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medicines optimisation

Driss Berdaï, Florence Thomas-Delecourt, Karine Szwarcensztein
Early market access of health products is associated with a larger number of requests for information by the health authorities. Compared with these expectations, the growing expansion of health databases represents an opportunity for responding to questions raised by the authorities. The computerised nature of the health system provides numerous sources of data, and first and foremost medical/administrative databases such as the French National Inter-Scheme Health Insurance Information System (SNIIRAM) database...
December 30, 2017: Thérapie
Chloë Campbell, Rhiannon Braund, Caroline Morris
INTRODUCTION Recognition of the need to reduce harm and optimise patient outcomes from the use of medicines is contributing to an evolution of pharmacy practice in primary health care internationally. This evolution is changing community pharmacy and leading to new models of care that enable pharmacist contribution beyond traditional realms. There is little information about the extent of these changes in New Zealand. AIM The aim of this study was to investigate emerging roles of pharmacists in primary health care...
December 2017: Journal of Primary Health Care
Susanne Ulbrich-Zürni, Michael Teut, Stephanie Roll, Robert T Mathie
BACKGROUND:  The randomised controlled trial (RCT) is considered the 'gold standard' for establishing treatment efficacy or effectiveness of an intervention, but its data do not infer response in an individual patient. Individualised clinical care, a fundamental principle in complementary and alternative medicine (CAM), including homeopathy, seems well disposed in principle to being researched by single-patient (N-of-1) study design. Guidelines for reporting N-of-1 trials have recently been developed...
February 2018: Homeopathy: the Journal of the Faculty of Homeopathy
Jiri Polivka, Irem Altun, Olga Golubnitschaja
The paper is motivated by severe concerns regarding currently applied care of the pregnancy-associated breast cancer (PABC) characterised by particularly poor outcomes of the disease. Psychological and ethical aspects play a crucial role in PABC: the highest priority not to damage the foetus significantly complicates any treatment generally, and it is quite usual that patients disclaim undergoing any breast cancer treatment during pregnancy. Although, due to global demographic trends, PABC is far from appearing rarely now, severe societal and economic consequences of the disease are still neglected by currently applied reactive medical approach...
March 2018: EPMA Journal
Mouna Sawan, Yun-Hee Jeon, Timothy F Chen
Psychotropic medicines have limited efficacy in the management of behavioural and psychological disturbances, yet they are commonly used in nursing homes. Organisational culture is an important consideration influencing use of psychotropic medicines. Schein's theory elucidates that organisational culture is underpinned by basic assumptions, which are the taken for granted beliefs driving organisational members' behaviour and practices. By exploring the basic assumptions of culture we are able to find explanations for why psychotropic medicines are prescribed contrary to standards...
February 15, 2018: Social Science & Medicine
Xin Wu, Hongbing Zhang, Shanshan Fan, Yidan Zhang, Zhen Yang, Simiao Fan, Pengwei Zhuang, Yanjun Zhang
BACKGROUND: The quality and quality evaluation system of traditional Chinese medicine (TCM) are crucial in the safety and effectiveness assessment of TCM. However, they are also the major bottlenecks that restrict the quality control of TCM. Given the nature of Chinese medicine and the limitations of science and technology, the quality evaluation of TCM involves a few difficulties. Therefore, scholars have conducted considerable amount of research on this topic and obtained promising results...
February 7, 2018: Phytomedicine: International Journal of Phytotherapy and Phytopharmacology
Pras Pathmanathan, Richard A Gray
Computational models of cardiac electrophysiology have a long history in basic science applications and device design and evaluation, but have significant potential for clinical applications in all areas of cardiovascular medicine, including functional imaging and mapping, drug safety evaluation, disease diagnosis, patient selection, and therapy optimisation or personalisation. For all stakeholders to be confident in model-based clinical decisions, cardiac electrophysiological (CEP) models must be demonstrated to be trustworthy and reliable...
2018: Frontiers in Physiology
Steven M Bishop, Ari Ercole
OBJECTIVES: The reliable detection of peaks and troughs in physiological signals is essential to many investigative techniques in medicine and computational biology. Analysis of the intracranial pressure (ICP) waveform is a particular challenge due to multi-scale features, a changing morphology over time and signal-to-noise limitations. Here we present an efficient peak and trough detection algorithm that extends the scalogram approach of Scholkmann et al., and results in greatly improved algorithm runtime performance...
2018: Acta Neurochirurgica. Supplement
Victor Ng, Allyn Walsh, Nandani de Silva, Eleni Politi, Heather Grusauskas
While all physicians must continue to learn new knowledge through their careers, their post-training continuing professional development (CPD) has received less attention. Problems include lack of support for physicians, frequent deviations from best practices such as mandatory participation, focus on community need, and clear conflicts of interest amongst providers. Additionally, specialists from other disciplines catering to different patient populations often provide CPD for family doctors. The Working Party on Education of the World Organisation of Family Doctors (WONCA) sought to develop global standards in CPD for family doctors...
February 23, 2018: Education for Primary Care
M Kreuter, U Ochmann, D Koschel, J Behr, F Bonella, M Claussen, U Costabel, S Jungmann, M Kolb, D Nowak, F Petermann, M Pfeiffer, M Polke, A Prasse, J Schreiber, J Wälscher, H Wirtz, D Kirsten
BACKGROUND:  Interstitial lung diseases (ILD) encompass different heterogeneous, mainly chronic diseases of the pulmonary interstitium and/or alveoli with known and unknown reasons. The diagnostic of ILD is challenging and should be performed interdisciplinary. The medical history is of major importance and therefore, in German-speaking countries the Frankfurter Bogen (published in 1985) was utilised to scrutinise the medical history of the patient. This by now more than 30-years-old questionnaire requires a revision with regard to content and language...
February 21, 2018: Pneumologie
J Geoffrey Chase, Jean-Charles Preiser, Jennifer L Dickson, Antoine Pironet, Yeong Shiong Chiew, Christopher G Pretty, Geoffrey M Shaw, Balazs Benyo, Knut Moeller, Soroush Safaei, Merryn Tawhai, Peter Hunter, Thomas Desaive
Critical care, like many healthcare areas, is under a dual assault from significantly increasing demographic and economic pressures. Intensive care unit (ICU) patients are highly variable in response to treatment, and increasingly aging populations mean ICUs are under increasing demand and their cohorts are increasingly ill. Equally, patient expectations are growing, while the economic ability to deliver care to all is declining. Better, more productive care is thus the big challenge. One means to that end is personalised care designed to manage the significant inter- and intra-patient variability that makes the ICU patient difficult...
February 20, 2018: Biomedical Engineering Online
Javier Ripollés-Melchor, Francesco Carli, Miquel Coca-Martínez, Macarena Barbero-Mielgo, José M Ramírez-Rodríguez, José A García-Erce
In the era of perioperative medicine, important advances have been made in the perioperative care of patients, usually within those known as Enhanced Recovery After Surgery (ERAS) protocols. These have led to a decrease in postoperative complications and the duration of hospital stays; however, there is still a lack of preoperative care, which could make perioperative medicine more prominent. Elderly patients, malnourished, anaemic and ones with a low physical function before surgery are likely to have sub-optimal recovery from surgery...
February 14, 2018: Minerva Anestesiologica
Meng Chen, Ruimiao Chang, Liying Xu, Yayun Huang, Hongfen Zhang, Anjia Chen
INTRODUCTION: Praeruptorin A, B and C are major bioactive constituents in Peucedani Radix. They display anti-inflammatory effect, anti-hypertension effect, antiplatelet aggregation, potential anti-cancer activities and so on. They are worthy of investigation as potentially novel and versatile drugs. OBJECTIVE: To develop a method using micellar electrokinetic chromatography (MEKC) for the application in simultaneously separation and determination of praeruptorin A, B and C from Peucedani Radix and its medicinal preparations...
February 2, 2018: Phytochemical Analysis: PCA
Jaroslava Švarc-Gajić, Sabrina Clavijo, Ruth Suárez, Aleksandra Cvetanović, Víctor Cerdà
Cherry stems have been used in traditional medicine mostly for the treatment of urinary tract infections. Extraction with subcritical water, according to its selectivity, efficiency and other aspects, differs substantially from conventional extraction techniques. The complexity of plant subcritical water extracts is due to the ability of subcritical water to extract different chemical classes of different physico-chemical properties and polarities in a single run. In this paper, dispersive liquid-liquid microextraction (DLLME) with simultaneous derivatisation was optimised for the analysis of complex subcritical water extracts of cherry stems to allow simple and rapid preparation prior to gas chromatography-mass spectrometry (GC-MS)...
January 31, 2018: Analytical and Bioanalytical Chemistry
Judith L Bowen, Bridget C O'Brien, Jonathan S Ilgen, David M Irby, Olle Ten Cate
CONTEXT: Transitions of patient care responsibility occur frequently between physicians. Resultant discontinuities make it difficult for physicians to observe clinical outcomes. Little is known about what physicians do to overcome the practical challenges to learning these discontinuities create. This study explored physicians' activities in practice as they sought follow-up information about patients. METHODS: Using a constructivist grounded theory approach, semi-structured interviews with 18 internal medicine hospitalist and resident physicians at a single tertiary care academic medical center explored participants' strategies when deliberately conducting follow-up after they transitioned responsibility for patients to other physicians...
January 30, 2018: Medical Education
David R Coghill, Tobias Banaschewski, Caleb Bliss, Brigitte Robertson, Alessandro Zuddas
BACKGROUND: SPD489-404 was the first 2-year safety study of lisdexamfetamine dimesylate in the treatment of attention-deficit/hyperactivity disorder in children and adolescents. In accordance with advice from the European Medicines Agency, assessment of cognitive function was a predefined safety outcome in SPD489-404. OBJECTIVE: The objective of this study was to assess cognitive function over 2 years in study SPD489-404, using the Cambridge Neuropsychological Test Automated Battery (CANTAB)...
January 30, 2018: CNS Drugs
Sten Ohlson, Minh-Dao Duong-Thi
Fragment-based drug discovery is an important tool for design of small molecule hit-to-lead compounds against various biological targets. Several approved drugs have been derived from an initial fragment screen and many such candidates are in various stages of clinical trials. Finding fragment hits, that are suitable for optimisation by medicinal chemists, is still a challenge as the binding between the small fragment and its target is weak in the range of mM to µM of Kd and irrelevant non-specific interactions are abundant in this area of transient interactions...
January 25, 2018: Methods: a Companion to Methods in Enzymology
Julia Etulain, Hebe A Mena, Roberto P Meiss, Gustavo Frechtel, Susana Gutt, Soledad Negrotto, Mirta Schattner
Although platelet-rich plasma (PRP) is used as a source of growth factors in regenerative medicine, its effectiveness remains controversial, partially due to the absence of PRP preparation protocols based on the regenerative role of platelets. Here, we aimed to optimise the protocol by analysing PRP angiogenic and regenerative properties. Three optimising strategies were evaluated: dilution, 4 °C pre-incubation, and plasma cryoprecipitate supplementation. Following coagulation, PRP releasates (PRPr) were used to induce angiogenesis in vitro (HMEC-1 proliferation, migration, and tubule formation) and in vivo (chorioallantoic membrane), as well as regeneration of excisional wounds on mouse skin...
January 24, 2018: Scientific Reports
Jeanette Schultz Johansen, Kjerstin Havnes, Kjell H Halvorsen, Stine Haustreis, Lillann Wilsgård Skaue, Elena Kamycheva, Liv Mathiesen, Kirsten K Viktil, Anne Gerd Granås, Beate H Garcia
INTRODUCTION: Drug-related problems (DRPs) are common in the elderly, leading to suboptimal therapy, hospitalisations and increased mortality. The integrated medicines management (IMM) model is a multifactorial interdisciplinary methodology aiming to optimise individual medication therapy throughout the hospital stay. IMM has been shown to reduce readmissions and drug-related hospital readmissions. Using the IMM model as a template, we have designed an intervention aiming both to improve medication safety in hospitals, and communication across the secondary and primary care interface...
January 23, 2018: BMJ Open
Shannon M Fernando, David Neilipovitz, Aimee J Sarti, Erin Rosenberg, Rabia Ishaq, Mary Thornton, John Kim
INTRODUCTION: Patients admitted to a critical care medicine (CCM) environment, including an intensive care unit (ICU), are susceptible to harm and significant resource utilisation. Therefore, a strategy to optimise provider performance is required. Performance scorecards are used by institutions for the purposes of driving quality improvement. There is no widely accepted or standardised scorecard that has been used for overall CCM performance. We aim to improve quality of care, patient safety and patient/family experience in CCM practice through the utilisation of a standardised, repeatable and multidimensional performance scorecard, designed to provide a continuous review of ICU physician and nurse practice, as well as departmental metrics...
January 21, 2018: BMJ Open
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