This study confirms the value of planned multidisciplinary family meetings for patients in specialist inpatient palliative care units. It identifies the often unmet needs of family members and the sustained benefits associated with formal family meetings.

No abstract

Poor adherence with antihypertensive therapies is a major factor in the low rates of blood pressure control among people with hypertension. Patient adherence is influenced by a large number of interacting factors but their exact impact is not well understood, partly because it is difficult to measure adherence. Longitudinal prescription data can be used as a measure of drug supply and are particularly useful to identify interruptions and changes of treatment. Obtaining a medicine does not ensure its use; however, it has been established that continuous collection of prescription medications is a useful marker of adherence. We found 20 studies published in the last 10 years that used large prescription databases to investigate adherence with antihypertensive therapies. These were assessed in terms of patient selection, the definition of the adherence outcome(s), and statistical modeling. There was large variation between studies, limiting their comparability. Particular methodological problems included: the failure to identify an inception cohort, which ensures baseline comparability, in four studies; the exclusion of patients who could not be followed up, which results in a selection bias, in 17 studies; failure to validate outcome definitions; and failure to model the discrete-time structure of the data in all the studies we examined. Although the data give repeated measurements on patients, none of the studies attempted to model patient-level variability. Studies of such observational data have inherent limitations, but their potential has not been fully realized in the modeling of adherence with antihypertensive drugs. Many of the studies we reviewed found high rates of nonadherence to antihypertensive therapies despite differences in populations and methods used. Adherence rates from one database ranged from 34% to 78% at 1 year. Some studies found women had better adherence than men, while others found the reverse. Novel approaches to analyzing data from such databases are required to use the information available appropriately and avoid the problems of bias.

Highlights d A methodology to dissect the architecture of complex behavior patterns d Foraging patterns are built from finite, genetically controlled modules of behavior d Different modules are linked to different economic behavior patterns d Parental alleles of the Prader-Willi syndrome gene Magel2 regulate distinct modules SUMMARY Complex ethological behaviors could be constructed from finite modules that are reproducible functional units of behavior.Here, we test this idea for foraging and develop methods to dissect rich behavior patterns in mice. We uncover discrete modules of foraging behavior reproducible across different strains and ages, as well as nonmodular behavioral sequences. Modules differ in terms of form, expression frequency, and expression timing and are expressed in a probabilistically determined order. Modules shape economic patterns of feeding, exposure, activity, and perseveration responses. The modular architecture of foraging changes developmentally, and different developmental, genetic, and parental effects are found to shape the expression of specific modules. Dissecting modules from complex patterns is powerful for phenotype analysis. We discover that both parental alleles of the imprinted Prader-Willi syndrome gene Magel2 are functional in mice but regulate different modules. Our study found that complex economic patterns are built from finite, genetically controlled modules.

No abstract