Effects of ganaxolone on non-seizure outcomes in CDKL5 Deficiency Disorder: Double-blind placebo-controlled randomized trial

CDKL5 deficiency disorder (CDD) is a rare developmental and epileptic encephalopathy. Ganaxolone, a neuroactive steroid, reduces the frequency of major motor seizures in children with CDD. This analysis explored the effect of ganaxolone on non-seizure outcomes. Children (2-19 years) with genetically confirmed CDD and ≥ 16 major motor seizures per month were enrolled in a double-blind randomized placebo-controlled trial. Ganaxolone or placebo was administered three times daily for 17 weeks. Behaviour was measured with the Anxiety, Depression and Mood Scale (ADAMS), daytime sleepiness with the Child Health Sleep Questionnaire, and quality of life with the Quality of Life Inventory-Disability (QI-Disability) scale. Scores were compared using ANOVA, adjusted for age, sex, number of anti-seizure mediations, baseline 28-day major motor seizure frequency, baseline developmental skills, and behaviour, sleep or quality of life scores. 101 children with CDD (39 clinical sites, 8 countries) were randomized. Median (IQR) age was 6 (3-10) years, 79.2 % were female, and 50 received ganaxolone. After 17 weeks of treatment, Manic/Hyperactive scores (mean difference 1.27, 95%CI -2.38,-0.16) and Compulsive Behaviour scores (mean difference 0.58, 95%CI -1.14,-0.01) were lower (improved) in the ganaxolone group compared with the placebo group. Daytime sleepiness scores were similar between groups. The total change in QOL score for children in the ganaxolone group was 2.6 points (95%CI -1.74,7.02) higher (improved) than in the placebo group but without statistical significance. Along with better seizure control, children who received ganaxolone had improved behavioural scores in select domains compared to placebo.

Treatment guidelines for rare, early-onset conditions associated with epileptic seizures: a literature review on Rett syndrome and tuberous sclerosis complex

BACKGROUND

Rett syndrome (RTT) and tuberous sclerosis complex (TSC) are two rare disorders presenting with a range of different epileptic seizures. Seizure management requires careful therapy selection, thereby necessitating development of high-quality treatment guidelines. This targeted literature review (TLR) aimed to characterise country-specific and international treatment guidelines available for pharmacological management of seizures in RTT and TSC.

METHODS

A TLR was performed between 25-Jan and 11-Mar 2021. Manual searches of online rare disease and guideline databases, and websites of national heath technology assessment bodies were conducted for the following countries: Australia, Canada, France, Germany, Israel, Italy, Japan, Spain, Switzerland, UK, and US as defined by pre-specified eligibility criteria. Search terms were developed for each condition and translated into local languages where appropriate. Eligible publications were defined as guidelines/guidance reporting pharmacological management of seizures in patients with RTT and TSC. Guideline development methodology, geographical focus, author information and treatment recommendations were extracted from guidelines. An author map was generated using R version 3.5.1 to visualise extent of collaboration between authors.

RESULTS

24 total guidelines were included, of which three and six contained only recommendations for RTT and TSC, respectively (some provided recommendations for ≥ 1 condition). Guideline development processes were poorly described (50% [12 guidelines] had unclear/absent literature review methodologies); reported methodologies were variable, including systematic literature reviews (SLRs)/TLRs and varying levels of expert consultation. Most (83% [20/24]) were country-specific, with guideline authors predominantly publishing in contained national groups; four guidelines were classified as 'International,' linking author groups in the US, UK, Italy and France. High levels of heterogeneity were observed in the availability of treatment recommendations across indications, with 13 and 67 recommendations found for RTT and TSC, respectively. For RTT, all treatment recommendations were positive and sodium valproate had the highest number of positive recommendations (Khwaja, Sahin (2011) Curr Opin Pediatr 23(6):633-9). All TSC treatments (21 medications) received either exclusively negative (National Organization for Rare Disorders (2019)) or positive (Chu-Shore et al. (2010) Epilepsia 51(7):1236-41) recommendations; vigabatrin received the highest number of positive recommendations (Kaur, Christodoulou (2019)).

CONCLUSIONS

This review highlights the need for the development of international high-quality and comprehensive consensus-based guidance for the management of seizures with pharmacological therapy in RTT and TSC.

TRIAL REGISTRATION

Not applicable.

Tuberous Sclerosis: A Rare Disease with an Orphan Complex

Introduction In the Republic of Ireland, there are no tuberous sclerosis complex (TSC) specialist clinics. Methods A clinical audit was carried out to assess the care received by patients attending two specialist adult epilepsy specialist centres, measuring their care against the UK guidelines. Results Although many baseline investigations are carried out, only one-third of patients had diagnostic genetic testing results available. Neuropsychiatry is largely neglected, and the completion of neuropsychiatric assessments checklists is inadequate. Discussions concerning SUDEP are not happening and access to treatment is limited. Reporting of radiological findings in TSC is inconsistent and the number of adults with TSC accessing specialist epilepsy services appear to be low. Discussion TSC care in the Republic of Ireland is fragmented, difficult to navigate and wasteful of resources due to the complex nature of the disease and no formal clinical setting to manage it. The service gaps echo the demand for an improved care system including consistent radiological reporting of TSC pathology. The absence of a specialist TSC clinic compounds the complexity of navigating care for individuals with TSC, families and healthcare professionals. Extending this audit nationally will give a more complete picture and highlight the resources required to bring care of these patients in line with recommended guidelines.

mRNA-1273 or mRNA-Omicron boost in vaccinated macaques elicits similar B cell expansion, neutralizing responses, and protection from Omicron

SARS-CoV-2 Omicron is highly transmissible and has substantial resistance to neutralization following immunization with ancestral spike-matched vaccines. It is unclear whether boosting with Omicron-matched vaccines would enhance protection. Here, nonhuman primates that received mRNA-1273 at weeks 0 and 4 were boosted at week 41 with mRNA-1273 or mRNA-Omicron. Neutralizing titers against D614G were 4,760 and 270 reciprocal ID50 at week 6 (peak) and week 41 (preboost), respectively, and 320 and 110 for Omicron. 2 weeks after the boost, titers against D614G and Omicron increased to 5,360 and 2,980 for mRNA-1273 boost and 2,670 and 1,930 for mRNA-Omicron, respectively. Similar increases against BA.2 were observed. Following either boost, 70%-80% of spike-specific B cells were cross-reactive against WA1 and Omicron. Equivalent control of virus replication in lower airways was observed following Omicron challenge 1 month after either boost. These data show that mRNA-1273 and mRNA-Omicron elicit comparable immunity and protection shortly after the boost.

A32 DEVELOPMENT AND VALIDATION OF THE TORONTO UPPER GASTROINTESTINAL CLEANING SCORE

Background

High quality esophagogastroduodenoscopy (EGD) depends on the ability to appropriately visualize upper gastrointestinal (GI) mucosa pathology. Evaluation can be limited by the presence of mucus, foam, bubbles and solid materials. Currently, there is no standardized method to assess mucosal visualization for use in clinical or research settings.

Aims

To develop and establish the content validity of the Toronto Upper Gastrointestinal Cleaning Score (TUGCS) and evaluate its interrater reliability.

Methods

An international panel of endoscopy experts rated potential items and their associated anchors for importance as indicators of adequacy of mucosal visualization during EGD. The survey utilized a Likert scale (1 (strongly disagree) to 5 (strongly agree)). The Delphi process was repeated until consensus was reached. Consensus was defined priori as ≥80% of experts in a given round scoring ≥4 on all survey items. To assess content validity, 48 EGD procedures were evaluated in real-time by two endoscopist reviewers using the TUGCS at a single institution. The interrater agreement between assessments was calculated for TUGCS total scores using intraclass correlation coefficient, one-way random effects model (ICC 1,1).

Results

Fourteen experts agreed to be part of the Delphi panel. An anatomical framework representing the upper GI mucosa and anchors for each mucosal portion representing various levels of visibility was generated through systematic review. Three survey rounds, with response rates of 100%, 100% and 71% respectively, achieved consensus. The final TUGCS includes four anatomical areas (fundus, body, antrum, duodenum) and mucosal visualization anchors ranging from 0 to 3 (Figure 1). TUGCS was used to assess foregut cleaning in 48 procedures (Table 1). The mean TUGCS for staff and trainee were 8.1 (±2.4) and 8.1 (±2.6), respectively. The ICC was 0.78 (95% confidence interval 0.62–0.88) indicating good reliability.

Conclusions

We developed and generated content validity evidence for the TUGCS through rigorous Delphi methodology, reflective of practice across different centres. Planned as future research is a video survey distributed to endoscopists internationally to further validate the TUGCS to create a tool that may be used to judge mucosal visualization for EGD in research and clinical settings.

Funding Agencies

None

Molecular docking, dynamics, and quantum chemical study of vanillylacetone and beta-hydroxy ketone derivatives against Mpro of SARS-CoV-2

This study is carried out to find novel active drug candidates which can effectively bind to key residues of main protease (Mpro) of SARS-CoV-2. We performed molecular docking of fifty-seven (57) ligands from two classes: vanillylacetone and its derivatives and beta-hydroxy ketone derivatives against Mpro of SARS-CoV-2. We also docked three antiviral drugs as reference/benchmark drugs including remdesivir (RDV), chloroquine (CQ), and hydroxychloroquine (HCQ) against Mpro for comparison of inhibition tendencies of selected ligands. Binding energies of our reference drugs are as: CQ = -5.1 kcal mol-1 (with predicted inhibition constant (Ki pred) = 177 μmol), HCQ = -5.7 kcal mol-1 (Ki pred = 64.07 μmol) and RDV -6.3 kcal mol-1 (Ki pred = 13.95 μmol). We got remarkable results for our docked ligands as 79% of total ligands indicated binding energies better than CQ, 39 % better than both HCQ and CQ, and 19 % better than all reference drugs. More interestingly interaction analysis of eight best-docked ligands showed that they interacted with desired key residues of Mpro. We further selected the four best-docked ligands L1 = -6.6 kcal mol-1 (Ki pred =13.95 μmol), L6 = -7.0 kcal mol-1 (Ki pred = 7.08 μmol), L34 = -6.0 kcal mol-1 (Ki pred = 38.54 μmol), and L50 = -6.6 kcal mol-1 (Ki pred =13.95 umol) for further analysis by quantum chemical study, molecular dynamic (MD) simulations and ADMET analysis. We have also carried out MD-simulations of six more docked ligand L2, L14, L20, L36, L46 and L48 some of which were showing weak binding affinities and some average binding affinities to check their simulation behavior. Their RMSD, RMSF and binding free energy results were also quite satisfying. We believe the current investigation will evoke the scientific community and highlights the potential of selected compounds for potential use as antiviral compounds against Mpro of SARS-CoV-2.

Change of Hemoglobin Level among Exclusively Breastfed Term and Preterm Babies up to Six Months of Age

There is progressive increase of Hb levels is observed during course of intrauterine development of fetus but high concentrations found at birth. In preterm neonate normal Hb is characteristically deviated from term neonate. Breast milk is the only natural ideal food for both term and preterm babies from birth up to 6 months. Preterm milk was found to contain significantly higher concentrations nutrients particularly iron than term milk. Preterm human milk is more suitable for the premature infant than term human milk. As Hb concentration varies in term and preterm babies in different counties in different feeding practices. The purpose of this longitudinal descriptive study is to find out the pattern of changes in the Hb level among exclusively breastfed preterm and term infants during the first six months of life. This study was carried in the Neonatal Intensive Care Unit (NICU), Mymensingh Medical College Hospital (MMCH), Mymensingh from September 2016 to February 2018. One hundred fifty (150) neonates both term and preterm were included in this study and followed up to 6 months of age. After admission informed written consent was taken from parents, thorough history taking and clinical examination were done. Data were collected in a pre-designed case record form. All the babies of Group A provided 2mg/kg iron supplementation from 6 weeks for 2 months for universal recommendation. Hb level was measured of all exclusively breast feed babies at admission after birth then next follow-up at 6 weeks, 3 months and 6 months. All information regarding history, anthropometrics measurement, Hb level was recorded in structural questionnaire. Data analysis was done by SPSS version 20.0. Male were predominant in both groups. Most of the preterm (72.0%) and term babies (65.3%) were delivered by vaginal route. Mean Hb level was found significantly higher among preterm babies than term babies after birth were 16.55g/dl and 15.98g/dl respectively. Sharp fall of Hb concentration was observed after birth up to 6 weeks in both preterm and term babies but Hb level was found significantly lower in preterm in comparison to term babies (9.27gm/dl vs. 9.58gm/dl). In term babies, even after 6 weeks fall of Hb level continued to 3 months of age followed by gradual increase up to 6 months without iron supplementation. Hb level of in preterm babies gradually increased from 6 weeks up to 6 months with universal iron supplementation. Hb level fall sharply up to 6 weeks in both exclusively breastfed term and preterm babies but even after 6 weeks term babies experienced gradual fall of Hb levels up to 3 months. Hb level increases in exclusively breast-fed term babies without iron supplementation from 3 months of age. Hb level in exclusively breastfed preterm babies increase from 6 weeks onward might be effect of universal iron supplementation.

Student screening for inherited blood disorders in Bahrain

In Bahrain and neighbouring countries inherited disorders of haemoglobin, i. e. sickle-cell disease, thalassaemias and glucose-6-phosphate dehydrogenase [G6PD] deficiency, are common. As part of the National Student Screening Project to determine the prevalence of genetic blood disorders and raise awareness among young Bahrainis, we screened 11th-grade students from 38 schools [5685 students], organized lectures and distributed information about these disorders. Haemoglobin electrophoresis, high performance liquid chromatography, blood grouping and G6PD deficiency testing were performed. Prevalences were: 1.2% sickle-cell disease; 13.8% sickle-cell trait; 0.09% beta-thalassaemia; 2.9% beta-thalassaemia trait; 23.2% G6PD deficiency; 1.9% G6PD deficiency carrier. Health education, carrier screening and premarital counselling remain the best ways to reduce disease incidence with potentially significant financial savings and social and health benefits

Dental Public Health in Action: Utilising a telephone triage system to run an Urgent Dental Care Hub during the COVID-19 pandemic

This paper aims to explore the outcome of a telephone triage system used by different team members to run an Urgent Dental Care Hub (UDCH) during the first wave of the COVID-19 pandemic. It will also look at the adjustments made to the system because of the challenges faced. Data were collected from the telephone triage proforma and clinical notes of patients that were triaged from 2nd April to 10th June 2020. With 65% of telephone triaged and accepted patients receiving definitive treatment that alleviated the presenting complaint, the value of telephone triage is highlighted in streamlining an urgent dental care service during a viral pandemic. Public health competencies being illustrated: Dental public health intelligence, Developing and monitoring quality dental services.

POS0325 RADIOMIC BIOMARKER OF PULMONARY VASCULAR RELATED STRUCTURES PREDICTS MORTALITY IN SYSTEMIC SCLEROSIS

Background:

Quantitative computed tomography (QCT) extracts features from high-resolution CT scans and quantifies lung parenchymal and vascular abnormalities which may not be discernable by qualitative review. The threshold values of individual parenchymal abnormalities and vascular features measured by QCT methods which associate with mortality in systemic sclerosis (SSc) are currently unknown.

Objectives:

To determine whether QCT measures, specifically pulmonary parenchymal abnormalities and pulmonary vascular related structures (PVRS), can predict mortality in SSc and to determine the optimal quantitative thresholds for those parameters.

Methods:

A total of 133 subjects (76% women) meeting 2013 ACR/EULAR classification criteria for SSc with a baseline CT within 3 years of diagnosis were retrospectively identified for inclusion. CALIPER (Computer-Aided Lung Informatics for Pathology Evaluation and Rating) was used to quantitatively measure volume of ground glass opacities (GGO), reticular densities, and honeycombing (HC). Total interstitial lung disease (ILD) was the summation of these features. PVRS was also quantified using CALIPER. Values for each feature were expressed as a percentage of total lung volume. Cox models evaluated the hazard ratio (HR) for mortality for each parameter adjusting for age at SSc diagnosis, sex, diffuse SSc subtype, and history of smoking. The optimal thresholds for mortality prediction for each parameter were determined using consensus between 4 methods: Contal and O’Quigley Method, Cox Model Hazard Ratio, Cox Model Wald P-value, and False Discovery Rate. The c-statistic was used to assess each models’ ability to predict mortality.

Results:

Mean ±SD for age at SSc diagnosis was 61 ± 13 years and length of follow-up was 4.7 ± 3.0 years. There were 32 deaths (24%). A Cox model including age (HR 1.05, 95% CI: 1.01-1.09), female sex (HR 0.49, 95% CI: 0.22-1.08), diffuse SSc subtype (HR 1.50, 95% CI: 0.69-3.30), and history of smoking (HR 2.09, 95% CI: 0.97-4.53) (Model 1) significantly predicted mortality (C-statistic 0.72, 95% CI: 0.63-0.81). Adjusting for Model 1, reticular densities% (HR 1.19, 95% CI: 1.05-1.35), total ILD% (HR 1.02, 95% CI: 1.00-1.03), and PVRS% (HR 1.19, 95% CI: 1.05-1.35) were associated with mortality on univariable analyses; GGO% (HR 1.01, 95% CI: 0.98-1.04) was not significantly associated with mortality. The optimal thresholds for mortality prediction were then determined and were as follows: GGO=20%, reticular densities=8%, total ILD=20%, and PVRS=5%. While the risk of mortality was significantly increased in subjects with GGO ≥20% (HR 2.70, 95% CI: 1.21-6.05), reticular densities ≥8% (HR 4.64, 95% CI: 1.68-12.81), and total ILD ≥20% (2.59, 95% CI: 1.12-5.99), these baseline thresholds did not improve upon mortality prediction when added individually to Model 1 (C-statistic 0.73 for each). PVRS ≥5%, which had an over six-fold increase in mortality (HR 6.42, 95% CI: 2.60-15.88), did improve mortality prediction when added to Model 1 (C-statistic 0.78, 95% CI: 0.70-0.86).

Conclusion:

PVRS strongly associates with early mortality in patients with SSc and represents a novel radiomic biomarker that provides prognostic information on mortality beyond pulmonary parenchymal abnormalities. CALIPER derived PVRS quantifies CT data through a function that defines connected tubular branching structures. This extracts pulmonary arteries and veins from the adjacent parenchyma but could potentially also include regions of adjoining of fibrosis.1 Larger studies examining the association between PVRS and progression of cardiopulmonary disease are warranted.

References:

[1]Jacob J, Bartholmai BJ, Rajagopalan S, et al. Predicting Outcomes in Idiopathic Pulmonary Fibrosis Using Automated Computed Tomographic Analysis. Am J Respir Crit Care Med 2018;198:767-76.

Acknowledgements:

This project was supported by the Mayo Clinic Margaret Harvey Schering Clinician Career Development Award.

Disclosure of Interests:

Alicia Hinze: None declared, Yasser Radwan: None declared, Mamoun Elnagar: None declared, Reto Kurmann: None declared, Shreyasee Amin: None declared, Robert Vassallo Grant/research support from: Pfizer, Bristol Myers Squibb, Sun Pharma, Cynthia S. Crowson: None declared, Brian Bartholmai Consultant of: AstraZenica, Boehringer Ingelheim, Promedior LLC (all <$5,000 annually)

Degradation and Toxicity Analysis of a Reactive Textile Diazo Dye-Direct Red 81 by Newly Isolated Bacillus sp. DMS2

An efficient diazo dye degrading bacterial strain, Bacillus sp. DMS2 was isolated from a long-term textile dye polluted environment. The strain was assessed for its innate ability to completely degrade and detoxify Direct Red 81 (DR81) textile dye under microaerophilic conditions. The degradation ability of strain showed significant results on optimizing the nutritional and environmental parameters. Based on statistical models, maximum efficiency of decolorization achieved within 24 h for 100 mg/l of dye supplemented with glucose (0.02%), MgSO₄ (0.002%) and urea (0.5%) at 30°C and pH (7.0). Moreover, a significant catabolic induction of a laccase and azoreductase suggested its vital role in degrading DR81 into three distinct metabolites (intermediates) as by-products. Further, toxicity analysis of intermediates were performed using seeds of common edible plants, aquatic plant (phytotoxicity) and the nematode model (animal toxicity), which confirmed the non-toxic nature of intermediates. Thus, the inclusive study of DMS2 showed promising efficiency in bioremediation approach for treating industrial effluents.

Hip load capacity and yield load in men and women of all ages

Quantitative computed tomography (QCT) based finite element (FE) models can compute subject-specific proximal femoral strengths, or fracture loads, that are associated with hip fracture risk. These fracture loads are more strongly associated with measured fracture loads than are DXA and QCT measures and are predictive of hip fracture independently of DXA bone mineral density (BMD). However, interpreting FE-computed fracture loads of younger subjects for the purpose of evaluating hip fracture risk in old age is challenging due to limited reference data. The goal of this study was to address this issue by providing reference data for male and female adult subjects of all ages. QCT-based FE models of the left proximal femur of 216 women and 181 men, age 27 to 90 years, from a cohort of Rochester, MN residents were used to compute proximal femoral load capacities, i.e. the maximum loads that can be supported, in single-limb stance and posterolateral fall loading (Stance_LC and Fall_LC, respectively) [US Patent No. 9,245,069] and yield load under fall loading (Fall_yield). To relate these measures to information about hip fracture, the CT scanner and calibration phantom were cross-calibrated with those from our previous prospective study of hip fracture in older fracture and control subjects, the Age Gene/Environment Susceptibility (AGES) Reykjavik cohort. We then plotted Stance_LC_, Fall_LC and Fall_yield versus age for the two cohorts on the same graphs. Thus, proximal femoral strengths in individuals above 70 years of age can be assessed through direct comparison with the FE data from the AGES cohort which were analyzed using identical methods. To evaluate younger individuals, reductions in Stance_LC, Fall_LC and Fall_yield from the time of evaluation to age 70 years can be cautiously estimated from the average yearly cross-sectional decreases found in this study (108 N, 19.4 N and 14.4 N, respectively, in men and 120 N, 19.4 N and 21.6 N, respectively, in women), and the projected fracture loads can be compared with data from the AGES cohort. Although we did not set specific thresholds for identifying individuals at risk of hip fracture, these data provide some guidance and may be used to help establish diagnostic criteria in future. Additionally, given that these data were nearly entirely from Caucasian subjects, future research involving subjects of other races/ethnicities is necessary.

Design of high-performance curling mascara through utilization of smart thermoresponsive polymer

OBJECTIVE

In this study, methoxy poly(ethylene glycol)-b-poly(D,L-lactide), or mPEG-PLA, was used as the smart thermoresponsive polymer in our mascara formulation. The utility of mPEG-PLA in a mascara formulation was investigated by a stepwise build-up in an oil in water (O/W) emulsion. The experimental results may pave the way to a strategy of developing more cosmetic formulation with thermoresponsive shape memory polymers (SMPs).

METHOD

mPEG-PLA was first incorporated in a simple emulsion for rheological evaluation such as shear flow viscosity and small deformation oscillation measurements over the relevant temperature settings to mascara application. Then, wax and pigment were incorporated to complete the basic formulation as an O/W mascara and evaluated rheologically as before. Finally, the formulation was applied by a heated mascara applicator to false lashes to evaluate its curing and lifting effect.

RESULTS

With 0.8% concentration of mPEG-PLA, the viscosity was able to increase from 0.20 Pas·s to 1.00 Pas·s. At 1.0% concentration of mPEG-PLA, the emulsion samples with mineral oil were evaluated from 55°C to 25°C for its storage modulus (G') and were found to have a consistent shear-thinning characteristic across all temperature range. The sample containing the polymer (M-1) arrived at a markedly higher elasticity when compared against the sample without (M-0). The same result holds true for the set of samples formulated with beeswax instead of mineral oil. When the formulations were applied with a heated mascara applicator on false eyelashes, the formulation containing mPEG-PLA was found to produce a more pronounced and longer-lasting curl.

CONCLUSION

This preliminary rheological study of an O/W mascara containing mPEG-PLA demonstrated that thermoresponsive SMP can be added to enhance the curl and lifting effect of a mascara formulation.

Designing high-performance colour cosmetics through optimization of powder flow characteristics

OBJECTIVE

Explore the impact of powder flow properties such as flow energy and compressibility on the performance characteristics of foundation powders such as cake strength and pay-off.

METHODS

FT4 Powder Rheometer from Freeman Technology was utilized to explore various powder compositions. The three major tests performed were flowability test, compressibility test and shear cell test.

RESULTS

The results highlight that the sample which has higher compressibility has the better cake strength, and the sample which requires lower total energy has better pay-off. Particles or samples with lower total flow energy, should have easier flow, therefore, should have better pay-off. Samples and components with higher compressibility, should hold the structure better, therefore, should have better cake strength. Talc has the highest compressibility and lowest flow energy. Foundation sample 5 has the highest concentration of talc and also has the best performance.

CONCLUSION

The lower the total flow energy, the easier it is for the powder to flow, and have better pay-off. Powder compressibility correlates with cake strength which means that a sample with better compressibility consequently has the better cake strength. Samples 5 and 10 require less total flow energy, have lower shear stress, and higher compressibility, therefore, have better final performance. Both samples 5 and 10 have higher talc concentrations compared to other formulations.

35 Enhanced Service Through An Integrated New Model of Care in A Buckinghamshire Care Home

Introduction

Care home residents often have multiple, chronic conditions and are receiving complex treatment regimes. Polypharmacy and medication errors are common. The frequency and quality of medication reviews is variable with limited general practice (GP) capacity to carry out comprehensive reviews.

The initiative used a care home pharmacist, technician, geriatrician and GPs to tackle these issues on an individual and care home level. The objective being to ensure the safe and effective use of medicines for all care home residents. NICE guideline [NG56] recommends reducing pharmacological treatment burden for adults with multimorbidity at risk of adverse drug events such as unplanned hospital admissions. A study by Dilles et al1 found adverse drug reactions in 60% of residents.

Methods

A new interdisciplinary model of care was delivered in a 120 bedded Buckinghamshire care home. Clinical Commissioning Group pharmacist, general practitioners and pharmacy technician reviewed medication for all residents. The most complex individuals were reviewed by the geriatrician and if needed by other multidisciplinary team members specialist.

Results

Overall 115 medications were stopped for 109 residents, with 31 interventions to reduce falls risk and 19 interventions on medication at high risk2 of causing admission. Total cost savings on medicines optimisation, medicines waste and non-elective admission prevented was £35,211. Residents’ care plans were updated to reflect best practice standards.

Conclusions

Future direction of this project focuses on system wide improvements to promote interdisciplinary healthcare professionals work in care homes. The success of this integrated model of care has enabled recurrent funding of pharmacist by the local county council and an additional 42 geriatrician sessions into Buckinghamshire care homes.

References

1. Dilles T, Vander Stichele R, Van Bortel L, Elseviers M. Journal of American Medical Directors Association 2013; 14: 371–6.

2. Pirmohamed M, et al. Br Med J 2004; 329: 15–9 61.