Empowering Patients to Start a Conversation: 5 Questions to Ask about Your Medications.

This quality improvement initiative to help prevent known medication-related failures during transitions of care was co-led by Patients for Patient Safety Canada, the Institute for Safe Medication Practices Canada, the Canadian Patient Safety Institute, the Canadian Pharmacists Association, and the Canadian Society for Hospital Pharmacists. Initially, the intervention was to develop, test, evaluate and disseminate a medication safety "checklist" for patients and healthcare providers. Through small tests of change, the checklist was redesigned as the "5 Questions to Ask about Your Medications." Collective results demonstrate a shared commitment among more than 200 organizations to empower patients with questions to ask about their medications.

Evaluation of a Novel Audit Tool for Medication Reconciliation at Hospital Discharge.

BACKGROUND: Discharge medication reconciliation (MedRec) is designed to reduce medication errors and inform patients and key postdischarge providers, but it has been difficult to implement routinely in Canadian hospitals. OBJECTIVES: To evaluate and optimize a new discharge MedRec quality audit tool and to use it at 3 urban teaching hospitals. METHODS: The discharge MedRec quality audit tool, developed by the Canadian Patient Safety Institute and the Institute for Safe Medication Practices Canada, was assessed and modified to improve comprehensiveness, clarity, and quality. The modified tool was then used to evaluate the quality of the discharge MedRec process for adult patients discharged to home from the general internal medicine service at 3 academic hospitals. Postdischarge telephone interviews were conducted with consenting patients, their community pharmacists, and their family doctors. RESULTS: The audit tool required modification to include aspects of admission MedRec, high-risk medication discrepancies, and direct communication of discharge MedRec to key follow-up providers. Thirty-five patients (mean age 67.7 years, standard deviation [SD] 18.0 years; 17 [49%] women), with a mean of 8.8 (SD 4.5) prescribed medications at discharge, participated in the discharge MedRec evaluation. Documentation of any discharge MedRec was found for only 1 patient (3%), and no discharge MedRec was carried out by pharmacists. Postdischarge follow-up interviews elicited major gaps in communication with community pharmacists and with family physicians, which could lead to serious medication errors. CONCLUSIONS: The modified audit tool was useful for identifying gaps in the quality of discharge MedRec.

CONTEXTE: Le bilan comparatif des médicaments (BCM) au moment du congé est conçu pour réduire les erreurs médicamenteuses et informer les patients ainsi que les principaux prestataires de soins de santé après le congé, mais sa mise en oeuvre systématique dans les hôpitaux canadiens s'est heurtée à de grandes difficultés. OBJECTIFS: Évaluer et optimiser un nouvel outil d'évaluation de la qualité du BCM au moment du congé et l'utiliser dans trois hôpitaux universitaires urbains. MÉTHODES: Cet outil développé par l'Institut canadien pour la sécurité des patients (ICSP) et l'Institut pour la sécurité des médicaments aux patients du Canada (ISMP) a fait l'objet d'une évaluation et d'une modification visant à améliorer son exhaustivité, sa clarté et sa qualité. L'outil modifié a ensuite servi à évaluer la qualité du processus du BCM pour des patients adultes ayant obtenu leur congé après un séjour dans un service général de médecine interne dans trois hôpitaux universitaires. Des entretiens téléphoniques après le congé ont été menés avec les patients consentants, leur pharmacien communautaire et leur médecin de famille. RÉSULTATS: L'outil d'évaluation a dû être modifié pour inclure le BCM au moment de l'admission, des écarts de médication à haut risque et une communication directe du BCM aux prestataires de soins de santé principaux chargés du suivi après le congé. Trente-cinq patients (âge moyen: 67,7 ans; écart type [ET] 18 ans; 17 [49 %] femmes), chacun ayant reçu en moyenne 8,8 (ET 4,5) médicaments prescrits, ont participé à l'évaluation du BCM au congé de l'hôpital. Au moment du congé, on n'a trouvé de renseignements relatifs au BCM que pour un seul patient (3 %) et aucun BCM n'avait été préparé par les pharmaciens. Le suivi après le congé a généré des écarts de communication importants entre les pharmaciens communautaires et les médecins de famille, ce qui pourrait entraîner des erreurs médicamenteuses importantes. CONCLUSIONS: L'outil d'évaluation modifié a été utile pour déterminer les écarts relatifs à la qualité du BCM au moment du congé.

Probing the ubiquinol-binding site of recombinant Sauromatum guttatum alternative oxidase expressed in E. coli membranes through site-directed mutagenesis.

In the present paper we have investigated the effect of mutagenesis of a number of highly conserved residues (R159, D163, L177 and L267) which we have recently shown to line the hydrophobic inhibitor/substrate cavity in the alternative oxidases (AOXs). Measurements of respiratory activity in rSgAOX expressed in Escherichia coli FN102 membranes indicate that all mutants result in a decrease in maximum activity of AOX and in some cases (D163 and L177) a decrease in the apparent Km (O2). Of particular importance was the finding that when the L177 and L267 residues, which appear to cause a bottleneck in the hydrophobic cavity, are mutated to alanine the sensitivity to AOX antagonists is reduced. When non-AOX anti-malarial inhibitors were also tested against these mutants widening the bottleneck through removal of isobutyl side chain allowed access of these bulkier inhibitors to the active-site and resulted in inhibition. Results are discussed in terms of how these mutations have altered the way in which the AOX's catalytic cycle is controlled and since maximum activity is decreased we predict that such mutations result in an increase in the steady state level of at least one O2-derived AOX intermediate. Such mutations should therefore prove to be useful in future stopped-flow and electron paramagnetic resonance experiments in attempts to understand the catalytic cycle of the alternative oxidase which may prove to be important in future rational drug design to treat diseases such as trypanosomiasis. Furthermore since single amino acid mutations in inhibitor/substrate pockets have been found to be the cause of multi-drug resistant strains of malaria, the decrease in sensitivity to main AOX antagonists observed in the L-mutants studied in this report suggests that an emergence of drug resistance to trypanosomiasis may also be possible. Therefore we suggest that the design of future AOX inhibitors should have structures that are less reliant on the orientation by the two-leucine residues. This article is part of a Special Issue entitled: 18th European Bioenergetic Conference.

Population structure of pierid butterflies : I. Numbers and movements of some montane Colias species.

The numbers, dispersal behavior, aging and residence, and Wrightian neighborhood configurations of three species of Colias butterflies have been studied in central Colorado, using mark-release-recapture techniques as major tools. All populations studied have nonoverlapping generations and mature one brood each year. A brief general review of these species' autecology is given. A system for measuring degree of physical damage to the adults is introduced. This "wear rating" varies with temporal position of any given sample in the course of a brood's flight season, the insects becoming progressively more damaged with time. The sex ratio also changes with brood aging: males eclose before females, and are in the majority early in the flight season, while females may predominate at the end of flight. Local population numbers for the montane grassland species C. alexandra may reach peak levels of 700-900 insects in favorable years, but be much lower in other years as a result of, e.g., drought. Peak densities are no more than 2/ha. The montane bog species, C. scudderi, maintains comparable low density but has much smaller local populations. The subalpine/alpine grassland species C. meadii displays peak local numbers as high as 3000, with peak density as high as 120/hectare. Dispersal varies both among and within species. Those C. alexandra who disperse show an average dispersal radius of about 1.3 km, with a radius for the whole population of about 0.6 km; maximum distance moved was 8 km. Dispersal proportions among recaptures are sharply curtailed by adverse weather, but the dispersal radius of those moving is unaffected by weather. C. scudderi's dispersal is strongly influenced by the geometry of its bog and streamside habitats. Some C. meadii populations approach isolated "island" status, but others show much dispersal. Dispersal radius of those dispersing ranges from 0.3 to 0.7 km in different populations, but the proportion of dispersals varies greatly. The longest observed movement by this species is 1.3 km, although up to 2.6 km could have been detected. Colias normally display constant loss (death plus emigration) rates with average residence expectations of 4-6 days; few insects reach their maximum physiological lifespan of approximately 1 month. Bad weather can increase the loss rate drastically. Females show shorter residence than males, appearently as a result of greater mortality. Total-numbers-per-brood estimates are given for our better studied populations. The reproductive strategy of Colias is such that Wright's models for neighborhood size apply. Neighborhood size for C. alexandra varied sixfold in numbers, and from 3 to 1.3 km in physical extent, between a favorable year and a drought year. One localized C. scudderi habitat is only 200 m in diameter, but a streamside population has a neighborhood length of 4.8 km. In C. meadii, one population of 2000-2500 insects is an 8-ha "island", while another of similar numbers extends a single neighborhood across 1.9 km distance, 450 m altitude, and a major ecological boundary (timberline). Factors such as weather, individuals' visual cueing, and thermoregulatory behavior can influence population structure. For some Colias populations, selection may be very uniform within neighborhoods, while for others, single neighborhoods cross sharp discontinuities in selective forces. These patterns may differ for different selective forces, and may also vary with stages of the insects' life cycle. these populations will now prove a valuable resource for studying evolutionary population genetics.