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.

Effects of speaking rate on EMA-derived lingual kinematics: a preliminary investigation

Electromagnetic articulography (EMA) was used to investigate how tongue movement characteristics (i.e., velocity, acceleration, duration, distance) change with. or indeed affect, increased rates of speech. Eight young adult males repeated /ta/ and /ka/ syllables first at a moderate rate that had been modelled at three syllables per second, and then 'as fast as possible'. Distance travelled by the tongue appeared to be the principal lingual kinematic feature manipulated by the group of speakers in producing increased syllable repetition rates, with velocity found to increase, decrease or remain unchanged. Acceleration remained unchanged, except in the case of increased velocity. One participant formed an exception in terms of manipulating distance by exhibiting marginally increased lingual velocities rather than distance changes. This preliminary study serves to direct future EMA-based studies of speech rate control as to the speech tasks that should be employed and the possible underlying anatomical and acoustic bases or constraints that could possibly influence the kinematic strategies employed to increase speech rate.

High rate of detection of primary aldosteronism, including surgically treatable forms, after 'non-selective' screening of hypertensive patients

Background Wide testing of the aldosterone: renin ratio among hypertensive individuals has revealed primary aldosteronism to be common, with most patients normokalaemic. Some investigators, however, have reported aldosterone-producing adenoma to be rare among patients so detected. Objective To test the hypothesis that differences among reported studies in the rate of detection of aldosterone-producing adenoma (as opposed to bilateral adrenal hyperplasia) reflect differences in the procedures used for diagnosis of primary aldosteronism, and the methods used to identify aldosterone-producing adenomas. Methods In the newly established Princess Alexandra Hospital Hypertension Unit (PAHHU), we used procedures developed by Greenslopes Hospital Hypertension Unit (which reports that more than 30% of patients with primary aldosteronism have aldosterone-producing adenomas) to diagnose primary aldosteronism and determine the subtype. All patients with an increased aldosterone: renin ratio (measured after correction for hypokalaemia and while the patient was not receiving interfering medications) underwent fludrocortisone suppression testing to confirm or exclude primary aldosteronism; if they were positive, they underwent genetic testing to exclude glucocorticoid-remediable aldosteronism before adrenal venous sampling was used to differentiate lateralizing from bilateral primary aldosteronism. Results This approach allowed PAHHU to diagnose, within 2 years, 54 patients [only seven (13%) hypokalaemic] with primary aldosteronism. All tested negative for glucocorticoid-remediable aldosteronism. Aldosterone production was lateralized to one adrenal in 15 patients (31%; only six hypokalaemic) and was bilateral in 34 (69%; all normokalaemic) of 49 patients who underwent adrenal venous sampling. Among patients with lateralizing adrenal hyperplasia, computed tomography revealed an ipsilateral mass in only six and a contralateral lesion in one. Fourteen patients underwent unilateral adrenalectomy, which cured the hypertension in seven and improved it in the remainder. In patients with bilateral primary aldlosteronism, hypertension responded to spironolactone (112.5-50 mg/ day) or amiloride (2.5-10 mg/day). Conclusion When performed with careful regard to confounding factors, measurement of the aldosterone: renin ratio in all hypertensive individuals, followed by fludrocortisone suppression testing to confirm or exclude primary aldosteronism and adrenal venous sampling to determine the subtype, can result in the detection of significant numbers of patients with specifically treatable or potentially curable hypertension. (C) 2003 Lippincott Williams Wilkins.

The effect of pretreatments on the drying rate and quality of dried bananas

The effects that four pretreatments (blanching, chilling, freezing, and combined blanching and freezing), used prior to drying, had on the drying rate and quality of bananas were investigated. An untreated sample was used as a control. The bananas were dried at 50 degreesC in a heat pump dehumidifier dryer, using an air velocity of 3.1 m s(-1), until a final moisture content of approximately 25% dry weight basis was attained. While the initial drying rate was highest for the blanched treatment, the two pretreatments involving freezing resulted in the shortest drying times. The blanched sample was most preferred in terms of colour while the frozen samples exhibited extensive browning. The texture and flavour was significantly (P < 0.05) reduced in all samples that involved blanching and/or freezing.

Simultaneous FT-NIR and ESR analyses to yield propagation rate coefficients for polymerization of methyl methacrylate based monomers

A hyphenated instrumental approach has been used to obtain reliable values for the propagation rate coefficients as a function of conversion for polymerizations of methyl methacrylate (MMA) and a mixture of MMA and ethyleneglycol dimethacrylate (EGDMA) with a 1:1 concentration of double bonds, from near the onset of the Trommsdorf region into the glass region. ESR spectroscopy was used to measure the radical concentration while FT-NIR fibre-optic spectroscopy was employed to measure instantaneously the double-bond concentration within the temperature-controlled cavity of the ESR instrument during polymerization. The advantage of this approach to the measurement of the rate coefficient is that it is equally applicable to branching and linear polymerizations. For the polymerization of methyl methacrylate, the values of the rate coefficient at the lowest conversions at which reliable values could be obtained were in agreement with recently reported values obtained by the PLP-SEC method. For the lowest conversions, the values obtained were 403 1 mol(-1) s(-1) at 306 K for MMA and 5201 mol(-1) s(-1) at 310 K for a 1:1 mixture of MMA and EGDMA. (C) 2003 Society of Chemical Industry.

Metodologia para obtenção do hidrograma de escoamento superficial em encostas e canais. Parte II: modelo computacional e análise de sensibilidade

Estimativas de vazão máxima de escoamento superficial são necessárias para o projeto de obras hidráulicas em bacias urbanas e rurais. A dificuldade em aplicar os procedimentos disponíveis para calcular a variação do escoamento superficial com o tempo e de seu valor máximo deve-se à inexatidão dos métodos usados para esse objetivo e à variabilidade nos resultados que podem ser obtidos por profissionais que usem o mesmo procedimento. Dessa forma, a investigação de um método que produza estimativas confiáveis da vazão máxima e do hidrograma de escoamento superficial é de grande interesse. Neste trabalho, desenvolveu-se e avaliou-se a sensibilidade de um software (HIDROGRAMA 2.1) que permite a obtenção do hidrograma de escoamento superficial, da vazão máxima e seu tempo de ocorrência, da altura e da velocidade máximas do escoamento, do volume e da lâmina de escoamento superficial em encosta e em canais. O modelo apresentou grande sensibilidade ao período de retorno, à taxa de infiltração estável e ao comprimento da encosta e do canal.

Influência da luminosidade na fisiologia e morfoanatomia de jequitibá branco (Cariniana estrellensis (Raddi.) Kuntze) e jequitibá rosa (Cariniana legalis (Mart.) Kuntze)

Cariniana estrellensis (Raddi.) Kuntze e C. legalis (Mart.) Kuntze são arbóreas nativas do Brasil que, além de possuírem alto poder econômico, são objeto de interesse em programas de recuperação de áreas degradadas e em plantios comerciais. A escassez de informações relacionadas ao desempenho ecofisiológico dessas espécies em condições ambientais estressantes dificultam o manejo e conservação das mesmas. Dessa forma, o presente estudo objetivou avaliar a ecofisiologia das espécies em um gradiente de irradiância, por meio de dois experimentos. No experimento 1, plantas de C. estrellensis com 12 meses de idade foram submetidas a quatro tratamentos: 40%, 50%, 70% e 100% de irradiância, durante 104 dias. Ao final desse período foram feitas análises de crescimento, do conteúdo de pigmentos fotossintéticos, de trocas gasosas, da fluorescência da clorofila a, do conteúdo foliar de carboidratos solúveis, das características anatômicas foliares e caulinares e da plasticidade fenotípica da espécie. No experimento 2, plantas de C. estrellensis e C. legalis com 14 meses de idade foram submetidas a dois tratamentos: 30% e 100% de irradiância (sombra e sol, respectivamente), durante 30 dias. Ao final desse período foram feitas análises do estresse oxidativo das espécies, por meio da quantificação da atividade das enzimas catalase e peroxidase do ascorbato e por meio da quantificação do conteúdo foliar de pigmentos fotossintéticos. No experimento 1, em 70% de irradiância, as plantas apresentaram melhor crescimento em altura e diâmetro, maior massa seca de folhas (MSF), de caule (MSC) e de raiz (MSR). Em 70% e 100% de irradiância, as plantas apresentaram folhas menores (AFU) e mais espessas (AFE e MFE) resultando em menor área foliar total (AFT). Nesses tratamentos as plantas também apresentaram menor conteúdo foliar de clorofila a (Chl a) e b (Chl b), porém, maior razão Chl a/b e maior conteúdo de carotenóides, o que implicou em menor razão Chl a/Carot. Taxas fotossintéticas maiores foram encontradas nas plantas em 70% e inibidas em 40% e 50%, em função da baixa irradiância solar, e em 100%, possivelmente pela ocorrência de fotoinibição, como mostraram os parâmetros do fluxo de energia do fotossistema II. De acordo com a análise da fluorescência da clorofila a, em pleno sol, as plantas apresentaram menor densidade de centros de reação ativos (RC/ABS) e maior dissipação de energia (DI0/ABS), culminando com menor desempenho do fotossistema II (PIabs) e desempenho total (PITotal). O conteúdo foliar de carboidratos solúveis foi maior nas plantas em 70%, seguido das plantas em 100% de irradiância, com exceção da glicose, que não variou entre os tratamentos. A maior espessura encontrada nas folhas sob 100% de irradiância foi em função da maior espessura das epidermes adaxial e abaxial e dos parênquimas paliçádico e esponjoso. E o maior diâmetro do caule em 70% de irradiância se deu pela maior espessura do xilema e floema secundários. No experimento 2, as plantas em pleno sol de ambas as espécies também apresentaram menor conteúdo foliar de clorofila a (Chl a) e b (Chl b) e maior razão Chl a/b. No entanto, o conteúdo de carotenóides foi maior, o que implicou em menores razões Chl a/Carot. A atividade da catalase (CAT) variou em função do tempo e da espécie, apresentando uma queda em C. estrellensis aos 16 dias, possivelmente em função de fotoinativação, e um aumento em C. legalis aos 30 dias. Já a atividade da peroxidase do ascorbato (APX) não variou em função do tempo, da espécie ou dos tratamentos. O estudo da plasticidade fenotípica mostrou que C. estrellensis é uma espécie plástica, principalmente em função das variáveis de fotossíntese e trocas gasosas, sendo capaz de sobreviver no gradiente de irradiância testado, o que viabiliza o seu uso em projetos de recuperação de áreas degradadas. E, uma vez que as análises ecofisiológicas mostraram que C. estrellensis e C. legalis apresentaram melhor desempenho em luminosidade moderada, sugere-se que ambas comportaram-se como espécies intermediárias no processo de sucessão florestal. No entanto, uma vez que a concentração de pigmentos foliares e a produção de enzimas antioxidantes inferiram maior susceptibilidade de C. estrellensis à fotoinibição em alta irradiância, sugere-se maior viabilidade do uso de C. legalis em projetos de recuperação de áreas degradas.

Remoção do herbicida 2,4 diclorofenoxiacético (2,4-D) no tratamento convencional de água e associado à adsorção em carvão ativado em pó (CAP) em escala piloto

O aumento do uso de agrotóxicos no Brasil tem causado muitas preocupações, tanto em relação à questão ambiental quanto a saúde pública. Muitos desses compostos não são eficientemente removidos das águas por tratamento convencional, sendo necessárias alternativas que os removam das águas de abastecimento. Dentre as tecnologias existentes, a adsorção em CAP é considerada uma das mais efetivas e confiáveis, cujas vantagens incluem alta eficiência de remoção e facilidade de operação. O objetivo desta pesquisa é avaliar a remoção, em escala piloto, do agrotóxico 2,4-D e o seu principal metabólito 2,4-DCP em amostras de águas tratadas por adsorção em CAP associado ao tratamento convencional. Os testes foram realizados em instalação piloto na áreada ETA Carapina/CESAN. A água bruta foi a proveniente do rio Santa Maria da Vitória contaminadaatravés da adição de agrotóxico em sua fórmula comercial. Foram realizados quatro ensaios, dois sem adição de CAP e dois com adição de CAP junto à unidade de mistura rápida. Os agrotóxicos foram detectados e quantificados através da cromatografia líquida de alta eficiência, em metodologia validada. As amostras coletadas foram caracterizadas de acordo com os parâmetros: temperatura, turbidez, condutividade elétrica, absorbância em 254 nm, cor real, cor aparente, alcalinidade, carbono orgânico total, além e concentração dos agrotóxicos 2,4-D e ácido 2,4,5-T e do metabólito 2,4-DCP. Os diferentes ensaios foram avaliados em termos da taxa de remoção destes parâmetros. Como resultado no TCVcom adição de CAP o composto de interesse foi removido abaixo de 30 μg. L-1,Valor Máximo Permitido, estabelecido pela Portaria do MS n° 2.914/2011 para dosagem de 100μg.L-1e mostrou-se eficiente, também, na remoção de matéria orgânica. Em nenhum dos testes foi detectado o composto 2,4-DCP e 2,4,5-T.

An e-marketplace of healthcare and social care services: the perceived interest

Purpose – The health and social care sector is receiving growing attention due to the increased life expectancy and to the public demand for a better quality of life and better health services. New cost-efficient approaches are required, and the paper aims to present and discuss the main results of a study undertaken in a Portuguese municipality on the perceived relevance of an e-marketplace of social and healthcare services for the inhabitants in general, and for people with special needs in particular, and the identification of the most relevant services to be offered through this platform. Design/methodology/approach – A wide survey was undertaken to identify the needs of potential users and their expectancies with relation to the proposed platform. The results of the study are a support for the project promoters to understand the viability of the solution and the requirements to the deployment of the pilot experiment, as well as to drive the selection of domains of activities/classes of services to be offered by the platform. Findings – Services such as information about healthcare services, home monitoring/accompanying services 24 hours per day, and personal hygiene services provided at home are the ones recognized by the inquired citizens as the most important, which indicates that the potential users will be mostly people with special needs or their family or caregivers. Originality/value – While still at a preliminary development phase, the project represents a good opportunity to develop a totally innovative service with high potential impact for the senior population and for individuals with special needs.

An e-marketplace of healthcare and social care services: the perceived interest

The health and social care sector is receiving growing attention for the last years, due to the increased life expectancy, the public demand for a better quality of life and for better health services. These requirements can be met with more cost-efficient approaches and using new technology-based solutions for providing services. The paper presents and discusses some of the main results of a study undertaken in Guimarães, a Municipality at the North of Portugal, on the perceived relevance of an e-Marketplace of social and healthcare services for the inhabitants in general, and in particular for people with special needs; the study also included the identification of the most relevant services to be offered by this platform and allowed concluding that such an e-Marketplace is of recognized relevance and that it is expected a good adhesion from the population.

Antibacterial activity of Baccharis trimera (Less.) DC. (carqueja) against bacteria of medical interest

Baccharis trimera (Less.) (Asteraceae), popularly know as "carqueja", is a species commonly used in folk medicine for the treatment or prevention of diseases. In this context, the purpose of this work was to study the antibacterial activity of crude hydroalcoholic extract from Baccharis trimera against Gram-positive bacterial strains (Staphylococcus aureus ATCC 29213, Staphylococcus saprophyticus ATCC 15305, Staphylococcus epidermidis ATCC 12228, Enterococcus faecalis ATCC 19433) and Gram-negative bacteria (Escherichia coli EHEC ATCC 43895, Pseudomonas aeruginosa ATCC 27853, Klebsiella pneumoniae ATCC 27736, Salmonella typhi ATCC 19430) of clinical interest. Antibacterial susceptibility was evaluated by broth microdilution assay following the CLSI (formerly the NCCLS) guidelines. The extract from B. trimera showed antibacterial activity against Gram-positive bacteria and the most interesting result was obtained against S. epidermidis that presented Minimal Inhibitory Concentration of 250μg/mL. These results indicate that B. trimera have bacterisostatic potential against Gram-positive bacterial strains of medical interest and could serve as a base for further studies on the use of isolated compounds from this species as future antimicrobials.

The impact of the digital divide on the perceived interest of an e-Marketplace to support healthcare and social care services

In a Europe increasingly aging, it is now recognized the importance and potential of the service industry for ageing well based on information and communication technologies (ICT), as exemplified by the electronic market of social services and health care, the GuiMarket, proposed by the authors. However, this new range of services requires that individuals have advanced digital skills to fully participate in society. Based on the results of a survey made on a sample of 315 individuals, this paper discusses the importance granted GuiMarket and the intended frequency of use, concluding there is a close relationship between ICT access and use that respondents anticipate making of GuiMarket and alike services.

Survival Analysis Employed in Predicting Corporate Failure: A Forecasting Model Proposal

In face of the current economic and financial environment, predicting corporate bankruptcy is arguably a phenomenon of increasing interest to investors, creditors, borrowing firms, and governments alike. Within the strand of literature focused on bankruptcy forecasting we can find diverse types of research employing a wide variety of techniques, but only a few researchers have used survival analysis for the examination of this issue. We propose a model for the prediction of corporate bankruptcy based on survival analysis, a technique which stands on its own merits. In this research, the hazard rate is the probability of ‘‘bankruptcy’’ as of time t, conditional upon having survived until time t. Many hazard models are applied in a context where the running of time naturally affects the hazard rate. The model employed in this paper uses the time of survival or the hazard risk as dependent variable, considering the unsuccessful companies as censured observations.