Understanding different beliefs held by adherers, unintentional nonadherers, and intentional nonadherers: application of the Necessity-Concerns Framework

OBJECTIVE: The objective of this study was to explore beliefs about medicines, using the Necessity-Concerns Framework, of patients who report adherence, unintentional nonadherence, and intentional nonadherence. METHOD: This study performed a cross-sectional survey of patients starting a new medication for a chronic condition. Self-reported adherence was assessed via telephone interview. The Necessity-Concerns Framework was operationalized using the Beliefs About Medicines Questionnaire, which assesses beliefs about the necessity of and concerns with taking medications. RESULTS: Intentional nonadherers, compared to adherers, had lower perceptions of the necessity of their new medication and higher levels of concerns about taking it. Conversely, unintentional nonadherers were not significantly different from adherers. Intentional nonadherers were more likely to rate their concerns as high relative to their need for treatment than both adherers and unintentional nonadherers. CONCLUSION: When patients start a new medication for a chronic condition, intentional nonadherers hold beliefs significantly different from those of adherers and unintentional nonadherers. These findings have implications for practice in helping clinicians to reduce this type of nonadherence.     

Endoplasmic reticulum stress and induction of the unfolded protein response in human sporadic amyotrophic lateral sclerosis

The unfolded protein response (UPR) is induced at symptom onset and disease end stage in rodent models of familial amyotrophic lateral sclerosis (ALS) that express superoxide dismutase (SOD1) mutations. However, ninety percent of human ALS is sporadic and mutations in SOD1 account for only 2% of total ALS. Here we show that a full UPR, including induction of stress sensor kinases, chaperones and apoptotic mediators, is also present in spinal cords of human patients with sporadic disease. Furthermore, the UPR chaperone protein disulphide isomerase (PDI) was present in CSF and was aggregated and widely distributed throughout the motor neurons of these patients. We also show up-regulation of UPR prior to the onset of symptoms in SOD1 rodents, implying an active role in disease. This study offers new insights into pathogenesis, placing ER stress onto a generic pathophysiology for ALS.     

The peroxisome proliferator-activated receptor-gamma agonist rosiglitazone decreases bone formation and bone mineral density in healthy postmenopausal women: a randomized, controlled trial

CONTEXT: Thiazolidinediones, which are peroxisome proliferator-activated receptor-gamma agonists, are widely prescribed to patients with disorders characterized by insulin resistance. Preclinical studies suggest that peroxisome proliferator-activated receptor-gamma signaling negatively regulates bone formation and bone density. Human data on the skeletal effects of thiazolidinediones are currently available only from observational studies. OBJECTIVE: The objective of the study was to determine whether rosiglitazone, a thiazolidinedione, inhibits bone formation. DESIGN: The study was a 14-wk randomized, double-blind, placebo-controlled trial. SETTING: The study was conducted in the general community. PATIENTS: Fifty healthy, postmenopausal women participated in the study. INTERVENTION: Intervention was rosiglitazone 8 mg/d. MAIN OUTCOME MEASURES: The primary end point was biochemical markers of bone formation, and secondary end points were a bone resorption marker and bone mineral density. RESULTS: The osteoblast markers procollagen type I N-terminal propeptide and osteocalcin declined by 13% (P<0.005 vs. placebo) and 10% (P=0.04 vs. placebo), respectively, in the rosiglitazone group. These changes were evident by 4 wk and persisted for the duration of the study. There was no change in the serum beta-C-terminal telopeptide of type I collagen, a marker of bone resorption (P=0.9 vs. placebo). Total hip bone density fell in the rosiglitazone group (mean change from baseline rosiglitazone -1.9%, placebo -0.2%; between-group difference 1.7%, 95% confidence interval 0.6-2.7, P<0.01); lumbar spine bone density fell significantly from baseline values in the rosiglitazone group (P=0.02 vs. baseline) but was not significantly different between groups (mean change from baseline rosiglitazone -1.2%, placebo -0.2%; between-group difference 1.0%, 95% confidence interval -0.2-2.3, P=0.13). CONCLUSIONS: Short-term therapy with rosiglitazone exerts detrimental skeletal effects by inhibiting bone formation. Skeletal end points should be included in future long-term studies of thiazolidinedione use.     

'A caring professional attitude': What service users and carers seek in graduate nurses and the challenge for educators

With the publication of the new NMC standards for pre-registration nursing education, undergraduate curricula are being written in universities across England. There are many drivers for the curricula but one that has until recently received scant attention is the service user's and carer's voice. This paper discusses the findings of a qualitative study that asked 52 service users and carers about the qualities they sought in nurses and their views on nurse education. Eight focus groups were conducted with a broad range of service users and carers from primary and secondary care, and voluntary organisations. Data were analysed using the framework approach facilitated by a qualitative analysis software programme. The sample was diverse, but there were similarities in the qualities they valued in nurses. They sought technical competence, knowledge and willingness to seek information, but overwhelmingly prioritised 'a caring professional attitude'. This was articulated as empathy, communication skills and non-judgmental patient centred care: major themes in the new NMC standards. Our participants also expressed concern about whether the educational preparation of nurses can develop these caring qualities. We discuss this concern, the challenges for nurse educators it presents and how we can engage service users and carers in shaping and delivering our new curricula.     

Patients' beliefs about medicines in a primary care setting in Germany

Objectives The aim of this study was to explore patients' beliefs about medicines by administering the German version of the Beliefs about Medicines Questionnaire (BMQ) in a primary care setting among chronically ill patients and to examine its psychometric properties. The BMQ assesses patients' beliefs about their individual prescribed medication as well as their beliefs about medicines in general. Methods A cross‐sectional survey of 485 chronically ill patients was performed. The German version of the BMQ was evaluated in terms of internal consistency, validity and scale structure. To assess validity the Medication Adherence Report Scale (MARS‐D) and the Satisfaction with Information about Medicines Scale (SIMS‐D) were applied. Results The BMQ showed good internal consistency (Cronbach's α 0.79–0.83). Patients' belief about the specific necessity of their medicines correlated positively with the MARS‐D (ρ = 0.202; P < 0.01). There were significant correlations in the predicted direction between the MARS‐D and all the BMQ subscales with the exception of the General‐Overuse subscale (ρ = ?0.06; P = 0.30). Relationship to the SIMS‐D was comparable to the original study. Factor analysis corroborated the scale structure. Conclusions The BMQ is a suitable instrument to measure patients' beliefs in medicines in German primary care settings. Most patients in our sample had positive beliefs concerning the necessity of their medication. Their levels of concern were associated with higher non‐adherence.