Therapiemöglichkeiten bei Schwangerschaftstübelkeit

Bis zu 85 Prozent der schwangeren Frauen leiden an Übelkeit in der Frühschwangerschaft, und weitere 25 Prozent zusätzlich an Erbrechen. Isabelle Arnet und Kurt Hersberger, beide im Departement für Pharmazeutik der Universität Basel tätig, und Ursula von Mandach, Präsidentin der Schweizerischen Arbeitsgemeinschaft für Perinatale Pharmakologie (SAPP), präsentieren aktuelle medikamentöse Therapieoptionen und die Mittel der ersten Wahl in der Selbstmedikation

Neue Möglichkeit der hormonellen Notfallkontrazeption

Die europäische Arzneimittelbehörde EMA hat im Mai 2009 für ellaOne® (Inhaltsstoff  Ulipristalacetat, UPA) die Zulassung als Notfallkontrazeptivum erteilt. Die neue Hormonpille kann bis 5 Tage (120 Stunden) nach ungeschütztem Geschlechtsverkehr eingenommen werden. Der OTC-Verkauf durch den Apotheker ist noch nicht vorgesehen, die Pille untersteht im europäischen Raum der Rezeptpflicht. Ob und wann das Medikament in der Schweiz auch auf den Markt kommen wird, ist noch unbekannt

Fundamental progress in investigating drug resistance with electronic multidrug compliance monitoring (e-MCM)

Current definitions of drug resistance are shaped by the pharmacotherapeutic fields they occurred in. They usually mention various contributing factors and refer either to the clinical or the biomarker level. Particular attention has been attracted by antiplatelet resistance, a phenomenon with clinical, cellular and pharmacogenetical contributors. However, the impact of every single factor to antiplatelet resistance in outpatients under prescribed antiplatelet therapy has not been comprehensively evaluated so far, neither has the temporal pattern of drug intake been studied as a possible contributor

Ground and excited states Gamow-Teller strength distributions of iron isotopes and associated capture rates for core-collapse simulations

This paper reports on the microscopic calculation of ground and excited states Gamow-Teller (GT) strength distributions, both in the electron capture and electron decay direction, for $^{54,55,56}$Fe. The associated electron and positron capture rates for these isotopes of iron are also calculated in stellar matter. These calculations were recently introduced and this paper is a follow-up which discusses in detail the GT strength distributions and stellar capture rates of key iron isotopes. The calculations are performed within the framework of the proton-neutron quasiparticle random phase approximation (pn-QRPA) theory. The pn-QRPA theory allows a microscopic \textit{state-by-state} calculation of GT strength functions and stellar capture rates which greatly increases the reliability of the results. For the first time experimental deformation of nuclei are taken into account. In the core of massive stars isotopes of iron, $^{54,55,56}$Fe, are considered to be key players in decreasing the electron-to-baryon ratio ($Y_{e}$) mainly via electron capture on these nuclide. The structure of the presupernova star is altered both by the changes in $Y_{e}$ and the entropy of the core material. Results are encouraging and are compared against measurements (where possible) and other calculations. The calculated electron capture rates are in overall good agreement with the shell model results. During the presupernova evolution of massive stars, from oxygen shell burning stages till around end of convective core silicon burning, the calculated electron capture rates on $^{54}$Fe are around three times bigger than the corresponding shell model rates. The calculated positron capture rates, however, are suppressed by two to five orders of magnitude.Comment: 18 pages, 12 figures, 10 table

Inconclusiveness of psychometric testing of medication adherence questionnaires.

PURPOSE: To propose a paradigm change for the validation procedures of medication adherence questionnaires. METHODS: A total of 121 validation procedures of unique questionnaires for medication adherence were analyzed. RESULTS: "Construct validity" and "internal consistency" were most often assessed, and test results varied largely. A more in-depth analysis indicated that the assessment of medication non-adherence included distinct but related constructs, such as the extent to which doses are missed, and the attempt to identify different facets of medication-taking behavior. Consequently, each construct requires a different measurement approach with different psychometric tests for establishing its validity and reliability. CONCLUSION: Results show that assessing the validity and reliability of adherence questionnaires with standard procedures including statistical tests is inconclusive. Refinement of the constructs of non-adherence is needed in pharmacy and medical practice. We suggest a distinction between the (i) extent of missed doses over the past 2 weeks, (ii) modifiable reasons for non-adherence behavior, and (iii) unmodifiable factors of non-adherence. Validation procedures and corresponding statistical methods should be selected according to the specific single constructs

Chylothorax in the neonate-A stepwise approach algorithm

Background: Chylothorax in neonates results from leakage of lymph from thoracic lymphatic ducts and is mainly congenital or posttraumatic. The clinical course of the effusion is heterogeneous, and consensus on treatment, timing, and modalities of measures has not yet been established. This review aims to present, along with levels of evidence and recommendation grades, all current therapeutic possibilities for the treatment of chylothorax in neonates. Methods: An extensive search of publications between 1970 and 2020 was performed in the PubMed, Cochrane Database of Systematic Reviews, and UpToDate databases. A stepwise approach algorithm was proposed for both congenital and traumatic conditions to guide the clinician in a rational and systematic way for approaching the treatment of neonates with chylothorax. Discussion and conclusion: The treatment strategy for neonatal chylothorax generally involves supportive care and includes drainage and procedures to reduce chyle flow. A stepwise approach starting with the least invasive method is advocated. Progression in the invasiveness of treatment options is determined by the response to previous treatments. A practical stepwise approach algorithm is proposed for both, congenital and traumatic chylothoraces

Development and validation of the 15-STARS - A novel self-report pharmacy-based questionnaire to screen for medication non-adherence.

BACKGROUND: Published scales measuring medication adherence are myriad. There is a need for a tool that guides towards downstream adherence interventions. OBJECTIVE: To develop and validate a self-report questionnaire able to detect modifiable determinants of medication non-adherence. METHODS: Workshops, surveys and meetings were used to identify items. Validation was performed in French and German (Switzerland) between March and April 2022. Face validation, content validation, construct validation, internal consistency and test-retest reliability were assessed. The questionnaire was finalized in August 2022. RESULTS: The first draft in English included 13 items divided into four areas. Following translation, validation was performed with 144 patients (63 German-, 81 French-speaking) who were recruited in 35 community pharmacies. Acceptability was good (<5% missing data). Psychometric properties were acceptable with good content validity and moderate construct validity. Internal consistency was acceptable for the French version (Cronbach's alpha = 0.71 [item 1-5] - 0.61 [item 6-9]) and less acceptable for the German version (Cronbach's alpha = 0.43 [item 1-5] - 0.45 [item 6-9]). Test-retest was given for all items (r = 0.52 to 1.0) except item 10 in French (r = 0.25). The final instrument is a 15-item questionnaire called the 15-STARS (Screening Tool for AdheRence to medicineS) that assesses practical difficulties with medicine use, reasons for non-adherence, doses missed, and need for further help. CONCLUSIONS: Our findings support the validity and clinical utility of the 15-STARS questionnaire. Reliability was inconclusive due to incoherent internal consistency, but explainable by the single-item nature of the scale. This new tool will enable the detection of patients who experience difficulties that negatively influence medication adherence. Pharmacists will be able to propose specific and tailored adherence interventions to the patients. Next steps will focus on evaluating its usefulness for developing targeted interventions that optimize medication adherence in routine care and research settings

How to screen for non-adherence to antihypertensive therapy

The quality of assessment of non-adherence to treatment in hypertensive is poor. Within this review, we discuss the different methods used to assess adherence to blood-pressure-lowering medications in hypertension patients. Subjective reports such as physicians’ perceptions are inaccurate, and questionnaires completed by patients tend to overreport adherence and show a low diagnostic specificity. Indirect objective methods such as pharmacy database records can be useful, but they are limited by the robustness of the recorded data. Electronic medication monitoring devices are accurate but usually track adherence to only a single medication and can be expensive. Overall, the fundamental issue with indirect objective measures is that they do not fully confirm ingestion of antihypertensive medications. Detection of antihypertensive medications in body fluids using liquid chromatography–tandem mass spectrometry is currently, in our view, the most robust and clinically useful method to assess non-adherence to blood-pressure-lowering treatment. It is particularly helpful in patients presenting with resistant, refractory or uncontrolled hypertension despite the optimal therapy. We recommend using this diagnostic strategy to detect non-adherence alongside a no-blame approach tailoring support to address the perceptions (e.g. beliefs about the illness and treatment) and practicalities (e.g. capability and resources) influencing motivation and ability to adhere

Handcycling: training effects of a specific dose of upper body endurance training in females

Purpose: This study aims to evaluate a handcycling training protocol based on ACSM guidelines in a well-controlled laboratory setting. Training responses of a specific dose of handcycling training were quantified in a homogeneous female subject population to obtain a more in depth understanding of physiological mechanisms underlying adaptations in upper body training. Methods: 22 female able-bodied participants were randomly divided in a training (T) and control group (C). T received 7-weeks of handcycling training, 3 × 30 min/week at 65 % heart rate reserve (HRR). An incremental handcycling test was used to determine local, exercise-specific adaptations. An incremental cycling test was performed to determine non-exercise-specific central/cardiovascular adaptations. Peak oxygen uptake (peakVO2), heart rate (peakHR) and power output (peakPO) were compared between T and C before and after training. Results: T completed the training sessions at 65 ± 3 % HRR, at increasing power output (59.4 ± 8.2 to 69.5 ± 8.9 W) over the training program. T improved on handcycling peakVO2 (+18.1 %), peakPO (+31.9 %), and peakHR (+4.0 %). No improvements were found in cycling parameters. Conclusion: Handcycling training led to local, exercise-specific improvements in upper body parameters. Results could provide input for the design of effective evidence-based training programs specifically aimed at upper body endurance exercise in females