Production networks are integral to economic dynamics, yet dis-aggregated network data on inter-firm trade is rarely collected and often proprietary. Here we situate company-level production... Show moreProduction networks are integral to economic dynamics, yet dis-aggregated network data on inter-firm trade is rarely collected and often proprietary. Here we situate company-level production networks within a wider space of networks that are different in nature, but similar in local connectivity structure. Through this lens, we study a regional and a national network of inferred trade relationships reconstructed from Dutch national economic statistics and re-interpret prior empirical findings. We find that company-level production networks have so-called functional structure, as previously identified in protein-protein interaction (PPI) networks. Functional networks are distinctive in their over-representation of closed squares, which we quantify using an existing measure called spectral bipartivity. Shared local connectivity structure lets us ferry insights between domains. PPI networks are shaped by complementarity, rather than homophily, and we use multi-layer directed configuration models to show that this principle explains the emergence of functional structure in production networks. Companies are especially similar to their close competitors, not to their trading partners. Our findings have practical implications for the analysis of production networks and give us precise terms for the local structural features that may be key to understanding their routine function, failure, and growth. Show less
Synergievoordelen binnen industri le clusters zijn een belangrijk uitgangspunt in het Nederlandse klimaatbeleid. Tegelijkertijd zijn deze clusters in de praktijk soms moeilijk waarneembaar. Een... Show moreSynergievoordelen binnen industri le clusters zijn een belangrijk uitgangspunt in het Nederlandse klimaatbeleid. Tegelijkertijd zijn deze clusters in de praktijk soms moeilijk waarneembaar. Een netwerkanalyse maakt een clustergericht industriebeleid met focus op verduurzaming mogelijk.In het kort:● Een effectief transitiebeleid vereist een beter begrip van de werking van industrieclusters.● Verduurzaming van de industrie vraagt om inzicht in de samenhang en interactie binnen industrieclusters.● Een toepassing van netwerkanalyse op het industriecluster Zeeland laat zien dat er sprake is van een functioneel netwerk. Show less
OBJECTIVE we compared the self-reported medication adherence and knowledge of older patients receiving their drugs via multidose drug dispensing (MDD users) with patients receiving manually... Show moreOBJECTIVE we compared the self-reported medication adherence and knowledge of older patients receiving their drugs via multidose drug dispensing (MDD users) with patients receiving manually dispensed drugs (non-MDD users). METHODS MDD users (≥ 65 years, ≥ 5 oral chronic drugs) were randomly selected from eight Dutch community pharmacies. Non-MDD users (≥ 5 oral chronic drugs) were matched on age and gender. Medication adherence was assessed by using the Medication Adherence Reporting Scale (MARS) and medication knowledge by asking the indication of drugs. Cognitive function was measured with Mini-Mental State Examination (MMSE) for a sub selection of patients. RESULTS the percentage of patients being adherent to all drugs was higher for MDD users (n = 119, 81%) compared with non-MDD users (n = 96, 58%, P < 0.001).The percentage of patients with adequate knowledge was lower for MDD users (40%) compared with non-MDD users (79%, P < 0.001). The differences in adherence were independent of knowledge and MMSE scores. CONCLUSION this study shows that older patients receiving their drugs via MDD reported a higher medication adherence compared with patients receiving manually dispensed drugs, despite a lower knowledge and lower cognitive function among patients receiving MDD. Show less
BACKGROUND Many studies have investigated the effect of medication review on a variety of outcomes, but the elements of the interventions have been quite diverse. Moreover, implementation rates of... Show moreBACKGROUND Many studies have investigated the effect of medication review on a variety of outcomes, but the elements of the interventions have been quite diverse. Moreover, implementation rates of recommendations also vary widely between studies. OBJECTIVE The objective of this study was to investigate how the extent of collaboration between the general practitioner (GP) and the pharmacist impacts on the implementation of recommendations arising from medication review. METHODS MEDLINE, EMBASE and Web of Science were searched for studies published between January 2000 and April 2012. Keywords included medication review, medication therapy management, pharmaceutical services and drug utilization review. Sixteen articles (describing 14 randomized controlled trials [RCTs]) out of 620 titles met the inclusion criteria. Inclusion criteria for the review were medication review, RCT design, involvement of both pharmacist and GP, and home-dwelling patients (mean age >70 years) who had not been recently discharged. After quality assessment of the article, the presence of the following eight key elements reflecting collaboration were scored for each intervention: pharmacist with clinical experience, own pharmacist involved, sharing of medical records, patient interview by pharmacist, invitation of patients by GP, case conference between GP and pharmacist, action plan, follow-up. The primary outcome was the implementation rate of recommendations. Meta-regression analysis was used to assess the association between the implementation rate and the number of key elements present. RESULTS Twelve RCTs were included after quality assessment. The mean number of key elements within the intervention was 5.2 (range 1-8). The mean implementation rate of recommendations was 50 % (range 17-86). The association between the number of key elements present in the intervention and the implementation rate of recommendations was significant: β = 0.085 (95 % CI 0.052-0.128; p < 0.0001). CONCLUSION This systematic review shows a significant association between the number of key elements of the intervention reflecting collaborative aspects in medication review and the implementation rate of recommendations. Show less
BACKGROUND There are concerns that automated drug dispensing may increase inappropriate drug use. Automated dispensing could lead to perpetual repeating of drug therapies without the necessary re... Show moreBACKGROUND There are concerns that automated drug dispensing may increase inappropriate drug use. Automated dispensing could lead to perpetual repeating of drug therapies without the necessary re-evaluation. OBJECTIVE The aim of this study was to examine the effect of a pharmacist-led medication review on drug-related problems (DRPs) in older patients receiving their drugs via automated dispensing. METHODS This was a pragmatic randomized controlled study conducted in primary care. Patients were recruited from six Dutch community pharmacies. They were eligible if they lived at home, were aged ≥ 65 years, and used five or more different drugs, of which at least one had to be dispensed via an automated system. Patients were randomly allocated to receive a medication review at the start of the study (intervention group) or after 6 months (waiting-list group). Each patient was independently reviewed by two pharmacist reviewers. The results of these medication reviews were sent to the community pharmacist to be discussed with the patient's general practitioner (GP). The primary outcome measure was the number of DRPs leading to a recommendation for drug change. Secondary outcomes were the total number of drug changes and the number of drug changes related to a recommendation. In order to analyse drug changes, medication records were collected 6 months after the medication review or index date in the waiting-list group. Potential DRPs were classified using the DOCUMENT classification. RESULTS There were no baseline differences between the 63 patients in the intervention group and the 55 patients in the waiting-list group with respect to age, sex, number of drugs per patient and type of drug prescribed. The mean number of DRPs per patient at baseline in the intervention group and waiting list combined was 8.5, with no difference between the groups. At baseline, the mean number of DRPs leading to a recommendation for drug change was 4.5 per patient and did not differ between the two groups. After 6 months, the number of DRPs leading to a recommendation for drug change decreased by 29% in the intervention group versus 5% in the waiting-list group (p < 0.01). Recommendations for cessation of a drug were more frequently accepted than recommendations to add a new drug (82% vs 44%, p = 0.01). CONCLUSIONS This study shows that patients using automated drug dispensing have a high number of DRPs. Medication review decreases the number of DRPs among these patients. We recommend that all patients with automatic drug dispensing should have a thorough medication review by pharmacists and prescribers. Show less