bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of Decompensated Cirrhosis With and Without Patent Paraumbilical Vein
Authors: Size Wu  , Jianhui Zhang  , Guangqing Liu
Published: May 2010

A patent paraumbilical vein (PUV) is a finding predominantly in patients with cirrhosis, with controversy regarding the clinical significance. This study evaluated whether there is a difference between patients with hepatitis B virus— and hepatitis C virus—related decompensated cirrhosis of Child-Pugh class C with and without a patent PUV. Fifty patients with patent PUV were selected and 50 patients without patent PUV were matched according to age and gender, and age and gender were of no significant difference between the two groups. Patent PUV was determined by Doppler duplex sonography, and laboratory data and clinical data were collected and studied. The results showed that the patent PUV of cirrhosis of Child-Pugh class C produces no additional significant impact on liver function, incidence, and bleeding of esophageal varices or hepatic encephalopathy.
Factors That Contribute to Wrist-Hand-Finger Discomfort in Diagnostic Medical Sonographers and Vascular Technologists
Authors: Evans Kevin , Roll Shawn C. , Hutmire Cristina , Baker Joan P.
Published: May 2010

A cross-sectional representative sample of 1722 sonographers and vascular technologists was analyzed using quantitative/qualitative methods to reveal that 60% are experiencing wrist-hand-finger discomfort, believed to be from work-related repetitive injury. The years of scanning accumulated by the participants was chosen as a variable to determine the relationship to the range of discomforts reported. A strong statistical correlation was noted between years of experience and the side of discomfort as well as the severity of hand-wrist-finger discomfort. In this study, a strong statistical association was also noted between increasing years of scanning and decreasing aggravation due to the transducer. A complete linkage between work-related exposure and hand-wrist-finger discomfort is difficult to make because of the contribution of leisure-time activities. A controlled experimental study is needed to determine the contribution that grip and pushing on the transducer may have on the incidence of hand-wrist-finger discomfort, leading to diagnoses such as carpal tunnel syndrome.
Stent-Induced Cholangitis Mimicking Biliary Dilatation on Sonography
Authors: Ghazle Hamad , Abu-Yousef Monzer
Published: May 2010

This study describes the sonographic features of stent-induced cholangitis, which could be mistaken for biliary dilatation and obstruction. It involves six patients with a mean age of 71 years (range, 29—81 years) who underwent endoscopic biliary stenting because of biliary obstruction. Stenting duration varied from nine days to five months. All patients had prestenting and poststenting sonograms. The sonographic characteristics were analyzed in all of the patients, with the diagnosis being confirmed by retrograde cholangiopancreaticography. All patients showed biliary dilatation without ductal wall thickening on prestenting sonograms. Follow-up sonograms demonstrated diffuse hypoechoic ductal wall thickening in all patients. In four patients, the ductal lumen was obliterated by wall thickening, which initially led to a misdiagnosis of persistent biliary dilatation. The degree of ductal wall thickening did not correlate with stenting duration. Diagnosis of stent-induced cholangitis should be considered when hypoechoic and thickened bile duct walls are found on sonography. Careful scanning technique and meticulous assessment of the sonographic images helped to separate the echo-free ductal lumen from the hypoechoic edematous mucosal lining. When evaluating patients following stenting, sonographers may need to obtain fine detailed views of the common bile duct to be able to differentiate ductal wall edema from biliary dilatation.
Subependymal Pseudocysts in the Fetal Brain and Unrelated Hydrocolpos
Authors: Epstein Sylvia , Cosgrove Maureen , Hanley Maryellen L.
Published: May 2010

Subependymal pseudocysts are found in approximately 5% of all neonates. When they are isolated, the outcome is usually favorable. However, when they are associated with other anomalies, the prognosis is often poor. The diagnosis of imperforate hymen is rarely diagnosed before puberty, but reports of diagnosis in utero have been documented. The authors present a case with two coexisting rare findings in one fetus. The postnatal outcome for the infant with these isolated unrelated findings proved to be reassuring.
Redirecting T-cell specificity by introducing a tumor-specific chimeric antigen receptor
Authors: Jena Bipulendu , Dotti Gianpietro , Cooper Laurence J. N.
Published: May 2010

Infusions of antigen-specific T cells have yielded therapeutic responses in patients with pathogens and tumors. To broaden the clinical application of adoptive immunotherapy against malignancies, investigators have developed robust systems for the genetic modification and characterization of T cells expressing introduced chimeric antigen receptors (CARs) to redirect specificity. Human trials are under way in patients with aggressive malignancies to test the hypothesis that manipulating the recipient and reprogramming T cells before adoptive transfer may improve their therapeutic effect. These examples of personalized medicine infuse T cells designed to meet patients' needs by redirecting their specificity to target molecular determinants on the underlying malignancy. The generation of clinical grade CAR+ T cells is an example of bench-to-bedside translational science that has been accomplished using investigator-initiated trials operating largely without industry support. The next-generation trials will deliver designer T cells with improved homing, CAR-mediated signaling, and replicative potential, as investigators move from the bedside to the bench and back again.
How I conduct the family meeting to discuss the limitation of life-sustaining interventions: a recipe for success
Authors: DeLisser Horace M.
Published: May 2010

The meeting with the family of a hospitalized patient dying with advanced cancer or hematologic disease in which the limitation of life-sustaining interventions is discussed can be a challenge, particularly for junior physicians. A successful conclusion to this discussion involves an outcome in which the family, without coercion or manipulation, comes to accept that the appropriate care has been provided to their loved one, while the caregivers are enabled to provide care that is goal-directed and patient-centered. This type of result can be achieved through an approach in which patient-focused recommendations are offered in the context of diligent efforts to establish and sustain trust, thoughtful preparation, and respectful discussions with the family.
MicroRNA-26a-mediated regulation of interleukin-2 expression in transformed avian lymphocyte lines
Authors: Xu Hongtao , Yao Yongxiu , Smith Lorraine P , Nair Venugopal
Published: May 2010

Background

Micro(mi)RNAs are a class of small non-coding RNAs that play critical roles in the induction of various cancers, including lymphomas induced by oncogenic viruses. While some of the miRNAs are oncogenic, miRNAs such as miR-26a are consistently downregulated in a number of cancers, demonstrating their potential tumor suppressor functions. Global miRNA expression profiles of a number of virus-transformed avian lymphoma cell lines have shown downregulation of gga-miR-26a expression, irrespective of molecular mechanisms of transformation or the viral aetiology. The neoplastic transformation of lymphocytes by many viruses accompanies high levels of proliferative responses, mostly mediated through cytokines such as IL-2. Chicken IL-2 can modulate T-cell proliferation and cytotoxicity in vitro and in vivo and dysregulation of IL-2 expression is observed in diseases such as leukaemia.

Results

The expression levels of gga-miR-26a in chicken lymphoma cells transformed by 3 distinct avian oncogenic viruses, viz Marek's disease virus (MDV), avian leukosis virus (ALV) and Reticuloendotheliosis virus (REV) were consistently downregulated compared to the levels in the normal lymphocytes. This downregulation of miR-26a regardless of the viral etiology and molecular mechanisms of transformation was consistent with the tumor suppressor role of this miRNA. Notwithstanding this well-established role in cancer, we demonstrate the additional role of this miRNA in directly targeting chicken IL-2 through reporter and biochemical assays. The downregulation of miR-26a can relieve the suppressive effect of this miRNA on IL-2 expression.

Conclusions

We show that miR-26a is globally downregulated in a number of avian lymphoma cells irrespective of the mechanisms of transformation, reiterating the highly conserved tumor suppressor function of this miRNA. However, with the potential for directly targeting chicken IL-2, the downregulation of miR-26a in these tumor cells could relieve the inhibitory effect on IL-2 expression assisting in the proliferative features of the transformed lymphocyte lines.
Dihydroartemisinin-piperaquine versus chloroquine to treat vivax malaria in Afghanistan: an open randomized, non-inferiority, trial
Authors: Awab Ghulam Rahim , Pukrittayakamee Sasithon , Imwong Mallika , Dondorp Arjen M , Woodrow Charles J , Lee Sue Jean , Day Nicholas PJ , Singhasivanon Pratap , White Nicholas J , Kaker Faizullah
Published: May 2010

Background

Afghanistan's national guidelines recommend chloroquine for the treatment of Plasmodium vivax infection, the parasite responsible for the majority of its malaria burden. Chloroquine resistance in P. vivax is emerging in Asia. Therapeutic responses across Afghanistan have not been evaluated in detail.

Methods

Between July 2007 and February 2009, an open-label, randomized controlled trial of chloroquine and dihydroartemisinin-piperaquine in patients aged three months and over with slide-confirmed P. vivax mono-infections was conducted. Consistent with current national guidelines, primaquine was not administered. Subjects were followed up daily during the acute phase of illness (days 0-3) and weekly until day 56. The primary endpoint was the overall cumulative parasitological failure rate at day 56 after the start of treatment, with the hypothesis being that dihydroartemisinin-piperaquine was non-inferior compared to chloroquine (Δ = 5% difference in proportion of failures).

Results

Of 2,182 individuals with positive blood films for P. vivax, 536 were enrolled in the trial. The day 28 cure rate was 100% in both treatment groups. Parasite clearance was more rapid with dihydroartemisinin-piperaquine than chloroquine. At day 56, there were more recurrent infections in the chloroquine arm (8.9%, 95% CI 6.0-13.1%) than the dihydroartemisinin-piperaquine arm (2.8%, 95% CI 1.4-5.8%), a difference in cumulative recurrence rate of 6.1% (2-sided 90%CI +2.6 to +9.7%). The log-rank test comparing the survival curves confirmed the superiority of dihydroartemisinin-piperaquine over chloroquine (p = 0.003). Multivariate analysis showed that a lower initial haemoglobin concentration was also independently associated with recurrence. Both regimens were well tolerated and no serious adverse events were reported.

Conclusions

Chloroquine remains an efficacious treatment for the treatment of vivax malaria in Afghanistan. In a setting where radical therapy cannot be administered, dihydroartemisinin-piperaquine provides additional benefit in terms of post-treatment prophylaxis, reducing the incidence of recurrence from 4-8 weeks after treatment.

Trial Registration

The trial was registered at ClinicalTrials.gov under identifier NCT00682578.
Parameterization of high magnetic field gradient fractionation columns for applications with Plasmodium falciparum infected human erythrocytes
Authors: Karl Stephan , Davis Timothy ME , St Pierre Tim G
Published: May 2010

Background

Magnetic fractionation of erythrocytes infected with Plasmodium falicparum has several research uses including enrichment of infected cells from parasite cultures or enhanced detection of P. falciparum gametocytes. The aim of the present study was to quantitatively characterize the magnetic fractionation process and thus enable optimization of protocols developed for specific uses.

Methods

Synchronized cultures of P. falciparum parasites incubated with human erythrocytes were magnetically fractionated with commercially available columns. The timing of the fractionation experiments was such that the parasites were in second half of their erythrocytic life cycle with parasite densities ranging from 1 to 9%. Fractionations were carried out in a single pass through the columns. Cells were enumerated and differentiated in the initial samples as well as in the positive and negative fractions. The capture of cells by the fractionation column was described by a saturation binding model.

Results

The magnetic binding affinity to the column matrix was approximately 350 times greater for infected cells compared with uninfected cells. The purity of infected cells in the captured fraction was generally >80% but decreased rapidly (to less than 50%) when the number of infected cells that passed through the column was substantially decreased (to less than 9 ± 5 × 105 cells). The distribution of captured parasite developmental stages shifted to mature stages as the number of infected cells in the initial samples and flow rate increased. The relationship between the yield of infected cells in the captured fraction and flow rate of cells conformed to a complementary cumulative log-normal equation with flow rates >1.6 × 105 cells per second resulting in yields <50%.

Conclusions

A detailed quantitative analysis of a batchwise magnetic fractionation process for malaria infected erythrocytes using high gradient magnetic fractionation columns was performed. The models applied in this study allow the prediction of capture efficiency if the initial infected cell concentration and the flow rate are known.
Molecular mechanisms of acquired resistance to tyrosine kinase targeted therapy
Authors: Sierra J. Rafael , Cepero Virna , Giordano Silvia
Published: May 2010

In recent years, tyrosine kinases (TKs) have been recognized as central players and regulators of cancer cell proliferation, apoptosis, and angiogenesis, and are therefore considered suitable potential targets for anti-cancer therapies. Several strategies for targeting TKs have been developed, the most successful being monoclonal antibodies and small molecule tyrosine kinase inhibitors. However, increasing evidence of acquired resistance to these drugs has been documented, and extensive preclinical studies are ongoing to try to understand the molecular mechanisms by which cancer cells are able to bypass their inhibitory activity.

This review intends to present the most recently identified molecular mechanisms that mediate acquired resistance to tyrosine kinase inhibitors, identified through the use ofin vitromodels or the analysis of patient samples. The knowledge obtained from these studies will help to design better therapies that prevent and overcome resistance to treatment in cancer patients.
Computational challenges in the analysis of ancient DNA
Authors: Prüfer Kay , Stenzel Udo , Hofreiter Michael , Pääbo Svante , Kelso Janet , Green Richard E
Published: May 2010

High-throughput sequencing technologies have opened up a new avenue for studying extinct organisms. Here we identify and quantify biases introduced by particular characteristics of ancient DNA samples. These analyses demonstrate the importance of closely related genomic sequence for correctly identifying and classifying bona fide endogenous DNA fragments. We show that more accurate genome divergence estimates from ancient DNA sequence can be attained using at least two outgroup genomes and appropriate filtering.
Coprescription of Tamoxifen and Medications That Inhibit CYP2D6
Authors: Sideras Kostandinos , Ingle James N. , Ames Matthew M. , Loprinzi Charles L. , Mrazek David P. , Black John L. , Weinshilboum Richard M. , Hawse John R. , Spelsberg Thomas C. , Goetz Matthew P.
Published: May 2010

Evidence has emerged that the clinical benefit of tamoxifen is related to the functional status of the hepatic metabolizing enzyme cytochrome P450 2D6 (CYP2D6). CYP2D6 is the key enzyme responsible for the generation of the potent tamoxifen metabolite, endoxifen. Multiple studies have examined the relationship of CYP2D6 status to breast cancer outcomes in tamoxifen-treated women; the majority of studies demonstrated that women with impaired CYP2D6 metabolism have lower endoxifen concentrations and a greater risk of breast cancer recurrence. As a result, practitioners must be aware that some of the most commonly prescribed medications coadministered with tamoxifen interfere with CYP2D6 function, thereby reducing endoxifen concentrations and potentially increasing the risk of breast cancer recurrence. After reviewing the published data regarding tamoxifen metabolism and the evidence relating CYP2D6 status to breast cancer outcomes in tamoxifen-treated patients, we are providing a guide for the use of medications that inhibit CYP2D6 in patients administered tamoxifen.
Basic Concepts and Methods for Joint Models of Longitudinal and Survival Data
Authors: Ibrahim Joseph G. , Chu Haitao , Chen Liddy M.
Published: May 2010

Joint models for longitudinal and survival data are particularly relevant to many cancer clinical trials and observational studies in which longitudinal biomarkers (eg, circulating tumor cells, immune response to a vaccine, and quality-of-life measurements) may be highly associated with time to event, such as relapse-free survival or overall survival. In this article, we give an introductory overview on joint modeling and present a general discussion of a broad range of issues that arise in the design and analysis of clinical trials using joint models. To demonstrate our points throughout, we present an analysis from the Eastern Cooperative Oncology Group trial E1193, as well as examine some operating characteristics of joint models through simulation studies.
Rituximab Maintenance Treatment of Relapsed/Resistant Follicular Non-Hodgkin's Lymphoma: Long-Term Outcome of the EORTC 20981 Phase III Randomized Intergroup Study
Authors: van Oers Marinus H.J. , Van Glabbeke Martine , Giurgea Livia , Klasa Richard , Marcus Robert E. , Wolf Max , Kimby Eva , van t Veer Mars , Vranovsky Andrej , Holte Harald , Hagenbeek Anton
Published: May 2010

Purpose

In 2006, we published the results of the European Organisation for Research and Treatment of Cancer phase III trial EORTC 20981 on the role of rituximab in remission induction and maintenance treatment of relapsed/resistant follicular lymphoma (FL). At that time, the median follow-up for the maintenance phase was 33 months. Now, we report the long-term outcome of maintenance treatment, with a median follow-up of 6 years.

Patients and Methods

Overall, 465 patients were randomly assigned to induction with either six cycles of cyclophosphamide, doxorubicin, vincristine, prednisone (CHOP) or rituximab plus CHOP (R-CHOP). Those in complete remission or partial remission after induction (n = 334) were randomly assigned to maintenance treatment with rituximab (375 mg/m2 intravenously once every 3 months) or observation.

Results

Rituximab maintenance significantly improved progression-free survival (PFS) compared with observation (median, 3.7 years v 1.3 years; P < .001; hazard ratio [HR], 0.55), both after CHOP induction (P < .001; HR, 0.37) and R-CHOP (P = .003; HR, 0.69). The 5-year overall survival (OS) was 74% in the rituximab maintenance arm, and it was 64% in the observation arm (P = .07). After progression, a rituximab-containing salvage therapy was given to 59% of patients treated with CHOP followed by observation, compared with 26% after R-CHOP followed by rituximab maintenance. Rituximab maintenance was associated with a significant increase in grades 3 to 4 infections: 9.7% v 2.4% (P = .01).

Conclusion

With long-term follow-up, we confirm the superior PFS with rituximab maintenance in relapsed/resistant FL. The improvement of OS did not reach statistical significance, possibly because of the unbalanced use of rituximab in post-protocol salvage treatment.
Phase I/IIa Study of Cilengitide and Temozolomide With Concomitant Radiotherapy Followed by Cilengitide and Temozolomide Maintenance Therapy in Patients With Newly Diagnosed Glioblastoma
Authors: Stupp Roger , Hegi Monika E. , Neyns Bart , Goldbrunner Roland , Schlegel Uwe , Clement Paul M.J. , Grabenbauer Gerhard G. , Ochsenbein Adrian F. , Simon Matthias , Dietrich Pierre-Yves , Pietsch Torsten , Hicking Christine , Tonn Joerg-Christian , Diserens Annie-Claire , Pica Alessia , Hermisson Mirjam , Krueger Stefan , Picard Martin , Weller Michael
Published: May 2010

Purpose

Invasion and migration are key processes of glioblastoma and are tightly linked to tumor recurrence. Integrin inhibition using cilengitide has shown synergy with chemotherapy and radiotherapy in vitro and promising activity in recurrent glioblastoma. This multicenter, phase I/IIa study investigated the efficacy and safety of cilengitide in combination with standard chemoradiotherapy in newly diagnosed glioblastoma.

Patients and Methods

Patients (age ≥ 18 to ≤ 70 years) were treated with cilengitide (500 mg) administered twice weekly intravenously in addition to standard radiotherapy with concomitant and adjuvant temozolomide. Treatment was continued until disease progression or for up to 35 weeks. The primary end point was progression-free survival (PFS) at 6 months.

Results

Fifty-two patients (median age, 57 years; 62% male) were included. Six- and 12-month PFS rates were 69% (95% CI, 54% to 80%) and 33% (95% CI, 21% to 46%). Median PFS was 8 months (95% CI, 6.0 to 10.7 months). Twelve- and 24-month overall survival (OS) rates were 68% (95% CI, 53% to 79%) and 35% (95% CI, 22% to 48%). Median OS was 16.1 months (95% CI, 13.1 to 23.2 months). PFS and OS were longer in patients with tumors with O6-methylguanine-DNA methyltransferase (MGMT) promoter methylation (13.4 and 23.2 months) versus those without MGMT promoter methylation (3.4 and 13.1 months). The combination of cilengitide with temozolomide and radiotherapy was well tolerated, with no additional toxicity. No pharmacokinetic interactions between temozolomide and cilengitide were identified.

Conclusion

Compared with historical controls, the addition of concomitant and adjuvant cilengitide to standard chemoradiotherapy demonstrated promising activity in patients with glioblastoma with MGMT promoter methylation.
Nonmyeloablative Allogeneic Hematopoietic Cell Transplantation in Patients With Acute Myeloid Leukemia
Authors: Gyurkocza Boglarka , Storb Rainer , Storer Barry E. , Chauncey Thomas R. , Lange Thoralf , Shizuru Judith A. , Langston Amelia A. , Pulsipher Michael A. , Bredeson Christopher N. , Maziarz Richard T. , Bruno Benedetto , Petersen Finn B. , Maris Michael B. , Agura Edward , Yeager Andrew , Bethge Wolfgang , Sahebi Firoozeh , Appelbaum Frederick R. , Maloney David G. , Sandmaier Brenda M.
Published: May 2010

Purpose

Allogeneic hematopoietic cell transplantation (HCT) after high-dose conditioning regimens imposes prohibitively high risks of morbidity and mortality for patients with high-risk acute myeloid leukemia (AML) who are older or have comorbid conditions. Here, we examined outcomes after nonmyeloablative allogeneic HCT in such patients.

Patients and Methods

Two hundred seventy-four patients (median age, 60 years) with de novo or secondary AML underwent allogeneic HCT from related (n = 118) or unrelated donors (n = 156) after conditioning with 2 Gy of total-body irradiation (TBI) with or without fludarabine. A calcineurin inhibitor and mycophenolate mofetil were used for postgrafting immunosuppression.

Results

With a median follow-up of 38 months in surviving patients, the estimated overall survival at 5 years was 33%. The estimated 5-year relapse/progression and nonrelapse mortality rates were 42% and 26%, respectively. The cumulative incidences of grades 2, 3, and 4 acute graft-versus-host disease (GVHD) were 38%, 9%, and 5%, respectively. The cumulative incidence of chronic GVHD at 5 years was 44%. Patients in first and second complete remission had better survival rates than patients with more advanced disease (37% and 34% v 18%, respectively). Patients with HLA-matched related or unrelated donors had similar survivals. Unfavorable cytogenetic risk status was associated with increased relapse and subsequent mortality. Chronic GVHD was associated with lower relapse risk.

Conclusion

Allogeneic HCT from related or unrelated donors after conditioning with low-dose TBI and fludarabine, relying almost exclusively on graft-versus-leukemia effects, can result in long-term remissions in older or medically infirm patients with AML.
Clinical Pharmacology in the Adolescent Oncology Patient
Authors: Veal Gareth J. , Hartford Christine M. , Stewart Clinton F.
Published: May 2010

Numerous studies have documented that adolescents and young adults (AYAs) experience a significant cancer burden as well as significant cancer mortality compared with other age groups. The reasons for the disparate outcomes of AYAs and other age groups are not completely understood and are likely to be multifactorial, including a range of sociodemographic issues unique to these individuals as well as differences between adolescents, younger pediatric patients, and adults in the pharmacology of anticancer agents. Because adolescence is a period of transition from childhood to early adulthood, numerous physical, physiologic, cognitive, and behavioral changes occur during this time. In this review, we provide an overview of the unique developmental physiology of the adolescent and explain how these factors and the behavioral characteristics of adolescents may affect the pharmacology of anticancer agents in this patient population. Finally, we describe examples of studies that have assessed the relation between drug disposition and age, focusing on the AYA age group.
Preventing Mix-Ups between Various Formulations of Amphotericin B; Cardiac Catheterization Lab Error; Say Again?; Colchicine Deaths
Authors: Cohen Michael R. , Smetzer Judy L.
Published: May 2010

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 (ISMP). If you have encountered medication errors and would like to report them, you may call USP tollfree, 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 United States Pharmacopeia (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.
Advanced Practice Programs in Hospital Pharmacy: Anticoagulation Management
Authors: Gonzaga Joedell M. , Weber Robert J.
Published: May 2010

The Director's Forum series is written and edited by Michael Sanborn and Robert Weber and is designed to guide pharmacy leaders in establishing patient-centered services in hospitals and health systems. Another specific goal of this column is to address many of the key challenges that pharmacy directors face today, while providing information to foster growth in pharmacy leadership and patient safety. This month's Forum focuses on specific ways to improve anticoagulation managment in your hospital pharmacy department. This area presents an important opportunity for pharmacists to participate actively in improving patient safety.
Scheduling of Pharmacist-Provided Medication Education for Hospitalized Patients
Authors: Donihi Amy Calabrese , Yang Eunjin , Mark Scott M. , Sirio Carl A. , Weber Robert J.
Published: May 2010

Purpose

In a comprehensive medication-education program at the University of Pittsburgh Medical Center, pharmacists provide medication education for hospitalized patients at high risk for nonadherence. This study assessed whether patients' ability to recall medication information after hospital discharge was influenced by the timing of education.

Methods

Patients who received medication education from pharmacists during a 10-week period were included. Patients were called 2 to 3 days after discharge and were asked to recall the indication, name, dose, frequency, and side effects for 2 medications that were reviewed by the pharmacist. After grouping patients by number of days between education and discharge, recall accuracy was compared between the groups.

Results

Of 270 patients who received education, 100 patients met inclusion criteria and were available for telephone follow-up. The highest recall responses were for frequency of administration (88%), medication name (78%), indication (78%), and dose (75%). In contrast, side effects were accurately recalled by only 34% of the patients. No significant differences were seen between the percentage of patients accurately recalling medication information and the time that education occurred; however, patients educated on the day of discharge tended to recall medication information less accurately.

Conclusion

Patients educated on the day of discharge did not recall medication information better than those educated prior to the day of discharge. It may be advantageous for medication education to occur 2 to 3 days prior to hospital discharge. Side-effect information was poorly retained; different strategies must be employed to improve patient recall of side effects.
To iPhone or Not, That is the Question
Authors: Felkey Bill G. , Fox Brent I.
Published: May 2010

Due to popular demand, we are resuming our PDA (personal digital assistant) Interface column and are devoting our first piece to helping readers evaluate the iPhone, which is Apple Computer's first entry into the smart-phone environment. In a recent national meeting, we asked our audience of pharmacists how many of them had purchased the iPhone. Only about 5% raised their hands. Since its introduction earlier in the year, we are frequently asked about the iPhone. The number 1 question we receive is whether or not the 2 of us have chosen to move to this device. Other questions focus on whether or not the iPhone is a good fit for a pharmacist. What follows is our considered opinion.
Fatty Liver Disease Associated with Leuprorelin Acetate; Methotrexate Used for Psoriasis Causes Different Dermatological Problem; Mefloquine-Induced Eosinophilic Pneumonia; Gingival Bleeding Due to Venlafaxine; Depression with Mycophenolate Mofetil; Propofol-Induced Movement Disorders; Erythema Nodosum and Erythema Multiforme after Local Lidocaine Spray
Authors: Shuster Joel
Published: May 2010

The purpose of this feature is to heighten awareness of specific adverse drug reactions (ADRs), discuss methods of prevention, and promote reporting of ADRs to the Food and Drug Administration's (FDA) medWatch program (800-FDA-1088). If you have reported an interesting preventable ADR to medWatch, please consider sharing the account with our readers.
Rasburicase: Gout
Authors: Generali Joyce , Cada Dennis J.
Published: May 2010

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 these 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 regarding “Off-Label Drug Uses” to hospitalpharmacy@wolterskluwer.com .
Computer-Based Monitoring as a Tool for Antimicrobial De-Escalation
Authors: Chambers Rachel M. , Wilson John W. , Estes Lynn L.
Published: May 2010

Purpose

Multiple studies have found an association between the prompt initiation of empirically-appropriate antimicrobial therapy and improved patient outcomes. Such empiric-antimicrobial therapy is often broad; however, once the patient's infectious syndrome, microbiology, and susceptibilities are more defined, it is important to refine antimicrobial therapy. Despite the potential benefits of an “antimicrobial de-escalation” approach, it may be difficult to enforce in clinical practice. Mayo Clinic's Computer-Based Antimicrobial Monitoring System (CBAM) is a medical-informatics tool that was used to assist in this endeavor. This study evaluates the hypothesis that CBAM can enhance the de-escalation of vancomycin and broad-spectrum combination antimicrobial therapy.

Methods

Hospitalized patients at the Mayo Clinic were screened from January through June 2006 using rule-based algorithms incorporated by CBAM. Interventions were performed by physicians and pharmacists as pertinent. These patients were compared with a historical group of patients obtained by CBAM reporting capabilities. De-escalation rates and mean duration of antimicrobial therapy were compared between groups.

Results

Vancomycin de-escalation rates significantly improved from 33% to 68% with intervention ( P = 0.001). In addition, the average duration of therapy was decreased from 10.4 ± 7.3 days to 7.7 ± 2.4 days among patients who underwent vancomycin de-escalation per recommendation ( P = 0.014).

Conclusions

Utilizing the Mayo Clinic's CBAM system to identify potential patients for de-escalation is a unique approach and was successful at improving adherence to vancomycin de-escalation.
Recent Publications on Medications and Pharmacy
Authors: Sterling Jacyntha
Published: May 2010

Hospital Pharmacy presents this feature to keep pharmacists abreast of new publications in the medical/pharmacy literature. Articles of interest will be abstracted monthly regarding a broad scope of topics
Docetaxel, Cisplatin, and Fluorouracil (DCF) Regimen for Head, Neck, and Advanced Gastric Cancers
Authors: Abouzaid Safiya , Solimando Dominic A. , Waddell J. Aubrey
Published: May 2010

The increasing complexity of cancer chemotherapy now requires that pharmacists be familiar with these highly toxic agents. This column will review various issues related to preparation, dispensing, and administration of cancer chemotherapy, and review various agents, both commercially available and investigational, used to treat malignant diseases.
Furosemide: Sublingual Administration
Authors: Generali Joyce , Cada Dennis J.
Published: May 2010

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 these 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 regarding “Off-Label Drug Uses” to hospitalpharmacy@wolterskluwer.com .
Sapropterin Dihydrochloride Tablets
Authors: Cada Dennis J. , Levien Terri , Baker Danial E.
Published: May 2010

Each month, subscribers to The Formulary Monograph Service receive 5 to 6 well-documented monographs on drugs that are newly released or are in late phase 3 trials. The monographs are targeted to your Pharmacy & Therapeutics Committee. Subscribers also receive monthly 1-page summary monographs on the agents that are useful for agendas and pharmacy/nursing inservices. A comprehensive target drug utilization evaluation (DUE) is also provided each month. With a subscription, the monographs are sent to you in print and are also 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 April 2008 monograph topics are fosaprepitant dimeglumine injection, thrombin (topical recombinant), etravirine, ciclesonide inhalation aerosol, and tetrabenazine. The DUE is on fosaprepitant dimeglumine injection.
Keeping Patients Safe from Iatrogenic Methadone Overdoses Final Curtain for IV Colchicine Overdoses
Authors: Cohen Michael R. , Smetzer Judy L.
Published: May 2010

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 (ISMP). 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 United States Pharmacopeia (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.
Bosentan: Raynaud Phenomenon
Authors: Generali Joyce , Cada Dennis J.
Published: May 2010

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 these 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 regarding “Off-Label Drug Uses” to hospitalpharmacy@wolterskluwer.com .
Lenalidomide: Behçet Syndrome
Authors: Generali Joyce , Cada Dennis J.
Published: May 2010

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 these 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 regarding “Off-Label Drug Uses” to hospitalpharmacy@wolterskluwer.com .
Warfarin Resistance and Enteral Tube Feeding: An Old Problem with a New Solution
Authors: Dickerson Roland N.
Published: May 2010

Nutrition Support Pharmacist features issues pertinent to the practice of clinical pharmacy in the area of metabolic support.
Medication Errors Associated with Cerebyx; Consumer Safety with Creams and Ointments; Caution Regarding Color-Coded Eye Medications; Strength Misread as Total Dose
Authors: Cohen Michael R.
Published: May 2010

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 (ISMP). 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 United States Pharmacopeia (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.
Vincristine, Dactinomycin, and Cyclophosphamide (VAC) Regimen
Authors: Waddell J. Aubrey , Solimando Dominic A.
Published: May 2010

The increasing complexity of cancer chemotherapy now requires that pharmacists be familiar with these highly toxic agents. This column will review various issues related to preparation, dispensing, and administration of cancer chemotherapy and review various agents, both commercially available and investigational, used to treat malignant diseases.
Pitfalls of the Application of the Modification of Diet in Renal Disease Equation to Drug-Dosing Practices: A Tertiary Care Teaching Hospital Experience
Authors: Probst Luke A. , Darko William , Smith Adrienne , Cwikla Gregory M.
Published: May 2010

Medications that are predominantly renally eliminated can result in accumulation and/or toxic adverse effects if prescribed in normal doses to a patient with renal dysfunction. Methods including mathematical formulas such as the Cockcroft-Gault equation have been used to estimate renal function. The Modification of Diet in Renal Disease (MDRD) equation has proven useful in staging the degree of renal dysfunction that a patient may have. However, the application of the MDRD equation for the purpose of determining drug dosage adjustments in patients with renal dysfunction has not yet been validated. Several examples are reported that depict how the use of the MDRD equation for the basis of drug dosing could lead to negative patient outcomes. The process undertaken at our institution to implement a policy prohibiting the use of the MDRD equation for the purpose of drug-dosing adjustments is described.
Sumatriptan Succinate/Naproxen Sodium
Authors: Cada Dennis J. , Levien Terri L. , Baker Danial E.
Published: May 2010

Each month, subscribers to The Formulary Monograph Service receive 5 to 6 well-documented monographs on drugs that are newly released or are in late phase 3 trials. The monographs are targeted to Pharmacy & Therapeutics Committees. Subscribers also receive monthly 1-page summary monographs on agents that are useful for agendas and pharmacy/nursing inservices. A comprehensive target drug utilization evaluation (DUE) is also provided each month. With a subscription, the monographs are sent to you in print and are also 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 August 2008 monograph topics are on alvimopan, tolvaptan, liraglutide, iclaprim injection, and alogliptin. The DUE is on alvimopan.
Linezolid-Induced Black Hairy Tongue Increased Intraocular Pressure Caused by Venlafaxine Hallucinations during Voriconazole Therapy Olanzapine-Associated, New-Onset Atrial Fibrillation Complete Atrioventricular Block Associated with Rivastigmine Imatinib as a Possible Cause of Severe Rhabdomyolysis Reversible Parkinsonism Seen with Octreotide
Authors: Shuster Joel
Published: May 2010

The purpose of this feature is to heighten awareness of specific adverse drug reactions (ADRs), discuss methods of prevention, and promote reporting of ADRs to the US Food and Drug Administration's (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.
Docetaxel and Cyclophosphamide Regimen in the Treatment of Breast Cancer
Authors: Whitmore M. Brooke , Waddell J. Aubrey , Solimando Dominic A.
Published: May 2010

The complexity of cancer chemotherapy requires that pharmacists be familiar with the complicated regimens and highly toxic agents used. This column reviews various issues related to preparation, dispensation, and administration of antineoplastic therapy and the agents, both commercially available and investigational, used to treat malignant diseases.