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Synaptopodin is an actin-binding protein of renal podocytes and dendritic spines. We have recently shown that synaptopodin is localized to the spine apparatus, a characteristic organelle of dendritic spines on forebrain neurons. Synaptopodin-deficient mice do not form spine apparatuses, indicating a role of synaptopodin in the formation of this organelle. Here we studied the development of synaptopodin expression in the postnatal rat hippocampus. At birth, synaptopodin mRNA is mainly expressed in CA3 pyramidal neurons. At postnatal day (P) 6, synaptopodin mRNA expression is still strongest in CA3 but is now also found in CA1 pyramidal neurons and granule cells of the suprapyramidal blade of the dentate gyrus. At P9, an almost adult pattern is seen with synaptopodin mRNA expressed by virtually all principal neurons. While synaptopodin mRNA was restricted to cell somata, immunostaining for synaptopodin protein labeled dendritic layers. At birth, no immunoreactivity was visible, while at P5 a weak staining mainly in stratum oriens was observed. At P9, immunolabeling was still strongest in stratum oriens followed by the molecular layer of the dentate gyrus. The adult pattern with strong labeling of all dendritic layers was reached by P12. Together these findings show that synaptopodin expression follows the well-known sequence of hippocampal principal neuron development. Unexpectedly, we also observed synaptopodin mRNA expression in a small population of interneurons as revealed by double labeling with interneuron markers. However, no immunolabeling for synaptopodin was observed in identified interneurons, confirming that the protein is mainly present in spine-bearing principal cells.

BackgroundMedication reviews are recognized services to increase quality of therapy and reduce medication risks. The selection of eligible patients with potential to receive a major benefit is based on assumptions rather than on factual data. Acceptance of interprofessional collaboration is crucial to increase the quality of medication therapy.ObjectiveThe research question was to identify and prioritize eligible patients for a medication review and to provide evidence-based criteria for patient selection. Acceptance of the prescribing general practitioner to implement pharmaceutical recommendations was measured and factors influencing physicians’ acceptance were explored to obtain an impression on the extent of collaboration in medication review in an ambulatory care setting.MethodsBased on data of a cluster-randomized controlled study (WestGem-study), the correlation between patient parameters and the individual performance in a medication review was calculated in a multiple logistic regression model. Physician’s acceptance of the suggested intervention was assessed using feedback forms. Influential factors were analyzed.ResultsThe number of drugs in use (p = 0.001), discrepancies between prescribed and used medicines (p = 0.014), the baseline Medication Appropriateness Index score (p<0.001) and the duration of the intervention (p = 0.006) could be identified as influential factors for a major benefit from a medication review, whereas morbidity (p>0.05) and a low kidney function (p>0.05) do not predetermine the outcome. Longitudinal patient care with repeated reviews showed higher interprofessional acceptance and superior patient benefit. A total of 54.9% of the recommendations in a medication review on drug therapy were accepted for implementation.ConclusionsThe number of drugs in use and medication reconciliation could be a first rational step in patient selection for a medication review. Most elderly, multimorbid patients with polymedication experience a similar chance of receiving a benefit from a medication review. Longitudinal patient care should be preferred over confined medication reviews. The acceptance of medication reviews by physicians supports further implementation into health care systems.Trial RegistrationISRCTN ISRCTN41595373

Posterior alien hand syndrome is a new addition to a poorly understood group of movement disorders. Historically, anatomical lesions causing uncontrolled limb movement and a feeling of foreignness were found to be located in the corpus callosum or frontal lobe. Recent case reports, however, demonstrate the typical symptoms of alien hand syndrome with lesions located in the parietal/occipital lobes. Disturbance of normal function in these regions tends to produce less complex motor activity, such as hand levitation, along with a sensory component characterized by feeling of estrangement. We discuss a patient who presented with unusual symptoms following an outpatient procedure and was found to have posterior alien hand syndrome.

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BackgroundPharmaceutical practice worldwide is developing towards patient care. Medication Review (MR) and Medication Therapy Management (MTM) are evolving as the most prominent services in pharmaceutical care and have a strong potential to provide a large benefit for patients and society. MTMs can only be performed in an interprofessional, collaborative setting. Several international studies have explored the effects of a MTM on the quality of therapy and costs. For Germany the data is still deficient. This study aims to provide data on the effects of an interprofessional MTM regarding quality of therapy, quality of life, costs and cost-effectiveness.Method/DesignThe study is designed as a cluster-randomized controlled trial in primary care, involving 12 outpatient clinics (clusters) and 165 patients. Primary care units are allocated to interventions using a Stepped Wedge Design. All units are initially assigned to the control group. After a 6 month observation period, general practitioners (GP) are randomly allocated to one of three groups and the interprofessional medication therapy management approach is implemented sequentially per each group with a lag of 3 months between. The primary outcome is the change in the quality of therapy measured by the MAI (Medication Appropriateness Index). Secondary outcomes include changes in the number of drug related problems, medication complexity, changes in drug-adherence, changes in health-status and function, quality of life, direct costs and the incremental cost-effectiveness ratio. The acceptance of the interprofessional Medication Therapy Management approach is assessed by qualitative methods.DiscussionThe patient interview and brown bag review are activities, typically provided by the pharmacist. In this trial the patient is blinded to the pharmacist. The strength of having the patient blinded to the pharmacists is to exclude skepticism of the patient toward unknown pharmacies, which might be a major confounder in a regional and community setting. A weakness is that some patient related data might reach the pharmacists in a way, which might differ from self-acquired data.Trial registrationCurrent controlled trials ISRCTN41595373.

BackgroundMultimorbidity is defined as suffering from coexistent chronic conditions. Multimorbid patients demand highly complex patient-centered care which often includes polypharmacy, taking an average of six different drugs per day. Adverse drug reactions, adverse drug events and medication errors are all potential consequences of polypharmacy. Our study aims to detect the status quo of the health care situation in Saxony’s general practices for multimorbid patients receiving multiple medications. We will identify the most common clinical profiles as well as documented adverse drug events and reactions that occur during the treatment of patients receiving multiple medications. We will focus on exploring the motives of general practitioners for the prescription of selected drugs in individual cases where there is evidence of potential drug-drug-interactions and potentially inappropriate medications in elderly patients. Furthermore, the study will explore general practitioners’ opinions on delegation of skills to other health professions to support medical care and monitoring of patients receiving multiple medications.Methods/designThis is a retrospective cross sectional study using mixed methods. Socio-demographic data as well as diagnoses, medication regimens and clinically important events will be analyzed retrospectively using general practitioners documentation in patients’ records. Based on these data, short vignettes will be generated and discussed by general practitioners in qualitative telephone interviews.DiscussionTo be able to improve outpatient health care management for patients receiving multiple medications, the current status quo of care, risk factors for deficient treatment and characteristics of concerned patients must be investigated. Furthermore, it is necessary to understand the physicians’ decision making process regarding treatment.