bluuebunny/crossref_metadata_2025 huggingface dataset:
Amphotericin B Formulation Confusion and Mortality in an HIV-Seropositive Patient
Authors: Stroup Jeffrey S. , Stephens Johnny R. , Baker Damon L. , Lad Madhuri
Published: June 2010

Amphotericin B (AmB) is commonly used in patients with a human immunodeficiency virus (HIV)-positive diagnosis for the treatment of disseminated fungal infections such as Histoplasma spp. or Cryptococcus spp. Newer liposomal formulations of AmB have been introduced to the market to avoid the toxic effects of the traditional agent. With the introduction of these new agents, there is a risk of confusion between the agents in regards to dosing, which may lead to toxicity. We report the case of an HIV-seropositive patient who inadvertently received five times the dose of AmB deoxycholate for disseminated Histoplasma capsulatum and died.
Doxorubicin and Cisplatin Regimen for High-Grade Osteosarcoma or Malignant Fibrous Histiocytoma (MFH) of the Bone
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.
Administrative Degree Options outside Pharmacy for Pharmacists Interested in Administrative Careers in the Health Care Field
Authors: Fink Joseph L.
Published: June 2010

A variety of challenges facing the health care system in general and the profession of pharmacy in particular creates a need for pharmacists who have completed advanced education and training in administration. Some may choose to look outside academic pharmacy for graduate degree programs in administration.

Four types of administrative degrees — MBA, MHA, MPA, and MPH — are described. A list of factors to be considered by a person thinking about pursuing graduate education in this area is presented and discussed. The admission process is described as it may typically occur for such programs in order to familiarize pharmacists with what criteria are likely to be used.

An informed evaluation of the alternatives available will help students select the program best suited to their career goals.
Code N: The Intervention Process
Authors: Siegel Jerry , O'neal Brian
Published: June 2010

This is the final article in a six-part series on diversion of controlled substances in an acute health care setting. This series is 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 This 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 the key to diversion detection; however, a pharmacy should not have to experience its 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. The fourth and fifth articles of this series described the investigation process and features of software packages that can aid in investigation, respectively. This article will describe the intervention process. An intervention, if warranted by the investigation, is the next step and a logical conclusion to this series.
Action Needed to Prevent Dangerous Heparin-Insulin Confusion; Sorting Things Out; Staff Unaware of Fentanyl Patch Starting Doses
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.
Corticosteroids in ARDS: The Never-Ending Story
Authors: Thomas Zachariah , Kimborowicz Katarzyna
Published: June 2010

This feature examines the impact of pharmacologic interventions on the treatment of the critically ill patient — an area of health care that has become increasingly complex. Recent advances in drug therapy (including evolving and controversial data) for adult intensive-care-unit patients will be reviewed and assessed in terms of clinical, humanistic, and economic outcomes.
Cancer Chemotherapy Update - Cisplatin, Doxorubicin, and High-dose Methotrexate for Osteosarcoma
Authors: Debellas Carmen , 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.
Naltrexone: Irritable Bowel Syndrome
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@wolterskluwer.com .
Consultant Pharmacist Drug Therapy Recommendations Acceptance and Rejection from Monthly Drug Regimen Reviews in a Geriatric Nursing Facility: Fourth Year Results and Cost Analysis
Authors: Cooper James W. , Wade William E. , Cook Christopher L. , Burfield Allison H.
Published: June 2010

Purpose

To document and compare the outcomes from monthly drug regimen review recommendation acceptance and rejection in one skilled nursing facility by one consultant pharmacist (CP) in the fourth year of evaluation with the prior 3 years' data.

Method

A non-randomized, observational, prospective cohort study with all patients being residents for at least 30 days over the 12-month period (October 1, 1997 to September 30, 1998) in a skilled nursing facility with more than 100 beds. The admission problem-oriented records of all patients and their respective CP reports were screened for pharmacotherapy recommendations and subsequent acceptance and rejection on a monthly, repeated-measures basis for 12 months. There were 2,004 monthly drug regimen review (DRR) reports. The percentage of DRR reports that made recommendations was tabulated. Written recommendations made to attending physicians that were either accepted or rejected within 3 months were analyzed. The charges for adverse outcomes were calculated from billing records or prior studies of the outcome. These results were compared with prior 1- and 2-year studies of outcomes within the same setting. Carryover effects of recommendations implemented in prior periods were also calculated.

Results

There were 178 recommendations made in 2,004 DRR reports (8.9%). A low acceptance rate, 27 of 178 recommendations (15.2%), resulted and was combined with carryover of prior acceptance in a cost savings of $113,962. The 151 recommendations that were rejected resulted in $226,503 of presumed unnecessary costs to the health care system. A prior 2-year study of recommendations with an acceptance rate of 89% showed costs savings of $111,609 per year with acceptance and $112,297 added costs per year with 11% rejection. The first-year study had a 93% acceptance rate at a projected cost savings of $43,854 and costs increased by $60,825 with a 7% rejection. The costs of recommendation rejection in the fourth year were substantially higher, with a higher rejection rate than was seen in the prior 3 years of observation.

Conclusion

Documentation of the costs from CP intervention should factor in costs of rejection that may increase with the percentage rejection of recommendations, length of observation period, and may vary between facilities.
Aliskiren
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 August 2007 monograph topics are temsirolimus, formoterol fumarate inhalation solution, levocetirizine, ambrisentan, and raltegravir. The DUE is on temsirolimus.
IV Tubing Misconnected to Tracheostomy Cuff; Unidentifiable Patches; A Risk that should Not be Tolerated
Authors: Cohen Michael R. , Smetzer Judy L.
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.
Keratitis with Cetuximab; Heparin-Induced Thrombocytopenia with Fondaparinux; Anaphylactic Shock with Cefuroxime Axetil; Cross-Reactivity between Vancomycin and Teicoplanin; Olanzapine-Associated Eyelid Edema; Another ADR with Olanzapine – Late-Onset Neuroleptic Malignant Syndrome; A Series of Published Drug Reviews of Specific ADRs
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 Food and Drug Administration's (FDA) medWatch program (800-FDA-1088). If you have reported an interesting preventable ADR to medWatch, please consider sharing the account with our readers.
Doxorubicin, Cisplatin, High-dose Methotrexate, and Ifosfamide for Osteosarcoma
Authors: Mbue John E. , Solimando Dominic A. , Waddell J. Aubrey
Published: June 2010

The increasing complexity of cancer chemotherapy now requires that pharmacists be familiar with these highly toxic agents. This column will review various issues related to preparation, dispensing, and administration of cancer chemotherapy, and review various agents, both commercially available and investigational, used to treat malignant diseases.
Nifedipine: Ureteral Stones
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@wolterskluwer.com .
Impact of a Series of Drug Information Interventions on Pharmacy Staff
Authors: Oswald Scott , Graham Angie
Published: June 2010

Purpose

A performance-improvement service project consisting of a series of drug information interventions was developed for pharmacy staff to improve the quality and consistency of drug information provided by clinical pharmacists at a university medical center. The impact of interventions was primarily assessed by attendee satisfaction; a secondary measurement was the use of the Stanford Drug Information Center (the center).

Methods

Five interventions reviewing different electronic drug-information references were presented in September and October 2005. The 1hour presentations consisted of live demonstrations to pharmacy staff. A handout with step-by-step instructions on how to access and search each reference was created and distributed along with a follow-up evaluation. At the end of the interventions, all of the handouts were compiled into a permanent drug-information resource manual. In addition, data regarding inhouse pharmacist call volume to the center and the type of questions asked by inhouse pharmacists were collected for 6 months before and after the interventions.

Results

Evaluations of the interventions were positive and indicated that the learning objectives for each session had been met. The number of requests from inhouse pharmacists actually increased for the 6-month period after the interventions, as compared to the 6-month period prior to the interventions.

Conclusion

Feedback from pharmacy staff was positive, and the performance improvement goal was met through the intervention program, as well as the development of a permanent drug-information resource manual. However, further education of pharmacy staff did not translate into decreased requests (lower call volume) to the center.
Retapamulin 1% Ointment
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 September 2007 monograph topics are rivastigmine transdermal system, ixabepilone, desvenlafaxine succinate extended-release, tedisamil, and sumatriptan succinate and naproxen sodium. The DUE is on formoterol fumarate inhalation solution.
Tendon Rupture with Statin Therapy; Sulfasalazine-Induced Immune Thrombocytopenia; Hyperammonemia with Valproic Acid; Cetuximab and Radiation Lead to Severe Cutaneous Reaction; Yet Another Skin Reaction Due to Monoclonal Antibodies; Manic Switching in Patients Receiving Duloxetine; Hyperprolactinemia and Galactorrhea Induced by SNRIs
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 Food and Drug Administration's (FDA) medWatch program (800-FDA-1088). If you have reported an interesting preventable ADR to medWatch, please consider sharing the account with our readers. 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.
Medication Tracers: A Systems Approach to Medication Safety
Authors: Hendrick Erin C. , Montanya Kathryn R. , Griffith Niesha
Published: June 2010

The Ohio State University Health System Department of Pharmacy Performance Improvement Committee has designed a tool, based on the concept of The Joint Commission on Accreditation of Healthcare Organization's patient tracer methodology, for continuous review of the medication-use process and to assess compliance with Medication Management Standards. Implementing this proactive strategy will improve the ability of institutions to continuously review the medication-use system in various practice areas and identify deviations in policy and practice. Key elements for successful implementation of the medication tracer tool are discussed.
Rotigotine Transdermal System
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 October 2007 monograph topics are maraviroc, etravirine, bifeprunox, regadenoson, and fesoterodine. The DUE is on maraviroc.
Using Standard Studies to Interpret the Scores from Scales for Assessing the Internal Validity of Randomized Controlled Trials
Authors: Slack Marion Kimball
Published: June 2010

Objective

A large number of tools for assessing the quality of randomized controlled trials are available; however, users have little guidance as to whether a given score represents high or low validity. The purpose of this study is to explore the use of studies identified as having high-internal validity, referred to as the standard studies, to interpret internal validity scores from studies with unknown internal validity.

Methods

The standard studies were identified by locating 6 candidate studies reporting the findings of randomized controlled trials from the Journal of American Medicine Association or the New England Journal of Medicine and scoring the studies using 2 scales, the Jadad scale (high score = 5; low = 0) and an internal validity information scale (IVI; high score = 70; low = 0). The 2 studies with the highest average rank were chosen as the standard studies. To determine if the standard studies facilitate interpretation of internal validity scores, 11 randomized controlled trials of garlic for the treatment of hypercholesterolemia were scored using both the Jadad and IVI scales and differences in scores resolved by consensus. The total mean scores were compared with the standard-study mean using a 1-sample t test; the interpretation was based on the comparison.

Results

The mean-internal validity score for the 2 standard studies was 4.5(90%) for the Jadad scale and 64 (91%) for the IVI scale. For the garlic studies, the Jadad scores ranged from 3 to 5 (60% to 80%), the IVI scores from 15 to 59 (21% to 84%); the mean scores were 4 (standard deviation = 0.9; 80%) and 37(53%), respectively. On the IVI scale, the garlic studies had lower internal validity (P < 0.001), a finding substantiated by the low scores for addressing withdrawals, blinding, and adherence. On the Jadad scale, the scores were comparable with the score for the standard studies (P = 0.093).

Conclusions

The strategy of using the standard studies to interpret the scores for the IVI scale worked well; the comparison indicated that, overall, the garlic studies were of low-internal validity. With the Jadad scale, the strategy resulted in erroneous conclusions that the garlic studies had relatively high-internal validity; however, it did indicate that the Jadad scale is limited and may not identify studies with very low-internal validity. The results of this study suggest that scales used to assess internal validity should be tested on studies with a range of validity, so the functional characteristics of the scale can be identified.
The Use of Colistin in Multidrug-Resistant Infections
Authors: Zapantis Antonia , Lopez Mary , Hoffman Emily , Lopez Angelica , Hamilton Grace
Published: June 2010

This feature examines the recent rise of colistin use in multidrug-resistant infections and puts it in perspective of its historical use in terms of its safety and tolerability profile. In addition, limitations of using colistin as a first-line agent due to risk of colistin resistance and cases of pandrug resistance are discussed.
Ambrisentan
Authors: Cada Dennis J. , Levien Terri , Baker Danial E.
Published: June 2010

Each month, subscribers to The Formulary Monograph Service receive 5 to 6 well-documented monographs on drugs that are newly released or are in late phase 3 trials. The monographs are targeted to your Pharmacy and Therapeutics Committee. Subscribers also receive monthly 1-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 December 2007 monograph topics are ixabepilone, doripenem for injection, raltegravir potassium, recombinant human thrombin, and icatibant. The DUE is on raltegravir potassium.
Strategies for Effective Medication Use Evaluations
Authors: Greer Nickie D. , Sanborn Michael
Published: June 2010

The Director's Forum series is written and edited by Michael Sanborn and Robert Weber and is designed to guide pharmacy leaders in establishing patient-centered services in hospitals and health systems. Another specific goal of this column is to address many of the key challenges that pharmacy directors face today, while providing information to foster growth in pharmacy leadership and patient safety. This month's Forum focuses on specific ways to improve the medication-use evaluation process.
Hyperglycemia Management Using Insulin in the Acute Care Setting: Therapies and Strategies for Care in the Non-Critically III Patient
Authors: Kirk Julienne K , Oldham Elizabeth C
Published: June 2010

Background:

Hyperglycemia is prevalent in hospitalized non-critically ill patients and is associated with higher morbidity and mortality. Poor glycemic control is related to elevated costs due to longer hospital stays and higher rates of complications.

Objective:

To review current literature evaluating treatment strategies for management of hyperglycemia in the non-critically ill hospitalized patient and to discuss the role of pharmacists in glycemia management.

Data Sources:

A literature review (January 2000–January 2010) was conducted via PubMed, Web of Science, Cumulative Index to Nursing and Allied Healh, the Cochrane Library, Combined Health Information Database, and Education Resources Information Center. MeSH terms for diabetes were used along with stress hyperglycemia, insulin therapy, and insulin analogs in combination with non-critically ill, hospitalized, acute care, or inpatient.

Study Selection and Data Extraction:

All articles identified from the data sources were reviewed for inclusion. Clinical trial reports, practice guidelines, and reviews involving insulin therapies and/or quality improvement initiatives for hyperglycemia in the acute care setting were evaluated. A total of 133 citations were reviewed and an additional 11 citations were identified from reference lists.

Data Synthesis:

The association between hyperglycemia and increased mortality is recognized in the acute care setting among critically ill patients; however, data to support glycemia management in non-critically ill patients continue to be established. National consensus guidelines support strategies for glycemia control that focus on insulin therapy and treatment-driven protocols. These initiatives can result in quality improvement when led by multidisciplinary teams, including pharmacists. Literature supports a pharmacist role in glucose monitoring and insulin dosing.

Conclusions:

Management of hyperglycemia is a critical component of acute care. Insulin treatment regimens and protocols for non-critically ill patients in the acute care setting are evolving with recognition of ideal glucose targets to prevent adverse outcomes. Glycemia management can be complex and presents opportunities for pharmacist involvement.
Performance of Community Pharmacists in Providing Clinical Medication Reviews
Authors: Laaksonen Raisa , Duggan Catherine , Bates Ian
Published: June 2010

Background:

Drug-related problems (DRPs) may result in adverse drug reactions causing hospital admissions (5–17%); older patients in particular may experience such reactions during a hospital stay (6–17%). While community pharmacists can identify DRPs through clinical medication reviews, little is known about how well they perform in providing such reviews.

Objective:

To assess trained community pharmacists' performance in writing care plans and referrals when providing clinical medication reviews to elderly patients as part of a patient outcome–focused Medicines Management project.

Methods:

In the south of England, 43 community pharmacists were recruited from 80 local community pharmacies; 37 completed clinical pharmacy training to provide medication reviews for elderly patients who were receiving prescriptions for 4 or more medicines from local general practices. Eleven trained pharmacists withdrew and did not provide any reviews. As part of quality assurance, a clinical pharmacist reviewed all care plans and referrals written by the community pharmacists and, if required, amended referrals before they were sent to the patients' family physicians with recommendations. The referrals written by the community pharmacists were compared with those written by the clinical pharmacist and were deemed to be accurate or incomplete (the community pharmacists could provide verbal information to the physicians) if the observations of DRPs and suggestions to solve them were beneficial to patients. Incorrect or missing observations and suggestions were considered non-beneficial to patients.

Results:

The performance assessment was based on a sample of 244 referrals written by 20 community pharmacists. The clinical pharmacist identified 908 DRPs and suggested 1489 solutions; the community pharmacists beneficially identified 75% of these DRPs (1% were incorrectly identified and 24% were missed) and suggested 58% of the solutions (6% were incorrectly suggested and 36% were missed).

Conclusions:

The community pharmacists beneficially identified most DRPs and suggested many solutions. However, the assessment may underestimate the community pharmacists' abilities, as it relied on the records they kept and was based on a gold standard. While the pharmacists were self-selected, this study provides valuable insight into trained community pharmacists' clinical medication review performance.
Assessing Anticoagulation Knowledge in Patients New to Warfarin Therapy
Authors: Winans Amanda R McFee , Rudd Kelly M , Triller Darren
Published: June 2010

Background:

Warfarin is highly efficacious for the treatment and prevention of thromboembolic disorders. However, anticoagulation control has been a longstanding challenge, as patients' lack of knowledge of warfarin therapy is a predictor of nonadherence and compromised patient safety.

Objective:

To ascertain whether hospitalized patients newly initiated on warfarin are provided adequate anticoagulation education during hospitalization, as measured at discharge, as well as determine whether there is a difference in the knowledge obtained by patients educated via a structured program versus those counseled by “usual care.”

Methods:

A prospective evaluation of warfarin education of inpatients new to warfarin therapy was performed at Bassett Medical Center, Cooperstown, NY. Patients who were admitted to the hospital and receiving warfarin for any given diagnosis, were >18 years of age and able to give informed consent, and spoke English were recruited. Patients with dementia or cognitive impairment, those who were pregnant, or those who had previously been on warfarin therapy were excluded. Recruited patients received warfarin education in the form of a structured program provided by a pharmacist or counseling by usual care during hospitalization. Prior to discharge, the Oral Anticoagulation Knowledge (OAK) test, a prevalidated tool used to measure warfarin knowledge, was administered to evaluate outcomes. Further warfarin education was provided post-test if necessary.

Results:

The intervention group (n = 20) scored significantly higher on the OAK test than the usual care group (n = 20): 74% versus 55%, respectively (p = 0.004).

Conclusions:

This preliminary study demonstrated that there is a large amount of variability regarding patient knowledge of warfarin on discharge from an inpatient facility. A formalized inpatient warfarin education program may empower patients to achieve a larger degree of initial warfarin knowledge than those educated by usual care. Previous studies have demonstrated that this may improve adherence and subsequently increase long-term safety associated with oral anticoagulation. Larger, prospective, randomized studies are necessary to further evaluate patient education and safety outcomes.
Light-induced multistep redox reactions: The diode-array spectrophotometer as a photoreactor
Authors: Fábián István , Lente Gábor
Published: June 2010

The light source of a photometer may induce chemical reactions in photosensitive reactive systems. Diode-array spectrophotometers are particularly suitable for producing such phenomena. This paper provides an overview on how this equipment can be used as a photoreactor. The principles of various techniques to control the intensity and spectral region of the illuminating light are discussed in detail. It will be shown that the quantum yields of various photochemically induced redox reactions can be determined by exploiting specific features of diode-array spectrophotometers. Kinetic coupling between primary photo-chemical and secondary thermally activated reaction steps are utilized to explore intimate details of composite redox reactions. Key aspects of the method applied are demonstrated via the photoreactions of 2,6-dichloro-1,4-benzoquinone (DCQ), the photoinduced autoxidation of S(IV) and a photochemically activated redox reaction of the chlorate ion.
Quantification of fungal colonization in modified wood: Quantitative real-time PCR as a tool for studies on Trametes versicolor
Authors: Pilgård Annica , Alfredsen Gry , Hietala Ari
Published: June 2010

Traditional wood preservatives based on biocides are effective against wood-deteriorating organisms because of their toxicity. By contrast, modified woods are non-toxic by definition. To investigate the efficiency of various wood modifications, quantitative real-time polymerase chain reaction (qPCR) was used to profile the DNA amounts of the white-rot fungus Trametes versicolor (L.) [Lloyd strain CTB 863 A] during an 8-week-long growth period in treated Pinus sylvestris (L.) sapwood. The studied wood was modified by acetylation, furfurylation, and thermal treatment. The traditional wood preservatives bis-(N-cyclohexyldiazeniumdioxy)-copper (Cu-HDO) and chromated copper arsenate (CCA) were used as references, whereas untreated P. sylvestris (L.) sapwood served as a control. The maximum levels of fungal DNA in native wood occurred at the end of the experiment. For all wood treatments, the maximum fungal DNA level was recorded after an incubation period of 2 weeks, followed by a decline until the end of the trial. For the preservative-treated woods, Cu-HDO showed the lowest level of fungal DNA throughout the experiment, indicating that exploratory hyphal growth is limited owing to the phytotoxicity of the treatment. The other treatments did not inhibit the exploratory hyphal growth phase. We conclude that qPCR studies of hyphal growth patterns within wood should provide a powerful tool for evaluating and further optimizing new wood protection systems.
Changes in C-reactive protein levels before type 2 diabetes and cardiovascular death: the Whitehall II study
Authors: Tabák A G , Kivimäki M , Brunner E J , Lowe G D , Jokela M , Akbaraly T N , Singh-Manoux A , Ferrie J E , Witte D R
Published: June 2010

Objective

Prospective studies show that high C-reactive protein (CRP) levels predict diabetes and cardiovascular disease (CVD), but changes in this marker preceding disease onset are not well characterized. This study describes CRP trajectories prior to type 2 diabetes onset and fatal CVD.

Methods

In a prospective cohort of 7350 British civil servants (70% male, mean age 51 years), 558 incident type 2 diabetes cases (75-g oral glucose tolerance test, doctor's diagnosis, or self-report) and 125 certified fatal cardiovascular events were observed during a median follow-up of >14 years. Trajectories of logarithmically transformed CRP levels prior to incident diabetes or fatal cardiovascular event (cases), or the end of follow-up (controls) were calculated using multilevel modeling.

Results

Baseline CRP levels were higher among participants who developed diabetes (median (interquartile range) 1.44 (2.39) vs 0.78 (1.21) mg/l) or fatal CVD (1.49 (2.47) vs 0.84 (1.30) mg/l) compared with controls (bothP<0.0001). In models adjusted for age, sex, body mass index, ethnicity, and employment grade, CRP levels increased with time among both incident diabetes cases and controls (P<0.0001), but this increase was less steep for cases group (P<0.05). CRP levels followed increasing linear trajectories in fatal cardiovascular cases and controls (P<0.0001) with no slope difference between the groups.

Conclusions

CRP levels were higher among those who subsequently developed diabetes or died from CVD. For type 2 diabetes, age-related increase in CRP levels was less steep in the cases group than in controls, whereas for fatal CVD these trajectories were parallel.
Treatment of endometriosis with laparoscopic surgery today
Authors: Berkes Enikő , Bokor Attila , Rigó János
Published: June 2010

Az endometriosis korszerű sebészi kezelésének célja a károsodott kismedencei anatómia helyreállításával az endometriosishoz társuló fájdalomtünetek csökkentése, illetve a teherbe esési esélyek javítása. Cikkünkben a különböző elhelyezkedésű kismedencei endometriosislaesiók eltávolításának műtéti lehetőségeit elemezzük. Az endometriosis sebészi kezelése döntően laparoszkópia útján valósul meg, míg a laparotomia alkalmazási köre egyre inkább beszűkült és csak speciális esetekre korlátozódik. A peritonealis endometriosis laesiói reszekció, elektrokoaguláció vagy lézervaporizáció segítségével kezelhetők, amelyek azonos mértékben csökkentik az endometriosishoz társuló fájdalomtüneteket, illetve javítják a teherbe esési esélyeket. Az endometrioma kezelésében hosszú éveken át kétféle műtéti megoldás terjedt el; a cisztatok eltávolítása az úgynevezett strippingtechnika segítségével, valamint a cisztatok megszüntetése az ablatiós műtéti technikával. Napjainkra egyértelműen bebizonyosodott, hogy a stripping előnyösebb az endometrioma ablatiójával szemben mind a fájdalomtünetek csökkenése, mind a reproduktív funkciók szempontjából. A mélyen infiltráló endometriosis kezelése jelenti a legnagyobb kihívást az endometriosis sebészetében. A mélyen infiltráló laesiók eltávolításában a lézertechnika alkalmazásának jut főszerep. A rectovaginalis septum endometriosisa esetén lézer segítségével a mélyen infiltráló laesio biztonsággal és maradéktalanul eltávolítható. Bélendometriosis esetén az érintett bélszakaszt szegmentális reszekcióval, discreszekcióval vagy az úgynevezett shavingtechnikával távolíthatjuk el. Leggyakrabban a szegmentális reszekciót alkalmazzuk, mivel egyedül ez esetben biztosítható a reszekciós szél biztos épsége. Az ureter endometriosisa esetén kisfokú érintettség mellett ureterolysis, míg obstruktív uropathia fennállásakor az ureter reszekciója javasolható. Az endometriosishoz társuló fájdalom hatékonyabb csökkentését célozza a praesacralis neurectomia és az uterusidegrost-ablatio. Ezen beavatkozások klinikai eredményessége azonban nem egyértelmű, az endometriosis kezelésében betöltött pontos szerepük tisztázása további vizsgálatokat igényel. Az endometriosis sebészetében a folyamatosan fejlődő műtéti technikák az endometriosislaesiók egyre teljesebb és hatékonyabb eltávolítását teszik lehetővé, amelynek köszönhetően egyre eredményesebben kezelhetők az endometriosishoz társuló klinikai tünetek és csökkenthető a betegség kiújulásának veszélye.
Role of environmental factors in the etiology of hepatocellular carcinoma
Authors: Tornai István
Published: June 2010

A krónikus vírushepatitisek jelentik ma a legismertebb okokat a hepatocellularis carcinoma (HCC) kialakulásában. A krónikus B- és C-vírus-hepatitis a májrákok körülbelül 40-50%-át okozza. A nyugati típusú társadalmakban a HCC előfordulása folyamatosan növekvő tendenciát mutat. Az alkohol számít a környezeti tényezők közül a legfontosabbnak, bár az alkoholfogyasztás a legtöbb országban csökken. Ez aláhúzza az egyéb környezeti tényezők fontosságát is. Az elfogyasztott alkoholmennyiséggel egyenes arányban növekszik a cirrhosis és a következményes HCC gyakorisága nőkben és férfiakban egyaránt. A kémiai anyagok közül a legismertebb a Kínában és Afrikában elterjedt aflatoxin, amely a gabonaféléket szennyező mycotoxin. Hasonló területeken endémiás, mint a hepatitis B-vírus, együtt szinergista hatást fejtenek ki. A dohányzás is egyértelműen bizonyított hepatocarcinogen hatással rendelkezik. Ez is jelentősen fokozódik, ha alkoholfogyasztással vagy vírushepatitisszel társul. Társadalmilag talán a legfontosabb az elhízás, a következményes nem alkoholos zsírmáj, illetve steatohepatitis és a 2-es típusú cukorbetegség, amelyek prevalenciája egyre fokozódik. Feltehetően ezek állnak a növekvő HCC-gyakoriság hátterében. Az inzulinrezisztencia és az oxidatív stressz képezik a legfontosabb patogenetikai lépéseket a májsejtkárosodásban. További fontos rizikótényező az orális fogamzásgátlók elterjedt használata. Egyes foglalkozások esetén a tartós szervesoldószer-expozíció is növeli a HCC rizikóját. Védelmet jelenthetnek az antioxidánsok, a szelén, a gyógyszerek közül a statinok és a feketekávé-fogyasztás.
Alterations on monoamines concentration in rat hippocampus produced by lipoic acid
Authors: Santos Ítala Mônica de Sales , Freitas Rizângela Lyne Mendes de , Saldanha Gláucio Barros , Tomé Adriana da Rocha , Jordán Joaquín , Freitas Rivelilson Mendes de
Published: June 2010

The purposes of the present study were to verify monoamines (dopamine (DA), norepinephrine (NE), serotonin (5-HT)), and their metabolites (3,4-hydroxyphenylacetic acid (DOPAC), homovanillic acid (HVA) and 5-hydroxyindoleacetic acid (5-HIAA)) contents in rat hippocampus after lipoic acid (LA) administration. Wistar rats were treated with 0.9% saline (i.p., control group) and LA (10, 20 or 30 mg/kg, i.p., LA10, LA20 and LA30 groups, respectively). After the treatments all groups were observed for 24 h. The NE and DA levels were increased only in 20 mg/kg dose of LA in rat hippocampus. Serotonin content and in their metabolite 5-HIAA levels was decreased in same dose of LA. On the other hand, in DOPAC and HVA levels did not show any significant change. The alterations in hippocampal monoamines can be suggested as a possible of brain mechanism of action from this antioxidant. The outcome of the study may have therapeutic implications in the treatment of neurodegenerative diseases.
Determinação do potencial biótico da "broca do café": Hypothenemus Hampei (Ferr.) - E considerações sôbre o crescimento de sua população. III - Curva termometabólica da "broca do café" e sua aplicação no estudo do crescimento de sua população
Authors: Mendes Luiz O. T.
Published: June 2010

Lançando mão de dados publicados por outro autor, (1) sôbre o comportamento da "Broca do Café", quando criada a várias temperaturas, em laboratório, o autor, aceitando em princípio que uma hipérbole equilátera traduz o termometabolismo da espécie, calcula a constante térmica da espécie (K = 339,26) e determina a sua temperatura mínima efetiva (T0 =15,12 °C). É deduzida a equação termometabólica para êsse inseto, dada por D = 339,26 / (T-15,12). Considerando que, num cafèzal, a temperatura do ar não é constante, variando de acôrdo com a estação do ano, o autor pondera que a curva de crescimento de uma população de "Broca do Café" será melhor representada em gráfico onde seja levada em conta a influência da temperatura no desenvolvimento do ciclo biológico do inseto. Dessa maneira, apreciando exemplos numéricos apresentados em trabalho anterior, e construindo novo gráfico, em vez de colocar os valores de "t" no eixo das abscissas, a intervalos regulares, coloca-os a intervalos previamente calculados pela aplicação da equação termometabólica do inseto, de acordo com a temperatura média do mês. Os exemplos são analisados em função das temperaturas normais de Campinas para um período de 58 anos (1890-1947). A análise dos gráficos apresentados mostra até onde a temperatura do ambiente pode influir no desenvolvimento de uma população de "Broca do Café", em condições de campo.
Trajetória da sociedade da informação no Brasil: proposta de mensuração por meio de um indicador sintético
Authors: Araújo Evandro Nicomedes , Rocha Elisa Maria Pinto da
Published: June 2010

A sociedade da informação (SI) retrata a crescente importância que a informação, o conhecimento e as inovações tecnológicas assumem na contemporaneidade. O objetivo do artigo é elaborar um exercício exploratório sobre o uso de indicador sintético voltado para o dimensionamento de aspectos relevantes da SI. Os procedimentos metodológicos envolveram a exploração de bases de dados e informações estatísticas, a padronização de variáveis, além de levantamento documental e bibliográfico. Os resultados sugerem que, embora favorável, a trajetória da SI não se mostrou linear no tempo. Dentre as dimensões sob consideração, a manifestação mais significativa da SI estaria associada à disponibilidade de infraestrutura tecnológica e meios de acesso à internet. Por sua vez, formação educacional e recursos financeiros representariam desafios a serem enfrentados para a consolidação da SI no Brasil. Ao tentar representar conceito complexo e multifacetado e buscar dimensionar aspectos associados à sua manifestação, o artigo representa esforço de sistematização de dados e informações de interesse para a ciência da informação.