999 resultados para Olmsted, Arthur George, 1827-1914.


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Editor: E. Jäckh.

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Edinburgh edition.

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Collection : Petite bibliothèque blanche

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Background
The majority of patients using antihypertensive medications fail to achieve their recommended target blood pressure. Poor daily adherence with medication regimens and a lack of persistence with medication use are two of the major reasons for failure to reach target blood pressure. There is no single intervention to improve adherence with antihypertensives that is consistently effective. Community pharmacists are in an ideal position to promote adherence to chronic medications. This study aims to test a specific intervention package that could be integrated into the community pharmacy workflow to enable pharmacists to improve patient adherence and/or persistence with antihypertensive medications - Hypertension Adherence Program in Pharmacy (HAPPY).

Methods/Design
The HAPPY trial is a multi-centre prospective randomised controlled trial. Fifty-six pharmacies have been recruited from three Australian states. To identify potential patients, a software application (MedeMine CVD) extracted data from a community pharmacy dispensing software system (FRED Dispense®). The pharmacies have been randomised to either 'Pharmacist Care Group' (PCG) or 'Usual Care Group' (UCG). To check for 'Hawthorne effect' in the UCG, a third group of patients 'Hidden Control Group' (HCG) will be identified in the UCG pharmacies, which will be made known to the pharmacists at the end of six months. Each study group requires 182 patients. Data will be collected at baseline, three and six months in the PCG and at baseline and six months in the UCG. Changes in patient adherence and persistence at the end of six months will be measured using the self-reported Morisky score, the Tool for Adherence Behaviour Screening and medication refill data.

Discussion

To our knowledge, this is the first research testing a comprehensive package of evidence-based interventions that could be integrated into the community pharmacy workflow to enable pharmacists to improve patient adherence and/or persistence with antihypertensive medications. The unique features of the HAPPY trial include the use of MedeMine CVD to identify patients who could potentially benefit from the service, control for the 'Hawthorne effect' in the UCG and the offer of the intervention package at the end of six months to patients in the UCG, a strategy that is expected to improve retention.

Trial Registration

Australian New Zealand Clinical Trial Registry ACTRN12609000705280

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zusammengest. von Arthur Richel und Aron Freimann

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Julian Barnes, Pat Barker, and Hanif Kureishi are all canonical authors whose fictions are widely believed to reflect the cultural and political state of a nation that is post-war, post-imperial and post-modern. While much has been written on how Barker’s and Kureishi’s early works in particular respond to and intervene in the presiding political narrative of the 1980s – Thatcherism – treatment of how revenants of Thatcherism have shaped these writers’ works from 1990 on has remained cursory. Thatcherism is more than an obvious historical reference point for Barker, Barnes, and Kureishi; their works demonstrate a sophisticated understanding of how Thatcher’s reworkings of the repertoires of Englishness – a representational as well as political and cultural endeavour – persist beyond her time in office. Barnes, Barker, and Kureishi seem to have reached the same conclusion as political and cultural critics: Thatcher and Thatcherism have remade not only the contemporary political and cultural landscapes but also the electorate and consequently the English themselves. Tony Blair’s conception of the New Britain proved less than satisfactory because contemporary repertoires of Englishness repeat and rework historical and not incidentally imperial formulations of England and Englishness rather than envision civic and populist formulations of renewal. Barnes’s England, England and Arthur & George confront the discourse of inevitability that has come to be attached to contemporary formulations of both political and cultural Englishness – both in terms of its predictable demise and its belated celebration. Kureishi’s The Buddha of Suburbia and “The Body” speak to an alteration that has taken place in which historical Englishness and Thatcherism have become complementary rather than contrasting discourses. What Barker’s Border Crossing and Double Vision offer against this backdrop is a subtle interrogation of how renewal itself comes to be a presiding mode of cultural reflection that absorbs revolutionary possibility.

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Mimeographed.