[Medication counselling and support with individual medication preparation for trail elderly living at home-preliminary results]. / Accompagnement des traitements des personnes âgées polymédiquées a domicile au moyen de la preparation de médication individuelle. Résulats préliminaires d'un project concernant la preparation de medication individuelle [PM} s'inscrivant dans le cadre des projects pour L'innovation des soins de santé en Flandre [<>].

Background Medication safety and adherence are important aspects of quality of life, especially for frail elderly in our society. However, many elderly living at home may experience difficulties when taking their medication, and are therefore at risk for medication- related problems. The current living lab was implemented within the framework of the Flanders Care Living Labs and set the objective to develop a care pathway to improve medication safety and adherence for elderly living at home. Automated Individual Medication Preparation [IMP] was provided by a community-pharmacist in order to support frail elderly in taking their medication more correctly and thereby improving adherence. Methods In a before and after study, each patient was supported for 13 weeks through a multidisciplinary care pathway. Key in this pathway was the shared medication schedule (between GP and pharmacist) as the starting point for IMP and medication counselling. The increased medication support based on IMP was evaluated in frail elderly (age a 65 years, complex medication scheme a 5 medicines and a 3 intakes / day) before and after the study, by measuring adherence and satisfaction with counselling and repackaging the medication in sachets. Results The preliminary results of the current study showed that the self-reported adherence rate in frail elderly was significantly higher (p <0.05) after implementation of the pharmacists' intervention with automated IMP. At the end of the study every patient indicated that the repackaging of the medication by dose was helpful in order to take their medication correctly. Conclusion Increased medication counselling with IMP by the community-pharmacist may be a useful aid and supporting tool for frail elderly living at home with a complex medication scheme.

Mutual perception of communication between general practitioners and hospital-based specialists.

BACKGROUND: Communication between general practitioners (GPs) and specialists is an important aspect of qualitative care. Efficient communication exchange is essential and key in guaranteeing continuity of care. Inefficient communication is related to several negative outcomes, including patient harm. This study aimed to investigate the perception of GPs and hospital-based specialists in Belgium of the quality of their mutual communication. METHODS: A cross-sectional study was conducted among GPs and specialists. Participants were asked to complete a validated questionnaire on several aspects of their mutual communication. RESULTS: Response rates of 17.9% (343/1.912) for GPs and 17.3% (392/2.263) for specialists were obtained. Both specialists and GPs qualify their mutual telephone accessibility as suboptimal. Specialists think poorly of the GP referral letter, in contrast to GP perception. Eighty per cent of the GPs feel that specialists address their questions appropriately; specialists have a similar perception of their own performance. According to 16.7% of the specialists, GPs not always follow their recommendations. Contrarily, GPs rate their compliance much higher (90.7%). Less than half of the GPs feel that the specialists' letter arrives on time, whereas specialists have a different and a more positive perception. CONCLUSIONS: GPs and specialists disagree on several aspects of their mutual communication. These include the perception of accessibility, in both directions, and of the timeliness of written communication. Feedback is positively appreciated, again in both directions. Nevertheless, specialists feel that uptake of their recommendations is insufficient. Hence, there may remain significant room for improvement, which could contribute significantly to continuity of care and patient safety.

[Role of the community pharmacist in the management of drug related problems in home care patients]. / Rôle du pharmacien d'officine dans la gestion des problèmes liès aux médicaments dans le cadre des soins à domicile.

Medication management in home care is an error prone process. In a small pilot project in Flanders, community pharmacists collaborated with physicians and home care nurses through a shared electronic care plan, to optimize the medication management of their home care patients. The pilot project shows that GPs and nurses are positive about the possible contribution of the pharmacist in medication management of home care patients. A larger follow up study is necessary to further identify possible roles of pharmacists in home care and to show related health benefits.

Habituation to treadmill walking.

The use of a treadmill to evaluate gait patterns makes it possible to analyze many gait cycles and stride to stride variations. The objective of this study was to assess the time required for a subject to habituate to walking on a treadmill. The evolution of knee kinematics and spatio-temporal parameters were analyzed to measure habituation to walking on the treadmill. To obtain this information, data were recorded on 10 healthy subjects for about 45 minutes as they walked on a treadmill. A steady state was attained for knee kinematics and most spatio-temporal parameters at the time the treadmill had attained its maximal speed (approximately 30 seconds). However, 10 minutes were necessary for stride length to become reproducible. Time for habituation to walking on a treadmill must be considered when kinematics are evaluated during gait of healthy and disabled subjects. We have shown that, at least for young, healthy individuals who are non-naïve to walking on a treadmill, a 10-minute warm-up is enough before three-dimensional knee kinematics and spatio-temporal data can be recorded.

Elucidation of the tumoritropic principle of hypericin.

Hypericin is a potent agent in the photodynamic therapy of cancers. To better understand its tumoritropic behaviour, we evaluated the major determinants of the accumulation and dispersion of hypericin in subcutaneously growing mouse tumours. A rapid exponential decay in tumour accumulation of hypericin as a function of tumour weight was observed for each of the six tumour models investigated, and a similar relationship was found between tumour blood flow and tumour weight. Moreover, there was a close correlation between the higher hypericin uptake in RIF-1 tumours compared to R1 tumours and tumour vessel permeability. To define the role of lipoproteins in the transport of hypericin through the interstitial space, we performed a visual and quantitative analysis of the colocalization of hypericin and DiOC18-labelled lipoproteins in microscopic fluorescent overlay images. A coupled dynamic behaviour was found early after injection (normalised fluorescence intensity differences were on the whole less than 10%), while a shifted pattern in localisation of hypericin and DiOC18 was seen after 24 h, suggesting that during its migration through the tumour mass, hypericin is released from the lipoprotein complex. In conclusion, we were able to show that the tumour accumulation of hypericin is critically determined by a combination of biological (blood flow, vessel permeability) and physicochemical elements (affinity for interstitial constituents).

Immunofunctional properties of a yolk sac epithelial cell line expressing two proteins gp280 and gp330 of the intermicrovillar area of proximal tubule cells: inhibition of endocytosis by the specific antibodies.

The apical domain of epithelial cells lining the proximal tubule and the yolk sac is characterized by the development of extensive microvilli which limit intermicrovillar spaces backed on their cytoplasmic aspect by a coat of clathrin. These membrane areas which give rise to endocytic vesicles are characterized by the expression on their outer aspect of two high molecular weight glycoproteins: gp330 and gp280. In this study we report on an epithelial cell line, BN/MSV, derived from a yolk sac carcinoma which expresses these two glycoproteins. By indirect immunofluorescence, gp330 and gp280 were detectable on the cell surface and after permeabilization in intracytoplasmic vesicles. At the ultrastructural level they were concentrated in clathrin-coated membrane areas and although gp280 could also be detected in non-coated areas. The two proteins were synthesized independently in the form of high molecular weight polymers by biosynthetically labeled BN/MSV cells. Both were released in the supernatant, but, in spite of previously reported similarities by peptide mapping, only gp330 coprecipitated with a 45 kDa protein comigrating with the alpha 2-macroglobulin receptor-associated protein (MRAP). Culture of the cells in the presence of antibodies to gp280 and to a lesser extent of antibodies to gp330 inhibited the internalization of [14C]sucrose and peroxidase. When followed intracellularly at the ultrastructural level, the compartments containing peroxidase in the presence of anti-gp280 or gp330 antibodies were morphologically distinct from those observed under control conditions: vesicles were of smaller size and irregular shape and accumulation in lysosomes was delayed.(ABSTRACT TRUNCATED AT 250 WORDS)