Medication adherence, self-efficacy and health literacy among patients with glaucoma: a mixed-methods study protocol.

INTRODUCTION: As the world population ages, glaucoma is becoming an increasingly significant cause of blindness. A key component in the management of glaucoma is the use of prescribed medications and the adherence to treatment. However, there is evidence of low adherence to prescribed medication in chronic diseases, such as glaucoma. This study aims to explore the level of medication adherence, self-efficacy, social support and health literacy among the patients with glaucoma and to determine if there are any correlations between them. The ultimate aim is to use the information to develop an educational programme for patients with glaucoma at a later stage. METHODS AND ANALYSIS: This is a mixed-methods study which includes two stages: a descriptive study (stage 1) and focus group discussions (stage 2). SAMPLE: Patients with glaucoma or ocular hypertension, using at least one kind of drops, from two ophthalmology clinics. Selected measures include: The Glaucoma Treatment Compliance Assessment Tool, The European Health Literacy Survey Questionnaire, The Glaucoma Medication Self-Efficacy Questionnaire and The Multidimensional Scale of Perceived Social Support. Two focus groups will be used for the collection of qualitative data, aiming to enrich the study with the patients' experiences. The data will be analysed with SPSS, using descriptive and inferential statistics for stage 1 whereas content analysis will be used for the data from the focus group discussions (stage 2). ETHICS AND DISSEMINATION: Permission to conduct the study was received from the National Bioethics Committee and the board of management of the two ophthalmology clinics. All participants will be informed fully on the purpose and methods of the study. Consent forms will be signed and at any time participants will have the right to withdraw. Confidentiality and the protection of data will be respected at all times.

Pharmacist-led program to improve transitions from acute care to skilled nursing facility care.

PURPOSE: A pharmacist-led process to improve medication management in transitions from acute care to skilled nursing facility (SNF) care is described. SUMMARY: The process of transitioning patients from an acute care facility to a SNF involves multiple steps, with the potential for delays in medication administration. As part of a health system's effort to evaluate barriers to timely first-dose administration after hospital-to-SNF transfers, a multidisciplinary team was tasked with defining the frequency of missed doses of high-risk medications and identifying reasons for medication administration delays. A retrospective review was conducted to evaluate medication orders for patients discharged from a community hospital and admitted to a SNF from January through June 2017 (the baseline period). This review found that 60% of first doses of high-risk medications were given after the scheduled administration time. One major barrier identified was a delay in entering medication orders in the SNF electronic medical record after SNF admission. It was also observed that 30-day readmission rates for transferred patients exceeded established readmission rate targets. To address identified process barriers, a pharmacist-led pilot program was developed. The program focused on process improvements at the same 2 hospitals and SNF sites during the period of March through May 2018. The pharmacist reviewed, reconciled, and entered medication orders prior to patient arrivals to the SNF. After pharmacist implementation, order entry delays were eliminated, and the mean delay from medication due time to administration was decreased by 68% relative to baseline data. The discharge summaries of 51% of transferred patients were found to contain medication errors, most of which were clarified and resolved prior to SNF admission. It was observed that the 30-day all-cause readmission rate after SNF transfers during the pilot program was 10.4% lower than during the same timeframe of the previous year. CONCLUSION: By implementing a pharmacist-led process for medication management in transitions from acute care to SNF care, major barriers such as delayed medication administration and medication order entry were reduced. In addition, discharge medication errors were addressed and resolved prior to patients' admission to the SNF.

A strontium isotope baseline of Cyprus. Assessing the use of soil leachates, plants, groundwater and surface water as proxies for the local range of bioavailable strontium isotope composition.

In this study, a strontium isotope baseline for Cyprus is presented. The aim of the study was two-fold; first to provide an environmental multi-proxy-based baseline (water/plants/soil leachates) suitable for archaeological provenance and mobility studies, food source authentication, and forensic investigations; and second, to contribute to the debate around which proxy (or combination of proxies) might be most suitable to define bioavailable fractions of strontium in geologically complex areas also exposed to sea-spray and other Sr-bearing aerosols. Lowest bioavailable strontium isotope signatures range is found within terranes dominated by ophiolites, where 87Sr/86Sr ratios range from 0.7055 to 0.7081, however, results reveal a high degree of variability in bioavailable 87Sr/86Sr ratios, both spatially, along depth profiles and amongst the different proxies. A narrower range of bioavailable Sr isotope signatures is observed within the Circum Troodos Sedimentary Successions (C.T.S.S.), both in spatial distribution and between different proxies. Observed range is 87Sr/86Sr = 0.7079 to 0.7089 in areas dominated by pre-Quaternary C.T.S.S., and 87Sr/86Sr ratios = 0.7076 to 0.7086 in areas covered by Quaternary C.T.S.S., revealing the lithologies to be very homogenous with respect to bioavailable strontium ratios. Intra-site variations in three archaeological sites (multiple samples from each site from within a 500 m radius) within the pre-Quaternary and Quaternary C.T.S.S. are smaller than inter-site variations, suggesting that tracing studies inferred from baselines sampled within a limited spatial area could lead to erroneous conclusions regarding provenance. The study points to the necessity for conducting multi-proxy, spatially extensive sampling to adequately characterize complex geological areas, if these should serve as reliable reference areas in provenance studies.

Identification and validation of novel androgen-regulated genes in prostate cancer.

Androgen-regulated genes (ARGs) are essential for the development of the prostate. Ironically, ARGs are also responsible for the pathogenesis of prostate cancer. We used oligonucleotide array technology to study the expression profiles of ARGs in LNCaP prostate cancer cells and identified 692 dihydrotestosterone-regulated genes. Representative clusters containing genes with similar expression patterns to prostate-specific antigen and other known ARGs are discussed. Based on functional information, we categorized several candidate targets for prostate cancer therapy and diagnosis. Although many of these candidate targets are known to play an important role in cancer development, several are novel genes to the field of prostate cancer. A cross-comparison study of our results with those that have been previously published from three other array experiments using a similar LNCaP model validated 13 of these candidate targets as androgen-regulated. FKBP51 (FK506-binding immunophilin 51) was found in the same cluster as prostate-specific antigen and its protein expression was increased in LNCaP cells treated with either dihydrotestosterone or synthetic androgen R1881. Results from mining the Gene Logic BioExpress database showed that FKBP51 expression is significantly higher in the prostate cancer group than in the normal and normal adjacent group. Additionally, the androgen-independent prostate tumor xenograft, CWR22R, had higher FKBP51 protein levels than that of the androgen-dependent prostate tumor xenograft, CWR22. A tissue microarray study further revealed that FKBP51 protein expression was higher in prostate cancer specimens than in benign prostate tumor samples. These results suggest the potential value of FKBP51 as a novel diagnostic marker or target for prostate cancer therapy.

Development and comparison of two nonradioactive kinase assays for I kappa B kinase.

In response to diverse stimuli, the transcription factor NF-kappaB is activated by the IKK kinase complex containing two kinases (IKKalpha and IKKbeta) that phosphorylate IkappaB, an inhibitory protein of NF-kappaB. The phosphorylation of IkappaB results in ubiquitination and degradation of IkappaB, allowing NF-kappaB to translocate to the nucleus where it regulates its target genes. To elucidate the role of IKK in the NF-kappaB signaling pathway, we have developed and characterized two quantitative, sensitive, and nonradioactive assays for evaluating IKKbeta activity: a dissociation-enhanced lanthanide fluorescence immunoassay called DELFIA and a homogeneous time-resolved fluorescence resonance energy transfer assay called LANCE. We show that the two assays have similar sensitivity and Michaelis constants (Km) for adenosine 5'-triphosphate and substrate; however, the LANCE format was far more efficient and easier to perform. Additionally, the assays were validated with the known kinase inhibitor K252a and several other kinase inhibitors, which showed that the IC(50) values of the two assays were comparable. In summary, both assays are quantitative, sensitive, reproducible, and amenable to high-throughput screening with improved waste management over radioactive assays.