseases : enteric pathogens

Laboratories represent a crucial link in the surveillance chain. Since only a small proportion of cases of enteric infections are asked to submit a stool sample, one needs to assess the practices for testing for enteric pathogens and their notification practices. Five local laboratories participated in this study. This included a description of the laboratory practices; capacity for stool sample analysis; awareness of the notification system and the factors which could improve the system at laboratory level.peer-reviewe

Finding consensus without computation

A canonical problem for swarms of agents is to collectively choose one of multiple options in their environment. We present a novel control strategy for solving this problem-the first to be free of arithmetic computation. The agents do not communicate with each other nor do they store run-time information. They have a line-of-sight sensor that extracts one ternary digit of information from the environment. At every time step, they directly map this information onto constant-value motor commands. We evaluate the control strategy with both simulated and physical e-puck robots. By default, the robots are expected to choose, and move to, one of two options of equal value. The simulation studies show that the strategy is robust against sensory noise, scalable to large swarm sizes, and generalizes to the problems of choosing between more than two options or between unequal options. The experiments-50 trials conducted with a group of 20 e-puck robots-show that the group achieves consensus in 96% of the trials. Given the extremely low hardware requirements of the strategy, it opens up new possibilities for the design of swarms of robots that are small in size (≪10 -3 m) and large in numbers (≫10 3 )

Tuberculosis in Malta : comparisons between the young and elderly in a low incidence country

Background: Malta has one of the lowest reported incidence rates of tuberculosis in Western Europe, and was approaching the elimination phase. It was observed that a disproportionate number of cases were occurring among persons of advanced age. Objective: To investigate the epidemiology of tuberculosis in the elderly Malta-born population. Methods: A retrospective review of national TB surveillance data from 1995 to 2005 with estimation of 11-year means. Age stratified comparisons between the general, the younger, and the elderly Malta-born populations were made. Results: One hundred and seventeen Malta-born patients were included in the study; 99% of all notified cases. The mean stratified incidence rates of TB among the general population, those less than 65 years of age, and the elderly (65 years and over) were 2.8, 1.6, amd 10.6 per 100,000 person-years respectively. When the study sample was stratified wnto 15-year age groups, their mean TB incidence showed an exponential increase. All major age groups showed a fall in incidence, with the elderly group featuring the steepest decline od about 5% per year. The stratified incidence ratio of males to females, and pulmonary to extra-pulmonary TB was greatest in the elderly. Relapse occurred more commonly amongst elderly males. Conclusion: Contrasting age-stratified differences in incidence, gender, site, relapse, and mortality rates were discovered between the two major age groups, with the elderly forming a sub-population with distinct TB-related characteristics. Thus, the elderly, even when living in very low TB-incidence regions, should receive particular consideration.peer-reviewe

The changing parameters of compensation for ship-source pollution damage

The International Convention on Civil Liability for Oil Pollution Damage 1969 [CLC 1969], the International Convention on the Establishment of an International Fund for Oil Pollution Damage 1971 [Fund Convention 1971], and their amending protocols of 1992, have, for a number of years, provided a largely effective framework for compensation for shipsource oil pollution damage. CLC 1969/1992 imposes strict but limited liability on a ship owner for damage caused by a spill of persistent oil from a tanker carrying persistent oil as cargo. The definition of ship has been slightly widened in the 1992 Civil Liability Convention Protocol. The shipowner's liability is subject to a number of exceptions including war and natural phenomenon of an exceptional, inevitable and irresistible nature . The imposition of liability in CLC 1969 and 1992 is backed up by a system of compulsory insurance which also provides for a right of direct action against the person providing security. The current general capping of shipowner's liability in CLC 1992 is set at 59.7 million units of account. The shipowner's liability is complemented by liability imposed on the International Oil Pollution Compensation Funds [IOPC] [that is, 1971 and 1992] in terms of the Fund Convention 1971 and the Fund Convention 1992, to which oil receivers in member States contribute. The current maximum liability of the IOPC Fund 1992 is 135 million units of account which can in certain instances rise to 200 million units of account; the limits contained in CLC 1992 and the Fund Convention 1992 were raised in October 2000 by the tacit amendment procedure contained in the Conventions. The Fund Convention 1971 will be cease to be in force on 24 May 2002; as of 1 December 2001 the number of states parties to the 1992 Fund Convention was seventy-four.peer-reviewe

Community pharmacist perception of supplementary prescribing

Objective: To determine the perception of Maltese community pharmacists regarding supplementary prescribing. Method: A self-administered questionnaire was developed, tested for validity and reliability and distributed to 50 community pharmacists selected by stratified random sampling. Statistical analysis was undertaken using Microsoft® Excel® XP and the BioMedical Data Package (BMDP) software. Key Findings: Cronbach’s alpha correlation coefficient for the questionnaire was 0.8191. Forty-six pharmacists responded to the questionnaire. Twentythree pharmacists were in favour of supplementary prescribing for a variety of conditions predominantly gastro-oesophageal reflux disease and asthma (both 19 pharmacists). Pharmacists (20) envisaged the introduction of supplementary prescribing by forming liaisons with general practitioners. Conclusion: The initial response to the concept of pharmacist prescribing is encouraging. Community pharmacy in Malta will need to make changes in order to provide such services to patients.peer-reviewe

Occlusion-based cooperative transport with a swarm of miniature mobile robots

This paper proposes a strategy for transporting a large object to a goal using a large number of mobile robots that are significantly smaller than the object. The robots only push the object at positions where the direct line of sight to the goal is occluded by the object. This strategy is fully decentralized and requires neither explicit communication nor specific manipulation mechanisms. We prove that it can transport any convex object in a planar environment. We implement this strategy on the e-puck robotic platform and present systematic experiments with a group of 20 e-pucks transporting three objects of different shapes. The objects were successfully transported to the goal in 43 out of 45 trials. When using a mobile goal, teleoperated by a human, the object could be navigated through an environment with obstacles. We also tested the strategy in a 3-D environment using physics-based computer simulation. Due to its simplicity, the transport strategy is particularly suited for implementation on microscale robotic systems

Clinical pharmacist implementation of a medication assessment tool for long-term management of atrial fibrillation in older persons

Background: Optimisation of drug therapy is important in the older population and may be facilitated by medication assessment tools (MATs). Objective: The purpose of the study was to evaluate whether appropriateness of drug therapy and clinical pharmacist intervention documentation improved following implementation of a previously developed MAT for the long-term management of atrial fibrillation (MAT-AF). Methods: Adherence to MAT-AF review criteria and clinical pharmacist intervention documentation was assessed by the researcher pre-MAT implementation in 150 patients aged ≥60 years admitted to a rehabilitation hospital with a diagnosis of atrial fibrillation. MAT-AF was introduced as a clinical tool in the hospital for identification of pharmaceutical care issues in atrial fibrillation patients. Adherence to MAT-AF and pharmacist intervention documentation were assessed by the researcher post-MAT implementation for a further 150 patients with the same inclusion criteria. Logistic regression analysis and measurement of odds ratio was used to identify differences in adherence to MAT-AF pre- and post-MAT implementation. The differences between two population proportions z-test was used to compare pharmacist intervention documentation pre- and post-MAT implementation. Results: Adherence to MAT-AF criteria increased from 70.9% pre-implementation to 89.6% post-implementation. MAT-AF implementation resulted in a significant improvement in prescription of anticoagulant therapy (OR 4.07, p<0.001) and monitoring of laboratory parameters for digoxin (OR 10.40, p<0.001). Clinical pharmacist intervention documentation improved significantly post-implementation of MAT-AF (z-score 20.249, p<0.001). Conclusions: Implementation of MAT-AF within an interdisciplinary health care team significantly improved the appropriateness of drug therapy and pharmacist intervention documentation in older patients with atrial fibrillation.peer-reviewe

Hymn to the heroes of Malta

Ġabra ta’ poeżiji u proża li tinkludi: Alla fil-ħolqien ta’ Ġużè Agius Bonello – Is-sena u l-bniedem ta’ Ġużè Ellul-Mercer – Li tiżra’ taħsad ta’ Vic. Apap – Huwa ta’ Gino Muscat-Azzopardi – Żewġ friefet ta’ Vincent Caruana – Iċ-ċagħka ta’ Ġużè Borg – Warda midbiela ta’ C. Gauci – It-tfajla tas-sulfarini ta’ Albert M. Cassola – L-aħħar traduzzjoni ta’ May Butcher qabel ma mietet – Hymn to the heroes of Malta.N/