Barriers and enablers affecting patient engagement in managing medications within specialty hospital settings

Background : Communication problems contribute enormously to medication errors and adverse events. Encouraging patient engagement can help to facilitate effective medication management.

Objectives : To examine barriers and enablers affecting how patients engage with managing their medications in specialty hospital settings.

Design : An exploratory qualitative design was used involving in-depth interviews with doctors, nurses, pharmacists, patients and family members.

Setting : An Australian public, metropolitan teaching hospital was the study site and five specialty hospital settings were used, including cardiac care, emergency care, intensive care, oncology care and perioperative care.

Results : In all, 21 health professionals, 11 patients and 12 family members participated in the study (n = 44). Barriers and enablers involved intrapersonal, interpersonal and environmental aspects, and differences in perceptions and experiences were found between the various settings. Health professionals had preconceived notions of what was appropriate behaviour in conveying information about medications. Many health professionals stated that they deliberately chose not to provide medication-related knowledge. Different barriers for patient engagement existed in various settings – in emergency care, patients could only stay for 4 h; in intensive care, medication changes regularly happened; in cardiac care, patients were discharged prematurely due to urgent need of beds; in oncology, there was lack of availability of oncology consultants; while in perioperative care, surgeons and anaesthetists were available just before surgery.

Conclusions : Complex barriers and enablers are associated with patient engagement in specialty clinical settings. By developing an understanding of these barriers and enablers, health professionals can help patients to understand and participate in their medication management.

The effect of community interventions on alcohol-related assault in Geelong, Australia

Alcohol has consistently been demonstrated to increase levels of aggression and violence, particularly in late night licensed venues. Since 2005, the City of Geelong in Australia has implemented a substantial number of interventions to reduce alcohol related violence, including a liquor accord, increased police surveillance, ID scanners, CCTV, a radio network and an alcohol industry sponsored social marketing campaign. The aim of the current study is to assess the individual and collective impact of community interventions on indicators of alcohol-related assaults in the Geelong region. This paper reports stage one findings from the Dealing with Alcohol-related problems in the Night-time Economy project (DANTE) and specifically examines assault rate data from both emergency department presentations, ICD-10 classification codes, and police records of assaults. None of the interventions were associated with reductions in alcohol-related as-sault or intoxication in Geelong, either individually or when combined. However, the alcohol industry sponsored social marketing campaign ‘Just Think’ was associated with an increase in assault rates. Community level interventions appeared to have had little effect on assault rates during high alcohol times. It is also possible that social marketing campaigns without practical strategies are associated with increased assault rates. The findings also raise questions about whether interventions should be targeted at reducing whole-of-community alcohol consumption.

Demographic risk factors for alcohol-related aggression in and around licensed venues

AIMS: Few studies have examined the role of gender and both area-level and individual socio-economic status (SES) as independent predictors of alcohol-related aggression (ARA) in and around licensed venues. METHODS: The aim of the present study was to investigate the relationship between gender, area-level SES and individual SES (operationalised as occupational category) and ARA in and around licensed venues. The sample comprised 697 men and 649 women aged 16-47, who completed a patron intercept survey as part of a larger study assessing trends in harm and stakeholders' views surrounding local community level interventions in dealing with alcohol-related problems in the night-time economy. RESULTS: Binary logistic regression analyses showed that age, gender, occupational category, area-level SES and level of intoxication at time of interview were all significant predictors of involvement in ARA. Being male doubled the odds of involvement in ARA, while age was a protective factor. Blue collar workers had more than double the odds of ARA involvement of professionals, while those living in the most socio-economically disadvantaged areas were over twice as likely to report experiencing ARA compared to those living in the most advantaged areas. However, assessment of the predictive model by gender revealed that effects of age, occupational category and area-level SES were restricted to male participants, with greater intoxication no longer predictive. CONCLUSIONS: ARA among patrons was significantly more likely to occur among men, those in blue collar occupations, and individuals living in low SES areas, suggesting both individual and area-level disadvantage may play a role in ARA.

Carrying capacity in agriculture: Environmental significance and some related patents

Agriculture is one of the most important and possibly the oldest economic activity developed by humans. This activity was developed extensively and is becoming more and more dependent on development of technologies. The goal of this manuscript was examining some patents related to technologies developed for improving crop yields. Such patents are mainly related to more efficient formulations of agrochemicals and management techniques of plants, cattle and natural resources. A brief comment is carried out about bioprospection and related problems, relating, for example the case of Cupuaçu. The article is concluded mentioning that the development of policies and management strategies that increase agricultural yield and simultaneously preserve or conserve natural resources should also be prioritized, because certainly this is the only way we have to get the real sustainability and to improve life quality abroad the world.

Intervenções farmacêuticas na atenção à saúde mental: Uma revisão

Uma revisão dirigida foi realizada nas bases de dados IBECS, LILACS e MEDLINE, até fevereiro/2011, para identificar intervenções farmacêuticas (IF) na atenção farmacêutica em saúde mental e os seus resultados. Para a busca utilizaram-se os descritores em saúde: Pharmaceutical Care, Pharmaceutical Services, Medication Adherence, Pharmacists, Mental Health, Mental Health Services, Mental Health Assistance, Community Mental Health Services, Mentally Ill Persons andMental Disorders. Identificaram-se 1686 publicações, das quais 21 contemplaram os critérios de inclusão. Após exploração do material, apenas cinco estudos tratavam-se de IF. Todos foram conduzidos no nível secundário de atenção, com abordagem individual, por meio do acompanhamento da terapia (3), intervenção educativa por cartas a médicos e pacientes (1), aconselhamento farmacêutico presencial e remoto e inserção de terapia com sistema transdérmico de nicotina (1). Os resultados, tais como promoção da adesão e resolução de problemas relacionados a medicamentos foram positivos para a terapêutica. No entanto, é necessário que as IF monitorem os parâmetros clínicos, as mudanças de hábitos, a melhora na qualidade de vida e os aspectos farmacoeconômicos a fim de avaliar os seus impactos. Palavras-chave:Atenção Farmacêutica. Assistência Farmacêutica. Adesão à Medicação. Farmacêuticos. Saúde Mental. ABSTRACT Pharmaceutical interventions in mental health services: a review A directed review was performed in IBECS, LILACS and MEDLINE databases, until February/2011, in order to identify the studies which developed pharmaceutical interventions (PI) in pharmaceutical care in mental health services and estimated their results. The search was carried out using the follow health science descriptors: Pharmaceutical Care, Pharmaceutical Services, Medication Adherence, Pharmacists, Mental Health, Mental Health Services, Mental Health Assistance, Community Mental Health Services, Mentally Ill Persons andMental Disorders. It was identified 1686 manuscripts, of whose 21 contemplated the inclusion criteria. After the content analysis of the eligible manuscripts, only five developed PI. All of them were conducted in the second level of health care, with individual approach, through: therapy follow-up (3), educational interventions by letters to physicians and patients (1), presence or remote pharmaceutical counseling and inclusion of therapy with nicotine transdermal patch (1). The data, such as adherence promotion and solving drug related problems, were positive for the therapeutic. However, it is necessary that the PI monitor the clinical parameters, the habit changes, the improvement in the quality of life and the pharmacoeconomic aspects, in order to assess their impacts. Keywords: Pharmaceutical Care. Pharmaceutical Services. Medication Adherence. Pharmacists. Mental Health. Mental Disorders.

Influência da atenção farmacêutica no seguimento do tratamento farmacológico de pacientes portadores de prolactinoma

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Validade e coerência de instrumentos utilizados em avaliações clínicas de idosos

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Estudo dos motivos do abandono do tratamento da hipertensão arterial: relato de usuários do CSE-Botucatu, 1995/1999

Pós-graduação em Saúde Coletiva - FMB

Intraoperative and Anesthesia-Related Cardiac Arrest and Its Mortality in Older Patients: A 15-Year Survey in a Tertiary Teaching Hospital

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

RELATED LAWS ON EXOTIC AND NATIVE WILD ANIMALS

This paper is submitted in an effort to acquaint the personnel of allied State agencies with related laws which control the public and private possession of live exotic and native wild animals. The need for this common knowledge of related laws by agencies with law enforcement responsibility is readily apparent when the annual number and related problems from imported or resident wild animals in California are examined. In addition to resident wild animal populations, millions of fish and thousands of mammals, birds, and reptiles enter California each year through the utilization of most methods of transportation. Most of these imported animals are exotic species from foreign lands which cannot be readily identified and pose various degrees of potential and actual threat to native wild life, agriculture, and public health if they are introduced into the wilds of this State. For the purpose of this report, a general picture of imported exotic animals is presented in an introduction, and specific animals with related laws are treated individu-ally under the headings of current laws and future regulations.

Enhancing health care for type 2 diabetes in Northern Brazil: A pilot study of pharmaceutical care in community pharmacy

To evaluate the impact of a medication therapy management (MTM) program on the clinical outcomes and the quality of life (QoL) of a group of elderly patients with type 2 diabetes mellitus (DM). The study was conducted in a community pharmacy in Aracaju, Brazil, from February to November 2009. A quasi-experimental, longitudinal, prospective study was conducted by intervention. The group patients received medication therapy management from a clinical pharmacist. A sample of convenience was obtained for patients of both genders aged from 60 to 75 years. Monthly visits were scheduled over 10 months. At these consultations, sociodemographic, clinical data were obtained. QoL assessment was conducted using a generic instrument-the Medical Outcomes Studies 36-item Short Form Survey (SF-36 (R)). In total, 34 completed the study. The mean age of the patients was 65.9 (4.7) years. In total, 117 DRPs were identified. Patients' baseline and final evaluation measures for glycosylated hemoglobin, capillary blood glucose, blood pressure, and waist circumference were significantly different (p < 0.05). The domains of QoL assessed by the SF-36 (R) also shows significant differences between patients' baseline and final evaluation scores. The co-responsibility and active participation on the part of the elderly may have helped pharmacotherapy achieve its clinical and humanistic aims.

Integrating Crew Scheduling and Rostering Problems

Crew scheduling and crew rostering are similar and related problems which can be solved by similar procedures. So far, the existing solution methods usually create a model for each one of these problems (scheduling and rostering), and when they are solved together in some cases an interaction between models is considered in order to obtain a better solution. A single set covering model to solve simultaneously both problems is presented here, where the total quantity of drivers needed is directly considered and optimized. This integration allows to optimize all of the depots at the same time, while traditional approaches needed to work depot by depot, and also it allows to see and manage the relationship between scheduling and rostering, which was known in some degree but usually not easy to quantify as this model permits. Recent research in the area of crew scheduling and rostering has stated that one of the current challenges to be achieved is to determine a schedule where crew fatigue, which depends mainly on the quality of the rosters created, is reduced. In this approach rosters are constructed in such way that stable working hours are used in every week of work, and a change to a different shift is done only using free days in between to make easier the adaptation to the new working hours. Computational results for real-world-based instances are presented. Instances are geographically diverse to test the performance of the procedures and the model in different scenarios.

Einfluss einer klinisch-pharmazeutischen Betreuung auf klinische, soziale und ökonomische Ergebnisse bei elektiven herzchirurgischen Patienten

Die Pharmazeutische Betreuung erfolgt mit dem Ziel der Identifikation, Vermeidung und Lösung von Arzneimittelbezogenen Problemen (AbP). In einer prospektiven, randomisierten Studie sollte geprüft werden, ob durch klinisch-pharmazeutische Betreuung bei multimorbiden Patienten mit Polymedikation die Dauer eines AbP verkürzt und ob durch einen individuellen, bebilderten Medikationsplan das Patientenwissen zur aktuellen stationären Medikation verbessert werden kann. In die Studie wurden 244 herzchirurgische Patienten eingeschlossen (≥65 Jahre, ≥5 Arzneimittel). Die Patienten wurden in vier Gruppen randomisiert. Es gab keine statistischen Unterschiede bezüglich der Patientenmerkmale Alter, Geschlecht, Aufnahmediagnose, Anzahl an Arzneimitteln bei der Aufnahme oder stationäre Verweildauer. Das Patientenwissen zur stationären Medikation wurde mittels Fragebogen bei 188 Patienten ermittelt (Rücklaufquote 78%). Zur objektiven Evaluation des Patientenwissens wurden die Patientenangaben zu Einnahmegründen, Arzneimittelbezeichnung, Stärke und Dosierung und zur Therapiedauer gerinnungshemmender Arzneimittel mit der tatsächlichen Medikation verglichen. Insgesamt wurden 1335 AbP bei 235 Patienten detektiert. Durch klinisch-pharmazeutische Betreuung konnten mehr AbP erkannt, frühzeitig gelöst und deren Dauer im Median von 4 auf 2 Tage signifikant (p-Wert<0,001) reduziert werden. Ein bebilderter Medikationsplan verbessert das Patientenwissen über die stationäre Medikation subjektiv und objektiv und erhöht die Motivation der Patienten, die Arzneimittel entsprechend den Einnahmehinweisen auf dem Medikationsplan einzunehmen.

Drug-related emergency department visits by elderly patients presenting with non-specific complaints

BACKGROUND Since drug-related emergency department (ED) visits are common among older adults, the objectives of our study were to identify the frequency of drug-related problems (DRPs) among patients presenting to the ED with non-specific complaints (NSC), such as generalized weakness and to evaluate responsible drug classes. METHODS Delayed type cross-sectional diagnostic study with a prospective 30 day follow-up in the ED of the University Hospital Basel, Switzerland. From May 2007 until April 2009, all non-trauma patients presenting to the ED with an Emergency Severity Index (ESI) of 2 or 3 were screened and included, if they presented with non-specific complaints. After having obtained complete 30-day follow-up, two outcome assessors reviewed all available information, judged whether the initial presentation was a DRP and compared their judgment with the initial ED diagnosis. Acute morbidity ("serious condition") was allocated to individual cases according to predefined criteria. RESULTS The study population consisted of 633 patients with NSC. Median age was 81 years (IQR 72/87), and the mean Charlson comorbidity index was 2.5 (IQR 1/4). DRPs were identified in 77 of the 633 cases (12.2%). At the initial assessment, only 40% of the DRPs were correctly identified. 64 of the 77 identified DRPs (83%) fulfilled the criteria "serious condition". Polypharmacy and certain drug classes (thiazides, antidepressants, benzodiazepines, anticonvulsants) were associated with DRPs. CONCLUSION Elderly patients with non-specific complaints need to be screened systematically for drug-related problems. TRIAL REGISTRATION ClinicalTrials.gov: NCT00920491.

Adult Asylum Seekers from the Middle East Including Syria in Central Europe: What Are Their Health Care Problems?

Background Forced displacement related to persecution and violent conflict has reached a new peak in recent years. The primary aim of this study is to provide an initial overview of the acute and chronic health care problems of asylum seekers from the Middle East, with special emphasis on asylum seekers from Syria. Methods Our retrospective data analysis comprised adult patients presenting to our emergency department between 01.11.2011 and 30.06.2014 with the official resident status of an “asylum seeker” or “refugee” from the Middle East. Results In total, 880 patients were included in the study. Of these, 625 (71.0%) were male and 255 (29.0%) female. The median age was 34 (range 16–84). 222 (25.2%) of our patients were from Syria. The most common reason for presentation was surgical (381, 43.3%), followed by medical (321, 36.5%) and psychiatric (137, 15.6%). In patients with surgical presentations, trauma-related problems were most common (n = 196, 50.6%). Within the group of patients with medical presentation, acute infectious diseases were most common (n = 141, 43.9%), followed by neurological problems (n = 70, 21.8%) and gastrointestinal problems (n = 47, 14.6%). There were no differences between Syrian and non-Syrian refugees concerning surgical or medical admissions. The most common chronic disorder of unclear significance was chronic gastrointestinal problems (n = 132, 15%), followed by chronic musculoskeletal problems (n = 108, 12.3%) and chronic headaches (n = 78, 8.9%). Patients from Syria were significantly younger and more often suffered from a post-traumatic stress disorder than patients of other nationalities (p<0.0001, and p = 0.05, respectively). Conclusion Overall a remarkable number of our very young group of patients suffered from psychiatric disorders and unspecified somatic symptoms. Asylum seekers should be carefully evaluated when presenting to a medical facility and physicians should be aware of the high incidence of unspecified somatic symptoms in this patient population.In general, there is no major difference between asylum seekers from Syria when compared to other nationalities of asylum seekers from the Middle East.