[Complex drug regimen in multimorbid elderly patients after hospital discharge - a qualitative study]. / Komplexe Medikamentenregime bei multimorbiden älteren Menschen nach Spitalaufenthalt - eine qualitative Studie.

BACKGROUND: Older people often have multimorbidity requiring a complex regime of medications, which may change following hospital discharge, thus presenting new challenges. The experiences of older people, who manage their own medications, in particular following hospital discharge, have rarely been studied. AIM: This study investigates the experiences of older people with multimorbidity taking multiple medications after hospital discharge and how they cope with medication-taking. METHOD: A qualitative-descriptive approach with ten interviews was chosen. The data were coded openly into two groups according to Saldaña (2013). RESULTS: It is important for older people, in spite of their multimorbidity, to maintain their independence and maintain responsibility for taking their medications. Routines are developed from taking medications over many years and the new medications are easily integrated. Unclear information by the medical staff and the inability of the older people to obtain the medications after discharge may lead to mistakes or interruptions in the drug therapy at home. The key person for this group is the general practitioner, even concerning the drug therapy initiated in hospital. CONCLUSION: It is advisable to adapt discharge education to the needs of older people, especially with regard to their drug therapy, to its integration into their daily routine, and to any possible shortcomings in their medication management.

The role of aldosterone antagonism agents in diabetic kidney disease.

BACKGROUND: Diabetic kidney disease is a common consequence of the development of diabetes. In the United Kingdom 18-30% of chronic kidney disease cases and 44% of end-stage renal disease cases in the United States have been attributed to complications of diabetic kidney disease. Angiotensin blockade using angiotensin converting enzyme inhibitors or angiotensin receptor blockers is the standard for slowing the progression of diabetic kidney disease. Evidence suggests that aldosterone antagonism added to standard therapy may be beneficial. AIM OF REVIEW: This paper aims to explore the pathophysiological contribution of aldosterone in diabetic kidney disease and review available literature for aldosterone antagonism through mineralocorticoid receptor blockade. METHODS: A comprehensive literature search was conducted. Results were analysed and summarised. RESULTS: Nine trials evaluating a total of 535 patients with diabetic kidney disease were identified that evaluated the use of aldosterone antagonists for reducing the signs of diabetic kidney disease. All trials demonstrated a marked decrease in urinary protein excretion when compared to, or added to angiotensin converting enzyme inhibition or angiotensin receptor blockade. The most commonly reported side effect in all of the trials was hyperkalaemia, which occurred in 6.1% of all patients evaluated. Aldosterone antagonists were generally well tolerated in the evaluated patient populations. CONCLUSION: Aldosterone antagonism may represent a safe and effective complimentary therapy to the use of angiotensin converting enzyme inhibition, or angiotensin receptor blockade, for slowing the progression of diabetic kidney disease.

[Risk factors for falls in the pediatric setting at the Hospital Agency of United Hospitals of Bergamo: a retrospective observational study]. / Fattori di rischio cadute in ambito pediatrico nell'Azienda Ospedaliera Ospedali Riuniti di Bergamo: studio osservazionale retrospettivo.

PURPOSE: To identify the main and most significant risk factors for falls and improve the quality of care delivered to pediatric patients by providing indications for interventions for the prevention of falls. METHODS: To investigate the correlation between falls and risk factors a retrospective observational case-control study was carried out, the sample was made up by all children who fell from 2004 to 2011 between 0-18 y.o. for which there was a record of the fall. RESULTS: 108 children were included in the study (36 cases and 72 controls). The data showed that 4 drugs have a correlation with falls,on the contrary intravenous therapy seemed to be a factor that protects against the risk of falling. CONCLUSION: The study confirms the importance of the problem of falls in children. A greater sample size could help to identify additional independent variables. This study may represent a starting point for further analysis.

Patients' experience and perceptions of polypharmacy in chronic kidney disease and its impact on adherent behaviour.

AIMS: To explore attitudes towards medicines, polypharmacy and adherence in patients with chronic kidney disease (CKD). BACKGROUND: Polypharmacy is common in CKD and associated with medication non-adherence. METHODS: As part of a mixed methodology project, a purposive sample of ten participants were recruited and interviewed to explore attitudes to medicines and reasons for adherent and non-adherent behaviour. RESULTS: Several reasons for non-adherence were reported. Interviewees described a variety of attitudes towards medicines. Complex medicine regimes were a frequently cited contributing factor in poor adherence. Concerns about or experience of side effects had a negative impact on adherence. Prioritisation of medicines was evident and the importance of communication with health professionals was a consistent theme. CONCLUSIONS: Non-adherence with prescribed medicines in CKD is a complex phenomenon, which has implications for clinical outcomes and cost. Adherent behaviour may change over time. Further research in this field is needed. No single intervention is likely to enhance adherence for all and clinicians should consider a variety of options to improve adherence with prescribed medicines.

[Hepatitis C! Experience in diagnosis and medical treatment. A literature review]. / Hepatitis C! Erleben der Diagnose und der medikamentösen Therapie. Eine Literaturübersicht.

Chronic hepatitis C can have physical, psychological or emotional effects on a person. The chronic infection can result in an advanced liver disease and/or influence daily life and self-perception. Today, the possibility to eliminate the virus exists but the therapy is difficult, a decrease in quality of life is known. Anyway, the sustained viral response isn't achievable for everyone. Care in Switzerland usually takes place in the outpatient clinics. Nurse participation to improve self-management is in discussion. For this specific work knowledge of patient's perception is crucial. A literature review was done to answer two questions: "What is the experience of the illness 'chronic hepatitis C'?" and additionally "What has to be managed when undergoing treatment?". A literature search was conducted in the databases of Pubmed and CINAHL. Seven qualitative studies were included. Diagnosis, contagion, illness, stigmatisation and fatigue are central themes and can influence each other. Discussion about treatment and the decision for it seems to be ambiguous. Patients feel reduced to their disease and demand for individual interventions especially for their experience with their illness. A targeted assessment seems important to appreciate their needs in each situation.

[Management of complex medication regimes in chronic illness - challenges and support needs from the health professional's view]. / Bewältigung komplexer Medikamentenregime bei chronischer Erkrankung - Herausforderungen und Unterstützungserfordernisse aus der Sicht der Gesundheitsprofessionen.

While chronic illness are mostly treated with pharmaceutical means, the management of medication regimes in everyday life often remains inadequate, especially for elderly people. In Germany, most efforts to change this situation focus on the role of physicians or pharmacists respectively. In contrast, this study concentrates on home care nurses and posits their potential to improve the management of complex medication regimes. To explore the professional's view 26 expert interviews with representatives of the different healthcare professions were conducted and analysed. The results indicate that regardless of their profession, all interviewees see a need to modify existing medication regimes and share the view that there is a necessity of communicative and educational support of patients. They also agree that improvements in the management of medication require a multi-professional approach and that home care nurses could provide substantial support to chronically ill in managing their daily medication regimes. Nevertheless, the experts also report structural and professional barriers to hinder professionals in meeting these demands. We conclude that an enhancement of nurses' clinical and educational skills is inevitable, if they are to support chronically ill in managing their daily medication regimes in cooperation with other professions.

Estudio reológico de emulsiones semisólidas de aplicación cutánea / Rheological study of semisolid emulsions for percutaneous application

En la formulacion de formas farmaceuticas de aplicacion percutanea, una de las caracteristicas mas importantes a estudiar son las propiedades reologicas, ya que estas tienen repercusion en la extensibilidad del preparado sobre la piel, su facilidad de aplicacion y su adherencia sobre la misma. Todo ello contribuye a la aceptacion por parte del paciente de la formulacion empleada. En este articulo se realiza el estudio reologico de tres formulaciones semisolidas (emulsiones A,B y C) para ver las posibles diferencias que existan entre ellas. La composicion de las mismas es similar, solo difieren en el agente emulsificante, que en el caso de las emulsiones A y B es Tefose 63„µ y en la emulsion C es Tween 80„µ y, en el componente de la fase oleosa, que en las emulsiones A y C es vaselina filante (solida) y en la emulsion B es vaselina liquida. Todas las emulsiones llevan acido salicilico (1%) como componente activo. Para ver las posibles diferencias reologicas que presentan entre ellas se realiza, a temperatura ambiente, la determinacion de la viscosidad del preparado utilizando, para ello, un viscosimetro Brookfield de cilindros concentricos (modelo RTV), aplicando todas las velocidades de cizalla (G) al semisolido. En todos los casos, los resultados indican que el coeficiente de viscosidad depende de la velocidad de cizalla aplicada. Estas determinaciones se llevan a cabo en las emulsiones recien preparadas (tiempo 0), a la semana y al mes de su elaboracion, con el fin de observar, no solo la influencia de los componentes de la formulacion en las propiedades reologicas, sino tambien, la posible influencia del almacenamiento en dichas propiedades. Con los datos obtenidos se deduce que, de las tres emulsiones ensayadas, la A es la mas estable (AU)

In the formulation of pharmaceutical forms of percutaneous application, rheological properties are amongst the most important characteristics to be studied, be- cause of its influence upon extensibility, easiness of application, and adherence to the skin, all of which contribute best to patient compliance. A rheological study on three semisolid formulations (emulsions A, B and C) is carried out in this paper to try to find out possible (rheological) differences between them. The composition of all three emulsions being similar, they nevertheless differ on the surfactant agent, Tefose 63 in emulsion A and B and Tween 80 in emulsion C, and on the oil agent, white soft Vaseline in emulsions A and C and mineral oil in emul- sion B. The active ingredient added to the formulations is salicylic acid (1%). Viscosity determinations are implemented by using a concentric cylinder Brookfield-RTV viscosimeter and then applying at room temperature all shear rates (G) to the semisolide. In all cases, the results indicate that the coefficient of viscosity de- pends on the share rate applied. Viscosity determinations are carried out at emulsion storage times 0 (fresh emulsion), 1 week and 1 month at room temperature in order to find out whether not only the composition of the emulsion, even the storage time has an influence on rheological properties. From the data, emulsion A was found out to be the most stable of the three (AU)