Polypharmacy is common in chronic medication users, which increases the risk of drug related problems. A suitable intervention is the clinical medication review (CMR) that was introduced in the ...Netherlands in 2012, but the effectiveness might be hindered by limited implementation in community pharmacies. Therefore our aim was to describe the current implementation of CMRs in Dutch community pharmacies and to identify barriers to the implementation.
An online questionnaire was developed based on the Consolidated Framework for Implementation Research (CFIR) and consisted of 58 questions with open ended, multiple choice or Likert-scale answering options. It was sent out to all Dutch community pharmacies (n = 1,953) in January 2021. Descriptive statistics were used.
A total of 289 (14.8%) community pharmacies filled out the questionnaire. Most of the pharmacists agreed that a CMR has a positive effect on the quality of pharmacotherapy (91.3%) and on medication adherence (64.3%). Pharmacists structured CMRs according to available selection criteria or guidelines (92%). Pharmacists (90%) believed that jointly conducting a CMR with a general practitioner (GP) improved their mutual relationship, whereas 21% believed it improved the relationship with a medical specialist. Lack of time was reported by 43% of pharmacists and 80% (fully) agreed conducting CMRs with a medical specialist was complicated. Most pharmacists indicated that pharmacy technicians can assist in performing CMRs, but they rarely do in practice.
Lack of time and suboptimal collaboration with medical specialists are the most important barriers to the implementation of CMRs.
Celotno besedilo
Dostopno za:
CEKLJ, DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
A metric space
X
is rigid if the isometry group of
X
is trivial. The finite ultrametric spaces
X
with |
X
| ≥ 2 are not rigid since for every such
X
there is a self-isometry having exactly |
X
|−2 ...fixed points. Using the representing trees we characterize the finite ultrametric spaces
X
for which every self-isometry has at least |
X
|−2 fixed points. Some other extremal properties of such spaces and related graph theoretical characterizations are also obtained.
Downstream migration of 112 radio-tagged Atlantic salmon smolts was studied in the Diemel, Germany, to examine 1) mortality and migration speeds during riverine migration and at a hydropower station, ...2) choice of migration routes at the power station, and 3) survival and transit speed through Archimedes screw and Francis turbines. Mortality was not elevated in the impounded stretch above the dam compared to a free-flowing control stretch (1.9 and 2.5% loss per km, respectively). Migration speeds did not differ among the control stretch, impounded stretch and in passing the power station, but there was large individual variation. Smolts reaching the power station (n=101) could choose between six possible passage routes. Most smolts passed through the Archimedes screw (43%), or via a route where Francis turbines were installed (33%). Three percent migrated over the dam, 14% used a fishway at the Archimedes screw and 8% used a fishway at the Francis turbines. The smolts used the fishways (instead of the Archimedes and Francis turbines) more often than expected from the proportion of water discharge, especially larger smolts at lower discharge. Smolts passed the power station mainly in the evening and early night. Migration speed past the power station was faster for smolts passing via the Archimedes screw and associated fishway than for those using other routes. Smolts were not markedly delayed in their downstream migration by using the Archimedes screw. Immediate mortality of smolts passing through the Archimedes screw and Francis turbines was probably below 10% and 13%, respectively.
Adverse drug events, including adverse drug reactions (ADRs), are responsible for approximately 5% of unplanned hospital admissions: a major health concern. Women are 1.5-1.7 times more likely to ...develop ADRs. The main objective was to identify sex differences in the types and number of ADRs leading to hospital admission.
ADR-related hospital admissions between 2005 and 2017 were identified from the PHARMO Database Network using hospital discharge diagnoses. Patients aged ≥ 16 years with a drug possibly responsible for the ADR and dispensed within 3 months before admission were included. Age-adjusted odds ratios (OR) with 95% CIs for drug-ADR combinations for women versus men were calculated.
A total of 18,469 ADR-related hospital admissions involving women (0.35% of all women admitted) and 14,678 admissions involving men (0.35% of all men admitted) were included. Most substantial differences were seen in ADRs due to anticoagulants and diuretics. Anticoagulants showed a lower risk of admission with persistent haematuria (ORadj 0.31; 95%CI 0.21, 0.45) haemoptysis (ORadj 0.47, 95%CI 0.30,0.74) and subdural haemorrhage (ORadj 0.61; 95%CI 0.42,0.88) in women than in men and a higher risk of rectal bleeding in women (ORadj 1.48; 95%CI 1.04,2.11). Also, there was a higher risk of admission in women using thiazide diuretics causing hypokalaemia (ORadj 3.03; 95%CI 1.58, 5.79) and hyponatraemia (ORadj 3.33, 95%CI 2.31, 4.81) than in men.
There are sex-related differences in the risk of hospital admission in specific drug-ADR combinations. The most substantial differences were due to anticoagulants and diuretics.
Downstream migration of radio‐tagged Atlantic salmon smolts, Salmo salar L., was studied in the Kinzig, Germany, to examine effects of passing a run‐of‐river hydropower station with a movable bulb ...turbine. Immediate mortality for smolts passing the power station was low (3%–6%), probably facilitated by a curved rack in front of the turbine and the possibility to pass over it. Mortality in the impounded stretch above the power station was also low (1.5% extra mortality compared to a control stretch). The combined mortality due to hydropower was 5%–8%, excluding delayed effects. Most smolts followed the main flow passing through the turbine area (94%). Only few used a fishway (4%) or a nearby millstream (2%). Migration speed was slowed down at the power station, but the passage only caused a short delay (average/median 8.6/1.3 hr). However, even low mortality and short delays at several power stations and reservoirs may have considerable cumulative effects.
Ikaite (CaCO
3
·6H
2
O) forms at near-freezing temperatures and its precipitation is favored by high alkalinity and high concentrations of dissolved phosphate. With increasing temperatures during ...early burial, ikaite transforms into its calcite pseudomorph referred to as glendonite. To further constrain the biogeochemical processes that impact the transformation of ikaite to glendonite, glendonites from Cenozoic strata of western Washington State, USA, were analyzed for their petrographic characteristics, stable isotope (C, O, S) patterns, and lipid biomarker inventories. Glendonites from the Humptulips, Pysht, Lincoln Creek, and Astoria Formations occur in strata that enclose abundant methane-seep deposits. Despite robust evidence for the anaerobic oxidation of methane (AOM) at these ancient seep sites, molecular signatures of this biogeochemical process were not found within glendonite. Glendonite was found to contain abundant, moderately
13
C-depleted
iso
- and
anteiso
-fatty acids, compounds interpreted as biomarkers of sulfate-reducing bacteria in marine settings. The
34
S-enrichment in carbonate-associated sulfate (δ
34
S
CAS
= 54.1 ‰) and the
34
S-depletion of pyrite (δ
34
S
CRS
= 6.8–12.5 ‰) in glendonite samples confirm that bacterial sulfate reduction was a prominent process in the sedimentary environment during the transformation of ikaite to glendonite. Low δ
13
C
glendonite
values, such as those of the Washington State glendonites (as low as −21‰), have previously been interpreted as signatures of methane-derived carbon; however, the admittedly small data set obtained from the Washington State glendonites is best explained with organoclastic sulfate reduction as the alkalinity engine driving carbonate precipitation. This surprising finding reveals that more comprehensive work is needed to decipher the biogeochemical processes that governed the transformation of ikaite to glendonite in ancient marine settings, including the relative contribution of organoclastic sulfate reduction and AOM.
Objectives
To describe the prevalence, temporal and regional trends in prescribing direct oral anticoagulants (DOACs) in conjunction with interacting medications.
Methods
We performed ...a cross-sectional study of pharmacy dispensing data in the Foundation for Pharmaceutical Statistics (SFK) registry on patients who have had a prescription for a DOAC filled at one of 831 randomly selected pharmacies in the Netherlands between Jan 2014–Jan 2019.
Results
We identified 99,211 patients who had a first DOAC prescription filled. Mean age was 71.6 ± 10.9 years, 58% were male. In 2014, 8,293 patients were treated with DOACs, in 2018, 35,415 were newly started on a DOAC. In 2018, the use of apixaban was most common (52%) in the Eastern region, whereas rivaroxaban was most frequently prescribed (32–48%) in the other regions. At time of first prescription, the vast majority (99.3%) used ≥ 1 concomitant interacting drug, and 3.2% used ≥ 3 interacting medications. Most common were digoxin (37.8%), atorvastatin (31.5%), verapamil (13.7%) and amiodarone (9.7%). While the number of interacting medications remained unchanged over time (median 1, interquartile range 1–1), there was a notable decrease in antiarrhythmic medications and an increase in non-cardiovascular interacting medications (e.g. dexamethasone from 0.9% to 7.1%, antiepileptic drugs from 2.5% to 3.8%, and haloperidol from 0.5% to 2.2% in 2014 and 2018, respectively).
Conclusion
DOAC use has quadrupled in Dutch clinical practice over the 5‑year period from 2014 to 2018. While the number of patients who take interacting medications remained stable, the profile of interacting medications has changed over time from cardiovascular to medications affecting other organ systems.
Background
Children are still prescribed age contraindicated drugs, but information about the number and type of these drugs dispensed for children in the Netherlands is limited.
Objective
To ...determine the incidence and prevalence of contraindicated drugs that were dispensed for the use by children.
Setting
The study was conducted in the Netherlands with routinely collected data from 95% of all community pharmacies.
Method
We performed a one-year nationwide observational study where all patients aged 17 years or younger who have received at least one prescription in 2016 were included. Contraindicated drugs were selected, according to the 5th level of ATC code, using different information sources.
Main outcome measure
The proportion of (newly) contraindicated drugs that were dispensed to children.
Results
In total, 3.9% of all children received at least one drug that was contraindicated for their age. The highest percentage of contraindicated drugs that was dispensed, was observed in patients aged 1–2 years and 13–17 years (7.0 and 5.7%, respectively) and the percentage of contraindicated drugs that were dispensed was higher in female than in male patients (4.3 and 3.6%, respectively;
p
value < 0.001).
Conclusion
The results of this study show that a substantial percentage of children received a drug that was conta-indicated for their age, and it happes more in female than in male patients. Furthermore, the information about this type of contraindications is limited and inconsistent.
Movements of dead fish in rivers Havn, T. B.; Økland, F.; Teichert, M. A. K. ...
Animal biotelemetry,
03/2017, Letnik:
5, Številka:
1
Journal Article
Recenzirano
Odprti dostop
Background The aim of telemetry studies is often to determine the fate and mortality rates of fish. A moving fish is usually regarded as alive and a long-term stationary fish as dead-and the site ...where it became stationary as the site where it died. Downstream transport of dead fish in rivers can lead investigators to mistake dead fish for live fish. We examined downstream movements of 60 dead Atlantic salmon smolts and 55 dead European silver eels, equipped with radio transmitters and released at hydropower stations in three German rivers. Results Overall, dead smolts drifted up to 2.4 km downstream and dead eels up to at least 30.1 km downstream. Smolts released in an Archimedes screw turbine drifted up to 1.1 km and eels up to at least 5.1 km downstream. Most smolts stopped moving further downstream within 1 week after release, whereas the eels (or their transmitters) moved downstream over several weeks, or even months, after release. However, the distance moved varied considerably also within species and among release sites. Eighteen (30%) dead smolts and nine (16%) dead eels moved upstream or disappeared from the rivers, indicating that they had been taken by scavengers. Some of these (four smolts and one eel) had recordings, indicating that they had been taken out of the river by birds. Conclusions Fish can drift considerable distances downstream after they have died in a river. This can make it difficult to identify dead fish, and the exact site and time of death from telemetry studies. Furthermore, dead fish can be moved within the river, or taken out of the river, by scavengers. These results are relevant for studies of mortality at power stations, but also for studies of tagged fish in rivers in general. When designing telemetry studies and interpreting telemetry data, investigators should keep in mind that dead fish (or their transmitters) may drift downstream. Investigators may also consider if it is useful to release dead fish as a control groups when planning and performing fish mortality studies.
The study explored the combined effects of density, physical habitat and different discharge levels on the growth of juvenile Atlantic salmon Salmo salar in artificial streams, by manipulating flow ...during both summer and winter conditions. Growth was high during all four summer trials and increased linearly with discharge and mean velocity. Differences in fish densities (fish m−3) due to differences in stream volume explained a similar proportion of the variation in mean growth among discharge treatments. Within streams, the fish aggregated in areas of larger sediment size, where shelters were probably abundant, while growth decreased with increasing densities. Fish appeared to favour the availability of shelter over maximization of growth. Mean growth was negative during all winter trials and did not vary among discharge treatments. These results suggest that increased fish densities are a major cause of reduced summer growth at low discharge, and that habitat‐mediated density differences explain the majority of the growth variation across habitat conditions both during summer and winter.
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