bluuebunny/crossref_metadata_2025 huggingface dataset:
Stability analysis of a time-optimally controlled electrostatic suspension system and suspension experiments in a vacuum
Authors: Le T T , Jeon J U
Published: June 2010

Electrostatic suspension permits conductive, semiconductive, and dielectric materials to be supported without mechanical contact, in contrast to electromagnetic levitation by which only ferromagnetic materials can be levitated. To expand applications of electrostatic suspension systems, a low-cost electrostatic suspension system using a time optimal bang—bang control scheme where linear analogue high-voltage amplifiers that are costly and bulky are not employed has already been implemented. In this article, a time optimal bang—bang control scheme is used to stabilize the system like the previous work. First, the process to find the recoverable set for all the states in which a time optimal bang—bang control exists is described in detail. Then, the switching criterion for the suspension system is derived by using a backward integration technique and the system stability is theoretically investigated using Lyapunov's function as well. To experimentally verify the system stability in vacuum, suspension experiments are carried out with 3.5 in aluminium discs in a vacuum environment. Experiments in the atmosphere are also conducted for comparison with the results in the vacuum. The experimental results show that an aluminium disc has been stably suspended at a reference gap length of 300 μm in a vacuum environment.
Experimental visualization of two-phase flow patterns and transition from stratified to slug flow
Authors: Vaze M J , Banerjee J
Published: June 2010

The transition from stratified to slug flow generates oscillations in pressure and flowrates. Large liquid surges associated with slug flow are detrimental to the operation of process equipments involving two-phase flow. The characterization of two-phase flow regimes and their transition is thus an important area of research. In the present work, flow patterns for various regimes of air—water two-phase flow are captured experimentally. A flow pattern map is established based on the visualized images. The developed flow regime map is compared with that obtained by Ghajar and Tang. Slug frequency is recorded for a variety of superficial Reynolds number to show the instances of impact pressure. The development of slug and transition to slug flow from stratified flow are analysed using these captured images. It is observed that slug becomes highly chaotic with dispersion of air bubbles, when gas superficial Reynolds number is increased for a fixed value of liquid superficial Reynolds number. For lower gas superficial Reynolds number, the slug is observed to be very clear (without air entrainment). This is true for higher value of liquid superficial Reynolds number as well. The air entrainment increases with increasing gas superficial Reynolds number. This air entrainment might play a dominant role in deciding the flow and thermal characteristics of such two-phase flows.
A higher-order shell model applied to shells with mixed boundary conditions
Authors: Yaghoubshahi M , Asadi E , Fariborz S J
Published: June 2010

By means of the principle of virtual work, the governing equations together with the required boundary conditions of a higher-order shear deformation theory are formulated for the analysis of laminated shells under static loads. A system of 31 first-order partial differential equations is performed for the determination of stress resultants and displacement components. These equations are then solved numerically, utilizing the generalized differential quadrature method for two isotropic cylindrical panels with equal arc length but different radii having S2-type simply supported boundary conditions. The results matched those of other theories. Another analysis is carried out for composite cylindrical panels with two lamination schemes, five different mixed boundary conditions, and two length-to-thickness ratios. The results are compared against solutions obtained from ANSYS finite-element software.
Buckling analysis of functionally graded annular sector plates resting on elastic foundations
Authors: Naderi A , Saidi A R
Published: June 2010

In this study, an analytical solution for the buckling of a functionally graded annular sector plate resting on an elastic foundation is presented. The buckling analysis of the functionally graded annular sector plate is investigated for two typical, Winkler and Pasternak, elastic foundations. The equilibrium and stability equations are derived according to the Kirchhoff's plate theory using the energy method. In order to decouple the highly coupled stability equations, two new functions are introduced. The decoupled equations are solved analytically for a plate having simply supported boundary conditions on two radial edges. Satisfying the boundary conditions on the circular edges of the plate yields an eigenvalue problem for finding the critical buckling load. Extensive results pertaining to critical buckling load are presented and the effects of boundary conditions, volume fraction, annularity, plate thickness, and elastic foundation are studied.
Radiation effects on natural convection flow over an inclined flat plate with temperature-dependent viscosity
Authors: Siddiqa S , Asghar S , Hossain M A
Published: June 2010

The effect of radiation on laminar natural convection flow of a viscous incompressible fluid over a semi-infinite flat plate inclined at a small angle to the horizontal with strong temperature-dependent viscosity has been investigated. The Rosseland approximation is considered while modelling the problem. The non-similar equations are obtained for upstream, downstream, and entire regimes, which are then solved numerically. For constant viscosity, the series solution technique has been employed in order to obtain solutions that are valid near the leading edge as well as in the downstream regime. Later, solutions of the governing equations have been obtained using the finite difference method along with the Keller box technique, taking into consideration variable viscosity. Effects of physical parameters like conduction—radiation para-meter Rd, surface temperature parameter θw, variable viscosity parameter λ, and Prandtl number Pr are shown on the local skin-friction coefficient Cf and the local Nusselt number, Nu. Effects of the parameters on the streamlines are also shown around the point of separation that occurs along the negatively inclined surface.
Intelligent robust tracking control for multi-arm mobile manipulators using a fuzzy cerebellar model articulation controller neural network
Authors: Zuo Y , Wang Y , Zhang Y , Liu X , Huang L , Wu X , Wang Z
Published: June 2010

This article originally analyses intelligent robust tracking for multi-arm fruit-harvesting mobile manipulators (MAFHMMs) with delayed angle-velocity uncertainties. The MAFHMMs are composed of two parts: a crawler-type mobile platform and a four-arm harvesting manipulator. The method proposed here does not require a matching condition for the non-linear uncertainties. A fuzzy cerebellar model articulation controller (CMAC) neural network system is used to approximate an unknown controlled system from the strategic manipulation of the model following the tracking errors. In addition, an adaptive robust compensator is presented to compensate for the uncertainties. Based on the Lyapunov stability theory and neural network approximation capability, several sufficient conditions are derived, which guarantee the convergence of the closed-loop error system. Both simulation and experimental results show the superior control performance of the proposed intelligent control method.
Influence of Track Stiffness Distribution on Vehicle and Track Interactions in Track Transition
Authors: Lei X , Zhang B
Published: June 2010

A model for dynamic analysis of the vehicle-track-subgrade coupling system was developed by utilizing the finite-element method. Based on the model, new types of vehicle and track elements are presented and their associated stiffness matrix, mass matrix, and damping matrix are formulated. Computational software is coded with Matlab. As an application example, influences of four kinds of transition patterns - abrupt change, step-by-step change, linear change, as well as cosine change for track stiffness distributions in track transitions - on dynamic behaviour of the vehicle and the track are investigated. The computational results show that the transition pattern of the track stiffness has primary influence on the dynamic behaviour of the vehicle and the track, and smoothing of the track stiffness distribution can significantly reduce the wheel-rail interaction forces and the rail vertical accelerations. From abating wheel-rail impact and improving traffic operation's point of view, the cosine change has the most effect, the linear change is somewhat effective and the abrupt change is the least effective for the four kinds of transition patterns of the track stiffness. However, the transition patterns of the track stiffness have essentially no influence on the vehicle vertical accelerations, due to the excellent behaviour of vibration isolation resulting from the primary and the secondary suspension systems of the vehicle.
Care pathways: some social scientific observations on the field
Authors: Allen Davina
Published: June 2010

In an earlier companion paper published in the journal, I drew on an ethnographic analysis of the care pathway field to argue that the growing popularity of pathway methodology can be explained, in part, by its effectiveness in aligning clinical and management interests in offering a single solution to shared health service problems. This breadth of appeal disguises tensions between clinical and management agenda which creates challenges in inscribing this multiplicity of interests into the pathway design and implementing the methodology in practice. This helps to explain the challenges of pathway development and implementation and the range of interventions to which the term ‘pathway’ is applied. In this paper I consider how pathway leaders have responded to these concerns and offer an alternative response, informed by social science.
An integrated care pathway for Guillain–Barré syndrome in children
Authors: Lakin Ben , White Elvina , Appleton Richard
Published: June 2010

Integrated care pathways are widely used for a range of medical and surgical conditions with the aim of providing a streamlined and unified approach to evidence-based care. They have been used for a number of years in the multidisciplinary management of adults with neurological conditions who are expected to require prolonged rehabilitation. Care pathways have been used in approximately 60 conditions at Alder Hey Children's Hospital over the past few years. This paper describes an experience of a care pathway for children with Guillain–Barré syndrome. As far as the authors are aware, this is the first care pathway to be used for children with a neurological disorder. Preliminary observations, which have yet to be formally audited, suggest that the pathway has benefited patient care and significantly improved patient documentation and interdisciplinary communication. It has also helped to reduce and minimize unnecessary variation from expected evidence-based management.
Scotland's national approach to improving mental health services: integrated care pathways as tools for redesign and continuous quality improvement
Authors: El-Ghorr Ali , Cameron Rosie , Fleming Mark , McKechnie Linda , Thomson David , Doherty Sean
Published: June 2010

National Health Service (NHS) Scotland is taking a national approach to improving the quality and safety of mental health services. This programme relies on implementing integrated care pathways (ICPs) for people with mental health conditions across the whole journey of care.

This long-term improvement programme has started with the publication of national standards by NHS Quality Improvement Scotland (NHS QIS), setting out the framework of what needs to be developed in each local area.

The emphasis of development and implementation of the ICPs lies with local NHS Boards to ensure they are developed with local ownership and to meet the needs of the local population. However, to ensure accreditation by NHS QIS, the local ICPs must incorporate the national standards and evidence improvement to the quality of care provided.

A concerted effort has been made to ensure good involvement of service users, social work colleagues and NHS staff in order to get buy-in from all stakeholders.

NHS QIS is also supporting local boards and their partner agencies in their implementation of ICPs through a team of National ICP Coordinators and has developed a web-based toolkit to act as an electronic resource: www.icptoolkit.org . This supportive and facilitative approach helped to ensure that person-centred care was driving service redesign.

This is the beginning of a long-term improvement programme that has been carefully staged and is being facilitated in order to give it the best chance for success. In Scotland, ICPs for mental health are being used as a tool for service redesign and continuous quality improvement and a way to focus on meeting service user needs.
The European Quality of Care Pathway (EQCP) Study: history, project management and approach
Authors: Vanhaecht K , Sermeus W , Peers J , Deneckere S , Lodewijckx C , Leigheb F , Panella M
Published: June 2010

The European Quality of Care Pathway (EQCP) study is the first, international, cluster randomized controlled trial launched to study the effect of the implementation of care pathways and to study why and under what circumstances pathways work. The study will be performed in Belgium, Italy, Ireland and Portugal and will include individual studies: a trial including chronic obstructive pulmonary disease patients, a trial including proximal femur fracture patients and a trial focusing on multidisciplinary teamwork within both populations. The study is managed by the European Pathway Association in close collaboration with a multidisciplinary team of the Catholic University Leuven (Belgium), the University of Eastern Piedmont (Italy), the National School of Public Health Lisbon (Portugal) and the Health Services Executive in Dublin (Ireland). This paper will describe the history, project management and overall approach of this international study.
RNase-assisted RNA chromatography
Authors: Michlewski Gracjan , Cáceres Javier F.
Published: June 2010

RNA chromatography combined with mass spectrometry represents a widely used experimental approach to identify RNA-binding proteins that recognize specific RNA targets. An important drawback of most of these protocols is the high background due to direct or indirect nonspecific binding of cellular proteins to the beads. In many cases this can hamper the detection of individual proteins due to their low levels and/or comigration with contaminating proteins. Increasing the salt concentration during washing steps can reduce background, but at the cost of using less physiological salt concentrations and the likely loss of important RNA-binding proteins that are less stringently bound to a given RNA, as well as the disassembly of protein or ribonucleoprotein complexes. Here, we describe an improved RNA chromatography method that relies on the use of a cocktail of RNases in the elution step. This results in the release of proteins specifically associated with the RNA ligand and almost complete elimination of background noise, allowing a more sensitive and thorough detection of RNA-binding proteins recognizing a specific RNA transcript.
Treatment of posterior ankle pain by excision of a bipartite talar fragment
Authors: Mann H. A. , Myerson M. S.
Published: June 2010

We describe five adolescent patients aged between 13 and 16 years with bipartite ossification of the posteromedial aspect of the talus. All presented without a history of trauma.

All the ankles had a similar radiological appearance. Clinically, some restriction of movement was noted in three ankles and two subtalar joints, In addition, pain was noted over the posteromedial aspect of the ankle in three patients. In each patient the bipartite fragment was excised through a posteromedial approach to the ankle. Complete resolution was achieved at six months in three patients, with the remaining two describing exercise-induced symptoms. In one of these this precluded participation in sport.

Despite numerous anatomical variations within the tarsus, a case series of a bipartite talus has not previously been reported. This anatomical variation should be recognised to avoid misinterpretation as post-traumatic or other pathological processes. In the presence of recalcitrant symptoms excision is an option, but this is not universally successful in abolishing symptoms.
Look-alike Bags of Sterile Water and Sodium Chloride; Enjuvia or Januvia?; Order Entry Error; Dose Counter May Not Work
Authors: Cohen Michael R.
Published: June 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. 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.
Docetaxel and Carboplatin (DC) for Solid Tumors
Authors: Solimando Dominic A. , Weaver Melanie S. , Waddell J. Aubrey
Published: June 2010

The increasing complexity of cancer chemotherapy increases 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, and review various agents, both commercially available and investigational, used to treat malignant diseases. Questions or suggestions for topics should be addressed to Dominic A. Solimando, Jr., President, Oncology Pharmacy Services, Inc., 4201 Wilson Blvd #110-545, Arlington, VA 22203, E-mail: OncRxSvc@aol.com ; or J. Aubrey Waddell, Associate Professor, University of Tennessee College of Pharmacy; Oncology Pharmacist, Pharmacy Department, Blount Memorial Hospital, 907 E. Lamar Alexander Parkway, Maryville, TN 37804, E-mail: waddfour@charter.net .
Thalidomide: Gastrointestinal Bleeding
Authors: Generali Joyce , Cada Dennis J.
Published: June 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 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 regarding “Off-Label Drug Uses” to hospitalpharmacy@drugfacts.com .
Thalidomide- and Lenalidomide-Associated; Thromboembolism; NMS with Delayed Fever Associated with Risperidone Another Interesting Adverse Effect to Risperidone – Priapism; Hyperlactatemia due to Nevirapine; Recurrent Anaphylaxis with Gonadotropin-Releasing Hormone Analogs; Psychotropic Effects of Antiepileptic Drugs; Literacy and Misunderstanding of Prescription Drug Labels
Authors: Shuster Joel
Published: June 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 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. Write to Dr. Shuster at ISMP, 1800 Byberry Road, Suite 810, Huntingdon Valley, PA 19006 (call 215-947-7797; fax 215-914-1492; E-mail: joel.shuster@temple.edu ). Your report will be published anonymously unless otherwise requested. This feature is provided by the Institute for Safe Medication Practices in cooperation with the FDA's medWatch Program and Temple University School of Pharmacy. ISMP is an FDA medWatch partner.
Outcomes of an Erythropoietic Growth Factor Interchange Program in Hospitalized Chronic Hemodialysis Patients
Authors: Mohammad Rima A. , Sweet Burgunda V. , Mueller Bruce A. , Perlman Rachel L. , Stevenson James G.
Published: June 2010

Background

The substantial cost of erythropoietic growth factors (EGFs), darbepoetin alfa and epoetin alfa, has led many institutions to evaluate EGF usage and costs in the hospital setting. The primary objectives of this study were to determine the clinical impact on hemoglobin (Hb) concentration, postdischarge epoetin alfa dose requirements, and the economic impact of a darbepoetin alfa for epoetin alfa therapeutic interchange program in hospitalized hemodialysis patients.

Methods

A retrospective review was conducted in 79 patients (43 during a control period and 36 during the interchange period). The control group consisted of chronic hemodialysis patients admitted to the hospital before the therapeutic interchange program was implemented (September 2002 through September 2003); the interchange group included patients admitted after implementation of the interchange program (October 2003 through October 2004). Clinical parameters including Hb concentration, concomitant iron therapy, packed red blood cell (PRBC) transfusions, EGF dose and cost were collected beginning 2 months prior to hospitalization, during hospitalization, through 2 months post hospital discharge.

Results

No differences were observed between groups in baseline demographics. There was a greater decrease in Hb concentration in the control group compared to the interchange group, but this did not achieve statistical significance (0.5 g/dL vs 0.3 g/dL, respectively; P = 0.67). EGF dose requirements did not differ between the two groups, nor did the total EGF cost per patient admission before and after hospitalization. Total cost per patient during hospitalization was $164 ± 144 in the control group and $165 ± 156 in the interchange EGF group ( P= 0.97). Conclusion: In the treatment of anemia in hospitalized chronic hemodialysis patients, there were no differences seen in Hb concentration, EGF dose requirements, or overall EGF cost per patient admission. Implementation of the interchange program allowed for market share gains to permit an overall economic benefit across all patients in the amount of $300,000 annually.
Sitagliptin Phosphate
Authors: Cada Dennis J. , Levien Terri , Baker Danial E.
Published: June 2010

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 FIX.

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 February 2007 monograph topics are zoledronic acid injection in Paget's disease and osteoporosis, paliperidone extended-release tablets, temsirolimus, continuous erythropoietin receptor activator, and levocetririzine. The DUE is on inhaled long-acting beta agonists.
PEN Injectors: Technology is not without ImPENding Risks; IV Lipid Emulsion for Bupivacaine Toxicity
Authors: Cohen Michael R.
Published: June 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. 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.
Error-Prone Abbreviation: SSRI or SSKI?; “e-Rx” Errors in the Drug Selection Process; How to Avoid Missing Critical Lab Values
Authors: Cohen Michael R.
Published: June 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. 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.
Docetaxel and Capecitabine (DC) Regimen for Solid Tumors
Authors: Rutledge Matthew R. , Solimando Dominic A. , Waddell J. Aubrey
Published: June 2010

The increasing complexity of cancer chemotherapy increases 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, and review various agents, both commercially available and investigational, used to treat malignant diseases.
A Novel Approach to Monitoring the Diversion of Controlled Substances: The Role of the Pharmacy Compliance Officer
Authors: Fleming Kent , Boyle Deborah , Billie W.J. , Carpenter Jesse , Linck Connie
Published: June 2010

Purpose

The true extent of drug diversion practices in acute health care settings is unknown. Drug abuse by professional staff may result in jeopardized patient safety discredited organizational reputations, compromised financial outcomes, and endangered community trust. Yet, limitations in reporting drug diversion behaviors by health care professionals precludes quantification of the scope of these practices in nurses, physicians, and pharmacists. This manuscript describes one institution's efforts to monitor drug diversion with the implementation of a novel pharmacy-based role, the Pharmacy Compliance Officer (PCO).

Methods

Nearly 5 years of PCO experience will be identified and organizational drug diversion methods will be delineated. Common profiles of professional drug diverters in acute care will be depicted with a review of the literature on pharmacist, nurse, and physician drug dependency characteristics. The collaborative process between the PCO and Nursing Directors will be described with particular emphasis on options for validating drug diversion and confronting employees with evidence. Exemplars of drug diversion by professional staff will be highlighted with the use of two case studies. Cost implications will be discussed as well.

Results

The PCO has assisted with the identification of staff at risk, and responsible for, drug diversion. Implementation of this novel role has facilitated the early recognition of staff with active substance abuse disorders. Our relationship with the State Boards of Pharmacy and Nursing has been enhanced due to this proactive approach to recognizing drug diversion practices in professional staff.

Conclusion

This contemporary strategy has the potential for replication, particularly in large, diverse, urban, acute care settings, where drug volume is high, information systems are frequently complex; hence, identification of drug-diverting professionals is circuitous.
Efforts to Ensure Safety of Hospital Pharmacy Personnel Occupationally Exposed to Antineoplastic Drugs during a Preparation Task
Authors: Ikeda Kenji , Yagi Yuriko , Takegami Manabu , Lu Yuquan , Morimoto Kanehisa , Kurokawa Nobuo
Published: June 2010

Purpose

Antineoplastic drugs are often detected in the plasma and urine of medical staff, despite the adoption of safety measures. This study involves ambulatory chemotherapy, which was prepared on a rotating schedule at the Department of Pharmacy. The first objective of this study was to evaluate occupational exposure by measuring epirubicin in the urine and plasma and sister chromatid exchanges (SCE) in the peripheral lymphocytes of the involved pharmacists. The second, to improve a previously reported method for ease of occupational exposure evaluation. The third, to determine environmental contamination.

Methods

Pharmacists were categorized into three groups based on three patterns, depending on the other tasks they performed. They were alternately responsible for the preparation in each group with the recommended protections. Samples were collected at the end of each work day. High-performance liquid chromatography (HPLC) analysis along with fluorescence detection was performed at a flow rate of 200 mcL/min using 0.1% formic acid, methanol, and acetonitrile (75:5:20). Epirubicin in the samples was extracted by solid-phase extraction. Chromosomes were prepared according to a standard protocol.

Results

A final concentration of 2 ng/mL was the lower quantification limit. Epirubicin was not detected in the urine and plasma, and the SCE levels were within the normal limits for all the subjects. However, epirubicin was detected in samples collected from the preparation gloves.

Conclusions

For personnel safety, it is important to periodically evaluate protective measures. Pharmacists on a rotating schedule who work less than 6 hours per week on preparatory tasks were not unduly exposed to antineoplastics.
Workplace Contamination with Antineoplastic Agents in a New Cancer Hospital Using a Closed-System Drug Transfer Device
Authors: Nyman Heather A. , Jorgenson James A. , Slawson Matthew H.
Published: June 2010

Objective

To determine levels of environmental chemotherapy contamination in a new cancer hospital that has exclusively used a closed-system drug transfer device (PhaSeal) for preparing and administering all compatible antineoplastics.

Methods

After 6 months of operation, surface samples were collected from pharmacy and nursing areas to determine levels of contamination with cyclophosphamide and ifosfamide. In addition, urine samples were collected from pharmacists, pharmacy technicians, and nurses to determine employee exposure to these agents. All samples were analyzed using liquid chromatography/tandem mass spectrometry.

Results

Twenty-one percent (7/34) of surface samples collected tested positive for cyclophosphamide contamination. Twelve percent (4/34) of surface samples tested positive for ifosfamide. To place this into perspective, historical data collected at our outpatient oncology infusion clinic 6 months after converting to PhaSeal from conventional methods of antineoplastic preparation showed 33% (7/21) and 71% (15/21) of samples tested positive for cyclophosphamide and ifosfamide, respectively. The level of ifosfamide contamination found in samples that tested positive at our new hospital also appeared to be lower than in positive samples at the outpatient infusion clinic. In the current study, the urine of one participant (1/11), a pharmacy technician, tested positive for low levels of cyclophosphamide and ifosfamide. To compare, 71% and 0% of participants tested at the outpatient infusion clinic had positive urine samples prior to and 6 months after implementation of PhaSeal, respectively. Conclusions: Compared with historical levels of contamination in our outpatient oncology infusion clinic, levels of chemotherapy contamination appeared lower. However, some contamination was still present in our new cancer hospital where PhaSeal had been used exclusively.
Development of a Treatment Algorithm for Staphylococcal Pyoderma in the Emergency Department
Authors: Segarra-Newnham Marisel
Published: June 2010

The incidence of culture-confirmed methicillin-resistant Staphylococcus aureus (MRSA) has been increasingly reported in the community. The number of patients presenting with pyoderma that were not responding to first-line agents with a corresponding increase of MRSA isolates was seen in our Emergency Department (ED). After evaluation of the literature and review of recent cases, the infectious diseases team developed a treatment algorithm for use by ED personnel in order to identify patients that are more likely to have an MRSA infection and to facilitate the provision of effective therapy with the initial visit. Three months after the algorithm implementation, 12 of 13 patients seen in the ED with MRSA pyoderma had cultures done, and 10 were appropriately treated with non-beta-lactam agents on initial visit. Monitoring of infections seen in the ED can help clinicians identify trends in resistance that warrant a change in treatment guideline recommendations with the ultimate aim of improving patient care outcomes.
Fentanyl Effervescent Buccal Tablet
Authors: Cada Dennis J. , Levien Terri , Baker Danial E.
Published: June 2010

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 FIX.

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 2007 monograph topics are paliperidone extended-release tablets, retapamulin ointment 1%, estradiol gel, diclofenac sodium solution 1.5%, and oral beclomethasone dipropionate. The DUE is on paliperidone extended-release tablets.
Code N: Multidisciplinary Approach to Proactive Drug Diversion Prevention
Authors: Siegel Jerry , O'neal Brian
Published: June 2010

This is the second of a six-part series on diversion of controlled substances in an acute health care setting. Controlled substance diversion is a constant threat that affects not only the safety of patients but the potential life and livelihood of the health care worker.

These articles are meant to accompany the recommendations in the Hospital Pharmacy article “Controlled Substance Diversion Detection: Go the Extra Mile” for a comprehensive analysis of all aspects of controlled substance handling. The series focuses on preventing diversion from automated dispensing cabinets, the operating room, and at all handling points within a pharmacy. The objective of the series is to provide practical recommendations to aid pharmacy managers as they seek to prevent or detect diversion. Experience is key to diversion detection; however, a pharmacy should not have to experience their own diversion in order to learn from it. The collective experience of pharmacy leaders at the Ohio State University Medical Center and the University of Kansas Hospital are gathered to assist other pharmacy leaders in the hopes that they do not have to gain this experience firsthand.
Developing a Medication Patient Safety Program, Part 2: Process and Implementation
Authors: Mark Scott M. , Weber Robert J.
Published: June 2010

The Director's Forum series is written and edited by Robert Weber and Michael Sanborn 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 is co-authored by Scott Mark and focuses directly on processes for determining program priorities for patient safety and implementing a successful program.
Improving Medication Safety in the ICU: The Pharmacist's Role
Authors: Lee Audrey J. , Chiao Teresa B. , Lam Jerika T. , Khan Shamima , Boro Maureen S.
Published: June 2010

Purpose

The clinical impact of a critical care pharmacist in reducing medication errors in the intensive care unit (ICU) setting was evaluated.

Methods

The study was divided into two 8-week phases: control phase without a critical care pharmacist and an ICU pharmacist phase with a critical care pharmacist. During both phases, pharmacy staff documented interventions using an electronic documentation system. Interventions that could be classified as medication errors were categorized by type of error and whether they were “averted” (intervention accepted) or “not averted” (intervention not accepted). The type and frequency of medication errors, number of medication errors “averted,” and clinical outcomes associated with the medication errors were compared between the control and ICU pharmacist phases.

Results

There was no significant difference between the groups for gender and mean age. Of the 267 interventions included in the ICU pharmacist phase, 256 were classified as medication errors compared with 54 of 58 interventions for the control phase. The average number of medication errors per day was significantly higher during the ICU pharmacist phase (4.27 ± 5.2) compared with the control phase (0.92 ± 1.29, P < 0.0001). The number of medication errors “averted” was higher in the ICU pharmacist phase compared with the control phase (212 vs 50). The “averted” medication errors during the ICU pharmacist phase were related to a higher percentage of improved or resolved clinical outcomes compared with the control phase (66/194 [34%] vs 7/46 [15.2%], P = 0.013).

Conclusion

A critical care pharmacist improves medication safety by identifying and preventing medication errors and improving outcomes.
Relationship between Antibiotic Exposure and Subsequent Clostridium Difficile-Associated Diarrhea
Authors: Minson Quentin , Mok Steve
Published: June 2010

Objective

The objective of this study was to assess the relationship between antibiotic exposure and subsequent Clostridium difficile-associated diarrhea (CDAD) in hospitalized patients.

Methods

A retrospective, case-control study with data collected between October 1, 2005 and March 31, 2006 was conducted. Cases consisted of patients with a documented new onset of diarrhea occurring a minimum of 72 hours following admission to the hospital and accompanied by a positive C. difficile toxin A and B enzyme immunoassay. Two controls were matched to each case according to known risk factors for CDAD other than antibiotic use. A complete assessment of antibiotic use was made, including all regimens the patient received during the previous 8 weeks. The difference in antibiotic use in cases and controls was tested using the chi-square test. The association between specific antibiotic classes and subsequent CDAD was evaluated with an odds ratio.

Results

Prior antibiotic exposure was observed more frequently in these cases than in controls ( P = 0.035). Specifically, third-generation cephalosporins were found to be significantly associated with CDAD (odds ratio, 4.64; 95% confidence interval, 1.64 to 13.14).

Conclusion

This study showed that prior antibiotic exposure is associated with increased incidence of subsequent CDAD. Specifically, third-generation cephalosporins were statistically associated with CDAD. Although results did not reach statistical significance, this study suggests that potential associations may exist between CDAD and prior exposure to antipseudomonal penicillins, cefepime, carbapenems, fluoroquinolones, and intravenous vancomycin.
Arformoterol Tartrate
Authors: Cada Dennis J. , Levien Terri , Baker Danial E.
Published: June 2010

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 2007 monograph topics are lapatinib, aliskiren, lisdexamfetamine dimesylate, telavancin, and ambrisentan. The DUE is on aliskiren.
The Investigative Process
Authors: Siegel Jerry , Wierwille Carol , O'Neal Brian
Published: June 2010

This is the fourth in a six-part series on diversion of controlled substances in an acute health care setting. The six articles are meant to accompany the recommendations in the Hospital Pharmacy article “Controlled Substance Diversion Detection: Go the Extra Mile” for a comprehensive analysis of all aspects of controlled substance handling.1 The series focuses on preventing diversion from automated dispensing cabinets, the operating room, and at all handling points within a pharmacy. The objective of the series is to provide practical recommendations to aid pharmacy managers as they seek to prevent or detect diversion. Experience is key to diversion detection; however, a pharmacy should not have to experience their own diversion in order to learn from it. The collective experience of pharmacy leaders at the Ohio State University Medical Center and the University of Kansas Hospital is gathered to assist other pharmacy leaders in the hopes that they will not have to gain this experience firsthand. This article will focus on the investigative process. Each point will be described in detail, with recommendations on how to improve your diversion detection system.
Developing a Pharmacy Information System Infrastructure
Authors: Sanborn Michael
Published: June 2010

This Director' Forum article will focus on the development of a pharmacy information system infrastructure, including the importance of system design and operation, strategic planning for technology improvement, and the emerging role of the pharmacy informaticist. Today these systems are an integral part of virtually every pharmacy operation and essential to effective patient care.
Information from Prior Admission Prevents Error; New Oral Morphine Strength; Confusion in Human Immunodeficiency Virus Guideline; Apothecary Measurement Still Causing Errors
Authors: Cohen Michael R.
Published: June 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. 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.
Paclitaxel and Gemcitabine (PG) for Advanced Breast Cancer
Authors: Waddell J. Aubrey , Solimando Dominic A.
Published: June 2010

The increasing complexity of cancer chemotherapy increases 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, and review various agents, both commercially available and investigational, used to treat malignant diseases.