Abstract
Background
Anticholinergic and sedative medications are frequently prescribed to older individuals. These medications are associated with short-term cognitive and physical impairment, but ...less is known about long-term associations. We therefore examined whether over 20 years cumulative exposure to these medications was related to poorer cognitive and physical functioning.
Methods
Older adult participants of the Longitudinal Aging Study Amsterdam (LASA) were followed from 1992 to 2012. On seven measurement occasions, cumulative exposure to anticholinergic and sedative medications was quantified with the drug burden index (DBI), a linear additive pharmacological dose–response model. Cognitive functioning was assessed with the Mini-Mental State Examination (MMSE), Alphabet Coding Task (ACT, three trials), Auditory Verbal Learning Test (AVLT, learning and retention condition), and Raven Colored Progressive Matrices (RCPM, two trials). Physical functioning was assessed with the Walking Test (WT), Cardigan Test (CT), Chair Stands Test (CST), Balance Test (BT), and self-reported Functional Independence (FI). Data were analyzed with linear mixed models adjusted for age, education, sex, living with a partner, BMI, depressive symptoms, comorbidities (cardiovascular disease, diabetes, cancer, COPD, osteoarthritis, CNS diseases), and prescribed medications.
Results
Longitudinal associations were found of the DBI with poorer cognitive functioning (less items correct on the three ACT trials, AVLT learning condition, and the two RCPM trials) and with poorer physical functioning (longer completion time on the CT, CST, and lower self-reported FI).
Conclusions
This longitudinal analysis of data collected over 20 years, showed that higher long-term cumulative exposure to anticholinergic and sedative medications was associated with poorer cognitive and physical functioning.
Radiative corrections to elastic scattering represent an important part of the interpretation of electron-induced nuclear reactions at small energy transfers, where they represent a dominant part of ...the background. Here we present and validate a new event generator for simulating QED radiative processes in electron-carbon scattering that exactly calculates the coherent sum of the Bethe-Heitler amplitudes for the leading diagrams. We demonstrate that the generator describes the shape of the radiative tail of an elastic peak with a precision better than
10
%
over the whole energy range of the scattered electrons and can thus be reliably employed in the analyses of electron scattering experiments for more precise extraction of inelastic cross-sections.
We present the achievements of the last years of the experimental and theoretical groups working on hadronic cross section measurements at the low-energy
e
+
e
−
colliders in Beijing, Frascati, ...Ithaca, Novosibirsk, Stanford and Tsukuba and on
τ
decays. We sketch the prospects in these fields for the years to come. We emphasise the status and the precision of the Monte Carlo generators used to analyse the hadronic cross section measurements obtained as well with energy scans as with radiative return, to determine luminosities and
τ
decays. The radiative corrections fully or approximately implemented in the various codes and the contribution of the vacuum polarisation are discussed.
Introduction
Healthcare professionals (HCPs) are informed about new drug safety issues through Direct Healthcare Professional Communications (DHPCs). The influence of DHPC content on the impact of ...the communication is unclear.
Objectives
The aim of this study was to assess the effect of content elements ‘frequency of the safety issue’, ‘seriousness of the safety issue’, ‘need to take action’, ‘life span of drug involved’ and ‘type of evidence supporting the safety issue’ on hospital-based HCPs’ preferences and responses towards DHPCs.
Methods
A survey study including a conjoint experiment was performed among hospital-based HCPs in the Netherlands. Hypothetical DHPCs varying on the five content elements were constructed. Each respondent received eight out of 16 hypothetical DHPCs and was asked about (1) importance to be informed (fixed-point scale), (2) preferred communication timing (multiple options) and (3) their stated actions (multiple options). Associations were tested using generalized linear mixed models.
Results
In total, 178 HCPs participated. DHPCs concerning more frequent or serious safety issues, or requiring action, were associated with a higher perceived importance to be informed and a preference for immediate communication. Periodic communication was preferred for DPHCs concerning less frequent or serious safety issues. The most commonly stated action was to discuss the DHPC with colleagues. Monitoring was common when this was recommended. High frequency and seriousness were associated with more prescribing-related actions.
Conclusion
Frequency and seriousness of the safety issue and the recommended action are likely to influence the impact of DHPCs. The timing of communication could be tailored depending on the content, where less urgent safety issues might be communicated periodically.
Introduction
Healthcare professionals (HCPs) and patients have various motives to report adverse drug reactions (ADRs) to their national agency. These motives may differ between countries.
Objective
...The aim of this study was to assess to what extent motives of HCPs and patients to report ADRs differ between countries.
Methods
HCPs and patients from Croatia (HR), The Netherlands (NL), and the UK were asked to complete a web-based survey containing questions regarding demographics and ADR reporting. HCPs and patients could select all motives for reporting that applied to them, with a total of 23 and 24 motives, respectively. Descriptive statistics are presented and Chi-square tests were used to test for differences across the countries, with effect sizes calculated using Cramer’s
V
.
Results
In total, 296 HCPs and 423 patients were included (60% and 32% from Croatia, 19% and 44% from NL, and 21% and 24% from the UK, respectively). For most of the motives to report or not to report an ADR, there were no differences between countries. Most HCPs from all countries would be motivated to report an ADR if there was a strong suspicion of causality (89%), if it concerned a severe/serious ADR (86%), and if it concerned an ADR for a new, recently marketed drug (77%). Most patients from all countries agreed that they would report an ADR if it concerned a severe ADR (96%), if the ADR influenced their daily activities (91%), and if they were worried about their own situation (90%). Differences across the countries (
p
< 0.05 and
V
≥ 0.21) were observed for three and four of the HCP and patient motives, respectively. For HCPs, these differences were seen in motives related to legal obligation (65% HR, 24% NL, 38% UK), black triangle medicines (27% HR, 4% NL, 77% UK), and the reporting of well-known ADRs (53% HR, 85% NL, 69% UK). For patients, these differences were seen in motives related to a linkage between the ADR report and the medical notes (59% HR, 60% NL, 30% UK), complexity and time taken to report (25% HR, 13% NL, 40% UK), medicines purchased on the internet (59% HR, 39% NL, 65% UK), and the reporting of embarrassing ADRs (32% HR, 11% NL, 35% UK).
Conclusions
HCPs’ and patients’ motives to report or not to report ADRs to the national agency were mostly similar across the three countries. Such motives can be used in general strategies to promote and increase ADR reporting. The observed differences provide guidance to further fine-tune ADR reporting at a national level.
Introduction
The implementation of new drug safety information and Direct Healthcare Professional Communications (DHPCs) in hospitals is important for patient safety.
Objectives
The aim of this study ...was to gain insight into which procedures and practices are in place to handle new drug safety information and particularly DHPCs in the Dutch hospital setting.
Methods
We first conducted focus groups including medical specialists and hospital pharmacists, focusing on handling of drug safety information at the individual and organisational level. A survey was then developed and distributed among hospital pharmacists in all Dutch hospitals to quantify the existence of specific procedures and committees to handle drug safety information and DHPCs.
Results
Eleven specialists and 14 pharmacists from six hospitals participated in focus groups. Drug safety information was usually considered before drugs were included in formularies or treatment protocols. Furthermore, drug safety information was consulted in response to patients experiencing adverse events. DHPCs were mostly dealt with by individual professionals. DHPCs could lead to actions but this was very uncommon. Completed surveys were received from 40 (53%) of the hospitals. In 32 (80%), the hospital pharmacy had procedures to deal with new drug safety information, whereas in 11 (28%) a hospital-wide procedure was in place. Drug safety was considered in committees concerning drug formulary decisions (69%) and antibiotic policies (63%). DHPCs were assessed by a hospital pharmacist in 50% of the hospitals.
Conclusions
Drug safety information was used for evaluation of new treatments and in response to adverse events. Assessment of whether a DHPC requires action was primarily an individual task.
The Dalitz decays η → e+e-γ and ω → π0e+e- have been measured in the γp → ηp and γp → ωp reactions, respectively, with the A2 tagged-photon facility at the Mainz Microtron. The value obtained for the ...slope parameter of the electromagnetic transition form factor of η, Λ$-2\atop{η}$ = (1.97 ± 0.11tot) GeV-2, is in good agreement with previous measurements of the η → e+e-γ and η → μ+μ-γ decays. The uncertainty obtained in the value of Λ$-2\atop{η}$ is lower than in previous results based on the η → e+e-γ decay. The value obtained for the ω slope parameter, Λ$-2\atop{ωπ^0}$ = (1.99 ± 0.21tot) GeV-2, is somewhat lower than previous measurements based on ω → π0μ+μ-, but the results for the ω transition form factor are in better agreement with theoretical calculations, compared to earlier experiments.
We have measured the cross section σ(e+e−→π+π−γ(γ)) at DAΦNE, the Frascati ϕ-factory, using events with initial state radiation photons emitted at small angle and inclusive of final state radiation. ...We present the analysis of a new data set corresponding to an integrated luminosity of 240 pb−1. We have achieved a reduced systematic uncertainty with respect to previously published KLOE results. From the cross section we obtain the pion form factor and the contribution to the muon magnetic anomaly from two-pion states in the mass range 0.592<Mππ<0.975 GeV. For the latter we find Δππaμ=(387.2±0.5stat±2.4exp±2.3th)×10−10.
We report a measurement of the spin polarization of the recoiling neutron in deuterium photodisintegration, utilizing a new large acceptance polarimeter within the Crystal Ball at MAMI. The measured ...photon energy range of 300-700 MeV provides the first measurement of recoil neutron polarization at photon energies where the quark substructure of the deuteron plays a role, thereby providing important new constraints on photodisintegration mechanisms. A very high neutron polarization in a narrow structure centered around E_{γ}∼570 MeV is observed, which is inconsistent with current theoretical predictions employing nucleon resonance degrees of freedom. A Legendre polynomial decomposition suggests this behavior could be related to the excitation of the d^{*}(2380) hexaquark.
PDF
