Pharmacist-Led Collaborative Medication Management for the Elderly with Chronic Kidney Disease and Polypharmacy.

Inappropriate polypharmacy is likely in older adults with chronic kidney disease (CKD) owing to the considerable burden of comorbidities. We aimed to describe the impact of pharmacist-led geriatric medication management service (MMS) on the quality of medication use. This retrospective descriptive study included 95 patients who received geriatric MMS in an ambulatory care clinic in a single tertiary-care teaching hospital from May 2019 to December 2019. The average age of the patients was 74.9 ± 7.3 years; 40% of them had CKD Stage 4 or 5. Medication use quality was assessed in 87 patients. After providing MMS, the total number of medications and potentially inappropriate medications (PIMs) decreased from 13.5 ± 4.3 to 10.9 ± 3.8 and 1.6 ± 1.4 to 1.0 ± 1.2 (both p < 0.001), respectively. Furthermore, the number of patients who received three or more central nervous system-active drugs and strong anticholinergic drugs decreased. Among the 354 drug-related problems identified, "missing patient documentation" was the most common, followed by "adverse effect" and "drug not indicated." The most frequent intervention was "therapy stopped". In conclusion, polypharmacy and PIMs were prevalent in older adults with CKD; pharmacist-led geriatric MMS improved the quality of medication use in this population.

Factors related to inappropriate edoxaban use.

WHAT IS KNOWN AND OBJECTIVE: The aim of this study was to evaluate the appropriateness and clinical outcomes of edoxaban use, and to determine the role of clinical pharmacists in improving the efficacy and safety of edoxaban use. METHODS: A retrospective study was performed by using an electronic medical record and anticoagulation clinical data from 600 patients who received edoxaban from 1 March 2016 to 16 July 2017 at a tertiary teaching university hospital. The appropriateness of edoxaban use was assessed using eight criteria based on drug use evaluation criteria developed by the American Society of Health-System Pharmacists drug use evaluation guidelines, details in Korea Food and Drug Administration approval of edoxaban. Clinical outcomes were evaluated between the appropriately prescribed and inappropriately prescribed groups regarding the incidence of thrombosis and bleeding episodes. RESULTS AND DISCUSSION: After excluding 86 patients due to the inability to assess renal function, 514 were eligible. Appropriate use was found in 294 patients (57.2%). The most frequent inappropriate use of edoxaban was dose adjustment (60.8%) in accordance with the dosing recommendation in patients with renal insufficiency (creatinine clearance [CrCl] of 15-50 mL/min) and a low body weight of <60 kg. Moreover, there were three cases of edoxaban use in patients with prosthetic heart valves and moderate-to-severe mitral stenosis, and 15 cases of non-valvular atrial fibrillation in patients with CrCl >95 mL/min in whom edoxaban use is not recommended. Furthermore, we found that the factors related to the appropriateness of edoxaban use were <60 kg body weight (adjusted odds ratio [OR]: 0.310; confidence interval [CI]: 0.197-0.488) and CrCl <50 mL/min (adjusted OR: 0.629; CI: 0.404-0.980). There were 45 events (8.75%) of any bleeding, 9 (1.8%) of stroke/transient ischaemic attack (TIA) and four events (0.8%) of deep vein thrombosis (DVT)/pulmonary embolism (PE). However, there was no difference between the appropriately prescribed group (294 patients) and inappropriately prescribed group (220 patients) in the incidence of bleeding events (27 [9.2%] vs 18 [8.2%]), stroke/TIA (7 [2.4%] vs 2 [0.9%]) and DVT/PE (2 [0.7%] vs 2 [0.9%]), respectively. WHAT IS NEW AND CONCLUSION: Although edoxaban has a broad therapeutic window that does not require routine monitoring, it should be cautiously used in patients with renal insufficiency (CrCl <50 mL/min) and body weight <60 kg.

Dynamic Response of Graphitic Flakes in Nematic Liquid Crystals: Confinement and Host Effect.

Electric field-induced reorientation of suspended graphitic (GP) flakes and its relaxation back to the original state in a nematic liquid crystal (NLC) host are of interest not only in academia, but also in industrial applications, such as polarizer-free and optical film-free displays, and electro-optic light modulators. As the phenomenon has been demonstrated by thorough observation, the detailed study of the physical properties of the host NLC (the magnitude of dielectric anisotropy, elastic constants, and rotational viscosity), the size of the GP flakes, and cell thickness, are urgently required to be explored and investigated. Here, we demonstrate that the response time of GP flakes reorientation associated with an NLC host can be effectively enhanced by controlling the physical properties. In a vertical field-on state, higher dielectric anisotropy and higher elasticity of NLC give rise to quicker reorientation of the GP flakes (switching from planar to vertical alignment) due to the field-induced coupling effect of interfacial Maxwell-Wagner polarization and NLC reorientation. In a field off-state, lower rotational viscosity of NLC and lower cell thickness can help to reduce the decay time of GP flakes reoriented from vertical to planar alignment. This is mainly attributed to strong coupling between GP flakes and NLC originating from the strong π-π interaction between benzene rings in the honeycomb-like graphene structure and in NLC molecules. The high-uniformity of reoriented GP flakes exhibits a possibility of new light modulation with a relatively faster response time in the switching process and, thus, it can show potential application in field-induced memory and modulation devices.

Characterization of white and black deposits on the surface of Korean stone cultural heritages.

White and black deposits have been frequently observed on the surface of Korean stone cultural heritages, and they are considered as damage factors in both conservation and esthetic points of view. In order to set up the appropriate conservation remedy, it is important to know their origins, characteristics, and compositions. In this study, optical and scanning electron microscopes (SEMs) equipped with an energy-dispersive spectrometer (EDS) and X-ray diffractometer were employed to determine the white and black deposits. It was found that both deposits consisted mainly of calcium carbonate (calcite) and calcium sulfate (gypsum). The calcite and gypsum were characterized by bladed, rhombohedral, tabular, and amorphous morphologies under a SEM. The black deposit was not only composed of calcite or gypsum, but also accompanied amorphous and irregular matrix. SEM-EDS analysis revealed an abundance of silicon, aluminum, iron, phosphorus, and carbon on the matrix, which were major elements of soil, atmospheric deposits, and organisms. The white deposit, on the other hand, barely contained those coloring substances. These salts and deposited substances were caused by chemical reaction and physical adhesion between rock-forming minerals, lime mortar, sulfur in polluted air environment, soil dust, and microorganisms.

Excitation dynamics in anisotropic nanostructures of star-shaped CdS.

Unique starlike CdS particles were prepared from the lyotropic triblock copolymer solution system. The starlike CdS consists of a spherical core and dozens of the attached conical nanolobes. From the comparative studies with the spherical and rod-shaped CdS nanoparticles, the unique photophysical property is presented for the starlike CdS particle. The experimental results suggest that the photogenerated charge carriers at the tip-edge region of the conical nanolobe in the starlike CdS system diffuse into the thicker inner part including the core region, which is possibly due to the decreasing excited state potential gradient from the tip edge to the thicker inner part. This type of charge carrier diffusion dynamics from the surrounding to the thicker inner part in this anisotropic morphology of the starlike CdS semiconductor closely resembles the energy transfer dynamics in the organic dendrimers.