bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluating a Training Program for Pharmacist Code Blue Response
Authors: Marlowe Karen F. , Woods Dennis D.
Published: December 2017

Objective

The purpose of this study was to determine if pharmacy-specific didactic and experiential education could increase pharmacists’ knowledge about code situations and their comfort level in responding to these events. Secondarily, we examined the impact of the program on pharmacists with various prior experience with cardiac arrest resuscitation (code blue events).

Design

Given the extensive use of medications during advanced cardiac life support, pharmacists working on resuscitation teams have a unique opportunity to improve patient care. If properly trained, pharmacists could potentially reduce medication errors, aid in medication preparation, and provide drug and compatibility information. However, a pharmacy-specific education program of this type is not currently available. Before beginning this project, a knowledge assessment and comfort level survey were administered to pharmacists to obtain baseline information about their knowledge of commonly used medications, hospital policies, and perceived comfort levels in performing resuscitation practices. The pharmacists attended an education session about these topics and were given an opportunity to practice medication preparation. Upon completion, each pharmacist repeated the knowledge assessment, a comfort survey, and a competency check list.

Results

Pharmacists’ performance on a written knowledge assessment improved by a mean of 3.5 ± 0.6 questions (P = 0.0001). Perceived comfort level also increased for several aspects of code involvement.

Conclusion

The data suggests that targeted education could increase pharmacists’ knowledge and comfort levels related to resuscitation efforts. Further investigation is required to determine the impact of the program on pharmacist performance during a resuscitation effort.
Development and Implementation of a Pharmacy Directed Community Health Education and Screening Program
Authors: Strain Joey D. , Jorgenson James A. , Martin Sandi
Published: December 2017

Purpose

A major obstacle to successfully offering health care education programs is a lack of access to large numbers of people. To capture a large audience we proposed a pharmacy directed community health education and screening program using the hockey games at the University of Utah as the venue to educate a significant population. The objectives of this project were to evaluate the patrons’ perception of health care screening/education sessions offered at hockey games and to discover the number of patrons participating in the programs.

Methods

A variety of health care screening/education programs were offered at 12 hockey games on the University of Utah campus. Health care professionals were present to provide information, conduct screenings, and answer questions. All patrons who participated were asked to complete an anonymous survey to determine if the health sessions in this setting were beneficial.

Results

A total of 801 useable surveys were received from patrons who were screened and/or educated. Overall, the health care screening/education sessions were well perceived with 92% of the patrons rating the overall value of the sessions as “very good” or “excellent.” Patrons who were identified as being at risk for certain disease states were encouraged to follow-up with a physician.

Conclusion

The health care education/screening sessions provided at the University of Utah hockey games were successful based on the survey results and the number of patrons who participated. This program also demonstrated pharmacists can play a very effective role in designing and delivering health education to large numbers of patients.
Pentetate Calcium Trisodium (Ca-DTPA) and Pentetate Zinc Trisodium (Zn-DTPA)
Authors: Cada Dennis J. , Levien Terri , Baker Danial E.
Published: December 2017

Each month, subscribers to The Formulary Monograph Service receive five to six well-documented monographs on drugs that are newly released or are in late Phase III trials. The monographs are targeted to your Pharmacy and Therapeutics Committee. Subscribers also receive monthly one-page summary monographs on the agents that are useful for agendas and pharmacy/nursing in-services. A comprehensive target drug utilization evaluation (DUE) is also provided each month. With a subscription, the monographs are sent to you in print and CD ROM forms and are available online. Monographs can be customized to meet the needs of your facility. Subscribers to the The Formulary Monograph Service also receive access to a pharmacy bulletin board, The Formulary Information Exchange (The F.I.X.). All topics pertinent to clinical and hospital pharmacy are discussed on The F.I.X.

Through the cooperation of The Formulary, Hospital Pharmacy publishes selected reviews in this column. If you would like information about The Formulary Monograph Service or The F.I.X., call The Formulary at 800-322-4349. The January 2005 monograph topics are lanthanum carbonate, erlotinib, indiplon immediate-release capsules, cyclosporine inhalation solution, and paricalcitol capsules. The DUE is on lanthanum carbonate.
Rhabdomyolysis Associated with Fluoroquinolones; Rhabdomyolysis and Myopathy with Combined Therapy for Hyperlipidemia; Incidence of Rhabdomyolysis in Hospitalized Patients and Conflict of Interest Controversy; Abdominal Cramping Associated with Prostaglandin Analog Ophthalmic Solution; Pioglitazone-Induced Heart Failure in a Patient with Normal Left Ventricular Function; Hearing Loss Due to Clarithromycin; Hyponatremia with Bupropion – Verified by Rechallenge; Dystonia Associated with Gabapentin
Authors: Shuster Joel
Published: December 2017

The purpose of this feature is to heighten awareness of specific adverse drug reactions (ADRs), to discuss methods of prevention, and to promote reporting of ADRs to the FDA's medWatch program (800-FDA-1088). If you have reported an interesting preventable ADR to medWatch, please consider sharing the account with our readers.
Lanthanum Carbonate
Authors: Cada Dennis J. , Levien Terri , Baker Danial E.
Published: December 2017

Each month, subscribers to The Formulary Monograph Service receive five to six well-documented monographs on drugs that are newly released or are in late Phase 3 trials. The monographs are targeted to your Pharmacy and Therapeutics Committee. Subscribers also receive monthly one-page summary monographs on the agents that are useful for agendas and pharmacy/nursing in-services. A comprehensive target drug utilization evaluation (DUE) is also provided each month. With a subscription, the monographs are sent to you in print and CD ROM forms and are available online. Monographs can be customized to meet the needs of your facility. Subscribers to the The Formulary Monograph Service also receive access to a pharmacy bulletin board, The Formulary Information Exchange (The F.I.X.). All topics pertinent to clinical and hospital pharmacy are discussed on The F.I.X.

Through the cooperation of The Formulary, Hospital Pharmacy publishes selected reviews in this column. If you would like information about The Formulary Monograph Service or The F.I.X., call The Formulary at 800-322-4349. The March 2005 monograph topics are ziconotide, eszopiclone, palifermin, paclitaxel, and darifenacin. The DUE is on eszopiclone.
New Drugs Approved by the FDA; New Dosage Forms and Indications; Agents Pending FDA Approval; Significant Labeling Changes Related to Safety
Authors: Baker Danial E.
Published: December 2017

This monthly feature will help readers keep current on new drugs, new indications and dosage forms, and safety-related changes in labeling or use. Each month, new information will be added to the table (shown in bold type) and older information will be removed. Efforts have been made to ensure the accuracy of the information; however, if there are any questions, let us know at hospitalpharmacy@drugfacts.com .
Medication Access through the Internet: Legal and Safety Considerations for Pharmacists
Authors: Veronin Michael A.
Published: December 2017

Today, it is common for patients to order prescription drugs via their home computer through an Internet pharmacy. Because of this, pharmacists may be faced with having to evaluate a patient's drug regimen that may include foreign-made imported drugs obtained through the Internet. This article addresses major issues involving drug importation via this mechanism. Topics discussed include types of Internet pharmacies, patient access to prescription drugs, self-medication, legal issues, and potential health risks. The current level of activity of Internet drug sales has reached record volume and does not appear to be subsiding; pharmacists should be aware of these emerging influences on their practice.
Measuring up to Medication Safety; An Error Waiting to Happen; Sterile Cockpit
Authors: Cohen Michael R.
Published: December 2017

These medication errors have occurred in health care facilities at least once. They will happen again—perhaps where you work. Through education and alertness of personnel and procedural safeguards, they can be avoided. You should consider publishing accounts of errors in your newsletters and/or presenting them in your inservice training programs.

Your assistance is required to continue this feature. The reports described here were received through the USP Medication Errors Reporting Program (MERP), which is presented in cooperation with the Institute for Safe Medication Practices. If you have encountered medication errors and would like to report them, you may call USP toll-free, 24 hours a day, at 800-233-7767 (800-23-ERROR).

Any reports published by ISMP will be anonymous. Comments are also invited; the writers’ names will be published if desired. ISMP may be contacted at the address shown below.

Errors, close calls, or hazardous conditions may be reported through the ISMP ( www.ismp.org ) or USP ( www.usp.org ) Web sites or communicated directly to ISMP by calling 800-FAIL SAFE or via E-mail at ismpinfo@ismp.org . ISMP guarantees the confidentiality and security of the information received and respects reporters’ wishes as to the level of detail included in publications.
Update on Resistance among Nosocomial Gram-Negative Pathogens to Extended-Spectrum Cephalosporins and Fluoroquinolones: Results of the Antimicrobial Resistance Management (ARM) Program
Authors: Gums John G. , Epstein Benjamin J.
Published: December 2017

Objective

To evaluate trends in antibiotic resistance among Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, and Pseudomonas aeruginosa isolates submitted to the Antimicrobial Resistance Management (ARM) program between 1990 and 2002.

Design

The ongoing Antimicrobial Resistance Management (ARM) program is a queriable Web-based surveillance system that tracks resistance patterns among U.S. inpatient and outpatient isolates. This report represents data from 285 institutions and over 17 million isolates. Using a Web-based analysis tool, antibiogram and sensitivity reports of E. coli, K. pneumoniae, P. mirabilis, and P. aeruginosa isolates were reviewed for resistance to extended-spectrum cephalosporins and fluoroquinolones.

Setting

285 teaching and non-teaching U.S Hospitals nationwide.

Results

For E. coli, resistance was 3.2% to ciprofloxacin (n = 444,947), 5.4% to levofloxacin (n = 201,532), and 0.8% to cefotaxime (n = 107,394), ceftriaxone (n = 464,931), and cefepime (n = 81,980), respectively. K. pneumoniae isolate resistance was 4.6% to ciprofloxacin (n = 144,698), 4.5% to levofloxacin (n = 57,462), 1.9% to cefotaxime (n = 33,189), 2.0% to ceftriaxone (n = 145,328) and 1.9% to cefepime (n = 25,503). For P. mirabilis, resistance was 12.5% to ciprofloxacin (n = 83,186), 12.2% to levofloxacin (n = 35,277), 1.0% to cefotaxime (n = 18,802), 0.7% to ceftriaxone (83,652), and 2.3% to cefepime (n = 13,968). P. aeruginosa resistance was also higher for fluoroquinolones (only 65.2% of isolates were susceptible to ciprofloxacin) compared to extended-spectrum cephalosporins, with ceftazidime exhibiting the greatest antipseudomonal activity. Clinically significant regional variations in the activity of fluoroquinolones and cephalosporins were apparent.

Conclusion

Resistance to the fluoroquinolones is increasing dramatically, whereas the third generation cephalosporins remain inherently more active. P. aeruginosa exhibits the most formidable resistance pattern with neither the antipseudomonal cephalosporins nor fluoroquinolones representing acceptable monotherapy options. Given the association between fluoroquinolone resistance and extended-spectrum β-lactamase production, continued surveillance is vital to preserve the activity of existing therapies.
A Training and Communications Team Develops Online Learning Modules in Response to JCAHO Standard TX 3.5.2
Authors: Neville Michael W.
Published: December 2017

Implementing house-wide training that affects multiple disciplines requires thoughtful and deliberate action. In response to JCAHO recommendations that require pharmacists to review all medication orders prior to medication dispensing, Emory Healthcare's pharmacy and nursing staff formed a coalition to improve the safety of the medication process using the Pyxis Profile automated cabinets. The Training and Communications Team (T&CT) developed online modules to inform staff members about new medication safety standards, required upgrades to the automated dispensing cabinets, and methods to avoid medication errors. Post implementation surveys indicated an overwhelming success of the education process.
Case Study: Challenges, Successes and Lessons Learned from Implementing Computerized Physician Order Entry (CPOE) at Two Distinct Health Systems: Implications of CPOE on the Pharmacy and the Medication-Use Process
Authors: Manzo John , Sinnett Mark J. , Sosnowski Frank , Begliomini Robert , Green Jill , Pane Fred
Published: December 2017

The purpose of this case study is to provide an understanding of the divergent experiences, challenges, and successes associated with implementing Computerized Physician Order Entry (CPOE) at two distinct health systems utilizing the same software vendor. Pharmacy leaders at Lehigh Valley Hospital and Health Network in Allentown, PA and Montefiore Medical Center in the Bronx, NY describe the various strategies deployed for CPOE planning and implementation, the outcomes and impacts of CPOE implementation, and valuable experience. Improvements and efficiencies in the medication management process and time savings will be described. Additionally, reductions in medication prescribing errors and enhancements in medication cost savings secondary to improved medication utilization are delineated. The authors conclude that while the challenges associated with planning and implementing CPOE for medication management and its impact on the pharmacy are great, pharmacist involvement early in the strategic planning is vital to ensure a successful and safer electronic medication management process.
Eszopiclone
Authors: Cada Dennis J. , Levien Terri , Baker Danial E.
Published: December 2017

Each month, subscribers to The Formulary Monograph Service receive five to six well-documented monographs on drugs that are newly released or are in late Phase 3 trials. The monographs are targeted to your Pharmacy and Therapeutics Committee. Subscribers also receive monthly one-page summary monographs on the agents that are useful for agendas and pharmacy/nursing in-services. A comprehensive target drug utilization evaluation (DUE) is also provided each month. With a subscription, the monographs are sent to you in print and CD ROM forms and are available online. Monographs can be customized to meet the needs of your facility. Subscribers to the The Formulary Monograph Service also receive access to a pharmacy bulletin board, The Formulary Information Exchange (The F.I.X.). All topics pertinent to clinical and hospital pharmacy are discussed on The F.I.X.

Through the cooperation of The Formulary, Hospital Pharmacy publishes selected reviews in this column. If you would like information about The Formulary Monograph Service or The F.I.X., call The Formulary at 800-322-4349. The May 2005 monograph topics are micafungin sodium, pramlintide acetate, vaccinia immune globulin intravenous, tipranavir, and sildenafil citrate. The DUE is on micafungin sodium.
Is a New USP Resolution Best for Safety?; Unsafe Tylenol Packaging; Don't Abbr Drg Nms
Authors: Cohen Michael R.
Published: December 2017

These medication errors have occurred in health care facilities at least once. They will happen again—perhaps where you work. Through education and alertness of personnel and procedural safeguards, they can be avoided. You should consider publishing accounts of errors in your newsletters and/or presenting them in your inservice training programs.

Your assistance is required to continue this feature. The reports described here were received through the USP Medication Errors Reporting Program (MERP), which is presented in cooperation with the Institute for Safe Medication Practices. If you have encountered medication errors and would like to report them, you may call USP toll-free, 24 hours a day, at 800-233-7767 (800-23-ERROR).

Any reports published by ISMP will be anonymous. Comments are also invited; the writers’ names will be published if desired. ISMP may be contacted at the address shown below.

Errors, close calls, or hazardous conditions may be reported through the ISMP ( www.ismp.org ) or USP ( www.usp.org ) Web sites or communicated directly to ISMP by calling 800-FAIL SAFE or via E-mail at ismpinfo@ismp.org . ISMP guarantees the confidentiality and security of the information received and respects reporters’ wishes as to the level of detail included in publications.
The Medicare Prescription Drug Benefit and Managed Care Pharmacy
Authors: Teagarden J. Russell
Published: December 2017

Managed care pharmacists are involved formally with the interface between the delivery and financing of health care; their work thus entails an accountability for both elements. Interpreted broadly managed care pharmacists are pharmacists working within the sphere of a health care system, health care purchaser, health insurer, managed care organization, or benefit administration agency. Patients, the pharmacy profession, and society are best served by this broad interpretation, because the interdependency of financing and delivery is inextricably linked to the achievement of good health outcomes. This continuing feature will explore contemporary issues facing managed care pharmacists.
Caution when Seeking Information about Palladone; Patients Need Education about Proper Use of Inhalers; Shaken, Not Stirred; Pharmacy Intervention Trigger; Hot Flashes from Hot Patches
Authors: Cohen Michael R.
Published: December 2017

These medication errors have occurred in health care facilities at least once. They will happen again—perhaps where you work. Through education and alertness of personnel and procedural safeguards, they can be avoided. You should consider publishing accounts of errors in your newsletters and/or presenting them in your inservice training programs.

Your assistance is required to continue this feature. The reports described here were received through the USP Medication Errors Reporting Program (MERP), which is presented in cooperation with the Institute for Safe Medication Practices. If you have encountered medication errors and would like to report them, you may call USP toll-free, 24 hours a day, at 800-233-7767 (800-23-ERROR).

Any reports published by ISMP will be anonymous. Comments are also invited; the writers’ names will be published if desired. ISMP may be contacted at the address shown below.

Errors, close calls, or hazardous conditions may be reported through the ISMP ( www.ismp.org ) or USP ( www.usp.org ) Web sites or communicated directly to ISMP by calling 800-FAIL-SAFE or via E-mail at ismpinfo@ismp.org . ISMP guarantees the confidentiality and security of the information received and respects reporters’ wishes as to the level of detail included in publications.
More on Delayed Heparin-Induced Thrombocytopenia; Neuropathy with Tumor Necrosis Factor-Alpha Blockers; Anaphylaxis Seen with Multiple Sclerosis Therapy; Dystonia Related to Scabies Therapy Recurrence of PTSD Associated with Antiretroviral Therapy; Clozapine-Induced Agranulocytosis – 11 Years Later!; More Reports of Serious Events with Fluoroquinolones – Seizures and Glycemic Control
Authors: Shuster Joel
Published: December 2017

The purpose of this feature is to heighten awareness of specific adverse drug reactions (ADRs), to discuss methods of prevention, and to promote reporting of ADRs to the FDA's medWatch program (800-FDA-1088). If you have reported an interesting preventable ADR to medWatch, please consider sharing the account with our readers.
Evaluation of the First International Normalized Ratio after Acute Care Discharge to the Primary Care Environment
Authors: Spray Jeffery W. , Brackbill Marcia L.
Published: December 2017

Purpose

To determine the percentage of patients who maintain a therapeutic INR (international normalized ratio) when presenting for their first INR follow-up in the primary care setting after hospital discharge.

Methods

Prospective observational trial enrolling patients newly initiated on warfarin.

Results

Data for 35 patients were collected. Fifty-one percent of patients were therapeutic at their first follow-up lab visit with 23% subtherapeutic and 26% supratherapeutic.

Conclusion

A low percentage of patients were therapeutic and more intervention is necessary in the immediate post-discharge time.
New Drugs Approved by the FDA; New Dosage Forms and Indications; Agents Pending FDA Approval; Significant Labeling Changes
Authors: Baker Danial E.
Published: December 2017

This monthly feature will help readers keep current on new drugs, new indications and dosage forms, and safety-related changes in labeling or use. Each month, new information will be added to the table (shown in bold type) and older information will be removed. Efforts have been made to ensure the accuracy of the information; however, if there are any questions, let us know at hospitalpharmacy@drugfacts.com .
Symlin Insulin Adjunct Presents Safety Issues; Changed Ophthalmic Color-Code; Name Pair Confusion
Authors: Cohen Michael R.
Published: December 2017

These medication errors have occurred in health care facilities at least once. They will happen again—perhaps where you work. Through education and alertness of personnel and procedural safeguards, they can be avoided. You should consider publishing accounts of errors in your newsletters and/or presenting them in your inservice training programs.

Your assistance is required to continue this feature. The reports described here were received through the USP Medication Errors Reporting Program (MERP), which is presented in cooperation with the Institute for Safe Medication Practices. If you have encountered medication errors and would like to report them, you may call USP toll-free, 24 hours a day, at 800-233-7767 (800-23-ERROR).

Any reports published by ISMP will be anonymous. Comments are also invited; the writers’ names will be published if desired. ISMP may be contacted at the address shown below.

Errors, close calls, or hazardous conditions may be reported through the ISMP ( www.ismp .org) or USP ( www.usp.org ) Web sites or communicated directly to ISMP by calling 800-FAIL-SAFE or via E-mail at ismpinfo@ismp.org . ISMP guarantees the confidentiality and security of the information received and respects reporters’ wishes as to the level of detail included in publications.
Seizure and Toxic Epidermal Necrolysis with Fluoroquinolone; Another Case of TEN with Levofloxacin; Neurotoxicity with Unexpected High Levels of Free Valproic Acid; Acute Clonidine Withdrawal Leads to an Acute Myocardial Infarction; Hepatotoxicity and Hepatorenal Toxicity with SSRIs; Serotonin Toxicity Associated with Linezolid; The RADAR Project – Research on Adverse Drug Events and Reports; Nonadherence Causes Problems!
Authors: Shuster Joel
Published: December 2017

The purpose of this feature is to heighten awareness of specific adverse drug reactions (ADRs), to discuss methods of prevention, and to promote reporting of ADRs to the FDA's medWatch program (800-FDA-1088). If you have reported an interesting preventable ADR to medWatch, please consider sharing the account with our readers.
The Uncertain Risk of Single-Dose Etomidate in the Critically III
Authors: Fraser Gilles L. , Riker Richard R.
Published: December 2017

This feature examines the impact of pharmacologic interventions on the treatment of the critically ill patient — an area of health care that has become increasingly complex. Recent advances in drug therapy for adult ICU patients (including evolving and controversial data) will be reviewed and assessed in terms of clinical, humanistic, and economic outcomes. Direct questions or comments to Gil Fraser, PharmD, at fraseg@mmc.org .
Leucovorin, Fluorouracil, and Oxaliplatin (FOLFOX 6 and 7) Regimens for Colorectal Cancer
Authors: Waddell J. Aubrey , Solimando Dominic A.
Published: December 2017

The increasing complexity of cancer chemotherapy heightens the requirement that pharmacists be familiar with these highly toxic agents. This column will review various issues related to preparation, dispensing, and administration of cancer chemotherapy. It will also serve as a review of various agents, both commercially available and investigational, used to treat malignant diseases.
Two Steps Forward and One Step Back for Patient Safety? Two Groups Focus on Improved Outcomes, Another on Rx “Vending” Machines Organ Storage Solution
Authors: Cohen Michael R.
Published: December 2017

These medication errors have occurred in health care facilities at least once. They will happen again—perhaps where you work. Through education and alertness of personnel and procedural safeguards, they can be avoided. You should consider publishing accounts of errors in your newsletters and/or presenting them in your inservice training programs.

Your assistance is required to continue this feature. The reports described here were received through the USP Medication Errors Reporting Program (MERP), which is presented in cooperation with the Institute for Safe Medication Practices. If you have encountered medication errors and would like to report them, you may call USP toll-free, 24 hours a day, at 800-233-7767 (800-23-ERROR).

Any reports published by ISMP will be anonymous. Comments are also invited; the writers’ names will be published if desired. ISMP may be contacted at the address shown below.

Errors, close calls, or hazardous conditions may be reported through the ISMP ( www.ismp.org ) or USP ( www.usp.org ) Web sites or communicated directly to ISMP by calling 800-FAIL-SAFE or via E-mail at ismpinfo@ismp.org . ISMP guarantees the confidentiality and security of the information received and respects reporters’ wishes as to the level of detail included in publications.
Decreasing Costs and Optimizing Therapy of Erythropoietic Medications in a Hospital-Based Outpatient Cancer Treatment Center
Authors: Clark Deidre B. , Byrd Debbie C. , Andrus Miranda R. , Rogers Tom , Martin Timothy A.
Published: December 2017

The objectives of this study were to decrease the costs associated with erythropoietic medications and to optimize the use of these medications for patients with chemotherapy-induced anemia.

Methods

A cost-analysis was completed by performing cost calculations which determined that darbepoetin is the most cost-effective erythropoietic medication for one Cancer Treatment Center (CTC). Darbepoetin protocol and order forms were then developed for chemotherapy-induced anemia. The total costs of all erythropoietic medications at the CTC before and after protocol implementation were evaluated via purchasing data. Pre- and post-protocol retrospective chart reviews were completed to determine if protocol implementation resulted in therapy optimization.

Results

Forty-two patients were included in the pre-protocol review, and 21 patients were included in the post-protocol review. After darbepoetin protocol implementation, the average cost per month of erythropoietic medications decreased by approximately $30,500. The percent of patients receiving an appropriate initial dose doubled post-protocol (pre: 38% vs post: 76%). Appropriate monitoring of hemoglobin at baseline, monthly, and before dose adjustments increased to 100% post-protocol implementation; and there was a 50% increase in the percent of patients who had their hemoglobin monitored appropriately until stable.

Conclusions

A savings of approximately $335,000 was expected for the year of 2004 with the protocol use and darbepoetin as the erythropoietic agent of choice. The optimization of therapy should continue to improve via continued use of the darbepoetin protocol.
PDAs for Patients
Authors: Felkey Bill G. , Fox Brent I.
Published: December 2017

Pharmacy is being recognized for provider status in the Medicare Modernization Act (MMA) of 2003. Moreover, the initiation of reimbursement for pharmacists’ delivery of cognitive services is staged to begin. Medication Therapy Management Services (MTMS) and Chronic Care Improvement Programs (CCIP) are both described in the new law. These reimbursable service components can be delivered starting in January of 2006. This installment addresses the convergence of MMA and patient-directed care supported by PDA technology.
Adalimumab: Crohn Disease
Authors: Generali Joyce , Cada Dennis J.
Published: December 2017

Off-Label Drug Uses

This Hospital Pharmacy feature is extracted from Off-Label DrugFacts, a quarterly publication available from Wolters Kluwer Health. Off-Label DrugFacts is a practitioner-oriented resource for information about specific FDA-unapproved drug uses. This new guide to the literature will enable the health care professional/clinician to quickly identify published studies on off-label uses and to determine if a specific use is rational in a patient care scenario. The most relevant data are provided in tabular form, so the reader can easily identify the scope of information available. A summary of the data—including background, study design, patient population, dosage information, therapy duration, results, safety, and therapeutic considerations—precedes each table of published studies. References direct the reader to the full literature for more comprehensive information prior to patient care decisions. Direct questions or comments on “Off-Label Drug Uses” to hospital pharmacy@drugfacts.com .
Impact of a Pharmacy-Initiated HIV Admission Note on Medication Errors within an Academic Hospital
Authors: Sterling Emily S. , Romanelli Frank , Martin Craig A. , Hoven Ardis D. , Smith Kelly M.
Published: December 2017

Purpose

Medication errors occur frequently in the medical management of patients infected with human immunodeficiency virus (HIV). Recent studies propose the use of a pharmacy admission note to help identify and prevent such errors during hospitalization. However, a clear reduction in the number of antiretroviral medication errors utilizing an admission note within a large, academic hospital has yet to be confirmed.

Methods

A retrospective, chart-review of hospitalized HIV-seropositive patients 1 year prior to and after implementation of an admission note policy was performed with the expedited Institutional Review Board (IRB) approval. Antiretroviral medication errors were identified and compared to documented pharmacy interventions at the time of admission.

Results

Twenty-seven antiretroviral medication errors existed in the pre-policy period (n = 32 admissions), with no identification or correction by pharmacy services at the time of admission. Forty-six antiretroviral medication errors were detected in the post-policy period (n = 59 admissions), of which three errors were identified in pharmacy admission notes. Common antiretroviral medication errors in the pre-policy period included incorrect dosing frequency (33.3%) and incorrect drug strength (33.3%). This contrasts with the post-policy period, during which the most frequent antiretroviral medication errors included missing antiretroviral components of known regimens (19.6%) and lack of renal or hepatic dosage adjustment (15.2%). Overall, no improvement in detection and reconciliation of medication errors occurred with admission note implementation.

Conclusions

Potential obstacles in the effective use of an admission note to reduce errors do exist. Strategies for improved outcomes in our academic hospital will focus on improved training of general pharmacy staff in HIV management, providing accessible online resources, and emphasizing reconciliation between outpatient and inpatient medication regimens.
Cardiac Catheter Laboratory Based Computer Generated Bivalirudin/Glycoprotein IIb/IIIa Flow Sheet
Authors: Zolnierz Michael
Published: December 2017

Bivalirudin and glycoprotein IIb/IIIa antagonists are commonly used during percutaneous coronary interventions (PCI). The Pharmacy Department of Charlton Memorial Hospital implemented a dosing flow sheet that is operated by the Cardiac Catheter Lab nursing staff. The computer-oriented program utilizes the Microsoft Excel spreadsheet program. The computer spreadsheet calculates an estimated creatinine clearance (CrCl) rate and inserts proper renal adjusted dosages of both bivalirudin and glycoprotein IIb/IIIa antagonists into a printed flow sheet. The computer program is encoded to follow specific medication regimens for patients whether or not they are on dialysis. Institutions can develop medication dosing flow-sheet forms utilizing the spreadsheet concept.
Preventing Errors with Neuromuscular Blocking Agents: Fluoxetine–Fluvoxamine Mix-Up: Sandoz Ceftriaxone Labeling
Authors: Cohen Michael R.
Published: December 2017

These medication errors have occurred in health care facilities at least once. They will happen again—perhaps where you work. Through education and alertness of personnel and procedural safeguards, they can be avoided. You should consider publishing accounts of errors in your newsletters and/or presenting them in your inservice training programs.

Your assistance is required to continue this feature. The reports described here were received through the USP Medication Errors Reporting Program (MERP), which is presented in cooperation with the Institute for Safe Medication Practices. If you have encountered medication errors and would like to report them, you may call USP toll-free, 24 hours a day, at 800-233-7767 (800-23-ERROR).

Any reports published by ISMP will be anonymous. Comments are also invited; the writers’ names will be published if desired. ISMP may be contacted at the address shown below.

Errors, close calls, or hazardous conditions may be reported through the ISMP ( www.ismp.org ) or USP ( www.usp.org ) Web sites or communicated directly to ISMP by calling 800-FAIL-SAFE or via E-mail at ismpinfo@ismp.org . ISMP guarantees the confidentiality and security of the information received and respects reporters’ wishes as to the level of detail included in publications.
Exenatide Injection
Authors: Cada Dennis J. , Levien Terri , Baker Danial E.
Published: December 2017

Each month, subscribers to The Formulary Monograph Service receive five to six well-documented monographs on drugs that are newly released or are in late phase 3 trials. The monographs are targeted to your Pharmacy and Therapeutics Committee. Subscribers also receive monthly one-page summary monographs on the agents that are useful for agendas and pharmacy/nursing in-services. A comprehensive target drug utilization evaluation (DUE) is also provided each month. With a subscription, the monographs are sent to you in print and CD ROM forms and are available online. Monographs can be customized to meet the needs of your facility. Subscribers to the The Formulary Monograph Service also receive access to a pharmacy bulletin board, The Formulary Information Exchange (The F.I.X.). All topics pertinent to clinical and hospital pharmacy are discussed on The F.I.X.

Through the cooperation of The Formulary, Hospital Pharmacy publishes selected reviews in this column. If you would like information about The Formulary Monograph Service or The F.I.X., call The Formulary at 800-322-4349. The November 2005 monograph topics are pregabalin, nepafenac ophthalmic suspension, mecasermin (rDNA origin) injection, abatacept, and rimonabant. The DUE is on pregabalin.
Does Aging and Disease Increase the Importance of Cognitive Strategies? Social and Temporal Comparisons in Healthy Younger and Older Adults and in Younger and Older Cancer Patients
Authors: Mehlsen Mimi , Mikkelsen Mai Bjørnskov , Andersen Christina Maar , Ollars Chaitali
Published: December 2017

Social and temporal comparisons may help the individual anchor his or her self-image in a social and temporal context. In the Life-Span Theory of Control, comparisons are included in the repertoire of secondary control strategies individuals may apply when primary control strategies are obstructed, for example, by age-related losses or physical decline. The aim of this study was to explore differences in prevalence and effects of social and temporal comparisons in younger and older adults and healthy and diseased individuals ( n = 34). Semistructured interviews were conducted and analyzed using a mixed-methods approach combining qualitative and quantitative data analysis. The results revealed that older adults engaged in more comparisons than younger adults and that the outcomes of comparisons were more positive for older adults, particularly older cancer patients. The results indicate that comparisons may be applied more often by older and diseased individuals in the service of maintaining well-being.
The Delta Survey: Minufiyeh Province, 2006–7
Authors: Rowland Joanne
Published: December 2017

This is the preliminary report for the 2006 and 2007 seasons of the EES Minufiyeh Archaeological Survey. It details the continuation of the ground survey started in the first season in 2005, and also reports upon the geophysical and topographic surveys at Quesna and Kom el-ahmar, Minuf, and the drill core survey carried out at selected sites in the province. The 2007 season included exploratory trenches at Quesna, and the report details the findings in both the Ptolemaic and Roman cemetery and the falcon necropolis. The results suggest substantial ancient settlement remains at several sites across the province.
An Apprentice's Board from DRA ABU EL-Naga*
Authors: Galán José M.
Published: December 2017

A wooden board used for drawing and writing was found in pieces by the Spanish–Egyptian mission at Dra Abu el-Naga (TT 11–12). It probably dates to the reign of Hatshepsut–Thutmosis III. On the recto there is a double drawing of a royal standing statue in frontal view. The two figures are drawn on squared grids traced in red ink. Next to the drawing exercise the first paragraph of Kemit has been written three times. On the left half of the verso a pharaoh is drawn in the posture of fowling, while the right half of the surface has been washed for re-use.
A New Old Kingdom Inscription from Giza (CGC 57163), and the Problem of SN-

D

T in Pharaonic third Millennium Society
Authors: García Juan Carlos Moreno
Published: December 2017

Panel CGC 57163 provides both a new inscribed monument from the poorly preserved tomb D 203 at Giza and another reference to the rather obscure term sn-dt ‘brother of the endowment’. Study of the epigraphic evidence as well as the administrative documents from the Old Kingdom shows that the use of this term was not limited to the funerary sphere: it also refers to individuals who replaced another person in the performance of certain duties, both of a ritual and administrative nature. In a funerary context, a sn-dt was an administrator of institutional goods formerly granted to a particular functionary but subsequently allotted — under condition — to a secondary recipient. The probable goal of this procedure was to keep their assets separate. In any case, the sn-dt disappears from the epigraphic and papyrological record from the beginning of the Sixth Dynasty.
A Demotic Inscribed Icosahedron from Dakhleh Oasis*
Authors: Minas-Nerpel Martina
Published: December 2017

A unique icosahedron was found at Qaret el-Muzzawaqa in the 1980s and is now housed in the New Valley Museum at Kharga. It probably dates to the first century AD. In contrast to other icosahedra known from Graeco-Roman Egypt, this one is not inscribed with Greek or Latin letters or numbers, but with 20 Egyptian divine names in Demotic, thus adapting Egyptian concepts to a Greek form. The piece provides striking evidence for the mixing of cultural traditions in Dakhleh Oasis in the Roman Period. The polyhedron was presumably used in an oracular procedure intended to establish which deity would provide help to the petitioner.
Lessons from the Great Recession
Authors: Fitzgerald Brian K. , Barkanic Steve , Cardenas-Navia Isabel , Chen Janet , Gross Ursula , Hughes Debbie
Published: December 2017

This essay reviews the work of the US Business–Higher Education Forum (BHEF) in data science and analytics and offers a brief review of how BHEF catalysed responses from its academic members to meet the talent needs of its business members, highlighting implications for business and higher education in the future.
‘Strong’ states and strategic governance: A model of territorial variation in state presence
Authors: Steinberg Jessica
Published: December 2017

Regions of limited state presence persist in weak states, but does unevenness persist even in so-called ‘strong’ states? An underlying assumption behind weak states is that they lack capacity to broadcast power evenly over the entirety of their territory. Yet all states have finite resources, thus it is not clear that uneven state presence should be restricted to weak states. I develop a formal model that explores when strong states might strategically retain regions of limited state presence or subcontract state functions to non-state actors. The model demonstrates subnational characteristics that render the broadcasting of power by the state to be suboptimal, creating incentives for even strong states to retain regions of limited state presence.
Safety and pharmacodynamics of venetoclax (ABT-199) in a randomized single and multiple ascending dose study in women with systemic lupus erythematosus
Authors: Lu P , Fleischmann R , Curtis C , Ignatenko S , Clarke S H , Desai M , Wong S L , Grebe K M , Black K , Zeng J , Stolzenbach J , Medema J K
Published: December 2017

Objective

The anti-apoptotic protein B-cell lymphoma 2 (Bcl-2) may contribute to the pathogenesis of systemic lupus erythematosus. The safety, tolerability, and pharmacodynamics of the selective Bcl-2 inhibitor venetoclax (ABT-199) were assessed in women with systemic lupus erythematosus.

Methods

A phase 1, double-blind, randomized, placebo controlled study evaluated single ascending doses (10, 30, 90, 180, 300, and 500 mg) and multiple ascending doses (2 cycles; 30, 60, 120, 240, 400, and 600 mg for 1 week, and then 3 weeks off per cycle) of orally administered venetoclax. Eligible participants were aged 18–65 years with a diagnosis of systemic lupus erythematosus for 6 months or more receiving stable therapy for systemic lupus erythematosus (which could have included corticosteroids and/or stable antimalarials).

Results

All patients (48/48) completed the single ascending dose, 25 continued into the multiple ascending dose, and 44/50 completed the multiple ascending dose; two of the withdrawals (venetoclax 60 mg and 600 mg cohorts) were due to adverse events. Adverse event incidences were slightly higher in the venetoclax groups compared with the placebo groups, with no dose dependence. There were no serious adverse events with venetoclax. The most common adverse events were headache, nausea, and fatigue. Venetoclax 600 mg multiple ascending dose treatment depleted total lymphocytes and B cells by approximately 50% and 80%, respectively. Naive, switched memory, and memory B-cell subsets enriched in autoreactive B cells exhibited dose-dependent reduction of up to approximately 80%. There were no consistent or marked changes in neutrophils, natural killer cells, hemoglobin, or platelets.

Conclusions

Venetoclax was generally well tolerated in women with systemic lupus erythematosus and reduced total lymphocytes and disease-relevant subsets of antigen-experienced B cells.

Registration

ClinicalTrials.gov: NCT01686555.
Abdominal Angiostrongyliasis: A Presentation of Eosinophilic Granulomatous Colitis
Authors: Walls Timothy , Cavuoti Dominick , Channabasappa Nandini , Yang Mary , Southern Paul , Gill Michelle A. , Park Jason Y.
Published: December 2017

We present a case of a 4-year-old girl with abdominal angiostrongyliasis who presented with persistent fevers, hepatosplenomegaly, acute abdominal pain, and eosinophilia. Computed tomography scan identified thickening of the ascending colon with a narrowed lumen. Endoscopic evaluation revealed ulcerations and erythema in the ascending colon. The microscopic findings in biopsies included active chronic inflammation with prominent eosinophils and granulomas. A subset of granulomas contained the eggs of Angiostrongylus costaricensis. The definitive method of diagnosing A costaricensis is histology; peripheral blood serology has low specificity and the stool from infected patients does not contain eggs or larvae. Pathologists from endemic regions (Central and South America) are familiar with the typical histologic changes; however, because of increasing global travel, all pathologists should become familiar with A costaricensis, which may mimic common gastrointestinal diseases such as Crohn’s disease, appendicitis, and Meckel’s diverticulum.
Radiographic Change of the Distal Tibiofibular Joint Following Removal of Transfixing Screw Fixation
Authors: Baek Jong Hun , Kim Tae Yong , Kwon Yoo Beom , Jeong Bi O
Published: December 2017

Background:

Syndesmosis disruptions in the ankle joint are typically treated with anatomic reduction followed by transfixing screw and/or suture button fixation. The purpose of our study was to analyze the effects of the removal of transfixing screws on syndesmosis integrity using plain radiographs and computed tomography (CT) scans.

Methods:

Twenty-nine cases (29 patients) who had been treated with transfixing screw fixation for syndesmosis disruptions were studied prospectively. Plain radiographs and CT scans were obtained 1 day before and 3 months after the removal of transfixing screws. The tibiofibular clear space (TCS) and tibiofibular overlap (TFO) were measured on plain radiographs, and the anterior and posterior measurement ratio (A/P ratio) of the syndesmosis was measured on axial CT scans to radiographically analyze the effect of the removal of screws on syndesmosis integrity.

Results:

On plain radiographs, syndesmosis diastasis was not observed before or after the removal of transfixing screws. No statistically significant difference was found in the TCS and the TFO between measurements at prescrew removal and at postscrew removal ( P = .761 and .628, respectively). However, the syndesmosis was found malreduced on CT scans in 7 cases (24.1%) before screw removal. All 7 cases showed anterior malreduction of the syndesmosis, 5 (71.4%) of which spontaneously reduced after screw removal. The A/P ratio of the 7 cases decreased from a mean of 1.37 (range, 1.26-1.61) at prescrew removal to a mean of 1.12 (range, 0.96-1.25) at postscrew removal ( P = .016).

Conclusion:

Syndesmosis malreduction not observed on plain radiographs after performing transfixing screw fixation was identified with CT scans. Of the cases with a malreduced syndesmosis, 71.4% showed spontaneous reduction after screw removal. Therefore, we believe the removal of transfixing screws is recommended after confirming malreduction on CT scans, although plain radiographs demonstrate anatomic reduction.

Level of Evidence:

Level II, prospective prognostic study.