An evaluation of an adapted United States model of pharmaceutical care to improve psychoactive prescribing for nursing home residents in Northern Ireland (Fleetwood NI Study).

OBJECTIVES: To test the effect of an adapted U.S. model of pharmaceutical care on prescribing of inappropriate psychoactive (anxiolytic, hypnotic, and antipsychotic) medications and falls in nursing homes for older people in Northern Ireland (NI).

DESIGN: Cluster randomized controlled trial.

SETTING: Nursing homes randomized to intervention (receipt of the adapted model of care; n=11) or control (usual care continued; n=11).

PARTICIPANTS: Residents aged 65 and older who provided informed consent (N=334; 173 intervention, 161 control).

INTERVENTION: Specially trained pharmacists visited intervention homes monthly for 12 months and reviewed residents' clinical and prescribing information, applied an algorithm that guided them in assessing the appropriateness of psychoactive medication, and worked with prescribers (general practitioners) to improve the prescribing of these drugs. The control homes received usual care.

MEASUREMENTS: The primary end point was the proportion of residents prescribed one or more inappropriate psychoactive medicine according to standardized protocols; falls were evaluated using routinely collected falls data mandated by the regulatory body for nursing homes in NI.

RESULTS: The proportion of residents taking inappropriate psychoactive medications at 12 months in the intervention homes (25/128, 19.5%) was much lower than in the control homes (62/124, 50.0%) (odds ratio=0.26, 95% confidence interval=0.14–0.49) after adjustment for clustering within homes. No differences were observed at 12 months in the falls rate between the intervention and control groups.

CONCLUSION: Marked reductions in inappropriate psychoactive medication prescribing in residents resulted from pharmacist review of targeted medications, but there was no effect on falls.

The Effect of Liposome Encapsulation on the Pharmacokinetics of Recombinant Secretory Leukocyte Protease Inhibitor (rSLPI) Therapy after Local Delivery to a Guinea Pig Asthma Model

Inhaled recombinant Secretory Leukocyte Protease Inhibitor (rSLPI) has shown potential for treatment of inflammatory lung conditions. Rapid inactivation of rSLPI by cathepsin L (Cat L) and rapid clearance from the lungs have limited clinical efficacy. Encapsulation of rSLPI within 1,2-Dioleoyl-sn-Glycero-3-[Phospho-L-Serine]:Cholesterol liposomes (DOPS-rSLPI) protects rSLPI against Cat L inactivation in vitro. We aimed to determine the effect of liposomes on rSLPI pharmacokinetics and activity in vitro and after local delivery to the airways in vivo.

Examination of the physical state of chlorhexidine within viscoelastic, bioadhesive semisolids using Raman spectroscopy

This study examined the effects of polymeric components on the physical state of chlorhexidine within bioadhesive, semisolid formulations using Raman spectroscopy. Semisolid formulations were prepared in which chlorhexidine base (CHX, 5%w/w, particle size

Development and validation of a dried blood spot LC-MS/MS assay to quantify ranitidine in paediatric samples.

A novel approach has been developed to determine ranitidine in paediatric samples using dried blood spots (DBS) on Guthrie cards (Whatman 903). A selective and sensitive HPLC-MS/MS assay has been developed and validated using small volumes of blood (30µl). A 6mm disc was punched from each DBS and extracted with methanolic solution of the internal standard (IS) nizatidine. This was further subjected to solid phase extraction (SPE), followed by reversed phase HPLC separation, using a XBridge™ C18 column and mobile phase 10mM ammonium acetate/methanol (98:2 v/v) with a flow rate of 0.3mL/min. This was combined with multiple reaction monitoring (MRM) mass detection using electrospray ionisation (ESI). The calibration curve for ranitidine was found linear over the range 10-500ng/mL (r=0.996). The limit of quantification (LOQ) of the method was validated at 10ng/mL. Accuracy and precision values for within and between days were

Gas and grain chemistry in a protoplanetary disk

The chemistry in a protoplanetary accretion disk is modelled between a radius of 100 and 0.1 AU of the central object. We find that interaction of the gas with the dust grains is very important, both by removing a large fraction of the material from the gas in the outer regions and through the chemical reactions which can occur on the dust grain surfaces. In addition, collision with grains neutralises gaseous ions effectively and keeps the ionization fraction low. This results in a chemistry which is dominated by neutral-neutral reactions, even if ionization is provided by cosmic rays or by the decay of radioactive isotopes. We model the effects of two desorption processes with very different efficiencies and find that while these produce similar results over much of the disk for many species, some molecules are extremely sensitive to the nature of the desorption and may one day be used as an observational test for the desorption process.

Sulphur chemistry and evolution in hot cores

We compare the results of our JCMT spectral line survey of molecular gas towards ultracompact HII regions with the predictions of models of sulphur chemistry in hot cores. We investigate the range of evolutionary models that are consistent with the observed physical conditions and chemical abundances, and see to what extent it is possible to constrain core ages by comparing abundances with the predictions of chemical models. The observed abundance ratios vary little from source to source, suggesting that all the sources are at a similar evolutionary stage. The models are capable of predicting the observed abundances of H2S, SO, SO2, and CS. The models fail to predict the amount of OCS observed, suggesting that an alternative formation route is required. An initial H2S abundance from grain mantle evaporation of similar to 10(-7) is preferred.

Chemistry in oxygen-rich circumstellar envelopes

We have considered the chemistry occuring in the circumstellar envelope surrounding an oxygen-rich AGE star and have specifically modelled 4 sources; R Dor, TX Cam, OH231.8+4.2 and IK Tau. Methane has been assumed to be a parent molecule and the resulting carbon chemistry is investigated. We find that carbon chain molecules up to C2H4 can be abundant as can CH3CN and CH3OH. Our model extends previous work by including the chemistry of silicon, chlorine and phosphorus. The presence of CH4 as a parent and hence its daughter species CH3 and CH3+ leads to other carbon-bearing species such as H2CS, SiCH2, H2CN and CCl.

Chemistry in anisotropic asymptotic giant branch winds

We have constructed a model for chemistry in the outflow of an asymptotic giant branch (AGB) star, using a spheroidal anisotropy in density, after that used by Jura. The predicted distributions of a selection of representative species are shown, and it is suggested that the abundance distributions observed by interferometry in IRC + 10216 may be the result of directional variation in outflow velocity.