Learning Journal 23

Answers to questions from previous journal entries:
I found it very difficult to find answers to the questions about time release medications. I might be looking for information in the wrong place.

New information found:
In a study that I found, a physician had looked at different factors that contribute to what he called adverse drug events. These are events that are harmful to a patient as a result of the medications they were taking. For example, falls, fractures, cognitive dysfunction, postural hypotension, electrolyte disorders and cardiac failure are events that could be caused by adverse drug effects. These events make up 23% of hospital visits in the elderly according to his sources. Also, he found that of all adverse drug effects in the elderly, 15-20% of them were due to drug-to-drug interactions.

The factors that increase the likelihood of adverse drug events are a higher number of drugs taken, older age, potentially inappropriate prescriptions, and others.

I started by looking into 'potentially inappropriate prescriptions' and it turns out that is an important key-phrase. When I began searching for articles using this phrase, I found a ton of information where I thought there was none. Apparently there are pretty widely accepted lists of potentially inappropriate prescriptions for adults age 65 and older.

New questions from this information:
How are the lists of potentially inappropriate prescriptions used?
Is it up to an individual physician to review it and make sure he is in compliance with it?
Are there policies being made to regulate prescribing drugs on the list? 

Keywords: potentially inappropriate prescriptions, drug prescribing policies

Extra Credit Learning Journal - Inquiry Conference

I attended the panel discussion following two presentations on Friday regarding the deaf community. The presenter that I heard, Charity, went to Ghana and studied education for the deaf. She learned that there is only one secondary school equipped to teach deaf students in the entire country. This makes secondary education for deaf students extremely limited. She also had insight into the social stigma regarding deaf children in Ghana. She made the comment that "they are treated like third class citizens in a third world country." There are also cultural explanations for why children are born such as the cursing of parents by a 'deaf god' to bear a deaf child. This type of cultural tradition many in the general population to view deaf children as 'pollutions.'

The part of the presentation that I found most applicable to my project came from the speaker before Charity whose name I don't remember. She will be attending law school in the coming year and has been involved in supporting public policy to help the deaf community. This made me think about my own project in that regard since solutions to many problems arising from polypharmacy will be found in policy changes. What type of legislation would it take to set up regulations for physicians prescribing multiple medications to the elderly? Have there been attempts in the past to set up certain regulations governing protocol for prescribing multiple medications to elderly patients? How do pharmaceutical companies view the issue of polypharmacy and are they willing to help set up regulations for physicians prescribing multiple drugs to elderly patients?

Keywords: inquiry conference

Learning Journal 22

Answers to questions from last entry:

I looked more into slow-release medications to see if there was a database with the effects of particular medications in the elderly. I didn't find anything and I guess that makes sense, that's why we go see a doctor, so they can tell us what effect certain medications will have in a patient. There's not a set way a medication will respond with every single person who takes it.

New information found:

I did find out a lot about slow-release medications though. Time release drugs have their active ingredient embedded in an insoluble matrix so that the molecules have to work their way through the matrix before released into the bloodstream. There is also a technology called microencapsulating which gives a more consistent release rate. These technologies only work for some types of medications however, ones where the pharmacological activity of the active ingredient is dependant upon blood levels. Also, if the active ingredient absorption involves an active transport protein mechanism then time release medications can be problematic.

I think this stuff is a whole different field that would take a ton of time and research to understand. I'm glad I found out that a basic concept though; that not all medications can be given in a time-release form with the current technology available. It seems like time-release medications are an effective way to increase patient compliance with prescription doses when the patient is elderly and is taking multiple medications.

Questions from this information:

What are the other methods to increase patient compliance that I can look into more?

Is there a big price difference with time-release medications?

When a time-release form of a medication is available do physicians know that prescribing it to an elderly person will make them more likely to comply with the prescription?

Keywords: patient compliance, time release medications

Learning Journal 21

Answer to questions from the last journal entry:
It turns out pharmacokinetics and pharmacodynamics are not the study of drug-to-drug interactions. After additional research I found that pharmacokinetics/dynamics is the study of the biological mechanisms of drugs.

New information found:
I found a study which showed that elderly patients are less likely to take the recommended doses of medications compared to other patients. This occurs for a number of reasons, but the reasons that are of interest to me are (1)too many prescriptions prescribed (2) poor synchronization of drugs (3)complexity of the medication schedule (4)not prescribing slow release drugs to limit the number of times per-day the patient must medicate (5)not paying attention to the size of capsules for prescribed drugs or utilizing syrups when possible.

Questions about this information:
Is there a database that has information on which drug combinations have adverse affects in elderly patients?
How many of the common drugs are available in a slow release form? This seems like it would be a good way to reduce the costs of medications for the elderly and increase the likelihood of patients actually taking their medications.

A possible survey question I could add might include:
Of all the medications that you take, how many do you follow the exact dosage recommended by your physician?

Notes to Maggie:
I realize that I haven't incorporated anything from the inquiry conference into my journal entry. At this point in my project I need to focus heavily on background research for my topic so I can complete section D in my IRB proposal by Friday. I'll make some connections between my project and what I learn from the conference in the extra-credit journal entry this week.
Also, Andrew wanted me to code my journal by keywords. Since this journal is viewed via web browser, the Ctr/F function allows me to search any text on the screen for certain words. When I want to search my journal by keyword I just enter Ctr/F and type in the keyword and that highlights the word throughout my whole journal. Is this sufficient for coding the journal?

Keywords: drug combinations, slow release drugs, patient compliance

Learning Journal 19

I have decided to shift the focus of my project. Since I am neither a psychologist nor a sociologist, I don't think I am very qualified to study social factors that contribute to high levels of stress in older adults. Instead, since I am a pre-medical student I will focus my research on polypharmacy (the use of multiple medications by a patient) in older adults.

I have read some literature on this subject that has given me background information on the issue of polypharmacy. As adults age, they are likely to have a combination of chronic medical conditions that require medication (i.e. a patient is diagnosed with diabetes, osteoporosis and hypertension). While these medications are warranted for the treatment of particular conditions, there are often considerations that must be taken into account due to the combination of multiple medications. Some of these considerations are pill burden (the high cost of multiple medications), drug-to-drug interactions (pharmacokinetics, pharmacodynamics) within the patient, and lack of coordination between multiple health-care providers (i.e. a patient visits multiple specialists, each prescribing medications).

How can there can be a lack of coordination between health care providers who see the same patient? Doesn't a person had a medical record that can be viewed by any physician?

How much do we know about drug-to-drug interactions (pharmacokinetics, pharmacodynamics) for specific medication combinations?

I read that the odds of being prescribed inappropriate medications increased by 22% for each additional medication prescribed. That seems very high to me. Why does this occur?

Keywords: polypharmacy, pharmacokinetics, pharmacodynamics

Learning Journal 20

I decided not to go to Ghana since I got engaged and decided to be married June 18th. Obviously this will have major implications for my project. I will not be going to Wiamoase for a field study so my project will completely change.

My first step is to develop a new research question and begin the 25 question exercise again:

Research question - What social factors contribute to high levels of anxiety in adults age fifty and older in Utah County?

25 questions beginning -

1. How large of a population sample do I need to eliminate population bias from my study?
2.Will a sample from Utah County give me useful data by itself or will I need a comparison group?
3. What is the best way to target adults age fifty and older while making the sample as random as possible?
4. What are some lurking variables that could potentially affect the study results? How do I include as many of these as possible so I am aware of all factors?
5. What type of response bias will be introduced if my sample is taken from this population? If the subjects know that I am a BYU student will that affect their willingness to participate and will that create a noticeable response bias in my data?
6. How can I evaluate stress levels of subjects while minimizing the risk of causing emotional stress from recalling stressful experiences?
7. This is a potentially vulnerable population (the elderly). What can I do to minimize other risks to my population?
8. Since anxiety is an affective disorder would subjects that have been diagnosed with anxiety be another vulnerable population?
9. What are indicators of anxiety for my population?
10. Are there common medications for anxiety that I should include in the survey as indicators on anxiety?

Keywords: Utah county, older adults, anxiety, 25 questions

Journal Entry 18

I've been reading the article from the malERA on vector control. The three main challenges facing effective control of anopheles vectors are (1)the preservation and improvement of existing insecticide based interventions (2)the development of interventions targeting species not currently affected by insecticides (3)the development of novel approaches that reduce the high vectorial capacities of sub-Saharan Africa. The questions this article led me to were these:

1. How can insecticides be used to target reproductive habitat for mosquitoes?
2. What ecological factors effect whether an area is more likely to have high vector populations?
3. Would it have a negative impact on Ghanaian ecology if mosquitoes were eliminated? How much would that cost?

I can see that there is not a ton of continuity in my learning journal entries. Each one seems to be separate from the others and I often don't address the questions that I asked in the previous entry. I think the reason for this is that my research is still quite broad. I find new material addressing questions that I had never thought of before quite frequently. And I find that the questions I ask are not always pertinent or easily answered so spending my research time answering these could take a significant amount of time and not be very helpful. I think at this point I am still doing a lot of exploratory research and want the information I find to dictate my research path rather than my questions.

Keywords: insecticides, malaria eradication research agenda, ecology