Patients' Use of a Standardized Medication List - A Mixed Methods Study.

Purpose: A medication list (ML) is a document listing the patient's entire medication, instructions for use, and indications. In Germany, a national standard was established in 2016 by law. However, data on patients' use of this standardized ML are scarce. We investigated (i) patients' practical use of the ML, (ii) patients' understanding of the ML, (iii) completeness and correctness of the current ML version, and (iv) reasons why patients did not adhere to their ML. Patients and Methods: Community pharmacists recruited patients possessing a standardized ML with ≥5 medications. Information sources to evaluate the ML were: (a) brown bag analysis, (b) practical demonstration, (c) patient interview, and (d) patient file. Data were analyzed using qualitative and quantitative methods. Results: Two hundred and eighty-eight patients (median age: 76 years, range: 27-95) were enrolled. (i) 38.5% of the patients used their ML regularly to prepare their medication and 73.3% to inform their physician. (ii) Overall, patients' understanding of the ML was good, with >80% of the patients being able to identify all relevant information. (iii) While n = 2779 medications were actually taken, n = 2539 were documented on the ML. No ML was fully correct and complete. Regarding particularly relevant items, ie, active ingredient, strength, dosage, medication missing or listed but not taken, 79.2% of ML were incorrect or incomplete. Handwritten modifications on the ML were frequent. (iv) Almost 60% of all patients did not follow their ML with "fear of adverse drug reactions" being the most frequently (n = 50) mentioned reason. Conclusion: Completeness and correctness of the current ML version was poor with handwritten modifications being frequent. Additionally, most of the patients did not adhere to their ML. This indicates that measures that lead to correct and up-to-date ML and improvements in patient counseling about their medication should be developed and implemented into routine practice.

Clinical pharmacy services are reimbursed in Germany: challenges of real world implementation remain.

Over the last two decades, community pharmacy has experienced major changes as the role of pharmacists is evolving from a product to a service and a patient focus. As part of this change, new and innovative clinical pharmacy services aimed at improving medicines use and patient outcomes have been designed, both nationally and internationally. Since June 2022, five services are reimbursed by all statutory health insurance funds and private insurance companies in Germany: medication review for patients with polymedication; blood pressure control in hypertension; assuring proper inhalation techniques for patients receiving a new device or a device change; medication review including a follow-up for patients taking oral anticancer drugs or immunosuppressants post-transplantation. Beyond reimbursement, the upscaling and sustainable provision of these professional services are now the main challenges. Implementation research will provide important information for the further development of pharmaceutical care programs.

[Electronically supported co-operation of physicians and pharmacists to improve medication safety in the ambulatory setting : The "Arzneimittelinitiative Sachsen-Thüringen" (ARMIN)]. / Elektronisch unterstützte Kooperation ambulant tätiger Ärzte und Apotheker zur Verbesserung der Arzneimitteltherapiesicherheit : Die Arzneimittelinitiative Sachsen-Thüringen (ARMIN).

In Germany, the number of drugs dispensed, prescription as well as drugs that are sold without a prescription (over-the-counter drugs), is rising continuously. As a consequence, the proportion of patients with polymedication and the risk for adverse drug events is rising as well.The ABDA - Federal Union of German Associations of Pharmacists and the Federal Association of Statutory Health Insurance Physicians developed a comprehensive concept based on an interdisciplinary approach. Overall, the concept aims to improve both the effectiveness and safety of pharmacotherapy. The program consists of three components: (1) preferred generic prescribing (instead of brand name products), (2) preferred prescribing of first-line drugs according to a medication catalogue, and (3) medication management (MM). In ARMIN (Arzneimittelinitiative Sachsen-Thüringen), a contract signed in 2014, this concept was implemented for the first time.Datasets were developed and integrated into the local software of physicians and pharmacies to establish the prescription of active ingredients and dispensing the appropriate product as well as the medication catalogue. For MM, processes and responsibilities were developed as well as a technical infrastructure to enable an electronic exchange of patients' medication data.By December 2017, 546 physicians and 969 pharmacists participated in ARMIN, of which 297 physicians and 285 pharmacists were technically able to offer MM, and approximately 3200 patients had signed up for the MM service.In ARMIN, a promising interdisciplinary concept has been developed and implemented. Defining responsibilities and integrating the components into the local software of the physicians and pharmacists facilitated implementation. Future evaluation will show to what extent this concept can contribute to medication safety.

Is there a role for conventional MRI and MR diffusion-weighted imaging for distinction of skull base chordoma and chondrosarcoma?

BACKGROUND: Chordoma and chondrosarcoma are locally invasive skull base tumors with similar clinical symptoms and anatomic imaging features as reported in the literature. PURPOSE: To determine differentiation of chordoma and chondrosarcoma of the skull base with conventional magnetic resonance imaging (cMRI) and diffusion-weighted MR imaging (DWI) in comparison to histopathological diagnosis. MATERIAL AND METHODS: This retrospective study comprised 96 (chordoma, n = 64; chondrosarcoma, n = 32) patients with skull base tumors referred to the Paul Scherrer Institute (PSI) for proton therapy. cMRI signal intensities of all tumors were investigated. In addition, median apparent diffusion coefficient (ADC) values were measured in a subgroup of 19 patients (chordoma, n = 11; chondrosarcoma, n = 8). RESULTS: The majority 81.2% (26/32) of chondrosarcomas displayed an off-midline growth pattern, 18.8% (6/32) showed clival invasion, 18.8% (6/32) were located more centrally. Only 4.7% (3/64) of chordomas revealed a lateral clival origin. Using cMRI no significant differences in MR signal intensities were observed in contrast to significantly different ADC values (subgroup of 19/96 patients examined by DWI), with the highest mean value of 2017.2 × 10(-6 )mm(2)/s (SD, 139.9( )mm(2)/s) for chondrosarcoma and significantly lower value of 1263.5 × 10(-6 )mm(2)/s (SD, 100.2 × 10(-6 )mm(2)/s) for chordoma (P = 0.001/median test). CONCLUSION: An off-midline growth pattern can differentiate chondrosarcoma from chordoma on cMRI in a majority of patients. Additional DWI is a promising tool for the differentiation of these skull base tumors.

Cationic Peptides Facilitate Iron-induced Mutagenesis in Bacteria.

Pseudomonas aeruginosa is the causative agent of chronic respiratory infections and is an important pathogen of cystic fibrosis patients. Adaptive mutations play an essential role for antimicrobial resistance and persistence. The factors that contribute to bacterial mutagenesis in this environment are not clear. Recently it has been proposed that cationic antimicrobial peptides such as LL-37 could act as mutagens in P. aeruginosa. Here we provide experimental evidence that mutagenesis is the product of a joint action of LL-37 and free iron. By estimating mutation rate, mutant frequencies and assessing mutational spectra in P. aeruginosa treated either with LL-37, iron or a combination of both we demonstrate that mutation rate and mutant frequency were increased only when free iron and LL-37 were present simultaneously. Colistin had the same effect. The addition of an iron chelator completely abolished this mutagenic effect, suggesting that LL-37 enables iron to enter the cells resulting in DNA damage by Fenton reactions. This was also supported by the observation that the mutational spectrum of the bacteria under LL-37-iron regime showed one of the characteristic Fenton reaction fingerprints: C to T transitions. Free iron concentration in nature and within hosts is kept at a very low level, but the situation in infected lungs of cystic fibrosis patients is different. Intermittent bleeding and damage to the epithelial cells in lungs may contribute to the release of free iron that in turn leads to generation of reactive oxygen species and deterioration of the respiratory tract, making it more susceptible to the infection.

The Evonik-Mainz-Eye-Care-Study (EMECS): design and execution of the screening investigation.

PURPOSE: To determine if screening for major ophthalmological diseases is feasible within the frame of routine occupational medicine examinations in a large working population. METHODS: 13037 employees of Evonik Industries aged 40 to 65 years were invited to be screened for major ophthalmological diseases (glaucoma, age related macular degeneration and diabetic retinopathy between June 2007 and March 2008 within an extended setting of occupational medicine. Ophthalmological examinations consisted of visual acuity, objective refraction, pachymetry, tonometry, perimetry (frequency doubling technology), confocal scanning laser ophthalmoscopy and digital fundus photography. Participants responded to a questionnaire addressing history of ocular and general diseases and social history. RESULTS: 4183 participants (961 female and 3222 male) were examined at 13 different sites. Response rates for eligible persons at those sites ranged from 17.9 to 60.5% but were in part limited by availability of examination slots. Average age of participants was 48.4 ± 5.4 years (mean ± SD). 4147 out of 4183 subjects (99.1%) had a visual acuity ≥ 0.5 in the better eye and 3665 out of 4183 (87.6%) subjects had a visual acuity ≥ 0.8 in the better eye. 1629 participants (38.9%) had previously not been seen by an ophthalmologist at all or not within the last three years. CONCLUSION: This article describes the study design and basic characteristics of study participants within a large occupational medicine based screening study for ophthalmological diseases. Response rates exceeded expectations and were limiting examination capacity. Meaningful data could be obtained for almost all participants. We reached participants who previously had not received ophthalmic care. Thus, ophthalmological screening appears to be feasible within the frame of routine occupational medicine examinations.

Shift work, chronodisruption and cancer?--The IARC 2007 challenge for research and prevention and 10 theses from the Cologne Colloquium 2008.

In October of 2007, an IARC panel of 24 scientists systematically evaluated epidemiologic, experimental, and mechanistic data and concluded that shift work that involves circadian or chronodisruption is probably carcinogenic in humans. In view of the possible scope of the problem--shift work is widespread and unavoidable on one hand and breast cancer and prostate cancer, which may be causally associated with chronodisruption, are epidemic worldwide on the other--German representatives of science and occupational medicine discussed the experimental and epidemiologic background and possible implications of the challenge identified by the International Agency for Research on Cancer (IARC) at a colloquium in Cologne in September 2008. This overview summarizes the key ideas presented at the Cologne Colloquium and offers 10 theses concerning the need for targeted studies and the necessity to develop possible means of prevention.

Different types of connective tissue alterations associated with cervical artery dissections.

This study describes the technical handling and the diagnostic evaluation of skin biopsies in order to standardize the assessment of the delicate morphologic abnormalities that are found in patients with spontaneous cervical artery dissections (sCAD). Skin biopsies from 126 patients with sCAD and from 29 healthy relatives were analyzed. The morphology of the connective tissue was normal in 54 patients with sCAD (43%) and aberrant in 72 patients with sCAD (57%). These latter patients were classified into three groups: in 43 patients, we repeatedly observed composite collagen fibrils and elastic fibers with fragmentation and minicalcifications. In 13 further patients, the dermis was significantly thinner than in healthy subjects. The collagen fibers contained fibrils with highly variable diameters. In a third group of 16 sCAD patients, the abnormalities were restricted to the elastic fibers (with fragmentation and minicalcifications) without significant alterations in the morphology of the collagen fibrils. The finding of different morphologic classes of aberrations among patients suggests that the connective tissue defects are genetically heterogeneous. The segregation of the connective tissue phenotype in three families suggested an autosomal dominant pattern of inheritance.