La collaboration médecin-pharmacien en soins de première ligne pour la gestion des dyslipidémies : un essai clinique contrôlé et randomisé en grappe (étude TEAM)

L’hypothèse de cette thèse est qu’une pratique collaborative médecins de famille-pharmaciens communautaires (PCMP) où le pharmacien fournit des soins pharmaceutiques avancés avec ajustement posologique d’une statine permettrait aux patients avec une dyslipidémie une réduction plus importante de leur LDL et augmenterait le nombre de patients atteignant leurs cibles lipidiques. Dans une étude clinique contrôlée et randomisée en grappe visant à évaluer une PCMP pour des patients ayant une dyslipidémie (l’étude TEAM), une journée de formation basée sur un protocole de traitement et des outils cliniques a été offerte aux pharmaciens PCMP pour les préparer à fournir des soins pharmaceutiques avancés. Les connaissances des pharmaciens sur les dyslipidémies étaient faibles avant la formation mais se sont améliorées après (moyenne de 45,8% à 88,2%; p < 0,0001). Après la formation, les pharmaciens avaient un haut niveau d’habiletés cliniques théoriques et pratiques. Bref, une journée de formation basée sur un protocole de traitement et des outils cliniques était nécessaire et adéquate pour préparer les pharmaciens à fournir des soins pharmaceutiques avancés à des patients ayant une dyslipidémie dans le contexte d’une étude clinique. Dans l’étude TEAM, 15 grappes de médecins et de pharmaciens (PCMP : 8; soins habituels (SH) : 7) ont suivi pendant un an, 225 patients (PCMP : 108; SH : 117) à risque modéré ou élevé de maladie coronarienne qui débutaient ou étaient déjà traités par une monothérapie avec une statine mais qui n’avaient pas atteint les cibles lipidiques. Au départ, par rapport aux patients SH, les patients PCMP avaient un niveau de LDL plus élevé (3,5 mmol/L vs 3,2 mmol/L) et recevaient moins de statine à puissance élevée (11,1 % vs 39,7 %). Après 12 mois, la différence moyenne du changement de LDL entre les groupes était égale à -0,2 mmol/L (IC95%: -0,3 à -0,1) et -0,04 (IC95%: -0,3 à 0,2), sans ajustement et avec ajustement, respectivement. Le risque relatif d’atteindre les cibles lipidiques était 1,10 (IC95%: 0,95 à 1,26) et 1,16 (1,01 à 1,32), sans ajustement et avec ajustement, respectivement. Les patients PCMP ont eu plus de visites avec un professionnel de la santé et d’analyses de laboratoire et étaient plus enclins à rapporter des changements de style de vie. La PCMP a amélioré l’adhésion aux lignes directrices en augmentant la proportion de patients aux cibles lipidiques. Les données intérimaires de l’étude TEAM (PCMP : 100 patients; SH : 67 patients) ont permis d’évaluer les coûts directs annuels du suivi du pharmacien du groupe PCMP (formation, visites, laboratoire), du médecin (visites, laboratoire) et du traitement hypolipémiant. Le suivi du pharmacien a coûté 404,07$/patient, incluant 320,67$ pour former les pharmaciens. Le coût global incrémental était 421,01$/patient. Une pratique collaborative pour des patients ayant une dyslipidémie engendre un coût raisonnable.

Croissance de l’équipe éditoriale, partenariat institutionnel et développement d’un volet grand public / Expanding the Editorial Team, an Institutional Collaboration and a Greater Public Reach

Éditoral / Editorial

Croissance de l’équipe éditoriale, partenariat institutionnel et développement d’un volet grand public / Expanding the Editorial Team, an Institutional Collaboration and a Greater Public Reach

Éditoral / Editorial

Electrochemical Reduction and Voltammetric Determination of Metronidazole Benzoate at Modified Carbon Paste Electrode

A metalloporphyrin incorporated carbon paste sensor has been developed for the determination of metronidazole benzoate (MTZB). Zn(II) complex of 5,10,15,20-tetrakis (3-methoxy-4-hydroxy phenyl) porphyrin (TMHPP) was used as the active material. The MTZB gave a well-defined reduction peak at - 0.713V in 0.1 mol l -1 phosphate buffer solution of pH around 7. Compared with bare carbon paste electrode (CPE), the TMHPP Zn(II) modified electrode significantly enhanced the reduction peak current of MTZB as well as lowered its reduction potential. Under optimum conditions the reduction peak current was proportional to MTZB concentration over the range 1×10-3 mol1-1 to 1×10-5mol1-1. The detection limit was found to be 4.36×10-6mol1-1 . This sensor has been successfully applied for the determination of MTZB in pharmaceutical formulations and urine samples.

An Inter-digital Capacitive Electrode Modified as a Pressure Sensor

Inter-digital capacitive electrodes working as electric field sensors have been developed for touch panel applications. Evaluation circuits to convert variations in electric fields in such sensors into computer compatible data are commercially available. We report development of an Interdigital capacitive electrode working as a sensitive pressure sensor in the range 0-120 kPa. Essentially it is a touch/proximity sensor converted into a pressure sensor with a suitable elastomer buffer medium acting as the pressure transmitter. The performance of the sensor has been evaluated and reported. Such sensors can be made very economical in comparison to existing pressure sensors. Moreover, they are very convenient to be fabricated into sensor arrays involving a number of sensors for distributed pressure sensing applications such as in biomedical systems.

Photoemission optogalvanic studies with copper as target electrode

Photoemission optogalvanaic (POG) effect has been observed by irradiating copper target electrode, in a nitrogen discharge cell using 1.06 μm and frequency doubled 532 nm Nd:YAG laser pulse. Measurement of the nature of the variation of POG signal strength with 532 nm laser fluence confirms the two photon induced photoelectric emission from copper. However, using 1.06 μm laser pulses thermally assisted photoemission is observed.

A Study Of The Effect Of Electrode And Overlayer Films On The Electrical Properties Of Certain Metal Films

This thesis consists of a study of the effect of electrode films and overlayer films on the electrical properties of certain metal films. The films have been prepared on glass substrates by thermal evapouration in a vaccum 10 terr. The properties of Al films on Ag, Al,Au and Cu films on In electrodes ,and Bi/Ag bilayer films have been studied. The influence of annealing electrodes at higher temperature on the electrical properties of metal films has also been investigated. Further the effect of varying layer thickness in the bilayer films ,both annealed at higher temperature and annealed at room temperature have been examined.

"Delayering in FACT - Impact on Managerial Motivation and Team Effectiveness

The main objective of the Research was to study the Delayering scheme implemented in FACT in all its aspects and to examine wlietlier implementation of delayering has contributed to improvement in organizational performance by improving managerial motivation and team effectiveness. To enable this, a post-delayering impact assessment was done by eliciting views and analyzing the perception of managers affected by the change programme. Organisation-wide Surveys were carried out as part of data collection - prior to, during and after implementation. The methodology adopted was the Case Study approach, which involved a longitudinal study of the Implementation process using tools such- as Observation, Opinion surveys and Interviews and relating the research findings with the theories/ studies on the subject for generalization and for drawing conclusions

Chemically Modified Glassy Carbon Electrode as Sensors for Various Pharmaceuticals

Voltammetric methods are applicable for the determination of a wide variety of both organic and inorganic species. Its features are compact equipment, simple sample preparation, short analysis time, high accuracy and sensitivity. Voltammetry is especially suitable for laboratories in which only a few parameters have to be monitored with a moderate sample throughput. Of various electrode materials, glassy carbon electrode is particularly useful because of its high electrical conductivity, impermeability to gases, high chemical resistance, reasonable mechanical and dimensional stability and widest potential range of all carbonaceous electrodes. Electrode modification is a vigorous research area by which the electrochemical determination of various analyte species is facilitated. The scope of pharmaceutical analysis includes the analytical investigation of pure drug, drug formulations, impurities and degradation products of drugs, biological samples containing the drugs and their metabolites with the aim of obtaining data that can contribute to the maximal efficacy and maximal safety of drug therapy. This thesis presents the modification of glassy carbon electrode using metalloporphyrin and dyes and subsequently using these modified electrodes for the determination of various pharmaceuticals. The thesis consists of 9 chapters.

Accuracy of outcome anticipation, but not gaze behavior, differs against left- and right-handed penalties in team-handball goalkeeping

Low perceptual familiarity with relatively rarer left-handed as opposed to more common right-handed individuals may result in athletes' poorer ability to anticipate the former's action intentions. Part of such left-right asymmetry in visual anticipation could be due to an inefficient gaze strategy during confrontation with left-handed individuals. To exemplify, observers may not mirror their gaze when viewing left- vs. right-handed actions but preferentially fixate on an opponent's right body side, irrespective of an opponent's handedness, owing to the predominant exposure to right-handed actions. So far empirical verification of such assumption, however, is lacking. Here we report on an experiment where team-handball goalkeepers' and non-goalkeepers' gaze behavior was recorded while they predicted throw direction of left- and right-handed 7-m penalties shown as videos on a computer monitor. As expected, goalkeepers were considerably more accurate than non-goalkeepers and prediction was better against right- than left-handed penalties. However, there was no indication of differences in gaze measures (i.e., number of fixations, overall and final fixation duration, time-course of horizontal or vertical fixation deviation) as a function of skill group or the penalty-takers' handedness. Findings suggest that inferior anticipation of left-handed compared to right-handed individuals' action intentions may not be associated with misalignment in gaze behavior. Rather, albeit looking similarly, accuracy differences could be due to observers' differential ability of picking up and interpreting the visual information provided by left- vs. right-handed movements.

Summary of Research Conducted by the Manufacturing Systems Team 1994-2002

The Manufacturing Systems team was one of the research teams within the Lean Aerospace Initiative (LAI) whose goal was to document, analyze and communicate the design attributes and relationships that lead to significant performance improvements in manufacturing systems in the defense aerospace industry. This report will provide an integrated record of this research using the Production Operations Transition to Lean Roadmap as its organizing framework.