bluuebunny/crossref_metadata_2025 huggingface dataset:
Chloride channel ClC-3 in gills of the euryhaline teleost,Tetraodon nigroviridis: expression, localization and the possible role of chloride absorption
Authors: Tang Cheng-Hao , Hwang Lie-Yueh , Lee Tsung-Han
Published: February 2010

Previous studies have reported the mechanisms of ion absorption and secretion by diverse membrane transport proteins in gills of various teleostean species. To date, however, the chloride channel expressed in the basolateral membrane of mitochondrion-rich (MR) cells for Cl− uptake in freshwater (FW) fish is still unknown. In this study, the combination of bioinformatics tools [i.e. National Center for Biotechnology Information (NCBI) database, Tetraodon nigroviridis (spotted green pufferfish) genome database (Genoscope), BLAT and BLASTn] were used to identify the gene of ClC-3 (TnClC-3), a member of the CLC chloride channel family in the T. nigroviridis genome. RT-PCR analysis revealed that the gene encoding for the ClC-3 protein was widely expressed in diverse tissues (i.e. gill, kidney, intestine, liver and brain) of FW- and seawater (SW)-acclimated pufferfish. In whole-mount double immunofluorescent staining, branchial ClC-3-like immunoreactive protein was localized to the basolateral membrane of Na+/K+-ATPase (NKA) immunoreactive cells in both the FW- and SW-acclimated pufferfish. In response to salinity, the levels of transcript of branchial TnClC-3 were similar between FW and SW fish. Moreover, the membrane fraction of ClC-3-like protein in gills was 2.7-fold higher in FW compared with SW pufferfish. To identify whether the expression of branchial ClC-3-like protein specifically responded to lower environmental [Cl−], the pufferfish were acclimated to artificial waters either with a normal (control) or lower Cl− concentration (low-Cl). Immunoblotting of membrane fractions of gill ClC-3-like protein showed the expression was about 4.3-fold higher in pufferfish acclimated to the low-Cl environment than in the control group. Furthermore, branchial ClC-3-like protein was rapidly elevated in response to acute changes of environmental salinity or [Cl−]. Taken together, pufferfish ClC-3-like protein was expressed in the basolateral membrane of gill MR cells, and the protein amounts were stimulated by hyposmotic and low-Cl environments. The enhancement of ClC-3-like protein may trigger the step of basolateral Cl− absorption of the epithelium to carry out iono- and osmoregulatory functions of euryhaline pufferfish gills.
Investigation of a problem with external quality assurance samples for faecal occult blood
Authors: Barlow Ian M , Del-Duca Clare , Jones Elizabeth
Published: February 2010

Background

It is vital that laboratories participate in External Quality Assurance (EQA) programmes, but results from such schemes do not necessarily help ensure assays are ‘in control’. We describe a series of experiments undertaken to explore apparent poor performance in an occult blood EQA scheme that manifested as a series of false-negatives. As a consequence of our laboratory misclassifying some EQA samples, we decided to design a simple sensitivity study that would reaffirm confidence in our testing procedures.

Methods

In order to verify analyst reliability and analytical sensitivity, a series of 10 faecal samples were supplemented with increasing amounts of whole blood (0–1.0 mg/Hb/g faeces) and these were then tested independently by four different operatives. EQA samples which our laboratory misclassified were shared with and tested by a second laboratory and results compared.

Results

The results demonstrated consistency in interpretation among the four ‘testers’ and also suggested that the sensitivity of the method is 0.7 rather than 0.6 mg/Hb/g faeces as claimed by the manufacturer. The second laboratory obtained identical results as our laboratory for the EQA samples which our laboratory had misclassified.

Conclusions

Occult blood EQA scheme results might not give a true reflection of a laboratory's ability to provide reliable results. We would encourage any laboratory observing relative poor performance to undertake local sensitivity studies and repeat testing of EQA samples if in any doubt.
National UK audit of the Short Synacthen® Test
Authors: Chatha Kamaljit K , Middle Jonathan G , Kilpatrick Eric S
Published: February 2010

We present the first national audit of the Short Synacthen Test (SST), identifying the clinical, analytical and interpretative procedures adopted by 89 laboratories.

Background

The SST has replaced the insulin stress test as the first-line test to assess adrenal insufficiency and has received considerable attention regarding its sensitivity and specificity. Concerns regarding this test include the bias of cortisol methods, cut-off values used, contraindications and the limitations of the test in diagnosing recent, mild secondary adrenal insufficiency. The audit took into consideration the protocols used by laboratories, the advice provided prior and after the SST and the analytical bias of the methods used.

Methods

A web-based questionnaire using Microsoft FrontPageTM was prepared to collect data from laboratories and provided drop-down lists and other form-field elements to capture additional comments. The resultant data were exported to Microsoft ExcelTM for data clean-up and analysis.

Results

The workloads were highly variable; however, most laboratories were in general agreement to the indications, contraindications, timing and reference ranges. In contrast, there was variability in the bias of the cortisol methods, which had not been translated to the cut-off values used by the majority of laboratories.

Conclusions

The audit has shown that though the preanalytical procedures were similar in most laboratories, there is a requirement to recognize the effect that method bias may have on the reference ranges and consequently on the diagnosis of adrenal insufficiency. There is a need to develop consensus guidelines, which can aid both clinicians and laboratories.
Intraoperative vital and haemodynamic monitoring using an integrated multiple-channel monitor in rats
Authors: Huang Hai , Deng Meihong , Jin Hao , Dirsch Olaf , Dahmen Uta
Published: February 2010

The aim of this study is to give a hands-on description of the successful monitoring procedure established for extended liver resections and liver transplantations in rats and to provide the typical range of data as obtained before and after a hepatobiliary surgical procedure (right median hepatic vein [RMHV] ligation) in healthy male Lewis rats. All manipulations were performed in anaesthetized (3% isoflurane in O2 1 L/min) healthy male Lewis rats (250–350 g) with an integrated multiple-channel intraoperative monitor (Powerlab® system) using a series of sensors for data acquisition. Vital parameters (body temperature, electrocardiogram, respiratory rate and heart rate), haemodynamic parameters (mean arterial blood pressure [MAP] and central venous pressure) and liver perfusion parameters (inferior hepatic venous pressure, portal vein pressure [PVP], blood flow of portal vein and inferior hepatic cava) were monitored. Catheters were placed in microsurgical technique after careful exposure guided by anatomical landmarks. Vascular incisions were closed with interrupted sutures. Complete instrumentation of animals was performed within 1 h. No specific complications occurred. Vital and haemodynamic parameters such as MAP (94 ± 16.2 mmHg) or portal pressure (9.6 ± 1.34 mmHg) were in the same range as known for humans (MAP = 100 mmHg, portal pressure = 5–10 mmHg), whereas parameters dependent on the size of the body or organ such as flow rates (portal blood flow = 16.2 ± 6 mL/min) were obviously different compared with those of humans (portal blood flow = 800 mL/min). In conclusion, the normal range for vital, haemodynamic and liver perfusion parameters was reported as reference values to allow quality control for future surgical hepatobiliary research projects. As the procedure can be easily learned, the extensive intraoperative monitoring can be used routinely.
Postmortem Redistribution of Fentanyl in Blood
Authors: Olson Kalen N. , Luckenbill Kristin , Thompson Jonathan , Middleton Owen , Geiselhart Roberta , Mills Kelly M. , Kloss Julie , Apple Fred S.
Published: February 2010

Fentanyl concentrations were measured in postmortem specimens collected in 20 medical examiner cases from femoral blood (FB), heart blood (HB), heart tissue, liver tissue, and skeletal muscle. Unique was a subset of 7 cases in which FB was obtained at 2 postmortem intervals, shortly after death (FB1) and at autopsy (FB2). The mean collection times of FB1 and FB2 after death were 4.0 and 21.6 hours, respectively. Fentanyl concentrations for FB1 and FB2 ranged from undetectable to 14.6 μg/L (mean, 4.6 μg/L) and 2.0 to 52.5 μg/L (mean, 17.3 μg/L), respectively. Corresponding mean HB, liver tissue, and heart tissue fentanyl concentrations were 29.8 μg/L, 109.7 mg/kg, and 103.4 mg/kg, respectively. The fentanyl HB/FB1 ratio (mean, 8.39) was higher compared with the corresponding HB/FB2 ratio (mean, 3.48). These results suggest that postmortem redistribution of fentanyl can occur in FB.
Shape Is Not Associated With the Origin of Pericolonic Tumor Deposits
Authors: Wünsch Katharina , Müller Jenny , Jähnig Hendrik , Herrmann Robert A. , Arnholdt Hans M. , Märkl Bruno
Published: February 2010

Pericolonic tumor deposits (PTDs) are associated with an adverse outcome in colorectal cancer. According to the International Union Against Cancer they are classified as N1 or V1/V2 depending on their shape. This recommendation, however, is not well supported by the literature. To elucidate the origin of PTDs, we performed a histomorphologic study of 69 PTDs, which were found in 7 of 21 colorectal specimens using the whole-mount step-section technique. Depending on the origin, the nodules were classified as venous invasions, lymphatic invasions, nerve sheath infiltrations, free PTDs, and continuous growth in 18 (26%), 3 (4%), 6 (9%), 34 (49%), and 8 (12%) of 69 PTDs, respectively. Polycyclic and oval-round shapes were identified in all categories. Continuous growth was found only within the inner third of the adhering fat, whereas the other morphologic features were found in all regions. The data of this study do not support PTD classification on the basis of their shape.
True Allergy or Other Symptom?; Too Much Hydromorphone; Patient Safety Increased in Obstetrics; Medication Patch Slips into Incorrect Automated Dispensing Cabinet Pocket; Volume Control Set Safety
Authors: Cohen Michael R.
Published: February 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 at your inservice training programs.

Your assistance is required to continue this feature. The reports described here were received through the Institute for Safe Medication Practices (ISMP) Medication Errors Reporting Program. 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 directly to ISMP through the ISMP Web site ( www.ismp.org ), 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.
Cetirizine-Induced Anaphylaxis; Celecoxib-Associated Anaphylaxis; Levetiracetam-Induced Pancytopenia; Trismus Induced by Fluoxetine; Aliskiren-Induced QT Interval Prolongation; Intestinal Necrosis Resulting from Sodium Polystyrene Sulfonate
Authors: Shuster Joel
Published: February 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.
BEACOPP(baseline) Regimen for Hodgkin Lymphoma
Authors: Solimando Dominic A. , Waddell J. Aubrey
Published: February 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 preparing, dispensing, and administering antineoplastic therapy and to the agents, commercially available and investigational, used to treat malignant diseases.
Ondansetron: Postanesthetic Shivering
Authors: Generali Joyce A. , Cada Dennis J.
Published: February 2010

This Hospital Pharmacy feature is extracted from Off-Label Drug Facts, a quarterly publication available from Wolters Kluwer Health. Off-Label Drug Facts is a practitioner-oriented resource for information about specific drug uses that are unapproved by the US Food and Drug Administration. This new guide to the literature enables the health care professional or clinician to quickly identify published studies on off-label uses and determine if a specific use is rational in a patient care scenario. A summary of the most relevant data is provided, including background, study design, patient population, dosage information, therapy duration, results, safety, and therapeutic considerations. References direct the reader to the full literature for more comprehensive information before patient care decisions are made. Direct questions or comments regarding Off-Label Drug Uses to hospital pharmacy@drugfacts.com .
Therapeutic Interchange Practices among Texas Medical Center Institutions
Authors: Moultry Aisha Morris , Wilmer Sonya R.
Published: February 2010

Purpose

There has been an increase in therapeutic interchange (TI) practices in institutional settings because of the growing number of “me too” drugs and the desire for hospitals to minimize their formularies' economic impact. The Texas Medical Center (TMC) Clinical Pharmacists Task Force conducted a study to determine TI practices at TMC member institutions.

Methods

The task force members who represented a hospital were polled to determine whether their institution participated in a TI process for medication dispensing. Members who provided a positive response were asked to submit a copy of the institution's policy and/or procedure for review. Each policy and procedure was reviewed to determine the therapeutic classes of agents involved in TI, as well as the preferred agents.

Results

Of the hospitals involved in the study, 6 reported the presence of policies/procedures for TI practices, and it was found that 3 policies/procedures were common. There were 5 common therapeutic classes of agents involved in TI at all 6 hospitals. Most endorsed the use of cefoxitin or cefepime as the preferred antimicrobial agent. Famotidine was the preferred H2 antagonist, and pantoprazole was the recommended proton pump inhibitor. Simvastatin was the approved alternative for beta-hydroxybeta-methylglutaryl-coenzyme A (HMG CoA) reductase inhibitors, and for all requested angiotensin-converting enzyme inhibitors, lisinopril was the recommended formulary agent.

Conclusion

Although this project identified some consistency in TI practices, it also recognized inconsistencies in the conversions used for select interchanges; these should be further researched.
Intravenous Infusion Safety Technology: Return on Investment
Authors: Danello Sherry H. , Maddox Ray R. , Schaack Gregory J.
Published: February 2010

Purpose

In 2006 the Institute of Medicine reported that at least 400,000 preventable adverse drug events (ADEs) occur annually among patients being hospitalized, with costs of $3.5 billion (or $8,750 per preventable ADE). Recommended medication error prevention technologies include computerized prescriber order entry, bar-code medication administration, and computerized intravenous (IV) safety systems with dose-error reduction software. When St. Joseph's/Candler Health System replaced its existing IV pumps, the decision to incur the incremental cost for “smart” IV safety systems rather than traditional IV pumps resulted in financial benefits, improved safety, improved quality of care, and increased nursing satisfaction.

Methods

Electronic data recorded at the bedside as caregivers administered medications provided information from which actual cost avoidance could be more readily calculated and presented objective evidence of the fiscal value of investments in innovative technologies.

Results

Over a 5-year period, implementation of these smart systems reduced high-risk medication errors and patient-controlled analgesia-related undesired outcomes, helped avert at least 471 preventable ADEs, and provided a 5-year return on investment (ROI) of $1.87 million, with an internal rate of return of 81%.

Conclusion

Financial analysis of the incremental costs of IV safety systems can help calculate anticipated ROI accurately and better prioritize implementation of these systems.
Febuxostat
Authors: Cada Dennis J. , Levien Terri L. , Baker Danial E.
Published: February 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 in print and are also available online. Monographs can be customized to meet the needs of a facility. Subscribers to 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. For more information about The Formulary Monograph Service or The F.I.X., call The Formulary at 800-322-4349. The August 2009 monograph topics are tolvaptan, besifloxacin ophthalmic suspension 0.6%, tadalafil, bromocriptine mesylate, and acetaminophen intravenous. The DUE is on tolvaptan.
New Drugs Approved by the FDA; New Dosage Forms and Indications Approved by the FDA; Agents Pending FDA Approval; New Drug/Biologics License Applications Filed by Manufacturer; Significant Labeling Changes or “Dear Health Care Professional” Letters Related to Safety
Authors: Baker Danial E.
Published: February 2010

This monthly feature will help readers keep current on new drugs, new indications, dosage forms, and safety-related changes in labeling or use. Efforts have been made to ensure the accuracy of this information; however, if there are any questions, please let us know at hospitalpharmacy@drugfacts.com .
Redefining the Enterprise
Authors: Felkey Bill G. , Fox Brent I.
Published: February 2010

Change is not a new phenomenon in the health care industry, and reactions to change are determined by many things—personal experiences and professional responsibilities to name a few. Gradual transformation in the way health care information is managed is now being met with an opportunity for swift and significant change with regard to how this information is aggregated and used. This article addresses these opportunities for change from an enterprise perspective.
Insulin Preparation Error by Physician; Should Zosyn Be Available in Automated Dispensing Cabinet Stock?; Medication List Filing Error; Institute for Safe Medication Practices Launches First Self-Assessment of Automated Dispensing Cabinet Safety
Authors: Cohen Michael R.
Published: February 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 at your inservice training programs.

Your assistance is required to continue this feature. The reports described here were received through the Institute for Safe Medication Practices (ISMP) Medication Errors Reporting Program. 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 directly to ISMP through the ISMP Web site ( www.ismp.org ), 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.
Microscopic Colitis Associated with Omeprazole and Esomeprazole; Overuse of Proton Pump Inhibitors; Chest Pain in a Young Man Treated with Prazosin; Mirtazapine-Associated Hyponatremia; Nephrotoxicity Associated with Intravenous Colistin; Drug-Induced Parkinsonism: A Review
Authors: Shuster Joel
Published: February 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.
Irinotecan and Carboplatin (IC) Regimen for Lung Cancer
Authors: Waddell J. Aubrey , Solimando Dominic A.
Published: February 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 preparing, dispensing, and administering antineoplastic therapy and to the agents, commercially available and investigational, used to treat malignant diseases.
Thyroxine: Once-Weekly Administration for Hypothyroidism
Authors: Generali Joyce A. , Cada Dennis J.
Published: February 2010

This Hospital Pharmacy feature is extracted from Off-Label Drug Facts, a quarterly publication available from Wolters Kluwer Health. Off-Label Drug Facts is a practitioner-oriented resource for information about specific drug uses that are unapproved by the US Food and Drug Administration. This new guide to the literature enables the health care professional or clinician to quickly identify published studies on off-label uses and determine if a specific use is rational in a patient care scenario. A summary of the most relevant data is provided, including background, study design, patient population, dosage information, therapy duration, results, safety, and therapeutic considerations. References direct the reader to the full literature for more comprehensive information before patient care decisions are made. Direct questions or comments regarding Off-Label Drug Uses to hospital pharmacy@drugfacts.com .
Optimizing Vancomycin Dosing through Pharmacodynamic Assessment Targeting Area under the Concentration-Time Curve/Minimum Inhibitory Concentration
Authors: Deryke C. Andrew , Alexander Donald P.
Published: February 2010

Because of its activity against multidrug resistant gram-positive organisms, vancomycin is one of the antimicrobials most utilized in health care systems worldwide. Despite its widespread use, application of the pharmacodynamic principles governing vancomycin efficacy are not frequently considered in contemporary clinical practice. Although the vancomycin trough serum concentration has been used historically to assess the adequacy of a prescribed dose, data validating that this practice leads to improved patient outcomes do not exist. Alternatively, both in vitro and clinical outcomes data demonstrate improved results when an area under the concentration-time curve/minimum inhibitory concentration (AUC/MIC) of 400 mcg•h/mL or greater is achieved. This article describes the process through which individualized vancomycin dosing regimens targeting an AUC/MIC of 400 mcg•h/mL or greater, rather than trough serum concentration, at the beside can be derived. The equations, methodology, thought processes, benefits, potential pitfalls, and practical applicability of this method are specifically examined. Obtaining the actual MIC value—not an interpretation—from the microbiology laboratory and/or the MIC distribution for Staphylococcus aureus within one's own institution is essential for implementation of this method. Although vancomycin dosing recommendations suggested in contemporary practice guidelines are likely adequate for most patients, using the methods described here may lead to improved clinical outcomes for nonstandard conditions in patients who are critically ill and would benefit from an individualized dosing approach.
Institutional Experience with Daptomycin Treatment in Patients with Gram-Positive Infections
Authors: Collins Curtis D. , Desmet Brian D. , Depestel Daryl D.
Published: February 2010

Purpose

Daptomycin was originally approved for the treatment of complicated skin and skin-structure infections caused by gram-positive bacteria, and recently, its indications were expanded to include bacteremia and right-sided infective endocarditis caused by Staphylococcus aureus. This retrospective chart review examines outcomes and costs for individuals treated with daptomycin at a tertiary care medical center.

Methods

During an 11-month period, records of patients treated with daptomycin at the institution were reviewed. Cases for which complete cost data were available were included in the analysis. Outcomes were assigned to 4 categories: cured, improved, failed, or unevaluable. Hospital stay details were recorded, and antibiotic and total hospital treatment costs were calculated.

Results

Thirty-five patients representing 37 cases were included in the review. Of those cases, 89% (33 of 37) involved documented infections with gram-positive bacteria, 22% involved confirmed methicillin-resistant S. aureus infections, and 32% involved confirmed vancomycin-resistant enterococcus infections. Most cases (27 of 37; 73%) involved infections with multiple bacterial isolates for which previous therapy had failed. Of all clinically evaluable cases, 54% were classified as cured and 42% as improved after daptomycin therapy. Median and mean ± standard deviation (SD) total cost of hospitalization were $46,730 and $111,604 ± $137,138, respectively. Overall median duration of therapy for all 37 cases was 14 days (range, 1 to 143; mean ± SD duration, 25.5 ± 32 days).

Conclusion

Daptomycin cured or improved most evaluable gram-positive infections. The results of this study suggest that daptomycin may be considered a therapeutic option for treatment of drug-resistant gram-positive infections.
Anticoagulation Patient Safety Goal Compliance at a University Health System: Methods for Achieving the Goal
Authors: Franco Ana Crystal , Maxwell Pamela , Green Kay , Barthol Colleen
Published: February 2010

Purpose

Outline steps taken at a university teaching health system to meet The Joint Commission's (TJC's) National Patient Safety Goal (NPSG) for anticoagulation therapy.

Description

The aim of NPSG 3E (recently renumbered as 03.05.01) was to reduce the likelihood of patient harm associated with anticoagulation therapy. Full implementation of a management program for individualization of patient care was required by January 1, 2009. University Health System (UHS) has formed an anticoagulation safety committee consisting of nurses, dieticians, pharmacists, and physicians. Monthly meetings are held to assign projects and responsibilities and to report progress of ongoing tasks. Subcommittees involving selected members have been formed to conduct in-depth evaluations of specific agenda items. The committee has defined target anticoagulants, including unfractionated heparin, enoxaparin, dalteparin, argatroban, lepirudin, fondaparinux, and warfarin. Current practice has been evaluated by gathering baseline adverse events data, performing drug utilization reviews, and analyzing usage. A timeline of progress and expected completion dates for each milestone has been created. Future tasks include developing standard protocols for all anticoagulants and ensuring consistency in discharge counseling. Recently, UHS created a new anticoagulation clinical pharmacist position, and a long-term goal is creation of an anticoagulation team. Responsibilities of this team will include therapy management, discharge counseling, staff education, and maintenance of evidence-based protocols.

Conclusion

Implementing a program of this caliber to meet TJC's January 2009 deadline for full implementation of a management program posed a challenge to this large teaching institution. This article outlines the steps necessary for ensuring achievement of milestone deadlines.
Impact of a Methicillin-Resistant Staphylococcus Aureus Active Surveillance Culture Protocol on Mupirocin Prescribing
Authors: Segarra-Newnham Marisel , John Kristin St.
Published: February 2010

Background

To identify patients colonized with methicillin-resistant Staphylococcus aureus (MRSA), an active surveillance culture (ASC) protocol has been in place since March 2007. Decolonization with mupirocin ointment is not recommended but may be attempted after a positive MRSA screen.

Objective

Assess the impact of an inpatient ASC protocol on prescribing of mupirocin nasal ointment for decolonization before and after protocol implementation.

Methods

A retrospective review of mupirocin inpatient prescribing and outpatient clinic requests from March 2006 through February 2007 (1 year before ASC implementation) and from March 2007 through February 2008 (1 year after ASC implementation) was conducted. Cultures for MRSA after decolonization were evaluated.

Results

During the 24 months reviewed, 38 inpatients received mupirocin (18 before and 20 after ASC). Only 14 patients (37%) had a follow-up nasal swab (5 before and 9 after ASC). Of these patients, 5 (36%) had a positive nasal swab after the initial decolonization attempt. Ten patients (26%) had at least 1 clinical culture positive for MRSA after the initial decolonization (7 before and 3 after ASC). Outpatient requests for mupirocin increased 2.5-fold after ASC implementation. Sixty percent of the requests were not appropriate.

Conclusion

After implementation of the ASC protocol, there was no change in mupirocin prescribing for decolonization in the inpatient setting. However, outpatient requests—most of which were not indicated—increased. Success of decolonization cannot be assessed because follow-up nasal screening was not universally performed.
Antithrombin (Recombinant)
Authors: Cada Dennis J. , Levien Terri L. , Baker Danial E.
Published: February 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 in print and are also available online. Monographs can be customized to meet the needs of a facility. Subscribers to 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. For more information about The Formulary Monograph Service or The F.I.X., call The Formulary at 800-322-4349. The September 2009 monograph topics are dronedarone, prasugrel, ferumoxytol injection, canakinumab injection, and ibuprofen injection. The DUE is on dronedarone.
Telepharmacy: Using Information Technology to Address Critical Needs
Authors: Fox Brent I. , Felkey Bill G.
Published: February 2010

The recent death of a well-known physician prompted a look at telehealth—specifically telepharmacy—in this installment. We begin with a discussion of the connection between telehealth and the physician. Telehealth is then addressed, looking briefly at the past and touching on several current telepharmacy activities.
A Pharmacy Director's Primer on the American Recovery and Reinvestment Act of 2009
Authors: Kelley Lindsey R. , Corman Shelby L. , Weber Robert J.
Published: February 2010

The Director's Forum series is written and edited by Michael Sanborn and Robert Weber and is designed for guiding pharmacy leaders in establishing patient-centered services in hospitals and health systems. Another specific goal of this column is addressing many of the key challenges that pharmacy directors currently face, while also providing information that will foster growth in pharmacy leadership and patient safety. Previous articles in this series have discussed the many different aspects of pharmacy management and leadership challenges. This feature addresses the impact of the American Recovery and Reinvestment Act (the Stimulus Program) on hospital pharmacy practices.
Increased Clinical Failures When Treating Acute Otitis Media with Macrolides: A Meta-Analysis
Authors: Courter Joshua D , Baker William L , Nowak Katherine S , Smogowicz Lori A , Desjardins Lindsey L , Coleman Craig I , Girotto Jennifer E
Published: February 2010

Background:

Macrolide antibiotics are often used to treat children with acute otitis media (AOM); however, the 2004 American Academy of Pediatrics (AAP) and American Academy of Family Physicians guidelines recommend against their use in patients without history of a type I allergic reaction to penicillins.

Objective:

To evaluate via meta-analysis the comparative efficacy of amoxicillin or amoxicillin/clavulanate to that of macrolide antibiotics in the treatment of children with AOM.

Methods:

A systematic literature search of MEDLINE, EMBASE, and International Pharmaceutical Abstracts was conducted from the earliest available date through September 2008. We used the following MeSH and key words: amoxicillin, amoxlcillin/clavulanate, Augmentin, azithromycin, ceftriaxone, clarithromycin, macrolides, AND media, otitis media, and effusion. Included studies were randomized, blinded, and controlled trials evaluating guideline-recommended antibiotics (amoxicillin or amoxicillin/clavulanate) compared to macrolide antibiotics (azithromycin or clarithromycin) in AOM in children. The primary outcome assessed was clinical failure measured between days 10 and 16 after starting antibiotic therapy. Results are reported as relative risks (RRs) with 95% confidence intervals and were calculated using a random-effects model.

Results:

A total of 10 trials (N = 2766) evaluating children 6 months–15 years old were included in the meta-analysis. Upon meta-analysis, the use of macrolide antibiotics was associated with an increased risk of clinical failure (RR 1.31 [95% CI 1.07 to 1.60]: p = 0.008) corresponding to a number needed to harm of 32. Upon safety analysis, rates of any adverse reaction (RR 0.74 [95% CI 0.60 to 0.90]: p = 0.003) and diarrhea (RR 0.41 [95% CI 0.32 to 0.52]: p < 0.0001) were significantly lower in the macrolide group.

Conclusions:

The meta-analysis suggests that patients treated with macrolides for AOM may be more likely to have clinical failures. As such, it supports the current AAP AOM recommendation that macrolides be reserved for patients who can not receive amoxicillin or amoxicillin/clavulanate.
Stability of Extemporaneously Prepared Rufinamide Oral Suspensions
Authors: Hutchinson David J , Liou Yayin , Best Robert , Zhao Fang
Published: February 2010

Background:

Rufinamide is an oral antiepileptic drug indicated for adjunctive therapy in treating generalized seizures associated with Lennox-Gastaut syndrome. Currently, rufinanide is available as 200-mg and 400-mg tablets. A liquid dosage form does not exist at the present time. Lack of a suspension formulation may present an administration problem for many children and adults who are unable to swallow tablets. The availability of a liquid dosage form will provide an easy and accurate way to measure and administer the medication.

Objective:

To determine the stability of both sugar-containing and sugar-free rufinamide suspensions over a 90-day period.

Methods:

A suspension of rufinamide 40 mg/mL was prepared by grinding twelve 400-mg tablets of rufinamide tablets in a glass mortar. Sixty milliliters of Ora-Plus and 60 mL of either Ora-Sweet or Ora-Sweet SF (sugar free) were mixed and added to the powder to make a final volume of 120 mL. Three identical samples of each formulation were prepared and placed in 60-mL amber plastic bottles and were stored at room temperature. A 1-mL sample was withdrawn from each of the 6 bottles with a micropipette immediately after preparation and at 7, 14, 28, 56, and 90 days. After further dilution to an expected concentration of 0.4 mg/mL, the samples were assayed using high-performance liquid chromatography. Stability was defined as the retention of at least 90% of the initial concentration.

Results:

At least 90% of the initial rufinamide concentration remained throughout the 90-day study period in both preparations. There were no detectable changes in color, odor, taste, and pH and no visible microbial growth.

Conclusions:

Extemporaneously compounded suspensions of rufinamide 40 mg/mL in a 1:1 mixture of Ora-Plus and Ora-Sweet or Ora-Sweet SF were stable for at least 90 days when stored in 59-mL amber polypropylene plastic bottles at room temperature.
Change blindness can cause mistaken eyewitness identification
Authors: Nelson Kally J. , Laney Cara , Fowler Nicci Bowman , Knowles Eric D. , Davis Deborah , Loftus Elizabeth F.
Published: February 2010

The current study investigated the effects of change blindness and crime severity on eyewitness identification accuracy. This research, involving 717 subjects, examined change blindness during a simulated criminal act and its effects on subjects' accuracy for identifying the perpetrator in a photospread. Subjects who viewed videos designed to induce change blindness were more likely to falsely identify the innocent actor relative to those who viewed control videos. Crime severity did not influence detection of change; however, it did have an effect on eyewitness accuracy. Subjects who viewed a more severe crime ($500 theft) made fewer errors in perpetrator identification than those who viewed a less severe crime ($5 theft). This research has theoretical implications for our understanding of change blindness and practical implications for the real‐world problem of faulty eyewitness testimony.
Ghostly Mothers and Fated Fathers: Gender and Genre in The Awntyrs off Arthure
Authors: Haught Leah
Published: February 2010

Personified as the ghost of Guenevere's dead mother, the past disrupts a present in the Awntyrs off Arthure to convey a warning about an ominous future to an unlikely subject: Guenevere herself. This interaction between mother and daughter functions as an important commentary on the inevitable limitations associated with any conception of history, temporal stability, or power.
Guenevere: the Abbess of Amesbury and the Mark of Reparation
Authors: Holbrook Sue Ellen
Published: February 2010

Malory elevates Guenevere to abbess of Amesbury where she heals her soul through a penitential process clarified by Cassian's teachings on attitude and supplication and by the cloister context and devotional formulas of her speech on salvation.
'...the quene in Amysbery, a nunne in whyght clothys and blak...': Guinevere's Asceticism and Penance in Malory's Le Morte D'Arthur
Authors: Blanton Virginia
Published: February 2010

This essay examines Malory's presentation of Guenevere's ascetic choices as abbess and considers how her behavior resonates with the choices of royal widows like Eleanor of Provence and her patronage of Amesbury.
Guenevere Burning
Authors: Kaufman Amy S.
Published: February 2010

Reading for Guenevere's desires within both historical and theoretical frameworks can reawaken the pleasures of Malory's Morte Darthur for feminist critics.
Postscript to University of the Philippines Komedya Fiesta 2008: Prelude to a Discourse on National Theatre
Authors: Tiatco Anril
Published: February 2010

This report documents the activities of the Komedya Fiesta 2008 and discusses how scholars and others have cited komedya as a national theatre for the Philippines, but argues why this form cannot serve as a national theatre because of its Roman Catholic religious orientation.
Baresahariya Bhaona : Community Drama Festival of Assam: A Living Tradition
Authors: Sarma Madan M. , Dutta Parasmoni
Published: February 2010

Baresahariya bhaona, a unique festival of Vaishnava theatrical performance, has been celebrated for more than two hundred years in the northeast Indian state of Assam. During the festival twenty-some plays are staged simultaneously under a uniquely designed roof in an acting area shaped like a lotus in bloom. The festival offers a veritable feast of spectacle, stylized acting, classical dance, and music, all imbued with a sense of spirituality. The performance is marked by a continuous shifting between the classical and the folk, the mundane and the spiritual, providing thousands of spectators a rare aesthetic experience. The festival offers an example of a rural community's adherence to simple faith and a desire to retain the best of their cultural-religious tradition, and their readiness to accommodate the inevitable changes in the difficult days of globalization and cultural homogenization.
Urban Style, Sexuality, Resistance, and Refinement in the Japanese Dance Sukeroku
Authors: Keister Jay
Published: February 2010

The entrance dance by the character Sukeroku is a highlight of Sukeroku Yukari no Edo Zakura , a kabuki play that has been a mainstay on the Japanese stage since the early eighteenth century. Analysis of this dance that features one of Japan's most iconic stage persona demonstrates the power of the presentational aspects of kabuki —dance, music, and costume—to symbolically express iki ("chic refinement"), the predominant aesthetic style of Edo era popular culture. As the foremost example of iki in a male character, Sukeroku displays in this dance the complexity of this aesthetic as both an expression of fashionable style on the surface and, at a more hidden level, a symbolic expression of resistance by commoners who sought to oppose the samurai ruling class.
Emotion, Materiality, and Subjectivity: Meng Jinghui's Rhinoceros in Love
Authors: Hsiung Yuwen
Published: February 2010

Leading director Meng Jinghui's theatrical works move toward a more popular and urbanized theatre in contemporary China. Meng's Rhinoceros in Love provides a poignant reflection of the capitalist cultural condition. This paper examines the significance of this work as well as Meng's theatrical vision from the angle of subjectivity, and reads Meng's cultivation of subjectivity not as subversive or reflective, but as individualized and privatized "psychic interiority." The notion of popular theatre is discussed in the context of the avant-garde in China.
Kheimeh Shab Bazi : Iranian Traditional Marionette Theatre
Authors: Massoudi Shiva
Published: February 2010

Kheimeh shab bazi is a traditional marionette form of Iran. The historical background is obscure, though we find references to puppetry in literature and travel reports. The practice of the art in twentieth- and twenty-first-century Iran is detailed.
Gender Concepts and Intuitions
Authors: Mikkola Mari
Published: February 2010

This paper has two goals: it takes issue with a revisionary analysis of the conceptwomanand it defends certain linguistic intuitions about the use of the term ‘woman’. A number of contemporary feminists have been concerned with how to best define the conceptwoman: how best to cash out under which conditions someone counts as a woman. This concern strikes non-feminist philosophers and ordinary language users as surprising since (ordinarily) cashing out the said conditions doesn't appear to be problematic: aren't women simply human females? Most feminists disagree. They standardly understandwomanas a gender concept and gender ascriptions are taken to depend on some social traits (like one's social role or position). These are distinct from sex ascriptions that are thought to depend on anatomical traits (like chromosomes and genitalia).
Promises to the Self
Authors: Habib Allen
Published: February 2010

I Can we make promises to ourselves? This is a question that has not received much consideration in the large body of philosophical work on promising. And in what commentary there is, the answer is uniformly negative. I think this negativity is a mistake, and that the conventional view that we can't make reflexive promises is wrong. I also think that this has some important implications for promissory theory in general. In what follows, I will attempt to argue for the first of these two claims, and to briefly outline my reasons for the second.
Ought a Four-Dimensionalist To Believe in Temporal Parts?
Authors: Miller Kristie
Published: February 2010

I borrow the title of this paper, slightly amended, from Parsons’ recent ‘Must a Four-Dimensionalist Believe in Temporal Parts?’ Four-dimensionalism, as I use the term, is the view that persisting objects have four dimensions: they are four-dimensional ‘worms’ in space-time. This view is contrasted with three-dimensionalism, the view that persisting objects have three-dimensions and are wholly present at each moment at which they exist. The most common version of four-dimensionalism is perdurantism, according to which these four-dimensional objects are segmented into temporal parts — shorter lived objects that compose the four-dimensional whole in just the same way that the segments of real earth worms compose the whole worm.
From Thick to Thin: Two Moral Reduction Plans
Authors: Elstein Daniel Y. , Hurka Thomas
Published: February 2010

Many philosophers of the last century thought all moral judgments can be expressed using a few basic concepts — what are today called ‘thin’ moral concepts such as ‘good,’ ‘bad,’ ‘right,’ and ‘wrong.’ This was the view, first, of the non-naturalists whose work dominated the early part of the century, including Henry Sidgwick, G.E. Moore, W.D. Ross, and C.D. Broad. Some of them recognized only one basic concept, usually either ‘ought’ or ‘good’; others thought there were two. But they all assumed that other moral concepts, including such ‘thick’ ones as the virtue-concepts ‘courageous’ and ‘kindly,’ can be reductively analyzed using one or more thin concepts and some more or less determinate descriptive content. This was also the view of many non-cognitivists who wrote later in the century, including C.L. Stevenson and R.M. Hare.
Temporally Token-Reflexive Experiences
Authors: Kriegel Uriah
Published: February 2010

John Searle has argued that all perceptual experiences are token-reflexive, in the sense that they are constituents of their own veridicality conditions. Many philosophers have found the kind of token-reflexivity he attributes to experiences, which I will callcausaltoken-reflexivity, unfaithful to perceptual phenomenology. In this paper, I develop an argument for a different sort of token-reflexivity in perceptual (as well as some non-perceptual) experiences, which I will calltemporaltoken-reflexivity, and which ought to be phenomenologically unobjectionable.