Engineering care transitions: Clinician perceptions of barriers to safe medication management during transitions of patient care

Medication safety during care transitions is a significant challenge, especially for older adults prescribed multiple medications. Using a systems approach to understand barriers to and strategies for safe medication management throughout high-risk periods of hospital-to-home transition is one important step in designing effective interventions. Framing the care transition as a collaboration between healthcare and patient "work systems," we conducted semi-structured interviews with 37 clinical team members, representing 10 different professional roles involved in providing transitional care for patients. Thematic analyses identified key strategies used by clinical team members in preparing patients to self-manage medications safely in the home environment: (1) streamlining and coordinating clinical management of medication reconciliation across care settings; (2) building patient capacity and engagement in self-management of medications; and (3) redesigning the transitional process. Our research highlights the value in aligning professionals' care transition goals with patients and caregiver(s) to better prepare them to self-manage medications upon discharge.

Idiopathic thrombocytopenic purpura (ITP) in Ethiopian children: clinical findings and response to therapy

This retrospective study provides information on the clinical findings and response to therapy in Ethiopian children with idiopathic thrombocytopenic purpura. Forty-nine cases of idiopathic thrombocytopenic purpura admitted to the teaching hospital, Ethio-Swedish Children's Hospital (ESCH) in Addis Abeba, Ethiopia between January 1982 and December 1993 were studied. Among these were 31 females and 18 males with a female to male ratio of 1.9:1. The age range was three to 12 years with a mean of seven years. The commonest presenting clinical features were petechiae, epistaxis, gingival and gastro-intestinal bleeding. Twenty-nine patients were treated with prednisolone, out of whom, 27 attained absolute remission. Twenty patients were observed and managed conservatively and attained spontaneous remission. One child went on to develop chronic idiopathic thrombocytopenic purpura and underwent splenectomy after immunosuppressive treatment failure, while another child is still being followed up with recurrent episodes of thrombocytopenia and epistaxis. No mortality was noted in the review of these series of patients.

Indeno[1,2-c]pyrazolone acetic acids as semirigid analogues of the nonsteroidal anti-inflammatory drugs

A series of 3-substituted indeno[1,2-c]pyrazol-4(1H)-one-2-acetic acids (3a-e) and 3-substituted indeno[1,2-c]pyrazol-4(1H)-one-1-acetic acids (4a-e) were synthesized as semirigid analogues of tolmetin (1). These compounds were evaluated for their anti-inflammatory action by investigating their ability to block arachidonic acid metabolism in vitro as well as the ability to block carrageenan-induced rat foot edema in vivo. No consistent pattern of biological activity was noted.