Development of a quality use of medicines coding system to rate clinical pharmacists' medication review recommendations

Objective: To develop a 'quality use of medicines' coding system for the assessment of pharmacists' medication reviews and to apply it to an appropriate cohort. Method: A 'quality use of medicines' coding system was developed based on findings in the literature. These codes were then applied to 216 (111 intervention, 105 control) veterans' medication profiles by an independent clinical pharmacist who was supported by a clinical pharmacologist with the aim to assess the appropriateness of pharmacy interventions. The profiles were provided for veterans participating in a randomised, controlled trial in private hospitals evaluating the effect of medication review and discharge counselling. The reliability of the coding was tested by two independent clinical pharmacists in a random sample of 23 veterans from the study population. Main outcome measure: Interrater reliability was assessed by applying Cohen's kappa score on aggregated codes. Results: The coding system based on the literature consisted of 19 codes. The results from the three clinical pharmacists suggested that the original coding system had two major problems: (a) a lack of discrimination for certain recommendations e. g. adverse drug reactions, toxicity and mortality may be seen as variations in degree of a single effect and (b) certain codes e. g. essential therapy were in low prevalence. The interrater reliability for an aggregation of all codes into positive, negative and clinically non-significant codes ranged from 0.49-0.58 (good to fair). The interrater reliability increased to 0.72-0.79 (excellent) when all negative codes were excluded. Analysis of the sample of 216 profiles showed that the most prevalent recommendations from the clinical pharmacists were a positive impact in reducing adverse responses (31.9%), an improvement in good clinical pharmacy practice (25.5%) and a positive impact in reducing drug toxicity (11.1%). Most medications were assigned the clinically non-significant code (96.6%). In fact, the interventions led to a statistically significant difference in pharmacist recommendations in the categories; adverse response, toxicity and good clinical pharmacy practice measured by the quality use of medicine coding system. Conclusion: It was possible to use the quality use of medicine coding system to rate the quality and potential health impact of pharmacists' medication reviews, and the system did pick up differences between intervention and control patients. The interrater reliability for the summarised coding system was fair, but a larger sample of medication regimens is needed to assess the non-summarised quality use of medicines coding system.

Reliability of scores between stroke patients and significant others on the Reintegration to Normal Living (RNL) Index

Purpose: This study measured reliability between stroke patients' and significant others' scores on items on the Reintegration to Normal Living (RNL) Index and whether there were any scoring biases. Method The 11-item RNL Index was administered to 57 pairs of patients and significants six months after stroke rehabilitation. The index was scored using a 10-point visual analogue scale. Patient and significant other demographic information and data on patients' clinical, functional and cognitive status were collected. Reliability was measured using the intra-class correlation coefficient (ICC) and percent agreement. Results: Overall poor reliability was found for the RNL Index total score (ICC=.36, 95% CI. 07 to .59) and the daily functioning subscale (ICC=.24, 95% CI -.003 to .46) and moderate reliability was found for the perception of self subscale (ICC=.55, 95 % CI .28 to .73). There was a moderate bias for patients to rate themselves as achieving better reintegration than was indicated by significant others, although no demographic or clinical factors were associated with this bias. Exact match agreement was best for the subjective items and worse for items reflecting mobility around the community and participation in a work activity. Conclusions: Caution is needed when interpreting patient information reported by significant others on the RNL Index. The use of a shorter scale to rate the RNL Index requires investigation.

Effects of physical activity on emotional well-being among older Australian women - Cross-sectional and longitudinal analyses

Objective: To explore relationships between physical activity and mental health cross-sectionally and longitudinally in a large cohort of older Australian women. Method: Women in their 70s participating in the Australian Longitudinal Study on Women's Health responded in 1996 (aged 70-75) and in 1999 (aged 73-78). Cross-sectional data were analyzed for 10,063 women and longitudinal data for 6472. Self-reports were used to categorize women into four categories of physical activity at each time point as well as to define four physical activity transition categories across the 3-year period. Outcome variables for the cross-sectional analyses were the mental health component score (MCS) and mental health subscales of the Medical Outcomes Study Short Form (SF-36). The longitudinal analyses focused on changes in these variables. Confounders included the physical health component scale (PCS) of the SF-36, marital status, body mass index (BMI) and life events. Adjustment for baseline scores was included for the longitudinal analyses. Results: Cross-sectionally, higher levels of physical activity were associated with higher scores on all dependent variables, both with and without adjustment for confounders. Longitudinally, the effects were weaker, but women who had made a transition from some physical activity to none generally showed more negative changes in emotional well-being than those who had always been sedentary, while those who maintained or adopted physical activity had better outcomes. Conclusion: Physical activity is associated with emotional well-being among a population cohort of older women both cross-sectionally and longitudinally, supporting the need for the promotion of appropriate physical activity in this age group. (C) 2003 Elsevier Science Inc. All rights reserved.

A comprehensive insight into floc characteristics and their impact on compressibility and settleability of activated sludge

This paper presents a comprehensive study of sludge floc characteristics and their impact on compressibility and settleability of activated sludge in full scale wastewater treatment processes. The sludge flocs were characterised by morphological (floc size distribution, fractal dimension, filament index), physical (flocculating ability, viscosity, hydrophobicity and surface charge) and chemical (polymeric constituents and metal content) parameters. Compressibility and settleability were defined in terms of the sludge volume index (SVI) and zone settling velocity (ZSV). The floc morphological and physical properties had important influence on the sludge compressibility and settleability. Sludges containing large flocs and high quantities of filaments, corresponding to lower values of fractal dimension (D-f), demonstrated poor compressibility and settleability. Sludge flocs with high flocculating ability had lower SVI and higher ZSV, whereas high values of hydrophobicity, negative surface charge and viscosity of the sludge flocs correlated to high SVI and low ZSV. The quantity of the polymeric compounds protein. humic substances and carbohydrate in the sludge and the extracted extracellular polymeric substances (EPS) had significant positive correlations with SVI. The ZSV was quantitatively independent of the polymeric constituents. High concentrations of the extracted EPS were related to poor compressibility and settleability. The cationic ions Ca, Mg, Al and Fe in the sludge improved significantly the sludge compressibility and settleability. (C) 2003 Elsevier Science B.V. All rights reserved.

Relationship between flocculation of activated sludge and composition of extracellular polymeric substances

Activated sludge floes are a flocculated mass of microorganisms, extracellular polymeric substances (EPS) and adsorbed organic and inorganic material. The structure of the floes is very heterogeneous and floes with very different properties and morphologies may occur, depending on the conditions in the activated sludge treatment plant and wastewater composition. Present thinking suggests that cations, such as calcium, create cationic bridges with EPS excreted by the bacteria and thereby hold the various floe constituents together. However, due to the complex and heterogeneous nature of activated sludge, the mechanisms have neither been thoroughly investigated nor successfully quantified. A better understanding and description of the biological flocculation process is necessary in order to establish more efficient operational strategies. The main aim of this study was to get a comprehensive and unique insight into the floe properties of activated sludge and to assess the relative impact of chemical and physical parameters. A variety of sludges from full scale treatment plants with different settling properties were characterised. The interrelationships between floe parameters such as composition of EPS, surface properties and floe structure, and their effect on the flocculation and separation properties were assessed. The results indicate that the EPS, both in terms of quantity and quality, are very important for the floe properties of the activated sludge. However, presence of filaments may alter the physical properties of the floes considerably. The EPS showed positive correlations to sludge volume index (SVI) if only sludges with low or moderate numbers of filaments were included. The surface properties were more affected by the composition of the EPS than by the number of filaments. The EPS showed positive correlation to negative surface charge and a negative correlation to relative hydrophobicity and flocculation ability. The negative correlation between flocculation ability and amount of EPS was surprising. The shear sensitivity, measured as degree of erosion of floes when subjected to shear, was more affected by floe size and number of filaments than amount of EPS.

The use of 16s rDNA restriction fragment length polymorphism analysis for the identification of non-fermenting gram negative bacilli in a cystic fibrosis microbiology referral service

The utility of 16s rDNA restriction fragment length polymorphism (RFLP) analysis for the partial genomovar differentiation of Burkholderia cepacia complex bacterium is well documented. We compared the 16s rDNA RFLP signatures for a number of non-fermenting gram negative bacilli (NF GNB) LMG control strains and clinical isolates pertaining to the genera Burkholderia, Pseudomonas, Achromobacter (Alcaligenes), Ralstonia, Stenotrophomonas and Pandoraea. A collection of 24 control strain (LMG) and 25 clinical isolates were included in the study. Using conventional PCR, a 1.2 kbp 16s rDNA fragment was generated for each organism. Following restriction digestion and electrophoresis, each clinical isolate RFLP signature was compared to those of the control strain panel. Nineteen different RFLP signatures were detected from the 28 control strains included in the study. TwentyoneyTwenty- five of the clinical isolates could be classified by RFLP analysis into a single genus and species when compared to the patterns produced by the control strain panel. Four clinical B. pseudomallei isolates produced RFLP signatures which were indistinguishable from B. cepacia genomovars I, III and VIII. The identity of these four isolates were confirmed using B. pseudomallei specific PCR. 16s rDNA RFLP analysis can be a useful identification strategy when applied to NF GNB, particularly for those which exhibit colistin sulfate resistance. The use of this molecular based methodology has proved very useful in the setting of a CF referral laboratory particularly when utilised in conjunction with B. cepacia complex and genomovar specific PCR techniques. Species specific PCR or sequence analysis should be considered for selected isolates; especially where discrepancies between epidemiology, phenotypic and genotypic characteristics occur.

Genotype and environment effects on dynamics of harvest index during grain filling in sorghum

An approach based on a linear rate of increase in harvest index (141) with time after anthesis has been used as a simple means-to predict grain growth and yield in many crop simulation models. When applied to diverse situations, however, this approach has been found to introduce significant error in grain yield predictions. Accordingly, this study was undertaken to examine the stability of the HI approach for yield prediction in sorghum [Sorghum bicolor (L.) Moench]. Four field experiments were conducted under nonlimiting water. and N conditions. The experiments were sown at times that ensured a broad range in temperature and radiation conditions. Treatments consisted of two population densities and three genotypes varying in maturity. Frequent sequential harvests were used to monitor crop growth, yield, and the dynamics of 111. Experiments varied greatly in yield and final HI. There was also a tendency for lower HI with later maturity. Harvest index dynamics also varied among experiments and, to a lesser extent, among treatments within experiments. The variation was associated mostly with the linear rate of increase in HI and timing of cessation of that increase. The average rate of HI increase was 0.0198 d(-1), but this was reduced considerably (0.0147) in one experiment that matured in cool conditions. The variations found in IN dynamics could be largely explained by differences in assimilation during grain filling and remobilization of preanthesis assimilate. We concluded that this level of variation in HI dynamics limited the general applicability of the HI approach in yield prediction and suggested a potential alternative for testing.

The genetics of glycosylation in Gram-negative bacteria

In recent years there has been a dramatic increase in reports of glycosylation of proteins in various Gram-negative systems including Neisseria meningitidis, Neisseria gonorrhoeae, Campylobacter jejuni, Pseudomonas aeruginosa, Escherichia coli, Caulobacter crescentus, Aeromonas caviae and Helicobacter pylori. Although this growing list contains many important pathogens (reviewed by Benz and Schmidt [Mol. Microbiol. 45 (2002) 267-276]) and the glycosylations are found on proteins important in pathogenesis such as pili, adhesins and flagella the precise role(s) of the glycosylation of these proteins remains to be determined. Furthermore, the details of the glycosylation biosynthetic process have not been determined in any of these systems. The definition of the precise role of glycosylation and the mechanism of biosynthesis will be facilitated by a detailed understanding of the genes involved. (C) 2002 Federation of European Microbiological Societies. Published by Elsevier Science B.V. All rights reserved.

Comprometimento no trabalho de gestores p??blicos em uma autarquia estadual no Brasil

O objetivo deste artigo ?? compreender a percep????o dos gestores, que atuam com o planejamento estrat??gico de uma organiza????o p??blica, sobre o construto de comprometimento no trabalho, bem como a influ??ncia dessa percep????o em suas pr??ticas cotidianas de gest??o. Para tanto, realizou-se, inicialmente, pesquisa bibliogr??fica focando quest??es relacionadas ao sentido e natureza do construto, bem como sobre os estudos realizados sobre o tema do comprometimento no contexto da administra????o p??blica. Em seguida, foram coletados dados com gestores mediante entrevista com roteiro semiestruturado, os quais foram analisados por meio da t??cnica de an??lise de conte??do. As evid??ncias indicam que os gestores associam o v??nculo ao trabalho a quest??es atitudinais e de inten????es comportamentais e que suas pr??ticas cotidianas s??o influenciadas pela percep????o de comprometimento dos indiv??duos, admitindo que as decis??es tomadas, motivadas por essa percep????o, podem trazer consequ??ncias negativas tanto para a organiza????o quanto para o indiv??duo.

Vantagens e desvantagens do preg??o na gest??o de compras no setor p??blico: o caso da Funasa/PB

O presente artigo ?? parte de um estudo explorat??rio cujo objetivo foi analisar as vantagens e desvantagens na aquisi????o de bens e servi??os por meio das modalidades de licita????o preg??o presencial e eletr??nico no servi??o p??blico. Para isso, foi realizado um estudo de caso na Funda????o Nacional de Sa??de da Para??ba. A parte da pesquisa divulgada neste artigo, al??m de uma s??ntese sobre o referencial te??rico, apresenta as caracter??sticas investigadas da modalidade de licita????o preg??o, comparando suas formas presencial e eletr??nica na institui????o estudada. Os resultados apontam aspectos relevantes quanto ??s quest??es: vantagens e desvantagens do preg??o eletr??nico em rela????o ao preg??o presencial e vice-versa; recursos para atendimento de despesas; planejamento anual da FUNASA/PB; economia de pre??o; economia e repasse de recursos para outras necessidades; prazos de fornecimento; treinamento e capacita????o de pessoal. Conclui a exposi????o destacando alguns pontos fortes e fracos do processo, sugerindo medidas a serem avaliadas no que tange a capacita????o de pessoal e planejamento anual na FUNASA/PB.

As reformas administrativas no Brasil: modelos, sucessos e fracassos

O artigo rev??, com base na bibliografia especializada, as reformas e tentativas de reformas administrativas realizadas no pa??s, desde o Estado Novo, passando pelas tentativas dos governos militares e pelas propostas mais recentes da Nova Rep??blica, e chegando at?? a reforma Bresser Pereira. O balan??o cr??tico ?? bastante negativo, sobretudo, porque as grandes reformas, precisamente pela sua abrang??ncia, nunca foram efetivamente implementadas. O sistema do m??rito no servi??o p??blico federal ?? um bom exemplo. As dificuldades de implementa????o das grandes reformas, advindas principalmente de sua grande complexidade, resultam tamb??m de sua intera????o negativa com o contexto pol??tico mais geral, pela carga ret??rica de que se fazem acompanhar, e pelo fato de subestimarem os aspectos t??cnicos necess??rios ?? sua implementa????o.

Reestrutura????o e expans??o do ensino superior p??blico: o programa Reuni na Universidade Federal do Cear?? sob a vis??o dos alunos

Com a institui????o do Programa de Apoio ao Plano de Reestrutura????o e Expans??o das Universidades Federais (Reuni), o governo federal tenta criar condi????es para ampliar o acesso e a perman??ncia dos estudantes na educa????o superior. Nesse contexto, esta pesquisa objetiva investigar a percep????o dos estudantes dos dez centros acad??micos da Universidade Federal do Cear?? (UFC), regularmente matriculados no 2?? semestre de 2008, em rela????o ao Reuni e ?? proposta de ades??o da UFC ao mencionado programa, a partir de uma perspectiva mercadol??gica. Para a determina????o da amostra de entrevistados foi utilizada a f??rmula de Cochran, para popula????es finitas, e amostras aleat??rias estratificadas, resultando em uma amostra de 378 estudantes para um n??vel de confian??a de 95%. Foram utilizadas vari??veis que influenciam o comportamento do p??blico-alvo, tais como renda, grupo social e idade, com foco no marketing educacional. Trata-se de uma pesquisa quantitativa quanto ?? sua natureza, descritiva quanto aos fins e realizada mediante survey. Constatou-se grande desconhecimento sobre o Reuni ??? 50,5% dos entrevistados nunca ouviram falar sobre o programa. Percebeu-se ainda que os estudantes que possuem uma atitude negativa sobre o Reuni aprovam o conte??do da proposta da UFC, da mesma maneira que os estudantes que n??o possuem essa atitude.

Transitory increased blood pressure after upper airway surgery for snoring and sleep apnea correlates with the apnea-hypopnea respiratory disturbance index

A transitory increase in blood pressure (BP) is observed following upper airway surgery for obstructive sleep apnea syndrome but the mechanisms implicated are not yet well understood. The objective of the present study was to evaluate changes in BP and heart rate (HR) and putative factors after uvulopalatopharyngoplasty and septoplasty in normotensive snorers. Patients (N = 10) were instrumented for 24-h ambulatory BP monitoring, nocturnal respiratory monitoring and urinary catecholamine level evaluation one day before surgery and on the day of surgery. The influence of postsurgery pain was prevented by analgesic therapy as confirmed using a visual analog scale of pain. Compared with preoperative values, there was a significant (P < 0.05) increase in nighttime but not daytime systolic BP (119 ± 5 vs 107 ± 3 mmHg), diastolic BP (72 ± 4 vs 67 ± 2 mmHg), HR (67 ± 4 vs 57 ± 2 bpm), respiratory disturbance index (RDI) characterized by apnea-hypopnea (30 ± 10 vs 13 ± 4 events/h of sleep) and norepinephrine levels (22.0 ± 4.7 vs 11.0 ± 1.3 µg l-1 12 h-1) after surgery. A positive correlation was found between individual variations of BP and individual variations of RDI (r = 0.81, P < 0.01) but not between BP or RDI and catecholamines. The visual analog scale of pain showed similar stress levels on the day before and after surgery (6.0 ± 0.8 vs 5.0 ± 0.9 cm, respectively). These data strongly suggest that the cardiovascular changes observed in patients who underwent uvulopalatopharyngoplasty and septoplasty were due to the increased postoperative RDI.

Prospecção de toxicidade de fungicidas por análises macroscópicas, microscópicas e moleculares em Allium cepa

Apesar dos benefícios econômicos dos agrotóxicos para a agricultura, os efeitos negativos à saúde humana e ao meio ambiente são questionados. Dentre os agroquímicos que são usados na agricultura, destacam-se os fungicidas, que são utilizados em grande quantidade nas lavouras para controle de doenças. Com intuito de verificar os danos ocasionados por esses compostos, diversos métodos de avaliação têm sido utilizados na análise de toxicidade e mutagenicidade dos agrotóxicos. As análises macroscópicas (germinação e crescimento radicular) e microscópicas (índice mitótico, aberrações cromossômicas e nucleares) são importantes na determinação da toxicidade de compostos lançados ao meio ambiente, porque permite averiguar danos na germinação, no desenvolvimento da plântula e no ciclo celular. No entanto, para melhor compreensão dos mecanismos moleculares da mutação e de seus efeitos sobre a população exposta à contaminação ambiental, os marcadores moleculares oferecem perspectivas, por medir o efeito direto da exposição sobre o DNA. O objetivo do trabalho foi avaliar o potencial tóxico dos fungicidas por análises macroscópicas, microscópicas e moleculares em Allium cepa. Os resultados indicam redução nos parâmetros de germinação, crescimento radicular e índice mitótico nas maiores concentrações para os princípios ativos difenoconazol, tebuconazol, procimidona e iprodiona, quando comparados ao controle negativo, mostrando que os princípios apresentaram efeito genotóxico, citotóxico, fitotóxico para as raízes de Allium cepa pela alta frequência de aberrações cromossômicas, nucleares e redução do índice mitótico. Os resultados moleculares indicaram mudança no perfil de amplificação dos primers SSR (Sequência Simples Repetitiva) e o ISSR (Inter Sequência Simples Repetitiva), após a exposição do Allium cepa aos princípios ativos, incluindo alterações na perda, ganho e mudança na intensidade de banda. A perda e o ganho de bandas aconteceram à medida que aumentou a concentração dos princípios ativos. O método de agrupamento e as distâncias e dissimilaridades mostraram relação de dose-dependência, pois conseguiu separar as maiores concentrações do controle negativo para os princípios ativos no ISSR e SSR, com exceção dos princípios procimidona e iprodiona no SSR. Esses dados indicam que possui relação entre as análises utilizadas, sendo indicadores confiáveis para detectar alterações por substâncias químicas. Os marcadores moleculares ISSR e SSR são ferramentas eficientes em avaliar alterações ocasionadas no DNA por fungicidas podendo ser utilizada em estudos de toxicidade.