An evaluation of an adapted United States model of pharmaceutical care to improve psychoactive prescribing for nursing home residents in Northern Ireland (Fleetwood NI Study).

OBJECTIVES: To test the effect of an adapted U.S. model of pharmaceutical care on prescribing of inappropriate psychoactive (anxiolytic, hypnotic, and antipsychotic) medications and falls in nursing homes for older people in Northern Ireland (NI).

DESIGN: Cluster randomized controlled trial.

SETTING: Nursing homes randomized to intervention (receipt of the adapted model of care; n=11) or control (usual care continued; n=11).

PARTICIPANTS: Residents aged 65 and older who provided informed consent (N=334; 173 intervention, 161 control).

INTERVENTION: Specially trained pharmacists visited intervention homes monthly for 12 months and reviewed residents' clinical and prescribing information, applied an algorithm that guided them in assessing the appropriateness of psychoactive medication, and worked with prescribers (general practitioners) to improve the prescribing of these drugs. The control homes received usual care.

MEASUREMENTS: The primary end point was the proportion of residents prescribed one or more inappropriate psychoactive medicine according to standardized protocols; falls were evaluated using routinely collected falls data mandated by the regulatory body for nursing homes in NI.

RESULTS: The proportion of residents taking inappropriate psychoactive medications at 12 months in the intervention homes (25/128, 19.5%) was much lower than in the control homes (62/124, 50.0%) (odds ratio=0.26, 95% confidence interval=0.14–0.49) after adjustment for clustering within homes. No differences were observed at 12 months in the falls rate between the intervention and control groups.

CONCLUSION: Marked reductions in inappropriate psychoactive medication prescribing in residents resulted from pharmacist review of targeted medications, but there was no effect on falls.

The United States subprime mortgage crisis and its implications for the Caribbean

The bursting of the property bubble – subprime mortgage crisis – in 2007 in the United States has engendered panic, recession fears and turmoil in the global financial system. Although the United States economy grew by 0.6 per cent in the last quarter of 2007, down from 4.9 per cent in the previous quarter, day by day worsening scenarios emerge, from escalating oil prices, to a depreciating dollar and financial institutions’ bailout by the Federal Reserve. Many economists and policy makers share the view that a subprime-led recession – i.e. two consecutive quarters with negative growth – is inevitable and will be much deeper and longer than the 2001 dot-com downturn. Moreover, the critical situation of the financial system has driven some analysts to argue that should the monetary policy response fails to restore confidence among investors, the outcome would be the worst crisis seen since the Great Depression. This pessimism is not only among specialists. Indeed, in late March 2008 the Consumer Confidence Index in the United States recorded its lowest level since February 1992. A recession in the United States will undoubtedly have an important impact on the world economy, despite the continuous rapid growth experienced by emerging economies, particularly China and India. The purpose of this article is threefold: first, to characterize the current situation in the United States economy; second, to discuss the economic policy responses; and finally, to elaborate on how Caribbean economies may be affected.

The hosiery industry: Report on the cost of production of hosiery in the United States

At head of title: Department of Commerce. Bureau of Foreign and Domestic Commerce. E.E. Pratt, Chief ...

The knit-underwear industry: Report on the cost of production of knit underwear in the United States

At head of title: Department of Commerce. Bureau of Foreign and Domestic Commerce. E.E. Pratt, Chief ...

The women's muslin-underwear industry: report on the cost of production of women's muslin underwear in the United States

Department of Commerce, Bureau of Foreign and Domestic Commerce.

Manuscript on United States relations with England and France,

Untitled and undated manuscript written by Tudor offering his opinions on political and commercial relations between the United States, England, and France, and the causes of American animosity toward those countries. Topics and events referenced include the slave trade, Napoleon, and the Little Belt Affair. Introduction and parts one through three.

Manuscript on United States relations with England and France,

Parts nine through thirteen and postscript including transcriptions of contemporary London newspaper accounts of American naval maneuvers that Tudor believes are meant to portray Americans as "wholly destitute of veracity."

In the Supreme Court of the United States, October term, 1980, Héctor García, petitioner v. Alton V.M. Gloor ... [et al.], respondents : on writ of certiorari to the United States Court of Appeals for the Fifth Circuit : petition for writ of certiorari /

At head of title: no.

Trade of the United States with Cuba in ... /

"Prepared by the Divisions of Regional Information and Business Review in cooperation with the Division of Foreign Trade Statistics."

Actas de la primera conferencia de la Office of Economic Opportunity sobre Programas Contra la Pobreza para Trabajadores Migratorios y Trabajadores de Periodos Temporales Durante el año Agrícola efectuadas el 18 al 20 de enero de 1966 en Washington, D. C.

Mode of access: Internet.

Opportunities for the preparation of teachers of children of native and minority groups,

At head of title: Project in Research in Universitites.

Report to the United States Bureau of Mines on the survey of southeastern Montana for areas suitable for synthetic liquid fuel plants.

Bibliography: p. 58-59.

Index to publications of the United States Department of agriculture, 1926-1930 /

Mode of access: Internet.

Library facilities of the Office of education ...

Mode of access: Internet.