Study reports few errors when applied to patients with chronic kidney disease

 

It can be difficult for patients with complex chronic diseases to take medications appropriately, but a study appearing in an upcoming issue of the Clinical Journal of the American Society of Nephrology (CJASN) finds that tailored mobile health technologies can help ensure the safety of their care. To determine whether user-friendly mobile technologies might help keep patients with chronic kidney disease (CKD) on track with their medications, Clarissa Jonas Diamantidis, MD, MHS, of the Duke University School of Medicine, and her colleagues at the University of Maryland School of Medicine evaluated the home-based usability of a mobile health medication inquiry system (MIS) that they designed as a patient-centered medication safeguard. The MIS application responds to study medications with 3 potential responses: "not safe in chronic kidney disease," "use with caution, speak with your healthcare provider," and "safe in chronic kidney disease." The investigators randomized 20 patients with CKD to a text-based MIS platform or a personal digital assistant (PDA)-based MIS platform. Participants were then mailed 3 randomly selected sample prescription pill bottles and asked to input the medication into the MIS and record the system responses to determine their appropriateness in CKD. "General usability of the MIS application was high, regardless of platform type, with only a 5% error rate," said Dr. Diamantidis. Two errors occurred in the text-based group and 1 in the PDA-based group. "The majority of participants found the application easy to use and helpful in avoiding the use of harmful medications, and they would recommend the application to others." Despite general proficiency with the mobile health MIS application, the study uncovered variable electronic health literacy among patients. When participants were administered the eHealth Literacy Scale, which evaluates individuals' perceived abilities to effectively apply electronic health information to health problems, the majority of participants felt the Internet was a useful source of health information, but only about half felt they knew where to find helpful health resources on the Internet. Even fewer reported being able to tell high quality from low quality Internet-based health information. In an accompanying editorial, Bryan Becker, MD, of the University of Chicago, noted that harnessing mobile technology to better treat CKD is logical. "What Diamantidis and colleagues have done is extend that treatment platform beyond traditional care settings into the home," he wrote. "They have used a tool to create a small but very important first step in achieving patient engagement and patient satisfaction in self-care." Story Source: The above post is reprinted from materials provided by American Society of Nephrology. Note: Materials may be edited for content and length. Journal References: Clarissa J. Diamantidis, Jennifer S. Ginsberg, Marni Yoffe, Lisa Lucas, Divya Prakash, Saurabh Aggarwal, Wanda Fink, Stefan Becker, and Jeffrey C. Fink. Remote Usability Testing and Satisfaction with a Mobile Health Medication Inquiry System in CKD. Clinical Journal of the American Society of Nephrology, July 2015 DOI: 10.2215/CJN.12591214 Bryan N. Becker. Medication Safety Mobile Health = Patient Engagement in Chronic Kidney Disease. Clinical Journal of the American Society of Nephrology, July 2015 DOI: 10.2215/CJN.06970615

Falls causing injury were more than twice as likely in older men taking a particular group of commonly used medicines

 

Using data from The Irish Longitudinal Study on Ageing (TILDA), scientists from Trinity College Dublin, St James's Hospital, Dublin, Ireland and three UK Universities have discovered a significant link between serious falls causing injury in older men and a particular group of commonly used medicines. The findings are published today by the Journal of the American Geriatrics Society. Many medicines which are commonly prescribed for older people for bladder problems, depression, psychosis, insomnia, and respiratory problems, have anti-cholinergic effects. The medications affect the brain by blocking a key chemical called acetylcholine which is involved in passing messages between nerve cells. This can lead to side effects including blurred vision, increased heart rate, sedation and confusion. Previous studies have shown an impact on cognitive function and mortality from taking multiple anti-cholinergic medicines. In this important new study, the researchers led by Dr Kathryn Richardson who carried out the research at the Department of Gerontology in Trinity and at the Faculty of Medicine and Health Sciences at the University of East Anglia, examined whether the use of such medicines increased the risk of subsequent serious falls (which caused injury) in people aged over 65 years in Ireland. Using the TILDA data which recorded the medications the participants were taking and the number and type of falls they had experienced, the team found that falls resulting in injury were more than twice as likely in men taking medicines with potent anti-cholinergic activity. The effect remained even after accounting for differences in health and other risk factors for falls. A greater use of such medicines increased the risk for these men further. There was no such association for women, however. Speaking about the significance of these findings for prescribing practices in older people, lead author Dr Kathryn Richardson, a former PhD student at Trinity, who is now a Research Fellow at the University of East Anglia said: "Our findings indicate the importance for doctors, pharmacists and healthcare professionals to regularly review the appropriateness of medications taken by their older patients. It is however, important that people don't stop taking any medications before speaking with their GP. It is not fully clear why the same link was not found in women and further research is needed to explore this and the reasons behind the findings in men." Dr Richardson continued: "Experiencing a fall can have a devastating impact on older people's lives and is a major contributor to care home admission and hospitalisation, so it is vitally important for us to find ways to reduce the risk of falls or their severity." Senior author and Principal Investigator of TILDA Professor Rose Anne Kenny said: "Falls are one of the leading causes of loss of independence as people get older and the principal reason given for admission into nursing home care in Europe. If early risk factors are identified and modified, falls can be prevented. This paper highlights important new risk factors for falls." Dr Chris Fox, Clinical Reader/Honorary Consultant Psychogeriatrician at the University of East Anglia said: "With the rising levels of frailty in older people we must develop strategies to maintain health and avoid prescribing medicines which could cause a deterioration- such an approach could be simply implemented using tools available" Dr Ian Maidment, Senior Lecturer in Clinical Pharmacy at Aston University said: "After a fall, an older person may never regain the same quality of life. This research helps us to understand how medication is linked to falls. It is vital that doctors, nurses and pharmacists review medication if someone has suffered a recent fall." Story Source: The above post is reprinted from materials provided by Trinity College Dublin. Note: Materials may be edited for content and length. Journal Reference: Kathryn Richardson, Kathleen Bennett, Ian D. Maidment, Chris Fox, David Smithard, Rose Anne Kenny. Use of Medications with Anticholinergic Activity and Self-Reported Injurious Falls in Older Community-Dwelling Adults. Journal of the American Geriatrics Society, 2015; DOI: 10.1111/jgs.13543

Slowness as organization principle in the brain

 

Prof Laurenz Wiskott investigates slowness as organisation principle for the brain. Credit: © RUBIN, photo: Gorczany The brain is so complex that its structure cannot be completely determined by genetics. Neuroscientists at the Ruhr-Universität Bochum (RUB) attempt to figure out which mechanisms nerve cells use to organize themselves. They have suggested that slowness may be the decisive factor. The Ruhr-Universität's science magazine RUBIN reports: http://rubin.rub.de/en/slowness-rather-genetics Cells extract features that vary slowly Prof Dr Laurenz Wiskott from the RUB Neural Computation Institute has been continuously developing the slowness principle since 1998. It states that the brain extracts features from the input signals that change only slowly in the course of time. Based on those slowly varying features, the organization structures of the nerve cells form. Laurenz Wiskott has created an algorithm, with which he can test the slowness principle in computer simulations. It is called Slow Feature Analysis. Slowness principle can, for example, explain the formation of place cells The input fed into the algorithm consists of video sequences. It searches for functions that extract features from the images which change as slowly as possible. After the simulation is completed, the analysis renders a set of different functions. Each corresponds with one cell with specific features. Thus, the Slow Feature Analysis generates nerve cells that have been described in numerous experiments. The researchers can thus, for example, explain the formation of place cells, i.e. nerve cells that fire only if an individual is in a certain location within a setting. They were found in experiments in the hippocampus of rats, a brain structure that, among other things, is responsible for spatial navigation. With the Slow Feature Analysis, RUB PhD student Fabian Schönfeld has recently reproduced the results of six additional physiological experiments. Facial recognition through Slow Feature Analysis Wiskott's team is researching into other areas as well, where the slowness principle could prove useful. The researchers have trained their algorithm to estimate, for example, the age of individuals based on a photo, with a precision of plus/minus 3.7 years. Story Source: The above post is reprinted from materials provided by Ruhr-Universitaet-Bochum. Note: Materials may be edited for content and length.