Potential risk factors for medication non-adherence in patients with chronic obstructive pulmonary disease (COPD)

Aims - To investigate the effect of a range of demographic and psychosocial variables on medication adherence in chronic obstructive pulmonary disease (COPD) patients managed in a secondary care setting. Methods - A total of 173 patients with a confirmed diagnosis of COPD, recruited from an outpatient clinic in Northern Ireland, participated in the study. Data collection was carried out via face-to-face interviews and through review of patients’ medical charts. Social and demographic variables, co-morbidity, self-reported drug adherence (Morisky scale), Hospital Anxiety and Depression (HAD) scale, COPD knowledge, Health Belief Model (HBM) and self-efficacy scales were determined for each patient. Results - Participants were aged 67 ± 9.7 (mean ± SD) years, 56 % female and took a mean (SD) of 8.2 ± 3.4 drugs. Low adherence with medications was present in 29.5 % of the patients. Demographic variables (gender, age, marital status, living arrangements and occupation) were not associated with adherence. A range of clinical and psychosocial variables, on the other hand, were found to be associated with medication adherence, i.e. beliefs regarding medication effectiveness, severity of COPD, smoking status, presence of co-morbid illness, depressed mood, self-efficacy, perceived susceptibility and perceived barriers within the HBM (p < 0.05). Logistic regression analysis showed that perceived ineffectiveness of medication, presence of co-morbid illness, depressed mood and perceived barriers were independently associated with medication non-adherence in the study (P < 0.05). Conclusions - Adherence in COPD patients is influenced more by patients’ perception of their health and medication effectiveness, the presence of depressed mood and co-morbid illness than by demographic factors or disease severity.

Ocular mycoses:infections of the eye caused by fungi

Fungi are ubiquitous organisms in nature and can be found in association with healthy eyes. The incidence of actual fungal infection of the eye, however, is relatively low compared with that attributable to viruses and bacteria. Nevertheless, fungal infection of the eye is increasing especially in immuno-compromised patients and a wide variety of fungal infections have now been described worldwide with species of Fusarium, Aspergillus, Candida, and dematiaceous fungi predominating. At present there are a limited number of compounds available to control ocular mycoses while resistance to anti-fungal agents has been growing in recent years, especially to azoles. Several mechanisms of resistance have been identified including modification of sterol synthesis pathways by the fungus, modification of enzymes to reduce the binding of azoles to fungal components and increased efficiency of removal of the azole within fungal cells. Although resistance to amphotericin-B has been reported, it continues to be the most important treatment for life-threatening conditions and more severe ophthalmic infections. Natamycin is often first choice for filamentous fungal keratitis and topical amphotericin-B for Candida keratitis. Continued monitoring of the behaviour of ocular fungi will be essential in future together with the development of new anti-fungal agents.

Pharmacokinetics of a CCR5 inhibitor in rhesus macaques following vaginal, rectal and oral application

Objectives: This study measured and compared the pharmacokinetics of CMPD167, a small molecule antiretroviral CCR5 inhibitor with potential as an HIV microbicide, following vaginal, rectal and oral administration in rhesus macaques. Methods: Avaginal hydroxyethylcellulose (HEC) gel, a rectal HEC gel, a silicone elastomer matrix-type vaginal ring and an oral solution, each containing CMPD167, were prepared and administered to rhesus macaques pretreated with Depo-Provera. CMPD167 concentrations in vaginal fluid, vaginal tissue (ring only), rectal fluid and blood plasma were quantified by HPLC-mass spectrometry. Results: CMPD167 concentrations measured in rectal fluid, vaginal fluid and blood plasma were highly dependent on both the route of administration and the formulation type. Although rectal and vaginal fluid concentrations were highest when CMPD167 was administered locally (via either gel or ring), lower concentrations of the drug were also measured in these compartments following administration at the remote mucosal site or orally. CMPD167 levels in the vaginal and rectal fluid following oral administration were relatively low compared with local administration. Conclusions: The study provides clear evidence for vaginal-rectal and rectal-vaginal drug transfer pathways and suggests that oral pre-exposure prophylaxis with CMPD167 may be less efficacious at preventing sexual transmission of HIV-1 than topically applied products. ©The Author 2013.

Team reflexivity and innovation:the moderating role of team context

We developed and tested a team level contingency model of innovation, integrating theories regarding work demands, team reflexivity - the extent to which teams collectively reflect upon their working methods and functioning -, and team innovation. We argued that highly reflexive teams will be more innovative than teams low in reflexivity when facing a demanding work environment. The relationships between team reflexivity, a demanding work environment (i.e. quality of the physical work environment and work load) and team innovation was examined among 98 primary health care teams (PHCTs) in the UK, comprised of 1137 individuals. Results showed that team reflexivity is positively related to team innovation, and that there is an interaction between team reflexivity, team level workload, and team innovation, such that when team level workload is high, combined with a high level of team reflexivity, team innovation is also higher. The complementary interaction between team reflexivity, quality of physical work environment, and team innovation, showed that when the quality of the work environment is low, combined with a high level of team reflexivity, team innovation was also higher. These results are discussed in the context of the need for team reflexivity and team innovation among teams at work facing high work demands.