Home medication management practices and associated factors among patients with selected chronic diseases in a community pharmacy in Uganda

ABSTRACT: BACKGROUND: Chronic diseases are rapidly increasing and are currently the major cause of death and disability worldwide. Patients with chronic diseases experience many challenges including medicine-related problems. However, there is limited information about the home management of medicines among these patients. This study therefore was to determine home medication management practices and associated factors among patients with chronic diseases seeking care in a community pharmacy in Uganda. METHODS: A cross-sectional study was conducted in a community pharmacy in Kampala from June to July 2010. A total of 207 consenting chronic disease patients or caregivers of children with chronic disease were consecutively sampled. The patients were visited at home to evaluate their drug management practices and to check their medical forms for disease types and drugs prescribed. An interviewer-administered questionnaire and an observation checklist were used to collect the data. RESULTS: Overall home medication management was inappropriate for 70% (n = 145) of the participants (95% CI = 63.3-76.2) and was associated with perceived severity of disease (not severe OR =0.40, moderately severe OR = 0.35), duration of disease >5 years (OR = 2.15), and health worker not assessing for response to treatment (OR = 2.53). About 52% (n = 107) had inappropriate storage which was associated with inadequate information about the disease (OR = 2.39) and distance to the health facility >5 kilometres (OR = 2.82). Fifteen percent (n = 31) had no drug administration schedule and this was associated with increasing age (OR = 0.97), inadequate information about the disease (OR = 2.96), and missing last appointment for medical review (OR = 6.55). About 9% (n = 18) had actual medication duplication; 1.4% (n = 3) had expired medicines; while 18.4% (n = 38) had drug hoarding associated with increasing number of prescribers (OR = 1.34) and duration of disease (OR = 2.06). About 51% (n = 105) had multiple prescribers associated with perceiving the disease to be non severe (OR = 0.27), and having more than one chronic disease (OR = 2.37). CONCLUSIONS: Patients with chronic disease have poor home management of medicines. In order to limit the occurrence of poor outcomes of treatment or drug toxicity, health providers need to strengthen the education of patients with chronic disease on how to handle their medicines at home.

Electron impact ionization of hydrogen-like molybdenum ions

The electron impact ionization cross sections of hydrogen-like molybdenum ions were measured with an electron beam ion trap at the electron energies of 49.4, 64.4 and 79.6 keV The results are 2.82(22) x 10(-23), 3.13(29) x 10(-23) and 3.23(51) x 10(-23) cm(2), respectively. These results are compared with the experimental results measured previously. The agreement with the results obtained with, scaling formulae is also discussed.

Methods to increase response to postal and electronic questionnaires

Background: Postal and electronic questionnaires are widely used for data collection in epidemiological studies but non-response reduces the effective sample size and can introduce bias. Finding ways to increase response to postal and electronic questionnaires would improve the quality of health research. Objectives: To identify effective strategies to increase response to postal and electronic questionnaires. Search strategy: We searched 14 electronic databases to February 2008 and manually searched the reference lists of relevant trials and reviews, and all issues of two journals. We contacted the authors of all trials or reviews to ask about unpublished trials. Where necessary, we also contacted authors to confirm methods of allocation used and to clarify results presented. We assessed the eligibility of each trial using pre-defined criteria. Selection criteria: Randomised controlled trials of methods to increase response to postal or electronic questionnaires. Data collection and analysis: We extracted data on the trial participants, the intervention, the number randomised to intervention and comparison groups and allocation concealment. For each strategy, we estimated pooled odds ratios (OR) and 95% confidence intervals (CI) in a random-effects model. We assessed evidence for selection bias using Egger's weighted regression method and Begg's rank correlation test and funnel plot. We assessed heterogeneity among trial odds ratios using a Chi 2 test and the degree of inconsistency between trial results was quantified using the I 2 statistic. Main results: Postal We found 481 eligible trials.The trials evaluated 110 different ways of increasing response to postal questionnaires.We found substantial heterogeneity among trial results in half of the strategies. The odds of response were at least doubled using monetary incentives (odds ratio 1.87; 95% CI 1.73 to 2.04; heterogeneity P < 0.00001, I 2 = 84%), recorded delivery (1.76; 95% CI 1.43 to 2.18; P = 0.0001, I 2 = 71%), a teaser on the envelope - e.g. a comment suggesting to participants that they may benefit if they open it (3.08; 95% CI 1.27 to 7.44) and a more interesting questionnaire topic (2.00; 95% CI 1.32 to 3.04; P = 0.06, I 2 = 80%). The odds of response were substantially higher with pre-notification (1.45; 95% CI 1.29 to 1.63; P < 0.00001, I 2 = 89%), follow-up contact (1.35; 95% CI 1.18 to 1.55; P < 0.00001, I 2 = 76%), unconditional incentives (1.61; 1.36 to 1.89; P < 0.00001, I 2 = 88%), shorter questionnaires (1.64; 95%CI 1.43 to 1.87; P < 0.00001, I 2 = 91%), providing a second copy of the questionnaire at follow up (1.46; 95% CI 1.13 to 1.90; P < 0.00001, I 2 = 82%), mentioning an obligation to respond (1.61; 95% CI 1.16 to 2.22; P = 0.98, I 2 = 0%) and university sponsorship (1.32; 95% CI 1.13 to 1.54; P < 0.00001, I 2 = 83%). The odds of response were also increased with non-monetary incentives (1.15; 95% CI 1.08 to 1.22; P < 0.00001, I 2 = 79%), personalised questionnaires (1.14; 95% CI 1.07 to 1.22; P < 0.00001, I 2 = 63%), use of hand-written addresses (1.25; 95% CI 1.08 to 1.45; P = 0.32, I 2 = 14%), use of stamped return envelopes as opposed to franked return envelopes (1.24; 95% CI 1.14 to 1.35; P < 0.00001, I 2 = 69%), an assurance of confidentiality (1.33; 95% CI 1.24 to 1.42) and first class outward mailing (1.11; 95% CI 1.02 to 1.21; P = 0.78, I 2 = 0%). The odds of response were reduced when the questionnaire included questions of a sensitive nature (0.94; 95% CI 0.88 to 1.00; P = 0.51, I 2 = 0%). Electronic: We found 32 eligible trials. The trials evaluated 27 different ways of increasing response to electronic questionnaires. We found substantial heterogeneity among trial results in half of the strategies. The odds of response were increased by more than a half using non-monetary incentives (1.72; 95% CI 1.09 to 2.72; heterogeneity P < 0.00001, I 2 = 95%), shorter e-questionnaires (1.73; 1.40 to 2.13; P = 0.08, I 2 = 68%), including a statement that others had responded (1.52; 95% CI 1.36 to 1.70), and a more interesting topic (1.85; 95% CI 1.52 to 2.26). The odds of response increased by a third using a lottery with immediate notification of results (1.37; 95% CI 1.13 to 1.65), an offer of survey results (1.36; 95% CI 1.15 to 1.61), and using a white background (1.31; 95% CI 1.10 to 1.56). The odds of response were also increased with personalised e-questionnaires (1.24; 95% CI 1.17 to 1.32; P = 0.07, I 2 = 41%), using a simple header (1.23; 95% CI 1.03 to 1.48), using textual representation of response categories (1.19; 95% CI 1.05 to 1.36), and giving a deadline (1.18; 95% CI 1.03 to 1.34). The odds of response tripled when a picture was included in an e-mail (3.05; 95% CI 1.84 to 5.06; P = 0.27, I 2 = 19%). The odds of response were reduced when "Survey" was mentioned in the e-mail subject line (0.81; 95% CI 0.67 to 0.97; P = 0.33, I 2 = 0%), and when the e-mail included a male signature (0.55; 95% CI 0.38 to 0.80; P = 0.96, I 2 = 0%). Authors' conclusions: Health researchers using postal and electronic questionnaires can increase response using the strategies shown to be effective in this systematic review. Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.


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Effect of Turbine Inlet Temperature on Rotor Blade Tip Leakage Flow and Heat Transfer

One of the most critical gas turbine engine components, the rotor blade tip and casing, is exposed to high thermal load. It becomes a significant design challenge to protect the turbine materials from this severe situation. The purpose of this paper is to study numerically the effect of turbine inlet temperature on the tip leakage flow structure and heat transfer. In this paper, the effect of turbine inlet temperature on the tip leakage flow structure and heat transfer has been studied numerically. Uniform low (LTIT: 444 K) and high (HTIT: 800 K) turbine inlet temperature, as well as non-uniform inlet temperature have been considered. The results showed the higher turbine inlet temperature yields the higher velocity and temperature variations in the leakage flow aerodynamics and heat transfer. For a given turbine geometry and on-design operating conditions, the turbine power output can be increased by 1.33 times, when the turbine inlet temperature increases 1.80 times. Whereas the averaged heat fluxes on the casing and the blade tip become 2.71 and 2.82 times larger, respectively. Therefore, about 2.8 times larger cooling capacity is required to keep the same turbine material temperature. Furthermore, the maximum heat flux on the blade tip of high turbine inlet temperature case reaches up to 3.348 times larger than that of LTIT case. The effect of the interaction of stator and rotor on heat transfer features is also explored using unsteady simulations. The non-uniform turbine inlet temperature enhances the heat flux fluctuation on the blade tip and casing.

Effect of turbine inlet temperature on blade tip leakage flow and heat transfer

One of the most critical gas turbine engine components, rotor blade tip and casing, are exposed to high thermal load. It becomes a significant design challenge to protect the turbine materials from this severe situation. As a result of geometric complexity and experimental limitations, Computational Fluid Dynamics (CFD) tools have been used to predict blade tip leakage flow aerodynamics and heat transfer at typical engine operating conditions. In this paper, the effect of turbine inlet temperature on the tip leakage flow structure and heat transfer has been studied numerically. Uniform low (LTIT: 444 K) and high (HTIT: 800 K) turbine inlet temperature have been considered. The results showed the higher turbine inlet temperature yields the higher velocity and temperature variations in the leakage flow aerodynamics and heat transfer. For a given turbine geometry and on-design operating conditions, the turbine power output can be increased by 1.48 times, when the turbine inlet temperature increases 1.80 times. Whereas the averaged heat fluxes on the casing and the blade tip become 2.71 and 2.82 times larger, respectively. Therefore, about 2.8 times larger cooling capacity is required to keep the same turbine material temperature. Furthermore, the maximum heat flux on the blade tip of high turbine inlet temperature case reaches up to 3.348 times larger than that of LTIT case. The effect of the interaction of stator and rotor on heat transfer features is also explored using unsteady simulations.

Arteriovenous fistula outcomes in the elderly

OBJECTIVE: Over several decades, there has been an increase in the number of elderly patients requiring hemodialysis. These older patients typically have an increased incidence of comorbidities including diabetes, hypertension, and peripheral vascular disease. We undertook a systematic review of the current literature to assess outcomes of arteriovenous fistula (AVF) formation in the elderly and to compare the results of radiocephalic AVFs vs brachiocephalic AVFs in older patients.

METHODS: A literature search was performed using MEDLINE, Embase, PubMed, and the Cochrane Library. All retrieved articles published before December 31, 2014 (and in English) primarily describing the creation of hemodialysis vascular access for elderly patients were considered for inclusion. We report pooled AVF patency rates and a comparison of radiocephalic vs brachiocephalic AVF patency rates using odds ratios (ORs).

RESULTS: Of 199 relevant articles reviewed, 15 were deemed eligible for the review. The pooled 12-month primary and secondary AVF patency rates were 53.6% (95% confidence interval [CI], 47.3-59.9) and 71.6% (95% CI, 59.2-82.7), respectively. Comparison of radiocephalic vs brachiocephalic AVF patency rates demonstrated that radiocephalic AVFs have inferior primary (OR, 0.72; 95% CI, 0.55-0.93; P = .01) and secondary (OR, 0.76; 95% CI, 0.58-1.00; P = .05) patency rates.

CONCLUSIONS: This meta-analysis confirms that adequate 12-month primary and secondary AVF patency rates can be achieved in elderly patients. Brachiocephalic AVFs have both superior primary and secondary patency rates at 12 months compared with radiocephalic AVFs. These important data can inform clinicians' and patients' decision-making about suitability of attempting AVF formation in older persons.

HST/STIS observations of the high-velocity interstellar cloud HVC 291.2-41.2+80: a warm, mainly ionized high-velocity cloud

We present intermediate-resolution HST/STIS spectra of a high- velocity interstellar cloud ((LSR)-L-upsilon = + 80 kms(-1)) towards DI1388, a young star in the Magellanic Bridge located between the Small and Large Magellanic Clouds. The STIS data have a signal-to-noise ratio (S/N) of 20-45 and a spectral resolution of about 6.5 km s(-1) (FWHM), The high-velocity cloud absorption is observed in the lines of C II, O I, Si II, Si III, Si IV and S III. Limits can be placed on the amount of S II and Fe II absorption that is present. An analysis of the relative abundances derived from the observed species, particularly C II and O I, suggests that this high-velocity gas is warm (T-k similar to 10(3)-10(4) K) and predominantly ionized, This hypothesis is supported by the presence of absorption produced by highly ionized species, such as Si IV, This sightline also intercepts two other high-velocity clouds that produce weak absorption features at (LSR)-L-upsilon = + 113 and + 130kms(-1) in the STIS spectra.

An evaluation of cyclooxygenase-2 as a prognostic biomarker in mid-gut carcinoid tumours

Background/Aims:Mid-gut carcinoids (MGC) are the most common of the gastrointestinal carcinoid tumours. There is a lack of reliable prognostic indicators for MGC. Cox-2 and Bcl-2 were evaluated as prognostic biomarkers in a cohort of well-characterised non-appendiceal MGC. Methods: Tissue from the primary MGC tumours of 37 patients was subjected to immunohistochemical detection of Cox-2 and Bcl-2. In 9 cases tissue from secondary lesions was also examined. The study assessed whether tumour-associated Cox-2 and Bcl-2 expression were related to patient survival. Results: Cox-2 expression was demonstrated in 30/36 primary tumours. When all tumours were analysed Cox-regression analysis indicated a trend towards worsening survival with increasing Cox-2 histoscore (intensity x proportion; hazard ratio 1.53, 95%CI 0.93, 2.52; p=0.09). Analysis of Cox-2 positive tumours revealed a highly significant association between increasing histoscore and decreased survival (hazard ratio 3.03, 95%CI 1.33, 6.91, p=0.008). Tumour-associated Bcl-2 expression had no effect on patient survival (hazard ratio 1.12, 95% CI 0.42, 2.99 p=0.82). There was no significant association between Cox-2 and Bcl-2 expression (ï?£2 p=0.16), or Cox-2 histoscore and Bcl-2 expression (MWU p=0.59). Analysis of the Cox-2 histoscores of primary tumours and their corresponding secondary lesions, revealed a statistically significant trend towards increasing histoscore in the latter (Wilcoxon p=0.04). Conclusions: This study has provided evidence that Cox-2 expression in primary MGC may be associated with a more negative prognostic outlook.

Tandem enzyme-catalysed reduction/cis-dihydroxylation of 2,2,2-trifluoroacetophenone: chemoenzymatic routes to new enantiopure phenol and benzylic alcohol reagents

Factors that control the competition between toluene dioxgenase-catalysed arene cis-dihydroxylation and dehydrogenase-catalysed ketone reduction have been studied, using whole cells of Pseudomonas putida UV and three alkylaryl ketones. The triol metabolite, obtained from 2,2,2-trifluoroacetophenone, has been used in the synthesis of single enantiomer chiral phenols and benzylic alcohols. Potential applications of the methylether derivatives of the chiral phenols and benzylic alcohols, as resolving agents, have been found. (c) 2007 Society of Chemical Industry.

Radiocarbon wiggle-match dating of proglacial lake sediments - Implications for the 8.2 ka event

The problem of insufficient age-control limits the utilisation of the 8.2 ka BP event for modelling freshwater forcing in climate change studies. High-resolution radiocarbon dates, magnetic susceptibility and lithostratigraphic evidence from a lake sediment core from Nedre Hervavatnet located at Sygnefjell in western Norway provide a record of the early Holocene. We use the method of radiocarbon wiggle-match dating of the lake sediments using the non-linear relationship between the C-14 calibration curve and the consecutive accumulation order of the sample series in order to build a high-resolution age-model. The timing and duration of Holocene environmental changes is estimated using 38 AMS radiocarbon dates on terrestrial macrofossils, insects and chironomids covering the time period from 9750 to 1180 cal BP. Chironomids, Salix and Betula leaves produce the most consistent results. Sedimentological and physical properties of the core suggest that three meltwater events with high sedimentation rates are superimposed on a long-term trend with glacier retreat between 9750 and 8000 cal BP. The lake sediment sequence of Nedre Hervavatnet demonstrates the following: only a reliable high-resolution geochronology based on carefully selected terrestrial macrofossils allows the reconstruction of a more refined and complex environmental change history before and during the 8.2 ka event. (C) 2009 Elsevier Ltd. All rights reserved.

Nutritional status of adult ewes during early and mid-pregnancy. 2. Effects of supplementation with selenised yeast on ewe reproduction and offspring performance to weaning

The objective of this study was to determine the effects of selenium (Se) supplementation of mature ewes in the period from day - 14 to day 90 post mating on Se status, productivity and viability of ewes and their offspring. Multiparous crossbred ewes (n = 82) were randomly assigned to receive a standard dried grass-based diet (control) or dried grass diet supplemented with 1 g of selenised yeast (Selplex (R)), providing 0.5 mg Se per ewe per day. After day 90 post mating, all ewes were offered grass-based diets supplemented with a standard multivitamin and mineral mix, up to lambing. Ewes that were fed additional Se had increased (P 0,05). Supplemented ewes weaned lambs on average 2 kg heavier than control ewes, due to the higher (P

Multiproxy evidence for terrestrial and aquatic ecosystem responses during the 8.2 ka cold event as recorded at Hojby So, Denmark

A sediment succession from Hojby So, a lake in eastern Denmark, covering the time period 9400-7400 cal yr BP was studied using high-resolution geochemistry, magnetic susceptibility, pollen, macrofossil, diatom, and algal pigment analysis to investigate responses of the terrestrial and aquatic ecosystems to the 8.2 ka cold event. A reduced pollen production by thermophilous deciduous tree taxa in the period c. 8250-8000 cal yr BP reveal that the forest ecosystem was affected by low temperatures during the summer and winter/early-spring seasons. This finding is consistent with the timing of the 8.2 ka cold event as registered in the Greenland ice cores. At Hojby So, the climate anomaly appears to have started 200-250 yr earlier than the 8.2 ka cold event as the lake proxy data provide strong evidence for a precipitation-induced distinct increase in catchment soil erosion beginning around 8500 cal yr BP. Alteration of the terrestrial environment then resulted in a major aquatic ecosystem change with nutrient enrichment of the lake and enhanced productivity, which lasted until c. 7900 cal yr BP. (C) 2009 University of Washington. Published by Elsevier Inc. All rights reserved.