Exploring the implementation of a medication adherence programme by community pharmacists : a qualitative study

Background Medication adherence has been identified as an important factor for clinical success. Twenty-four Swiss community pharmacists participated in the implementation of an adherence support programme for patients with hypertension, diabetes mellitus and/or dyslipidemia. The programme combined tailored consultations with patients about medication taking (expected at an average of one intervention per month) and the delivery of each drug in an electronic monitoring system (MEMS6?). Objective To explore pharmacists' perceptions and experiences with implementation of the medication adherence programme and to clarify why only seven patients were enrolled in total. Setting Community pharmacies in French-speaking Switzerland. Method Individual in-depth interviews were audio-recorded, with 20 of the pharmacists who participated in the adherence programme. These were transcribed verbatim, coded and thematically analysed. Process quality was ensured by using an audit trail detailing the development of codes and themes; furthermore, each step in the coding and analysis was verified by a second, experienced qualitative researcher. Main outcome measure Community pharmacists' experiences and perceptions of the determining factors influencing the implementation of the adherence programme. Results Four major barriers were identified: (1) poor communication with patients resulting in insufficient promotion of the programme; (2) insufficient collaboration with physicians; (3) difficulty in integrating the programme into pharmacy organisation; and (4) insufficient pharmacist motivation. This was related to the remuneration perceived as insufficient and to the absence of clear strategic thinking about the pharmacist position in the health care system. One major facilitator of the programme's implementation was pre-existing collaboration with physicians. Conclusion A wide range of barriers was identified. The implementation of medication adherence programmes in Swiss community pharmacies would benefit from an extended training aimed at developing communication and change management skills. Individualised onsite support addressing relevant barriers would also be necessary throughout the implementation process.

State Library of Iowa Strategic Plan 2008-2011, October 24, 2008

Mission: The State Library advocates for Iowa libraries & promotes excellence & innovation in library services in order to provide statewide access to information for all Iowans.

State Library of Iowa Strategic Plan FY09-FY11

Mission: The State Library advocates for Iowa libraries & promotes excellence & innovation in library services in order to provide statewide access to information for all Iowans.

Iowa Commission on the Status of African-Americans Department of Human Rights Strategic Plan, 2004

The Commission on the Status of African-Americans, formerly known as the Commission on the Status of Blacks, was created by statute in 1988. The nine members of the commission are appointed by the Governor and represent each region of the State where there is a significant African-American population. Meetings are open to the public. The commission sets policy for and provides direction to the Division of the Status of African-Americans within the Department of Human Rights. The division administrator is appointed by the Governor and confirmed by the Iowa Senate.

Iowa Commission on the Status of African-Americans Department of Human Rights Strategic Plan, August 1999

The Commission on the Status of African-Americans, formerly known as the Commission on the Status of Blacks, was created by statute in 1988. The nine members of the commission are appointed by the Governor and represent each region of the State where there is a significant African-American population. Meetings are open to the public. The commission sets policy for and provides direction to the Division of the Status of African-Americans within the Department of Human Rights. The division administrator is appointed by the Governor and confirmed by the Iowa Senate.

Iowa Commission on the Status of African-Americans Department of Human Rights Strategic Plan, August 2000

The Commission on the Status of African-Americans, formerly known as the Commission on the Status of Blacks, was created by statute in 1988. The nine members of the commission are appointed by the Governor and represent each region of the State where there is a significant African-American population. Meetings are open to the public. The commission sets policy for and provides direction to the Division of the Status of African-Americans within the Department of Human Rights. The division administrator is appointed by the Governor and confirmed by the Iowa Senate.

Iowa Commission on the Status of African-Americans Department of Human Rights Strategic Plan, August 2001

The Commission on the Status of African-Americans, formerly known as the Commission on the Status of Blacks, was created by statute in 1988. The nine members of the commission are appointed by the Governor and represent each region of the State where there is a significant African-American population. Meetings are open to the public. The commission sets policy for and provides direction to the Division of the Status of African-Americans within the Department of Human Rights. The division administrator is appointed by the Governor and confirmed by the Iowa Senate.

Iowa Commission on the Status of African-Americans Department of Human Rights Strategic Plan, August 2002

The Commission on the Status of African-Americans, formerly known as the Commission on the Status of Blacks, was created by statute in 1988. The nine members of the commission are appointed by the Governor and represent each region of the State where there is a significant African-American population. Meetings are open to the public. The commission sets policy for and provides direction to the Division of the Status of African-Americans within the Department of Human Rights. The division administrator is appointed by the Governor and confirmed by the Iowa Senate.

Iowa Commission on the Status of African-Americans Department of Human Rights Strategic Plan, August 2003

The Commission on the Status of African-Americans, formerly known as the Commission on the Status of Blacks, was created by statute in 1988. The nine members of the commission are appointed by the Governor and represent each region of the State where there is a significant African-American population. Meetings are open to the public. The commission sets policy for and provides direction to the Division of the Status of African-Americans within the Department of Human Rights. The division administrator is appointed by the Governor and confirmed by the Iowa Senate.

The Georgian adolescent health survey: methodological and strategic issues.

OBJECTIVES: To conduct a national survey on adolescent health and lifestyles in Georgia and to thus set up a database on adolescent. METHODS: A two-stage cluster sample of around 8000-10000 in-school 15-18 years adolescents are being reached through a random selection of classes in Georgia. The sample has been stratified by age, region, type of school and language. A self-administered questionnaire of 87 questions has been developed and translated into the four main languages used in Georgia. RESULTS: Up to June 2004, the researchers have reached 511 classes (9306 pupils). In total, 8039 questionnaires have been considered valid. The main concerns encountered for this survey are linked with acceptance of the survey, cross-cultural issues, political and strategic problems as well as inadequate physical environmental support. CONCLUSION: Despite Georgia's unfavourable economical and political situation, it has been possible to run a national survey on the health of adolescents, according to the usual standards used in the field. This survey should allow for 1) the identification of priorities in the field of health care and health promotion 2) the monitoring of adolescent health in the future.

Europe and the Petersberg Tasks – Nation-State behavior through the prism of Strategic Culture

Les missions Petersberg són l'operatiu militar més ambiciós organitzat per la Unió Europea en el desenvolupament de la CSDP, Política Europea de Seguretat i Defensa. Amb l'objectiu d'aconseguir una organització efectiva y funcional d'aquestes missions, és desitjable que les cultures estratègiques dels diferents Estats membres siguin, en gran mesura, compatibles en benefici d'una cultura estratègica europea amb directrius clares. Aquest estudi compara les cultures estratègiques d'Alemanya, el Regne Unit i França en referència al seu nivell de compatibilitat contrastant-les amb dos casos recents, exemples paradigmàtics de cultures estratègiques integrals. D'aquesta manera, pretenem descriure les circumstàncies en què es desenvolupen les missions Petersberg.

State Library of Iowa Strategic Plan FY08-FY11

Mission: The State Library advocates for Iowa libraries & promotes excellence & innovation in library services in order to provide statewide access to information for all Iowans.

Inferring transport characteristics in a fractured rock aquifer by combining single-hole ground-penetrating radar reflection monitoring and tracer test data

Investigations of solute transport in fractured rock aquifers often rely on tracer test data acquired at a limited number of observation points. Such data do not, by themselves, allow detailed assessments of the spreading of the injected tracer plume. To better understand the transport behavior in a granitic aquifer, we combine tracer test data with single-hole ground-penetrating radar (GPR) reflection monitoring data. Five successful tracer tests were performed under various experimental conditions between two boreholes 6 m apart. For each experiment, saline tracer was injected into a previously identified packed-off transmissive fracture while repeatedly acquiring single-hole GPR reflection profiles together with electrical conductivity logs in the pumping borehole. By analyzing depth-migrated GPR difference images together with tracer breakthrough curves and associated simplified flow and transport modeling, we estimate (1) the number, the connectivity, and the geometry of fractures that contribute to tracer transport, (2) the velocity and the mass of tracer that was carried along each flow path, and (3) the effective transport parameters of the identified flow paths. We find a qualitative agreement when comparing the time evolution of GPR reflectivity strengths at strategic locations in the formation with those arising from simulated transport. The discrepancies are on the same order as those between observed and simulated breakthrough curves at the outflow locations. The rather subtle and repeatable GPR signals provide useful and complementary information to tracer test data acquired at the outflow locations and may help us to characterize transport phenomena in fractured rock aquifers.

On the depth of blowup algebras of ideals with analytic deviation one

Let I be an ideal in a local Cohen-Macaulay ring (A, m). Assume I to be generically a complete intersection of positive height. We compute the depth of the Rees algebra and the form ring of I when the analytic deviation of I equals one and its reduction number is also at most one. The formu- las we obtain coincide with the already known formulas for almost complete intersection ideals.