Vivian Auyeung

A comparison of lexical-gustatory and grapheme-colour synaesthesia

This study compares two different profiles of synaesthesia. One group (N = 7) experiences synaesthetic colour and the other (N = 7) experiences taste. Both groups are significantly more consistent over time than control subjects asked to generate analogous associations. For the colour synaesthetes, almost every word elicits a colour photism and there are systematic relationships between the colours generated by words and those generated by graphemes within the word (hence “grapheme-colour” synaesthesia). For the taste synaesthetes, by contrast, some words elicit no synaesthesia at all, and in those words that do, there is no relationship between the taste attributed to the word and the taste attributed to component graphemes. Word frequency and lexicality (word vs. nonword) appear to be critical in determining the presence of synaesthesia in this group (hence “lexical-gustatory” synaesthesia). Moreover, there are strong phonological links (e.g., cinema tastes of “cinnamon rolls”) suggesting that the synaesthetic associations have been influenced by vocabulary knowledge from the semantic category of food. It is argued that different cognitive mechanisms are responsible for the synaesthesia in each group, which may reflect, at least in part, the different geographical locations of the affected perceptual centres in the brain.

Prolonged benefit in post-polio syndrome from comprehensive rehabilitation: A pilot study

Purpose. To report physical, psychological and functional outcomes from a pilot study of a multi-disciplinary rehabilitation programme for post-polio syndrome (PPS). Method. Twenty-seven participants completed the nine-day programme and were available for re-assessment at three and six months. Physical outcome measures were muscle strength and endurance; psychological outcomes included illness perceptions (IPQ), depression and anxiety (HADS); functional outcomes were fatigue (HFS) and client-centred occupational performance and satisfaction (COPM). Results. There was no significant change at six months for muscle strength or anxiety. Significant improvements were recorded for exercise endurance, depression and levels of fatigue. A shift towards an endorsement that the patients own behaviour could be important in symptom severity of PPS was seen. Five out of 24 participants demonstrated significant clinical changes in occupational performance and satisfaction on the COPM. Conclusions. Prolonged benefits were found for physical, psychological and functional outcomes. A qualitative study is planned to investigate the patient-reported benefits of attending the programme such as the support gained interacting with others with similar disability and in lifestyle adjustment such as pacing of physical activities.

Information about medicines to cardiac in-patients: Patient satisfaction alongside the role perceptions and practices of doctors, nurses and pharmacists

OBJECTIVE To explore the satisfaction of cardiac in-patients regarding the information they received about their medicines, and the role perceptions and practices of practitioners whose responsibility it was to provide such information. METHOD A questionnaire was constructed by selecting medicine information topics from a validated instrument, the Satisfaction with Information about Medicines Scale. Patients and practitioners were recruited from cardiac wards at a London teaching hospital providing tertiary care. RESULTS Questionnaires were returned by 140 patients and 52 doctors, 53 nurses and 4 pharmacists. Patients were satisfied with information about the action and usage of medicines but were significantly less satisfied with information about potential problems with their medicines. In parallel, practitioners provided more information about the action and usage of medicines than its potential problems. CONCLUSIONS Information gaps existed largely around potential problems with medicines which reflected the general lack of focus on these issues by the healthcare professionals studied. There was no consensus between doctors, nurses and pharmacists on perceptions of role responsibility of information provision. PRACTICE IMPLICATIONS Patients may become non-adherent to their medicines if insufficient information is provided. Role responsibilities should be co-ordinated when information about medicines is provided by a range of practitioners.

Adherence to long-term anticoagulation treatment, what is known and what the future might hold.

Adherence to medication, commonly reported as being 50% in chronic diseases, is of great concern in healthcare. Medication non‐adherence is particularly apparent in chronic diseases, where treatment is often preventative and may provide little or no symptomatic relief or feedback for the patient. A lot of research has been undertaken to describe the extent of non‐adherence to long‐term anticoagulation therapy, particularly with vitamin K antagonists and more recently with direct oral anticoagulants. However, the literature is scarce with respect to describing adherence to anticoagulation in terms of the behavioural aspects that influence medicine use. Utilizing the COM‐B (capability, opportunity, motivation and behaviour) psychological model of non‐adherence, we present the available evidence, not only in terms of describing the extent of the non‐adherence problem, but also describing why patients do not adhere, offering theory‐driven and evidence‐based solutions to improve long‐term adherence to chronic anticoagulation therapy. Lessons learned are not only applicable within the field of anticoagulation but throughout haematology.

Women’s views on and adherence to low-molecular-weight heparin therapy during pregnancy and the puerperium

Summary.  Background: Non‐adherence to prescribed medication represents a significant factor associated with treatment failure. Pregnant women identified at risk of venous thromboembolism are increasingly being prescribed low‐molecular‐weight heparin (LMWH) during pregnancy and the puerperium. It is important to understand women’s views on and adherence to LMWH during pregnancy and the puerperium, so that women gain maximum benefit from the treatment. Objectives: To monitor women’s adherence to enoxaparin, when prescribed during pregnancy and the puerperium, and explore their beliefs about the enoxaparin therapy prescribed. Patients/Methods: A prospective cohort study involving 95 nullparous and multiparous women prescribed enoxaparin for recognized antenatal indications. Adherence to enoxaparin was assessed through self‐completion of a diary, additionally verified through laboratory tests. An adapted beliefs about medication questionnaire was administered to women during their pregnancy. Results: Women were highly adherent to enoxaparin: antenatally, mean percentage adherence 97.92%; postnatally, mean percentage adherence 93.37% (paired t‐test, P = 0.000). In the cohort of women we followed, their perceived necessity for enoxaparin therapy outweighed any concerns they had regarding enoxaparin antenatally, necessity‐concerns differential 2.20. In some women, however, this perceived necessity does decrease postnatally. Conclusions: Our results suggest that most women prescribed enoxaparin are highly adherent to their therapy during the antenatal period and that women’s antenatal beliefs about enoxaparin are able to predict a decrease in postnatal adherence. Our results have important clinical implications, particularly when women are initiated on LMWH just during the postnatal period.

Determination of the influence of home delivery of HIV therapy on virological outcomes and adherence

The aim of this study was to evaluate whether the change in the mode of supply of HIV medicines to a homecare model was associated with any change in adherence and patient outcomes. We conducted a retrospective analysis of medical records of 100 patients who received supplies from a clinic-based hospital HIV pharmacy and 100 patients who were started on home delivery over a three-month period and were followed up over six months. Data on patient demographics, type of HIV drug regimen, HIV viral load, CD4% and adherence status were analysed. The mode of delivery had no significant effect on CD4% (p > 0.05), HIV viral load status (p > 0.05) or adherence status (p > 0.05). There was a significant increase in CD4% over time for both groups (p < 0.01). This study suggests that expanding home delivery as a model of care in London HIV clinics is safe and does not affect adherence and patient outcomes as indicated by HIV viral load and CD4%.

Inter-rater reliability of the assessment of adverse drug reactions in the hospitalised elderly

BackgroundThe identification and assessment of adverse drug reactions (ADRs) is very challenging especially among the older person. Inter observer reliability of an ADR classification system by different healthcare providers is vital to establish the validity of the reaction.ObjectiveTo assess the inter-rater reliability of an ADR classification system in hospitalised elderly patients and to investigate the differences in reliability by different professions.MethodsFrom a cohort of 330 elderly patients, patients who experienced a suspected medication related incident (n=87) were selected. The data were analysed by four healthcare professionals (2 pharmacists and 2 physicians) who independently classified the events into event type, types of adverse drug reactions, severity and preventability after a standardised induction based on previously published criteria. Fleiss’ kappa was used to assess the level of agreement between the four raters. The difference in level of agreement between the professions was assessed using the weighted least-squares approach for comparing correlated kappa of Barnhart et al.ResultsPharmacists and physicians showed high agreement in the identification and on the type and causality of ADRs. However there was lower (moderate) agreement for the severity (kappa = 0.61) and preventability of ADR (kappa = 0.48). Statistically significant differences were also noted between the professions; pharmacists have higher agreement in the classification of preventability (p=0.03) whereas the physicians pairs showed stronger agreement for classifying severity (p<0.001).ConclusionDespite the high agreement in the identification, type and causality of ADRs, physicians and pharmacists have difficulties in classifying preventability and severity in a reliable way. A multi-disciplinary approach would enable each profession to share their expert knowledge in order to facilitate better or safer patient care.

Exploration of adherence and patient experiences with DOACs one year after switching from vitamin-K antagonists- insights from the switching study

BACKGROUND Current UK and European guidelines recommend anticoagulated patients prescribed warfarin with time in therapeutic range (TTR) <65% be considered for DOAC therapy. There has been considerable concern that adherence with DOACs may be poor compared with warfarin. Little is known about the patient experience of switching from warfarin to DOAC and how patients manage their DOAC long term. Our aim was to conduct focus groups exploring patients previous experiences with warfarin, their current experience with DOACs, their adherence to DOACs and the long-term service provision they envisage. METHODS Patients enrolled on the Switching Study who had been switched from warfarin to a DOAC >1year previously were invited to participate in focus groups. Two focus groups for atrial fibrillation (AF) and two for secondary prevention of venous thromboembolism (VTE) patients were held at anticoagulation clinics in South London, UK. Data was analysed using framework analysis to extract dominant themes. RESULTS Five VTE patients and 15 AF patients attended the focus groups. Dominant themes that emerged were: indication specific anticoagulation prioritisation, warfarin as a necessary inconvenience, DOACs as the anticoagulant of choice, concerns regarding DOAC monitoring, high adherence to DOACs and desire for long-term access to specialist anticoagulation services. DISCUSSION VTE patients prioritised anticoagulation over other therapies whereas AF patients did not. All participants reported high levels of adherence to DOACs. Patients derived confidence from long-term management in specialist anticoagulation clinics stating a preference to be managed in such a service.

Associations between illness beliefs, medication beliefs, anticoagulation-related quality of life, and INR control: Insights from the Switching Study

Anticoagulation control with vitamin‐K antagonists (VKAs) in patients with atrial fibrillation (AF) or venous thromboembolism (VTE) can be measured using time in therapeutic range (TTR), where TTR >65% is considered good and low TTR may be associated with low adherence.

Is the provision of paediatric oral liquid unlicensed medicines safe

In the last two decades, international legislation has been introduced to try to ensure that medicines for use in children are of high quality, ethically researched and authorised appropriately.1 2 This is stimulating improvements in the research and development of suitable paediatric medicines by increasing the number of licensed products (see box 1) with reliable evidence-based dosing and safety profiles.Box 1 ### ‘Licensed medicine’ A medicine with a marketing authorisation which defines its terms of use. It has also been assessed for efficacy, safety and quality; has been manufactured to appropriate quality standards and when placed on the market is accompanied by appropriate product information and labelling.3 Although these improvements in legislation have encouraged and promoted the licensing of paediatric medicines, there are still many patients receiving unlicensed medicines due to a lack of available suitable licensed products. Studies across Europe have shown that at least one-third of children in hospital and up to 90% of neonates in neonatal intensive care receive unlicensed medicines (see boxes 2 and 3).4 Similarly, previous UK studies of paediatric populations within primary care show that unlicensed and/or off-label medicines are used around 11% of the time.5 Box 2 ### ‘Unlicensed medicines’ A medicinal product that does not have a marketing authorisation. The medicine has not been assessed for efficacy, safety and quality to the same standards as a licensed product. Box 3 ### Types of unlicensed medicines15