From drug-oriented curriculum to patient-oriented curriculum in Chile: Alumni satisfaction as a quality indicator for a pharmacy programme

Background: In 2005, a Health Care Reform in Chile established the role of pharmacists as contributors to achieving therapeutic goals. To fulfil the needs of the country in 2007 the pharmacy programme at Austral University of Chile started transiting from a drug-oriented to a patient-oriented curriculum. Objective: Monitoring this transition process using alumni satisfaction as a quality indicator. Methods: A questionnaire to assess alumni satisfaction with the pharmacy programme was designed and validated in its content and reliability. Subsequently, cross-sectional surveys over samples of graduates from both, drug-oriented and patient-oriented curriculum alumni were conducted. Satisfaction scores of both samples were statistically compared. Results: Cronbach´s alpha for all six dimensions of the final questionnaire was ≥ 0.70. The patient-oriented curriculum generated higher satisfaction scores (p < 0.001), noteworthy in dimensions ‘Design and organisation’, ‘Teachers’ and ‘Emotional bonding with the program/university’. In three out of 34 items the patient-oriented curriculum was less satisfactory than the drug-oriented one. Conclusions: Alumni satisfaction assessment is a useful source of feedback for quality assurance and continuous improvement of programmes. Considering this indicator, the transition of the pharmacy programme at Austral University of Chile to a patient-oriented curriculum was essentially successful.

Multiplexed Profiling of Extracellular Vesicles for Biomarker Development

Extracellular vesicles (EVs) are cell-derived membranous particles that play a crucial role in molecular trafficking, intercellular transport and the egress of unwanted proteins. They have been implicated in many diseases including cancer and neurodegeneration. EVs are detected in all bodily fluids, and their protein and nucleic acid content offers a means of assessing the status of the cells from which they originated. As such, they provide opportunities in biomarker discovery for diagnosis, prognosis or the stratification of diseases as well as an objective monitoring of therapies. The simultaneous assaying of multiple EV-derived markers will be required for an impactful practical application, and multiplexing platforms have evolved with the potential to achieve this. Herein, we provide a comprehensive overview of the currently available multiplexing platforms for EV analysis, with a primary focus on miniaturized and integrated devices that offer potential step changes in analytical power, throughput and consistency.

Multimicronutrient supplements in nutrition of pregnant women: critical analysis of research results

The purpose of the review is to analyze the results of the use of vitamin-mineral supplements (MMS) during pregnancy using the databases of the RSCI, CyberLeninka, pubMed. The detection of micronutrient deficiency in a significant part of pregnant women requires its unconditional correction by taking vitamin-mineral supplements. In recent years, the emphasis has shifted to studying the effect of MMS intake on the course and outcomes of pregnancy. The effects described in the literature should be treated critically. Most of the studies are based only on a retrospective survey of pregnant women (according to the ‘yes' or ‘no' principle), their supply of micronutrients is not monitored; no causal relationship is established. There is no objective monitoring of the MMS intake. Uncertainties include the composition and doses of micronutrients in the MMS used, the lack of data on drug intake, the assumption that all MMS are equivalent in composition and micronutrient content, and the grouping of women taking MMS with different composition into one group. In addition, the use of incorrect indicators in assessing the physical growth of children occurs. The positive effect of additional intake of MMS is manifested only if initially there was a deficiency of micronutrients.Conclusions. The intake of MMS during pregnancy improves the supply of vitamins for those women in whose diet there is a lack of them. This prophylaxis reduces the risk of adverse pregnancy outcomes due to vitamin deficiencies.

Parkinson’s Disease: Personalized Pathway of Care for Device-Aided Therapies (DAT) and the Role of Continuous Objective Monitoring (COM) Using Wearable Sensors

Parkinson’s disease (PD) is a chronic, progressive neurological disorder and the second most common neurodegenerative condition. Advanced PD is complicated by erratic gastric absorption, delayed gastric emptying in turn causing medication overload, and hence the emergence of motor and non-motor fluctuations and dyskinesia, which is initially predictable and then becomes unpredictable. As the patient progresses to the advanced stage, advanced Parkinson’s disease (APD) is characterized by refractory motor and non motor fluctuations, unpredictable OFF periods, and troublesome dyskinesias The management of APD is a complex affair. There is growing recognition that GI dysfunction is common in PD, with virtually the entire GI system (the upper and lower GI tracts) causing problems from dribbling to defecation. The management of PD should focus on personalized care addressing both motor and non-motor symptoms, ideally including not only dopamine replacement but also associated non-dopaminergic circuits, particularly focusing on noradrenergic, serotonergic, and cholinergic therapies bypassing the gastrointestinal tract (GIT) by infusion or device-aided therapies (DAT), including levodopa–carbidopa intestinal gel infusion, apomorphine subcutaneous infusion, and deep brain stimulation, which are available in many countries for the management of the advanced stage of Parkinson’s disease (APD). The PKG (KinetiGrap) can be used as a continuous objective monitoring (COM) aid, as a screening tool to help to identify advanced PD (APD) patients suitable for DAT, and can thus improve clinical outcomes.

Heart rate variability as a strain indicator for psychological stress for emergency physicians during work and alert intervention: a systematic review

Background The workloads of emergency physicians are severe. The prevalence of burnout among emergency physicians is higher than with other physicians or compared to the general population. The analysis of heart rate variability (HRV) is a valid method for objective monitoring of workload. The aim of this paper is to systematically evaluate the literature on heart rate variability as an objective indicator for mental stress of emergency physicians. Methods A systematic literature review examining heart rate variability of emergency physicians in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement for reporting systematic reviews was performed. PubMed, Ovid, Cochrane Libary, Scopus, and Web of Science electronic databases were used. The methodological quality was evaluated by using a modified STARD for HRV. Results Two studies matched the inclusion criteria by using HRV between alert intervention and two other studies were considered that used HRV in other question areas. It showed an adaptation of HRV under stress. The studies were not comparable. Conclusions There is a need for occupational health studies that examine strains and stress of emergency physicians. The well-established parasympathetic mediated HRV parameters seem to be suitable parameters to objectify the stress.

Current Advances in Wearable Devices and Their Sensors in Patients With Depression

In this study, a literature survey was conducted of research into the development and use of wearable devices and sensors in patients with depression. We collected 18 studies that had investigated wearable devices for assessment, monitoring, or prediction of depression. In this report, we examine the sensors of the various types of wearable devices (e.g., actigraphy units, wristbands, fitness trackers, and smartwatches) and parameters measured through sensors in people with depression. In addition, we discuss future trends, referring to research in other areas employing wearable devices, and suggest the challenges of using wearable devices in the field of depression. Real-time objective monitoring of symptoms and novel approaches for diagnosis and treatment using wearable devices will lead to changes in management of patients with depression. During the process, it is necessary to overcome several issues, including limited types of collected data, reliability, user adherence, and privacy concerns.

Predicting Brain Regions Related to Alzheimer's Disease Based on Global Feature

Alzheimer's disease (AD) is a neurodegenerative disease that commonly affects the elderly; early diagnosis and timely treatment are very important to delay the course of the disease. In the past, most brain regions related to AD were identified based on imaging methods, and only some atrophic brain regions could be identified. In this work, the authors used mathematical models to identify the potential brain regions related to AD. In this study, 20 patients with AD and 13 healthy controls (non-AD) were recruited by the neurology outpatient department or the neurology ward of Peking University First Hospital from September 2017 to March 2019. First, diffusion tensor imaging (DTI) was used to construct the brain structural network. Next, the authors set a new local feature index 2hop-connectivity to measure the correlation between different regions. Compared with the traditional graph theory index, 2hop-connectivity exploits the higher-order information of the graph structure. And for this purpose, the authors proposed a novel algorithm called 2hopRWR to measure 2hop-connectivity. Then, a new index global feature score (GFS) based on a global feature was proposed by combing five local features, namely degree centrality, betweenness centrality, closeness centrality, the number of maximal cliques, and 2hop-connectivity, to judge which brain regions are related to AD. As a result, the top ten brain regions identified using the GFS scoring difference between the AD and the non-AD groups were associated to AD by literature verification. The results of the literature validation comparing GFS with the local features showed that GFS was superior to individual local features. Finally, the results of the canonical correlation analysis showed that the GFS was significantly correlated with the scores of the Mini-Mental State Examination (MMSE) scale and the Montreal Cognitive Assessment (MoCA) scale. Therefore, the authors believe the GFS can also be used as a new biomarker to assist in diagnosis and objective monitoring of disease progression. Besides, the method proposed in this paper can be used as a differential network analysis method for network analysis in other domains.

Identification of Rock Mass Critical Discontinuities While Borehole Drilling

Modern technologies need more mineral resources for energy generation, metallurgical products, chemicals, and many other uses. These resources are usually extracted from the Earth’s crust. Many engineering underground-space infrastructures are left after mining activity, with their very interesting features such as very large storage capacities (e.g., for hydrocarbons, hydrogen, radioactive, or other waste), and long-term geomechanical stability. Our original experiments were carried out in the conditions of an underground metal ore mine where typical mobile drilling rigs, additionally equipped with a set of sensors for recording signals as effects of rock–drill interaction were used for the research testing. A series of boreholes with diameters of Ø38 and lengths of up to 9 m in the rock medium were drilled in the “weak” and “strong” rock masses, and the frequency spectra of their signals were analyzed with the use of the fast Fourier transform (FFT) and short-time Fourier transform (STFT) algorithms. According to the proposed idealized theoretical model of the disturbance and the distinctive acceleration value of the drilling characteristic, the location of the critical discontinuities in the roof of the excavation were recognized. The most important advantage of the proposed method is the quantity and objective monitoring method for detection of a critical rock mass defect (discontinuity) that is significant for the potential functionality of underground workings as a potential energy storage room and their reinforcement.

P552 Assessing adherence to objective disease monitoring and outcomes with adalimumab in a real-world IBD cohort

Background Data suggests that tight objective monitoring may improve clinical outcomes in IBD. Methods The aim of this study is to assess the adherence to serial tight objective monitoring(clinical and biomarkers) and its effect on clinical outcomes. We retrospectively reviewed the chart of 428 consecutive IBD patients started on adalimumab between January 1,2015–January 1,2019 [338 Crohn’s disease(CD), 90 ulcerative colitis(UC)]. Clinical symptoms (assessed by Harvey-Bradshaw-Index, partial Mayo score), C-Reactive Protein(CRP), and fecal calprotectin(FCAL) assessments were captured at treatment initiation and at 3, 6, 9, and 12 months. Dose optimization and drug sustainability curves were plotted by Kaplan-Meier method Results Clinical evaluation was available in nearly all patients at 3(CD-UC:95-94%), 6(90-83%), 9(86-85%) and 12(96-89%) months. CRP was also available in nearly all patients but testing frequency decreased in CD patients over time. Compliance to serial FCAL testing was low. Clinical remission at one-year was higher in patients adherent to early assessment visit at 3 months (p=0.001 for CD and UC). Adherence to early follow-up resulted in earlier dose optimisation in CD and UC patients (pLogrank=0.026 for UC & p=0.09 for CD). Overall drug sustainability did not differ. Conclusion Clinical and CRP, but not FCAL, were frequently assessed in patients starting adalimumab. Adherence to early objective combined follow-up visits resulted in earlier dose optimization, improved one-year clinical outcomes but did not change drug sustainability.