Impact of pharmacist interventions on medication management by the elderly: a review of the literature

OBJECTIVE: To review the impact of pharmacist interventions designed to assist older people in managing their medication regimens. DATA SOURCES: A computer search of literature published between 1975 and 1990 was conducted using MEDLINE. References were also identified from the bibliographies of pertinent articles. STUDY SELECTION: Studies included in the review were those evaluating pharmacist interventions that were designed to assist in medication management by people over 65 years of age. Only nine studies were identified by these criteria. Interventions that have not been evaluated are discussed briefly. The studies included were chosen by consensus of the authors. DATA EXTRACTION: A data extraction form was used to summarize the information in each study. RESULTS: This was a qualitative review. Some studies evaluating the effects of short verbal medication counseling episodes showed positive benefits; others showed no benefit. Written medication information, some memory devices, and audiovisual techniques have also been found to be of limited use. Self-medication programs for hospitalized elderly people need to be evaluated. CONCLUSIONS: This review identified the lack of published evaluations of pharmacist interventions in medication management by elderly people. Well-designed studies need to be performed to determine the effects of individualized advice and counseling. The cost-effectiveness of such interventions should be assessed, with consideration of long-term outcomes, such as readmission rates to the hospital and cost savings accruing from increased duration of independent living.     

Position estimation and object collision detection of a tendon-driven actuator based on a polytopic observer synthesis

This paper proposes a multi-model based approach that estimates joint position and collision detection of a lightweight electric actuator dedicated to manipulation tasks. Taking advantage of an optimized back-drivable mechatronic design, the use of proprioceptive measures at the motor level enables the estimation of the unmeasured terminal position of the mechanical motor-to-joint transmission and force contact disturbance. A polytopic formulation is introduced based on an accurate model of the mechatronic transmission. Then, a multi-model observer-based estimator is synthesized using root-clustering for exteroceptive variables estimation without additional position/force sensor. The approach is experimentally validated with a single degree-of-freedom manipulator.     

Experimental Investigation on the Reliability of Thermal Wave Interferometry in the Thermophysical Characterization of Plasma Sprayed Coatings

The main focus of this work is to compare thermal diffusivity and effusivity data resulting from thermal wave interferometry (TWI) experiments on tungsten coatings of different thicknesses with those obtained using reference techniques, namely, the laser flash method and scanning electron microscopy (SEM). The deviations between TWI and the latter techniques are discussed in terms of lack of data in the low frequency range. The investigation shows that the lack of data at low frequencies does not affect diffusivity measurements, while it has a strong effect on effusivity measurements for thermally thick coatings. The conclusions of this experimental study are in good agreement with theoretical predictions resulting from a sensitivity analysis reported in a previous study.     

Basic science of small cell lung cancer

The Gilles de la Tourette syndrome is a neuropsychiatric condition characterized by waxing and waning tics, both vocal and motor, over a lifelong course with an onset under the age of 21 years. Once considered a rare curiosity, its prevalence is now agreed to be around 5/10,000, and is seen worldwide. Many cases are mild and never require medical attention. It is now thought to have a genetic basis, but linkage has not yet been achieved, owing possibly to the inadequacy of a single-gene hypothesis. There is a strong association with obsessive compulsive disorder, and some postulate that many other psychiatric conditions may be determined as variations of the same phenotype. Attention deficit hyperactivity disorder is also common among sufferers. Management is with a combination of psychosocial measures and drugs; in particular dopamine antagonists, the efficacy of which has led to the theory that the syndrome is caused by an abnormality of the dopaminergic system. Studies using functional imaging techniques have both supported and rejected this hypothesis. Future research is expected to concentrate on the further application of genetic and brain imaging techniques in addition to clinical trials to identify optimal treatments. Studies relating to clinical, genetic, etiological, and historical aspects are reviewed.     

Antiplasmodial triterpene from Vernonia brasiliana

The hexane extract from leaves of Vernonia brasiliana (L.) Druce (Compositae) was active in vitro against Plasmodium falciparum and in vivo in mice infected with Plasmodium berghei. This extract was subjected to a bioassay-guided fractionation protocol based on the in vitro model. Lupeol was identified as a compound responsible for the activity, inhibiting the P.falciparum growth by 45% when tested at 25 micrograms/ml. However, this triterpene was inactive in vivo when 15 mg/kg were administered per os during four consecutive days to mice infected with P.berghei. beta-Amyrin and germanicol, isolated from the same fraction that yielded lupeol, were inactive in the in vitro assay.     

Complications of motility peg placement for the hydroxyapatite orbital implant

PURPOSE: The hydroxyapatite implant is an ocular motility implant designed to provide natural movement of the artificial eye. The movement of the prosthesis is maximized when the implant is coupled to the prosthesis via a peg. The purpose of this study is to determine the complications of the hydroxyapatite motility peg and the factors related to those complications. DESIGN: Retrospective review of 47 cases over 5 years. METHODS: A retrospective review was performed on all cases of hydroxyapatite motility peg placement. The technique of hydroxyapatite and peg placement, follow-up details, and complications of the peg were recorded. RESULTS: The complications of peg placement included peg extrusion in 26% (12 of 47), nonspecific conjunctivitis in 6% (3 of 47), audible click in 6% (3 of 47), temporary excessive conjunctival edema in 4% (2 of 47), and temporary excessive postoperative pain in 4% (2 of 47). There were no cases of infection, persistent pain, persistent edema, or discharge at peg site. The median time interval from peg placement to extrusion was 16 months (range, 1-52 months). The only statistically significant factor related to peg extrusion was age over 50 years (P = 0.04). There was a trend toward peg extrusion with use of a nonsleeved peg (versus sleeved peg) (P = 0.10). The extrusion rate was 32% (12 of 38) for nonsleeved pegs and 0% (0 of 9) for sleeved pegs. Factors unrelated to peg extrusion were patient sex, prior ocular surgery or radiotherapy, presence of giant papillary conjunctivitis, time interval from enucleation to peg placement, and degree of implant vascularization on magnetic resonance imaging. Of the 12 nonsleeved pegs that extruded, a sleeved peg system was subsequently successfully placed in 5 patients, a nonsleeved peg in 1 patient, and 6 patients remained without a peg system. CONCLUSIONS: Hydroxyapatite motility pegs have relatively few complications except for extrusion. The rate of extrusion can be minimized by employing a sleeved peg rather than a nonsleeved peg system.     

Monitoring frequency of occurrence without awareness: evidence from patients with Alzheimer''s disease

Mouse mammary tumor virus (MMTV) is a type B retrovirus that is transmitted as an infectious milk-borne particle and that causes mammary carcinomas by insertional activation of cellular protooncogenes. Germ line infections result in endogenous Mtv proviruses integrated in the genome of most mouse strains. These endogenous proviruses have been integrated into the genomes of mice for only the past 3-5 million years. The open reading frame present in the 3' long terminal repeat (LTR) of the provirus encodes a superantigen (SAg) which is able to stimulate a large proportion of T cells sharing a common T-cell receptor beta chain variable domain (v beta). Expression of this SAg is critical to the MMTV life cycle. After expression of the SAg in B cells a significant number of T cells are recruited to respond to these MMTV infected cells. As a consequence both the T cells expressing the relevant TCR V beta domain and the infected B cells become activated and start dividing. This would facilitate integration of MMTV and amplify the number of virus infected lymphocytes. Most likely during lactation the mammary glands become receptive to viral infection. The presence of endogenous Mtvs induces an early clonal deletion of reactive T cells. For this reason it has been argued that the presence of these proviruses confers a selective advantage to the mouse population by protecting the host from infection with an exogenous MMTV coding for a cross-reactive SAg. However, recent results discussed herein suggest that Mtv proviruses may also be detrimental to the mouse population by participating in recombinations with exogenous MMTVs, giving rise to highly tumorigenic recombinant particles. These results are discussed in the light of recent reports suggesting the involvement of viral sequences with a high homology to MMTV in human mammary tumorigenesis.     

Adenoviral vector-mediated overexpression of serum amyloid A in apoA-I-deficient mice

Serum amyloid A (SAA) is an acute phase reactant that can become the predominant apolipoprotein of high density lipoprotein (HDL) during severe inflammatory states. However, the function of SAA is unknown. To study the ability of SAA to form HDL in the absence of apolipoprotein A-I, we expressed the mouse SAA pI 6.15 (CE/J) isoform in apolipoprotein A-I knock-out (apoA-I (-/-)) mice using a recombinant adenovirus. As a control, apoA-I (-/-) mice were injected with an adenovirus expressing human apoA-I. High level expression of plasma SAA was obtained in the absence of any endogenous acute phase SAA production. SAA expression increased plasma HDL cholesterol levels about 2-fold, but to a lesser extent than the expression of apoA-I (about 10-fold). The HDL particles isolated by density ultracentrifugation from SAA-expressing mice were heterogeneous in size and composition and rich in free cholesterol as well as apoE and apoA-IV. Of the SAA expressed in the plasma, only a small fraction (4%) was associated with HDL particles in contrast to expressed apoA-I, of which 62% was associated with HDL. We conclude that SAA is unable to substitute for apoA-I in HDL particle formation.