Preliminary analysis of subclinical leaflet thrombosis after percutaneous aortic valve replacement with balloon dilation / 中国胸心血管外科临床杂志

@#Objective    To analyze the factors influencing the occurrence of subclinical leaflet thrombosis (SLT) after percutaneous aortic valve replacement using balloon-expandable valve (Sapien3, S3). Methods     Retrospective analysis was made on 62 patients with severe aortic stenosis undergoing percutaneous aortic valve replacement using S3 in our center from September 2020 to June 2022. Patients with a history of vascular atherosclerosis or with significant increase or insignificant decrease of aortic valve flow or gradient pressure during follow-up were selected for CT examination. Results     A total of 26 patients were finally included, with an average age of 70.31±8.90 years, and the male proportion was higher (n=15, 57.69%). Among them, 5 patients had SLT. Compared with the non-SLT group, patients in the SLT group were older (68.52±8.80 years vs. 77.80±4.66 years, P=0.007). The age factor (≥75 years) and the diameter of the ascending aorta were associated with SLT (both P<0.05). Conclusion     The incidence of SLT is higher in the elderly patients. It is speculated that SLT is related to the characteristics of short balloon dilation valves and low blood flow dynamics of valve racks.

Pregnant women awareness and attitude on use of patient information leaflets (PILs) in Ado Local Government, Ekiti State, Nigeria

Patient information leaflets are valuable documents that inform and guide users, particularly pregnant women, about medication. Thispaper examined pregnant women's awareness and attitude toward the use of patient information leaflets. Thestudy employed a cross-sectional survey design, using a structured questionnaire for data collection. Purposive sampling technique was used in selecting three public comprehensive health centres in the Ado Local Government Area in Ekiti state, Nigeria,for two weekswhileconvenience sampling technique was used in selecting the patients. Participants included 120 pregnant women who attended antenatal clinics during the antenatal meeting days. Data were collected atthe antenatal clinicsusing a questionnaire. Ninety copies of the questionnaire were returned and found useful for the study. The results showed that most of the pregnant women were aware of the patient information leaflets enclosed in medicine packs and the extent of use was encouraging. The pregnant women had a positive attitude to the patient information leaflet. Also, the respondents had a high level of patient information leaflet use. Reading difficulty (=2.91) was one of the biggest challenges for pregnant women when going through the patient information leaflets. The study also found that pregnant women's awareness and attitudes influenced their use of patient information leaflets. Among other things, it was recommended that health information professionals collaborate with healthcare professionals and pharmaceutical companies to ensure the accuracy, readability and cultural appropriateness of patient information leaflets for pregnant women.

Online Educational Program for Parents of Adolescents on Human Papillomavirus Vaccination during COVID Pandemic: A Feasibility Check

Background: Human papillomavirus (HPV) vaccination for adolescents helps in the prevention of preventable cancers caused due to HPV infection. However, many adolescents are not vaccinated due to lack of knowledge among parents. Objective: This study aimed to compare the level of knowledge and attitude of parents on HPV vaccination before and after the online educational intervention. Methods: A cross-sectional pilot study was conducted among a sample of 45 parents of adolescents studying in class 7th–9th. The parents were selected two-stage simple random sampling and assigned randomly to three groups with three different methods of education – online lecture with PowerPoint presentation, online short film with discussion, and self?learning online booklet. Pre? and postintervention knowledge was assessed with a structured questionnaire and attitude with modified Likert scale administered online. Wilcoxon and Kruskal–Wallis tests were used to find the statistical significance in the study. Results: Only 36% of samples stated that they have not heard about HPV vaccination, while others had heard from health?care workers, family members, friends, or television, but their knowledge was inadequate. In all the three groups, there was significant improvement in level of knowledge, but there was no significant difference in attitude. The posttest knowledge scores of parents educated with short film were significantly more than the other two interventions. Conclusion: Online educational programs were found to be effective in improving the knowledge of parents on HPV vaccination and of the three methods; short film was more effective than the other two methods.

Role of Transesophageal Echocardiography in the Recurrent Biatrial Myxoma of Uncommon Origin

After surgical excision of myxoma recurrence usually happens adjacent to the initial origin site. We report a case of recurrent myxomas in a young male patient that had biatrial recurrence with one tumor originating very unusually from the base of the anterior mitral leaflet. Intraoperative transesophageal echocardiography was instrumental in localizing the site of the origin of left atrial myxoma from the base of the anterior mitral leaflet and in detecting an additional myxoma attached to the wall of the right atrium.

Echocardiographic diagnosis of special type of atrioventricular septal defect / 中华超声影像学杂志

Objective:To improve the understanding of special type of atrioventricular septal defect (AVSD) and reduce clinical missed diagnosis and misdiagnosis by investigating its echocardiographic features.Methods:Echocardiographic images of patients with special type of AVSD diagnosed by echocardiography and confirmed by surgery in Pediatric Cardiovascular Center, Beijing Anzhen Hospital, Capital Medical University from November 2011 to November 2021 were retrospectively analyzed. Depending on the presence of ventricular septal defect(VSD), special type of AVSD were divided into two types, namely AVSD with intact ostium primum and AVSD with intact ostium primum and ventricular septum. The echocardiographic features of special type of AVSD were summarized.Results:Twenty-five cases of special type of AVSD were diagnosed by echocardiography and 13 cases were confirmed by surgery, including 12 cases with intact ostium primum and 1 case with intact ostium primum and ventricular septum. There were 5 cases without surgical indications, and 1 case was kept under observation due to small VSD. One patient with complex malformation only underwent pulmonary artery banding operation without treating intracardiac malformation. The other 4 cases of perimembrane VSD and 1 case of partial AVSD were misdiagnosed as special type of AVSD by echocardiography. All patients had mild to severe left atrioventricular regurgitation before surgery, and most patients remained left atrioventricular regurgitation of varying degrees after left atrioventricular valve formation. Characteristic sonographical findings included: ①The ostium primum was continuous and there was no ostium primum defect. ②The attachment points of the left and right atrioventricular valves were at the same level. ③The left atvioventricular valve was a trileaflet left atrioventricular valve and attached to the crest of the ventricular septum, forming the so-called "anterior mitral valve leaflet cleft". ④The two groups of papillary muscles of the left ventricle changed the normal anterolateral and posterolateral alignment, but showed a anteriorly and posteriorly relationship (counterclockwise transposition). ⑤In the presence of VSD, an inlet ventricular septal defect would be present. ⑥Color Doppler showed varying degrees of regurgitation signals from the left atrioventricular valve during systolic period. ⑦Other complex deformities may be combined with special type of AVSD.Conclusions:Echocardiography can make a definite diagnosis for special types of AVSD. The prognosis of this malformation is closely related to the left atrioventricular valve, and the shaping effect depends on the development of left atrioventricular valve and regurgitation.

Leaflet foldoplasty of mitral valvuloplasty for mitral regurgitation in children / 中国胸心血管外科临床杂志

@#Objective    To report the short-term outcomes of a standardized, simplified and reproducible strategy of mitral valvuloplasty (MVP), which was focused on leaflet foldoplasty and anatomic anomalies of congenital mitral regurgitation (MR). Methods    Consecutive 74 patients who underwent MVP by our standardized strategy in our institution from 2016 to 2018 were included retrospectively. There were 30 males and 44 females with a median age of 18.5 (6-146) months and weight of 15.4 (7-51) kg. Results    Anatomic anomalies of MR included: (1) subvalvular apparatus: 72 (97.3%) patients with mal-connected chordae tendineae, 31 (41.9%) with absent chordae tendineae and 14 (18.9%) with fused or dysplastic papillary muscle; (2) leaflet: 10 (13.5%) patients with cleft of anterior leaflet, 61 (82.4%) with leaflet prolapse including 56 (91.8%) with anterior leaflet prolapse; (3) annulus: 71 (95.9%) patients with annular dilatation. Leaflet foldoplasty was performed in 61 (82.4%) patients with leaflet prolapse. All patients were successfully discharged and 4 (5.4%) patients were with moderate MR. The follow-up time was 22.0 (9.1-41.8) months. During the follow-up period, 3 patients had moderate MR and 1 patient had reoperation for severe MR. All patients were in normal cardiac function with a mean left ventricular ejection fraction of 66.0%±6.1%. In addition, the mean left ventricular end-diastolic dimension was 31.8±6.0 mm, which was significant smaller than that before the operation (t=6.090, P<0.000 1). Conclusion    The standardized leaflet foldoplasty with resection of mal-connected chordae tendineae and posterior annuloplasty technique is safe and feasible with favorable short-term outcomes in MR patients.

Family Members’ Satisfaction Levels : Impact Of An Intensive Care Unit Information Leaflet With Verbal Information Compared To Conventional Verbal Information

@#Introduction: Patients admitted to the Intensive Care Unit (ICU) experience intense physical stress. Family members of these patients also experience stress during the admission. Therefore, it is an important task of the ICU staff to provide the family members with appropriate and clear information. There are many methods to do this. This study aimed to compare the impact of two methods of information sharing on the satisfaction levels among families of ICU patients. The novel method being introduced and investigated was a locally designed information leaflet in combination with verbal explanation. This new method was compared with the traditional method of verbal explanation only. Methods: This was a randomized controlled study, conducted at the ICU of Teluk Intan Hospital. A total of 60 participants were enrolled, with 30 participants each in the intervention and control group. The Malay version of the Validated Critical Care Family Satisfaction Survey (CCFSS) was used to measure family satisfaction with the care received during their ICU admission. Results: The intervention group reported significantly higher level of satisfaction in all of the components (Assurance, Proximity, Information, Support and Comfort). Upon further examination of the results of the intervention group, the scores in the Assurance, Proximity and Comfort component were significantly higher compared to the scores in the Information and Support component. Conclusion: Integrating an information leaflet with the traditional verbal method of delivering information has proven to provide a significant difference in satisfaction levels to the family members of patients who were admitted to the ICU.

"De mão-em-mão tramando redes e normas: a vida social das pílulas anticoncepcionais, a partir de suas bulas" / "From hand to hand plotting networks and norms: The social life of contraceptive pills through their patient information leaflet "

Resumo Com o objetivo de descortinar aspectos da vida social das pílulas anticoncepcionais, o artigo analisou o conteúdo de suas bulas publicados no guia de medicamentos Dicionário de Especialidades Farmacêuticas (DEF), entre 1971 e 1990. Procuramos explorar os discursos veiculados nesses dispositivos - a quem se dirigiam, o que propunham e que efeitos pretendiam - e compreender como contribuíram e o que nos revelaram sobre o seu percurso biográfico. As bulas se comportaram como importantes veículos de intercomunicação entre os atores que participaram da trajetória desses medicamentos, desde sua produção pela da indústria farmacêutica, até chegarem às suas consumidoras finais, as mulheres, passando também por médicos, enfermeiros, farmacêuticos, donos e balconistas de farmácias e transitando entre consultórios, serviços de saúde, entidades de planejamento familiar, estabelecimentos comerciais, lares e bolsas femininas. Nessa enorme cadeia de associações produzidas pelas pílulas, as bulas contribuíram para a geração de um mínimo denominador comum que permitiu a normalização e naturalização das práticas de controle da fecundidade hormonal e para a formação do mercado - não só no sentido econômico, mas em sentido sociológico, como redes de interações e trocas, onde circularam bens que agregaram a um só tempo valores econômicos, simbólicos e normativos.

Abstract In order to uncover aspects of social life of pharmaceutical pills and based on the theoretical-methodological perspective of the drugs biography, this paper analyzes the instructions of their leaflets, published in the Dictionary of Pharmaceutical Specialties (DEF), between 1971 and 1990. It seeks to explore the speeches conveyed in papers that accompanied the packaging of the "medicine pill" - to whom they were headed, what they proposed and what social effects they intended - and to understand their participation in the set of associations that allowed the stabilization of oral contraceptives in Brazil. Leaving the pharmaceutical laboratories, the patient information leaflet transited among physicians, nurses, pharmacists, owners and shopkeepers of pharmacies and women, passing from hand to hand, in offices, health services family planning entities, pharmacy counters, medical departments of companies, households and women's bag. They were the important intercommunication vehicles between these actors and in the big chain of associations produced by contraceptive pills, the patient information leaflets contributed to a minimum common denominator that allowed to return a normal and natural control practices of hormone-mediated fecundity and the formation of the fertility control pill market, where goods were giving movement to add economic, symbolic and normative values at the same time.

Anatomical and histochemical characterization of Dipteryx odorata and Taralea oppositifolia, two native Amazonian species

Abstract Dipteryx odorata (Aubl.) Willd. and Taralea oppositifolia Aubl., Fabaceae: Dipterygeae, are two Amazonian species of great economic and pharmacological potential. The anatomy of these species, however, remains poorly studied. The aim of this work was to inventory leaf anatomical characteristics of D. odorata and T. oppositifolia and to locate and identify secretory structures and determine the main classes of metabolites they store. Vegetative branches were collected in Parque Ecológico de Gunma, Belém, state of Pará, Brazil. Some of the branches were destined for herborization while the remainder was submitted to standard protocols for anatomical analysis and histochemical tests. Both species were found to possess an unstratified epidermis, with D. odorata being amphistomatic and T. oppositifolia being hypostomatic, and dorsiventral mesophyll with spongy parenchyma and wide cellular space. The two species were also found to possess idioblasts and secretory cavities that produce a heterogeneous exudate consisting of polysaccharides, lipids, alkaloids and phenolic compounds. The species presented differences in leaf anatomy and chemical composition of the secretory structures, which may be useful in their differentiation.

Research advance of surgical transcatheter mitral valve repair / 中国胸心血管外科临床杂志

@#Mitral regurgitation (MR) with multi-pathogenesis is a common disease in cardiac surgery department. MR can be classified into two categories-primary mitral regurgitation and secondary mitral regurgitation. With the development of cardiac intervention, numerous patients who cannot tolerate open heart surgery for the reason of high risk of surgery receive the treatment of intervention and achieve the favorable endpoint. The technique of transcatheter therapy which could be used to treat MR is comprised of leaflet repair, annuloplasty and implantation of artificial chordae. Comparing to primary mitral regurgitation, surgical effect of secondary mitral regurgitation is not desirable for the reasons of complex pathophysiologic mechanism. Hence, based on the perspective of surgeon, we will introduce the research progress of transcatheter interventional mitral valve repair which is focused on the treatment of primary mitral valve regurgitation and reviewed from three aspects of surgical risks, surgical types and outlook.

Long-Term Results of the Leaflet Extension Technique for Rheumatic Aortic Regurgitation: A 20-Year Follow-up / 대한흉부외과학회지

BACKGROUND: Although aortic valve repair can reduce prosthesis-related complications, rheumatic aortic regurgitation (AR) caused by leaflet restriction is a significant risk factor for recurrent AR. In this study, we evaluated the long-term results of the leaflet extension technique for rheumatic AR. METHODS: Between 1995 and 2016, 33 patients underwent aortic valve repair using the leaflet extension technique with autologous pericardium for rheumatic pure AR. Twenty patients had severe AR and 9 had combined moderate or greater mitral regurgitation. Their mean age was 32.2±13.9 years. The mean follow-up duration was 18.3±5.8 years. RESULTS: There were no cases of operative mortality, but postoperative complications occurred in 5 patients. Overall survival at 10 and 20 years was 93.5% and 87.1%, respectively. There were no thromboembolic cerebrovascular events, but 4 late deaths occurred, as well as a bleeding event in 1 patient who was taking warfarin. Twelve patients underwent aortic valve reoperation. The mean interval to reoperation was 13.1±6.1 years. Freedom from reoperation at 10 and 20 years was 96.7% and 66.6%, respectively. CONCLUSION: The long-term results of the leaflet extension technique showed acceptable durability and a low incidence of thromboembolic events and bleeding. The leaflet extension technique may be a good option for young patients with rheumatic AR.

Echocardiographic features of indirect Gerbode defect in a cat / 대한수의학회지

This report describes the echocardiographic features of an indirect Gerbode defect in a young cat. Echocardiography revealed high-velocity, turbulent systolic flow directed from left ventricle to right ventricle through a ventricular septal defect. The flow immediately entered the right atrium through a tricuspid septal leaflet. The indirect-type Gerbode defect was confirmed through necropsy. When a high-velocity turbulent flow in the RA without pulmonary hypertension is observed on echocardiography, Gerbode defect should be considered.

Influence of valve height on the opening/closure performance of transplanted aortic valve / 生物医学工程学杂志

Valve transplantation is often used in the treatment of aortic valve insufficiency. However, after surgery, the reconstructed aortic roots have an expansion phenomenon, in which the lack of valve height causes the aortic valve to close again. In this paper, the effects of different aortic valve height design on valve opening and closing performance were studied. The optimal surgical plan was obtained by numerical simulation, providing technical support and theoretical basis. In this paper, six groups of three-dimensional geometric models with a valve height increment of ± 0.5 mm were established with a root diameter of 26.0 mm and a valve height of 14.0 mm. Through the structural mechanics calculation and analysis of the parameters such as maximum stress, valve area and contact force of the model, reasonable geometrical dimensions are obtained. The study found that the maximum stress values of the six groups of models ranged from 640 to 690 kPa, which was consistent with the results of the literature; the three-group models with valve heights of 13.5 mm, 14.0 mm, and 14.5 mm were within a reasonable range. The contact force value of the 6 groups of leaflets increased with the increase of valve height. Studies have shown that the height of the aortic valve has an effect on the aortic valve closure performance. A valve height that is too small or too large will reduce the aortic systolic valve area and affect the aortic function.

Is tricuspid valve really tricuspid? / 대한해부학회지

Advancement in imaging techniques and interventional cardiology procedures have generated renewed interest in anatomy of tricuspid valve complex. The purpose of the present study was to characterize the morphology of tricuspid valve leaflets using objective criteria. Thirty-six embalmed cadaveric hearts were utilized for the present study. Leaflet morphology was studied using newly defined criteria. Commissural zones were identified and leaflets were delineated. Presence of scallops was also recorded. Single leaflet was observed in six cases, double in 26 cases, and triple in four cases. The anterior leaflet is large with multiple scallops and frequently accrues portion of inferior leaflet. The septal leaflet is in the form of a plateau and also frequently accrues parts of inferior leaflet. The inferior leaflet rarely occurs as independent leaflet. A wide un-indented basal zone exists across the valve leaflets. The study found that the tricuspid valve is rarely tricuspid. It also generated the hypotheses that the tricuspid valve does not open completely due to presence of a wide basal zone and the valve does not close completely owing to incongruence and lack of coaptation of leaflets. The findings provide clear understanding of leaflet morphology of tricuspid valve. This will help imaging specialists for interpretation of images and cardiologists for interventional procedures. The findings also enhance our understanding of pathophysiology of conditions like functional tricuspid regurgitation.

Research and practice on readability test of Danshen Capsule for registration as THMPs in EU / 中草药

The package leaflet is a legal document relevant with drug information, which plays an important role for instructing the rational use of the medicinal product for the patient population. During the registration application in the EU countries, the patient readability test on package leaflet is the essential requirement to ensure the leaflet information easy-to-understand and avoid any risk caused by misunderstanding. The readability research on package leaflet can improve its quality and drug use safety to patients. Currently, CFDA does not publish any regulation/guidance on the drug application in China. By the successful case of registration application of Danshen Capsule as the herbal medicine in the EU, this paper not only discusses the relevant requirements of readability test in the EU, but also offers the regulatory advice on future regulations of readability research of the pharmaceutical products in China.

Investigation and Analysis on the Effects of 3 New Medication Education Intervention Methods on Patients' Awareness of Rational Drug Use and Compliance in Obstetrics and Gynecology Outpatient Department / 中国药房

OBJECTIVE:To provide reference for ensuring safe and effective drug use in obstetrics and gynecology outpatient department.METHODS:Medication education intervention was conducted among some patients in obstetrics and gynecology outpatient department from 4 third grade class A hospitals of our province through making Wechat pushing messages,videos and leaflets.The difference of rational drug use knowledge awareness and compliance was compared before and after intervention by questionnaire survey.RESULTS:A total of 60 questionnaires were distributed,and 60 valid questionnaires were collected with effective recovery rate of 100％.Compared to before intervention,correct rate of 20 questions about the knowledge of rational drug use were improved after intervention in respects of awareness and compliance.The awareness and compliance scores about the knowledge of rational drug use after intervention were higher than before intervention;there was statistical significance in Wechat pushing message group [(53.18 ± 11.51) vs.(88.48 ± 7.12),(55.15 ± 11.82)vs.(86.81 ± 7.69)],in video group [(49.50 ± 17.23) vs.(85.00 ± 11.55),(52.00 ± 17.70)vs.(86.00 ± 6.99)],in leaflets group[(41.47 ± 9.14)vs.(77.05 ± 9.36),(43.23 ± 10.89)vs.(78.82 ± 9.11)] be-fore and after intervention (P＜0.05).There was no statistical significance in the improvement of awareness or compliance score among those groups (P=0.992 and P=0.397).CONCLUSIONS:Three intervention methods can effectively improve the awareness and compliance of patients about rational drug use knowledge in obstetrics and gynecology outpatient department.Pharmacists can choose the appropriate medication education intervention based on the patient's different educational levels,preferences and acceptability.

Investigation and Analysis on the Effects of 3 New Medication Education Intervention Methods on Patients' Awareness of Rational Drug Use and Compliance in Obstetrics and Gynecology Outpatient Department / 中国药房

OBJECTIVE:To provide reference for ensuring safe and effective drug use in obstetrics and gynecology outpatient department.METHODS:Medication education intervention was conducted among some patients in obstetrics and gynecology outpatient department from 4 third grade class A hospitals of our province through making Wechat pushing messages,videos and leaflets.The difference of rational drug use knowledge awareness and compliance was compared before and after intervention by questionnaire survey.RESULTS:A total of 60 questionnaires were distributed,and 60 valid questionnaires were collected with effective recovery rate of 100％.Compared to before intervention,correct rate of 20 questions about the knowledge of rational drug use were improved after intervention in respects of awareness and compliance.The awareness and compliance scores about the knowledge of rational drug use after intervention were higher than before intervention;there was statistical significance in Wechat pushing message group [(53.18 ± 11.51) vs.(88.48 ± 7.12),(55.15 ± 11.82)vs.(86.81 ± 7.69)],in video group [(49.50 ± 17.23) vs.(85.00 ± 11.55),(52.00 ± 17.70)vs.(86.00 ± 6.99)],in leaflets group[(41.47 ± 9.14)vs.(77.05 ± 9.36),(43.23 ± 10.89)vs.(78.82 ± 9.11)] be-fore and after intervention (P＜0.05).There was no statistical significance in the improvement of awareness or compliance score among those groups (P=0.992 and P=0.397).CONCLUSIONS:Three intervention methods can effectively improve the awareness and compliance of patients about rational drug use knowledge in obstetrics and gynecology outpatient department.Pharmacists can choose the appropriate medication education intervention based on the patient's different educational levels,preferences and acceptability.

Developing and Evaluating a Drug Information Leaflet of Antidiabetics for Senior Citizens; Employing Performance-based User-testing

OBJECTIVE: The study purpose was to develop a drug information leaflet for the elderly and to evaluate it with performance-based user-testing. METHODS: We performed a stratified randomized controlled trial. We recruited 62 elderly patients with age of 65 or above who were taking antidiabetic medications at the point of participating and excluded those who suffered illiteracy. We randomly allocated them into the intervention group with a leaflet for the elderly and the control group with a leaflet for the general public. Main outcome measures were to ‘be able to find information’ and to ‘be able to understand information.’ We measured outcome variables by employing performance-based user-testing and analyzed data to find any differences between two groups with t-tests, chi-squared tests or Fisher's exact tests accordingly. RESULTS: More participants in the intervention group understood how to store their medications than those in the control group (intervention group 93% vs. control group 70%; p=0.02). There were no significant differences in other information items between two groups. Mostly ‘being able to understand information’ was lower than ‘being able to find information.’ The gaps between two outcome variables were about 10% in the intervention group and about 18% in the control group. The lowest understanding was observed in information relating to drug names and their potential adverse events. CONCLUSION: Without providing personalized drug information, it might be hard for the elderly to improve their drug knowledge even with leaflets that were developed specifically for the elderly.

Performance-based User Testing of a Patient Drug Leaflet in the Elderly

OBJECTIVE: This study aimed to explore the readability and comprehensibility of the drug information on a patient leaflet for the senior by employing performance-based user-testing. METHODS: We included 36 elderly (65 years old or older) as the senior group (intervention group) and 36 adults (40~59 years old) as the adult group (control). We developed a questionnaire to test if participants could access to drug information. After completing a questionnaire, the participant was interviewed about their understanding over the patient leaflet. We performed t-test, χ2-test or Fisher's exact test to examine differences between two groups in primary outcomes. RESULTS: The senior were less likely able to find information (78%) than the adult (91%); they were much less likely able to understand information (42%) than the adult (69%). While we found differences between the ability of finding and understanding drug information in both groups, the senior group had greater difficulties in understanding all kinds of drug information. They had significant difficulties to remember information after reading the patient leaflet and frequently failed to find proper information even though they were allowed to access freely to the leaflet during interviewing. CONCLUSION: To secure safe and effective use of drugs for the senior, it is necessary to develop drug leaflets for the senior.

Developing a Drug Information Leaflet of Antihypertensives for Senior Citizens; Employing Performance-based User-testing

OBJECTIVE: Written information could be helpful for senior population to adhere to complex medication therapies, but must be well prepared and empirically assessed to achieve such end. We purposed to develop a drug information leaflet for senior citizens by applying 'performance-based user-testing.' METHODS: We employed a user-testing, a mixed method to figure difficulties out with patients' leaflets from the user perspective. The cycle made of test and revision can be repeated as necessary. We recruited senior citizens with age of 65 or above who were taking antihypertensive medications at the point of participating and excluded the elderly who suffered illiteracy. We firstly rectified a drug information leaflet of antihypertensive medications for the general public distributed by the Korean authority based on focus group interviews (9 participants). The revised leaflets were tested four times with 8~12 participants in each round (40 seniors in total). We targeted to develop a leaflet which more than 80% of participants understood 10 key information. Main outcomes measures were to be able to find information and be able to understand information. This study was approved by the Yeungnam University Research Ethics Committee. RESULTS: Focus group interviews identified difficulties with small font of words, professional language, long information, and a poor structure. The leaflet was revised and in the first round questionnaire found problems with 4/10 information points; interviews disclosed all but one (normal blood pressure range) were ill-understood. The second round questionnaire and interview found fewer problems but the comprehensiveness of participants was still poor in several points. For the third and fourth rounds we revised the leaflets in the individual-targeted manner. Finally, the fourth round showed all key information found and understood by at least 80% of participants except one question about drug name. CONCLUSION: The drug leaflets need to be developed in a personalized mode for the seniors. There was a limit for Korean seniors to understand nonproprietary name of their drugs because they used to producers' trade names which the Korean health system predominantly works with.