The population of developed countries is aging, leading to an increase in the use of medication in daily practice, which can lead to serious treatment costs and irrational polypharmacy. A ...collaborative care approach, such as providing medication review service provided by a clinical pharmacist (CP), is a possible way to reduce drug-related problems and irrational polypharmacy. The aim of this study was to determinate whether a CP's medication review service can improve the quality of drug prescribing in elderly patients treated with polypharmacy in primary care.
In a retrospective observational medical chart review study, patients aged 65 years or more in the period 2012-2014 who received 10 or more medications concomitantly and who were screened by a CP were included. Data on pharmacotherapy and CPs' interventions were obtained from the patients' medical records (non-electronic chart review). Potential drug-drug interactions (pDDIs) were determined with Lexicomp Online™ 3.0.2. Only potential X-type DDIs (pXDDIs) were included. Potentially inappropriate medications in the elderly (PIMs) were identified using the PRICUS list.
Ninety-one patients were included. The CPs suggested 625 interventions, of which 304 (48.6%) were accepted by the general practitioners (GPs). After adopting the CPs' interventions, the number of total medications decreased by 11.2% (p < 0.05) and the number of pXDDIs decreased by 42% (p < 0.05). The number of clinically important pXDDIs decreased by 50% (3 cases). The number of prescribed PIMs decreased by 20% (p = 0.069). The acceptance of CP's recommendations reduced the number of pXDDIs (p < 0.05) and improved the adherence to heart failure treatment guidelines.
A collaborative care approach offering a CP medication review service significantly improved the quality of pharmacotherapy by reducing the total number of medications and pXDDIs. The results support the implementation of this service in the Slovenian healthcare system.
Celotno besedilo
Dostopno za:
CEKLJ, DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Abstract Objectives Although antipsychotic prescribing in elderly patients using polypharmacy has not been studied in well-designed clinical trials and meta-analyses, there is an urgent need to ...monitor prescribing practice in this population. One of the possible approaches to optimize pharmacotherapy may be the involvement of clinical pharmacists (CPs). The aim of this research was to examine whether the involvement of a CP can improve treatment guidelines adherence and change the total number of medications per patient in older patients who are treated with excessive polypharmacy that includes antipsychotics. Methods This cohort retrospective study included older patients (65 years or older) treated with at least one antipsychotic and excessive polypharmacy (10 or more medications concurrently) between 2012 and 2014 in primary care. The main outcome measures were antipsychotic treatment guidelines’ adherence and the total number of medications per patient after the CP’s interventions. Only interventions including antipsychotics were studied in detail (i.e., discontinuation, switching, initiation, dose adjustment, change of another medication because of a drug-related problem). Data on diagnoses, patient pharmacotherapy and the CP’s interventions were obtained from clinical records and medical reviews. Age and acceptance of the CP’s interventions were used as predictive factors for antipsychotic treatment guidelines’ adherence. Results Forty-nine patients were included. The CP suggested 21 different interventions of which nine (42.8%) were accepted by the general practitioners. The number of medications that patients received decreased after the CP’s interventions (N of medications before: 15.4; N of medications after: 12.0, p < 0.05). The acceptance of the CP’s recommendations, but not age, improved antipsychotic treatment guidelines’ adherence (p = 0.041). Conclusions These results show that a collaborative care approach including a CP in primary care significantly improved the adherence to treatment guidelines. The results also support the implementation of this service in the Slovenian healthcare system, although more studies are needed.
The production pathway and carbon source of CH₄ in the surface sediment of a eutrophic alpine lake (Lake Bled, northwest Slovenia), in which the hypolimnion is anoxic for most of the year, were ...determined from molecular and biogeochemical studies. The average
δ
13
C
CH
4
value of −69.5%± 1.2%, associated with low acetate concentrations, suggested that CH4 should be formed, predominantly, hydrogenotrophically. The proportion of ‘‘fresh’’ autochthonous lipids in total extractable lipids in sediment decreased from 62% at the surface to 41% at a depth of 20 cm. The contribution of lipids of bacterial origin was more pronounced at the surface, comprising 13%. Terminal restriction fragment length polymorphism (T-RFLP) analysis of 16S ribosomal ribonucleic acid (rRNA) sequences of bacterial and archaeal community members suggested that larger sediment-depth–dependent changes occurred in the latter. The majority of archaeal sequences belonged to Euryarchaeota. The methanogenic population accounted for 73%and 38%of the archaeal community at depths of 0–2 cm and 10–12 cm, respectively. In the upper 2 cm, hydrogenotrophs, mostly Methanomicrobiaceae, were dominant. In the deeper sediment, archaeal sequences were mostly those of unknown affiliation with Euryarchaeota, Thermoplasmatales, and related linkages, and only 21% of the hydrogenotrophic methanogenic archaea were detected. Somewhat lower percentages (< 18%) of sequences representing acetotrophic archaea (Methanosaetaceae) were present in the two layers. The biogeochemical processes and structure of the archaeal community support the hypothesis that hydrogenotrophic methanogenesis is the dominant pathway in the sediment of alpine Lake Bled, despite low temperature and the prevalence of ‘‘fresh’’ autochthonous-derived organic matter.
Bioinformatic evidence of the presence of a large conjugative transposon in ruminal bacterium
Prevotella bryantii
B
1
4
T
is presented. The described transposon appears to be related to another large ...conjugative transposon CTnBST, described in
Bacteroides uniformis
WH207 and to the conjugative transposon CTn3-Bf, which was observed in the genome of
Bacteroides fragilis
strain YCH46. All three transposons share
tra
gene regions with high amino acid identity and clearly conserved gene order. Additionally, a second conserved region consisting of hypothetical genes was discovered in all three transposons and named the GG region. This region served as a specific sequence signature and made possible the discovery of several other apparently related hypothetical conjugative transposons in bacteria from the genus
Bacteroides
. A cluster of genes involved in sugar utilization and metabolism was discovered within the hypothetical CTnB
1
4, to a certain extent resembling the polysaccharide utilization loci which were described recently in some
Bacteroides
strains. This is the first firm report on the presence of a large mobile genetic element in any strain from the genus
Prevotella
.
Prispevek se osredotoča na temeljne značilnosti in najnovejše trende v gospodarskem sodelovanju Kitajske z Afriko, zlasti z vidika geografskih učinkov obsega in strukture trgovinske menjave, tujih ...neposrednih investicij in razvojne pomoči. V drugem delu članka so predstavljene ključne ugotovitve empirične raziskave v Angoli, ki osvetljujejo odnos Angolcev do gospodarske navezanosti na Kitajsko, kakor tudi do kitajskih priseljencev ter njihove vloge v afriški družbi in gospodarstvu.
Prispevek se osredotoča na temeljne značilnosti in najnovejše trende v gospodarskem sodelovanju Kitajske z Afriko, zlasti z vidika geografskih učinkov obsega in strukture trgovinske menjave, tujih ...neposrednih investicij in razvojne pomoči. V drugem delu članka so predstavljene ključne ugotovitve empirične raziskave v Angoli, ki osvetljujejo odnos Angolcev do gospodarske navezanosti na Kitajsko, kakor tudi do kitajskih priseljencev ter njihove vloge v afriški družbi in gospodarstvu.
ABSTRACT IN SLOVENE: Prispevek se osredotoca na temeljne znacilnosti in najnovejse trende v gospodarskem sodelovanju Kitajske z Afriko, zlasti z vidika geografskih ucinkov obsega in strukture ...trgovinske menjave, tujih neposrednih investicij in razvojne pomoci. V drugem delu clanka so predstavljene kljucne ugotovitve empiricne raziskave v Angoli, ki osvetljujejo odnos Angolcev do gospodarske navezanosti na Kitajsko, kakor tudi do kitajskih priseljencev ter njihove vloge v afriski druzbi in gospodarstvu. // ABSTRACT IN ENGLISH: The paper focuses on the main characteristics and the latest trends in China's economic co-operation with Africa, especially regarding the geographical implications of trade volume and structure, foreign direct investment, and development assistance. The second part of the paper presents key findings of empirical research in Angola, highlighting Angolan perception of economic ties to China as well as attitudes towards Chinese immigrants and their role in African society and economy.
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