Planting coconuts in Indian villages: ethnoecological aspects and evaluation of a "sustainable development" project

Apesar de cientistas e tomadores de decisão abraçarem o conceito geral de "desenvolvimento sustentável", há pouco acordo sobre como se atingir esta meta em situações específicas. Assim, projetos de desenvolvimento sustentável são amplamente criticados por etno-cientistas quanto à forma como são inter-culturalmente formulados. Aqui reportamos um caso controverso de plantio de coco-da-Bahia em aldeias Kayapó do sul do Pará, e fazemos a nossa autocrítica. Nós partimos da premissa de que o reflorestamento e o estado geral de saúde/nutrição caminham lado a lado. Portanto, o desenvolvimento da cultura de cocos por si só deve contribuir para a conservação da floresta no longo prazo e, simultaneamente, contribuir para o bom estado nutricional do povo Kayapó que protege a floresta da ameaça de práticas não-sustentáveis. Nós buscamos descobrir como que o comportamento dos Kayapó afeta o desenvolvimento da cultura de cocos quando amparada com suporte externo. Nós apresentamos resultados de duas viagens de campo para a terra Kayapó, onde detectamos fatores sócio-ecológicos relevantes para o sucesso de nosso projeto de apoio à cultura de coqueiros nas aldeias indígenas. Primeiro, em novembro de 2007, nós visitamos as aldeias Kikretum, Moikarakô e Aukre (dentre 10 aldeias que receberam mudas de coqueiros de nosso programa de apoio) para entregar um segundo carregamento de mudas de coqueiro (o primeiro carregamento aconteceu em abril de 2006). E descrevemos quantitativamente um aspecto do comportamento dos dispersores de sementes de coco (os Kayapó). Especificamente, como as palmeiras pré-existentes nas aldeias são distribuídas dentre as famílias dos índios e como este carregamento sobreviveu a fatores etno-ecológicos. Segundo, em julho de 2008 nós visitamos as aldeias Kokraimoro e Pykararankre e estimamos a posição dos coqueiros pré-existentes e dos novos em relação a outras árvores cultivadas, fazendo uso de censos partindo do centro das aldeias para seus limites exteriores. Nas três aldeias indígenas visitadas em 2007, virtualmente todos os coqueiros pré-existentes pertenciam a poucas famílias e a distribuição de frutos era, na maior parte dos casos, altamente concentrada dentre os membros destas famílias. Entretanto, assumindo que todos os coqueiros jovens que sobreviveram ao primeiro ano chegarão à maturidade (do primeiro carregamento em abril de 2006), eles representam um aumento considerável no numero projetado de coqueiros adultos nas três aldeias visitadas (48, 195 e 101% em Kikretum, Moikarakô e Aukre, respectivamente). E uma redução substancial na desigualdade de acesso aos cocos. Na expedição de 2008, encontramos que os índios geralmente plantam coqueiros bem próximos das suas casas onde a competição com outras árvores cultivadas podem limitar o desenvolvimento das palmeiras.

Patient Education and Self-Care for the Management of Jaw Pain upon Awakening: A Randomized Controlled Clinical Trial Comparing the Effectiveness of Adding Pharmacologic Treatment with Cyclobenzaprine or Tizanidine

Aims: To compare the effectiveness of adding cyclobenzaprine, tizanidine, or placebo to patient education and a self-care management program for patients with myofascial pain and specifically presenting with jaw pain upon awakening. Methods: Forty-five patients with a diagnosis of myofascial pain based on the guidelines of the American Academy of Orofacial Pain participated in this 3-week study. The subjects were randomly assigned into one of three groups: placebo group, TZA group (tizanidine 4 mg), or CYC group (cyclobenzaprine 10 mg). Patients were evaluated for changes in pain intensity, frequency, and duration by using the modified Severity Symptoms Index and changes in sleep quality with the use of the Pittsburgh Sleep Quality Index. Data were analyzed by ANOVA and post-hoc or nonparametric statistical tests as appropriate. Results: All three groups had a reduction in pain symptoms and improvement of sleep quality based on a comparison of pretreatment and treatment scores. However, no significant differences among the groups were observed at the posttreatment evaluation. Conclusion: The use of tizanidine or cyclobenzaprine in addition to self-care management and patient education was not more effective than placebo for the management of patients with myofascial jaw pain upon awakening.

Nanostructured screen-printed electrodes modified with self-assembled monolayers for determination of metronidazole in different matrices

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

The influence of self-weight of elastic 2D structures in topology optimization via numerical technique Smooth Evolutionary Structural Optimization (SESO)

This paper deals with topology optimization in plane elastic-linear problems considering the influence of the self weight in efforts in structural elements. For this purpose it is used a numerical technique called SESO (Smooth ESO), which is based on the procedure for progressive decrease of the inefficient stiffness element contribution at lower stresses until he has no more influence. The SESO is applied with the finite element method and is utilized a triangular finite element and high order. This paper extends the technique SESO for application its self weight where the program, in computing the volume and specific weight, automatically generates a concentrated equivalent force to each node of the element. The evaluation is finalized with the definition of a model of strut-and-tie resulting in regions of stress concentration. Examples are presented with optimum topology structures obtaining optimal settings. (C) 2012 CIMNE (Universitat Politecnica de Catalunya). Published by Elsevier Espana, S.L.U. All rights reserved.

Self-perception, complaints and vocal quality among undergraduate students enrolled in a Pedagogy course

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Longitudinal evaluation of bond strength to enamel of dental adhesive systems associated with Nd:YAG laser

Objectives: This study evaluated the durability of bond strength to enamel using total-etch (Single Bond/SB) and self-etch (Clearfil SE Bond/CSEB) adhesives associated with neody-mium: yttrium-aluminu- garnet (Nd:YAG) laser irradiation through the uncured adhesives.Methods: Bovine incisors were worn to expose an area of enamel and were divided into four groups: group 1 (control) SB + polymerization; group 2 (control) CSEB + polymerization; group 3 (laser) - B + Nd:YAG laser (174.16 J/cm(2)) + polymerization; and group 4 (laser) CSEB + Nd:YAG (174.16 J/cm(2)) + polymerization. Blocks of composite were fabricated and stored for 24 hours or 12 months, sectioned into beams, and submitted to microtensile tests. Results were analyzed by three-way analysis of variance (ANOVA) (adhesive, technique, and storage time) and Tukey tests.Results: ANOVA revealed significant differences for adhesive 3 technique and technique 3 storage time (p<0.05). The mean values (MPa) for interaction adhesive x technique (standard deviation) were as follows: SB/control = 35.78 (6.04)a; SB/laser = 26.40 (7.25)b, CSEB/control = 26.32 (5.71)b, CSEB/laser = 23.90 (7.49)b. For interaction technique x storage time the mean values were as follows: control/24 hours = 32.58 (6.49)a; control/12 months = 29.52 (8.38)a; laser/24 hours = 29.37 (5.71)a; laser/12 months = 20.92 (6.5)b. Groups with the same letters showed no statistically significant differences.Conclusion: Scanning electron microscope analysis showed evident areas of micromorphological alterations in lased samples after 12 months of water storage. Nd: YAG laser irradiation of enamel through unpolymerized totaletch adhesive significantly reduced bond strength compared with the control. Bond strength decreased when enamel samples irradiated with Nd: YAG laser through unpolymerized adhesives were stored in water for 12 months.

Evaluation of dietary intake of calcium in adult subjects with idiopathic arterial hypertension

The calcium-intake relationship with other alimentary and anthropometric variables was investigates in a group of 60 adult (19-75 year-old) subjects, 50 females and 10 males, with essential arterial hypertension (DAP > 90 mmHg). The calcium intake was assessed by three different protocols: 24-hour food intake recall, food-frequency questionnaire and 3 day self-food intake register, repeated along with anthropometric measurements on three different occasions (2-15 month-intervals). The calcium intake assessed by the three methods, as well as the anthropometric data, were statistically similar on all three occasions. The mean data were then compared with those form the control, composed of 75 healthy subjects matched with the hypertensive group by age and sex. The patients ingested less calcium (mean +/- SD) than the controls on the daily (517 +/- 271 x 740 +/- 353 mg/d) and body-weight (8.1 +/- 5.0 x 11.4 +/- 5.9 mg/kg/d) basis. Among the males the calcium intake was the only difference found between groups and could be attributed to the lower intake of calcium-rich foods. The hypertensive females showed also higher lean-body mass (Body-mass index and arm muscle circumference). Thus the calcium intake discriminated both groups being associated with changes in other nutritional parameters only in females.

Tank experiments with borehole self-potential data

Despite their importance in the evaluation of petroleum and gas reservoirs, measurements of self-potential data under borehole conditions (well-logging) have found only minor applications in aquifer and waste-site characterization. This can be attributed to lower signals from the diffusion fronts in near-surface environments because measurements are made long after the drilling of the well, when concentration fronts are already disappearing. Proportionally higher signals arise from streaming potentials that prevent using simple interpretation models that assume signals from diffusion only. Our laboratory experiments found that dual-source self-potential signals can be described by a simple linear model, and that contributions (from diffusion and streaming potentials) can be isolated by slightly perturbing the borehole conditions. Perturbations are applied either by changing the concentration of the borehole-filling solution or its column height. Parameters useful for formation evaluation can be estimated from data measured during perturbations, namely, pore water resistivity, pressure drop across the borehole wall, and electrokinetic coupling parameter. These are important parameters to assess, respectively, water quality, aquifer lateral continuity, and interfacial properties of permeable formations.

Behavioural changes and occlusal splints are effective in the management of masticatory myofascial pain: a short-term evaluation

The aim of this research was to test the hypothesis that treatment with intra-oral appliances with different occlusal designs was beneficial in the management of pain of masticatory muscles compared with a control group. A total of 51 patients were analysed according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) to obtain the diagnosis of masticatory myofascial pain (MMP). The sample was then randomly divided into three groups: group I (n = 21) wore a full coverage acrylic stabilisation occlusal splint; group II (n = 16) wore an anterior device nociceptive trigeminal inhibitory (NTI) system; and group III (n = 14) only received counselling for behavioural changes and self-care (the control group). The first two groups also received counselling. Follow-ups were performed after 2 and 6 weeks and 3 months. In these sessions, patients were evaluated by means of a visual analogue scale (VAS) and pressure pain threshold (PPT) of the masticatory muscles. Possible adverse effects were also recorded, such as discomfort while using the appliance and occlusal changes. The results were analysed with KruskalWallis, anova, Tukeys and Friedman tests, with a significance level of 5%. Group I showed improvement in the reported pain at the first follow-up (2 weeks), whereas for groups II and III, this progress was detected only after 6 weeks and 3 months, respectively. The PPT values did not change significantly. It was concluded that behavioural changes are effective in the management of pain in MMP patients. However, the simultaneous use of occlusal devices appears to produce an earlier improvement.

Videolaryngostroboscopy and voice evaluation in patients with rheumatoid arthritis

Arthritis may affect the larynx and produce symptoms such as hoarseness and vocal fatigue. Objective: This paper aimed to evaluate the laryngeal manifestations of rheumatoid arthritis. Methods: This is prospective study assessed 27 patients with rheumatoid arthritis with the aid of videolaryngostroboscopy, auditory-perceptual analysis of the speech using the GIRBAS scale, acoustic analysis and the Voice Handicap Index questionnaire. Results: Nineteen patients had laryngeal complaints, the main ones being intermittent dysphonia and sensation of a foreign body in the throat. The most frequent laryngoscopical finding was overlapping arytenoids. Three patients had low pitch, nine patients had mild dysphonia and roughness. Median acoustic measures were: F0, 198.39 Hz; Jitter, 0.815; Shimmer, 4.915; and NHR, 0.144. Regarding the Voice Handicap Index, the median score was zero in all domains. There was a statistically significant correlation between voice complaints and the domains of this index. Functional classes were significantly correlated to: overlapping arytenoids (p = 0.001), PPQ (p = 0.0257), Shimmer (p = 0.0295), APQ (p = 0.0195), and the VHI physical (p = 0.0227) and total domains (p = 0.0425). Conclusion: Laryngeal complaints were reported by 70.4% of the patients and laryngoscopical alterations were observed in 48% of the subjects. Voice acoustic evaluation and self-perception were altered.

Clinical evaluation of the failure rate of metallic brackets bonded with orthodontic composites

The purpose of the present study was to evaluate in vivo the failure rate of metallic brackets bonded with two orthodontic composites. Nineteen patients with ages ranging from 10.5 to 38.7 years needing corrective orthodontic treatment were selected for study. The enamel surfaces from second premolars to second premolars were treated with Transbond Plus-Self Etching Primer (3M Unitek). Next, 380 orthodontic brackets were bonded on maxillary and mandibular teeth, as follows: 190 with Transbond XT composite (3M Unitek) (control) and 190 with Transbond Plus Color Change (3M Unitek) (experimental) in contralateral quadrants. The bonded brackets were light cured for 40 s, and initial alignment archwires were inserted. Bond failure rates were recorded over a six-month period. At the end of the evaluation, six bond failures occurred, three for each composite. Kaplan-Meyer method and log-rank test (Mantel-Cox) was used for statistical analysis, and no statistically significant difference was found between the materials (p=0.999). Both Transbond XT and Transbond Plus Color Change composites had low debonding rates over the study period.

Clinical evaluation of the failure rates of metallic brackets

OBJECTIVES: The aim of this study was to evaluate in vivo the bonding of metallic orthodontic brackets with different adhesive systems. MATERIAL AND METHODS: Twenty patients (10.5-15.1 years old) who had sought corrective orthodontic treatment at a University Orthodontic Clinic were evaluated. Brackets were bonded from the right second premolar to the left second premolar in the upper and lower arches using: Orthodontic Concise, conventional Transbond XT, Transbond XT without primer, and Transbond XT associated with Transbond Plus Self-etching Primer (TPSEP). The 4 adhesive systems were used in all patients using a split-mouth design; each adhesive system was used in one quadrant of each dental arch, so that each group of 5 patients received the same bonding sequence. Initial archwires were inserted 1 week after bracket bonding. The number of bracket failures for each adhesive system was quantified over a 6-month period. RESULTS: The number of debonded brackets was: 8- Orthodontic Concise, 2- conventional Transbond XT, 9- Transbond XT without primer, and 1- Transbond XT + TPSEP. By using the Kaplan-Meier methods, statistically significant differences were found between the materials (p=0.0198), and the Logrank test identified these differences. Conventional Transbond XT and Transbond XT + TPSEP adhesive systems were statistically superior to Orthodontic Concise and Transbond XT without primer (p<0.05). There was no statistically significant difference between the dental arches (upper and lower), between the dental arch sides (right and left), and among the quadrants. CONCLUSIONS: The largest number of bracket failures occurred with Orthodontic Concise and Transbond XT without primer systems and few bracket failures occurred with conventional Transbond XT and Transbond XT+TPSEP. More bracket failures were observed in the posterior region compared with the anterior region.

New Synthetic Polyamines as Multi-Target-Directed Ligands for the Treatment of Alzheimer's Disease and Cancer: Design, Synthesis and Biological Evaluation

Alzheimer's disease (AD) and cancer represent two of the main causes of death worldwide. They are complex multifactorial diseases and several biochemical targets have been recognized to play a fundamental role in their development. Basing on their complex nature, a promising therapeutical approach could be represented by the so-called "Multi-Target-Directed Ligand" approach. This new strategy is based on the assumption that a single molecule could hit several targets responsible for the onset and/or progression of the pathology. In particular in AD, most currently prescribed drugs aim to increase the level of acetylcholine in the brain by inhibiting the enzyme acetylcholinesterase (AChE). However, clinical experience shows that AChE inhibition is a palliative treatment, and the simple modulation of a single target does not address AD aetiology. Research into newer and more potent anti-AD agents is thus focused on compounds whose properties go beyond AChE inhibition (such as inhibition of the enzyme β-secretase and inhibition of the aggregation of beta-amyloid). Therefore, the MTDL strategy seems a more appropriate approach for addressing the complexity of AD and may provide new drugs for tackling its multifactorial nature. In this thesis, it is described the design of new MTDLs able to tackle the multifactorial nature of AD. Such new MTDLs designed are less flexible analogues of Caproctamine, one of the first MTDL owing biological properties useful for the AD treatment. These new compounds are able to inhibit the enzymes AChE, beta-secretase and to inhibit both AChE-induced and self-induced beta-amyloid aggregation. In particular, the most potent compound of the series is able to inhibit AChE in subnanomolar range, to inhibit β-secretase in micromolar concentration and to inhibit both AChE-induced and self-induced beta-amyloid aggregation in micromolar concentration. Cancer, as AD, is a very complex pathology and many different therapeutical approaches are currently use for the treatment of such pathology. However, due to its multifactorial nature the MTDL approach could be, in principle, apply also to this pathology. Aim of this thesis has been the development of new molecules owing different structural motifs able to simultaneously interact with some of the multitude of targets responsible for the pathology. The designed compounds displayed cytotoxic activity in different cancer cell lines. In particular, the most potent compounds of the series have been further evaluated and they were able to bind DNA resulting 100-fold more potent than the reference compound Mitonafide. Furthermore, these compounds were able to trigger apoptosis through caspases activation and to inhibit PIN1 (preliminary result). This last protein is a very promising target because it is overexpressed in many human cancers, it functions as critical catalyst for multiple oncogenic pathways and in several cancer cell lines depletion of PIN1 determines arrest of mitosis followed by apoptosis induction. In conclusion, this study may represent a promising starting pint for the development of new MTDLs hopefully useful for cancer and AD treatment.

Evaluation einer kognitiv-verhaltensbezogenen Gruppen- und Einzeltherapie zur Behandlung von Patienten mit Hypochondrie

Das Störungsbild der Hypochondrie stellt für die Betroffenen eine erhebliche Belastung und Beeinträchtigung dar und ist zudem von hoher gesundheitspolitischer Relevanz. Hieraus ergibt sich die Notwendigkeit für die Entwicklung und Evaluation wirkungsvoller Behandlungsansätze. Mit der vorliegenden Untersuchung wird die bisher umfangreichste Studie zur Wirksamkeit von gruppentherapeutischen Interventionen bei Patienten mit Hypochondrie beschrieben. Insgesamt nahmen 35 Patienten, die die DSM-IV-Kriterien der Hypochondrie erfüllten, an der Studie teil. Die durchgeführte Behandlung bestand aus insgesamt acht Gruppen- und sechs Einzelsitzungen. Zur Beurteilung des Therapieerfolgs wurden standardisierte Fragebogen und Einschätzungen der behandelnden Therapeuten eingeholt. Zudem wurde vor und nach der Behandlung die implizite Ängstlichkeit der Patienten mit Hilfe des Ängstlichkeits-IATs (Egloff & Schmukle, 2002) erfasst. Die Datenerhebung der Fragebögen erfolgte zu vier Messzeitpunkten. Eine Teilgruppe der Patienten (n = 10) konnte zudem über eine zweimonatige Wartezeit befragt werden. Ingesamt wurde die Therapie von den Patienten gut akzeptiert. Im Laufe der Behandlung zeigten sich auf den Selbstbeurteilungsverfahren umfangreiche Veränderungen im Erleben und Verhalten der Patienten. Es zeigte sich eine Reduktion von krankheitsbezogenen Kognitionen und Ängsten, eine Abnahme des Krankheitsverhaltens und eine Zunahme von Störungs- und Bewältigungswissen. Die Reduktion der hypochondrischen Symptomatik stellte sich als klinisch relevant heraus. Zudem zeigte sich eine Reduktion der allgemeinen Belastung und Ängstlichkeit sowie depressiver und körperlicher Symptome. Die Einschätzungen der behandelnden Therapeuten bestätigten die mittels Fragebogen ermittelten Befunde. Mit Hilfe des Ängstlichkeits-IATs konnte eine Veränderung des angstbezogenen Selbstkonzepts nachgewiesen werden. In einer Wartekontrollzeit zeigten sich nur geringfügige Reduktionen der hypochondrischen Symptomatik und keine bedeutsamen Reduktionen der allgemeinen Psychopathologie. Die Ergebnisse der durchgeführten Kombinationstherapie sind mit den Befunden bisheriger Evaluationen zur Effektivität von Einzeltherapien bei Hypochondrie vergleichbar. Die Befunde unterstreichen die Gleichwertigkeit von ökonomischeren gruppentherapeutischen Interventionen bei der Behandlung der Hypochondrie.

Evaluation der Langzeitcompliance lebertransplantierter Patienten mit der immunsuppressiven Therapie und eines Betreuungsmodells zur intersektoralen kooperativen pharmazeutischen Betreuung durch eine Krankenhausapotheke und öffentliche Apotheken

Ein wichtiger Baustein für den langfristigen Erfolg einer Lebertransplantation ist die Compliance mit der lebenslang einzunehmenden immunsuppressiven Therapie. Im Rahmen der vorliegenden Arbeit wurde erstmals mittels MEMS® die Compliance bei lebertransplantierten Patienten untersucht, deren Transplantation einige Jahre zurücklag. Rekrutiert wurden Patienten, die vor 2, 5, 7 oder 10 Jahren (Gruppe 2 y.p.t., 5 y.p.t., 7 y.p.t., 10 y.p.t.) in der Universitätsmedizin Mainz lebertransplantiert wurden. 39 Patienten nahmen an der prospektiven Anwendungsbeobachtung teil. Die Compliance wurde mittels MEMS® über eine Beobachtungszeit von 6 Monaten erfasst. Bei der MEMS®-Auswertung war zu vermuten, dass 10 Patienten diese nicht wie vorgesehen verwendet hatten. Folglich konnten die mittels MEMS® gemessenen Compliance-Parameter nur für 29 Patienten valide ermittelt werden. Die mittlere Dosing Compliance betrug 81 ± 21 %, wobei die Gruppe 2 y.p.t. mit 86 ± 14 % bessere Werte zu verzeichnen hatte als die Gruppe 5 y.p.t. (75 ± 27 %) und 7 y.p.t. (74 ± 28 %). Die Ergebnisse waren jedoch nicht signifikant unterschiedlich (p=0,335, Kruskal-Wallis-Test). Unter Einbeziehung aller mittels MEMS® gemessenen Compliance-Parameter wurden 19 von 29 Patienten (66 %) als compliant eingestuft. Bei der Analyse der Gesamtcompliance basierend auf den subjektiven Compliance-Messmethoden (Morisky-Fragebogen, MESI-Fragebogen, Selbsteinschätzung), der Arzneimittel-Blutspiegel und der Anzahl an Abstoßungsreaktionen, in der alle 39 Patienten einbezogen werden konnten, wurden 35 Patienten (90 %) als compliant eingestuft. rnIm zweiten Teil der Arbeit wurde die Etablierung und Bewertung eines intersektoralen Pharmazeutischen Betreuungskonzepts für lebertransplantierte Patienten untersucht. Erstmals wurden anhand eines entwickelten schnittstellenübergreifenden, integrierten Betreuungskonzepts niedergelassene Apotheker in die Pharmazeutische Betreuung lebertransplantierter Patienten eingebunden. 20 Patienten wurden rekrutiert und während ihres stationären Aufenthaltes nach Transplantation pharmazeutisch betreut. Die Betreuung umfasste eine intensive Patientenschulung mit drei bis vier Gesprächen durch einen Krankenhausapotheker. Während des stationären Aufenthaltes wurden arzneimittelbezogene Probleme erkannt, gelöst und dokumentiert. Bei Entlassung stellte der Krankenhausapotheker einen Medikationsplan für den Hausarzt sowie für den niedergelassenen Apotheker aus und führte mit den Patienten ein ausführliches Entlassungsgespräch. Darüber hinaus wurden den Patienten Arzneimitteleinnahmepläne und eine Patienteninformation über ihr immunsuppressives Arzneimittel übergeben. 15 Patienten konnten daraufhin ambulant von niedergelassenen Apothekern pharmazeutisch weiterbetreut werden. Das kooperierende pharmazeutische Personal wurde durch ein eigens für die Studie erstelltes Manual zur Pharmazeutischen Betreuung lebertransplantierter Patienten geschult und unterstützt. Die niedergelassenen Apotheker sollten die Patienten in ihrer Arzneimitteltherapie begleiten, indem Beratungsgespräche geführt und arzneimittelbezogene Probleme erkannt und gelöst wurden. Die Nutzeffekte der intensiven Pharmazeutischen Betreuung konnte anhand verschiedener Erhebungsinstrumente dargelegt werden. Im Ergebnis resultierte eine hohe Zufriedenheit der Patienten und Apotheker mit dem Betreuungskonzept, die mittels Selbstbeurteilungsfragebögen ermittelt wurde. Die Compliance der Patienten wurde anhand des Morisky- und MESI-Fragebogens, der Selbsteinschätzung der Patienten, Blutspiegelbestimmungen sowie der Einschätzung durch den niedergelassenen Apotheker bestimmt. 86 % der Patienten wurden als compliant eingeordnet. Die Kenntnisse der Patienten über ihre immunsuppressive Therapie, welche anhand von Interviews erfragt wurden, lagen auf einem sehr hohen Niveau. Abschließend kann festgestellt werden, dass die Pharmazeutische Betreuung lebertransplantierter Patienten in den niedergelassenen Apotheken durchführbar ist. Anhand der Dokumentationsprotokolle lässt sich allerdings nur sehr schwer beurteilen, in welchem Maße die Betreuung tatsächlich erfolgte. Das tatsächliche vorliegen einer mangelnden Betreuung oder aber eine lückenhafte Dokumentation der Betreuungsleistung war nicht zu differenzieren. Ein limitierender Faktor für die intensivierte Betreuung ist sicherlich der erhebliche Aufwand für nur einen Patienten mit einem seltenen Krankheitsbild. Das Erkennen und Lösen von 48 ABP durch den Krankenhausapotheker und 32 ABP durch die niedergelassenen Apotheker, d. h. insgesamt 4,5 ABP pro Patient zeigt, dass die Pharmazeutische Betreuung einen wichtigen Beitrag für eine qualitätsgesicherte Arzneimitteltherapie leistet. Die intersektorale Pharmazeutische Betreuung stellt eine wesentliche Hilfe und Unterstützung der Patienten im sicheren Umgang mit ihrer Arzneimitteltherapie dar.rn