Med Wise: A theory-based program to improve older adults' communication with pharmacists about their medicines.

BACKGROUND: The health and economic toll of medication errors by older adults is well documented. Poor communication and medication coordination problems increase the likelihood of adverse drug events (ADEs). Older adults have difficulty communicating with health care professionals, including pharmacists. As such, the theory-based Med Wise program was designed. Building on the Self-efficacy Framework and the Chronic Care Model, this program was tested with community-dwelling older adults. OBJECTIVES: This study and its resultant paper: (1) describe the theory-based design of the Med Wise program; (2) describe the collaboration of multiple community partners to develop a sustainable model for implementing Med Wise; and (3) present findings from the Med Wise course evaluation. METHODS: Med Wise was designed to be a sustainable, skill-based educational and behavior change program consisting of two, 2-h interactive classes to enhance participants' medication communication skills and self-efficacy. To explore the potential to disseminate Med Wise throughout the state, a partnership was formed between the pharmacy team and the statewide Aging & Disability Resource Centers (ADRCs), as well as the Community-Academic Aging Research Network (CAARN). Over 30 lay volunteer leaders in 8 Wisconsin (U.S. State) counties were trained, and they delivered Med Wise through ADRC community centers. The CAARN staff evaluated the fidelity of the course delivery by leaders. To evaluate Med Wise, a quasi-experimental design using pre/post surveys assessed knowledge, worry and self-efficacy. A telephone follow-up three months later assessed self-efficacy and translation of medication management skills and behaviors. RESULTS: Med Wise programs were presented to 198 community-dwelling older adults while maintaining program fidelity. This evaluation found significant increases in older adults' knowledge about pharmacists' roles and responsibilities, likelihood of talking with a pharmacist about medication concerns, and self-efficacy for communicating with pharmacists. At the 3 month follow-up, participants reported increased interactions with pharmacists, with 29.2% of participants reported seeking medication reviews and 28.5% medication schedule reviews. CONCLUSIONS: The two-class Med Wise program showed sustained impact at 3 months on key outcomes. Further, the community partners successfully implemented the program with fidelity across 8 counties suggesting its ability to be disseminated and sustained. Future directions include expanding the program to examine wider adoption, and measuring program impact on regimen safety and health outcomes linked to increases in patient engagement.

Fluorimetric multiparameter cell assay at the single cell level fabricated by optical tweezers.

A fluorimetric multi-parameter cell sensor at the single cell level is presented which makes it possible to observe the physiological behavior of different cell lines, different physiological parameters, and statistical data at the same time. Different cell types were immobilized at predefined positions with high accuracy using optical tweezers and adhesion promoting surface layers. The process is applicable to both adherent and non-adherent cells. Coating of the immobilization area with mussel adhesive protein was shown to be essential for the process. Intracellular proton and calcium concentrations in different cell classes were simultaneously imaged and the specific activation of T lymphocytes was demonstrated. This method should be especially useful for drug screening due to the small sample volume and high information density.

Multifrequency evaluation of different immunosorbents on acoustic plate mode sensors.

Previous studies of acoustic plate modes on ZX-LiNbO3 have indicated that practical mass-sensitive immunosensors can be implemented by using devices with higher frequencies of operation and/or by improving techniques for the immobilization of antibodies. However, it is also known from these studies that the viscoelastic properties of aminosilane films, used for the covalent immobilization of antibodies on the crystal surface, cannot be ignored in the sensor response. In the present work, in an attempt to study the effect of viscoelasticity of the binding film, three different films with different viscoelasticity and binding capacities, an aminosilane, a dextran, and a poly-(etherurethane)-based immunosorbent (XP-5), were prepared on the sensor surface for the immobilization of antibodies. Immunochemical reactions were monitored by the acoustic plate mode sensor at three different frequencies, thus allowing the direct observation of the frequency dependence of mass sensitivity with different films. Depending on the type of immunosorbent, the sensitivity at the third harmonic was enhanced by a factor of 2-5 with respect to the fundamental response. A third acoustic mode at a closely spaced frequency to the third harmonic yielded lower sensitivity values, which indicates that sensitivity depends not only on the frequency of device operation but also on particle displacement amplitude and components of the selected wave. Since antigen binding capacities of the different immunosorbents were determined independently by a modified ELISA test, sensor responses can also be correlated to the immunosorbent structure, and hence the viscoelastic properties. A dual delay line configuration was used which compensates for second-order effects such as temperature variations and nonspecific adsorption.