scholarly journals The use of Multi-compartment Compliance Aids (MCAs) in Pharmacies in England and North Wales

2020 ◽  
Author(s):  
Ana Pedro
Keyword(s):  
Cardiovascular Disease ◽  
Western Europe ◽  
Patient Adherence ◽  
Drug Stability ◽  
Significant Proportion ◽  
Geographic Area ◽  
Disease Category ◽  
Treatment Benefits ◽  
North Wales ◽  
Single Dosing

Multicompartment compliance aids (MCAs) are devices with each discrete section denoting a single dosing occasion. The purpose of an MCA is to maximize patient adherence and thereby optimize the treatment benefits. These devices are widely employed throughout western Europe and UK and use appears to be rapidly increasing (2) although the RPS as moved away from these devices as a means to improve adherence. We analysed MCAs from various pharmacies over a wide geographic area in England and North Wales. We concluded that most MCA users are elderly patients. Also, most of the patients suffer of combined cardiovascular disease. However, a significant proportion of patients falls in the mental/ neurological disease category. Additionally, most of the externals added to MCAs are inhalers and painkillers. Moreover, SDIs are more frequent in female patients and these SDI are mainly related with mental health medication, cardiovascular disease medication and neurological medication. In conclusion, a directive for dispensing of MCAs in pharmacies by pharmacists through an enhanced service should be elaborated having in consideration PIMs, SDIs, drug stability and use of externals and MCA design and brand.

scholarly journals Reference Standards for Cardiorespiratory Fitness by Cardiovascular Disease Category and Testing Modality: Data From FRIEND

2021 ◽  
Author(s):  
James E. Peterman ◽  
Ross Arena ◽  
Jonathan Myers ◽  
Susan Marzolini ◽  
Philip A. Ades ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Cardiorespiratory Fitness ◽  
Clinical Care ◽  
Cardiopulmonary Exercise Testing ◽  
Age Groups ◽  
Reference Standards ◽  
National Database ◽  
Disease Category ◽  
Men And Women ◽  
The Mean

Background The importance of cardiorespiratory fitness for stratifying risk and guiding clinical decisions in patients with cardiovascular disease is well‐established. To optimize the clinical value of cardiorespiratory fitness, normative reference standards are essential. The purpose of this report is to extend previous cardiorespiratory fitness normative standards by providing updated cardiorespiratory fitness reference standards according to cardiovascular disease category and testing modality. Methods and Results The analysis included 15 045 tests (8079 treadmill, 6966 cycle) from FRIEND (Fitness Registry and the Importance of Exercise National Database). Using data from tests conducted January 1, 1974, through March 1, 2021, percentiles of directly measured peak oxygen consumption (VO 2peak ) were determined for each decade from 30 through 89 years of age for men and women with a diagnosis of coronary artery bypass surgery, myocardial infarction, percutaneous coronary intervention, or heart failure. There were significant differences between sex and age groups for VO 2peak ( P <0.001). The mean VO 2peak was 23% higher for men compared with women and VO 2peak decreased by a mean of 7% per decade for both sexes. Among each decade, the mean VO 2peak from treadmill tests was 21% higher than the VO 2peak from cycle tests. Differences in VO 2peak were observed among the age groups in both sexes according to cardiovascular disease category. Conclusions This report provides normative reference standards by cardiovascular disease category for both men and women performing cardiopulmonary exercise testing on a treadmill or cycle ergometer. These updated and enhanced reference standards can assist with patient risk stratification and guide clinical care.

scholarly journals Practical ways to deal with the high burden of cardiovascular disease in hemodialysis patients

2006 ◽  
Vol 124 (1) ◽  
pp. 36-41 ◽  
Author(s):  
José Jayme Galvão de Lima
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Cardiovascular Risk ◽  
General Population ◽  
Cardiovascular Risk Factors ◽  
Ventricular Hypertrophy ◽  
Significant Proportion ◽  
Hemodialysis Patients ◽  
Left Ventricular ◽  
Dialysis Patients

Cardiovascular disease is the main cause of death among hemodialysis patients. Although uremia by itself may be considered to be a cardiovascular risk factor, a significant proportion of dialysis patients die because of cardiovascular disease not directly attributable to uremia. Indeed, many of the cardiovascular diseases and cardiovascular risk factors in these patients are common to those occurring in the general population and are amenable to intervention. Lack of proper medical care during the early stages of renal insufficiency and present-day dialysis routines, by failing to correct hypertension, hypervolemia and left ventricular hypertrophy in many patients, may also add to the cardiovascular burden. The author suggests that, in addition to early treatment and referral to a specialist, chronic renal failure patients should undergo intensive cardiovascular screening and treatment, and correction of cardiovascular risk factors based on guidelines established for the general population.

Domestic service and social modernization in urban Galicia, 1752–1920

1999 ◽  
Vol 14 (2) ◽  
pp. 207-226 ◽  
Author(s):  
ISIDRO DUBERT
Keyword(s):  
Western Europe ◽  
Significant Proportion ◽  
Domestic Service ◽  
Early Age ◽  
Formation Model ◽  
Northern European ◽  
The Family ◽  
Social Modernization ◽  
Marriage Formation

Since the late 1980s historians of the family have been interested in the socio-demographic analysis of the role of domestic service in European societies during the Ancien Régime. These scholars have been concerned with the consequences of life-cycle service since it appeared that a significant proportion of Europe's inhabitants were in service at some point in their lives. This proportion was highest in countries of Northwestern Europe, such as England, where between 10 and 12 per cent of the population worked as servants, usually while young, moving readily from one household to another. This process began at an early age, around adolescence, and tended to end with a change in occupation, generally just before entering into marriage, in other words, prior to forming a separate family unit. By relating the mobility of servants to the specific characteristics of the marriage-formation model, historians have been able to highlight the contribution of domestic service to social and familial reproduction. Encouraged by their results, the next step for social historians was to elaborate an explanatory model of this system of family reproduction. Although the model offered was derived from the behaviour of a concrete social and demographic structure which was basically Northern European, it was nonetheless presented as the principal model for all of Western Europe.

scholarly journals Differences in oviposition behaviour of two sympatric sibling species of the genus Ostrinia

2008 ◽  
Vol 98 (2) ◽  
pp. 193-201 ◽  
Author(s):  
T. Malausa ◽  
B. Pélissié ◽  
V. Piveteau ◽  
C. Pélissier ◽  
D. Bourguet ◽  
...  
Keyword(s):  
Host Plant ◽  
Assortative Mating ◽  
European Corn Borer ◽  
Western Europe ◽  
Significant Proportion ◽  
Natural Populations ◽  
Host Shift ◽  
Oviposition Behaviour ◽  
Host Preferences ◽  
Corn Borer

AbstractChanges in host preferences are thought to be a major source of genetic divergence between phytophagous insect taxa. In western Europe, two sympatric taxa, O. nubilalis (the European corn borer) and O. scapulalis, feed mainly on maize and hop or mugwort, respectively. These two species may have diverged without geographic isolation after a host shift of ancestral populations onto maize or another cultivated species (e.g. sorghum). A previous study using inbred laboratory strains revealed that the two species differ in their oviposition choices in maize-mugwort tests. We sampled four natural populations in France (two of each taxon) and tested their oviposition behaviour toward four of their main host plant species: maize, sorghum, mugwort and hop. O. nubilalis females showed a very high preference for laying their eggmasses on maize, whereas O. scapulalis females displayed a more balanced range of preferences. O. nubilalis females were attracted slightly to sorghum, suggesting that this plant is an accidental, rather than a regular and ancestral host plant of O. nubilalis. One important result arising from this study is the significant proportion of eggs laid by both Ostrinia species on hop. This may explain why some stands of hop are sometimes not only infested by O. scapulalis but also by O. nubilalis larvae, a situation preventing assortative mating based on microallopatry. Hence, further studies must be conducted to see whether the host preference in the genus Ostrinia might be linked to assortative mating by a mechanism that is not mediated by the host plant.

scholarly journals Domestication and Feed Restriction Programming Organ Index, Dopamine, and Hippocampal Transcriptome Profile in Chickens

2021 ◽  
Vol 8 ◽  
Author(s):  
Siyu Chen ◽  
Chao Yan ◽  
Jinlong Xiao ◽  
Wen Liu ◽  
Zhiwei Li ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Neurodegenerative Disease ◽  
Feed Restriction ◽  
Transcriptome Profile ◽  
Disease Category ◽  
Fast Growing ◽  
Organ Index ◽  
Ad Libitum ◽  
Slow Growing ◽  
The Brain

The domestication process exerts different phenotypic plasticity between slow- and fast-growing breeds of chicken. Feed restriction has a critical role in production performance, physiological plasticity, and stress response. Our study aimed to explore how feed restriction programed the organ index, dopamine, and hippocampal transcriptome profile between slow- and fast-growing chickens, which were fed either ad libitum (SA and FA), or feed restricted to 70% of ad libitum (SR and FR), for 30 days. Results showed that feed restriction influenced the brain organ index (P &lt; 0.05), but not the organ index of the heart, liver, and spleen. The slow-growing breed tested had a higher brain organ index than the fast-growing breed (P &lt; 0.05). Under feed restriction conditions, both the slow- and fast-growing breeds had significantly elevated dopamine concentrations (P &lt; 0.05) compared to those fed ad libitum. In the GO term, upregulated genes in the FA group were enriched in the mitochondria, respiratory chain, and energy metabolism compared to the SA group (P &lt; 0.05). Membranes and ribosomes were enriched in the cellular component between the SR and FR groups (P &lt; 0.05). In the KEGG functional pathways, upregulated DEGs in the FR group were enriched in the cardiovascular disease category and neurodegenerative disease category compared to the FA group (P &lt; 0.05). Downregulated DEGs in the FA group were enriched in the oxidative phosphorylation and neurodegenerative disease categories (Parkinson's disease and Huntington's disease) compared with the SA group (P &lt; 0.05). Upregulated DEGs in the FR group were enriched in the cardiovascular disease category, neurodegenerative disease category, and energy metabolism than the SR group (P &lt; 0.05). In conclusion, feed restriction had profound effects on the brain organ index and plasma dopamine in the slow- and fast-growing chickens. Feed restriction may result in issues relating to cardiovascular and neurodegenerative diseases in the fast-growing breed tested, but not in the slow-growing breed.

scholarly journals Cardiovascular disease and severe hypoxemia associated with higher rates of non-invasive respiratory support failure in COVID-19

2020 ◽  
Author(s):  
Jing Gennie Wang ◽  
Bian Liu ◽  
Bethany Percha ◽  
Stephanie Pan ◽  
Neha Goel ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Significant Proportion ◽  
Respiratory Support ◽  
Positive Pressure ◽  
Hypoxemic Respiratory Failure ◽  
Acute Hypoxemic Respiratory Failure ◽  
Subdistribution Hazard ◽  
Non Invasive ◽  
Increased Risk ◽  
High Flow Oxygen

Rationale Acute hypoxemic respiratory failure (AHRF) is the major complication of coronavirus disease 2019 (COVID-19), yet optimal respiratory support strategies are uncertain. Objectives To describe outcomes with high-flow oxygen delivered through nasal cannula (HFNC) and non-invasive positive pressure ventilation (NIPPV) in COVID-19 AHRF and identify individual factors associated with failure. Methods We performed a retrospective cohort study of hospitalized adults with COVID-19 treated with HFNC and/or NIPPV to describe rates of success (live discharge without endotracheal intubation (ETI)), and identify characteristics associated with failure (ETI and/or in-hospital mortality) using Fine-Gray sub-distribution hazard models. Results A total of 331 and 747 patients received HFNC and NIPPV as the highest level of non-invasive respiratory support, respectively; 154 (46.5%) in the HFNC cohort and 167 (22.4%) in the NIPPV cohort were successfully discharged without requiring ETI. In adjusted models, significantly increased risk of HFNC and NIPPV failure was seen among patients with cardiovascular disease (subdistribution hazard ratio (sHR) 1.82; 95% confidence interval (CI), 1.17-2.83 and sHR 1.40; 95% CI 1.06-1.84), respectively, and among those with lower oxygen saturation to fraction of inspired oxygen (SpO2/FiO2) ratio at HFNC and NIPPV initiation (sHR, 0.32; 95% CI 0.19-0.54, and sHR 0.34; 95% CI 0.21-0.55, respectively). Conclusions A significant proportion of patients receiving non-invasive respiratory modalities for COVID-19 AHRF achieved successful discharge without requiring ETI, with lower success rates among those with cardiovascular disease or more severe hypoxia. The role of non-invasive respiratory modalities in COVID-19 related AHRF requires further consideration.

scholarly journals Generalizability and Validation of PROMIS Scores to Predict Surgical Success in Foot and Ankle Patients

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0000 ◽  
Author(s):  
Judith Baumhauer ◽  
Michael Anderson ◽  
Charles Saltzman ◽  
Man Hung ◽  
Florian Nickisch ◽  
...  
Keyword(s):  
Patient Reported Outcomes ◽  
Significant Proportion ◽  
Geographic Area ◽  
Current Data ◽  
Foot And Ankle ◽  
Chi Square ◽  
Data Set ◽  
Post Surgery ◽  
Patient Reported ◽  
Chi Square Analysis

Category: Patient Reported Outcomes Introduction/Purpose: Patient-reported outcomes are advancing clinical care by improving patient satisfaction and engagement. A recent publication reported preoperative PROMIS scores to be highly predictive in selecting patients who would and would not benefit from foot and ankle (F/A) surgery. Although this publication used the data from 5 fellowship trained foot and ankle surgeons at one institution, the generalizability to other patient populations and geographic areas is unknown. This validation study assesses the pre-operative PROMIS physical function (PF) and pain interference (PI) t-scores as a predictor of post-operative success from a separate geographic area. Methods: Prospective consecutive patient visits to a multi-surgeon tertiary F/A clinic were obtained between 1/2014-11/2016 resulting in 18,565 unique visits and 1,408 new patients. Patients undergoing elective operative intervention for F/A were identified by ICD-9/10; CPT code. PROMIS PF and PI were assessed at initial and follow-up visits (minimum 6 months, mean 7.8 months). Two-way ANOVA was used to determine differences in PROMIS PF and PI from pre to post surgery with age and gender as co- variates. The distributive method of estimating a minimal clinical important difference (MCID) was used. Receiver operator curve (ROC) analysis was used to determine cut offs for achieving and failing to achieve MCID. To determine the validity of previously published cut offs, 1) they were compared to cut offs for this data set and 2) the percentage of patients achieving and failing to achieve MCID based on previous cut offs were evaluated using a chi-square analysis. Results: There were significant improvements in PROMIS PF scores (mean=6.0; sd=11.6; p<0.01) and PI scores (mean=-7.0; sd=8.4; p<0.01). The AUC for PROMIS PF (0.77) was significant (p < 0.01) and the cut offs for achieving MCID (current data = <23.8 versus previous study= <29.7) and failing to achieve MCID (current data=>41.1 versus previous study=>42) were comparable (Figure 1). Of the patients identified as unlikely to achieve MCID, a significant proportion (88.9%) failed to achieve an MCID ((Chi square=4.7; p=0.03). Of the patients identified as likely to achieve MCID, a significant proportion (84.2%) achieved MCID ((Chi square=17.8; p<0.01). This validates the prior preoperative PROMIS PF thresholds for patients undergoing F/A surgery who will and will not demonstrate MCID improvement in PROMIS PF. The AUC for PROMIS PI was not significant. Conclusion: PROMIS PF cut offs from published data were successful in classifying patients who would improve in PF with surgery from a different geographic area and academic institution with a broad unique array of surgical procedures, diagnoses, and a diverse patient population. This study provides validation evidence to support using the PROMIS PF as a potential tool for surgical selection to help identify patients who would benefit from surgery as well as those who would not. This can allow for appropriate utilization of healthcare dollars and manpower resources to benefit our patients.

scholarly journals Predictors of Access to Rehabilitation in the Year Following Traumatic Brain Injury: A European Prospective and Multicenter Study

2020 ◽  
Vol 34 (9) ◽  
pp. 814-830
Author(s):  
Louis Jacob ◽  
Mélanie Cogné ◽  
Olli Tenovuo ◽  
Cecilie Røe ◽  
Nada Andelic ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Multicenter Study ◽  
Western Europe ◽  
Injury Severity ◽  
Traumatic Injury ◽  
Significant Proportion ◽  
Sociodemographic Factors ◽  
Related Factors ◽  
Direct Discharge

Background Although rehabilitation is beneficial for individuals with traumatic brain injury (TBI), a significant proportion of them do not receive adequate rehabilitation after acute care. Objective Therefore, the goal of this prospective and multicenter study was to investigate predictors of access to rehabilitation in the year following injury in patients with TBI. Methods Data from a large European study (CENTER-TBI), including TBIs of all severities between December 2014 and December 2017 were used (N = 4498 patients). Participants were dichotomized into those who had and those who did not have access to rehabilitation in the year following TBI. Potential predictors included sociodemographic factors, psychoactive substance use, preinjury medical history, injury-related factors, and factors related to medical care, complications, and discharge. Results In the year following traumatic injury, 31.4% of patients received rehabilitation services. Access to rehabilitation was positively and significantly predicted by female sex (odds ratio [OR] = 1.50), increased number of years of education completed (OR = 1.05), living in Northern (OR = 1.62; reference: Western Europe) or Southern Europe (OR = 1.74), lower prehospital Glasgow Coma Scale score (OR = 1.03), higher Injury Severity Score (OR = 1.01), intracranial (OR = 1.33) and extracranial (OR = 1.99) surgery, and extracranial complication (OR = 1.75). On contrast, significant negative predictors were lack of preinjury employment (OR = 0.80), living in Central and Eastern Europe (OR = 0.42), and admission to hospital ward (OR = 0.47; reference: admission to intensive care unit) or direct discharge from emergency room (OR = 0.24). Conclusions Based on these findings, there is an urgent need to implement national and international guidelines and strategies for access to rehabilitation after TBI.

Hidden Cost of Rheumatoid Arthritis (RA): Estimating Cost of Comorbid Cardiovascular Disease and Depression Among Patients with RA

2009 ◽  
Vol 36 (4) ◽  
pp. 743-752 ◽  
Author(s):  
AMIE T. JOYCE ◽  
PAULA SMITH ◽  
REZAUL KHANDKER ◽  
JEFFREY M. MELIN ◽  
AMITABH SINGH
Keyword(s):  
Rheumatoid Arthritis ◽  
Cardiovascular Disease ◽  
Healthcare Cost ◽  
Generalized Linear Model ◽  
Healthcare Costs ◽  
Clinical Characteristics ◽  
Claims Data ◽  
Significant Proportion ◽  
Hidden Cost ◽  
Utilization Patterns

Objective.To examine resource utilization and direct healthcare cost associated with comorbid cardiovascular disease (CVD) and depression among patients with prevalent rheumatoid arthritis (RA) based on analyses of retrospective healthcare claims data.Methods.The index date was set as the first observed claim with an RA diagnosis. Patients were required to be ≥ 18 years of age, to have received RA-related treatment during the pre-index period, and to have 12-month pre- and post-index data. Based on pre-index utilization, patients were classified into 4 diagnosis groups: RA alone, RA + CVD, RA + depression, and RA + CVD + depression. Analyses focused on annual differences in costs between patients with RA alone and those with CVD and/or depression. A generalized linear model was applied to control for demographic and clinical characteristics and to estimate cohort-specific adjusted mean annual healthcare cost.Results.Of 10,298 patients, 8,916 had RA alone (86.6%), 608 had RA + CVD (5.9%), 716 had RA + depression (7.0%), and 58 had RA + CVD + depression (0.5%). All patients with CVD and/or depression incurred significantly higher followup costs compared with patients with RA alone. Adjusted annual mean healthcare costs were highest for RA + CVD (US$14,145), followed by RA + CVD + depression ($13,513), RA + depression ($12,225), and RA alone ($11,404). Although patients with CVD and/or depression had a greater rate of RA-related hospitalization, adjusted RA-related healthcare costs did not reflect any statistically significant differences as compared to the RA-alone cohort.Conclusion.A significant proportion (13.4%) of patients with prevalent RA have comorbid CVD and/or depression. The presence of these conditions significantly affects annual healthcare costs as well as specific RA-related utilization patterns.

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