Medication regimen complexity in institutionalized elderly people in an aging society

Background Complex medication regimens may adversely affect compliance and treatment outcomes. Complexity can be assessed with the medication regimen complexity index (MRCI), which has proved to be a valid, reliable tool, with potential uses in both practice and research. Objective To use the MRCI to assess medication regimen complexity in institutionalized elderly people. Setting Five nursing homes in mainland Portugal. Methods A descriptive, cross-sectional study of institutionalized elderly people (n = 415) was performed from March to June 2009, including all inpatients aged 65 and over taking at least one medication per day. Main outcome measure Medication regimen complexity index. Results The mean age of the sample was 83.9 years (±6.6 years), and 60.2 % were women. The elderly patients were taking a large number of drugs, with 76.6 % taking more than five medications per day. The average medication regimen complexity was 18.2 (±SD = 9.6), and was higher in the females (p < 0.001). The most decisive factors contributing to the complexity were the number of drugs and dosage frequency. In regimens with the same number of medications, schedule was the most relevant factor in the final score (r = 0.922), followed by pharmaceutical forms (r = 0.768) and additional instructions (r = 0.742). Conclusion Medication regimen complexity proved to be high. There is certainly potential for the pharmacist’s intervention to reduce it as part as the medication review routine in all the patients.

Cloud parameter retrievals from Meteosat and their effects on the shortwave radiation at the surface

A method based on Spinning Enhanced Visible and Infrared Imager (SEVIRI) measured reflectance at 0.6 and 3.9 µm is used to retrieve the cloud optical thickness (COT) and cloud effective radius (re) over the Iberian Peninsula. A sensitivity analysis of simulated retrievals to the input parameters demonstrates that the cloud top height is an important factor in satellite retrievals of COT and re with uncertainties around 10% for small values of COT and re; for water clouds these uncertainties can be greater than 10% for small values of re. The uncertainties found related with geometries are around 3%. The COT and re are assessed using well-known satellite cloud products, showing that the method used characterize the cloud field with more than 80% (82%) of the absolute differences between COT (re) mean values of all clouds (water plus ice clouds) centred in the range from ±10 (±10 µm), with absolute bias lower than 2 (2 μm) for COT (re) and root mean square error values lower than 10 (8 μm) for COT (re). The cloud water path (CWP), derived from satellite retrievals, and the shortwave cloud radiative effect at the surface (CRESW) are related for high fractional sky covers (Fsc >0.8), showing that water clouds produce more negative CRESW than ice clouds. The COT retrieved was also related to the cloud modification factor, which exhibits reductions and enhancements of the surface SW radiation of the order of 80% and 30%, respectively, for COT values lower than 10. A selected case study shows, using a ground-based sky camera that some situations classified by the satellite with high Fsc values correspond to situations of broken clouds where the enhancements actually occur. For this case study, a closure between the liquid water path (LWP) obtained from the satellite retrievals and the same cloud quantity obtained from ground-based microwave measurements was performed showing a good agreement between both LWP data set values.