bluuebunny/crossref_metadata_2025 huggingface dataset:
Analysis of Aerodynamic Performances of Experimental Flying Test Bed in High-Altitude Flight
Authors: Zuppardi G , Visone G , Votta R , Schettino A
Published: August 2010

An aerodynamic, computational study has been performed on the 3.9.2_FW50 configuration of the winged experimental flying test bed (FTB-X) of an experimental unmanned space vehicle in the altitude interval 90—110 km, where the vehicle is in transitional regime. The range of the angle of attack was 0—40° and the side slip angle was 15°. The flow field has been solved by the three-dimensional (3D) direct simulation Monte Carlo (DSMC) code: DS3V. The results showed better aerodynamic behaviour both in symmetric and in side-slip flights, but worst longitudinal stability in symmetric flight with respect to the previous version of FTB-X (1.1.2). In fact, both the aerodynamic efficiency and the derivative of pitching moment coefficient in symmetric flight increased. Furthermore, a preliminary analysis about the possibility of an aerodynamic control of the vehicle by deflection of a trailing edge flap has been fulfilled. This analysis has been carried out in terms of the lift and drag forces and pitching moment at the altitude of 70 km in the range of the angle of attack 0—30° and flap deflection 0—30°. The flow field has been solved by a 2D DSMC code (DS2V) and computational fluid dynamic code (H3NS). A thermal analysis has been also carried out for evaluating the heat flux on the flap. This heat flux is comparable with that at the nose stagnation point, and therefore a thermal protection system should be necessary also on the flap. The effect of the flap deflection on the flow separation has been also evaluated. In particular, at high flap deflection angle, the shock wave boundary layer interaction produces a decrease of the airfoil aerodynamic efficiency. Therefore, the increases of lift and drag of the aerodynamic force, as functions of the flap deflection angle, encourage performing similar tests considering the whole vehicle.
Dry Sliding Wear Behaviour of Oil Jet Peened Aluminium Alloy, AA6063-T6
Authors: Prakash Arun N , Gnanamoorthy R , Kamaraj M
Published: August 2010

Oil jet peening makes use of high-pressure oil jet to impart compressive residual stresses on the surface of metallic materials in order to improve the surface properties. This article reports the dry sliding wear characteristics of oil jet peened aluminium alloy, AA6063-T6. The presence of compressive residual stress and high hardness improves the wear resistance of oil jet peened surfaces. Changes in the hardness, surface morphology, and residual stress distribution due to peening affect the tribological behaviour. The initial and steady-state coefficient of friction are less in the treated samples compared to untreated samples. The scanning electron microscope images of the worn surfaces reveal the dominant adhesive and mild abrasive form of wear.
Preparation, Characterization, and Tribological Evaluation of Triethanolamine Monooleate-Modified Lanthanum Borate Nanoparticles
Authors: Hao L , Li J , Xu X , Ren T
Published: August 2010

To develop a potential substitute for conventional lubricant additive, lanthanum borate nanoparticles modified by triethanolamine monooleate (TEMO-LaB) were prepared. The composition and microstructures of the samples were characterized by inductively coupled plasma optical emission spectroscopy, X-ray power diffraction, infrared spectra, transmission electron microscope, and thermogravimetric analysis. The results indicate that TEMO-LaB with the size around 50 nm is amorphous and the composition is La2[B4O5(OH)4]3. Tribological properties of the prepared nanoparticles were evaluated using a four-ball tribometer and compared with a commercial borate ester (Vanlube 289). The results show that TEMO-LaB has better friction-reducing property in base oil than Vanlube 289. A three-dimensional non-contact surface profilometer was used to explore the morphology of the worn surface and X-ray photoelectron spectroscopy analysis was carried out. Based on the results of surface analysis, the action mechanism of nanoparticles during the friction process was preliminarily discussed.
Comparative study of the performances during match play of an elite-level spin bowler and an elite-level pace bowler in cricket
Authors: Justham L M , Cork A E J , West A A
Published: August 2010

A study of one right-hand pace bowler and one left-arm wrist spin bowler, during the 2006–2007 Ashes series between England and Australia, has been undertaken to understand better the existing knowledge regarding cricket bowling performance during match play. Data from Hawk-Eye and Feedback Cricket performance analysis software programs have been used to analyse 624 pace deliveries and 949 spin deliveries, bowled to five opposition batters. Pace deliveries have been classified on the basis of the pitching length, and spin deliveries have been categorized into one of four delivery types (the leg break, flipper, slider, or googly). One-way analyses of variance were carried out on all deliveries to determine the differences of statistical significance in bowling. For spin bowling, the speed of the ball at release, vertical release angle, and deviation angle after pitching varied for different delivery types. For pace bowling, the pitching line of the ball became closer to the centre stump as the delivery length became fuller and the ball release angle became flatter towards the horizontal. The outcome of this investigation has been to determine the expected ranges of delivery combinations for both an elite spin bowler and an elite pace bowler during match play.
Melioidosis in an urban-dwelling Taiwanese man with splenic abscesses
Authors: Wu Yu-Chiuan , Hsu Jin-Wen , Chang Tsung-Hung , Kung Wen-Ching
Published: August 2010

We report a case of melioidosis with splenic abscesses caused by Burkholderia pseudomallei in an urban-dwelling, 54-year-old Taiwanese man. The patient presented with prolonged fever and abdominal pain. A splenectomy was performed, followed by successful treatment with ceftazidime and amoxicillin-clavulanate. The patient recovered fully.
Development and Implementation of Standardized Intravenous Immune Globulin Orders for Pediatric Patients
Authors: Speight Kathy Palmer , Zillmer Rhonda H. , Alexander Benjamin S. , Yeakey Anne M.
Published: August 2010

Purpose

To develop and implement a standardized intravenous immune globulin (IVIG) order set for pediatric patients in a community hospital.

Methods

Standardized orders are used in many hospitals to help guide the medication ordering process. WakeMed Health and Hospitals in Raleigh, North Carolina, developed and implemented a standardized pediatric IVIG order set. The IVIG orders were designed and approved by a multidisciplinary team. All standing orders at WakeMed are maintained by the Clinical Analysis Department and reviewed every 3 years by the pharmacy and medical staff. The standardized IVIG order set must be completed anf signed by the attending physician for all pediatric IVIG orders. Standardization of the IVIG orders helps promote accurate physician medication ordering, provides safe administration guidelines, and minimized the risk of medication errors and adverse events.

Results

As a result of the implementation of standardized IVIG orders, the hospital has decreased the potential for adverse events and medication errors in the pediatric population and has eliminated product waste. Hospital pharmacists should encourage the development of standardized orders for pediatric patients receiving immune globulin.
Safety of Long-Term Benzodiazepine Therapy; Topiramate and Reversible Anorgasmia; Lymphadenitis and Phenytoin-Induced Hypersensitvity; Syndrome Seeing Double with Your Antidepressant?; Cabergoline and Heart Valve Pathology; Toxicity with Rectal Fentanyl; Tardive Dystonia with Ziprasidone; Prescription of Teratogenic Medications in the US
Authors: Shuster Joel
Published: August 2010

The purpose of this feature is to heighten awareness of specific adverse drug reactions (ADRs), discuss methods of prevention, and promote reporting of ADRs to the FDA's medWatch program (800-FDA-1088). If you have reported an interesting preventable ADR to medWatch, please consider sharing the account with our readers.
Mirtazapine: Hot Flashes
Authors: Generali Joyce , Cada Dennis J.
Published: August 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 hospital pharmacy@drugfacts.com .
Personal Digital Assistant (PDA) Clinical Intervention Documentation System: Development, Implementation, and Comparison to a Previous Paper-Based System
Authors: Nystrom Kelly K. , Foral Pamela A. , Wilson Amy F. , Christensen Carla M. , Miller Chanda K.
Published: August 2010

Purpose

In preparation for the complete decentralization of pharmacists at our institution, we were asked to create a user-friendly intervention program the pharmacists could use on the patient floors.

The current system was cumbersome; the paper-based system made it hard to retrieve meaningful data and many interventions were not being captured. We felt that personal digital assistants (PDAs), with a tailored intervention program developed with Pendragon forms, would best meet our needs. A form was developed and modified based on the feedback of specific staff. After staff training, the program was implemented in June 2002. In an attempt to simplify the program, more forms were added and current forms were streamlined also based on staff feedback. The program is bridged with a Microsoft Access database and reports generated from this database provide essential information for administration to justify current positions, as well as, new positions. A literature search was performed and evaluated to determine our cost avoidance data (based on published cost avoidance associated with clinical pharmacy interventions). Institution-specific ingredient costs were used for cost savings data. Based on pre-PDA data, the number of interventions increased from an average of 112/mo to 361/mo (322% increase). An increase in the number of accepted interventions was also noted. The total cost savings and avoidance by pharmacists for the 21-month period assessed was $1,827,286: intervention total cost savings and avoidance of $1,580,593 and drug information cost avoidance of $246,693.

Conclusion

This program has increased the documentation of clinical pharmacy services at our institution, while reaping the additional benefit of transferring our total cost avoidance and savings into additional full-time equivalent positions.
Pregabalin
Authors: Cada Dennis J. , Levien Terri , Baker Danial E.
Published: August 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 February 2006 monograph topics are fentanyl (hydrochloride) patient-activated transdermal system, sipuleucel-T artificial embolization device, anecortave acetate for depot suspension, and dextromethorphan/quinidine sulfate. The DUE is on fentanyl (hydrochloride) patient-activated transdermal system.
Core Competencies in Hospital Pharmacy — Drug Dispensing
Authors: Sanborn Michael
Published: August 2010

The next several Director's Forum articles will focus on core practices or competencies in hospital pharmacy practice. This series of articles will discuss the key fundamentals, resources, challenges, and opportunities associated with drug dispensing. Future core competency forums will include discussions on medication ordering, intravenous admixtures, data analysis, and regulatory requirements.

In Director's Forum, we hope to answer key questions that pharmacy directors face and provide others with information to foster growth in pharmacy leadership. The articles in this column will build on one another and, when put together, will serve as a “tool kit” to develop patient-centered pharmacy services in hospitals of all sizes. Examples of topics in future Director's Forums will include establishing clinical service priorities, justifying clinical pharmacist positions, implementing a patient safety program, and budgeting for patient-centered services.
Work to Resolve Oral-to-IV Dosing Conflicts; On the Watch: Rozerem vs Razadyne; USP Focuses on Radiological Procedures in 6th Annual Medmarx Report; Unsafe Abbreviation (at least for Cats)
Authors: Cohen Michael R.
Published: August 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.
Bleomycin, Vincristine, Lomustine, and Dacarbazine (BOLD) with Interferon Regimen for Metastatic Melanoma
Authors: Seo Cate Yujin , Solimando Dominic A. , Waddell J. Aubrey
Published: August 2010

The increasing complexity of cancer chemotherapy heightens the requirement that pharmacists be familiar with these highly toxic agents. This column will review various issues related to preparation, dispensing, and administration of cancer chemotherapy. It will also serve as a review of various agents, both commercially available and investigational, used to treat malignant diseases. Questions or suggestions for topics should be addressed to Dominic A. Solimando, Jr., President, Oncology Pharmacy Services, Inc., 4201 Wilson Blvd #110-545, Arlington, VA 22203, email: OncRxSvc@aol.com ; or J. Aubrey Waddell, Director, Oncology Pharmacy Residency Program, Department of Pharmacy, Walter Reed Army Medical Center, 6900 Georgia Avenue NW, Rm 2P02, Washington, D.C.; E-mail: waddfour@charter.net .
Stability of Two Extemporaneously Prepared Oral Metoprolol and Carvedilol Liquids
Authors: Yamreudeewong Weeranuj , Dolence E. Kurt , Pahl Deborah
Published: August 2010

The stability of metoprolol and carvedilol in extemporaneously prepared oral liquids was studied. An aqueous liquid formulation of each drug was prepared by reconstituting the powder from triturated tablets with a mixture of deionized water and 70% sorbitol solution. The expected metoprolol concentration was 1.25 mg/mL and for carvedilol was 0.625 mg/mL. Polyethylene terephthalate (PET) plastic bottles containing metoprolol and carvedilol liquids were stored at ambient room temperature (22° to 26°C, and in the refrigerator (4° to 8C). After storage periods of 1, 2, 4, and 8 weeks, these samples were analyzed in triplicate for the respective drug concentrations by high-performance liquid chromatography (HPLC). The concentration of each drug was found to be within the acceptable limit (± 10% of the initial concentration) in all test samples, which indicated that metoprolol and carvedilol liquids were stable at room temperature and refrigerated for up to 8 weeks. However, there were signs of possible decomposition in metoprolol oral liquid after 8 weeks of storage at room temperature. Additionally, our study findings revealed that there was no microbial growth in either drug liquid after a refrigerated storage period of 2 weeks.

Hosp Pharm — 2006;41:254-259
Use of Filgrastim among Febrile Inpatients who Received Outpatient Filgrastim or Pegfilgrastim
Authors: Adamson Robert T. , Lew Indu , Mathis A. Scott , Beyzarov Elena
Published: August 2010

Purpose

To characterize the inpatient use of filgrastim in cancer patients hospitalized for management of post-chemotherapy fever after receiving either outpatient filgrastim or pegfilgrastim.

Method

Retrospective review of chart records in a single-center, tertiary-care, teaching hospital and outpatient oncology center of cancer patients hospitalized for fever after outpatient chemotherapy and proactive administration of filgrastim or pegfilgrastim. Patients with the following tumor types were included: breast cancer, cervical cancer, colon cancer, Hodgkin disease, intermediate- or high-grade non-Hodgkin lymphoma, small cell or non-small cell lung cancer, and ovarian cancer.

Result

Billing data identified 1,438 outpatient chemotherapy patients treated with filgrastim or pegfilgrastim; 261 (18.2%) of whom were hospitalized for fever. All patients in the filgrastim groups, and 78% of those in the pegfilgrastim group, were given inpatient filgrastim. Duration of filgrastim administration in the inpatient setting was significantly shorter ( P < 0.001) for the pegfilgrastim group.

Conclusions

Filgrastim was frequently administered to cancer patients hospitalized for fever, even after outpatient pegfilgrastim was administered as an adjunct to chemotherapy. Patients treated with once-per-cycle pegfilgrastim in an outpatient setting do not require filgrastim if they are hospitalized for fever before neutrophil recovery. Thus, hospitals could realize immediate cost savings by not treating those patients with filgrastim. This study illustrates the need to develop operational procedures in institutions to rapidly identify prior outpatient pegfilgrastim administration as a patient is admitted for post-chemotherapy fever.
Core Competencies in Hospital Pharmacy — Medication Order Review
Authors: Weber Robert J.
Published: August 2010

The next several Director's Forum articles will focus on core practices or competencies in hospital pharmacy practice. This series of articles will discuss the key fundamentals, resources, challenges, and opportunities associated with drug dispensing. Future core competency forums will include discussions on medication ordering, intravenous admixtures, data analysis, and regulatory requirements.

In Director's Forum, we hope to answer key questions that pharmacy directors face and provide others with information to foster growth in pharmacy leadership. The articles in this column will build on one another and, when put together, will serve as a “tool kit” to develop patient-centered pharmacy services in hospitals of all sizes. Examples of topics in future Director's Forums will include establishing clinical service priorities, justifying clinical pharmacist positions, implementing a patient safety program, and budgeting for patient-centered services.
Hemostasis in Trauma: Focus on Factor VIIa
Authors: Voils Stacy A.
Published: August 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 for adult ICU patients (including evolving and controversial data) will be reviewed and assessed in terms of clinical, humanistic, and economic outcomes. Direct questions or comments to Gil Fraser, PharmD, at fraseg@mmc.org or Sandra Kane-Gill, PharmD, MSc, at kanesl@upmc.edu .
Myopathy with Ezetimibe Monotherapy; Statin-Associated Pancreatitis; Linezolid Associated Toxic Optic Neuropathy; Hiccups and Dopamine Agonists; SIADH and Seizures in a Patient Treated with Duloxetine; Prevention of a Well-Known Adverse Drug Reaction
Authors: Shuster Joel
Published: August 2010

The purpose of this feature is to heighten awareness of specific adverse drug reactions (ADRs), discuss methods of prevention, and promote reporting of ADRs to the FDA's medWatch program (800-FDA-1088). If you have reported an interesting preventable ADR to medWatch, please consider sharing the account with our readers.
Deferasirox; Lenalidomide
Authors: Wryter Leonard E. , Solimando Dominic A. , Waddell J. Aubrey
Published: August 2010

The increasing complexity of cancer chemotherapy heightens the requirement that pharmacists be familiar with these highly toxic agents. This column will review various issues related to preparation, dispensing, and administration of cancer chemotherapy. It will also serve as a review of various agents, both commercially available and investigational, used to treat malignant diseases.
Current FDA-Related Drug Information - New Drugs Approved by the FDA; New Dosage Forms and Indications; Agents Pending FDA Approval; Significant Labeling Changes
Authors: Baker Danial E.
Published: August 2010

This monthly feature will help readers keep current on new drugs, indications, dosage forms, and safety-related changes in labeling or use. Efforts have been made to ensure the accuracy of the information; however, if there are any questions, let us know at hospitalpharmacy@drugfacts.com .
Hyper-Fractionated Cyclophosphamide, Vincristine, Doxorubicin, and Dexamethasone Alternating with Methotrexate and Cytarabine (Hyper-CVAD) Regimen
Authors: Jones April D. , Waddell J. Aubrey , Solimando Dominic A.
Published: August 2010

The increasing complexity of cancer chemotherapy heightens the requirement that pharmacists be familiar with these highly toxic agents. This column will review various issues related to preparation, dispensing, and administration of cancer chemotherapy. It will also serve as a review of various agents, both commercially available and investigational, used to treat malignant diseases. Questions or suggestions for topics should be addressed to Dominic
Health Literacy, Medication Errors, and Health Outcomes: Is There a Relationship?
Authors: Warner April , Menachemi Nir , Brooks Robert G.
Published: August 2010

Purpose

To definitively examine the relationship between health literacy and medication errors by reviewing the existing literature.

Over the past decade, our understanding of health literacy and its impact on society has greatly evolved, with research showing that patients with inadequate literacy levels are often subjected to inferior health outcomes. While several theoretical reasons exist to explain this suboptimal situation, one possible explanation is that patients with lower literacy levels do not have the skills necessary to effectively navigate the medication use process thus potentially leading to an increase in medication errors. Although the main focus of this article is to search for a direct association between literacy and medication errors, we also sought to identify an indirect relationship by evaluating previous studies, which explore the effects of literacy on health outcomes.

Conclusion

While we identified numerous studies that suggest that low literacy adversely affected patient outcomes, no study was found that directly linked low-health literacy to medication errors. The authors conclude that additional studies are needed to clarify this relationship.
Recent Publications on Medications and Pharmacy
Authors: Generali Joyce
Published: August 2010

Hospital Pharmacy presents this new feature to keep pharmacists abreast of new publications in the medical/pharmacy literature. Articles of interest will be abstracted monthly regarding a broad scope of topics.
Omeprazole: Extended-Interval Dosing (Alternate-Day Dosing)
Authors: Generali Joyce , Cada Dennis J.
Published: August 2010

Off-Label Drug Uses

This Hospital Pharmacy feature is extracted from Off-Label DrugFacts, a quarterly publication available from Wolters Kluwer Health. Off-Label DrugFacts is a practitioner-oriented resource for information about specific FDA-unapproved drug uses. This new guide to the literature will enable the health care professional/clinician to quickly identify published studies on off-label uses and to determine if a specific use is rational in a patient care scenario. The most relevant data are provided in tabular form, so the reader can easily identify the scope of information available. A summary of the data—including background, study design, patient population, dosage information, therapy duration, results, safety, and therapeutic considerations—precedes each table of published studies. References direct the reader to the full literature for more comprehensive information prior to patient care decisions. Direct questions or comments regarding “Off-Label Drug Uses” to hospitalpharmacy@drugfacts.com .
Power of Attorney Documents and Pharmacy
Authors: Fink Joseph L.
Published: August 2010

Some pharmacists have used a power of attorney document for quite some time when submitting orders for controlled substances. This is authorized by Drug Enforcement Administration (DEA) regulations. Increasingly pharmacists are encountering power of attorney documents in another context – durable powers of attorney authorizing an Agent to make health care decision for the Principal. Medicare requirements have greatly expanded use of such advance directives. Thus, pharmacists may encounter these documents with both professional and personal issues.

Types of power of attorney documents are reviewed with the differences highlighted. A variety of legal requirements that may apply are discussed and situations where such documents may prove helpful are listed. Issues related to the Agent are discussed, because pharmacists may find themselves in this role or in the role of advising someone selecting an Agent. How to revoke such legal documents is described as well.
Core Competencies in Hospital Pharmacy Practice: Department Financial Management
Authors: Weber Robert J.
Published: August 2010

This series of articles in the Director's Forum continue to review key core competencies necessary for a pharmacy department to define their value in patient care. Competencies of medication order review, medication order dispensing, preparing intravenous admixtures, and data management provide a foundation in patient centered services. The goal of the Director's Forum throughout 2006 is to provide readers with information on all of the necessary core competencies of hospital pharmacy practice, comprising a “toolkit” in establishing a patient-centered pharmacy department.
Meeting the Standards for Emergency Medications and Labeling
Authors: Kienle Patricia C.
Published: August 2010

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) Medication Management Standards and certain National Patient Safety Goals (NPSG) contain specific requirements aimed at promoting medication safety. Medication Management Standard 2.30 requires that emergency medications are consistently available, controlled, and secured. Changes made in 2004 in the CMS Interpretive Guidelines for hospital Conditions of Participation deal with security of mobile carts. Since JCAHO requires compliance with applicable federal and state laws and regulations, these CMS regulations need to be considered when designing and controlling emergency medication supplies. Medication Management standard 4.30 requires that medications are labeled. A new 2006 NPSG details requirements for medication labels on and off the sterile field.
New Drugs Approved by the FDA; New Dosage Forms and Indications; Agents Pending FDA Approval; Significant Labeling Changes
Authors: Baker Danial E.
Published: August 2010

This monthly feature will help readers keep current on new drugs, indications, dosage forms, and safety-related changes in labeling or use. Each month, new information will be added to the table (shown in bold type) and older information will be removed. Efforts have been made to ensure the accuracy of the information; however, if there are any questions, let us know at hospitalpharmacy@drugfacts.com .
Medication Reconciliation and Community Pharmacy; Drug Name Alerts; Another ADC Stocking Error; Unsafe Marketing Practice
Authors: Cohen Michael R.
Published: August 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.
Acute Pancreatitis with Isotretinoin; Adrenal Insufficiency Caused by Azole Antifungal; High-Dose Quetiapine and Photopsia; Levamisole and Leukoencephalopathy; Metabolic Syndrome and Clozapine; Increased ADRs to Antimicrobials and Anticonvulsants in AIDS Patients; Unsuspected Trouble with an OTC Medication
Authors: Shuster Joel
Published: August 2010

The purpose of this feature is to heighten awareness of specific adverse drug reactions (ADRs), discuss methods of prevention, and promote reporting of ADRs to the FDA's medWatch program (800-FDA-1088). If you have reported an interesting preventable ADR to medWatch, please consider sharing the account with our readers. Write to Dr. Shuster at ISMP, 1800 Byberry Road, Suite 810, Huntingdon Valley, PA 19006 (call 215-947-7797; fax 215-914-1492; E-mail: joel.shuster@temple.edu ). Your report will be published anonymously unless otherwise requested. This feature is provided by the Institute for Safe Medication Practices in cooperation with the FDA's medWatch Program and Temple University School of Pharmacy. ISMP is an FDA medWatch partner.
Doxorubicin and Cyclophosphamide Followed by Docetaxel (AC Followed by D) in the Treatment of Breast Cancer
Authors: Waddell J. Aubrey , Solimando Dominic A.
Published: August 2010

The increasing complexity of cancer chemotherapy increases the requirement that pharmacists be familiar with these highly toxic agents. This column will review various issues related to preparation, dispensing, and administration of cancer chemotherapy, and review various agents, both commercially available and investigational, used to treat malignant diseases. Questions or suggestions for topics should be addressed to Dominic A. Solimando, Jr., President, Oncology Pharmacy Services, Inc., 4201 Wilson Blvd #110-545, Arlington, VA 22203, E-mail: OncRxSvc@aol.com ; or J. Aubrey Waddell, Associate Professor, University of Tennessee College of Pharmacy; Oncology Pharmacist, Pharmacy Department, Blount Memorial Hospital, 907 E. Lamar Alexander Parkway, Maryville, TN 37804, E-mail: waddfour@charter.net .
Ondansetron: Postanesthetic Shivering
Authors: Generali Joyce , Cada Dennis J.
Published: August 2010

Off-Label Drug Uses

This Hospital Pharmacy feature is extracted from Off-Label DrugFacts, a quarterly publication available from Wolters Kluwer Health. Off-Label DrugFacts is a practitioner-oriented resource for information about specific FDA-unapproved drug uses. This new guide to the literature will enable the health care professional/clinician to quickly identify published studies on off-label uses and to determine if a specific use is rational in a patient care scenario. The most relevant data are provided in tabular form, so the reader can easily identify the scope of information available. A summary of the data—including background, study design, patient population, dosage information, therapy duration, results, safety, and therapeutic considerations—precedes each table of published studies. References direct the reader to the full literature for more comprehensive information prior to patient care decisions. Direct questions or comments regarding “Off-Label Drug Uses” to hospitalpharmacy@drugfacts.com .
Newmod+, a New Version of the Newmod Program for Interpreting X-Ray Powder Diffraction Patterns from Interstratified Clay Minerals
Authors: Yuan Hongji , Bish David L.
Published: August 2010

NEWMOD was developed by R.C. Reynolds, Jr., for the study of two-component interstratifications of clay minerals. One-dimensional X-ray diffraction (XRD) profiles of an interstratified system of two clay minerals can be simulated using NEWMOD, given a set of parameters that describes instrumental factors, the chemical composition of the system (e.g. the concentration of Fe and interlayer cations), and structural parameters (e.g. proportions of the two components, the nature of ordering, and crystallite size distribution). NEWMOD has served as the standard method for quantitatively evaluating interstratified clay minerals for >20 y. However, the efficiency and accuracy of quantitative analysis using NEWMOD have been limited by the graphical user interface (GUI), by the lack of quantitative measures of the goodness-of-fit between the experimental and simulated XRD patterns, and by inaccuracies in some structure models used in NEWMOD. To overcome these difficulties, NEWMOD+ was coded in Visual C++ using the NEWMOD architecture, incorporating recent progress in the structures of clay minerals into a more user-friendly GUI, greatly facilitating efficient and accurate fitting. Quantitative fitting parameters (unweighted R-factor, Rp, weighted R-factor, Rwp, expected R-factor, Rexp, and chisquare, χ2) are included, along with numerous other features such as a powerful series generator, which greatly simplifies the generation of multiple simulations and makes NEWMOD+ particularly valuable for teaching.
Use of Natural and Modified Magadiite As Adsorbents to Remove Th(IV), U(VI), and Eu(III) from Aqueous Media — Thermodynamic and Equilibrium Study
Authors: Guerra Denis L. , Ferrreira Josane N. , Pereira Mário J. , Viana Rúbia R. , Airoldi Claudio
Published: August 2010

The contamination of aquatic environments by toxic metals such as radionuclides is of great concern because of the tendency of those metals to accumulate in the vital organs of humans and animals, causing severe health problems. The objective of this study was to investigate the use of natural and modified magadiite clay as an adsorbent to remove Th(IV), U(VI), and Eu(III) from aqueous solutions. Magadiite from the Amazon region, Brazil, was modified chemically with 5-mercapto-1-methyltetrazole (MTTZ) using a multi-step or heterogeneous synthesis pathway. The natural and modified materials were characterized using 29Si and 13C nuclear magnetic resonance, scanning electron microscopy, nitrogen gas adsorption, and elemental analysis. The physical-chemical properties of the chemically modified magadiite sample were modified, e.g. the specific surface area changed from 35.0 to 678.9 m2 g−1. The ability of the magadiite to remove Th(IV), U(VI), and Eu(III) from aqueous solution was then tested by a series of adsorption isotherms adjusted to a Sips equation. The effects of properties such as pH, contact time, and metal concentration on the adsorption capacity were studied. The adsorption maxima were determined to be 7.5 × 10−3, 9.8 × 10−3, and 12.9 × 10−3 mmol g−1 for Th(IV), U(VI), and Eu(III), respectively. From calorimetric determinations, the quantitative thermal effects for all these cations/basic center interactions gave exothermic enthalpy, negative Gibbs free energy, and positive entropy, confirming the energetically favorable conditions of such interactions at the solid/liquid interface for all systems.
New Template Effect in Hydrotalcite Synthesis. Nodular vs. Layered Morphologies
Authors: Sommer Alicia E. , Fetter Geolar , Bosch Pedro , Lara Victor H.
Published: August 2010

The morphology of hydrotalcites determines their use in catalysis, biomedicine, or adsorption as they may work as anion exchangers or as drug deliverers. In catalysis, reagents need access to as much surface area as possible; in biomedicine, drugs have to be encapsulated. However, the parameters and the mechanisms which direct the synthesis towards a certain morphology are not well understood. Precipitating agents or crystallization conditions are expected to play a crucial role. In the present study, hydrotalcites were synthesized in the presence of two precipitating agents (NaOH or NH4OH) under three different crystallization conditions (conventional, microwave, or ultrasound irradiation) which determined the morphology of the final product, layered or vesicular. The features are explained through the template effect of the liberated gases on the co-precipitation and crystallization processes and consequently on the final structure/morphology of the synthesized solids. Indeed, the nodular particles crystallize using the effluent gases as templates. Fractal dimension and particle-size distributions, determined by small-angle X-ray scattering (SAXS) and gas adsorption are compared and correlated to the presence of ammonium. Although the materials obtained are heterogeneous, it is possible to propose a microscopic geode model.
Precipitation and Transformation of Secondary Fe Oxyhydroxides in a Histosol Impacted by Runoff from a Lead Smelter
Authors: Gao Xiaodong , Schulze Darrell G.
Published: August 2010

Secondary Fe(III) oxyhydroxides play a key role in controlling the mobility and bioavailability of trace metals in acidic, sulfate-rich soils, such as mining and smelter sites. Schwertmannite, jarosite, goethite, and ferrihydrite are the most common mineral phases identified in such soils. A good understanding of the precipitation and transformation of these minerals in soils is very important for predicting the mobility and long-term stability of trace metals associated with them. In the present study, bulk powder X-ray diffraction (XRD), scanning electron microscopy (SEM), synchrotron based micro- X-ray diffraction (µ-XRD), and micro X-ray fluorescence (µ-SXRF) spectroscopy were used to investigate precipitates fromthe surface horizon of an organic soil (Histosol) at a site that once contained a lead smelter. Soil samples were collected from 0 to ≈10 cm depth during both wet and dry seasons. Goethite and akaganeite were identified as the major mineral phases in this soil. Schwertmannite and jarosite were also occasionally identified, particularly in the soil samples from dry periods. The peaks in the akaganeite XRD pattern were significantly broadened and the relative intensities of some major peaks were distinctly different compared with the diffraction pattern of synthetic akaganeite, possibly due to the effects of pH and the incorporation of sulfate. The SEM and µ-XRD data support the hypothesis that the goethite in the precipitates is not the product of direct precipitation froms olution but the transformation of previously precipitated schwertmannite or akaganeite.
Illitization of Early Paleozoic K-Bentonites in the Baltic Basin: Decoupling of Burial- and Fluid-Driven Processes
Authors: Somelar Peeter , Kirsimäe Kalle , Hints Rutt , Kirs Juho
Published: August 2010

The mineralogical characteristics of Ordovician and Silurian K-bentonites in the Baltic Basin were investigated in order to understand better the diagenetic development of these sediments and to link illitization with the tectonothermal evolution of the Basin. The driving mechanisms of illitization in the Baltic Basin are still not fully understood. The organic material thermal alteration indices are in conflict with the illite content in mixed-layer minerals. The clay fraction of the bentonites is mainly characterized by mixed-layered illite-smectite and kaolinite except in the Upper Ordovician Katian K-bentonites where mixed-layer chlorite-smectite (corrensite) occurs. The variation in expandability plus other geological data suggest that the illitization of Ordovician and Silurian K-bentonites in the Baltic Basin was controlled by a combination of burial and fluid driven processes. The illitization in the south and southwest sectors of the basin was effected mainly by burial processes. The influence of the burial process decreases with decreasing maximum burial towards the central part of the basin. The advanced illitization of the shallowburied succession in the north and northwest sectors of the basin was enhanced by the prolonged flushing of K-rich fluids in relation to the latest phase of development of the Scandinavian Caledonides ≈420–400 Ma.
Sex Differences in the Genetic Architecture of Optimism and Health and Their Interrelation: A Study of Australian and Swedish Twins
Authors: Mosing Miriam A. , Pedersen Nancy L. , Martin Nicholas G. , Wright Margaret J.
Published: August 2010

Optimism has a positive influence on mental and somatic health throughout lifetime and into old age. This association is mainly due to shared genetic influences, with some indication of sex differences in the heritability of these and related traits (e.g., depression and subjective wellbeing). Here we extend our initial study of Australian twins by combining with data available from Swedish twins, in order to increase the power to explore potential sex differences in the genetic architecture of optimism, mental and self-rated health and their covariation. Optimism, mental, and self-rated health were measured in 3053 Australian (501 identical female (MZf), 153 identical male (MZm), 274 non-identical female (DZf), 77 non-identical male (DZm), and 242 non-identical opposite-sex twin pairs, and 561 single twins; mean age 60.97 ± 8.76), and 812 Swedish (71 MZf, 53 MZm, 93 DZf and 67 DZm twin pairs, and 244 single twins; mean age 60 ± 14.3) twin individuals using the Life Orientation Test (LOT), the General Health Questionnaire (GHQ) and a single-item self-rating of overall health, respectively. In females all three traits were moderately heritable (.27–.47), whereas in males heritability was substantially lower (.08–.19), but genetic modeling showed that sex differences were not significant. The absence of significant sex differences, despite the consistent trend across the two cohorts, is likely due to a lack of power, raising the importance for future studies, on the same or similar traits, to utilize large samples and to keep the possibility of sex differences in mind when conducting their analyses.
The Family History Method in Disordered Gambling Research: A Comparison of Reports Obtained from Discordant Twin Pairs
Authors: Slutske Wendy S. , Piasecki Thomas M. , Ellingson Jarrod M. , Martin Nicholas G.
Published: August 2010

The purpose of this study was to examine potential biases in family history reports of problem gambling and gambling frequency. Same-sex twin pairs discordant for a history of problem (n= 230 pairs) and pathological gambling (n= 48 pairs) and for three indexes of gambling frequency (ever gambling, monthly gambling, and weekly gambling;n= 44–517 pairs) were identified from a large Australian national twin study. The problem gambling affected twin was significantly more likely to endorse paternal problem gambling than the problem gambling unaffected cotwin (OR = 5.5), and similar findings were obtained for family history reports of gambling frequency (OR = 2.0–2.8). These results could not be explained by differences between the discordant pairs in whether they had spent time gambling with the parents; there was no association between a history of problem, monthly or weekly gambling and having gambled with the parents among discordant twin pairs. The results of this study suggest that relying solely on family history assessments of disordered gambling and gambling involvement can lead to incorrect estimates of the strength of the family history effect.
Nicotine Withdrawal Symptoms in Adolescent and Adult Twins
Authors: Pergadia Michele L. , Agrawal Arpana , Heath Andrew C. , Martin Nicholas G. , Bucholz Kathleen K. , Madden Pamela A. F.
Published: August 2010

We examined the variation and heritability of DSM-IV nicotine withdrawal (NW) in adult and adolescent male and female twin cigarette smokers (who reported smoking 100 or more cigarettes lifetime). Telephone diagnostic interviews were completed with 3,112 Australian adult male and female smokers (53% women; age: 24–36) and 702 Missouri adolescent male and female smokers (59% girls; age: 15–21). No gender or cohort differences emerged in rates of meeting criteria for NW (44%). Latent class analyses found that NW symptoms were best conceptualized as a severity continuum (three levels in adults and two levels in adolescents). Across all groups, increasing NW severity was associated with difficulty quitting, impairment following cessation, heavy smoking, depression, anxiety, conduct disorder and problems with alcohol use. NW was also associated with seeking smoking cessation treatment and with smoking persistence in adults. The latent class structure of NW was equally heritable across adult and adolescent smokers with additive genetic influences accounting for 49% of the variance and the remaining 51% of variance accounted for by unique environmental influences. Overall, findings suggest remarkable similarity in the pattern and heritability of NW across adult and adolescent smokers, and highlight the important role of NW in psychiatric comorbidity and the process of smoking cessation across both age groups.
The Sex Ratios of Monozygotic and Dizygotic Twins
Authors: James William H.
Published: August 2010

Fellman and Eriksson (2010) cited my suggestion that the sex ratio (proportion male) of monozygotic (MZ) twins is lower than that of dizygotic (DZ) twins (James 1975). Here I offer elaborations on and potential explanations for this.