Collaborative medication review (CMR) practices for older adults are evolving in many countries. Development has been under way in Finland for over a decade, but no inventory of evolved practices has ...been conducted. The aim of this study was to identify and describe CMR practices in Finland after 10 years of developement.
An inventory of CMR practices was conducted using a snowballing approach and an open call in the Finnish Medicines Agency's website in 2015. Data were quantitatively analysed using descriptive statistics and qualitatively by inductive thematic content analysis. Clyne et al's medication review typology was applied for evaluating comprehensiveness of the practices.
In total, 43 practices were identified, of which 22 (51%) were designed for older adults in primary care. The majority (n = 30, 70%) of the practices were clinical CMRs, with 18 (42%) of them being in routine use. A checklist with criteria was used in 19 (44%) of the practices to identify patients with polypharmacy (n = 6), falls (n = 5), and renal dysfunction (n = 5) as the most common criteria for CMR. Patients were involved in 32 (74%) of the practices, mostly as a source of information via interview (n = 27, 63%). A medication care plan was discussed with the patient in 17 practices (40%), and it was established systematically as usual care to all or selected patient groups in 11 (26%) of the practices. All or selected patients' medication lists were reconciled in 15 practices (35%). Nearly half of the practices (n = 19, 44%) lacked explicit methods for following up effects of medication changes. When reported, the effects were followed up as a routine control (n = 9, 21%) or in a follow-up appointment (n = 6, 14%).
Different MRs in varying settings were available and in routine use, the majority being comprehensive CMRs designed for primary outpatient care and for older adults. Even though practices might benefit from national standardization, flexibility in their customization according to context, medical and patient needs, and available resources is important.
Purpose
Medication-related problems and declined functional capacity are closely associated factors among older people. The purpose of this study is to describe the procedure of interprofessional ...medication assessment in home care context and the baseline characteristics of the study population.
Methods
The FIMA study was a randomized, controlled intervention study comparing general practitioner-led interprofessional medication assessment and usual care. Patients’ chronic diagnoses and medication use as well as physical and cognitive functions were investigated. Performance in daily activities, use of care services and help from family and relatives, self-rated health and health-related quality of life, and adverse effects commonly related to medication were assessed.
Results
The home care patients (
n
= 512) had significant disease burden and functional limitations. The mean number of all medicines was 15 and that of regularly taken medicines 10. The majority of patients (87%) had excessive polypharmacy. The most commonly used (97%) ATC medicine class was nervous system medicines. Clinically relevant (class C or D SFINX record) drug–drug interactions were seen in 74% of the patients. The most frequent risks of adverse effects were risk of bleeding (66%), constipation (58%) and orthostatism (54%) occurring in over half of the patients. Medicines affecting renal function were used by 85% of the patients.
Conclusions
There is an evident need and justification for medication assessments in home care. In most cases, home care patients fulfill the criteria for regular medication assessments.
Two endoxylanases, Nf Xyn11A and Nf Xyn10A, were cloned from a Nonomuraea flexuosa (previously Actinomadura flexuosa) DSM43186 genomic expression library in Escherichia coli. The coding sequences of ...xyn11A and xyn10A consist of 344 and 492 amino acids, respectively. The catalytic domains belong to family 11 and family 10 of glycoside hydrolases. The C-termini share strong amino acid sequence similarity to carbohydrate-binding module (CBM) families CBM2 and CBM13, respectively. Native Nf Xyn11A, and recombinant Xyn11A expressed in the filamentous fungus Trichoderma reesei, were purified from cultivation media and characterized. The molecular masses of the full-length enzymes determined by mass spectrometry were 32.9 kDa and 33.4 kDa, the recombinant enzyme having higher molecular mass due to glycosylation. In addition, shorter polypeptides with molecular masses of 23.8 kDa and 22.0 kDa were characterized from the T. reesei culture medium, both lacking the C-terminal CBM and the 22.0 kDa polypeptide also lacking most of the linker region. The recombinant polypeptides were similar to each other in terms of specific activity, pH and temperature dependence. However, the 23.8 kDa and 22.0 kDa polypeptides were more thermostable at 80 degrees C than the full-length enzyme. All polypeptide forms were effective in pretreatment of softwood kraft pulp at 80 degrees C.
A simulation method to predict the reliability of clamped metal contacts under cyclic loading is presented. The main idea is to predict the development of contact condition of a joint by simulating a ...spatially variable coefficient of friction (COF) and wear. Frictional energy dissipation drives the COF evolution rule, and classic Archard's equation is employed as the evolution rule for wear depth. As both the COF and wear evolution are considered, the presented approach is capable of predicting changes in the contact condition over time. The approach is based on the Finite Element Method (FEM) and is generally applicable to industrial cases. The method is implemented as a subroutine to a FEM solver Abaqus to define a contact formulation in both normal and tangential directions. The subroutine allows full coupling between normal and tangential contact variables, which makes the approach robust also in complex industrial applications. As the effect of wear is described in the contact pressure calculation, there is no need for mesh modification. The presented approach was validated by simulating cylinder-on-plane configuration. The presented method provides similar results obtained with a simulation where geometry is updated due to wear. The results of the case study were qualitatively verified against a bolted joint type fretting experiment. The area of slip after stabilized COF distribution corresponds well with the experimental fretting scars. However, Archard's wear law seems to be limited, at least in partial slip cases, as it overestimates the amount of wear without considering entrapment of wear debris in the contact. A case study of medium speed combustion engine component is presented to show how the simulation method can be used in engine development to ensure reliable contact interfaces.
•Novel local coefficient of friction and wear simulation methodology for finite element method.•A new approach to simulate changing contact condition.•Surface damage criterion for fretting damage is introduced.•Method is applicable to real industrial size problems.
The influence of non-ionic polyethylene glycol and poly(vinylpyrrolidone) on monophasic-like nanoparticulate aluminosilicate with mullite bulk composition was investigated. The chemical homogeneity ...in the sol–gel state, as well as the evolution of the calcined aluminosilicate/mullite structures thereof, was studied by dynamic laser scattering, small angle X-ray scattering, nuclear magnetic resonance spectroscopy, X-ray diffraction, differential thermal analysis, dilatometry, N
2 adsorption and Fourier transform infrared spectroscopy. The results show that the organic additives have virtually no influence on the chemical structure of the monophasic-like nanoparticles in the sol–gel state, and the overall homogeneity of monophasic gels in the fired ceramics was generally sustained, as judged by the Type I crystallization. The porosity was not due to the polymers directly acting as porogens, but due to voids formed during the restructuring of matter during heat treatment.
Many fretting-prone contacts are surrounded by oils, although they are not intended to lubricate them. To study the fretting behavior of contacts whose edge is exposed to engine oil, self-mated ...34CrNiMo6 +QT steel was employed with a large annular flat-on-flat contact. A displacement-controlled loading was tested in a range, encompassing stick and gross sliding. No stick-to-slip transition with displacement amplitude was observed up to a tangential-to-normal traction ratio of 1.6, compared to that of 0.5 in dry contact. Beyond that, a typical peak-to-stabilized friction curve was reached in oil with a steady-state value of roughly 0.4, lower than that of dry contact. Adhesive wear existed as the dominant wear mechanism, and the severity of adhesion increased with higher loading.
•High traction ratio in slip-stick, even more than friction peak in gross sliding.•While high-level of traction ration, mild surface damage was seen in slip-stick.•Reduced and earlier friction peaks with displacement amplitude in gross sliding.•Higher tangential loading led to more martensite grain refining and strain hardening.•Formation of carbonaceous phases like graphite on fretted surfaces in gross sliding.
The effect of a rough, textured surface and contact orientations on the fretting behavior of self-mated martensitic 34CrNiMo6 +QT steel was examined via a large annular flat-on-flat contact. A ...friction study accompanied by microscopy analyses was performed to provide a clear insight into fretting characteristics. In gross sliding, the rough surface revealed a lower delayed friction peak and the same steady-state friction as the fine-ground smooth one. In partial slip, the stable friction threshold was around 0.5 for both surfaces. The oxidation-abrasion and its combination with adhesion were observed as wear mechanisms in partial slip and gross sliding, respectively.
Rat bone marrow stromal cell differentiation on aluminosilicate 3Al
2O
3–2SiO
2 coatings was investigated. Thin ceramic coatings were prepared on α-alumina substrates by the sol–gel process and ...calcined in order to establish an amorphous aluminosilicate ceramic phase with and without nanosized transitional mullite crystals. In addition, coatings of thermally sprayed aluminosilicate and diphasic γ-alumina–silica nanosized colloids were prepared. Cell culture testing by rat osteoblasts showed good biocompatibility for aluminosilicates with sustained normal osteoblast functions. Despite mutual disparities in physical and chemical nanostructures, the culture findings suggested fairly similar osteoblast response to all tested coatings. The results suggest that topographical frequency parameters and chemical uniformity are important parameters in determining the best conditions for osteoblasts on sol–gel derived aluminosilicate materials.
High temperature corrosion tests were performed on low-alloy ferritic steel and austenitic stainless steel, five high velocity oxy-fuel (HVOF) coatings, a laser cladding, and a diffusion chromized ...steel. Test conditions simulated superheater conditions of biofuel-fired boiler. The samples were exposed to synthetic salt containing 40 wt% K
2SO
4, 40 wt% Na
2SO
4, 10 wt% KCl, and 10 wt% NaCl. Exposures were carried out in oxidizing and in reducing atmospheres. The test temperature was 550 °C and the test duration was 100 h. Corrosion was extremely severe in oxidizing conditions because of active oxidation. In reducing atmosphere corrosion was retarded due to depletion of chlorine in the scales by evaporation of metal chlorides, and formation of a layer rich in chromium, sodium, sulfur, and oxygen adjacent to the metal surface. The corrosion resistance of coatings was determined by composition and microstructure. Oxides at splat boundaries were attacked by chlorine, and chlorine was able to penetrate through the coatings along splat boundaries.
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