[Nurses write their work plans on their own].
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Humans↗
Biomedical subjects
Christine Beck
Publications and source records attributed to Christine Beck.
[Physicians establish their own schedules].
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Child↗
Drug prescriptions after acute myocardial infarction: dosage, compliance, and persistence.
BACKGROUND: Although it has been well documented that aspirin, beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, and lipid-lowering drugs are under-prescribed for patients with acute myocardial infarction (Am Heart J 2003;145:438-44.), few studies have examined dosage and long-term compliance and persistence patterns for the use of these drugs after AMI. METHODS: Using Quebec administrative data on all elderly (aged > or =65 years) survivors of hospital admissions for AMI between 1996 and 1998 (n = 14,057), we studied the discharge prescriptions, dosages, patient compliance, and persistence during this period for aspirin, beta-blockers, ACE inhibitors, and lipid-lowering drugs. RESULTS: Rates of discharge medications were suboptimal (aspirin 65%, beta-blockers 54%, ACE inhibitors 45%, lipid-lowering drugs 21%). Most patients with prescriptions for aspirin and ACE inhibitors were prescribed dosages equivalent to those administered in clinical trials (99% and 88%, respectively). In contrast, only 20% of patients with beta-blocker prescriptions and 48% of patients with lipid-lowering drug prescriptions were prescribed clinical trial doses. For patients with discharge prescriptions, 1-year compliance rates were high (aspirin 74%, beta-blockers 74%, ACE inhibitors 70%, lipid-lowering drugs 84%), as were the 1-year persistence rates (aspirin 71%, beta-blockers 72%, ACE inhibitors 69%, lipid-lowering drugs 80%). CONCLUSION: Although cardiac drugs are under-prescribed to patients with AMI, once prescribed, patients are likely to adhere to these prescriptions, with high rates of compliance and persistence.
Acute Disease↗
DRPEER: a motif in the extracellular vestibule conferring high Ca2+ flux rates in NMDA receptor channels.
The high flux rate of Ca2+ through NMDA receptor (NMDAR) channels is critical for their biological function and may depend on a Ca2+ binding site in the extracellular vestibule. We screened substitutions of hydrophilic residues exposed in the vestibule and identified a cluster of charged residues and a proline, the DRPEER motif, positioned C terminal to M3, that is unique to the NR1 subunit. Charge neutralization or conversion of residues in DRPEER altered fractional Ca2+ currents in a manner consistent with its forming a binding site for Ca2+. Similarly, in a mutant channel in which all of the negative charges are neutralized (ARPAAR), the block by extracellular Ca2+ of single-channel current amplitudes is attenuated. In these same channels, the block by extracellular Mg2+ is unaffected. DRPEER is located extracellularly, and its contribution to Ca2+ influx is distinct from that of the narrow constriction. We conclude that key residues in DRPEER, acting as an external binding site for Ca2+, along with a conserved asparagine in the M3 segment proper, contribute to the high fractional Ca2+ currents in these channels under physiological conditions. Therefore, these domains represent critical molecular determinants of NMDAR function in synaptic physiology.
Amino Acid Motifs↗
The effects of cost-sharing on essential drug prescriptions, utilization of medical care and outcomes after acute myocardial infarction in elderly patients.
BACKGROUND: After a change in Quebec's policy on drug coverage in August 1996, elderly patients' copayments for prescription drugs increased. We assessed the impact of this drug policy reform on prescribing patterns for essential cardiac medications, utilization of medical care and related health outcomes after acute myocardial infarction. METHODS: Patients at least 65 years of age who experienced acute myocardial infarction between 1994 and 1998 were identified through the Quebec discharge summary database. Drug claims databases were analyzed to determine rates of prescription of essential cardiac medications for cohorts of patients admitted before and after the policy reform. The impact on readmissions for cardiac-related complications, outpatient visits to physicians and emergency departments, and mortality rate was also assessed. RESULTS: The proportion of patients who received prescriptions for beta-blockers, angiotensin-converting enzyme inhibitors and lipid-lowering drugs increased over time and, more specifically, did not appear to decline with the change in the drug policy. In addition, the policy reform did not appear to affect persistence of drug therapy (the proportion of time for which patients were covered by prescriptions over the year after discharge). There was no within-class shift from more to less expensive drugs. Use of cardiac procedures increased over time, but this increase was unrelated to the date of the policy reform. Finally, rates of readmission for complications, visits to individual physicians and to emergency departments, and mortality rate were unchanged. The findings did not vary with sex or socioeconomic status. INTERPRETATION: Prescriptions for essential cardiac medications and care related to acute myocardial infarction in elderly patients did not change with increases in out-of-pocket copayment, regardless of sex or socioeconomic status.
Adrenergic beta-Antagonists↗
Molecular rearrangements of the extracellular vestibule in NMDAR channels during gating.
Many N-methyl-D-aspartate receptor (NMDAR) channel blockers that have therapeutic potential can be trapped in the closed state. Using a combination of the substituted cysteine accessibility method and open channel blockers, we found that the M3 segment forms the core of the extracellular vestibule, including a deep site for trapping blockers. The M3 segment, as well as more superficial parts of the extracellular vestibule, undergo extensive remodeling during channel closure, but do not define the activation gate, which is located deeper in the pore. Rather, the pore walls lining the extracellular vestibule constrict during channel closure. This movement is essential for coupling ligand binding to activation gate opening and accounts for the different mechanisms of open channel block, including trapping.
Aminacrine↗