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International Journal of Clinical... Apr 2016Medicines reconciliation-identifying and maintaining an accurate list of a patient's current medications-should be undertaken at all transitions of care and available to...
BACKGROUND
Medicines reconciliation-identifying and maintaining an accurate list of a patient's current medications-should be undertaken at all transitions of care and available to all patients.
OBJECTIVE
A self-completion web survey was conducted for chief pharmacists (or equivalent) to evaluate medicines reconciliation levels in secondary care mental health organisations.
SETTING
The survey was sent to secondary care mental health organisations in England, Scotland, Northern Ireland and Wales.
METHOD
The survey was launched via Bristol Online Surveys. Quantitative data was analysed using descriptive statistics and qualitative data was collected through respondents free-text answers to specific questions.
MAIN OUTCOMES MEASURE
Investigate how medicines reconciliation is delivered, incorporate a clear description of the role of pharmacy staff and identify areas of concern.
RESULTS
Forty-two (52 % response rate) surveys were completed. Thirty-seven (88.1 %) organisations have a formal policy for medicines reconciliation with defined steps. Results show that the pharmacy team (pharmacists and pharmacy technicians) are the main professionals involved in medicines reconciliation with a high rate of doctors also involved. Training procedures frequently include an induction by pharmacy for doctors whilst the pharmacy team are generally trained by another member of pharmacy. Mental health organisations estimate that nearly 80 % of medicines reconciliation is carried out within 24 h of admission. A full medicines reconciliation is not carried out on patient transfer between mental health wards; instead quicker and less exhaustive variations are implemented. 71.4 % of organisations estimate that pharmacy staff conduct daily medicine reconciliations for acute admission wards (Monday to Friday). However, only 38 % of organisations self-report to pharmacy reconciling patients' medication for other teams that admit from primary care.
CONCLUSION
Most mental health organisations appear to be complying with NICE guidance on medicines reconciliation for their acute admission wards. However, medicines reconciliation is conducted less frequently on other units that admit from primary care and rarely completed on transfer when it significantly differs to that on admission. Formal training and competency assessments on medicines reconciliation should be considered as current training varies and adherence to best practice is questionable.
Topics: Guidelines as Topic; Humans; Medication Reconciliation; Mental Health; Mental Health Services; Pharmacists; Secondary Care; Surveys and Questionnaires; United Kingdom
PubMed: 26739128
DOI: 10.1007/s11096-015-0236-7 -
Bone mineral density in patients with prostatic cancer treated with orchidectomy and with estrogens.Calcified Tissue International Aug 1995Bone mineral density (BMD) and bone mineral content (BMC) were measured in the femoral neck area, trochanteric area and Wards triangle, and in the distal radius of the... (Clinical Trial)
Clinical Trial Comparative Study
Bone mineral density (BMD) and bone mineral content (BMC) were measured in the femoral neck area, trochanteric area and Wards triangle, and in the distal radius of the left forearm before and after 1 year of endocrine treatment in 27 patients with prostatic cancer. Eleven of the patients were treated with orchidectomy and 16 with combined oral and intramuscular estrogens. The patients were free from metastases during the entire observation period. In the orchidectomized patients, BMD and BMC of the distal radius decreased significantly following treatment, whereas no changes were observed in the estrogen-treated patients. These preliminary results demonstrate that estrogens may protect bone in male subjects also and may merit further investigations on larger groups of patients.
Topics: Aged; Antineoplastic Agents, Hormonal; Bone Density; Estradiol; Estradiol Congeners; Estrogens; Ethinyl Estradiol; Humans; Male; Orchiectomy; Prostatic Neoplasms
PubMed: 7584882
DOI: 10.1007/BF00298427 -
The European Journal of Surgery = Acta... Aug 1992To find out whether chronic hypercalcaemia and excessive secretion of parathyroid hormone (PTH) is associated with skeletal demineralisation in familial hypocalciuric...
OBJECTIVE
To find out whether chronic hypercalcaemia and excessive secretion of parathyroid hormone (PTH) is associated with skeletal demineralisation in familial hypocalciuric hypercalcaemia (FHH).
DESIGN
Open study.
SETTING
Huddinge University Hospital, Sweden.
SUBJECTS
Nine affected and three unaffected members of two kindreds with FHH, and 12 age- and sex-matched controls.
INTERVENTIONS
Measurement of bone mineral density (g/cm2) in the proximal femur and lumbar spine by dual photon absorptiometry, and of bone mineral content in the distal radius and midradius (g/cm) by single photon absorptiometry. Measurement of serum concentrations of PTH, total and ionised calcium, phosphate, and magnesium, and alkaline phosphatase activity, and 24 hour urinary calcium excretion were also made.
RESULTS
Bone mineral density was significantly higher in Wards's triangle of the femur (p < 0.05) in the members of families with FHH than in control subjects. In the other parts of the femur and in the lumbar vertebrae it was slightly but not significantly higher, as was the bone mineral content of the distal radius and midradius. Family members with FHH all had increased total and ionised serum calcium concentrations, except for the index case in one of the families who developed hypoparathyroidism postoperatively. Twenty-four urinary calcium excretion was less than 5 mmol (the upper limit of the reference range for FHH) in all the affected patients.
CONCLUSION
Chronic hypercalcaemia in affected members of families with FHH is not the result of an increase rate of bone mineralisation, because they have normal bone mass. They seem to be relatively insensitive to the deleterious effects of PTH on bone mineral state, because raised concentrations of PTH were not associated with reduced bone mass.
Topics: Adult; Aged; Bone Density; Bone and Bones; Calcium; Chromosome Aberrations; Chromosome Disorders; Female; Genes, Dominant; Humans; Hypercalcemia; Hyperparathyroidism; Male; Middle Aged; Pedigree
PubMed: 1356477
DOI: No ID Found -
Perspectives on Sexual and Reproductive... Sep 2008Women's relationship context likely influences both their ability and their motivation to use contraceptives. No recent studies, however, have examined associations...
CONTEXT
Women's relationship context likely influences both their ability and their motivation to use contraceptives. No recent studies, however, have examined associations between women's relationship characteristics and use of different methods.
METHODS
Data were collected in a longitudinal study of 839 low-income women at risk of unintended pregnancy who visited public family planning and postpartum clinics and maternity wards in two Southeastern cities. Simulated probabilities calculated from multivariate analyses assessed associations between a wide range of relationship characteristics and the use of no method, condoms, withdrawal, female methods or dual methods.
RESULTS
Women who had had a child with their partner had an increased likelihood of contraceptive nonuse and use of withdrawal, and a decreased likelihood of using any female method. Respondents who were in a relationship for a relatively long time had an elevated likelihood of nonuse and use of female methods, but a lowered likelihood of condom use. Furthermore, married or cohabiting women were less likely than others to use dual methods. Respondents who had good communication with their partner had an elevated likelihood of using condoms. In addition, women who expected to receive a lot of emotional support from their partner if they became pregnant were more likely than others to report any condom use or dual method use, and less likely to report contraceptive nonuse.
CONCLUSIONS
When counseling family planning clients, providers should consider women in the context of their relationships. Future research exploring factors associated with contraceptive method use should examine variables related to the establishment, quality and expectations of their relationships.
Topics: Adolescent; Adult; Contraception Behavior; Female; Health Surveys; Humans; Interpersonal Relations; Motivation; Poverty; Southeastern United States; Young Adult
PubMed: 18803799
DOI: 10.1363/4017108 -
Maturitas Oct 2005The aim of this study was to investigate the relationships between the levels of gonadotrophins, estradiol, inhibin-b and bone mass and turn-over in regularly...
OBJECTIVES
The aim of this study was to investigate the relationships between the levels of gonadotrophins, estradiol, inhibin-b and bone mass and turn-over in regularly menstruating women aged 35-50 years.
METHODS
The study group included 87 healthy volunteers from the community aged 35-50 years. Bone mineral density of lumbar vertebras, wards triangle, throchanter, femur neck, bone resorption and formation markers were studied as well as the serum levels of gonadotrophins, estradiol and inhibin-b on the day 3 of menstrual cycle.
RESULTS
The gonadotrophin levels showed significant positive relation with age, whereas inhibin-b and estradiol levels showed significant negative correlation with age. The gonadotrophins and estradiol levels had no significant association with bone mass and bone formation markers. Increased gonadotrophin (p < 0.001) levels and decreased inhibin-b (p < 0.01) levels independent from age were correlated with increased bone resorption. Gonadotrophins, estradiol, age, inhibin-b, body mass index (BMI) were the confounding factors for bone resorption (p = 0.015, R(2) = 0.190) and lumbar bone mass (p = 0.041, R(2) = 0.148). Multivariate analysis showed an independent contribution of inhibin-b and BMI in the prediction of lumbar bone mass.
CONCLUSION
This findings suggested that estradiol was not the only factor responsible for bone loss and decrease in reproductive function because increased gonadotrophins and decreased inhibin-b levels might trigger some changes in bone metabolism prior to the menopause.
Topics: Adult; Body Mass Index; Bone Density; Bone Remodeling; Calcium; Collagen; Collagen Type I; Estradiol; Female; Follicle Stimulating Hormone; Humans; Inhibins; Luteinizing Hormone; Middle Aged; Multivariate Analysis; Osteocalcin; Ovary; Peptides; Regression Analysis
PubMed: 16186077
DOI: 10.1016/j.maturitas.2005.01.009 -
Diabetic Medicine : a Journal of the... Dec 1997Reduced bone mineral density (BMD), termed diabetic osteopenia, has been reported in patients with insulin-dependent (Type 1) diabetes mellitus (IDDM). To examine BMD in... (Comparative Study)
Comparative Study
Reduced bone mineral density (BMD), termed diabetic osteopenia, has been reported in patients with insulin-dependent (Type 1) diabetes mellitus (IDDM). To examine BMD in long-term IDDM patients with normal kidney function, but with different degrees of urinary albumin excretion rate (UAER), compared to that of patients with elevated plasma creatinine, 36 IDDM male patients (mean duration 27 years) were subdivided according to UAER (<30, 30-300, >300, >300 mg 24 h(-1) and plasma creatinine 0.120-0.350 mmol l(-1)) and 15 controls were recruited. BMD was measured by dual energy X-ray absorptiometry and UAER by enzyme linked immunosorbent assay. BMD was normal in IDDM patients with normal UAER and reduced in the femoral neck, the trochanter major, and the Wards triangle in patients with increased UAER (p < 0.01, p < 0.05, p < 0.02). BMD correlated to creatinine clearance in both cortical and cancellous bone sites (p < 0.001, p < 0.0001), and inversely to the levels of plasma PTH (p < 0.0005). We conclude that BMD is normal in long-term IDDM male patients with normal kidney function and normal UAER and reduced in patients with increased UAER. Diabetic osteopenia seems to be a progressive phenomenon related to diabetic nephropathy and associated with the decrease in creatinine clearance and with the resulting rise in plasma PTH.
Topics: Absorptiometry, Photon; Adult; Albuminuria; Biomarkers; Bone Density; Bone Diseases, Metabolic; Cohort Studies; Creatinine; Diabetes Mellitus, Type 1; Diabetic Nephropathies; Glycated Hemoglobin; Humans; Male; Middle Aged; Parathyroid Hormone; Reference Values
PubMed: 9455931
DOI: 10.1002/(SICI)1096-9136(199712)14:12<1038::AID-DIA509>3.0.CO;2-1 -
European Journal of Obstetrics,... Apr 1996Oestrogens are widely believed to be effective against postmenopausal osteoporosis. However there are some outstanding questions which still need an answer. For example,... (Clinical Trial)
Clinical Trial
OBJECTIVES
Oestrogens are widely believed to be effective against postmenopausal osteoporosis. However there are some outstanding questions which still need an answer. For example, the minimal effective dose regimen of oestradiol needs to be established and the relationship between oestradiol levels and efficacy on bone turnover and bone mass needs to be further clarified.
METHODS
Menorest is being tested in the prevention of postmenopausal bone loss. A phase II/III clinical program, that includes two double blind, dose-ranging, placebo-controlled, parallel group, 2-year studies, has started in 58 centers in Europe and South Africa. Four-hundred eighty women will be enrolled in the two studies (201 and 305). The objective of the studies is to evaluate the efficacy of Menorest at different doses and regimens, in the prevention of bone loss in early postmenopausal women. In study 201, the treatment regimen is 'cyclic sequential' (24 days of transdermal oestradiol during a 28-day cycle with progestin taken during the last 14 days of oestrogen administration). In study 305 the treatment regimen is "continuous sequential' (28 days of transdermal oestradiol during, a 28-day cycle with progestin taken during the last 14 days of oestrogen administration). The doses studied are 50, 75, 100 micrograms/day in study 201, and 25, 50, 75 micrograms/day in study 305, (the two studies are otherwise identical). All 'active-dose' treated groups receive dydrogesterone 20 mg/day during the last 14 days of Menorest administration and placebo tablets are given to the placebo patch group. The main entry criteria are natural or surgical menopause, (with hormonal confirmation) from 1 to 6 years, with no contra-indication to HRT and with a bone mineral density (BMD) at the lumbar spine with a T-score between 0 and -3. Women with severe vasomotor symptoms are excluded from the studies. The primary efficacy variable is the mean change from baseline, measured with dual energy X-ray absorptiometry (DXA) at 2 years, in the lumbar spine BMD (L1-L4). Whole body and hip BMD are also evaluated. Markers of bone turnover (bone-specific alkaline phosphatase, osteocalcin and CrossLaps) are monitored throughout the study. Blood samples are drawn on the third day of patch application at certain visits in order to monitor oestradiol levels and establish any potential correlation with activity on bone (BMD, bone markers). Besides routine safety analysis, lipid profile and coagulation factors are also monitored. Special attention is drawn to endometrial safety with endometrial aspiration or trans vaginal sonography (TVS) performed before study start, after 1 year and at 2 years of treatment.
RESULTS
Data presented here refer to 146 patients for whom demographics and clinical data are already available, and to 370 patients for whom baseline DXA data have already been validated. The mean (+/-S.D.) age of the women included in the two studies is 53.4 (+/-3.2) with a menopausal age of 38.3 (+/-19.6) months. None of the women who entered the study had severe postmenopausal symptoms as shown by a mean number of hot flushes of 2.2 (+/-2.6) per day, during the last 14 days before inclusion. The mean (+/-S.D.) lumbar spine (L1-L4) BMD is 0.914 (+/-0.122) g/cm2 which corresponds to a Z-score of -0.26 and a T-score of -1.17. Femoral neck, trochanter and Wards triangle have a BMD which is below the mean of age-matched controls but still within the normal range (Z-scores between 0 and -1). Only the whole body BMD is over the mean of age-matched controls, with a Z-score of 0.32. The in-vivo precision mean (+/-S.D.), was calculated and showed a value of 0.868 (+/-0.872), which can be considered a good performance.
CONCLUSIONS
In summary, the use of one of the most recent techniques to assess the bone mineral content/density together with an accurate quality control program on all the densitometers used in the studies will help to improve the in-vivo BMD precision and therefore mak
Topics: Administration, Cutaneous; Adult; Bone Density; Double-Blind Method; Endometrium; Estradiol; Estrogen Replacement Therapy; Female; Humans; Lipids; Menopause; Middle Aged; Osteoporosis, Postmenopausal; Social Class
PubMed: 8732473
DOI: 10.1016/0301-2115(95)02356-9 -
Oncotarget Feb 2018Tristetraprolin (TTP), an mRNA-binding protein that negatively controls levels of inflammatory factors, is highly expressed in the lactating mouse mammary gland. To...
Tristetraprolin (TTP), an mRNA-binding protein that negatively controls levels of inflammatory factors, is highly expressed in the lactating mouse mammary gland. To determine the biological relevance of this expression profile, we developed bi-transgenic mice in which this protein is specifically down-regulated in the secretory mammary epithelium in the secretory mammary epithelium during lactation. Our data show that TTP conditional KO mice produced underweight litters, possibly due to massive mammary cell death induced during lactation without the requirement of additional stimuli. This effect was linked to overexpression of inflammatory cytokines, activation of STAT3 and down-regulation of AKT phosphorylation. Importantly, blocking TNFα activity in the lactating conditional TTP KO mice inhibited cell death and similar effects were observed when this treatment was applied to wild-type animals during 48 h after weaning. Therefore, our results demonstrate that during lactation TTP wards off early involution by preventing the increase of local inflammatory factors. In addition, our data reveal the relevance of locally secreted TNFα for triggering programmed cell death after weaning.
PubMed: 29492194
DOI: 10.18632/oncotarget.23904 -
Calcified Tissue International Feb 1992The contributions of polygenic loci and environmental factors to femoral bone mineral density (BMD) in g/cm2) variability were estimated in modified family sets...
The contributions of polygenic loci and environmental factors to femoral bone mineral density (BMD) in g/cm2) variability were estimated in modified family sets consisting of women of child-bearing age. Femoral BMDs were measured in 535 women who were members of 137 family sets consisting minimally of an index, her sister, and unrelated female control. The family set could also include multiple sisters and first cousins. Women included in these family sets were all between 20 and 40 years of age to minimize the cohort effects of maturation and menopause on measures of BMD. BMDs were measured at three femoral sites using dual photon densitometry. Values were regressed on age and Quetelet Index which explained 13-15% of the variability in BMD (dependent on site). Subsequent variance components analysis on the residuals indicated that unmeasured polygenic loci accounted for substantial additional variability: 67% for femoral neck, 58% for Wards triangle, and 45% for trochanter. These results suggest that polygenic loci account for approximately half of the variability in maximal femoral BMD.
Topics: Adult; Analysis of Variance; Bone Density; Epidemiologic Methods; Female; Femur; Genetic Variation; Humans; Osteoporosis
PubMed: 1571827
DOI: 10.1007/BF00298785 -
The Journal of Clinical Endocrinology... Mar 2000Recently, it was reported that 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors increased bone mineral density (BMD) in mice. We studied the effect... (Clinical Trial)
Clinical Trial
Recently, it was reported that 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors increased bone mineral density (BMD) in mice. We studied the effect of HMG-CoA reductase inhibitors on BMD of type 2 diabetes mellitus by a retrospective review of medical records. Sixty-nine type 2 diabetic patients were included. The control group (n = 33) did not take HMG-CoA reductase inhibitors. The treatment group (n = 36) was administered either lovastatin, pravastatin, or simvastatin. BMD of the spine, femoral neck, femoral trochanter, and total hip were measured by dual-energy X-ray absorptiometry. There were no significant differences between control and treatment groups in age, sex, body mass index, glycemic control, and serum insulin levels. In the control group, BMD of the spine significantly decreased (from 1.116 +/- 0.165 to 1.081 +/- 0.178 g/cm2) after 14 months. In the treatment group, BMD of the femoral neck significantly increased (from 0.853 +/- 0.139 to 0.878 +/- 0.147 g/cm2) after 15 months. In male subjects treated with HMG-CoA reductase inhibitors, there was a significant increase in BMD of the femoral neck and femoral trochanter (from 0.899 +/- 0.139 to 0.934 +/- 0.139 and from 0.801 +/- 0.145 to 0.833 +/- 0.167 g/cm2, respectively), but in female subjects, only BMD of the femoral neck increased (from 0.819 +/- 0.132 to 0.834 +/- 0.143 g/cm2). Percentage increments of BMD of the femoral neck, femoral wards triangle, femoral trochanter, and total hip in the treatment group were significantly higher than in the control group (2.32% vs. -0.99, 1.77% vs. -1.25%, 1.40% vs. -1.21%, 0.88% vs. -1.03%, respectively). The proportion of subjects who had an increase in BMD of the spine and total hip more than two percentages was significantly larger in the treatment group than in the control group (30.6% vs. 15.2% and 30.6% vs. 9.1%, respectively). The increased increment in BMD of the treatment group was significantly greater than those in the control group after adjustment for age and body mass index (P < 0.05). These results suggest that HMG-CoA reductase inhibitors may increase BMD of the femur in male patients with type 2 diabetes mellitus.
Topics: Bone Density; Diabetes Mellitus, Type 2; Female; Follow-Up Studies; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Hypoglycemic Agents; Male; Middle Aged; Osteoporosis; Retrospective Studies
PubMed: 10720052
DOI: 10.1210/jcem.85.3.6476