A pilot study to evaluate the self-medication system for liver transplant patients at the Queen Elizabeth Hospital in Birmingham

Background and Objective: Medication non-compliance is a considerable obstacle in achievinga therapeutic goal, whichcan result in poorerhealthcare outcomes, increased expenditure, wastage and potential for medication resistance. The UK Government’s Audit Commission’s publication ‘A Spoonful of Sugar’1 addresses these issues and promotes self-medication systems as a possible solution. The self-medication system within the Liver Transplant Unit (LTU) was implemented to induct patients onto new post- transplantation medication regimes ready for discharge. The system involves initial consultations with both the Liver Transplant Pharmacist and Trans- plant Co-ordinator, supported with additional advice as and when necessary. Design: Following ethical approval, evaluation of the self-medication sys- tem for liver transplant patients was conducted between January and March 2004 via two methods: audit and structured post-transplantation interview. The audit enabled any discrepancies between current Hospital guidelines and Liver Transplant Unit (LTU) practices to be highlighted. Patient interviews generated a retrospective insight into patient acceptance of the self-medication system. Setting: LTU, Queen Elizabeth Hospital, Birmingham, England. Main Outcome Measures: LTU compliance with Hospital self-medication guidelines and patient insight into self-medication system. Results: A total of seven patients were audited. Findings illustrated that self- medication by transplant patients is a complex process which was not fully addressed by current Hospital self-medication guidelines. Twenty-three patients were interviewed, showing an overwhelming positive attitude to- wards participating in their own care and a high level of understanding towards their individual medication regimes. Following a drugs counselling session, 100% of patients understood why they were taking their medica- tion, and their doses, 95% understood how to take their medication and 85% were aware of potential side effects. Conclusions: From this pilot evaluation it can be stated that the LTU self-medication system is appreciated by patients and assists them in fully understanding their medication regimes. There appear to be no major defects in the system. However areas such as communication barriers and on-going internet education were illustrated as areas for possible future investigation. References: 1. Audit Commission. A spoonful of sugar – medicines management in NHS hospitals. London: Audit Commission; 2001.

Increasing flower longevity in Alstroemeria

The vase-life of Alstroemeria (cv. Rebecca) flowers is terminated when the tepals abscise. Abscission was accelerated by both chloroethylphosphonic acid (CEPA) and 1-aminocyclopropane-1-carboxylic acid (ACC). Petals abscised 24 h earlier compared with controls, when isolated cymes were placed in 340 nM CEPA, and earlier still when higher concentrations were used. This suggests that flowers of this Alstroemeria cultivar are very ethylene sensitive. Treatment with silver thiosulphate (STS) overcame the effects of exposure to CEPA and delayed perianth abscission of untreated isolated flowers by 3-4 days. The inclusion of 1% sucrose in the vase solution also extended longevity but not by as much as STS treatment; combined STS and sucrose treatments did not increase longevity beyond that of either treatment alone. However, removal of the young buds from the axil of the first flower was the most effective treatment to extend vase-life and encouraged the growth and development of the remaining flower. Flowers on cut inflorescences from which young axillary buds were trimmed more than doubled in fresh weight 6 days after flower opening compared with an increase of only 70-80% in those untreated or treated with STS and/or sucrose. Growth was less in isolated cymes but followed a similar pattern. The effect of STS and/or sucrose treatment was synergistic with the trimming treatment and thus the vase-life of trimmed, STS and sucrose-treated flowers was over 7 days longer than that for untreated controls. © 2003 Elsevier B.V. All rights reserved.